Papers by Matthew Loscalzo
Textbook of Palliative Care Communication, 2015
Hematology Oncology Clinics of North America, Feb 1, 1996
Asco Meeting Abstracts, Nov 1, 2014
The Cancer Journal, 2013
Many families and close friends are experiencing bereavement due to cancer. A review of recent st... more Many families and close friends are experiencing bereavement due to cancer. A review of recent studies of bereavement outcomes, mainly elevated psychological distress, suggests that bereaved family members, compared with nonbereaved, have poorer quality of life. They display high levels of complicated grief, anxiety, and depression and use bereavement services, but also report finding meaning in the loss, during the first 6 months after death. Similar demographic (e.g., female sex and younger age) and psychological (e.g., premorbid mental health conditions and lack of preparedness for the death) predictors are related to the bereavement outcomes across different familial groups. However, the severity of psychological distress and bereavement needs expressed vary by familial groups. Unrelieved pain and anxiety of the patient before the death and family members being unprepared for the impending death appear to be related to several postdeath psychological and physical morbidities of the surviving family members. Although the number of articles addressing bereavement-related issues associated with cancer has been growing in recent years, more rigorous studies that use longitudinal prospective designs, which bridge cancer survivorship with bereavement research, are needed.
Oncology (Williston Park, N.Y.)
The Moores UCSD Cancer Center has implemented the use of an innovative instrument for screening c... more The Moores UCSD Cancer Center has implemented the use of an innovative instrument for screening cancer patients at first visit to assist them with distress due to cancer-related problems. This 36-question screening instrument addresses physical, practical, social, psychological and spiritual problems. Patients are asked to rate the severity of each problem on a scale of 1 to 5, and to circle "Yes" if they would like staff assistance. Data from a prospective study of the first 2,071 patients to complete this questionnaire has been entered into a database and analyzed to identify common patient problems, demographics, and trends. The five most common causes of problem-related distress were fatigue, sleeping, finances, pain, and controlling my fear and worry about the future. The five most common problems for which patients circled "Yes" to ask for assistance were understanding my treatment options, fatigue, sleeping, pain, and finances. Compared to the entire population, patients who circled "Yes" on a particular problem, demonstrated a robust increase in problem-related distress.
Journal of the National Comprehensive Cancer Network: JNCCN
As demands on physician time mount, and patients and families increasingly expect accommodation a... more As demands on physician time mount, and patients and families increasingly expect accommodation and understanding of their specific, personal situations, care providers must boost efficiency and minimize the expense of their clinic processes and draw on connections with community resources. Third-party payors may also expect that the biopsychosocial needs of patients and families be addressed as an essential part of cancer care. Quality of care, cost, patient satisfaction, adherence to treatment, safety, and allocation of limited resources are all related to the identification and effective management of the psychosocial elements of cancer care. Experts suggest that health care has lagged far behind other industries in using technology to improve efficiency, and slow adoption of this technology means that critical information about the biopsychosocial needs of patients fails to reach the right professionals in a timely way. Systematic and automated screening can promote physician control in managing time, the efficiency of the clinical encounter, and rapid triage to other professionals and community resources. (JNCCN 2010;8:496-504) From the As many as 47% of cancer patients have been shown to experience emotional distress at the level of a diag-
Medical Clinics of North America
Cognitive-behavioral interventions are effective for symptoms control and reduction of suffering ... more Cognitive-behavioral interventions are effective for symptoms control and reduction of suffering in cancer pain patients. This article outlines the theoretical and technical principles of these nonmedical interventions and illustrates their integrated application with two case reports.
BACKGROUND: Cancer patients face numerous stressors in physical, emotional, social and spiritual ... more BACKGROUND: Cancer patients face numerous stressors in physical, emotional, social and spiritual life domains, not only because of the stigma related to this disease, but mainly because the treatment has a substantial amount of acute and late symptoms. The current literature emphasizes the effect of cancer, disease stage and treatment type on distress levels. In this study we examined the chemotherapy regimen (CR) relationship with distress levels on different stages of treatment. METHOD: Ninety women with breast cancer completed the Distress Thermometer (DT) and Problem List (PL) before first chemotherapy infusion (T1), halfway time point (T2), and at completion of treatment (T3). Five types of CR were prescribed: 34.4% of the patients took AC-TX (doxorubicin/cyclophosphamide/paclitaxel) regimen, 23.3% TC (docetaxel/cyclophosphamide), 14.4% TXT (doxorubicin/ciclophosphamide/docetaxel), 14.4% TAC (docetaxel/doxorubicin/cyclophosphamide), and 13.3% FEC (fluorouracil/epirubicin/cyclophosphamide). The data was analyzed with three-regressions of DT as dependent and CR as independent variables (controlling for age, marital status and disease stage) followed by a repeated measures ANOVA with CR as independent and five problems as dependent variables (practical, family, emotional, spiritual, physical). RESULTS: Severe to moderate distress (SMD) was reported by 48.9% of the patients at T1, 18.9% at T2 and 15.6% at T3. The most reported emotional problems were for FEC (fears, worry, sadness) and TXT (worry, depression, nervousness). For physical problems were AC-TX (constipation, fatigue, pain, appearance), TXT (appearance, sleep, nausea, fatigue) and TAC (fatigue, appearance, pain). Only TAC was a significant predictor of distress at T1 (p = 0.004) and T2 (p = 0.02) while TXT regimen was significant at T3 (p = 0.04). The repeated measures ANOVA revealed a significant interaction between CR and Physical problems (p = 0.02). CONCLUSIONS: The incidence of SMD and problems-related distress decreased between T1 to T3, despite the increase of patients’ side effects. FEC and TXT causes more emotional problems and AC-TX, TXT and TAC more physical problems. Considering the toxicity of the protocol, these results are consistent with the literature. The highest problem-related distress associated with CR was physical problems. Moreover, TAC showed to be predictive of distress in T1 and T2. RESEARCH IMPLICATIONS: Our results indicate that CR predicts distress in all treatments phases. Nonetheless, the effects of chemo can be persisted even after the end of treatment; and breast cancer survivors have increased risk for distressful symptoms related to fear of recurrence, death and disability. More studies are thus needed to investigate those factors increasing the sample in order to make the data more generalizable. CLINICAL IMPLICATIONS: The findings suggest a very positive benefit from the discussion between psychologist and physician, in which side effects and distress during treatment are addressed. It is important to create a strategy to help cancer patients to deal with chemo, mainly for patients who report problems related to TAC and TXT. This strategy could be related to tailored psychosocial education, preventive care for side effects, psychological management intervention, coping strategies and should be reinforced regularly. ACKNOWLEDGEMENT OF FUNDING: None.
A Quick Reference on the Psychosocial Dimensions of Cancer Symptom Management, 2014
Supportive Care in Cancer, 2015
Psychosocial (PsySoc) distress in caregivers is a well-described entity, with some caregivers exp... more Psychosocial (PsySoc) distress in caregivers is a well-described entity, with some caregivers experiencing more distress than patients themselves. The American College of Surgeons' Commission on Cancer mandates that psychosocial services be provided to all cancer patients and their caregivers, through the entire continuum of cancer care. We developed a program for newly diagnosed breast cancer patients and their partners. Both were screened for biopsychosocial stressors. The couple was then paired with two clinican-educators trained in communication and gender differences, who educated the couple in communication-based problem solving and provided referrals to supportive services. Eighty-six patients and 82 partners returned surveys. Compared to partners, patients were more likely to report feeling anxious or fearful (59 vs. 38 %, p = 0.014), report difficulty in managing their emotions (46 vs. 11 %, p = 0.003), and experience distress over being unable to take care of themselves (37 vs. 6 %, p = 0.000). Interestingly, there was no difference between patients and partners in feeling unsupported by their partner (6 vs. 5 %, p = 0.85) or in feeling down or depressed (29 vs. 30 %, p = 0.96). Both patients and partners experience significant distress after a breast cancer diagnosis. We found that partners are equally likely to feel unsupported by their partner (patient) and feel down or depressed. Further study is needed to learn about both patients' and partners' significant distress over lack of support. Partner-focused PsySoc interventions should be initiated in all cancer centers to address the emotional needs of both breast cancer patients and their partners.
Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program, 2008
Psychosocial domains and palliative care medicine are the connective tissue of our fragmented hea... more Psychosocial domains and palliative care medicine are the connective tissue of our fragmented health care system. The psychosocial domains of palliative care are central to creating new partnerships with physicians, patients, and their caregivers in emotionally charged medical environments, especially Intensive Care Units. Managing the psychological, social, emotional, spiritual, practical and existential reactions of patients and their loved ones supports effective action and problem-solving. Practical aspects to establishing realistic goals of care among the health care team and other specialists, communicating effectively with patients and families in crisis, using the diverse and ambiguous emotional responses of patients, families, faculty and staff therapeutically, and helping to create meaning in the experience is essential to whole-patient and family care centered. The family conference is an excellent vehicle to create an environment of honest and open communication focused ...
Cancer treatment and research, 2007
Fertility has always been associated with awe, curiosity, and magical thinking. Since the beginni... more Fertility has always been associated with awe, curiosity, and magical thinking. Since the beginning of time, fertility has been deeply imbedded in the human experience and expressed throughout the ages by all cultures in symbolic art. In trying to decipher the atavistic meanings given to fertility, it is essential to consider the hostile world in which our progenitors struggled and eventually thrived. The population of the earth is an incredible success story. No species have ever so dominated the earth as have humans. Fertility has always been the central theme of our ancestors. In many ways, cancer, as a life-threatening disease, brings people back to their most basic and primitive selves.
Palliative and Supportive Care, 2014
Objective: We replicated a 1994 study that surveyed the state of supportive care services due to ... more Objective: We replicated a 1994 study that surveyed the state of supportive care services due to changes in the field and the increased need for such services. We provide an updated assessment, comparing the changes that have occurred and describing the current status of supportive care services in comprehensive cancer settings. Method: We used Coluzzi and colleague's 60-question survey from their 1995 Journal of Clinical Oncology article to frame the 98-question survey employed in the current study. Medical and palliative care directors for the 2011 National Cancer Institute (NCI) comprehensive cancer centers were surveyed regarding their supportive care services and their subjective review of the overall effectiveness of the services provided. Results: We achieved a 76% response rate (n = 31). The data revealed increases in the number of cancer beds in the hospitals, the degree of integration of supportive care services, the availability of complementary services, and the number of pain and palliative care services offered. There was also an overall shift toward centers becoming more patient centered, as 65% reported now having a patient and family advisory council. Our findings revealed a growing trend to offer distress screening for both outpatients and inpatients. Medical and palliative care directors' evaluations of the supportive care services they offered also significantly improved. However, the results revealed an ongoing gap in services for end-of-life care and timely referrals for hospice services. Significance of results: Overall, both the quantity and quality of supportive care services in the surveyed NCI-designated cancer centers has improved.
Cancer Practice, 2001
A program evaluation was conducted to explore the potential effects of a 90-minute problem-solvin... more A program evaluation was conducted to explore the potential effects of a 90-minute problem-solving education session for persons with advanced cancer and their families.
Patient Education and Counseling, 2001
The ®rst study in this series [Houts PS, Bachrach R, Witmer JT, Tringali CA, Bucher JA, Localio R... more The ®rst study in this series [Houts PS, Bachrach R, Witmer JT, Tringali CA, Bucher JA, Localio RA. Patient Educ. Couns. 1998;35:83±8] found that recall of spoken medical instructions averaged 14% but that, when pictographs (drawings representing the instructions) accompanied the spoken instructions and were present during recall, 85% of medical instructions were remembered correctly. Those ®ndings suggested that spoken instructions plus pictographs may be a way to give people with low literacy skills access to medical information that is normally available only in written form. However, there were three important limitations to that study: (1) the subjects were literate and perhaps literate people remember pictograph meanings better than people with low literacy skills; (2) only short term recall was tested and, for medical information to be useful clinically, it must be remembered for signi®cant periods of time and (3) a maximum of 50 instructions were shown in pictographs, whereas managing complex illnesses may require remembering several hundred instructions. This study addresses those limitations by investigating 4-week recall of 236 medical instructions accompanied by pictographs by people with low literacy skills. Subjects were 21 adult clients of an inner city job training program who had less than ®fth grade reading skills. Results showed 85% mean correct recall of pictograph meanings immediately after training (range from 63 to 99%) and 71% after 4 weeks (range from 33 to 94%). These results indicate that people with low literacy skills can, with the help of pictographs, recall large amounts of medical information for signi®cant periods of time. The impact of pictographs on symptom management and patient quality of life remains to be studied. #
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Papers by Matthew Loscalzo