Objective The objectives of this study were to evaluate, in the Italian cultural context, breast cancer patients' main meaning themes related to the experience of the disease, on the one side, and to be part of an existentially oriented group intervention, on the other. Method A short reorientation-existential (RET) group intervention, structured by using some tools and background from cognitive analytic therapy (CAT) and based on the meaning-centered psychotherapy (MCP) existential framework, was delivered to 29 breast cancer patients. The sessions were audio-recorded and transcribed verbatim, with the narratives from reflective exercises (meaning of the journey cancer, meaning of the journey of intervention) uploaded to computer software NVivo 11. Analysis of the transcripts emerged from reflective exercises on the personal meaning of cancer and the letters of meaning (goodbye letter) written by the patients to express the meaning of their experience in the group was conducted through the interpretative phenomenological analysis (IPA) framework. Results Four superordinate themes were identified in the exercise meaning of the experience of cancer, namely "sense of stigma and loneliness (the foreigner)," "guilt (unjust guilt and anticipatory guilt)," "reconsidering one's own life and nostalgia," and "rebirth (a new life, life after life)." Three superordinate themes were found in the meaning of the group experience in the letters, namely "togetherness and gratitude," "legacy," and "acceptance." Significance of results The study confirmed that a short group intervention, based on the existentially oriented framework and delivered in a public clinical healthcare setting, was enriched by focusing on the personal meaning of cancer. Some themes, such as loneliness, nostalgia, and rebirth, emerged during reflection giving, in written letters to participants, the sense of the group therapeutic experience.

Introduction: Post-traumatic Symptoms (PTSS) and Post-traumatic Stress Disorder (PTSD) have been reported to affect a quite significant proportion of cancer patients. No study has examined the relationship between serotonin transporter gene-linked polymorphic region (5-HTTLPR) and cancer, including Gene-Environment interactions between this polymorphism and specific causes of distress, such as cancer related problems (CRP) or life stressful events (SLE). Methods: One hundred and forty five breast cancer outpatients participated in the study and were assessed using the Impact of Event Scale (IES), the Problem List (PL) developed by the National Comprehensive Cancer Network (NCCN) Distress Management Guidelines and the Paykel's Life Events Interview to evaluate the exposure to SLE during the year before the cancer diagnosis. Each patient was genotyped for 5-HTTLPR polymorphism by analyzing genomic DNA obtained from whole blood cells. Gene-Environment interactions were tested through moderation analysis. Results: Twenty-six patients (17.7%) were classified as PTSS cases using the IES. Genotype and phenotype distributions did not differ across individuals with/without PTSS (genotype: χ2 = 1.5; df = 2; p = 0.3; phenotype χ2 = 0.9; df = 1; p = 0.2). For both the genotype and phenotype model, using CRP as a predictor showed significant gene-environment interactions with IES total score (p = 0.020 and p = 0.004, respectively), with individuals carrying the l/l allele showing a greater probability of experiencing PTSS. No interaction was found in relationship to SLE (p = 0.750). Conclusion: This study showed a significant GEI between CRP and PTSS in breast cancer patients, with carriers of the l/l allele showing indicators consistent with greater sensitivity to stress.

Objective In the present study, we aimed to assess hostility and to examine its association with formal psychiatric diagnosis, coping, cancer worries, and quality of life in cancer patients. Methods The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) to make an ICD-10 (International Classification of Disease) psychiatric diagnosis was applied to 516 cancer outpatients. The patients also completed the Brief Symptom Inventory-53 to assess hostility (BSI-HOS), and the Mini-Mental Adjustment to cancer scale (Mini-MAC). A subset of patients completed the Cancer Worries Inventory (CWI), the Openness Scale, and the Quality of Life Index. Results By analyzing the distribution of the responses 25% of the patients had moderate and 11% high levels of hostility, with about 20% being BSI-HOS "cases." Hostility was higher in patients with a formal ICD-10 psychiatric diagnosis (mainly major depression, other depressive disorders, anxiety disorders) than patients without ICD-10 diagnosis. However, about 25% of ICD-10-non cases also had moderate-to-high hostility levels. Hostility was associated with Mini-MAC hopelessness and anxious preoccupation, poorer quality of life, worries (mainly problems sin interpersonal relationships), and inability to openly discuss these problems within the family. Conclusions Hostility and its components should be considered as dimensions to be more carefully explored in screening for distress in cancer clinical settings for its implications in negatively impacting on quality of life, coping and relationships with the family, and possibly the health care system.

Background:Type-D (distressed) personality has not been prospectively explored for its association with psychosocial distress symptoms in breast cancer patients. Objective:The objective of the study was to test the hypothesis that Type-D personality can be associated with psychosocial distress variables in cancer over a 2-point period (6 month-follow-up). Aims:The aim of the study was to analyze the role of Type-D personality in relation to anxiety, depression, post-traumatic stress symptoms, general distress, and maladaptive coping among cancer patients. Methods:145 breast cancer patients were assessed within 6 months from diagnosis (T0) and again 6 months later (T1). The Type-D personality Scale, the Hospital Anxiety and Depression Scale, Depression subscale (HAD-D), the Brief Symptom Inventory (BSI-18) Anxiety subscale, the Distress Thermometer (DT), the Post-traumatic Symptoms (PTS) Impact of Event Scale (IES), and the Mini Mental Adjustment to Cancer (Mini-MAC) Anxious Preoccupation and Hopelessness scales were individually administered at T0 and T1. Results:One-quarter of cancer patients met the criteria for Type-D personality, which was stable over the follow-up time. The two main constructs of Type-D personality, namely social inhibition (SI) and negative affectivity (NA), were related to anxiety, depression, PTS, BSI-general distress and maladaptive coping (Mini-MAC anxious preoccupation and hopelessness). In regression analysis, Type-D SI was the most significant factor associated with the above-mentioned psychosocial variables, both at T0 and T1. Conclusion:Likewise other medical disorders (especially cardiology), Type-D personality has been confirmed to be a construct significantly related to psychosocial distress conditions and maladaptive coping that are usually part of assessment and intervention in cancer care. More attention to personality issues is important in oncology.

a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy; b University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, Health Trust and University S. Anna Hospital, Ferrara, Italy; c Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada; d Department of Psychiatry, University of Toronto, Toronto, ON, Canada; e Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy; f Psycho-Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy Received: October 12, 2019 Accepted after revision: January 12, 2020 Published online: March 19, 2020

Patients with advanced cancer suffer from psychosocial distress that may impair quality of life and that may be ameliorated by psychotherapeutic treatment. We describe here the methodology of a randomized controlled trial (RCT) to assess the effectiveness of a novel, brief, semi-structured psychotherapeutic intervention to reduce distress and increase well-being in patients with advanced or metastatic cancer. The intervention, called Managing Cancer and Living Meaningfully (CALM), was originally developed in Canada and we are now testing its Italian adaptation (CALM-IT).The study is a single-blinded phase III RCT with assessment at baseline, 3 and 6 months with two conditions: CALM-IT versus a nonspecific supportive intervention (SPI). Eligibility criteria include: ≥ 18 years of age; fluency in the Italian language; no cognitive deficit, and diagnosis of advanced or metastatic cancer with an expected survival of 12–18 months. CALM-IT includes up to 12 sessions, delivered over 6 months and covers 4 domains: i) Symptom Management and Communication with Health Care Providers; ii) Changes in Self and Relations with Close Others; iii) Sense of Meaning and Purpose; and iv) the Future and Mortality. The primary outcome is difference in severity of depressive symptoms between treatment arm and the primary endpoint is 6 months. The secondary endpoint is 3 months and secondary outcomes are: generalized anxiety, distress about dying and death, demoralization, spiritual well-being, attachment security, posttraumatic growth, communication with partners, quality of life, and satisfaction with clinical care.If shown to be effective, CALM-IT can be implemented nationally to relieve distress and to promote psychological well-being in patients with advanced cancer.

BACKGROUND:Demoralization, as assessed through the Diagnostic Criteria for Psychosomatic Research-Demoralization (DCPR/D) interview or the Demoralization Scale (DS), has been found to affect about 30% of patients with medical disorders, while few studies have been done in patients with psychiatric disorders.METHODS:A convenience sample of 377 patients with ICD-10 diagnoses of mood, anxiety, stress-related disorders or other non-psychotic disorders was recruited from two Italian university psychiatry centers. The DCPR/D interview and the Italian version of the DS (DS-IT) were used to assess demoralization and the Patient Health Questionnaire-9 (PHQ-9) to assess depression.RESULTS:Demoralization was diagnosable in more than 50% of the patients. Factor analysis of the DS-IT indicated four main factors, Meaninglessness/Helplessness, Disheartenment, Dysphoria and Sense of Failure, explaining 62% of the variance of the scale. Patients with bipolar or unipolar major depression and personality disorders had the highest prevalence of demoralization (DCPR/D) and the highest scores on all the DS-IT factors in comparison with patients with adjustment or anxiety disorders. About 50% of patients with moderate demoralization (DS-IT) were not clinically depressed (PHQ-9 <10), while almost all with severe demoralization were depressed.LIMITATIONS:Prospective studies on larger samples with other psychiatric disorders, also taking into account subjective incompetence, are needed. Since the DCPR/D assesses demoralization as a categorical construct, a dimensional framework should be necessary.CONCLUSIONS:The findings enrich the research on demoralization, showing for the first time the importance of this construct, as measured by the DCPR/D and the DS-IT, in patients with psychiatric disorders.

Objective: Individuals may experience a wide range of psychological reactions in response to negative life events.Even if events that threaten life have been always played a central role in research, recent studies have outlined that experiences, considered exceptional but part of the human existence (e.g., divorce, unemployment, or chronic illness) may also lead individuals to experience enduring emotional states of suffering.Demoralization has been substantially described as an important condition occurring in response to stressful events, while a recent interest is growing on embitterment as a common reaction.Method: By analyzing the most relevant studies (MEDLINE, EMBASE, PsycLit, and Cochrane Library), this article discusses the main features of embitterment and demoralization, summarizing the similarities as well as the differences detectable between the 2 constructs.Results: Some authors have described these phenomena as spectrum or gradients that start with normal human responses until getting to pathological conditions, characterized by prolonged intense psychological distress in relation to stressful events.Both have shown distinct psychopathological features than other stress-related mental disorders and have been recognized as predictors of negative outcomes, such as impairment in work and social functioning, reduction of quality of life, risk for mental and physical disorders, and suicidality.Conclusions: Demoralization and embitterment are multidimensional phenomena, connected to each other by bridge dimensions and in the meanwhile characterized by distinct features.Accurately exploring these clinical conditions is an ongoing challenge to clinicians and researchers, who are called for improving their recognition and proper therapeutic interventions that can ameliorate patients quality of life.

BACKGROUND Given the adverse consequences of psychiatric and psychosocial morbidity on the quality of life for patients with cancer, prompt detection of psychological symptoms is mandatory. The authors examined the properties and accuracy of the Brief Symptom Inventory (the 53‐item version [BSI] and the 18‐item version [BSI‐18]) for the detection of psychiatric morbidity compared with the World Health Organization Composite International Diagnostic Interview (CIDI) for International Classification of Diseases‐10th Revision psychiatric diagnoses. METHODS A convenience sample of 498 patients with newly diagnosed cancer who were recruited in cancer outpatient services participated in the CIDI interview and in BSI and BSI‐18 assessments. RESULTS The prevalence of psychiatric morbidity was 39.75%. When participants were classified as cases using the BSI standard case rule, agreement with the CIDI was potentially acceptable (sensitivity, 72.7%; specificity, 88.7%). In contrast, the accuracy of the BSI‐18 in identifying cases was poor according to the standard case rule, with very low sensitivity (29.3%) (misclassification rate, 28.7%). By using a first alternative case‐rule system (a BSI‐18 global severity index [GSI] T‐score ≥57), sensitivity marginally improved (45%), whereas a second alternative case‐rule system (a GSI T‐score ≥50) significantly increased sensitivity (77.3%). In receiver operating characteristic curve analysis, a further cutoff GSI T‐score ≥48 exhibited good discrimination levels (sensitivity, 82.3%; specificity, 72.4%). There were some differences in GSI cutoff T‐scores according to the International Classification of Diseases‐10th Revision diagnosis and sex. CONCLUSIONS The BSI appeared to have acceptable diagnostic accuracy compared with a standardized psychiatric interview. For the BSI‐18, it is mandatory to use alternative case‐rule systems, to identify patients with psychiatric morbidity. Cancer 2018;124:2415‐26 . © 2018 American Cancer Society .

The psychiatric, psychosocial, and existential/spiritual pain determined by chronic medical disorders, especially if in advanced stages, have been repeatedly underlined. The right to approach patients as persons, rather than symptoms of organs to be repaired, has also been reported, from Paul Tournier to Karl Jaspers, in opposition and contrast with the technically-enhanced evidence-based domain of sciences that have reduced the patients to 'objects' and weakened the physician's identity deprived of its ethical value of meeting, listening, and treating subjects. The paper will discuss the main psychosocial and existential burden related to chronic and advanced medical illnesses, and the diagnostic and therapeutic implications for a dignity preserving care within a person-centred approach in medicine, examined in terms of care of the person (of the person's whole health), for the person (for the fulfilment of the person's health aspirations), by the person (with physicians extending themselves as total human beings), and with the person (working respectfully with the medically ill person).

With cancer incidence increasing over time, attention to the burden of related psychiatric and psychosocial consequences of the disease and treatment is a major topic for both cancer patients and their caregivers. Among cancer patients, psychiatric (e.g. adjustment, anxiety, depressive disorders) and neuropsychiatric disorders (e.g. cognitive disorders secondary to treatment, delirium) have been shown to affect an average of 30-35% patients, with differences according to stage and type of cancer. Also other psychosocial syndromes (e. g. demoralization, health anxiety, irritable mood) not taken into account in usual nosological systems should be considered for their impact on the patient's quality-of-life. Also, it has been repeatedly reported that psychological distress reverberates substantially throughout the nuclear family, and that a family approach is necessary in cancer care, with the caregiver-patient dyad as a unit to be the focus and direction of assessment and intervention. In this review the most significant psychosocial disorders causing burden for cancer patients and their caregivers are examined, and the main methods of assessment for more proper referral and treatment are summarized.

Demoralization is a commonly observed syndrome in cancer patients, deserving to be carefully assessed in cross‐cultural contexts.

Depressive spectrum disorders, including major depression, persistent depression, minor and sub-syndromal depression, and other forms of depressive conditions, such as demoralization, are among the most common psychiatric consequences of cancer patients, affecting up to 60% of patients. In spite of the negative effects and the burden for cancer patients and their families, these disorders often remain under-recognized and undertreated. The present review aims at summarizing the relevant data concerning the diagnostic challenges within the depressive spectrum disorders among cancer patients. Also, the most relevant data relative to integrated intervention, including psychopharmacological and psychosocial treatment, for depression in cancer patients are critically evaluated. It is mandatory that health care professionals working in oncology (e.g., oncologists, surgeons, radiation oncologists, primary care physicians, nurses, social workers, psychologists) receive training in the diagnosis and integrated management of the different types of disorder within the spectrum of clinical depression.

Psycho-OncologyVolume 26, Issue 2 p. 282-285 CLINICAL CORRESPONDENCE Beliefs about medicines, doctor–patient relationship, and coping among European patients with cancer Luigi Grassi, Corresponding Author Luigi Grassi luigi.grassi@unife.it Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Program in Psycho-Oncology and Psychiatry in Palliative Care, University S. Anna Hospital and Health Authorities, Ferrara, Italy Correspondence to: Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Corso Giovecca 203, 44121 Ferrara, Italy. E-mail: luigi.grassi@unife.it Search for more papers by this authorElena Meggiolaro, Elena Meggiolaro Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) S.r.l, Meldola, Forlì-Cesena, ItalySearch for more papers by this authorMaria Alejandra Berardi, Maria Alejandra Berardi Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) S.r.l, Meldola, Forlì-Cesena, ItalySearch for more papers by this authorAgustina Sirgo, Agustina Sirgo Psycho-Oncology Unit, Oncology Department, University Hospital Sant Joan de Reus, Reus, SpainSearch for more papers by this authorMaria Cristina Colistro, Maria Cristina Colistro Istituto Oncologico Romagnolo (IOR), Forlì, ItalySearch for more papers by this authorElisabeth Andritsch, Elisabeth Andritsch Psycho-Oncology Service, Clinical Department of Oncology, University Medical Center of Internal Medicine, Medical University of Graz, Graz, AustriaSearch for more papers by this authorAlessandra Montesi, Alessandra Montesi Psycho-Oncology Unit, Oncology Department, University Hospital Sant Joan de Reus, Reus, SpainSearch for more papers by this authorTatiana Bertelli, Tatiana Bertelli Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) S.r.l, Meldola, Forlì-Cesena, ItalySearch for more papers by this authorClemens Farkas, Clemens Farkas Psycho-Oncology Service, Clinical Department of Oncology, University Medical Center of Internal Medicine, Medical University of Graz, Graz, AustriaSearch for more papers by this authorRosangela Caruso, Rosangela Caruso Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Program in Psycho-Oncology and Psychiatry in Palliative Care, University S. Anna Hospital and Health Authorities, Ferrara, ItalySearch for more papers by this authorSilvana Sabato, Silvana Sabato Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Program in Psycho-Oncology and Psychiatry in Palliative Care, University S. Anna Hospital and Health Authorities, Ferrara, ItalySearch for more papers by this authorSara Massarenti, Sara Massarenti Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Program in Psycho-Oncology and Psychiatry in Palliative Care, University S. Anna Hospital and Health Authorities, Ferrara, ItalySearch for more papers by this authorEva Juan Linarez, Eva Juan Linarez Psycho-Oncology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainSearch for more papers by this authorMaria Giulia Nanni, Maria Giulia Nanni Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Program in Psycho-Oncology and Psychiatry in Palliative Care, University S. Anna Hospital and Health Authorities, Ferrara, Italy The paper is co-authored by: Marta Bellè (Department of Oncology, Cà Foncello Hospital of Treviso, Treviso, Italy), Giorgia Bellini (IOR Forlì), Antonella Carbonara (Institute of Psychiatry, University of Ferrara), Laura Cavana (IOR Forlì), Silvia De Padova (IRST Forlì), Maura Muccini (IOR Forlì), Elisa Ruggeri (IOR Forlì), Elena Samorì (IOR Forlì), and Ilaria Strada (IOR Forlì).Search for more papers by this author Luigi Grassi, Corresponding Author Luigi Grassi luigi.grassi@unife.it Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Program in Psycho-Oncology and Psychiatry in Palliative Care, University S. Anna Hospital and Health Authorities, Ferrara, Italy Correspondence to: Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Corso Giovecca 203, 44121 Ferrara, Italy. E-mail: luigi.grassi@unife.it Search for more papers by this authorElena Meggiolaro, Elena Meggiolaro Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) S.r.l, Meldola, Forlì-Cesena, ItalySearch for more papers by this authorMaria Alejandra Berardi, Maria Alejandra Berardi Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) S.r.l, Meldola, Forlì-Cesena, ItalySearch for more papers by this authorAgustina Sirgo, Agustina Sirgo Psycho-Oncology Unit, Oncology Department, University Hospital Sant Joan de Reus, Reus, SpainSearch for more papers by this authorMaria Cristina Colistro, Maria Cristina Colistro Istituto Oncologico Romagnolo (IOR), Forlì, ItalySearch for more papers by this authorElisabeth Andritsch, Elisabeth Andritsch Psycho-Oncology Service, Clinical Department of Oncology, University Medical Center of Internal Medicine, Medical University of Graz, Graz, AustriaSearch for more papers by this authorAlessandra Montesi, Alessandra Montesi Psycho-Oncology Unit, Oncology Department, University Hospital Sant Joan de Reus, Reus, SpainSearch for more papers by this authorTatiana Bertelli, Tatiana Bertelli Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) S.r.l, Meldola, Forlì-Cesena, ItalySearch for more papers by this authorClemens Farkas, Clemens Farkas Psycho-Oncology Service, Clinical Department of Oncology, University Medical Center of Internal Medicine, Medical University of Graz, Graz, AustriaSearch for more papers by this authorRosangela Caruso, Rosangela Caruso Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Program in Psycho-Oncology and Psychiatry in Palliative Care, University S. Anna Hospital and Health Authorities, Ferrara, ItalySearch for more papers by this authorSilvana Sabato, Silvana Sabato Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Program in Psycho-Oncology and Psychiatry in Palliative Care, University S. Anna Hospital and Health Authorities, Ferrara, ItalySearch for more papers by this authorSara Massarenti, Sara Massarenti Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Program in Psycho-Oncology and Psychiatry in Palliative Care, University S. Anna Hospital and Health Authorities, Ferrara, ItalySearch for more papers by this authorEva Juan Linarez, Eva Juan Linarez Psycho-Oncology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainSearch for more papers by this authorMaria Giulia Nanni, Maria Giulia Nanni Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Program in Psycho-Oncology and Psychiatry in Palliative Care, University S. Anna Hospital and Health Authorities, Ferrara, Italy The paper is co-authored by: Marta Bellè (Department of Oncology, Cà Foncello Hospital of Treviso, Treviso, Italy), Giorgia Bellini (IOR Forlì), Antonella Carbonara (Institute of Psychiatry, University of Ferrara), Laura Cavana (IOR Forlì), Silvia De Padova (IRST Forlì), Maura Muccini (IOR Forlì), Elisa Ruggeri (IOR Forlì), Elena Samorì (IOR Forlì), and Ilaria Strada (IOR Forlì).Search for more papers by this author First published: 13 April 2016 https://doi.org/10.1002/pon.4125Citations: 6 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. 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