HKU_Newsletter_Issue 40_Preview

New Insights in Psychological Distress Experienced by Cancer Patients Having unmanaged physical symptoms was another risk factor for chronic distress. For women diagnosed with breast cancer, the most common symptoms experienced include pain, fatigue, sleep disturbance, tightness of scarring tissues, and limited range of motion on shoulder joints. To address these unmanaged symptoms, we recently conducted a randomized controlled trial (RCT) to evaluate the effectiveness of yoga therapy to relief tightness of scarring tissues and improve range of motion on shoulder joints among women with breast cancer. This study was funded by Hong Kong Cancer Fund. Over 400 women were recruited to participate in this three-arms trial. The results of this RCT will be disseminated at the end of this year. Furthermore, we conducted a pilot study to assess the feasibility and acceptability of integrating a nurse-led symptom clinic with the specialized outpatient oncology clinic for breast cancer survivors. The nurse-led symptom clinic aims to identify patients with residual physical symptoms and psychological distress and thereby to provide appropriate interventions/referral to address the unmet supportive care needs among cancer survivors. The next step is to conduct a RCT to evaluate the effectiveness of this programme in reducing physical and psychological distress among cancer survivors. References Lam WWT, Bonanno GA, Mancini AD, Ho S, Chan M, Hung WK, Or A, Fielding R. Trajectories of psychological distress among Chinese women diagnosed with breast cancer. Psycho-Oncology (2010) 19: 1044-1051. Lam WWT, Shing YT, Bonanno GA, Mancini AD, Fielding R. Distress trajectories at the first year diagnosis of breast cancer in relation to 6-years survivorship. Psycho-Oncology (2010) 21:90-99. Lam WWT, Au AHY, Wong JHF, Lehmann C, Koch U, Fielding R, Mehnert A. Unmet support care needs: a cross-cultural comparison between Hong Kong Chinese and German Caucasian women with breast cancer. Breast Cancer Research Treatment (2011) 130:531-541. Lam WWT, Ye M, Fielding R. Trajectories of quality of life among Chinese patients with nasopharynegeal cancer. PLoS One (2012) doi:10.1371/ journal.pone.0044022. Lam WWT, Soong I, Yau TK, Wong KY, Tsang J, Yeo W, Suen J, Ho WM, Sze WK, Ng A, Kwong A, Suen D, Fielding R. The evolution of psychological distress trajectories in women diagnosed with advanced breast cancer: a longitudinal study. Psycho-Oncology doi: 10.1002/pon.3361. Lam WWT, Yoon SW, Sze WK, Ng AWY, Soong I, Kwong A, Suen D, Tsang J, Yeo W, Wong KY, Fielding R. Comparing the meanings of living with advanced breast cancer between women resilient to distress and women with persistent distress: a qualitative study. Psycho-Oncology (2017) 26:255-261. Lam WWT, Ng D, Wong S, Lee TMC, Kwong A, Fielding R. The role of cognitive bias in relation to persistent distress among women diagnosed with breast cancer. Psycho-Oncology (2017) doi: 10.1002/pon.4620. The psychosocial impact of cancer is well documented. The prevailing view is that the diagnosis and treatment of cancer disrupt patients’ lives, leading to psychological distress. Usually, this psychological distress resolves within the first year following diagnosis, but recent evidence suggests that individual differences affect how cancer patients respond to the cancer diagnosis over time. Our research team was one of the first groups to adopt an alternative approach to demonstrate that there are distinct patterns of adjustment in response to cancer diagnosis. To test the hypothesis of distinct patterns of psychological adjustment in response to cancer diagnosis, we conducted four longitudinal studies on different cancer populations including women with early stage breast cancer, patients with colorectal cancer, patients with nasopharyngeal cancer, and women with advanced breast cancer. Consistently, we found most cancer patients were psychologically resilient in response to cancer diagnosis, with little or no distress. About 10% to 20% of patients showed chronic distress throughout the illness trajectory. Furthermore, our study on early breast cancer showed that women who experienced chronic distress at the first year of the breast cancer diagnosis reported greater psychological distress, post-traumatic stress symptoms, poor social relationship, and poor self-image and sexuality at 6 years of survivorship. This study highlights that cancer patients who are at risk to develop chronic distress need to be identified early and offered support to assist in managing their distress. The recent evidence from our group and a few others overturns the widely-held assumption that cancer diagnosis inevitably causes substantial psychological distress. Therefore, the next step is to understand why, in response to cancer diagnosis, some patients have persistent distress while the majority either has little distress or only transient distress. Who are at risk for developing chronic distress in response to cancer diagnosis? Our studies showed poor personal resources (i.e. being pessimistic and having negative intrusive thoughts), unmanaged physical symptom, and unmet cancer-care support were risk factors for chronic distress. We recently completed a General Research Fund-funded study to examine the role of cognitive bias in differentiate cancer patients with persistent psychological distress and those with low or transient distress. The study found breast cancer women with persistent distress showed bias away from negative stimuli or cancer-related information, suggesting that they may adopt avoidance strategies to cope with cancer demands. Furthermore, women with persistent distress tend to interpret ambiguous information negatively, leading to illness preoccupation. Hence, tailored interventions such as attention bias modification promoting active goal-focused attention search may be beneficial to women who are at risk for persistent distress. Research F eature Stories Dr. Wendy Lam Associate Professor 2 Vision to L ead Mission to Serve