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OBJECTIVES: To assess the factors associated with desire for hastened death and depression in early-stage dementia as well as the association between them. Also, to explore the mediator and moderator role of age in the relationship between depression and desire for hasten death. METHODS: A prospective cross-sectional study including 100 patients diagnosed with early-stage dementia from a rehabilitation center between December 2018 and July 2019. Measurement tools used were the Mini-Mental State Examination, the Greek Montreal Cognitive Assessment, the Greek Schedule of Attitudes toward Hastened Death, and the Geriatric Depression Scale-15 item. Patients diagnosed with dementia as a result of Stroke history were excluded. RESULTS: Factors of multifactorial analysis significantly associated with desire for hastened death were as follows: age (p = 0.009), marital status (p = 0.001), and depression (p < 0.001). The factor significantly associated with depression was age (p = 0.001). Also, a mediation/moderation analysis has shown that depression and age are significant predictors of desire for hasten death. SIGNIFICANCE OF RESULTS: The desire for hastened death and depression in people diagnosed with early-stage dementia includes many components. Younger patients, men, higher educated patients, single, childless, and those with higher depression scores had higher desire for hastened death, while men and older patients had higher scores of desire for depression. Our study provides important information about the desire for hastened death and depression in early-stage dementia, their risk factors, and their association.

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Introduction: The concept of demoralization is used to describe situations of existential distress and self-perceived inability to effectively deal with stressors. The Demoralization Scale-II (DS-II) is a short and modified version of the original DS that measures the level of demoralization in patients. The purpose of this study is to evaluate the psychometric properties of the Greek version of the Greek Demoralisation Scale-II (DS-II GR) in the population of patients with cancer. Methods: The main tool used in this cross-sectional study is the DS-II GR translated and evaluated for its psychometric properties in a sample of 150 Greek patients with cancer. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), convergent validity, known groups' validity, cut-off points, internal consistency reliability and test-retest reliability were done. Results: According to the CFA, a two-factor model emerged with a different conceptual content and grouping than the original. The correlation coefficients between DS-II GR and Hospital Anxiety and Depression Scale-Greek (HADS-GR) The internal consistency of DS-II GR for factor 1, factor 2, and total score were measured with Cronbach's alpha and calculated to be 0.906, 0.810, and 0.913. Conclusion: The Greek version of the demoralization scale is reliable and valid for assessing demoralization in Greek patients with cancer.

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Background Hope has a positive impact on health, playing a significant role in managing illness and its associated losses. In oncology patients, hope is crucial for effective adaptation to the disease, as well as a strategy for coping with physical and mental distress. It enhances disease management, psychological adaptation, and overall quality of life. However, due to the complexity of the effect of hope on patients, particularly those under palliative care, identifying its relationship with anxiety and depression remains a challenge. Methodology In this study, 130 cancer patients completed the Greek version of the Herth Hope Index (HHI-G) and the Hospital Anxiety and Depression Scale (HADS-GR). Results The HHI-G hope total score was strongly negatively correlated with HADS-anxiety (r = -0.491, p < 0.001) and HADS-depression (r = -0.626, p < 0.001). Patients with performance status, as defined by the Eastern Cooperative Oncology Group (ECOG), of 0-1 without radiotherapy had higher HHI-G hope total scores compared to those with ECOG status 2-3 (p = 0.002) and radiotherapy (p = 0.009). Multivariate regression analysis showed that patients who received radiotherapy had 2.49 points higher HHI-G hope scores compared to those who did not (explaining 3.6% of hope). An increase of 1 point in depression led to a 0.65-point decrease in the HHI-G hope score (explaining 40% of hope). Conclusions A deeper understanding of common psychological concerns and hope in patients with serious illnesses can improve their clinical care. Mental health care should focus on managing depression and anxiety, as well as other psychological symptoms, to enhance and maintain patients' hope.

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OBJECTIVES: This study aims to develop the Greek version of the Herth Hope Index (HHI) and assess its psychometric properties to a palliative care patient sample, using a cross-sectional design. MATERIALS AND METHODS: The HHI was translated into Greek (HHI-Gr) using the 'forward-backward' procedure. It was administered to 130 eligible cancer patients, while for the stability of patients' responses, 40 of these patients completed the HHI-Gr 3 days later. Along with the HHI-Gr, patients also completed the Hospital Anxiety and Depression Scale (HADS) and the Beck Hopelessness Scale (BHS). The HHI-Gr internal consistency reliability (Cronbach's a), stability (intraclass correlation coefficient [ICC]), factor structure (factor analysis) and convergent validity (correlation with the HADS and the BHS questionnaires) were examined using the Eastern Cooperative Oncology Group (ECOG) performance status. RESULTS: The HHI-Gr yielded a one-factor model and a Cronbach alpha (0.860) with excellent internal consistency reliability and stability ICC (>0.90). Satisfactory convergent validity was supported by the correlation analysis between the HHI-Gr and BHS (r = 0.718, P < 0.001). Overall test-retest reliability was satisfactory with a range between 0.77 and 0.96 (P < 0.001). CONCLUSION: These results demonstrate that the HHI-Gr is an instrument with satisfactory psychometric properties and is a valid research tool for the measurement of the levels of hope among Greek oncology patients.

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Objectives: Comparison of the effects of reflexology and relaxation on pain, anxiety, and depression, and quality of life (QoL) of patients with cancer. Design: A stratified random sample was selected, using an experimental design. Location: An outpatient Palliative Care Unit in Attica, Greece. Subjects: 88 patients suffering with cancer. Interventions: The sample was randomly divided into two equal groups, a reflexology and a relaxation group. The number of interventions for both groups was six 30-min weekly sessions. Outcome measures: The Greek Brief Pain Inventory (G-BPI) was used to measure pain, the Greek Hospital Anxiety and Depression Scale for screening anxiety and depression, and finally the Short Form Health Survey was used to measure QoL. Measurements of the above tools were taken three times in both groups as follows: preintervention, at fourth and at sixth week of intervention. Results: Anxiety and depression for both groups exhibited a statistically significant decrease during the observation period (p < 0.001, η2 > 0.25) but at the sixth week, there was a more significant decrease in the reflexology group compared with the relaxation group (p = 0.062, η2 = 0.044 vs. p = 0.005, η2 = 0.096 for anxiety), (p = 0.006, η2 = 0.094 vs. p = 0.001, η2 = 0.138 for depression). QoL physical and mental component measurements were significantly greater for the reflexology group (p < 0.001, η2 = 0.168 and p = 0.017, η2 = 0.071, respectively). The baseline-to-sixth week G-BPI measurements were markedly decreased for the reflexology group (p = 0.207, η2 = 0.020). Conclusions: Both interventions, relaxation and reflexology, seemed to be effective in decreasing anxiety and depression in patients with cancer. However, reflexology was found to be more effective in improving QoL (physical component) and to have a greater effect on pain management than relaxation.

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AIMS: The aim of this study is to investigate and compare distress and quality-of-life parameters among head-and-neck cancer patients who underwent intensity-modulated radiotherapy (IMRT). SUBJECTS AND METHODS: The patients' sample consists of 55 individuals under IMRT treatment. Three questionnaires (Quality of Life Questionnaire [QLQ]-C30 and QLQ-H and N35) of the European Organization for the Research and Treatment of Cancer and the Greek Hospital Anxiety and Depression Scales were used. RESULTS: Functioning and symptoms scales measured a week before the scheduled treatment worsen significantly until the end of the treatment and at the 3-month follow-up, tend to revert to their pretreatment values. CONCLUSIONS: Our results showed that all parameters (functioning scales, symptoms scales, and G-HAD subscales) worsen from the start to the end treatment and tend to revert to their pretreatment values after a 3-month period.

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PURPOSE: To assess the effect of cancer patients' attachment patterns on their satisfaction of medical care. METHODS: This was a cross-sectional design study performed in an outpatient palliative care clinic. The sample consisted of 100 cancer patients. Participants completed the Greek versions of patients' satisfaction, and attachment orientation to close others (Family, Close Friends, Medical Care Providers). RESULTS: "Information/interaction with health-care professionals" subscale positively correlated with "disease duration". "Availability of care" subscale was negatively correlated with "discomfort with closeness", "anxiety", and "avoidance". "Information/interaction with health-care professionals" positively correlated with "metastasis", "chemotherapy", and "hormonotherapy", while "availability of care" had positive correlations with "education", "chemotherapy", and "hormonotherapy". Multiple regression model showed that "discomfort with closeness" was associated with "information/interaction with health-care professionals". Similarly, "chemotherapy" and "surgery" were positively associated with "information/interaction with health-care professionals". Disease duration was associated with increased satisfaction with "information/interaction with health-care professionals". Predictors of "availability of care" were "discomfort with closeness", "education", and "avoidance". CONCLUSIONS: "Chemotherapy", "surgery" and "discomfort with closeness" predicted low satisfaction with "information/interaction with health-care professionals", while "discomfort with closeness" and "avoidance" predicted low satisfaction with "availability of care" and at the same time a high level of "education" predicted patients' satisfaction with "availability of care".

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Objectives: The goal of this article is to investigate the correlation between sexuality and depression of cervical cancer (CC) patients. Methods: A bibliographical search was carried out in the databases CINAHL, PubMed, and Cochrane Library with the following terms in English for the years 2006 to 2017: sexuality, sexual function, sexual dysfunction, sexual problems, mood, depression, emotional distress, cervical cancer. Results: Fourteen studies were included. They present heterogeneity in the stage of the disease, the selected treatments, and their sample. From the studies, only 7 are evaluated as good methodologically. Sexual dysfunction and depression of CC patients persist for many years after treatments. The younger women, those who underwent radiotherapy, and those who had chronic fatigue, as an aftereffect of treatments, had increased depression. Women that underwent surgery and adjuvant therapy experienced the highest rates of depressive symptoms. There is a positive relationship between sexuality and depression in patients with CC. Conclusions: Sexuality and depression οf women with CC are affected by their therapies to a significant extent. There is a positive correlation between the two variables. The existing methodologically good studies are scarce, and for this reason the results cannot be generalized in all CC patients.

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The objectives of the study were to evaluate the relationship between depression, preparatory grief, and loss of dignity in patients with advanced cancer and whether depression has a mediator and/or a mediator role between preparatory grief and dignity. The participants were 120 patients with advanced cancer who completed the Greek version of the Patient Dignity Inventory, the Greek Hospital Anxiety and Depression Scale, and the Preparatory Grief in Advanced Cancer Patients questionnaire. Depression was highly correlated with preparatory grief and loss of dignity. Additionally, strong relationship was found between preparatory grief and loss of dignity. Mediation analyses revealed that preparatory grief influenced loss of dignity as well as indirectly by its effect on depression. However, there was not any affect of depression as moderator. The effect of depression on preparatory grief in patients with advanced cancer and dignity emphasizing the need for further research to confirm the current relationship as well as the need for treatment of depression.

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PURPOSE: Previous findings have shown that depression in advanced stages of cancer is associated with hopelessness and frequently with wishes for hastened death. The current study tries to investigate the relationship between hopelessness and desire for hastened death and if depression may be a moderator and/or mediator role in patients with advanced cancer. METHOD: The participants were 102 patients with advanced cancer which they completed the Beck Hopelessness Scale (BHS), the Greek Schedule of Attitudes towards Hastened Death (G-SAHD), and the Greek Beck Depression Inventory (BDI). RESULTS: Depression was highly correlated with hopelessness and desire for hastened death. Mediation analyses revealed that hopelessness influenced desire for hastened death as well as indirectly by its effect on depression. Similarly, depression was found as moderator in the relationship between hopelessness with desire for hastened death. CONCLUSIONS: Hopelessness and desire for hastened death in patients with advanced cancer should be diagnosed and treated by taking into consideration the optimum care of depression as a priority in palliative care.

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BACKGROUND: Psychosocial well-being in the workplace may increase retention of oncology nurses, while a lack of social support has been a predictor of occupational stress in nurses. PURPOSE: To further explore this phenomenon by examining the psychometric properties of the Multidimensional Scale of Perceived Social Support in Greek nurses working in oncology and mental health settings. METHODS: A cross-sectional design was used. The sample consisted of 150 nurses (70 oncology nurses and 80 mental health nurses) from the area of greater Athens who joined the study. The scale was translated to Greek using the "forward-backward" procedure. The Multidimensional Scale of Perceived Social Support's internal consistency reliability (Cronbach's α), stability (intraclass correlation coefficient), factor structure (factor analysis), and convergent validity (correlation with Ways of Coping Questionnaire) were examined. RESULTS: A three-factor (significant others, family, and friends) model was confirmed. The subscales representing the three factors demonstrated excellent internal consistency reliability (Cronbach's αs > .90) and stability intraclass correlation coefficient (>.90). CONCLUSIONS: The measure is reliable and valid, and it can be used to assess nurses' social support; the results of such an assessment could be helpful when selecting strategies for assisting nurses.

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PURPOSE: Pain is prevalent in cancer patients, appearing to be moderate to severe in more than one third of them. Despite the fact that fentanyl is widely used with effective analgesic results, some patients do not correspond to treatment, resulting in opioid change. METHODS: This is a cohort study, performed in Greek patients with cancer. Its scope was to identify potential reasons responsible for opioid change, due to transdermal-fentanyl intolerance, resulting from inadequate analgesia (pain relief<33% in 1week) and/or unacceptable adverse-events (grade≥3 at Common Terminology Criteria-v4.0). The final sample included 289 participants. To investigate responsible reasons for transdermal-fentanyl intolerance we studied its relation with patients' history, haematology, biochemistry, body-mass-index, demographic and disease related characteristics. The Eastern Cooperative Oncology Group performance status scale, the Mini Mental State Examination questionnaire, the M.D.Anderson Symptom Inventory and the Greek Brief Pain Inventory were also used to measure performance status and quality-of-life for the same reason. RESULTS: Almost one third of the patients had to change to an alternative opioid oral-morphine in order to achieve adequate analgesia or/and avoid adverse-events. The most common adverse-events observed were nausea/vomiting and sleepiness. Statistical analysis demonstrated that younger age (OR=0.976) and obesity (OR=0.29 against underweight, OR=0.39 against normal, OR=0.48 against pre-obese) had a higher possibility to contribute to modification of the analgesic treatment. Furthermore, a higher impact of symptoms in patient's life (OR=1.184) and chemotherapy (OR=2.109) could also contribute to the need of change of the opioid analgesic medication. CONCLUSION: This study found significant variables for transdermal-fentanyl intolerance. This knowledge may help person-center care in moderate to severe cancer pain. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

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PURPOSE: The present study assesses the relationship between patient dignity in advanced cancer and the following variables: psychological distress, preparatory grief, and sociodemographic and clinical characteristics. METHODS: The sample consisted of 120 patients with advanced cancer. The self-administered questionnaires were as follows: the Preparatory Grief in Advanced Cancer Patients (PGAC), the Patient Dignity Inventory-Greek (PDI-Gr), the Greek Schedule for Attitudes toward Hastened Death (G-SAHD), and the Greek version of the Hospital Anxiety and Depression Scale (G-HADS). RESULTS: Moderate to strong statistically significant correlations were found between the 4 subscales of PDI-Gr (psychological distress, body image and role identity, self-esteem, and social support) with G-HADS, G-SAHD, and PGAC ( P < .005), while physical distress and dependency was moderately correlated with depression. Multifactorial analyses showed that preparatory grief, depression, and age influenced psychological distress, while preparatory grief, depression, and performance status influenced body image and role identity. CONCLUSIONS: Preparatory grief, psychological distress, and physical symptoms had significant associations with perceptions of dignity among patients with advanced cancer. Clinicians should assess and attend to dignity-distressing factors in the care of patients with advanced cancer.

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BACKGROUND CONTEXT: Few data exist concerning the natural history of degenerative osteoarthritis (OA) of the spine and its associated gene investigation. Degenerative spinal OA demonstrates an international prevalence of 15% in the general population. PURPOSE: The aim of this Greek case-control study is to examine gene polymorphisms that have been previously shown or hypothesized to be correlated to degenerative OA. Gene polymorphisms, especially for OA, have never been previously studied in the Greek population. STUDY DESIGN/SETTING: The study was conducted from May 2009 to December 2012. Eligible subjects who agreed to take part in the study were Greek adults from all of Greece, referred for consultation to the Palliative Care and Pain Relief Unit of Aretaieion University Hospital, in Athens, Greece. PATIENT SAMPLE: A total of 601 matched pairs (cases and controls) participated in the study, 258 patients (188 women and 70 men) with clinically and radiologically confirmed degenerative OA and 243 control subjects (138 women and 105 men). OUTCOME MEASURES: All patients presented with chronic pain at the spine (cervical, thoracic or lumbar) caused by sympomatic osteophytes or disc narrowing, whereas clinical diagnosis of OA was based on the presence of both joint symptoms and evidence of structural changes seen on plain conventional X-rays. METHODS: We investigated genetic variation across candidate OA gene GDF5, CDMP1, CDMP2, Asporin, SMAD3, and chromosomal region 7q22, in a sample of 258 patients with clinically and radiologically confirmed degenerative OA, and 243 control subjects from the Greek population. All subjects (patients and controls) were subsequently matched for the epidemiologic, demographic, and clinical risk factors, to prevent selection biases. A tagging single nucleotide polymorphism (SNP) approach was pursued to cover variation across all targeted loci. Single marker tests as well as haplotypic tests of association were performed. There is no conflict of interest, and also, there are no study funding sources. RESULTS: We found significant association of spine OA with SNPs and haplotypes along the 7q22 chromosomal region and the SMAD3 gene. At 7q22, single marker association tests showed SNPs rs3801954 and rs2023685 to be associated with the disorder (p-value .0312 and .0041, respectively), but only SNP rs2023685 retained a significant p-value (.046) after performing 1,000 permutation tests. At the SMAD3 gene, SNP rs422342 was also found to be statistically associated (p-value .0282) to intervertebral disc degeneration (permutation p-value .042). CONCLUSIONS: This is the first study to investigate genetic variation in relation to spine OA in the Greek population. Our results indicate that the genetic basis of the disease may differ in the Greek population in relation to populations of Asian origin, although larger sample sizes are required to underpin the full extent of the involvement of analyzed loci.

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CONTEXT: The patient dignity inventory (PDI) is an instrument to measure dignity distressing aspects at the end of life. OBJECTIVES: The aims of the present study were the translation of the PDI in Greek language as well as to measure its psychometric aspects in a palliative care unit. METHODS: A back-translation method was obtained at the Greek version. One hundred twenty advanced cancer patients completed the Greek version of the PDI, the Greek hospital anxiety and depression scale, the Greek schedule of attitudes toward hastened death (SAHD-Gr), and the Greek 12-item short form health survey. RESULTS: Confirmatory factor analysis failed to fit to the original instrument's structure and exploratory factor analysis was conducted revealing five factors ("Psychological Distress," "Body Image and Role Identity," "Self-Esteem," "Physical Distress and Dependency," and "Social Support"). The psychometric analysis of the PDI-Gr demonstrated a good concurrent validity, and the instrument discriminated well between subgroups of patients regarding age differences. Cronbach α were between 0.71 and 0.9 showing a good internal consistency. CONCLUSION: The Greek version of the PDI showed good psychometric properties in advanced cancer patients, supported the usefulness of the instrument assessing the sense of dignity distressing aspects of the terminally ill cancer patients.

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PURPOSE: To investigate the psychometric properties of the Greek 13-item measure of patients' satisfaction (FAMCARE-P13) in palliative care setting. METHODS: A hundred patients completed the FAMCARE-P13. Exploratory factor analysis and confirmatory factor analysis (CFA) have been conducted. Two factors' solution was revealed from CFA. The questionnaire was administered to an initial validation sample and then for test-retest in a sample of 40 patients 3 days later. The Rosenberg Self-Esteem Scale measuring global self-esteem has been also used as a gold standard for construct validity. Subscale and known groups validity have also been tested for FAMCARE-P13s' validity. RESULTS: A reduced 13-item version of our measure (FAMCARE-P13) possessed 2-factor structure with high reliability. Patient satisfaction was correlated with physical distress, communication and relationship with health-care providers, and caregiver satisfaction. CONCLUSIONS: We recommend the use of the Greek FAMCARE-P13 to assess care satisfaction of patients with advanced-stage cancer.

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PURPOSE: Health-care professionals may serve as attachment figures, nevertheless little research has been made in the palliative context. The psychometric properties of the brief ECR-M16 in Greek cancer patients were explored. METHODS: The ECR-M16 was translated into Greek (G-ECR-M16), and was administered to 100 patients before starting palliative care and 7 days later to test its stability. Patients (N=35) also completed the EORTC QLQ-C30 scales. RESULTS: Cronbach's alphas for the discomfort for closeness, anxiety and avoidance scales were 0.871, 0.762, and 0.761, respectively. Test-retest reliability was very satisfactory (p< 0.0005). Factor analysis yielded three factors (58.75% of the variance). Known-groups validity showed that discomfort with closeness had a statistically significant correlation with advanced disease stage (p=0.022). CONCLUSIONS: The G-ECR-M16 is a valid research tool for the attachment patterns' impact in Greek cancer patients.

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The authors sought to determine the reliability and validity of psychometric properties of the Greek Patient-Generated Subjective Global Assessment (PG-SGA) in cancer patients attending a palliative care unit. The scale was translated into Greek. The study took place in an outpatient palliative care unit and 238 cancer patients completed the nutrition assessment. For treatment effect, the index was administered to 164 patients, whereas for the test of the instrument's robustness to 100 patients. Both assessments took place 15 days after the baseline assessment. Ninety-three patients were well-nourished, 104 were moderately malnourished, and 41 were severely malnourished. Reliability was assessed by the internal consistency and test-retest of the instrument. Validity was assessed with construct validity using the PG-SGA items, treatment effect, and criterion validity. Weight loss, physical examination, activities and function, and symptoms were predictors to the classification. Mean values in male patients classified as severely malnourished had the lowest values in all objective parameters except serum albumin, whereas severely malnourished female patients had the lowest values in all objective parameters except serum albumin and arm muscle circumference (AMC). Values of serum transferrin, AMC, and body mass index were significantly lower in patients classified as severely malnourished. The Greek PG-SGA is a psychometrically sound assessment in Greek cancer patients.

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AIM: To evaluate prospectively disease- and treatment-related symptoms, anxiety and quality of life (QoL), in patients with different types of cancer undergoing external-beam radiotherapy (RT) and examine the relationship among them, at baseline and at the end of the treatment. PATIENTS AND METHODS: This study included 90 patients with cancer. Patients' QoL was evaluated using the Linear Analog Scale Assessment (LASAs) questionnaire, anxiety was measured with the Spielberger state and trait inventory (STAI), while symptoms were assessed using the MD Anderson Symptom Inventory (MDASI). The assessments were carried-out at baseline and at the end of RT. RESULTS: At baseline, the QoL scores were reduced (7.5±6.5) and MDASI elevated (2.35±1.7). Patients' QoL was correlated with symptoms (r=-0.684, p=0.0005). A correlation was found between STAI-trait with MDASI scores (r=0.214, p=0.046). At the second assessment, there were significant correlations between MDASI and QoL (r=-0.68, p=0.0005). The STAI-trait had a moderate correlation with MDASI score (r=0.43, p=0.0005) and with QoL (r=-0.253, p=0.0017). CONCLUSION: The present study showed a significant impact of symptoms and high levels of anxiety following RT, which correlated with a compromised QoL. The worsening in patients' perception of their QoL did not seem to lead to a significant reduction in daily activities or treatment tolerance.

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This review of the literature on elderly cancer patients and their psychiatric disorders was undertaken to determine the extent of the problem. It consists of articles with elderly cancer patients. Keyword terms included "cancer", "elderly", "aging", "geriatric", "psychiatric disorders", "psychiatric symptoms", "psychological problems", "aged >60 years", "sucidal ideation, geriatric, cancer", "suicide geriatric cancer". We conducted searches on the following databases: PubMed; PsychINFO (1980-2013); finally, 102 publications were suitable for the current review. Depression in elderly cancer patients is the most common disorder in elderly cancer patients associated with disability, morbidity and mortality. Anxiety disorders may be less frequent in geriatric patients; however, it seemed to be a major problem in late life. Psychiatric disorders are common in geriatric patients with cancer especially at advanced stages of the disease. In addition, health care professionals can help provide treatment and emotional support. Future research should aim to provide data about the real prevalence and severity of psychiatric disorders in elderly patients with cancer, for the improvement of patients' quality of life and their caregivers.

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