Aarhus 1 22022018 EPoS Psykooncology Research Unit established - PDF document

22‐02‐2018 Robert Zachariae Professor, DMSc. Aarhus 1

22‐02‐2018 EPoS • Psykooncology Research Unit established in 2000 at the Dept. Of Oncology, AUH based on a grant from the Danish Cancer Society • EPoS established in 2011 in collaboration between AUH, Dept. Of Oncology, BSS, AU, and Dept of Psychology and Behavioural Science • Current staff: 17 (1 professor, 3 assoc. prof. 1 assist prof, 1 senior researcher, 4 post‐docs, 6 PhD’s, 1 adm.) + 8‐10 research assistants. EPoS • Mission – 1) to produce scientific evidence about the psychosocial consequences of disease and treatment and about the role of psychosocial factors for the course of illness and health‐ related quality‐of‐life – with special emphasis on cancer – 2) to develop and evaluate approaches and interventions aimed at minimizing the physical, psychological, social, and societal costs associated with illness and treatments – 3) to contribute to the development of an interdisciplinary perspective in health care 2

22‐02‐2018 EPoS • Contractual obligations – 1) Research: to conduct health psychology and behavioral medicine research at an international level, – 2) Knowledge: to disseminate the knowledge gained through scientific publications, training of researchers, teaching university students, and popular dissemination – 3) Implementation: to promote the practical application of the knowledge gained in the health care system in collaboration with health care professionals. PSYCHOONCOLOGY predictors, moderators, mediators, outcomes Independent var. Mediators/moderators Dependent var. Quality of Life Expanded from Holland, 1998 Individual differences Sociodemographic Physical Coping Psychological Personality traits Social, Spiritual Cancer Social factors Cancer treatment Social support Social network Bio‐ Stressors behavioral Medical Patient‐clinician‐relationship Survival Compliance/adherence Premorbid factors Genetic Recurrence Sociodemographic Psychosocial Intervention Health behaviors Zachariae 3

22‐02‐2018 Psychooncology Biopsychosocial factors Cancer prognosis Cancer, Cancer, Cancer Treatments Treatments Cancer risk Biopsychosocial Biopsychosocial consequences consequences The cancer survivor Recurrence Mortality Zachariae Psychooncology Biopsychosocial factors Cancer prognosis Cancer, Cancer, Cancer Treatments Treatments Cancer risk Biopsychosocial Biopsychosocial consequences consequences The cancer survivor Recurrence Mortality Zachariae 4

22‐02‐2018 EPoS • Research projects – Epidemiological • The Danish Breast Cancer Cohort (N=4917) • Side effects, late effects, prognosis – Behavioral Intervention studies (RCTs): • Expressive writing intervention • Mindfulness‐Based Cognitive Therapy (MBCT) • Emotion Regulation Therapy (cancer caregivers) • Conquer Fear (Fear of Cancer Recurrence) – Internet‐delivered behavioral interventions (RCT’s): • Cognitive training (breast cancer patients with cognitive impairment), • Cognitive Behavioral Therapy for Insomnia (breast cancer patients with insomnia) (SHUTi) • MBCT for distress (breast‐ and prostate cancer) EPoS – Evaluating Self‐management programs (RCT’s) for: • Chronic pain • Anxiety and depression • Back‐to‐work after sick leave – Cancer‐related fatigue • Systematic Light Exposure • Sleep intervention – Cognition and cancer • Cognitive impairment among cancer patients (“chemo brain”) and possible genetic, endocrinological, neurological, neuropsychological, and psychosocial mechanisms – Use, consequences and mechanisms of Complementary and Alternative Medicine (CAM) • CAM use among women treated for breast cancer • Acupuncture • Healing – Patient‐health professional communication and Health‐Related Quality‐of‐Life • Exploring the role of physician‐patient and nurse‐patient communication and developing and validating instruments to measure these aspects 5

22‐02‐2018 EPoS • Research projects (cont.) – Systematic reviews and meta‐analyses: – The influence of stress and expectancy • Stress and upper respiratory infections • Stress and response to influenza vaccination • Stress/distress and outcomes of ART • Expectancy and post‐chemotherapy nausea • Psychosocial predictors of pain in breast cancer – The efficacy of psychosocial interventions • Efficacy of Mindfulness‐Based Therapy for distress in cancer patients • Efficacy of Expressive Writing Intervention on psychological and physical health outcomes in cancer patients • Effects of psychosocial interventions on pain in breast cancer patients and survivors • Efficacy of psychosocial interventions on psychological and physical health outcomes in chronic obstructive pulmonary disease (COPD) • Efficacy of psychological interventions on outcomes of ART treatments • Efficacy of CBTs for distress in cancer caregivers • Efficacy of Internet‐delivered CBT for insomnia Danish Cancer Society national center for breast cancer survivorship 6

22‐02‐2018 Late effects of cancer and cancer treatment The cancer survivor • Every third Dane will be diagnosed with cancer • Increased cancer incidence and improved treatment leads to a growing number of people living with cancer (Denmark: 267.496, Nordic Cancer Registries, 2014 ) Zachariae 7

22‐02‐2018 Cancer and cancer treatment challenges Quality of Life (QoL) Physical : Pain, sensory disturbances, physical changes, fatigue, disturbed sleep, etc. Social : Mental : Family issues, problems Depression, post‐ QoL with partner, work traumatic stress, problems, social roles anxiety, cognitive and function, etc. impairment, etc. Spiritual : Meaning, living with uncertainty, maintaining hope, etc. (1) World Health Organization. The first ten years. The health organization. Geneva: World Health Organization; 1958. (2) WHOQOL SRPB Group. A cross‐cultural study of spirituality, religion, and personal beliefs as components of quality of life. Soc Sci Med 2006 Mar;62(6):1486‐97. Zachariae Psychosocial sequelae Problem Prevalence Depression 0 – 55% Post‐Traumatic Stress (PTSD) 0 – 35% Fear of Cancer Recurrence 0 – 87% Fatigue 35 – 80% Pain 21 – 88% Sexual problems 30 – 65% Body image 30 – 70% Cognitive complaints (”chemo brain”) 0 – 45% Impaired sleep 1 – 30% Brandao et al. 2016; Horneber et al. 2012; Saligan et al. 2015; Otte et al. 2016; van den Beuken‐van Everdingen et al. 2007; Simard et al. 2013; Zachariae & Mehlsen, 2011; Moore et al. 2014. Zachariae 8

22‐02‐2018 Symptom clusters Depression Anxiety Pain Inflammation Sleep Fatigue disturbance Correlated processes! Lee et al. 2004; Irwin et al. 2013; Carlotto et al. 2013; Dong et al. 2014 Zachariae Sickness behavior • Proinflammatory cytokines (IL‐1B, IL‐6, TNF  , a.o.) released by activated immune cells induce: – Fatigue – Muscle pain – Reduced appetite – Fever – Depressed mood Hart, 1988; Cirulli et al. 1998; Dantzer et al. 2008 Zachariae 9

22‐02‐2018 Sickness behavior Immune system‐induced motivational states enable flexible responses to select appropriate strategies under varying external and internal threats – all bio‐behavioral processes involve trade‐offs Cancer Pathogen‐associated Cancer Stress Molecular patterns treatments Pathogens External threats Peripheral cytokines Cortisol IMMUNE Brain cytokines COMPETENCE Anorexia Cognitive Depressed Sleep Anhedonia Fatigue Pain Cachexia changes mood disorder SICKNESS BEHAVIOR Hart, 1988; Cirulli et al. 1998; Dantzer et al. 2008 Zachariae Zachariae Symptom cluster Depression Anxiety Pain Inflammation Sleep Fatigue Zachariae 10

22‐02‐2018 Symptom cluster Depression Anxiety Pain Inflammation Intervention Sleep Fatigue Zachariae Cancer‐related distress DEPRESSION POST‐TRAUMATIC STRESS FEAR OF CANCER RECURRENCE CARE‐GIVERS 11

22‐02‐2018 Sources of distress across the cancer trajectory Treatment Survival Pre‐diagnosis Diagnosis Surgery Fear of Risk of cancer Testing Adjuv. treatm. recurrence Fear of cancer Waiting Testing Disability Surveillance Fear of cancer Side‐efects Post‐traumatic Prevention Body‐image stress Premorbid riskfactors : Lack of Social stressors : stigmatization, socio‐economic ressources, discrimination, social isolation comorbidity, psychiatric history Danish Psychosocial Breast Cancer Cohort • 2001‐2004: 4917 women treated for primary breast cancer • Clinical and sociodemographic data from DBCG and other national registries • 3 mo. Baseline questionnaire • 15 mo. Followup questionnaire • 7‐9 year followup questionnaire 12