Cancer in the Adolescent and Young Adults (AYA) and Children: A Comprehensive Analysis of the Epidemiology and Psychosocial Morbidity in the Indian Population

Aims Adolescent and young adults (AYAs), children with cancer, and their guardians have unique psychosocial morbidities adversely effecting quality of life (QOL). This is measurable using patented tools. We analyzed epidemiological and clinicopathological patterns of solid organ cancers in this subgroup. We also assessed psychosocial morbidity and changes in QOL faced by them. Methods All patients aged 2 to 39 years, newly diagnosed with cancer from April 2017 to March 2019 were included. Clinical history, diagnosis, staging, treatment, outcomes, and follow-up were recorded. The National Comprehensive Cancer Network (NCCN) distress thermometer and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C-30) were used to assess psychosocial morbidity of AYAs, children ≥ 12 years, and parents of children < 12 years. Pediatric Quality of Life Inventory (Peds QL) version 3.0 was used for children < 12 years. Data was analyzed using descriptive statistics. Results A total of 571 patients (512 AYAs, 59 children) were enrolled. Median age was 30 years with male predominance (58.1%). Most cases (98.6%) were absent from school or work. Carcinoma breast was the most common in females (29.3%) and non-Hodgkin lymphoma in males (12.6%). 91.06% had overall NCCN distress score ≥ 4. Also, 73.81 and 79.49% had “quite a bit” or “very much” responses on functional and symptom scales, respectively, in EORTC QLQ C-30 questionnaire. Peds QL version 3.0 revealed total score ranging from 276 to 523 for each patient. Conclusion AYAs and children with cancer are extremely vulnerable to psychological stress and morbidity. Use of well-established tools help in assessing their mental status and timely psychiatric referral can be initiated.

A case of lichen planopilaris associated with lichen planus following Blaschko lines successfully treated with topical corticosteroid

Lichen planopilaris (LPP) is characterized by erythematous, keratotic follicular papules and cicatricial alopecia. LPP, the most common cause of cicatricial alopecia, is usually seen in women and causes significant psychosocial morbidity. We describe here a 42-year-old woman with a 6-month history of hair loss accompanied by itching on the scalp. Dermatological examination revealed patchy cicatricial alopecia in the vertex and band-like purple flat patches and plaques following the Blaschko lines on the right half of the body, together with post-inflammatory hyperpigmentation. Histopathological examination of the scalp biopsy was consistent with LPP, while thigh biopsy was consistent with lichen planus. With the histopathological and clinical evidence, our patient was evaluated as LPP associated with LP and successfully treated with topical corticosteroid. A few LPP and LP cases following the Blaschko lines have previously been reported separately. However, LPP, together with LP following Blaschko lines, have not been reported in the same patient.

Designing Support Structures Post Sepsis in Children: Perspectives of the Queensland Paediatric Sepsis Program

Introduction: Paediatric post sepsis syndrome is poorly defined and causes physical, neurocognitive, psychosocial morbidity, and family dysfunction. Families of sepsis survivors report unmet needs during care. Worldwide, the provision of post sepsis care is in its infancy with limited evidence to design clinical support pathways.Perspective: The Queensland Paediatric Sepsis Program (QPSP) developed a family support structure (FSS) to improve care during all stages of childhood sepsis. It was designed in partnership with consumers guided by information from consumers and it is partly delivered by consumers. Key areas include online, multimodal education for families and the ability to connect with other families affected by sepsis. The FSS is delivered by a multidisciplinary team (MDT) acting with clinicians local to the child. Families can join the FSS registry at any stage of their sepsis journey which connects them to our MDT team and opens opportunities to participate in future research and other initiatives. Improving public awareness is a critical outcome for our consumers and they have co-designed media and digital campaigns.Discussion: The ideal FSS for post sepsis syndrome management is a clinical pathway designed in partnership with consumers of interventions proven to improve outcomes from sepsis that meets their requirements. The QPSP FSS is novel as it is co-designed with, and partly delivered by, consumers with interventions aimed to improve the entire spectrum of morbidities suffered by survivors and their families, not just physical sequelae. Evaluation is embedded in the program and outcomes will guide evolution of the FSS.

Psychosocial Care for Adult Cancer Patients: Guidelines of the Italian Medical Oncology Association

Psychosocial morbidity can have negative consequences for cancer patients, including maladaptive coping, poor treatment adherence, and lower quality of life. Evidence shows that psychosocial interventions can positively impact quality of life, as well as symptoms and side effects; however, they are not always offered to patients who might benefit from them. These guidelines were produced by a multidisciplinary panel of 16 experts, including patients, following GRADE methodology. The panel framed clinical questions and voted on outcomes to investigate. Studies identified by rigorous search strategies were assessed to rate certainty of evidence, and recommendations were formulated by the panel. Although the quality of the evidence found was generally moderate, interventions could be recommended aimed at improving patient information, communication with healthcare professionals and involvement in decision-making; detecting and managing patient psychosocial needs, particularly with non-pharmacological therapy; and supporting families of patients with advanced cancer. The role of nurses as providers of information and psychosocial care is stressed. Most recommended interventions do not appear to necessitate new services or infrastructures, and therefore do not require allocation of additional resources, but predominantly involve changes in clinical staff behavior and/or ward organization. Patients should be made aware of psychosocial care standards so that they can expect to receive them.

The Clinical Characteristics of Patients With Borderline Personality Disorder in Different Treatment Settings

The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project compares patients with borderline personality disorder (BPD) in an outpatient practice (n = 390) and a partial hospital setting (n = 358) on diagnostic comorbidities, symptoms experienced, suicidality, and occupational impairment. The patients in the partial program were diagnosed with significantly more psychiatric disorders and were more frequently diagnosed with dysthymia, generalized anxiety disorder, alcohol and substance use disorders, adjustment disorders, and posttraumatic stress disorder. Those at the partial hospital had significantly higher levels of suicidal ideation than those in the outpatient practice. The samples did not differ on utilization of disability or suicide attempts. Treatment setting may have implications in the recognition of the disorder in clinical practice, the development and support of etiological theories, identification of core deficits, and evaluation of psychosocial morbidity associated with BPD.

THE 308-nm EXCIMER LASER: AN XCEPTIONAL TREATMENT MODALITY IN VITILIGO- A CASE SERIES

Objective: Vitiligo is a common depigmenting condition that carries a high psychosocial morbidity and social stigma. Present treatment modalities for vitiligo like topical corticosteroids, immunomodulators, phototherapy with psoralens plus UVA radiations and broadband or narrowband UVB radiation phototherapy requires many months of treatment with not so promising results. The excimer laser comprising of a targeted phototherapy with single wavelength laser light is a new treatment option which may be time efficient and a better treatment option in terms of repigmentation in management of vitiligo.

Quality of Life and Adjustment to Psychosocial Morbidity Among Adults Attending a Dermatology Clinic

Background: The skin is the largest organ in the body and has aesthetic significance. The presence of any skin lesion or skin disease might be associated with psychosocial morbidity and negative impact on the quality of life. Objectives: To determine the level and degree of adjustment to psychosocial morbidity associated with the presence of dermatological conditions and assessing the quality of life of affected adults. Methods: Data were collected from 189 new patients attending the Dermatology Clinic at the Federal Medical Centre, Abeokuta, Nigeria using systematic random sampling. The validated Adjustment to Chronic Skin (ACS) diseases questionnaire and Finlay’s Dermatology Life Quality Index (DLQI) questionnaire were the research instruments. Results: The respondents consisted of 80 males (42.3%) and 109 females (57.7%) with a mean age of 36.3± 15.3 years. The least adjustment to skin-related psychosocial morbidity (49.7%) was observed with the helplessness scale. The mean score on the DQoL was 9.9 ± 6.2 and over half of the respondents (53.9%) reported moderate to an extremely large negative effect on their quality of life. Conclusion: The presence of dermatological conditions impact negatively on the quality of life and the least adjustment to skin-related psychosocial morbidity was experienced on the helplessness scale. Dermatology practitioners should acquire psychological evaluation and/or counselling skills to provide holistic care.

Psychosocial morbidity profile in a community based sample of low back pain patients

Low back pain (LBP) is a major health concern and is closely associated with psychosocial morbidity and diminished Health-related quality of life (HRQoL). This is minimally investigated in community-based samples of developing nations like India. This study is aimed to specifically investigate the exposure-outcome associations between LBP and burden of disability (Modified Oswestry questionnaire (MODQ)), psychological morbidities (Depression, Anxiety and Stress Scale (DASS-21)), and HRQoL (Short Form -12 version 2 (SF12V2). A Cross-sectional study using a community-based sample of LBP positive population was conducted. The range of treatment options sought was also collected. Chi-square tests and independent t-test were used to analyze the data. Of 1531 recruited participants, 871(57%) were identified as LBP positive of whom 60% were females. Mean (SD) of age and pain intensity of LBP patients was 33 (11) years and numeric rating scale4.2 (2.6) respectively. Two-third reported minimal/moderate disability. Mean (SD) scores of depression 11.87 (4.05), anxiety (8.32), stress 13.7 (5.98), physical and mental summary scores of SF-12v2 were 47.9 (7.4) and 42.2 (10.4). A multitude of remedial options was sought for the ailment. LBP causes significant disability and psychological morbidity among affected population. This may adversely affect their HRQoL and subsequently productivity. Acupuncture was a preferred treatment sought by Indian LBP patients.

Body Image Disturbances in Patients Undergoing Mastectomy for Breast Cancer

BACKGROUND Body image can be defined as a subjective picture of an individual’s own physical appearance established by self-observation and by noticing the reaction of others. Breast cancer and its treatment has been shown to have tremendous impact on the body image of the patients. We wanted to assess the level of body image disturbance in patients undergoing mastectomy for breast cancer and identify the relation between the body image disturbance and measures of psychosocial morbidity and quality of life. METHODS 35 female patients who had mastectomy for breast cancer were assessed preoperatively, immediately after surgery and 2 months after the surgery. They were administered body image scale questionnaire, HADS (Hospital Anxiety and Depression Scale), General Health Questionnaire (GHQ-12) and WHO QOL BREF. RESULTS Our results showed that 24 out of 35 patients (68.5 %) were Body Image Scale positive at the first interview itself. The number of positive patients increased to 27 at the second interview (77.1 %), but this change was not statistically significant and there was no change from second to third visit. Those who were Body Image Scale Positive had significantly higher anxiety, depression and GHQ12 scores. Those who had a body image disturbance also had a poorer quality of life across all domains. CONCLUSIONS This study shows that there is a high level of body image disturbance in patients undergoing mastectomy for breast cancer even before surgery. This high level also contributes significantly to their psychosocial morbidity and also negatively affects their quality of life. KEYWORDS Body Image, Anxiety, Depression, Quality of Life, Breast Cancer, Mastectomy