Showing papers by "David Spiegel published in 2003"
TL;DR: Evidence of a bidirectional relationship between cancer and depression, offering new opportunities for therapeutic intervention is found, although studies in this latter area are also divided.
778 citations
TL;DR: New data in the human and animal literature suggest that circadian regulation may be an important prerequisite for the maintenance of host defenses against cancer, and stress-related circadian disruption may have negative implications for cancer prognosis.
Abstract: Psychosocial factors may modulate the course of cancer, but few data have been gathered on the biological mechanisms by which these effects may be mediated. We briefly review evidence of psychosocial effects on cancer progression and discuss one potential pathway that may underlie these effects: the disruption of neuroendocrine and immune circadian rhythms. Circadian system alterations occur in tumor tissue, tumor-bearing animals, and cancer patients with greater disruption seen in more advanced cases. Rhythm alterations include diminished amplitude, phase shifts, period changes, and erratic peaks and troughs in endocrine, metabolic, immunological, and rest- activity cycles. Psychosocial factors can engender dysregulation of circadian function. Cancer-related circadian dysregulation may also be driven by genetic factors, environmental and behavioral influences, and effects of the tumor on host clock regulation. There are several mechanisms by which circadian disruption might hasten tumor growth: via direct effects of altered hormone levels on tumor cells, effects on tumor versus host metabolism, neuroimmune effects resulting in cancer-relevant immunosuppression, or reduced efficacy and tolerability of cancer treatments for which the timing of administration is based upon the assumption of normal circadian rhythms. Emerging data in the human and animal literature suggest that circadian regulation may be an important prerequisite for the maintenance of host defenses against cancer. Thus, stress-related circadian disruption may have negative implications for cancer prognosis. Psychosocial effects on cancer progression may be measured, and possibly mediated, by disruption of circadian function.
354 citations
TL;DR: Examination of coping strategies showed that participants reporting drug and alcohol use to cope with HIV-related stress were more likely to be nonadherent, calling for adherence interventions designed to address barriers and strengths, such as community norms or traditional cultural values, specific to certain populations.
Abstract: This study examined the relationship of adherence to antiretroviral treatment with three types of social support (partner, friends, and family) and use of two coping strategies (denial and substance use). Participants were 73 men and women with HIV infection drawn from a larger sample of 186 clinical trial patients. Based on inclusion criteria, parent trial participants taking antiretroviral therapies, and those with complete data on self-reported measures of adherence were considered eligible for the present study. Overall, 26% of participants were found to be nonadherent, which was defined as one or more missed doses of treatment in the prior 4-day period. Logistic regression analysis was conducted to determine associations of sociodemographic and psychosocial variables with adherence to antiretroviral regimen. Results indicated that heterosexual participants (p < 0.01) and participants of Latino ethnicity (p < 0.05) were significantly more likely to report missed medications. Perceived satisfaction wit...
159 citations
TL;DR: Expression of negative affect and an attitude of realistic optimism may enhance adjustment and reduce distress for cancer patients in support groups.
97 citations
TL;DR: Results suggest that specialized end-stage clinical interventions are particularly needed for cancer patients as they approach death and intervention studies for patients with deteriorating illnesses may need to take this "spike" in psychological distress and pain proximal to death into account to avoid Type II errors in evaluations of psychological outcomes.
Abstract: Objective This study was designed to examine the course of psychological distress and pain from study entry to death in 59 women with metastatic breast cancer participating in a randomized trial of the effects of group psychotherapy on psychosocial outcomes and survival. It was hypothesized that psychological distress would increase significantly before death independent of changes in pain. Method Data were collected as part of a larger study (N = 125). Analyses were based on data from a subset of women who had died and for whom we had data from at least three assessments. Mean levels of mood, trauma symptoms, depression symptoms, well-being, and pain over three time points were examined: at baseline (T1), the second-to-last assessment before death (T2), and the last assessment before death (T3). Results Results indicate that while psychological distress remained relatively constant or declined from T1 to T2, means on all measures significantly changed in the hypothesized direction from T2 to T3. Neither self-reported pain, nor the passage of time, appeared to account for these changes. Additionally, participation in group psychotherapy did not have a significant impact on this change in distress proximal to death. Conclusions Results suggest that specialized end-stage clinical interventions are particularly needed for cancer patients as they approach death. Moreover, intervention studies for patients with deteriorating illnesses may need to take this "spike" in psychological distress and pain proximal to death into account to avoid Type II errors in evaluations of psychological outcomes.
96 citations
TL;DR: Interventions aimed at developing adaptive coping strategies and improving pain management may improve functional aspects of quality of life in persons living with HIV/AIDS.
88 citations
TL;DR: Although the decision to obtain magnetic resonance imaging in a patient with scoliosis should be based on both clinical and radiographic criteria, it is suggested that a heightened index of suspicion is warranted with certain curve patterns, and with a high or low apex and/or end vertebra, especially in males and patients with a normal to hyperkyphotic thoracic spine.
Abstract: Study design A retrospective radiographic review was performed on 41 patients with scoliosis associated with a Chiari I malformation and/or syringomyelia. Objectives To characterize curve patterns and curve features in this population and possibly refine the radiographic indications for magnetic resonance imaging in patients with a normal history and physical examination. Summary of background data A subset of patients with "idiopathic" scoliosis may have an underlying neurologic abnormality. The radiographic indications for magnetic resonance imaging in asymptomatic patients with a normal clinical examination are not well defined. Methods Data were collected from standing posteroanterior and lateral radiographs. The curve pattern and specific curve features were recorded and compared with historic controls. Thoracic kyphosis and total lumbar lordosis were also measured. Results Fifty-one percent of patients were male. Ten curve patterns were identified, and, based on our criteria, approximately 50% of patients had an "atypical" pattern (left thoracic, double thoracic, triple, long right thoracic). A subset of those with "typical" patterns (right thoracic, right thoracic/left lumbar) had atypical features including a superior or inferior shift of the apex and/or the upper or lower end vertebrae. The mean kyphosis (T3-T12) was 41.8 degrees. Conclusions Although the decision to obtain magnetic resonance imaging in a patient with scoliosis should be based on both clinical and radiographic criteria, we suggest that a heightened index of suspicion is warranted with certain curve patterns (left thoracic, double thoracic, triple, and a long right thoracic curve with end vertebra caudal to T12), and with a high or low apex and/or end vertebra, especially in males and patients with a normal to hyperkyphotic thoracic spine.
67 citations
TL;DR: A strong need to assess individual patients' use of alternative treatment approaches as well as to further investigate their efficacy among HIV-positive patients is indicated.
57 citations
TL;DR: Positive obstructive hallucinations seem to allow for a hypnotic focus inward, activating the functioning of attentional neural systems and reducing perceptual ones.
Abstract: La perception modifiee par l'hypnose affecte le fonctionnement du cerveau. Ces instructions hypnotiques qui reduisent la perception en creant une obstruction illusoire reduisent la reponse du cerveau a la perception au niveau de cortex sensoriel apparente, comme cela a pu etre mesure par l'amplitude (ERP) des potentiels connexes a un evenement et le debit sanguin (PET scan). Ces instructions hypnotiques qui affectent la reaction du sujet a la perception, activent le systeme anterieur d'attention, particulierement le cortex anterieur cingulaire dans des etudes faites au PET Scan. L'hypnose implique l'activation sans eveil et elle peut etre particulierement mediatisee par l'intermediaire des voies dopaminergiques. Le changement de perception hypnotique est accompagne des changements mesurables de la fonction perceptive et attentionnelles de ces regions specifiques du cerveau qui traitent ces activites, qui sont modulees par la nature de l'instruction hypnotique specifique. Les hallucinations obstructives positives semblent tenir compte d'un foyer hypnotique centripete, activant le fonctionnement des systemes neuraux attentionnels, reduisant alors les systemes perceptifs.
48 citations
TL;DR: A substantial subgroup of home hospice patients expressed problems dealing with their approaching death, such as fear of death, unresolved issues, parting with family, and pain, which are amenable to psychological treatment.
Abstract: Objective: To determine how home hospice patients deal with their impending death and whether there is a need for greater involvement of mental health professionals in the care of patients dying at home. Method: In a pilot study, 12 female home hospice patients with advanced cancer and a median survival time of 42 days were assessed using structured interviews and brief questionnaires. Topics of inquiry included facing death, fear of death, pain, fatigue, depression, and anxiety. Three key themes were extracted from the information reported by the women: ~1! confronting the issue of death, ~2! fear of dying and death and its correlates, and ~3! spirituality0religious faith and its role in mitigating fear of death. Results: First, all subjects reported thinking about their approaching death. For half of them, this thought was bothersome and these women were frequently troubled by unresolved issues and higher anxiety, pain, and fatigue. The majority of the subjects expressed a desire to actively discuss their impending death. Second, more than half of the patients reported being afraid of death and high death anxiety was associated with fear of dying in pain, high peak or usual pain, unresolved issues, and difficulty in parting with family in death. Third, most subjects experienced their religious faith as an important source of comfort and strength. Significance of results: A substantial subgroup of home hospice patients expressed problems dealing with their approaching death. These problems are amenable to psychological treatment, such as fear of death, unresolved issues, parting with family, and pain. The findings, thus, highlight the need for close collaboration of mental health professionals with home hospice institutions.
Book•
01 Jan 2003
TL;DR: This chapter discusses quality of life in Culturally Diverse Cancer Patients, Complementary and Alternative Medicine in Patients with Cancer, and the Unmet Need: Addressing Spirituality and Meaning through Culturally Sensitive Communication and Intervention.
Abstract: Chapter 1 - Introduction Part I: Cancer across Cultures Chapter 2 - Culture and Oncology: Impact of Context Effects Chapter 3- Quality of Life in Culturally Diverse Cancer Patients Chapter 4- Cancer and Aging: A Biological, Clinical, and Cultural Analysis Chapter 5 - Children with Cancer: Cultural Differences in Communication between the United States and the United Kingdom Chapter 6 - Cancer Risk Assessment: Clinically Relevant Information is Key Part II: Cancer Interventions across Cultures Chapter 7- Cancer Prevention: Lifestyle as the Definitive Means of Cancer Control Chapter 8 - Cross-Cultural Aspects of Cancer Care Part III: Symptoms and Their Management across Cultures Chapter 9 - The Cultural Experience of Cancer Pain Chapter 10 - Complementary and Alternative Medicine in Patients with Cancer Part IV: Dying and Death in Different Cultures Chapter 11- Bereavement across Cultures Chapter 12 - The Unmet Need: Addressing Spirituality and Meaning through Culturally Sensitive Communication and Intervention
TL;DR: It is suggested that dissociative symptoms in response to recent life stress are associated with cortisol dysregulation among women with PTSD for CSA.
Abstract: This study examined dissociative symptoms in relation to changes in evening salivary cortisol levels after recounting traumatic experiences among 49 women with PTSD for child sexual abuse (CSA). Each woman was interviewed to describe her sexual abuse and was assessed on acute dissociative symptoms in response to a recent stressful event in the previous month. Salivary cortisol was assessed during the interview using saliva samples taken immediately before and after the interview. Changes in cortisol levels were measured at one hour, 24 hours, and 48 hours after the interview. Acute dissociative symptoms were related to salivary cortisol levels 24 hours after the interview, with high dissociators showing elevated levels compared to low dissociators. These results suggest that dissociative symptoms in response to recent life stress are associated with cortisol dysregulation among women with PTSD for CSA.
TL;DR: A clinical and radiographic review of patients with longitudinal deficiency of the tibia treated between 1981 and 2001 found that prosthetic problems relating to proximal or distal tibiofibular instability may necessitate additional surgical intervention.
Abstract: We performed a clinical and radiographic review of 15 patients (19 limbs) with longitudinal deficiency of the tibia treated between 1981 and 2001. Ten limbs with Kalamchi type I deficiencies were managed by through-knee amputation. Five type II deficiencies were treated by foot ablation and tibiofibular synostosis, either at the same time or staged, but prosthetic problems may arise from varus alignment and prominence of the proximal fibula. Patients with type III deficiencies (four cases) were treated by foot ablation. Prosthetic problems relating to proximal or distal tibiofibular instability may necessitate additional surgical intervention.
TL;DR: There was an interaction effect between time and coping such that the less time that elapsed since HIV diagnosis and the more an individual used emotion-focused coping, the more likely they were to report an STD.
Abstract: This study examined the prevalence of sexually transmitted diseases (STDs) as well as the relationships between STDs and coping strategies used to deal with the stress of living with HIV among adults. The sample comprised 179 men and women, 58% were Caucasian, 54% were male, more than half (61%) were diagnosed with AIDS, 43% were heterosexual, and 39% reported an STD post-HIV diagnosis. Logistic regression analysis indicated that individuals reporting longer time elapsed since HIV diagnosis and greater use of emotion-focused coping were more likely to report STDs. There was an interaction effect between time and coping such that the less time that elapsed since HIV diagnosis and the more an individual used emotion-focused coping, the more likely they were to report an STD. Tailoring interventions to address specific stressors associated with length of time living with HIV, may be a particularly effective prevention strategy.
TL;DR: Evidence is reviewed regarding the relationship between trauma and dissociation, the prevalence of these dissociative symptoms in the acute aftermath of trauma, and their salience in predicting the development of later PTSD symptoms.
Abstract: Hypnosis and the related phenomenon of dissociation have long been linked to trauma. Evidence is reviewed regarding the relationship between trauma and dissociation, the prevalence of these dissociative symptoms in the acute aftermath of trauma, and their salience in predicting the development of later PTSD symptoms. The evidence reviewed regarding the prevalence of dissociative and other symptoms in the immediate aftermath of trauma formed the basis for including Acute Stress Disorder (ASD) as a new diagnosis in the DSM-IV. Dissociative amnesia is described as the key commonality between formally induced hypnosis and dissociative symptomatology, and controversy regarding traumatic amnesia is discussed. Finally principles of psychotherapy involving hypnosis and related techniques for dissociative and other post-traumatic symptoms are reviewed.
TL;DR: The authors' results suggest that bone age is statistically equivalent to chronologic age in the unilateral clubfoot population and do not provide indirect support for a neurologic etiology.
Abstract: The goals of this retrospective review were to evaluate leg-length discrepancy in patients with a unilateral clubfoot and to determine the relationship between bone age and chronologic age in the same population. Thirty-two of 47 patients referred for scanograms had a discrepancy more than 0.5 cm. Shortening was predominantly in the tibia, and four patients had radiographic evidence of growth disturbance. Five had been treated surgically at the time of review. If clinically indicated, a scanogram and standing radiographs of the ankle are necessary to determine the location and magnitude of discrepancy. Although the literature supports a neurologic etiology in some patients, and bone age may be delayed in certain neuromuscular conditions associated with limb shortening (hemiplegia), the authors' results suggest that bone age is statistically equivalent to chronologic age in the unilateral clubfoot population. These findings do not provide indirect support for a neurologic etiology.
TL;DR: Perceptions of family relationships associated with a husband's ambivalence and dependency in anticipating losing his wife to metastatic/recurrent breast cancer showed that a wife's positive evaluation of cohesiveness in her family relations was associated with having her husband report that he felt highly dependent on her in anticipating her loss.
Abstract: This study examined perceptions of family relationships associated with a husband's ambivalence and dependency in anticipating losing his wife to metastatic/recurrent breast cancer. Baseline data were collected from 50 husbands of women with metastatic/recurrent breast cancer who participated in a randomized clinical trial examining the effects of group therapy on emotional adjustment and health. Both women with metastatic/recurrent breast cancer and their husbands completed the Family Relations Index and were assessed for their demographic characteristics. Also, husbands completed the Anticipation of Loss Questionnaire, assessing their ambivalence and dependency in anticipating the loss of their wives. The results showed that a wife's positive evaluation of cohesiveness in her family relations was associated with having her husband report that he felt highly dependent on her in anticipating her loss. In contrast, the husband's positive evaluation of family relations was associated with his reporting low ...
TL;DR: Twenty children were treated for an isolated femoral shaft fracture using distal tibial traction incorporated into a spica cast with the knee in full extension and all patients were asymptomatic with normal function.
Abstract: We treated 20 children for an isolated femoral shaft fracture using distal tibial traction incorporated into a spica cast with the knee in full extension. Patients were discharged from the hospital at a mean of 5.1 days following injury. All fractures healed, and there were four minor complications. At a mean follow-up of 35 (13–72) months, all patients were asymptomatic with normal function. All but one fracture healed in acceptable alignment, and there was no clinically significant leg-length discrepancy. The method is relatively simple to employ and may be advantageous in a setting of limited resources.
TL;DR: The authors conclude that patients who were aided by an external focus intraoperatively are postoperatively less able or willing to follow suggestions measuring hypnotizability than patients who had guidance to self-hypnotic relaxation.
Abstract: Characteristics of patients in test and attention-control groups should be comparable and be unaffected by the intervention to be tested in clinical trials. The authors assessed whether this is the case for measures of hypnotizability in the postoperative period. One hundred and forty-six patients undergoing percutaneous peripheral vascular or renal interventions were randomized into 2 groups. One group received structured empathic attention during their procedures; the other was guided to self-hypnotic relaxation. Hypnotizability was assessed postoperatively by the Hypnotic Induction Profile. The eye-roll scores, which measure the biological hypnotic potential, were not significantly different, but the average induction scores, which measure the expression of the hypnotic performance, were significantly lower in the attention group than the hypnosis group (4.9 vs. 5.9). The authors conclude that patients who were aided by an external focus intraoperatively are postoperatively less able or willing to foll...
TL;DR: It is hoped that the free Cancer Supportive Care Program within the Center for Integrative Medicine Clinic at Stanford University Hospital and Clinics can become a model for the development of similar programs in various parts of the United States and abroad.
Abstract: The cancer patient's journey not only includes a threat to one's life, but the need to face many medical and emotional challenges. The free Cancer Supportive Care Program (CSCP) within the Center for Integrative Medicine Clinic at Stanford University Hospital and Clinics has been identified as a successful model for helping patients to deal with these challenges. Its programs include informational lectures, support groups, chair massages, exercise, alternative modality classes, a Life Tapes Project, an informational website, and a bimonthly newsletter available free to anybody touched by cancer. Now in its third year, this program benefits from a blending of leadership resources, availability of space, institutional agreement on patient need and funds from private and corporate donations. By presenting the basic premises of the Cancer Supportive Care program and outlining specifics about the program, institutions in various national and international demographic regions may implement similar programs according to their resources and the needs of patients. It is our hope that the CSCP can become a model for the development of similar programs in various parts of the United States and abroad.
TL;DR: The 3-year, 9-month old boy presented for evaluation of an asymptomatic left knee mass that had been present for at least 1 year with no history of trauma, or any systemic symptoms such as fever, weight loss, or malaise.
Abstract: 363 A 3-year, 9-month old boy presented for evaluation of an asymptomatic left knee mass that had been present for at least 1 year. There was no history of trauma, or any systemic symptoms such as fever, weight loss, or malaise. He was fully active, and his parents suspected a gradual increase in size. His medical history was unremarkable. On physical examination, a soft, nontender mass greater than 5 cm in diameter was identified in the popliteal fossa. A component of this mass extended anteriorly and medially. The mass was nontender, nonpulsatile, did not transilluminate, and was not adherent to the overlying skin. There was no increased warmth, no changes in color of the overlying skin, and both lower extremities were symmetric in girth and length. Neurologic examination was normal, and no inguinal adenopathy was appreciated. A complete blood count with differential and a sedimentation rate were normal. The initial plain films are shown in Figure 1, and MRI scans were obtained (Figs 2–4). Based on the history, physical findings, and imaging studies, what is the differential diagnosis? Orthopaedic • Radiology • Pathology Conference