Joost Dekker

Purpose: Patients with cancer frequently experience a wide range of emotions in response to their diagnosis and treatment. Emotions are essentially adaptive, helping patients to cope with the disease. In a minority of patients, however, emotions may become maladaptive and warrant professional mental healthcare. In the field of psycho-oncology, the intensity of emotions is used to distinguish between adaptive and maladaptive emotions. Emotion dynamics (that is changes in emotions over time) may provide additional information on the adaptiveness of the emotions. The aim of this study was to investigate whether emotion dynamics (specifically inertia, variability, and instability) as well as emotion intensity are indicators of maladaptive emotions. Method: Patients with a solid malignancy (metastatic and non-metastatic disease; n = 132) were categorized as having adaptive or maladaptive emotions based on one of two reference standards: the psychiatric diagnostic assessment or the subjective need for professional mental healthcare. Patients reported on eight negative emotional symptoms for 14 days using Ecological Momentary Assessment on their mobile phone. Autocorrelation (inertia), standard deviation (variability), root mean square successive differences (instability), and emotional intensity were compared between patients with adaptive or maladaptive emotions using t -tests. Results: Variability and instability as well as intensity were higher in patients with maladaptive emotions, compared to patients with adaptive emotions. Little evidence was found that patients with maladaptive emotions experienced more emotional inertia. Conclusion: This is the first study to report that in patients with cancer, emotional instability and variability are indicators of maladaptive emotions, in addition to the intensity of emotions.

Background: Cancer is a major stressor leading to a wide range of emotions. Emotions, also negative emotions, are essentially adaptive, in the sense that they help patients cope with cancer. Emotions can also be maladaptive, if they are disproportionately severe or persistent, or interfere with functioning. Our overall goal was to explore whether disturbance of life goals provides a fruitful framework for developing indicators that can distinguish between adaptive and maladaptive emotions. Objective: To test the hypotheses that (1) goal disturbance and emotional symptoms are reciprocally and positively associated to each other; and (2) the association between goal disturbance and emotional symptoms is stronger in patients with maladaptive emotions as compared to patients with adaptive emotions. Methods: Patients with (non)metastasized disease who recently started systemic treatment (n = 132) filled out Ecological Momentary Assessments 5 times per day for 14 consecutive days in which emotional symptoms and activities related to life goals were documented. The importance of life goals in six domains was assessed with an interview (work/study, disease-related health, lifestyle health, social activities, religious, spiritual and intellectual activities, and leisure). Patients were grouped as having adaptive or maladaptive emotions based on a reference standard (a psychiatric diagnostic assessment, or the subjective need for professional mental healthcare). Linear mixed models were built in R, with either goal disturbance or negative emotional symptoms as dependent variable. Results: Goal disturbance for social activities and leisure activities was significantly associated with more emotional symptoms. Goal disturbance for disease-related health activities was significantly associated with less emotional symptoms. No significant association was found for other activities (with one exception). With negative emotions as outcome variable, goal disturbance was more strongly associated with more emotional symptoms in patients with maladaptive emotions than patients with adaptive emotions for social, leisure and lifestyle health activities. Conclusion: Further research is warranted to develop an indicator of maladaptive emotions in patients with cancer based on the extent of goal disturbance of social, leisure and lifestyle health activities.

Background: The existential dimension is a key aspect of palliative care but is often insufficiently integrated in clinical practice. We developed a structured meaning‐making conversation for patients living long‐term with incurable cancer led by a spiritual counsellor to support patients' meaning‐making process. To support the integration of the existential dimension, a synopsis of patient's sources of meaning and existential needs was shared afterwards with the referring health care provider (HCP) via the electronic health record. Aims: This study explored HCPs' experiences with this meaning‐making synopsis and its impact on patient care. The findings will inform further refinement of the intervention to enhance perceived benefits. Methods: Semi‐structured interviews were conducted with HCPs who referred patients for a meaning‐making conversation. A reflexive thematic analysis was performed. Results: The following themes were constructed from the interviews with HCPs ( n = 10): providing potentially useful existential information to HCPs, supporting personalised, value‐based care through the synopsis and barriers and facilitators for using the synopsis. HCPs appreciated the synopsis for its insight into patients' sources of meaning and existential needs, for its ability to initiate conversations about meaning and its potential impact on discussing treatment options. For half of them, it helped deliver more personalised care. For some it provided reassurance that the treatment aligned with patients' wishes. The most frequently mentioned barriers to starting a conversation about meaning were lack of contact due to disrupted continuity of care and limited time. Conclusions: HCPs appreciated the meaning‐making synopsis and recognised the (potential) impact on enhancing personalised care. The synopsis can assist HCPs in integrating the existential dimension into clinical care.

Background: Many patients with incurable cancer are expected to live for a considerable period of time, yet with the knowledge of their disease’s inevitable end-of-life outcome. This duality can lead to existential concerns. A single one-hour meaning-making conversation was developed in which a patient explores their sources of meaning together with a spiritual counselor. Aim: To explore how patients experience and benefit from a conversation aimed at supporting meaning-making, in order to inform further refinement of this intervention. Design: We conducted a formative mixed method pilot study. Evaluation interviews assessed patients’ experience and reported benefits. A reflexive thematic analysis was conducted. Key themes were compared and contrasted by intervention timing and patients’ experience of existential concerns. Validated questionnaires were administered to assess patients’ existential wellbeing, problems, and needs pre- and post-intervention. Setting/Participants: Twenty-one patients with advanced solid malignancies and a prognosis >1 year participated at two different hospitals. Results: All patients experiencing existential concerns appreciated the meaning-making conversation and reported benefits, such as reflection, validation, insight and actions related to sources of meaning. Half of the those not experiencing existential concerns reported no benefits, and some reported a negative experience. Quantitative data suggest a decrease in most existential problems and needs post-intervention. Existential wellbeing increased post-intervention. Conclusions: A meaning-making conversation can support the process of meaning-making for patients living long-term with incurable cancer. Refinement of the intervention should focus on targeting patients experiencing existential concerns.

Background: Psychosocial factors are argued to increase cancer risk. This study aims to clarify the association between various psychosocial factors and cancer incidence (including breast, lung, prostate, and colorectal cancers) via individual‐participant data (IPD) meta‐analysis. The psychosocial factors considered were perceived social support (PSS), loss, relationship status, neuroticism, and general distress. Methods: The Psychosocial Factors and Cancer Incidence consortium used data from 22 cohorts with a measure of at least one psychosocial variable of interest at baseline (up to N = 421,799; cancer incidence, N = 35,319; person‐years of follow‐up, N = 4,378,582). In stage 1 of the IPD meta‐analysis, Cox regression models were used with age as the timescale. In stage 2, results were pooled in random‐effects meta‐analyses. Results: No psychosocial factors were associated with an increased risk of overall cancer and with breast, prostate, and colorectal cancers, as well as with cancers with alcohol as a common potential causal factor. PSS, currently not in a relationship, and a loss event were associated with an increased risk of lung cancer (hazard ratio [HR], 1.09–1.55). Estimates decreased for PSS and relationship status when adjusting for several known risk factors, such as a family history of cancer (HR, 1.05–1.08). Similar findings were observed for relationship status and cancers with tobacco smoking as a common potential causal factor. Conclusions: For most types of cancer, psychosocial factors (measured at a single point in time) were not associated with increased risk. PSS, currently not in a relationship, and loss were associated with an increased risk of lung cancer, although most effects attenuated when adjusting for several known risk factors.

Introduction: Migraine is a leading cause of disability worldwide. Although effective, the use of pharmacological prophylaxis is low due to suboptimal efficacy and poor tolerability. This has led to a growing interest in non-pharmacological approaches such as manual therapy (MT), especially among patients with comorbid neck pain. While evidence for MT remains inconclusive, its adjunctive use is recommended. This study evaluated the effect of MT in patients with migraine and neck pain, compared to usual care provided by general practitioners (UC).Methods: In this randomized controlled trial in primary care, participants with migraine and neck pain were allocated to MT (n = 36) or UC (n = 31). MT included mobilizations, exercises and myofascial techniques. Follow-up assessments were performed at 12-, 26-, and 52-weeks post-inclusion. The primary outcome was the number of migraine days. Secondary outcomes included migraine intensity, disability, medication use, neck pain intensity, neck muscle endurance, pressure pain thresholds, allodynia, and perceived recovery.Results: There were no significant between-group differences in migraine days or most secondary outcomes. Compared with usual care, the MT group demonstrated significantly higher-pressure pain thresholds over the occipital muscles and reported greater perceived recovery at both 12 and 52 weeks. Use of prophylactic medication was higher in the UC group throughout follow-up.Conclusion: MT, including postural and cranio-cervical exercises, was not superior to usual care in reducing migraine days and most secondary outcomes. Still, patient preference and treatment satisfaction for MT were high and may be considered in migraine management.

Background: Cancer is generally perceived as a major stressor. Occasionally, patients are able to accept their diagnosis and prognosis, and it is not uncommon for patients who initially experience great distress to eventually learn to accept their disease. A deeper understanding of acceptance can enable clinicians to better support patients in achieving a more peaceful state of mind. The purpose of this literature review was to provide a comprehensive overview of existing research on acceptance in patients with cancer. Recent Findings: Study selection resulted in the inclusion of 54 studies. All studies except one were published after the year 2000. Acceptance was defined in terms of cognition, emotion, behavior, spiritual processes, social processes, or other terms. Acceptance focused on disease, illness, cancer, poor prognosis/imminent death, or was not specified, and was measured by interview or questionnaire. Evidence was found for a range of factors associated with acceptance. Conclusions: Acceptance is a relatively new field of research, characterized by significant heterogeneity in both its definition and focus, as well as the hypothesized determinants and outcomes. To advance this field, it is essential to develop a generally accepted definition of acceptance and to consistently specify its focus. The present scoping review provides a solid foundation for this endeavor.

Purpose: The clinical management of patients with cancer by oncologists and nurses needs to differentiate between maladaptive emotions that do require professional mental health care and adaptive emotions that do not require such care. Previous qualitative research identified six symptoms as potential indicators of maladaptive emotions. These included lingering, increasing or extreme emotions, emotions that interfere with daily life or with treatment, and unexplained somatic symptoms. The present study tested the validity of these symptoms as indicators of maladaptive emotions in patients with cancer. Methods: Patients with a solid malignancy were assessed 3 to 7 months after the start of chemo- or immunotherapy. Patients were categorized as experiencing either adaptive or maladaptive emotions, using two reference standards: (a) a psychiatric diagnostic assessment or (b) patient’s subjective need for professional mental health care. Oncologists and nurses assessed the presence of the six symptoms, using a checklist. A total count was made of the number of symptoms that were rated as present. Results: As hypothesized, the total symptom count was statistically significantly greater in patients with maladaptive emotions than in patients with adaptive emotions. This was consistently observed for the ratings by oncologists as well as nurses, and for both reference standards. Conclusion: The current study confirmed six symptoms assessed by oncologists and nurses as valid indicators of maladaptive emotions in patients with cancer. We recommend assessing these symptoms in the broader context of managing emotional well-being of patients with cancer.

Objectives Knowledge about the long-term course and prognosis of persistent somatic symptoms (PSS) is important to improve clinical decision-making and guidance for patients with PSS. Therefore, we aimed to: (1) identify distinct 5-year trajectories of symptom severity, physical and mental functioning in adult patients with PSS and (2) explore patient characteristics associated with these trajectories. Design We used longitudinal data (seven measurements over a 5-year period) of the PROSPECTS study: a prospective cohort of adult patients with PSS. We applied Latent Class Growth Mixture Modelling to identify distinct trajectories for the three outcomes. Setting and participants Patients were recruited in general practices and specialised treatment facilities for PSS throughout the Netherlands. The study population consisted of participants with three or more measurements available (n=297). Primary outcome measures Symptom severity (Patient Health Questionnaire 15), physical and mental functioning (RAND-36 Physical Component Summary and Mental Component Summary). Results For symptom severity, we identified two ‘stable’ trajectories: ‘severe symptoms, stable’ (15.8%) and ‘moderate symptoms, stable’ (84.2%). For physical functioning, we identified three trajectories: ‘poor physical functioning, marked improvement’ (8.5%); ‘poor physical functioning, stable’ (34.7%) and ‘moderate physical functioning, slight improvement’ (56.8%). For mental functioning, we identified three trajectories: ‘poor mental functioning, marked improvement’ (13.9%); ‘moderate mental functioning, deterioration’ (12.2%) and ‘moderate mental functioning, slight improvement’ (73.8%). Patients’ characteristics such as personal, social and environmental background, illness stressors, comorbid diseases, cognitive, emotional and behavioural responses varied for the distinct trajectories. Conclusions We identified distinct 5-year trajectories for the three outcomes. Our findings suggest a high prevalence of persistence of symptoms and limited improvement in physical and mental functioning in the majority of patients with PSS. In a small proportion of patients, we identified trajectories that showed considerable physical or mental improvement or deterioration. Patient characteristics differed for the identified trajectories and may guide early recognition, although predictive studies are warranted.