Quality of Life: Psychosocial Intervention in Men with Advanced Prostate Cancer

Research Paper Title

Technology-Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men with Advanced Prostate Cancer: Results from a Randomized Controlled Trial.

Background

Men with advanced prostate cancer (APC) face multiple challenges including poor prognosis, poor health-related quality of life (HRQOL), and elevated symptom burden.

This study sought to establish the efficacy of a tablet-delivered, group-based psychosocial intervention for improving HRQOL and reducing symptom burden in men with APC.

The researchers hypothesised that men randomised to cognitive-behavioural stress management (CBSM) would report improved HRQOL and reduced symptom burden relative to men randomised to an active control health promotion (HP) condition.

Condition effects on intervention targets and moderators of these effects were explored.

Methods

Men with APC (N = 192) were randomised (1:1) to 10-week tablet-delivered CBSM or HP, and followed for 1 year.

Multilevel modelling was used to evaluate condition effects over time.

Results

Changes in HRQOL and symptom burden did not differ between groups.

Men in both groups improved across several intervention targets; men in the CBSM condition reported greater increases in self-reported ability to relax, and both conditions showed improvements in cancer-related anxiety, cancer-related distress, and feelings of cohesiveness with other patients over time.

Moderating factors included baseline interpersonal disruption, fatigue, and sexual functioning.

Conclusions

Tablet-delivered CBSM and HP were well received by men with APC.

The hypothesised effects of CBSM on HRQOL and symptom burden were not supported, though improvements in intervention targets were observed across conditions.

Participants reported high-baseline HRQOL relative to cancer and general population norms, possibly limiting intervention effects.

The identified moderating factors should be considered in the development and implementation of interventions targeting HRQOL and symptom burden.

Reference

Penedo, F.J., Fox, R.S., Oswald, L.B., Moreno, P.I., Boland, C.L., Estabrook, R., McGinty, H.L., Mohr, D.C., Begale, M.J., Dahn, J.R., Flury, S.C., Perry, K.T., Kundu, S.D. & Yanez, B. (2020) Technology-Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men with Advanced Prostate Cancer: Results from a Randomized Controlled Trial. International Journal of Behavioral Medicine. doi: 10.1007/s12529-019-09839-7. [Epub ahead of print].

Is Anxiety in People with Rheumatoid Arthritis Associated with Increased Disease Activity & Worse Quality of Life?

Research Paper Title

The association between anxiety and disease activity and quality of life in rheumatoid arthritis: a systematic review and meta-analysis.

Background

In people with rheumatoid arthritis (RA), mental health problems are common, but often not recognized or treated, contributing to increased morbidity and mortality.

Most studies examining the impact of mental health problems in RA have focused on depression.

The researchers aimed to determine the association between anxiety, and disease activity and quality of life (QoL) in people with RA.

Methods

A systematic review and meta-analysis were performed. A protocol was registered with PROSPERO (CRD2-17062580).

Databases (Web of Science, PsycINFO, CINAHL, Embase, Medline) were searched for studies examining the association between anxiety and disease activity and QoL, in adults with RA, from inception to February 2019.

Primary outcome measures were DAS28 and SF-36.

Eligibility screening and data extraction were completed by two reviewers.

Disagreements were resolved by discussion or a third reviewer.

Quality assessment was carried out using the Newcastle-Ottawa Scale.

Results

From 7712 unique citations, 60 articles were assessed for eligibility.

The final review included 20 studies involving 7452 people with RA (14 cross-sectional, 6 cohort).

Eleven examined disease activity, 6 reported QoL outcome measures and 3 included both.

Anxiety was associated with increased disease activity and worse QoL.

Meta-analysis showed anxiety to be correlated with increased DAS28 scores (r = 0.23, CI 0.14, 0.31) and reduced physical (r = - 0.39, CI - 0.57, - 0.20) and mental QoL (- 0.50, CI - 0.57, - 0.43).

Conclusions

Anxiety in people with RA is associated with increased disease activity and worse QoL.

Improved recognition and management of comorbid anxiety may help to improve outcomes for people with RA.

Key Points:

  • This is the first systematic review and meta-analysis to examine the relationship between anxiety and disease activity and QoL in people with RA.
  • Anxiety was associated with higher disease activity both cross-sectionally and at up to 12-month follow-up.
  • Anxiety may have a more significant impact on disease activity in early RA, highlighting the importance of early recognition and management of co-morbid anxiety.
  • People with anxiety had poorer self-reported physical and mental QoL, although there was some heterogeneity in study findings, particularly for physical QoL (I2 = 78.5%).

Reference

Machin, A.R., Babatunde, O., Haththotuwa, R., Scott, I. Blagojevic-Bucknall, M., Corp, N., Chew-Graham, C.A. & Hider, S.L. (2020) The association between anxiety and disease activity and quality of life in rheumatoid arthritis: a systematic review and meta-analysis. Clinical Rheumatology. doi: 10.1007/s10067-019-04900-y. [Epub ahead of print].