The use of psychotropic drugs, namely those with an antidepressant profile (ADs), is a mandatory part of an integrated treatment of psychiatric disorders among cancer patients. We aimed to synthetize ...the most relevant data emerging from published studies to provide tips about the use of ADs in oncology.
A search was made of the major databases over the last 30 years (Embase/Medline, PsycLIT, PsycINFO, the Cochrane Library), including narrative reviews, systematic reviews and meta-analyses summarizing the results from observational studies and randomized clinical trials assessing effectiveness, safety profile, interactions, contraindications and use of ADs in oncology with regard to both psychiatric (depressive spectrum, stress-related, anxiety disorders) and cancer-related symptoms (e.g. pain, hot flashes and fatigue).
The weight of evidence supports the ef cacy of ADs for more severe major depression in individuals with cancer and as an adjuvant treatment in cancer-related symptoms, although the methodological limitations of reported randomized controlled trials do not permit definite conclusions. Data also indicate that there should be caution in the use of ADs in cancer patients in terms of their safety profile and potential clinically significant interactions with other prescribed medications. Practical recommendations that have been made for the use of ADs in cancer patients, in the context of a multimodal approach to depression treatment, have been summarized here.
ADs are a relatively safe and effective treatment for more severe major depression in cancer patients. However, more research is urgently needed regarding the efficacy of ADs in different cancer types and cancer settings, their interactions with anticancer agents and their additive benefit when integrated with psychosocial interventions.
Early palliative care improves the quality of life (QoL) and satisfaction with care of patients with advanced cancer, but little is known about its effect on caregivers. Here, we report outcomes of ...caregiver satisfaction with care and QoL from a trial of early palliative care.
Twenty-four medical oncology clinics were cluster-randomised, stratified by tumour site (lung, gastrointestinal, genitourinary, breast and gynaecological), to early palliative care team referral, or to standard oncology care with palliative care only as needed. Caregivers of patients with advanced cancer (clinical prognosis of 6–24 months, Eastern Cooperative Oncology Group 0–2) in both trial arms completed validated measures assessing satisfaction with care (FAMCARE-19) and QoL SF-36v2 Health Survey; Caregiver QoL-Cancer (CQoL-C), at baseline and monthly for 4 months. We used a multilevel linear random-intercept mixed-effect model to test whether there was improvement in the intervention group relative to the control group over 3 and 4 months.
A total of 182 caregivers completed baseline measures (94 intervention, 88 control); 151 caregivers (77 intervention, 74 control) completed at least one follow-up assessment. Satisfaction with care improved in the palliative intervention group compared with controls over 3 months (P=0.007) and 4 months (P=0.02). There was no significant improvement in the intervention group compared with controls for CQoL-C (3 months: P=0.92, 4 months: P=0.51), Physical Component Summary of the SF-36v2 Health Survey (3 months: P=0.83, 4 months: P=0.20), or Mental Component Summary of the SF-36v2 Health Survey (3 months: P=0.87, 4 months: P=0.60).
Early palliative care increased satisfaction with care in caregivers of patients with advanced cancer.
NCT01248624.
Felt security in close relationships may affect individual adaptation responses to existential threat in severe illness. We examined the contribution of attachment security to demoralization, a state ...of existential distress involving perceived pointlessness and meaninglessness in advanced cancer.
A mixed cross-sectional sample of 382 patients with advanced cancer (mean age 59, 60% female) was recruited from outpatient oncology clinics. Participants completed self-report measures of attachment security, demoralization, depression, and physical symptom burden. We used multiple linear regression to analyze the association between attachment security and demoralization, controlling for demographic factors and symptom burden and tested whether attachment security moderated the association of symptom burden with demoralization. Separate analyses compared the contribution of the dimensions of attachment anxiety and attachment avoidance.
The prevalence of clinically relevant demoralization was 35%. Demoralization was associated with lower attachment security (β = −0.54, 95%CI: −0.62 to 0.46). This effect was empirically stronger for attachment anxiety (β = 0.52, 95%CI: 0.44 to 0.60) compared to attachment avoidance (β = 0.36, 95%CI: 0.27 to 0.45). Attachment security also significantly moderated the association of physical symptom burden with demoralization, such that with less attachment security, there was a stronger association between symptom burden and demoralization.
Attachment security may protect from demoralization in advanced cancer. Its relative lack, particularly on the dimension of attachment anxiety, may limit adaptive capacities to deal with illness burden and to sustain morale and purpose in life. An understanding of individual differences in attachment needs can inform existential interventions for severely ill individuals.
•Perceived security about the availability of others is associated with lower demoralization in advanced cancer.•Low attachment security may limit adaptive capacity to deal with illness burden and to sustain morale and purpose in life.•Helping individuals to derive a sense of meaning from significant relationships may alleviate existential distress.
Existential distress is of clinical concern in patients with terminal illness. Although existential distress has been used to describe a broad spectrum of psychological disturbances, its narrower ...definition may be confined to distress that arises when the meaning and value of one's life is unclear, and is comorbid with feelings of loneliness and low self‐worth. To promote further study, we developed and pilot‐tested a 10‐item Existential Distress Scale (EDS). Twenty‐one patients with advanced cancer were recruited from a palliative care unit. Measures of existential distress, death anxiety, depression, performance status and physical symptom burden were collected. The EDS showed promising psychometric properties, including significant associations with death anxiety and depression. Thirty‐eight per cent of the sample reported great or unbearable distress on at least one existential concern. The EDS may be administered to measure existential distress in patients with advanced cancer and clinicians may find the instrument useful to initiate a structured discussion about this symptom.
•Anxiety and depressive disorders are common in patients with cancer.•A higher prevalence seen in patients with cancer than the general population is often underrecognised.•Psychotherapy, cognitive ...behavioural therapy and mindfulness-based therapies are effective treatments.•Psychopharmacological treatments have been shown to be effective treatments of anxiety and depressive disorders.
High-speed optical reconstruction of 3D-scenes can be achieved using digital holography with binary digital micromirror devices (DMD) or a ferroelectric spatial light modulator (fSLM). There are many ...algorithms for binarizing digital holograms. The most common are methods based on global and local thresholding and error diffusion techniques. In addition, hologram binarization is used in optical encryption, data compression, beam shaping, 3D-displays, nanofabrication, materials characterization, etc. This paper proposes an adaptive binarization method based on a combination of local threshold processing, hologram division into blocks, and error diffusion procedure (the LDE method). The method is applied for binarization of optically recorded and computer-generated digital holograms of flat objects and three-dimensional scenes. The quality of reconstructed images was compared with different methods of error diffusion and thresholding. Image reconstruction quality was up to 22% higher by various metrics than that one for standard binarization methods. The optical hologram reconstruction using DMD confirms the results of the numerical simulations.
Background: Insulin-dependent diabetes mellitus (IDDM) and eating disorders are relatively common among young women in North America. Their coexistence could lead to poor metabolic control and an ...increased risk of the microvascular complications of IDDM. Methods: We studied 91 young women with IDDM at base line and four to five years later to determine the prevalence and persistence of disordered eating behavior (on the basis of self-reported eating and weight-loss practices, including the intentional omission or underdosing of insulin to control weight) and the association of such eating disorders with metabolic control, diabetic retinopathy, and urinary albumin excretion. At base line, the mean age of the young women was 15 +/- 2 years and the duration of diabetes was 7 +/- 4 years. Results: At base line, 26 of 91 young women (29 percent) had highly or moderately disordered eating behavior, which persisted in 16 (18 percent) and improved in 10 (11 percent). Of the 65 women with normal eating behavior at base line (71 percent), 14 (15 percent) had disordered eating at follow-up. Omission or underdosing of insulin to lose weight was reported by 12 of 88 young women (14 percent) at base line and 30 (34 percent) at follow-up (P=0.003). At base line, the mean (+/- SD) hemoglobin A1c value was higher in the group with highly disordered eating behavior (11.1 +/- 1.2 percent) than in the groups whose eating behavior was moderately disordered (8.9 +/- 1.7 percent) or nondisordered (8.7 +/- 1.6 percent, P<0.001). Disordered eating at base line was associated with retinopathy four years later (P=0.004), when 86 percent of the young women with highly disordered eating behavior, 43 percent of those with moderately disordered eating behavior, and 24 percent of those with nondisordered eating behavior had retinopathy. Conclusions: Disordered eating behavior is common and persistent in young women with IDDM and is associated with impaired metabolic control and a higher risk of diabetic retinopathy.
Fast reconstruction of holographic and diffractive optical elements (DOE) can be implemented by binary digital micromirror devices (DMD). Since micromirrors of the DMD have two positions, the ...synthesized DOEs must be binary. This work studies the possibility of improving the method of synthesis of amplitude binary inline Fresnel holograms in divergent beams. The method consists of the modified Gerchberg-Saxton algorithm, Otsu binarization and direct search with random trajectory technique. To achieve a better quality of reconstruction, various binarization methods were compared. We performed numerical and optical experiments using the DMD. Holograms of halftone image with size up to 1024 × 1024 pixels were synthesized. It was determined that local and several global threshold methods provide the best quality. Compared to the Otsu binarization used in the original method of the synthesis, the reconstruction quality (MSE and SSIM values) is improved by 46% and the diffraction efficiency is increased by 27%.
This article discusses optical methods and technologies that can register, transform, store, transmit, and reproduce large arrays of information. Digital holograms recorded using photographic ...equipment of various types is common carriers of experimentally recorded information. The size of digital hologram files is several tens of megabytes. Hence, for the storage and transmission of holographic data archives via communication channels, holograms should be compressed. Binarization represents one of the options for reducing the hologram size. For binarization, an iterative adaptive method for selecting the weight coefficients of the error diffusion procedure is proposed. The method has been tested on digital holograms that were optically recorded under various conditions. The quality of the measured objects was evaluated through numerical methods of image reconstruction and after displaying digital holograms on a micromirror light modulator. The proposed method can be used for compressing and storing holographic data, measuring the characteristics and shape of micro- and macroobjects, and fast optical image reconstruction using a micromirror light modulator.
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