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Optimal communication associated with lower risk of acute traumatic stress after lung cancer diagnosis

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Abstract

Purpose

The aim of this study was to assess the role of the patient’s background and perceived healthcare-related factors in symptoms of acute stress after lung cancer diagnosis.

Methods

The study population consisted of 89 individuals referred for diagnostic work-up at Landspitali National University Hospital in Iceland and subsequently diagnosed with lung cancer. Before diagnosis, the patients completed questionnaires on sociodemographic characteristics, pre-diagnostic distress (Hospital Anxiety and Depression Scale), social support, and resilience. At a median of 16 days after diagnosis, the patients reported symptoms of acute stress on the Impact of Event Scale-Revised (IES-R) and experience of communication and support from healthcare professionals and family during the diagnostic period.

Results

Patients were on average 68 years and 52% reported high levels of post-diagnostic acute stress (IES-R > 23) while 24% reported symptoms suggestive of clinical significance (IES-R > 32). Prior history of cancer (β = 6.7, 95% CI: 0.1 to 13.3) and pre-diagnostic distress were associated with higher levels of post-diagnostic acute stress (β = 8.8, 95% CI: 2.7 to 14.9), while high educational level (β = − 7.9, 95% CI: − 14.8 to − 1.1) was associated with lower levels. Controlling for the abovementioned factors, the patients’ perception of optimal doctor-patient (β = − 9.1, 95% CI: − 14.9 to − 3.3) and family communication (β = − 8.6, 95% CI: − 14.3 to − 2.9) was inversely associated with levels of post-diagnostic acute stress after lung cancer diagnosis.

Conclusions

A high proportion of patients with newly diagnosed lung cancer experience high levels of acute traumatic stress of potential clinical significance. Efforts to improve doctor-patient and family communication may mitigate the risk of these adverse symptoms.

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Data Availability

The authors have full access to the primary data and can make the data available to the journal or interested researchers upon the approval of the National Bioethics Committee of Iceland.

Abbreviations

CD-RISC-10:

Connor-Davidson Resilience Scale, the 10-item version

HADS:

Hospital Anxiety and Depression Scale

HADS-T:

Hospital Anxiety and Depression Scale-Total score

IES-R:

Impact of Event Scale-Revised

LUCASS:

LUng CAncer, Survival, and Stress study

NSCLC:

Non-small cell lung cancer

PTS:

Posttraumatic stress

PTSD:

Posttraumatic stress disorder

SCLC:

Small cell lung cancer

SNI:

The Berkman-Syme Social Network Index

TNM:

Tumor, node, and metastasis staging system

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Acknowledgements

We are very grateful to Sigrún B. Guðmundsdóttir and Hrönn Árnadóttir for their assistance with this study as well as the personnel at the medical department A2 at Landspitali University Hospital, Reykjavík, Iceland.

Code availability

All statistical analyses were performed in R, version 3.5.1 (2018-07-02).

Funding

This work was supported by the Rannis Research Fund (grant number: 141667-051), the Swedish Cancer Foundation (grant number: 16 0720), the Doctoral Grant from the University of Iceland Research Fund/Eimskip University Fund 2018, and the Landspitali University Hospital Research Fund 2015.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland

    Hronn Hardardottir & Steinn Jonsson

  2. Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland

    Hronn Hardardottir, Thor Aspelund, Jianwei Zhu, Arna Hauksdottir, Donghao Lu & Unnur A. Valdimarsdottir

  3. Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Jianwei Zhu, Donghao Lu & Unnur A. Valdimarsdottir

  4. Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610000, Sichuan Province, China

    Jianwei Zhu

  5. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden

    Katja Fall

  6. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    Katja Fall & Fang Fang

  7. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Donghao Lu & Unnur A. Valdimarsdottir

  8. Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Donghao Lu

  9. Respiratory, Allergy and Sleep Research, Department of Medical Sciences, Uppsala University, Uppsala, Sweden

    Christer Janson

  10. Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavik, Iceland

    Steinn Jonsson

  11. Department of Psychology, Reykjavík University, Reykjavik, Iceland

    Heiddis Valdimarsdottir

  12. Mount Sinai School of Medicine, New York, NY, USA

    Heiddis Valdimarsdottir

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  1. Hronn Hardardottir
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  2. Thor Aspelund
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Contributions

All authors have made significant contribution to the (1) conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, and (3) approval of the final version to be submitted for publication.

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Correspondence to Hronn Hardardottir.

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Approval for the study was granted by the National Bioethics Committee, Iceland (VSNb201460025/03.07).

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Informed consent was obtained from all participating patients before any study material was collected.

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Hardardottir, ., Aspelund, T., Zhu, J. et al. Optimal communication associated with lower risk of acute traumatic stress after lung cancer diagnosis. Support Care Cancer 30, 259–269 (2022). https://doi.org/10.1007/s00520-021-06138-4

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