Andy Roth - Academia.edu (original) (raw)
Papers by Andy Roth
Handbook of Geriatric Oncology, 2017
Background and objective. Acutely ill older patients with cognitive impairment represent a major ... more Background and objective. Acutely ill older patients with cognitive impairment represent a major subgroup in acute care hospitals. In this context, communication plays a crucial role for patients' well-being, healthcare decisions, and medical outcomes. As
Journal of the National Comprehensive Cancer Network, 2003
Optimism about improved survival from cancer has increased. However, even with tremendous improve... more Optimism about improved survival from cancer has increased. However, even with tremendous improvements in screening techniques and treatment, a cancer diagnosis may shatter the dream of a dignified old age for elderly patients. Cancer diagnosis and treatment often produce psychological stresses resulting from the actual symptoms of the disease, as well as the patient and family's perceptions of the disease and its stigma. Concerns related to cancer have particular meaning for aging individuals who undergo these situations in the context of retirement, widowhood, other medical disabilities, and other losses. Today, patients and families are more interested in treatment issues and quality of life, both during and after treatment. In this article we discuss late life depression, anxiety, and delirium and treatments related to elderly patients coping with cancer.
Psycho-oncology, Jan 16, 2016
To examine the ability of three popular self-report measures of depression to assess depression i... more To examine the ability of three popular self-report measures of depression to assess depression in a geriatric cancer setting. Cancer patients 70 years or older and on active treatment completed the Geriatric Depression Scale-Short Form, the Hospital Anxiety and Depression Scale, and the Center for Epidemiological Studies Depression Scale-Revised, and were interviewed using the depression module of the Structured Clinical Interview for DSM disorders (SCID) as the 'gold standard.' Analyses included calculating internal consistency, ROC curves, and the sensitivity and specificity to detect major depression (MDD) or minor depression (i.e. subthreshold depression). In a sample of 201 cancer patients (85% White; 64% completed college degree or higher), all three of the self-report measures produced adequate internal consistency and predicted depression greater than chance. However, the published cutoff scores for detecting MDD produced inadequate sensitivity, suggesting these sco...
Psycho-Oncology, 2015
Objectives-Erectile rehabilitation (ER) following radical prostatectomy (RP) is considered an ess... more Objectives-Erectile rehabilitation (ER) following radical prostatectomy (RP) is considered an essential component to help men regain erectile functioning; however many men have difficulty adhering to this type of a program. This qualitative study explored men's experience with ER, erectile dysfunction (ED), and ED treatments to inform a psychological intervention designed to help men adhere to ER post-RP. Methods-Thirty men, one to three years post-RP, who took part in an ER program, participated in one of four focus groups. Thematic analysis was used to identify the primary themes. Results-Average age was 59 (SD=7); mean time since surgery was 26 months (SD=6). Six primary themes emerged: 1) frustration with the lack of information about post-surgery ED; 2) negative emotional impact of ED and avoidance of sexual situations; 3) negative emotional experience with penile injections and barriers leading to avoidance; 4) the benefit of focusing on the long-term advantage of ER versus short-term anxiety; 5) using humor to help cope; and 6) the benefit of support from partners and peers. Conclusions-Men's frustration surrounding ED can lead to avoidance of sexual situations and ED treatments, which negatively impact men's adherence to an ER program. The theoretical construct of Acceptance and Commitment Therapy (ACT) was used to place the themes into a framework to conceptualize the mechanisms underlying both avoidance and adherence in this population. As such, ACT has the potential to serve as a conceptual underpinning of a psychological intervention to help men reduce avoidance to penile injections and adhere to an ER program.
The Oncologist, 2009
Learning Objectives After completing this course, the reader will be able to: Explain why older c... more Learning Objectives After completing this course, the reader will be able to: Explain why older cancer patients have better coping skills than younger cancer patients.Analyze the relationship between aging, and anxiety, depression and quality of life in prostate cancer patients.Explain the dynamics between anxiety and depression in older prostate cancer patients. This article is available for continuing medical education credit at CME.TheOncologist.com
Cancer, 2008
BACKGROUND-Men who receive androgen-deprivation therapy (ADT) for prostate cancer experience seve... more BACKGROUND-Men who receive androgen-deprivation therapy (ADT) for prostate cancer experience several side effects from this treatment. A few recent studies have examined the cognitive implications of ADT and how they impact a patient's treatment decision-making, occupational pursuits, and quality of life. For this report, the authors explored possible mechanisms for this association, reviewed research in animal studies and aging men, and examined the growing literature focused on the relation between ADT and cognitive functioning in patients with prostate cancer. METHODS-A systematic literature search was conducted using the PubMed and Information Sciences Institute Web of Knowledge-Web of Science databases to identify relevant studies that investigated the relation between ADT in men with prostate cancer and its cognitive effects. RESULTS-Testosterone and its derivatives may have an impact on cognition through several mechanisms in the brain, as supported by studies of animals and in aging men. Studies that researched the impact of ADT on cognition in patients with prostate cancer patients were designed relatively well but suffered from small sample sizes. Between 47% and 69% of men on ADT declined in at least 1 cognitive area, most commonly in visuospatial abilities and executive functioning. Some studies reported contradictory results with increased functioning in verbal memory. CONCLUSIONS-There is a strong argument that androgen-ablation therapy is linked to subtle but significant cognitive declines in men with prostate cancer. The authors believe that clinicians should become aware of this correlation as the use of ADT increases and should inform and monitor patients for this possible side effect of treatment.
Annals of Behavioral Medicine, 2009
Purpose This study aims to develop a theoretical framework of the relationship among religiosity,... more Purpose This study aims to develop a theoretical framework of the relationship among religiosity, spirituality, and depression, potentially explaining the often mixed and inconsistent associations between religiosity and depression. Methods In this cross-sectional study, 367 men (average age of 66 ± 9 years) with prostate cancer completed measures of religiosity (extrinsic/intrinsic), spirituality (Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale), quality of life (FACT-G), and depression (Hospital Anxiety and Depression Scale). Results There was a small relationship between intrinsic religiosity and depression (r=−0.23, p<0.05) but a strong association between spirituality and depression (r=−0.58, p< 0.01). Using a mediation model, the meaning/peace subscale of the spirituality measure mediated the relationship between intrinsic religiosity and depression. This model controlled for age, marital status, stage of disease, time since diagnosis, hormone therapy, quality of life, and anxiety. Conclusions When examining religiosity and spirituality, the main component that may help reduce depression is a sense of meaning and peace. These results highlight the potential importance of developing a patient's sense of meaning through activities/interventions (not exclusive to religious involvement) to achieve this goal.
Journal of Clinical Oncology, 2010
PurposeGeriatric issues in cancer are becoming prominent. Depression is a significant concern for... more PurposeGeriatric issues in cancer are becoming prominent. Depression is a significant concern for both the elderly and patients with cancer, yet identifying depression in these patients is difficult and often leads to under-recognition. We conducted a systematic review to determine which depression instruments are appropriate for use in geriatric patients with cancer.MethodsWe identified the most commonly used self-report depression instruments. We then used the criteria established in the US Food and Drug Administration Draft Guidance on Patient-Reported Outcome Measures to determine the extent of validation evidence of these measures in geriatric cancer populations. Finally, we determined which instruments captured depressive symptoms that are common among elderly patients with cancer.ResultsEight measures were selected as the most commonly used instruments. These were the Beck Depression Inventory-II, Brief Symptom Inventory-18, Center for Epidemiologic Studies–Depression Scale, ...
Psychopharmacology in Cancer Care
Anxiety is common in cancer patients, but it is not necessarily predictable, tolerable, or inevit... more Anxiety is common in cancer patients, but it is not necessarily predictable, tolerable, or inevitable. It can arise from the illness experience or as an exacerbation of a pre-existing anxiety disorder. Anxiety is commonly seen with a new cancer diagnosis, with complications of cancer treatment or medications, related to changes in body image, associated with fear of recurrence after treatment, when dealing with recurrence or progression of cancer after treatment, or when finding out that there is no further active treatment for the cancer and concerns about mortality must be engaged. Although understandable, these worries can intensify, causing severe panic or emotional paralysis, and interfere with completing cancer treatment. This chapter discusses the medical and psychiatric causes of anxiety, the medications used to treat anxiety, and the pros and cons of various choices. It is hoped that all practitioners can help educate patients about antianxiety medications, including fears ...
Psychopharmacology in Cancer Care, 2020
Cancer-related fatigue is common, occurring in up to 80% of patients. Distressing fatigue can be ... more Cancer-related fatigue is common, occurring in up to 80% of patients. Distressing fatigue can be related to psychiatric or medical causes such as significant depression, frequent intense anxiety, or panic attacks, as well as sleep disturbances, pain, and electrolyte or hormonal abnormalities. It is often caused by a wide range of medications and substances. This chapter presents the various causes of fatigue to help non-prescribing clinicians distinguish fatigue from other look-alike diagnoses such as depression and make appropriate referrals to prescribers. Identifying opportunities to supplement nonpharmacologic therapies with an activating medication can improve a patient’s quality of life and joy in living. This chapter will help all clinicians become more aware of medications used to boost energy, such as energizing antidepressants, wakefulness agents, and psychostimulants, as well as the potential side effects of these medications.
Psychopharmacology in Cancer Care, 2020
Although many people with cancer experience depressive moods, not all will have a major depressiv... more Although many people with cancer experience depressive moods, not all will have a major depressive episode. It is therefore important to distinguish and address subsyndromal depression from a depressive syndrome that could benefit from psychopharmacologic intervention. This chapter discusses risk factors for depression in cancer patients and provides suggestions for improving identification of depression in complicated cancer situations. The goal is to help non-prescribing clinicians more easily decide when referrals for medication are warranted and how to maintain connections and enhance communication with prescribers after medications are started. Pearls and potholes of why different medications are used for specific circumstances, and how prescribers seek to obtain more than one use out of a single medication, are described.
Psycho-Oncology, 2021
Cancer survivors face a unique set of treatment-related issues impacting sexual function and qual... more Cancer survivors face a unique set of treatment-related issues impacting sexual function and quality of life. While some treatment-related sexual adverse effects are temporary, many survivors face long-term effects such as treatment-induced menopause, altered gonadal function, and significant surgical disfigurement. Treatment modalities including surgery, chemotherapy, radiation therapy, and endocrine therapy present with persistent changes in tissue quality and sexual response. Common changes in sexual function for cancer survivors include decreased libido or sexual interest and pain with penetration in women and erectile dysfunction in men. As cancer survivorship improves, it is increasingly important for medical professionals to inquire about the sexual health of their patients. Health promotion strategies such as vulvovaginal moisturizers and dilator therapy for women or prescription medication for men can be recommended to counteract sexual side effects during and after treatme...
Practical Geriatric Oncology
Handbook of Communication in Oncology and Palliative Care, 2010
The Oncologist, 2009
Learning Objectives Identify the two “gateway” symptoms of depression. Describe and differentiate... more Learning Objectives Identify the two “gateway” symptoms of depression. Describe and differentiate symptoms of depression in cancer patients. Analyze the most common symptoms of depression in geriatric cancer patients in order to determine best care management. This article is available for continuing medical education credit at CME.TheOncologist.com.
Handbook of Geriatric Oncology, 2017
Background and objective. Acutely ill older patients with cognitive impairment represent a major ... more Background and objective. Acutely ill older patients with cognitive impairment represent a major subgroup in acute care hospitals. In this context, communication plays a crucial role for patients' well-being, healthcare decisions, and medical outcomes. As
Journal of the National Comprehensive Cancer Network, 2003
Optimism about improved survival from cancer has increased. However, even with tremendous improve... more Optimism about improved survival from cancer has increased. However, even with tremendous improvements in screening techniques and treatment, a cancer diagnosis may shatter the dream of a dignified old age for elderly patients. Cancer diagnosis and treatment often produce psychological stresses resulting from the actual symptoms of the disease, as well as the patient and family's perceptions of the disease and its stigma. Concerns related to cancer have particular meaning for aging individuals who undergo these situations in the context of retirement, widowhood, other medical disabilities, and other losses. Today, patients and families are more interested in treatment issues and quality of life, both during and after treatment. In this article we discuss late life depression, anxiety, and delirium and treatments related to elderly patients coping with cancer.
Psycho-oncology, Jan 16, 2016
To examine the ability of three popular self-report measures of depression to assess depression i... more To examine the ability of three popular self-report measures of depression to assess depression in a geriatric cancer setting. Cancer patients 70 years or older and on active treatment completed the Geriatric Depression Scale-Short Form, the Hospital Anxiety and Depression Scale, and the Center for Epidemiological Studies Depression Scale-Revised, and were interviewed using the depression module of the Structured Clinical Interview for DSM disorders (SCID) as the 'gold standard.' Analyses included calculating internal consistency, ROC curves, and the sensitivity and specificity to detect major depression (MDD) or minor depression (i.e. subthreshold depression). In a sample of 201 cancer patients (85% White; 64% completed college degree or higher), all three of the self-report measures produced adequate internal consistency and predicted depression greater than chance. However, the published cutoff scores for detecting MDD produced inadequate sensitivity, suggesting these sco...
Psycho-Oncology, 2015
Objectives-Erectile rehabilitation (ER) following radical prostatectomy (RP) is considered an ess... more Objectives-Erectile rehabilitation (ER) following radical prostatectomy (RP) is considered an essential component to help men regain erectile functioning; however many men have difficulty adhering to this type of a program. This qualitative study explored men's experience with ER, erectile dysfunction (ED), and ED treatments to inform a psychological intervention designed to help men adhere to ER post-RP. Methods-Thirty men, one to three years post-RP, who took part in an ER program, participated in one of four focus groups. Thematic analysis was used to identify the primary themes. Results-Average age was 59 (SD=7); mean time since surgery was 26 months (SD=6). Six primary themes emerged: 1) frustration with the lack of information about post-surgery ED; 2) negative emotional impact of ED and avoidance of sexual situations; 3) negative emotional experience with penile injections and barriers leading to avoidance; 4) the benefit of focusing on the long-term advantage of ER versus short-term anxiety; 5) using humor to help cope; and 6) the benefit of support from partners and peers. Conclusions-Men's frustration surrounding ED can lead to avoidance of sexual situations and ED treatments, which negatively impact men's adherence to an ER program. The theoretical construct of Acceptance and Commitment Therapy (ACT) was used to place the themes into a framework to conceptualize the mechanisms underlying both avoidance and adherence in this population. As such, ACT has the potential to serve as a conceptual underpinning of a psychological intervention to help men reduce avoidance to penile injections and adhere to an ER program.
The Oncologist, 2009
Learning Objectives After completing this course, the reader will be able to: Explain why older c... more Learning Objectives After completing this course, the reader will be able to: Explain why older cancer patients have better coping skills than younger cancer patients.Analyze the relationship between aging, and anxiety, depression and quality of life in prostate cancer patients.Explain the dynamics between anxiety and depression in older prostate cancer patients. This article is available for continuing medical education credit at CME.TheOncologist.com
Cancer, 2008
BACKGROUND-Men who receive androgen-deprivation therapy (ADT) for prostate cancer experience seve... more BACKGROUND-Men who receive androgen-deprivation therapy (ADT) for prostate cancer experience several side effects from this treatment. A few recent studies have examined the cognitive implications of ADT and how they impact a patient's treatment decision-making, occupational pursuits, and quality of life. For this report, the authors explored possible mechanisms for this association, reviewed research in animal studies and aging men, and examined the growing literature focused on the relation between ADT and cognitive functioning in patients with prostate cancer. METHODS-A systematic literature search was conducted using the PubMed and Information Sciences Institute Web of Knowledge-Web of Science databases to identify relevant studies that investigated the relation between ADT in men with prostate cancer and its cognitive effects. RESULTS-Testosterone and its derivatives may have an impact on cognition through several mechanisms in the brain, as supported by studies of animals and in aging men. Studies that researched the impact of ADT on cognition in patients with prostate cancer patients were designed relatively well but suffered from small sample sizes. Between 47% and 69% of men on ADT declined in at least 1 cognitive area, most commonly in visuospatial abilities and executive functioning. Some studies reported contradictory results with increased functioning in verbal memory. CONCLUSIONS-There is a strong argument that androgen-ablation therapy is linked to subtle but significant cognitive declines in men with prostate cancer. The authors believe that clinicians should become aware of this correlation as the use of ADT increases and should inform and monitor patients for this possible side effect of treatment.
Annals of Behavioral Medicine, 2009
Purpose This study aims to develop a theoretical framework of the relationship among religiosity,... more Purpose This study aims to develop a theoretical framework of the relationship among religiosity, spirituality, and depression, potentially explaining the often mixed and inconsistent associations between religiosity and depression. Methods In this cross-sectional study, 367 men (average age of 66 ± 9 years) with prostate cancer completed measures of religiosity (extrinsic/intrinsic), spirituality (Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale), quality of life (FACT-G), and depression (Hospital Anxiety and Depression Scale). Results There was a small relationship between intrinsic religiosity and depression (r=−0.23, p<0.05) but a strong association between spirituality and depression (r=−0.58, p< 0.01). Using a mediation model, the meaning/peace subscale of the spirituality measure mediated the relationship between intrinsic religiosity and depression. This model controlled for age, marital status, stage of disease, time since diagnosis, hormone therapy, quality of life, and anxiety. Conclusions When examining religiosity and spirituality, the main component that may help reduce depression is a sense of meaning and peace. These results highlight the potential importance of developing a patient's sense of meaning through activities/interventions (not exclusive to religious involvement) to achieve this goal.
Journal of Clinical Oncology, 2010
PurposeGeriatric issues in cancer are becoming prominent. Depression is a significant concern for... more PurposeGeriatric issues in cancer are becoming prominent. Depression is a significant concern for both the elderly and patients with cancer, yet identifying depression in these patients is difficult and often leads to under-recognition. We conducted a systematic review to determine which depression instruments are appropriate for use in geriatric patients with cancer.MethodsWe identified the most commonly used self-report depression instruments. We then used the criteria established in the US Food and Drug Administration Draft Guidance on Patient-Reported Outcome Measures to determine the extent of validation evidence of these measures in geriatric cancer populations. Finally, we determined which instruments captured depressive symptoms that are common among elderly patients with cancer.ResultsEight measures were selected as the most commonly used instruments. These were the Beck Depression Inventory-II, Brief Symptom Inventory-18, Center for Epidemiologic Studies–Depression Scale, ...
Psychopharmacology in Cancer Care
Anxiety is common in cancer patients, but it is not necessarily predictable, tolerable, or inevit... more Anxiety is common in cancer patients, but it is not necessarily predictable, tolerable, or inevitable. It can arise from the illness experience or as an exacerbation of a pre-existing anxiety disorder. Anxiety is commonly seen with a new cancer diagnosis, with complications of cancer treatment or medications, related to changes in body image, associated with fear of recurrence after treatment, when dealing with recurrence or progression of cancer after treatment, or when finding out that there is no further active treatment for the cancer and concerns about mortality must be engaged. Although understandable, these worries can intensify, causing severe panic or emotional paralysis, and interfere with completing cancer treatment. This chapter discusses the medical and psychiatric causes of anxiety, the medications used to treat anxiety, and the pros and cons of various choices. It is hoped that all practitioners can help educate patients about antianxiety medications, including fears ...
Psychopharmacology in Cancer Care, 2020
Cancer-related fatigue is common, occurring in up to 80% of patients. Distressing fatigue can be ... more Cancer-related fatigue is common, occurring in up to 80% of patients. Distressing fatigue can be related to psychiatric or medical causes such as significant depression, frequent intense anxiety, or panic attacks, as well as sleep disturbances, pain, and electrolyte or hormonal abnormalities. It is often caused by a wide range of medications and substances. This chapter presents the various causes of fatigue to help non-prescribing clinicians distinguish fatigue from other look-alike diagnoses such as depression and make appropriate referrals to prescribers. Identifying opportunities to supplement nonpharmacologic therapies with an activating medication can improve a patient’s quality of life and joy in living. This chapter will help all clinicians become more aware of medications used to boost energy, such as energizing antidepressants, wakefulness agents, and psychostimulants, as well as the potential side effects of these medications.
Psychopharmacology in Cancer Care, 2020
Although many people with cancer experience depressive moods, not all will have a major depressiv... more Although many people with cancer experience depressive moods, not all will have a major depressive episode. It is therefore important to distinguish and address subsyndromal depression from a depressive syndrome that could benefit from psychopharmacologic intervention. This chapter discusses risk factors for depression in cancer patients and provides suggestions for improving identification of depression in complicated cancer situations. The goal is to help non-prescribing clinicians more easily decide when referrals for medication are warranted and how to maintain connections and enhance communication with prescribers after medications are started. Pearls and potholes of why different medications are used for specific circumstances, and how prescribers seek to obtain more than one use out of a single medication, are described.
Psycho-Oncology, 2021
Cancer survivors face a unique set of treatment-related issues impacting sexual function and qual... more Cancer survivors face a unique set of treatment-related issues impacting sexual function and quality of life. While some treatment-related sexual adverse effects are temporary, many survivors face long-term effects such as treatment-induced menopause, altered gonadal function, and significant surgical disfigurement. Treatment modalities including surgery, chemotherapy, radiation therapy, and endocrine therapy present with persistent changes in tissue quality and sexual response. Common changes in sexual function for cancer survivors include decreased libido or sexual interest and pain with penetration in women and erectile dysfunction in men. As cancer survivorship improves, it is increasingly important for medical professionals to inquire about the sexual health of their patients. Health promotion strategies such as vulvovaginal moisturizers and dilator therapy for women or prescription medication for men can be recommended to counteract sexual side effects during and after treatme...
Practical Geriatric Oncology
Handbook of Communication in Oncology and Palliative Care, 2010
The Oncologist, 2009
Learning Objectives Identify the two “gateway” symptoms of depression. Describe and differentiate... more Learning Objectives Identify the two “gateway” symptoms of depression. Describe and differentiate symptoms of depression in cancer patients. Analyze the most common symptoms of depression in geriatric cancer patients in order to determine best care management. This article is available for continuing medical education credit at CME.TheOncologist.com.