Papers by Cristiane Decat Bergerot
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Europe PMC (PubMed Central), 2017
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Journal of Clinical Oncology, Jun 1, 2023
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Cancer Research, Jun 15, 2022
Background: In a previous randomized phase I trial, addition of CBM-588 to the nivolumab/ipilimum... more Background: In a previous randomized phase I trial, addition of CBM-588 to the nivolumab/ipilimumab (N/I) regimen showed improved objective response rate, clinical benefit rate, and progression free survival compared to N/I alone in patients (pts) with metastatic renal cell carcinoma (mRCC; Meza et al., ASCO 2021). Furthermore, genomic alterations such as PBRM1 have been associated with clinical benefit to anti-PD-1 monotherapy in patients with mRCC (Miao et al., Science 2018). The primary aim of this study was to investigate tumor genomic characteristics according to treatment arms. Methods: We retrospectively identified pts with mRCC who received N/I alone or with CBM-588 supplementation along with whole exome and transcriptome sequencing (Ashion Analytics). Responses were measured according to RECIST v1.1. A two-tailed Fischer’s exact test was performed to compare genomic characteristics across arms. Results: In this study, 29 mRCC pts were randomized to receive N/I +/- CBM-588 and 21 (72%) pts (71% in N/I with CBM-588 arm and 29% N/I arm) had available genomic data. Within this cohort, the median age was 66.8 (range 46-90) and 71% of pts were male. Eleven (52.4%) pts had clear-cell histology and 10 (47.6%) pts had sarcomatoid features; 15 pts received N/I with CBM-588 and 6 pts received N/I alone. The most commonly mutated genes in the overall cohort were VHL (61.9%), PBRM1 (42.9%), and SETD2 (33.3%). Alterations in VHL, PBRM1, and SETD2 were seen in 66.7% vs. 73.3% (p=0.115), 50.0% vs. 40.0% (p=0.523) and 33.3% vs. 33.3% (p=0.686), in N/I vs. N/I with CBM-588 arm, respectively. Conclusions: There was no significant difference observed in clinically relevant genomic features across study arms. The clinical benefit from CBM-588 appears to be independent of tumor genomic characteristics. More extensive investigations are needed to characterize the determinants of benefit from CBM-588 supplementation. Citation Format: Daniela V. Castro, Nazli Dizman, Zeynep B. Zengin, Jasnoor Malhotra, Luis A. Meza, Ramya Muddasani, Ameish Govindarajan, Neal S. Chawla, Alex Chehrazi-Raffle, JoAnn Hsu, Paulo G. Bergerot, Cristiane D. Bergerot, Tanya B. Dorff, Yung Lyou, Sumanta K. Pal. Genomic characteristics of nivolumab/ipilimumab with or without CBM-588 supplementation in patients with metastatic renal cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6293.
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Journal of Clinical Oncology, Feb 20, 2022
324 Background: mRCC is associated with high rates of distress, high levels of symptom burden, an... more 324 Background: mRCC is associated with high rates of distress, high levels of symptom burden, and broad impairments in quality of life. In the setting of localized breast cancer, a smartphone application directed at enhancing mindfulness has been developed from a Mindfulness-Based Cancer Recovery program demonstrated to mitigate these factors (Utkarsh et al. Digital Health 2021); we sought to determine if the benefit of a similar application could be translated to patients with mRCC. Methods: Patients were recruited across two sites in the US and Brazil, and were eligible for the study if they had been diagnosed with mRCC, were receiving immunotherapy, reported clinically-relevant anxiety, had a smart phone with internet access, were currently not engaging in meditation, and had not participated in a mindfulness program in the past 5 years. Patients were asked to participate in mindfulness app-based activities for 20-30 minutes each day guided by the Mindfulness-Based Cancer Survivorship Journey program within AM Mindfulness smartphone app (AmDTx™), for a minimum of 4 days per week, over a period of 4 weeks. The application leads the patient through exercises in guided meditation and suggestions for cancer/cancer symptom coping. Patients were assessed at baseline and 2-weeks after using the 4-week smartphone-app based intervention using the Fear of Cancer Recurrence-7 and Functional Assessment of Chronic Illness Therapy-General scales. Reported data is evaluated using paired t-tests with a p-value of < 0.05 considered significant. Results: A total of 23 patients have been recruited to date. Median age was 59 years old; most were male (52%), white/Caucasian (52%), married (69%) and college educated (82%), and primarily receiving treatment with nivolumab (34%) or nivolumab/ipilimumab (30%). The majority of patients (78%) expressed satisfaction and engaged with the intervention; however, a minority (13%) noted that the intervention reminded them of their cancer diagnosis, which was seen as a negative aspect. Preliminary analyses of data after two weeks of the intervention have demonstrated a statistically significant decreases in fear of cancer progression (mean differences: baseline = 22; week 2 = 18, p = 0.012) and increases in quality of life (mean differences: baseline = 77; week 2 = 85, p = 0.001) over time. Physical and emotional well-being also showed significant improvement over time. Complete data with 12 weeks of follow-up will be presented at the meeting. Conclusions: This is the first study to implement an evidence-based, smartphone-accessible psychosocial support tool among mRCC patients. After only two weeks, we noted significant improvements in the fear of cancer progression and quality of life. This preliminary data suggests that this type of low-cost, mobile-app based intervention was acceptable to patients and may be effective at addressing psychosocial distress
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Journal of Clinical Oncology, Feb 20, 2021
75 Background: Exposure to bright white light (BWL) has been shown to improve outcomes including ... more 75 Background: Exposure to bright white light (BWL) has been shown to improve outcomes including fatigue, depression, and sleep disturbances among the general older population but the benefit has not been demonstrated as yet in prostate cancer. Older men with prostate cancer on androgen deprivation therapy (ADT) are at risk for obese frailty (components: fatigue, weakness, poor mood, slowness and obesity). In this pilot study, we aimed to determine if BWL, compared to dim white wight (DWL), reduces obese frailty in older prostate cancer patients starting anti-androgens. Methods: Men age ≥ 65 with prostate cancer initiating ADT were randomly assigned to either the BWL (exposure to full spectrum light, 500-1500 lux) or DWL cohort (exposure to low dose white light (<50 lux)) and were blinded to assignment. Men received daily 30-minute morning light session from special glasses (Luminette) for 3 months. Participants were assessed at the beginning of treatment and 3 months later with the Short Physical Performance Battery (SPPB) - including timed 4m walk, tandem balance, and timed chair stands (range: 0 to 12) - energy levels (self-reported 5-point Likert scale), waist circumference (measured via tape (mm)), and muscle strength (handgrip: assessed via dynamometer (kg)). Pre-post outcomes (means differences) were evaluated using paired t-tests with a p-value of 0.05 considered significant. Results: 18 patients (9 per cohort) were recruited. Patients in the BWL arm showed a statistically significant improvement in muscle strength (BWL p=0.012 versus in DWL p=0.22). Compared with DWL, BWL arm showed no decline in energy levels, (BWL p=0.28 vs. DWL p=0.035) nor gain in waist circumference (BWL p=0.51, DWL p=0.046). There were no statistically significant differences in either arm on the SPPB (BWL p=0.44, and in DWL p=0.09). Conclusions: BWL may offset negative effects of ADT for older men with prostate cancer, through improved muscle strength, maintained energy levels, and no waist circumference gain. While a small pilot study, the intervention warrants further research in a larger sample.
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Journal of Clinical Oncology, Feb 20, 2022
336 Background: SBRT in indicated for the management of locally recurrent and oligometastatic mRC... more 336 Background: SBRT in indicated for the management of locally recurrent and oligometastatic mRCC as per National Comprehensive Cancer Network guidelines. Our study evaluates both the efficacy of radiotherapy (RT) in prolonging systemic treatment along with RT toxicity in the oligoprogressive RCC setting. Methods: A single institution retrospective data collection was performed in which we identified mRCC patients who experienced oligoprogression (defined as <1 sites of progressive disease) while on an FDA approved systemic therapy and were concurrently treated with SBRT, while remaining on the same therapy. Clinicopathologic characteristics and SBRT-related data along with duration of systemic therapy (DOT) were collected. DOT was then quantified into two categories which included the duration of systemic therapy prior to oligoprogression (DOT[P]) and duration of systemic therapy after completion of SBRT (DOT[S]). The ratio of DOT[S]/DOT[P] was calculated to determine the impact of SBRT on systemic treatment prolongation. Results: 23 patients diagnosed with mRCC meeting criteria were identified, 91% (n = 21) with clear cell histology and 9% (n = 2) with papillary histology. At the time of oligoprogression, 15 patients (65%) were on immunotherapy, 7 patients (30%) were on targeted therapy, and 1 patient (5%) was on combination therapy. We noted the preponderance of patients were on a first-line therapy at the time of oligoprogression (n = 10, 43%). A median of 2 (range, 1-3) lesions were treated per patient, with lung being the most frequent site (n = 14, 40%). The median total dose of SBRT was 30 Gy (range, 27-50 Gy) with a median dose per fraction of 6 Gy (range, 3-12 Gy). SBRT related toxicities, all of which were grade <2, were noted in 5 patients (22%), of which fatigue was the most frequent side effect (n = 3, 13%). Median DOT[S] was 13.4 months (range, 0.5-37.7 months) and the median DOT[P] was 12.8 months (range, 0.4-46.3 months). Results demonstrated a median DOT[S]/DOT[P] ratio to be 1.3 (range, 0.01-25.8). Conclusions: Based on our data, we discovered the addition of SBRT to systemic therapy during oligoprogression is not only well-tolerated, but that this treatment had clinical benefit in prolonging time on systemic therapy for patients with mRCC. The utilization of SBRT may prolong lines of therapy, thereby decreasing additional toxicities associated with exposure to new regimens.
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Journal of Clinical Oncology, Oct 1, 2021
313 Background: Treatment decisions for patients with cancer have changed during the COVID-19 pan... more 313 Background: Treatment decisions for patients with cancer have changed during the COVID-19 pandemic due to the increased risk of infection among this population. In recognition of the impact of COVID-19 in Brazil, this study sought to explore the potential consequences of this disruption to oncology care by comparing the prevalence and place of death one year prior to the pandemic (January 2019 to February 2020) and during the pandemic (March 2020 to March 2021). Methods: Consecutive patients with cancer receiving treatment at a single institution located in the capital of Brazil were included in this analysis. Patients’ characteristics were collected via chart review: age, sex, histology, COVID-19, hospital admission and place of death. Chi-square analysis was used to determine differences among this sample of patients (pre-COVID-19 and during COVID-19). Results: We reviewed data from 3,833 patients (53% of patients during the pandemic). Patients’ characteristics were well balanced between both groups of patients. The proportion of patients with breast and prostate cancers increased (P &lt; 0.01). Rates of hospital admission were similar between both timepoint, with reasons for hospital admission also similar: surgery (22% vs 19%, respectively) and pulmonary dysfunction (14% vs 19%, respectively); 9% were diagnosed with COVID-19 during the pandemic. Similarly, no differences were found among rates of deaths between samples (7%); 42% of patients pre-COVID were receiving supportive care, while 40% were during pandemic. The proportion of patients dying at home was the same among both groups (12%). A slight increase was observed for those dying in the ICU (45% vs 46%, respectively) or hospital (35% vs 36%, respectively). Pre-COVID-19, no patient has died in the emergency room, and during pandemic, 3% has died). Conclusions: A similar proportion of hospital admission and place of death were found between patients prior and during the COVID-19 pandemic. Most patients died in institutional settings. Future studies are needed to better understand patient’s wishes and preferences and to develop strategies to improve communication surrounding death and dying.
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Journal of Clinical Oncology, Jun 1, 2023
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Journal of Clinical Oncology, Feb 20, 2023
614 Background: Racial minorities experience intersecting forms of marginalization and suffer sig... more 614 Background: Racial minorities experience intersecting forms of marginalization and suffer significant healthcare disparities. Prospective trials have shown similar outcomes with partial and radical nephrectomy among patients with localized RCC (Van Poppel et al Eur Urol 2011), and multiple studies suggest increasing use of the former technique (Breau et al Can J Urol 2020). We hypothesize that patients from minority groups, as well as those with non-private insurance, will have less access to this specialized procedure and therefore have a higher rate of radical nephrectomy. Methods: We utilized the California Office of Statewide Health Planning and Development (OSHPD) database that collects information from all inpatient admissions, emergency room visits and inpatient/outpatient procedures in the state. All patients undergoing nephrectomy (both partial and radical) were identified from Jan 1, 2012 to Dec 31, 2018 using CPT and ICD-9/10 codes to identify patients. Demographic data was collected with specific attention to race and payor status. Univariate and multivariate analyses were conducted to determine the association between demographic data and procedure type. Results: In total, 31,093 patients were identified; 57% were males, with a mean age of 58 years. Among these, 16,142 (51.9%), 8,645 (27.8%), 2,795 (9.0%), 2,032 (6.5%) and 1,479 (4.8%) were characterized as White, Hispanic, Asian, Black and other, respectively. Partial nephrectomy and radical nephrectomy were performed in 15,840 (50.9%) and 15,253 (49.1%) of patients. By race, partial nephrectomy was performed in 8,576 (53.1%), 4,107 (47.5%), 1,286 (46.0%), 1,124 (55.3%) and 747 (50.5%) of White, Hispanic, Asian, Black and other patients, respectively (p&lt;0.001). Use of partial nephrectomy also differed among patients based on payor status, with rates of 6,800 (56.4%), 5,036 (43.9%), 1,817 (38.3%) and 2,187 (77.7%) among patients with private, Medicare, indigent coverage (e.g., MediCal or Medicaid) and other insurance, respectively (p&lt;0.001). On multivariate analysis controlling for age, gender, comorbidities and frailty, race was independently associated with type of nephrectomy procedure. Conclusions: Our study confirms that race and payor status may have an influence on utilization of partial versus radical nephrectomy, with the highest rate of partial nephrectomies among Whites and patients with private insurance. Although there are multiple potential confounders (e.g., latency of diagnosis and resulting tumor size/complexity), it is possible that access to care may be an important driver of these disparities.
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Journal of Clinical Oncology, Feb 20, 2023
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Journal of Clinical Oncology, Feb 20, 2023
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Clinical Genitourinary Cancer, May 1, 2023
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European Urology, Jul 1, 2018
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Journal of Clinical Oncology, Jun 1, 2023
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Clinical Genitourinary Cancer, Jun 1, 2023
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Oncologist, Mar 14, 2023
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Cancer Cell, Nov 1, 2020
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Papers by Cristiane Decat Bergerot
Depression and anxiety are highly prevalent in patients (pts) with genitourinary tumors, including UC (Yang et al PLoS ONE 2016). Given that mUC has a high rate of somatic genomic alterations (GAs), we sought to determine if tumor mutational burden (TMB) or specific alterations were related to the incidence of these psychiatric disorders.
Methods:
From a single institution, we identified consecutive pts with mUC who had comprehensive genomic profiling done in the course of routine clinical care. In a CLIA-certified laboratory, DNA was extracted from 40 microns of FFPE sections. Hybridization-captured, adaptor ligation based libraries were used to a mean coverage depth of 718X for up to 315 cancer-related genes plus introns from up to 28 genes frequently rearranged in cancer. TMB was estimated based on the cumulative number of GAs. ICD-9 diagnoses corresponding to adjustment disorder (309.28), anxiety (300) and depression (311) were derived from detailed chart review, including review of established diagnoses and medication history.
Results:
A total of 43 pts (74.4% M / 25.6% F) were assessed with a median age of 65.5 (range, 49-81). Formal diagnoses of adjustment disorder, anxiety and depression were noted in 16.3%, 9.3% and 7.0% pts, respectively. An average of 6.3 GAs/pt (range, 0-14) were observed over the entire cohort. The rate of GA was higher in pts with anxiety vs adjustment disorder or depression (8.5 vs 6.8 or 4.0, P=0.01). No significant difference was observed in adjustment disorder or depression based on the frequency of GAs. GAs in BAP1, PIK3CB, NOTCH1, ALK, CDH1 and FANCC were noted to be associated with higher rates of anxiety (P=0.02). Similarly, GAs in FGFR1 was noted to be associated with higher rates of depression (P=0.002) and in CHEK2 in depression and adjustment disorder (P=0.03).
Conclusions:
Our study represents the first pyschogenomic analysis of pts with mUC. While higher TMB has been associated with favorable prognosis (Isharwal et al EU Focus 2017), we paradoxically found this to be related to higher rates of anxiety. Our findings suggest that genomically selected subsets of patients may be prime candidates for early psychosocial screening and intervention.
A correlation between depression/anxiety and survival has been established in patients (pts) with mRCC (Cohen et al PLoS One 2012). We hypothesize that frequently encountered genomic alterations (GAs) in mRCC may identify pts with these psychological disorders.
Methods:
Data was obtained from pts with mRCC who received ctDNA profiling as a part of routine clinical care at progression using a CLIAA-certified platform evaluating 73 genes. Genomic alterations (GAs) were pooled for the entire cohort. ICD-9 diagnoses corresponding to anxiety and depression (300 and 311, respectively) were derived from detailed chart review, including review of established diagnoses and medication history. The chi-square test was used to determine the association between frequent GAs (those occurring in ≥5% of the study population) and the presence of depression and anxiety.
Results:
ctDNA results from 52 pts with mRCC were assessed (gender: 69.2% M, 30.8% F; average age: 58; histology: 84.6% clear cell, 15.4% non-clear cell). The most commonly used 1st-line treatment was sunitinib (46.1%). GAs were detected in 55.8% of pts. The most frequent GAs in the overall cohort included TP53 (21.1%), VHL (17.3%) and EGFR (7.7%). 5 and 8 pts were coded as having depression and anxiety, respectively. The average number (range) of ctDNA alterations detected was 1.1 (0-4) in patients with depression/anxiety and 1.6 (0-10) in those without (P = 0.001). The presence of VHL mutation was found to occur exclusively in pts with no depression/anxiety (P = 0.05), while 13 patients (25%) lacking VHL GAs had these psychological disorders.
Conclusions:
The absence of VHL alterations have been associated with poorer survival in pts with RCC (Patard et al Int J Cancer 2008), and our findings suggest that these patients may further have higher rates of depression/anxiety. Our data imply that patients bearing mutations in VHL may a prime target for early psychosocial interventions.
A joint survey was developed by the EAU RCC Guidelines Panel and KCCure, a non-profit patient advocacy group, to ascertain patient perceptions towards adjuvant therapy for RCC (Battle D et al ASCO GU 2018). This survey included open-ended questions pertaining to sources of frustration in cancer-related care, the results of which are summarized herein.
Methods:
An online survey was conducted from April to June, 2017, publicized through social media and patient networking platforms. The survey obtained basic clinicopathologic, treatment related information, and open-ended questions asking for common sources of frustration in cancer-related care. Patients were also asked how they might reconcile these sources of frustration. Each response was analyzed and categorized into descriptive categories. The Kruskal-Wallis test was used to define associations between baseline characteristics and sources of frustration.
Results:
Among 450 patients with RCC, median age was 56, and 56% were female. The majority was diagnosed with clear cell histology (85%) and most patients had non-metastatic disease (73%). The most common sources of frustration were related to poor communication (20%), lack of confidence in diagnosis (18%), fear of recurrence/progression (14%) and financial issues (9%). Practical sources of frustration (e.g., lack of information, financial issues) were more common among patients with non-clear cell histology (P = 0.05) and older age (P = 0.01). In contrast, emotional sources of frustration (e.g., fear of recurrence/progression) were more common in females (P = 0.001). Patients posited that care could be improved if physicians demonstrated greater compassion (21%), spent more time supplying information (20%) and if they could circumvent financial issues (11%).
Conclusions:
RCC patients have varied and multiple concerns around care delivery. Based on this findings, practitioners should aim to better inform patients and should be cognizant of psychosocial issues surrounding their care. Certain baseline characteristics (age, gender and histology) can be considered in individualizing care delivery to minimize patient frustration.
Design/Methods: A study was conducted among 122 AYA patients with cancer aged 18 to 35 years, treated at a Brazilian public hospital. They were assessed using the Distress Thermometer, the Hospital Anxiety and Depression Scale and the Functional Assessment of Cancer Therapy - General. Descriptive statistics were obtained for all measures, item level frequencies were examined to identify common unmet needs and relationships between distress and unmet needs were explored.
Results: AYA patients were mostly were male (50.8%), single (54.1%), white (52.5%), diagnosed with, central nervous system (31.1%), hematologic (23%) or genitourinary (15.6%) cancers, at an advanced disease stage (41.8%). AYA reported greater distress (50%), being commonly related to practical (60.7%), emotional (73.8%) and physical (86.1%) problems. Financial (32%), worry (56.6%), nervousness (50%), sadness (31.1%), pain (47.5%), fatigue (39.3%), memory concentration (35.2%), and sleep (32%)were the highest scored. However, 25.4% reported clinical symptoms of anxiety and 9.8% of depression. AYA patients reported poor levels of quality of life that is at 50th percentile of the US norm.
Distress, symptoms of anxiety/depression and quality of life were significantly associated with biopsychosocial problems reported (p<.001). Higher levels of distress was predicted by symptoms of anxiety (B=0.2; p<.001), depression (B=0.2; p<.001), emotional (B=0.8; p<.001) and physical (B=0.3; p<.01) problems.
Conclusions: Brazilian AYA patients reported high levels and numbers of unmet needs and substantial distress. Strong associations were found between increased distress and more unmet needs. Findings suggest the need for psychosocial intervention for Brazilian cancer patients that target helping them cope with biopsychosocial distress. Further, this preliminary data highlight opportunities to re-orientate services to better meet AYA needs.
Methods: Participants were recruited from two different types of health care facilities, public [PUB] and private [PRI] institutions, in Brazil. A cross-sectional analysis of common biopsychosocial symptoms (anxiety, depression, pain, and fatigue), and quality of life reported by older patients undergoing chemotherapy treatment was performed.
Results: Older patients (n=167) were enrolled (Mean age=73; SD=5.6); 59.3% from PUB. Majority were female (56.3%; 38.9% PUB), white (68.9%; 35.7% PRI, p<.01), married (59.3%; 32.1% PUB, p<.01); and diagnosed with GI (29.9%; 15.8% PUB), GU (16.2%; 4.9% PUB), and hematologic (13.8%; 7.5% PRI) cancers. Almost 16% of patients reported depression symptoms (9.6% PUB) and 12% of anxiety (8.4% PUB). PUB patients also reported associated lower QOL, which is at 50th percentile of the US norm (PRI is at 75th percentile). PUB patients reported significantly more biopsychosocial problems including distress (21.6% vs 7.2%), pain (28.1% vs 12.0%), fatigue (34.7% vs 16.8%), sleep (22.8% vs 15%), neuropathy (22.8% vs 8.4%), and financial toxicity (16.2% vs 5.4%), compared to patients treated at PRI (all p<0.05). Mostly pain (B=1.8; B=-6.6), fatigue (B=0.8; B=-6.5) and sleep (B=1.2; B=-8.3) were associated with moderate to severe distress and worst QOL (all p<.01).
Conclusion: Older patients with late-stage cancer in Brazil suffer substantial unrecognized morbidity which impacts their distress and QOL. Biopsychosocial screening for older patients should be included in quality cancer care. Moreover, patients treated within PUB show worse outcomes than PRI counterparts, and they are at higher risk for multiple physical, psychological, and financial morbidity. Earlier initiation of biopsychosocial screening with appropriate supportive care may improve their QOL.
Methods: A cohort study compared data from GBCP (n=6) and BCP (n=46), undergoing the same treatment at a Brazilian public hospital. Measures included the DT, HADS and FACT-G. GBCP also completed a semistructured interview.
Results: GBCP reported lower levels of distress, anxiety/depression and better QoL than BCP. The content analyses revealed that GBCP discovered their pregnancy weeks after their diagnosis. Fears were related to risk of miscarriage or potential harm of treatment to the unborn baby. Ultrasonography helped to monitor baby’s health and to lessen anxiety. After the first chemotherapy infusion, 83.3% turned their focus to their baby. One patient reported increased distress associated with smoking cessation efforts. Other preferred to minimize social contact and avoided celebrations until their baby's healthy birth. Health care providers was essential and helped them to address issues regarding baby’s health and well-being.
Conclusions: Unexpectedly, our preliminary findings suggest that GBCP experience less psychological turmoil than BC. It is possible that pregnancy provides a sense of meaning and a broader perspective for women diagnosed with cancer, possibly through the focus given to ensuring the health of their unborn child. Future studies should explore the long-term impact of GBCP.
Methods: Data from 31 patients (64.5% female; M=51.32 of age) diagnosed with a rare cancer (74.2% at late disease stage) and treated at a Brazilian public hospital were evaluated for distress (DT), anxiety/depression (HADS) and QOL (FACT-G). All patients previous knew that their diagnostic was rare. Descriptive statistics and correlations between variables assessed were generated.
Results: 48.4% patients reported high distress levels, with 32.3% endorsing anxiety and 25.8% depression. A low mean QOL score was found (at 25th percentile of the US norm), with emotional and functional well-being the most impaired subscales. Statistically significant correlations were identified between distress, anxiety/depression and QOL (p<.01). The most concerns were nervousness (71%), worry (71%), pain (64.5%), sadness (51.6%) and fatigue (51.6%).
Conclusions: Patients reported poorer psychosocial outcomes and impaired QOL when compared to normative data, suggesting that this patient population may be at elevated risk. A rare cancer diagnosis can be traumatic and prompt anxiety and uncertainty. Given their rarity, limited disease specific support groups or counseling exists, thus potentially invoking feelings of isolation. Further research should be conducted to investigate psychosocial aspects and possible interventions targeting this poorly understood group.
Methods: 270 patients were assessed for distress (DT), anxiety/depression (HADS) and QOL (FACT-G). Half of them was recruited at a private institution (PRI) and the other at a public institution (PUB) (each group: n=135; 68.9% breast and 31.1% gynecological cancers). We calculated descriptive statistics and examined QOL and distress using T-test and ANOVA.
Results: We found ethnic differences between PUB (50.4% white, 32.6% mulato and 14.1% black) and PRI patients (82.9% white), and income disparities (PUB patients report almost a third less monthly income than PRI patients). PUB patients were mostly late-stage diagnosed 70.4% compared to PRI counterpart 42.2% (p<.001). In general PUB patients reported higher rates of distress and anxiety/depression (p<.03); and poorer QoL outcomes (p<.01).
Conclusions: This preliminary study is one of the first to investigate inequities in cancer outcomes among patients in Brazilian healthcare settings. Analyses revealed notable differences between groups across demographic characteristics, while individuals of lower socioeconomic status reported significantly poorer psychosocial outcomes. These results suggest a complex interaction between ethnicity, access to care and cancer outcomes, and warrants further research to better understand and address these inequities. Further discussion of the role of psycho-oncology research and clinical practice in reducing disparate outcomes among Brazilian cancer patients is warranted.
Methods: The participants included 315 cancer patients (65-89 years, M=72.5; 54% female), recruited at two Brazilian cancer centers. Patients were undergoing chemotherapy for gastrointestinal (27.9%), hematologic (22.2%) and breast (14.9%) cancer; 80% were at advanced disease stage. They were assessed using the DT, HADS and FACT-G.
Results: Approximately 22% of patients reported moderate to severe distress, 11.7% symptoms of anxiety and 14% of depression. Patients also reported associated impairments in QoL. On the problem list, 59.9% reported an average of 1.6 Emotional Problems, and 93% an average of 4.6 Physical Problems. Linear regression analysis identified depression, sadness, worry, fatigue, nausea, pain and sleep as predictors of distress; and sadness, nervousness, worry, loss of interest in usual activities, eating, fatigue, nausea, pain and sleep predicting worse scores at FACT-G.
Conclusions: A lower prevalence of distress among older patients was established in the current study, as well as higher rates of depression symptomatology compared to anxiety. The present findings also highlights a set of intersecting concerns among older patients, including sadness, worry, fatigue, pain and sleep; potential risk factors that should be considered as part of the psychosocial care routine. Further, it is possible that the screening program served as a tool to prompt discussion of psychological support services that may not have arisen organically due to stigma.