Showing papers in "Psycho-oncology in 2009"

Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer

Abstract: Objectives: Considerable morbidity persists among survivors of breast cancer (BC) including high levels of psychological stress, anxiety, depression, fear of recurrence, and physical symptoms including pain, fatigue, and sleep disturbances, and impaired quality of life. Effective interventions are needed during this difficult transitional period. Methods: We conducted a randomized controlled trial of 84 female BC survivors (Stages 0–III) recruited from the H. Lee Moffitt Cancer and Research Institute. All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and/or chemotherapy. Subjects were randomly assigned to a 6-week Mindfulness-Based Stress Reduction (MBSR) program designed to self-regulate arousal to stressful circumstances or symptoms (n=41) or to usual care (n=43). Outcome measures compared at 6 weeks by random assignment included validated measures of psychological status (depression, anxiety, perceived stress, fear of recurrence, optimism, social support) and psychological and physical subscales of quality of life (SF-36). Results: Compared with usual care, subjects assigned to MBSR(BC) had significantly lower (two-sided p<0.05) adjusted mean levels of depression (6.3 vs 9.6), anxiety (28.3 vs 33.0), and fear of recurrence (9.3 vs 11.6) at 6 weeks, along with higher energy (53.5 vs 49.2), physical functioning (50.1 vs 47.0), and physical role functioning (49.1 vs 42.8). In stratified analyses, subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning. Conclusions: Among BC survivors within 18 months of treatment completion, a 6-week MBSR(BC) program resulted in significant improvements in psychological status and quality of life compared with usual care. Copyright © 2009 John Wiley & Sons, Ltd

Mindfulness-based stress reduction and cancer: A meta-analysis

Abstract: Objective: This meta-analysis was conducted to investigate the effects of mindfulness-based stress reduction (MBSR) on the mental and physical health status of various cancer patients. Methods: Ten studies (randomized-controlled trials and observational studies) were found to be eligible for meta-analysis. Individual study results were categorized into mental and physical variables and Cohen's effect size d was computed for each category. Results: MBSR may indeed be helpful for the mental health of cancer patients (Cohen's effect size d=0.48); however, more research is needed to show convincing evidence of the effect on physical health (Cohen's effect size d=0.18). Conclusion: The results suggest that MBSR may improve cancer patients' psychosocial adjustment to their disease. Copyright © 2008 John Wiley & Sons, Ltd.

Fear of cancer progression and cancer-related intrusive cognitions in breast cancer survivors.

Abstract: OBJECTIVE: To assess the character and frequency of fear of progression (FoP) and to clarify its relationship with cancer-related intrusive cognitions in breast cancer survivors. METHODS: A sample of 1083 patients was recruited in this cross-sectional study through a population-based Cancer Registry an average of 47 month following diagnosis (66% response rate). Participants completed self-report measures assessing fear of cancer progression (FoP-Q-SF), posttraumatic stress-disorder symptoms (PCL-C), coping strategies (DWI) and quality of life (QoL) (SF-8). RESULTS: In total, 23.6% of women were classified as having moderate to high FoP. Being nervous prior to doctors' appointments or examinations and being afraid of relying on strangers for activities of daily living were the most frequent fears. FoP was significantly associated with younger age, having children, disease progress, chemotherapy, perceived amount of impairments, physical and mental QoL, but not with time since initial diagnosis. Intrusive cognitions were screened in 37% of the sample. We found significant correlations between FoP and intrusive thoughts (r=0.63), avoidance (r=0.57), hyperarousal (r=0.54) and posttraumatic stress disorder diagnosis (r=0.42). Factors significantly associated with moderate and high FoP included a depressive coping style as well as an active problem-oriented coping style, intrusion, avoidance and hyperarousal symptoms (Nagelkerke's R(2)=0.44). CONCLUSIONS: Findings of this study give information regarding the frequency and the character of anxiety in breast cancer survivors and underline the relation of FoP to the reality of living with breast cancer. Results suggest that intrusive cognitions as well as avoidance and hyperarousal symptoms seem to be closely related to future-oriented fears of cancer recurrence.

Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature

Abstract: The number of hematopoietic stem cell transplant (HSCT) survivors is rapidly increasing, as more than 45 000 people receive HSCT annually throughout the world [1]. The term HSCT encompasses bone marrow transplants (BMT), stem cell transplants (SCT) from peripheral blood or umbilical cord blood, and mini/light procedures (with lower toxicity) that are used primarily for hematologic and lymphoid cancers, and also for many other disorders [1]. HSCT involves an initial regimen of high doses of chemotherapy and/or radiation followed by infusions of stem cells to reestablish hematopoietic function. During the initial regimen patients’ lymphocytes are destroyed, and the subsequent transplant attempts to restore immune function. During this time the low lymphocyte count may reach the ‘nadir’, the lowest count, and the person is at great risk for infections, which could be lethal. Although the introduction of novel agents and the use of peripheral blood stem cells instead of bone marrow have improved HSCT outcomes [2], about 40% of advanced cancer patients who undergo allogeneic HSCT die from complications related to the transplant [1]. This review focuses on patients’ quality of life following two types of HSCT—allogeneic and autologous transplantation. Allogeneic transplantation uses donor stem cells and therefore may be associated with graft-versus-host disease (GVHD), which involves attacks by donor T lymphocytes on the patient's organs and the potential for severe complications. Autologous transplantation uses the patient's own stem cells; therefore, there is no GHVD risk. For nearly two decades researchers have examined the quality of life of HSCT recipients [3], including the effects of transplantation on physical function, psychological status, social interactions, and economic and/or vocational status. In this review we examine all of these domains of quality of life following HSCT and conceptualize the patient's life-threatening disease and transplantation as a psychosocial transition. According to Parkes [4], a psychosocial transition is a major life experience that requires individuals ‘to restructure [their] ways of looking at the world and [their] plans for living in it’ (p. 102). Psychosocial transitions can potentially result in simultaneous positive and negative outcomes for the same individual as his or her world view evolves to accommodate the stressful event [4,5]. For example, an HSCT patient may experience career disruption and existential distress and simultaneously experience renewed relationships and a greater appreciation of life. Concurrent reports of personal growth and deficits in physical, social, and emotional well-being among HSCT survivors are consistent with the transition paradigm [5,6]. This review of quality of life following HSCT is limited to articles published from January 2002 to October 2007, though some earlier publications are mentioned. We focus on these more recent studies because they are more likely than older studies to reflect changes in HSCT protocols and because they are generally more methodologically rigorous than earlier studies. Articles were identified through a search of PsycINFO using the following keywords: (bone marrow or stem cell) and transplant$.1 MEDLINE searches also included the following keywords: psycho$, quality of life, fatigue, or sexual. Use of the terms (mini or light or partial or tandem) and transplant$ in combination with the above-mentioned keywords did not result in any relevant publications. Further pertinent studies were found through searches of reference lists in published articles. The database searches yielded 1513 results, and we reviewed the titles, abstracts, and, if necessary, the full papers in order to extract articles that focused on quality of life, fatigue, sexuality, or distress outcomes (e.g. global distress or mood, negative affect, depressive or anxious symptoms) in adult HSCT survivors. We found 22 articles that met our criteria (see Table 1). Table 1 Prospective investigations of quality of life following hematopoietic stem cell transplantation Articles presented in Table 1 had to (1) be published in the English language, (2) include at least one assessment prior to transplant and one assessment after transplant, and (3) include at least 20 participants at baseline. We excluded articles in which pediatric populations were included or original empirical data were not reported. Although we generally excluded articles that focused on psychological interventions for HSCT recipients, we note the intervention literature when providing directions for future research. Although we cite papers that included measures of neuropsychological functioning, we do not discuss the cognitive effects of chemotherapy and radiation and refer the reader to recent reviews [7,8]. Throughout this paper cross-sectional work is only cited if few longitudinal studies with HSCT survivors have examined a particular issue (e.g. posttraumatic stress symptoms), or scarce data are available for a particular time point (e.g. 10-year follow-up data). This article first reviews the literature on HSCT recipients’ self-reported physical well-being with an emphasis on fatigue, a common complaint of HSCT survivors. Second, the psychological distress of HSCT recipients is discussed, including depression, anxiety, and posttraumatic stress symptoms. Third, research on vocational and financial status, social well-being, and sexuality and fertility is reviewed. Finally, methodological and conceptual limitations of prior research are presented along with directions for future research.

The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain.

Abstract: Anxiety and depression are troubling and disabling symptoms in patients with cancer. Significant psychological distress is common across all stages of this life-threatening disease, with anxiety and depression representing its most typical manifestation (1). Anxiety disorders are the most common mental health problem in the U.S. with a 1-year general population prevalence rate of 16.4% (2). It is found in 10% to 30% of people with cancer. The most commonly diagnosed anxiety disorders in cancer patients are generalized anxiety disorder (GAD), specific phobias, panic disorder with or without agoraphobia, adjustment disorder with anxious mood, and posttraumatic stress disorder (3, 4). Depression occurs in about 10% to 25% of cancer patients, a rate estimated to be at least four times greater than in the general population (5, 6) but similar to rates of depressive states in patients similarly ill with other medical diagnoses (7). These important psychological symptoms have historically been under-diagnosed and undertreated in cancer care but are gaining more attention recently as researchers seek ways to improve quality of life during treatment and survivorship. Of these two symptoms, depression has received the most attention from cancer researchers and its adverse effects on functional status and quality of life are well established. The importance of diagnosing and treating depression has been recognized not only to enhance quality of life but because it may adversely affect compliance with treatment, length of time in the hospital, and ability for self-care (8). Although less is known about anxiety, some suggest that its disabling effects may be as troubling as that of depression (3). With prevalence equal to or exceeding that of depression and a potential for adversely affecting functional status, anxiety is an important symptom to target in cancer research. Anxiety and depression are highly comorbid, both in cancer and non-cancer samples, and distinguishability of the two disorders has long been the subject of investigation with mixed and inconclusive results (9). Various conceptualizations of the relationship between the two symptoms have been advanced over time. Anxiety and depression have recently been viewed by various researchers as being related in one of several ways—as different points on the same continuum, as alternative manifestations of a common underlying diathesis, as heterogeneous syndromes that are associated because of shared subtypes, as separate phenomena that may develop into the other over time, or as distinct phenomena. The current diagnostic system supports the last view listed—a categorical conceptualization; however, dimensional views have gained momentum on the strength of recent evidence. Although some investigators have gone so far as to question whether anxiety and depression are actually distinct phenomena, a comprehensive review of the literature led researchers to conclude that despite significant overlap, the two constructs are indeed distinguishable (2, 9, 10). Greater clarity about the nature of anxiety and depression in cancer patients would enhance our ability to recognize and treat it effectively. We were interested in examining the relationship of anxiety and depression with health-related quality of life (HRQL) in cancer patients. Of particular interest was the degree to which anxiety may be associated with HRQL independent of depression—and vice versa. We hypothesized that depression severity has a clear association with multiple domains of HRQL (H1) and that anxiety severity examined separately also has a similarly clear association (H2). We further expected to find that depression severity and anxiety severity have moderate independent associations with multiple domains of HRQL (H3); and that these independent associations are only mildly attenuated by adjusting for covariates (H4). We also conducted exploratory analyses of the associations of anxiety and depression on several domains of functional status.

Restorative yoga for women with breast cancer: findings from a randomized pilot study

Abstract: Objectives: Restorative yoga (RY) is a gentle type of yoga that may be beneficial for cancer patients and post-treatment survivors. Study goals were: to determine the feasibility of implementing a RY intervention for women with breast cancer; and to examine group differences in self-reported emotional, health-related quality of life, and symptom outcomes. Methods: Women with breast cancer (n=44; mean age 55.8 years) enrolled in this study; 34% were actively undergoing cancer treatment. Study participants were randomized to the intervention (10 weekly 75-minute RY classes) or a waitlist control group. Participants completed questionnaires at Week 0 (baseline) and Week 10 (immediately post-intervention for the yoga group). Results: Group differences favoring the yoga group were seen for mental health, depression, positive affect, and spirituality (peace/meaning). Significant baseline*group interactions were observed for negative affect and emotional well-being. Women with higher negative affect and lower emotional well-being at baseline derived greater benefit from the yoga intervention compared to those with similar values at baseline in the control group. The yoga group demonstrated a significant within-group improvement in fatigue; no significant difference was noted for the control group. Conclusions: Although limited by sample size, these pilot data suggest potential benefit of RY on emotional outcomes and fatigue in cancer patients. This study demonstrates that a RY intervention is feasible for women with breast cancer; implications for study design and implementation are noted with an emphasis on program adoption and participant adherence. Copyright © 2009 John Wiley & Sons, Ltd.

Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: a 3-month longitudinal examination of cognitive processing.

Abstract: Introduction The experience of cancer can be understood as a psychosocial transition, producing both positive and negative outcomes. Cognitive processing may facilitate psychological adjustment.

Sexual dysfunction and spousal communication in couples coping with prostate cancer.

Abstract: Objective: To characterize the sexual function of both prostate cancer patients and their partners, and to examine whether associations between sexual dysfunction and psychosocial adjustment vary depending on spousal communication patterns. Methods: In this cross-sectional study, 116 prostate cancer patients and their partners completed psychosocial questionnaires. Results: Patients and partners reported high rates of sexual dysfunction. Within couples, patients' and their partners' sexual function was moderately to highly correlated (r=0.30–0.74). When patients had poor erectile function, their partners were more likely to report that the couple avoided open spousal discussions; this in turn was associated with partners' marital distress (Sobel's Z=12.47, p=0.001). Patients and partners who reported high levels (+1SD) of mutual constructive communication also reported greater marital adjustment, regardless of their own sexual satisfaction. In contrast, greater sexual dissatisfaction was associated with poorer marital adjustment in patients and partners who reported low levels (−1SD) of mutual constructive communication (p<0.05). Conclusion: Our findings underscore the need for psychosocial interventions that facilitate healthy spousal communication and address the sexual rehabilitation needs of patients and their partners after prostate cancer treatment. Although some couples may be reluctant to engage in constructive cancer-related discussions about sexual problems, such discussions may help alleviate the negative impact that sexual problems have on prostate cancer patients' and their partners' marital adjustment. Copyright © 2008 John Wiley & Sons, Ltd.

Existential concerns among patients with cancer and interventions to meet them: an integrative literature review.

Abstract: OBJECTIVES: An integrative literature review was undertaken to explore existential concerns among patients with cancer with respect to components, related concepts and targets of interventions. METHODS: Comprehensive searches in MEDLINE, CINAHL, PsychINFO, Social Citation Index, SweMed+, Eurethics, NLM Gateway, Faculty of 1000 Medicine, Cochrane Library, EMBACE were undertaken. Each paper was read and classified according to design as descriptive qualitative, descriptive quantitative or interventional. Main themes, interventions and outcomes were identified. RESULTS: The searches yielded a total of 162 articles, of which 109 met inclusion criteria. Existential components from the qualitative studies were divided into two main themes: struggle to maintain self-identity and threats to self-identity. Quantitative studies mainly concerned relationships between existential concerns and other concepts. Interventions and assessed outcomes were consistent with components and relationships found in the descriptive studies. Relationships concerned physical and psychological domains; however, few interventions were evaluated against physical outcomes. No interventions applicable to everyday health-care practice were found. CONCLUSION: Interventions targeted and evaluated concepts related to existential concerns found in the descriptive studies. Gaps in research on existential concerns in patients with cancer include the need to clarify the concept; how patients' existential well-being may best be supported by health-care professionals in everyday practice; effects of existential interventions on physical symptoms; and stability of results of interventions.

The transition from breast cancer 'patient' to 'survivor'.

Abstract: Background: While much is now known about breast cancer survivors' long-term health, quality of life, and psychological state, relatively little is known about the period immediately following completion of treatment, when women transition out of the role of breast cancer ‘patient’ to life as ‘survivor’. Objective: To explore women's fears regarding risk of cancer recurrence, sense of loss of medical monitoring, and social support from health-care providers and other patients, and the strategies they use to cope with these issues. Method: Focus group interviews were conducted with women who had completed adjuvant chemotherapy or radiation for new stage I or II breast cancer in the prior 12 months. Interviews were audio-taped, transcribed, and analyzed using a constant comparative analysis approach. Results: Of 216 women identified as eligible, over half (155) were reached by telephone and invited to participate. Of those invited, 47 (30%) agreed. Findings suggest that while women acknowledge positive life changes as a result of the cancer experience, emotional and physical stresses are prevalent following the completion of treatment. Conclusion: The period of time when women who have been treated for breast cancer transition to life without treatment presents numerous emotional and physical challenges. By illuminating patients' experience during this transition period, this study provides insights into the development of interventions to support women after treatment. Copyright © 2008 John Wiley & Sons, Ltd.

A couple-based intervention for female breast cancer.

Abstract: OBJECTIVE: Although women's breast cancer affects both women and their male partners, as well as their relationships, few interventions have been developed to work with couples confronting breast cancer. The current investigation presents the pilot results from a new couple-based intervention program for breast cancer that teaches couples how to minimize negative effects and maximize positive functioning during this difficult time. METHOD: In this pilot study, 14 couples in which the wife had early stage breast cancer were randomly assigned to one of the two treatment conditions: Couple-based relationship enhancement (RE) or treatment-as-usual (TAU). RESULTS: The results from this study suggest that compared with couples receiving treatment-as-usual, both women and men in the RE condition experienced improved functioning on individual psychological variables as well as relationship functioning at posttest and 1-year follow-up. In addition, women in RE show fewer medical symptoms at both time periods. CONCLUSIONS: In this pilot study, the couple-based intervention, RE, has shown promise in improving individual, medical, and relationship functioning for couples in which the woman is facing breast cancer, and therefore merits further investigation on a larger scale.

Fear of recurrence and psychological distress in head and neck cancer patients and their carers.

Abstract: Background: Fear of recurrence (FOR) has been increasingly recognised as an issue of significant burden for most cancer patients, and has been associated with psychological morbidity and reduced quality of life. More recently, the impact of recurrence fears has been indicated in the families of cancer patients. However, there has been a lack of prospective research. Aim: To systematically examine distress and illness concerns among patient–carer dyads. Methods: A multi-centre prospective study of head and neck cancer patients and their carers (patients, n=101; carers, n=101), surveyed at two time-points following diagnosis. Results: Carers recorded higher recurrence concerns on average than the patient group (p<0.001). A predictive path model of patient and carer self-reports of distress and FORs was explored, with an excellent overall fit of the final model (χ2=15.4, df=12, p=0.22, Comparative Fit Index (CFI)=0.994, Root Mean Square Estimate of Approximation (RMSEA)=0.053). Conclusions: The preliminary results establish that early fears and distress within individuals govern later reports on these same attributes, but that there is some weak evidence of influence from one attribute to another within and across individuals in the dyad. Future prospective dyadic research is warranted to ascertain the level of these fears over an extended time and their relationship to patient and carer adaptation. Intervention may be needed to reduce this disease concern to a manageable level at an early stage of the illness trajectory. Copyright © 2008 John Wiley & Sons, Ltd.

Pre-treatment symptom cluster in breast cancer patients is associated with worse sleep, fatigue and depression during chemotherapy.

Abstract: Objective The concept of symptom clusters is relatively new in cancer patients' symptom management. This study, which spanned four cycles of chemotherapy, combined three commonly seen pre-treatment symptoms in cancer patients (i.e., sleep disturbances, fatigue and depression) into one symptom cluster, to explore the associations between pre-treatment cluster categories and longitudinal profiles of these same symptoms during chemotherapy.

Quality of life and sexual functioning after cervical cancer treatment: a long‐term follow‐up study

Abstract: Objective: The purpose of the study was to investigate the long-term treatment side effects on the quality of life (QoL) and sexual functioning of cervical cancer survivors undergoing different treatment regimens. Methods: QoL and sexual functioning were measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, the Cervix Cancer Module, and the Sexual Activity Questionnaire. Results: One hundred twenty-one cervical cancer survivors (63 Surgery, 38 Surgery/CT, and 20 Surgery/RT) participated. Patients in the Surgery/RT Group reported significantly worse QoL outcomes (lower scores on physical, role, cognitive, and social functioning) compared with patients in the Surgery Group or patients in the Surgery/CT Group. The level of symptoms such as nausea/vomiting, pain, appetite loss, frequent urination (p=0.019), leaking of urine (p=0.015), and the feeling of a tight vagina (p=0.018) was significantly higher in irradiated patients. Concerning sexual functioning, patients in the Surgery/RT Group reported a significantly lower sexual activity rate compared with women in the Surgery Group or women in the Surgery/CT group (p 0.05). Conclusions: Cervical cancer survivors treated with adjuvant radiotherapy are more likely at risk for impaired QoL. Survivors treated with surgery or adjuvant chemotherapy return to a similar level of QoL as women without a history of cancer. Although the sexual activity rate is lower in irradiated patients their sexual pleasure is similar to patients after surgery and chemotherapy. Copyright © 2008 John Wiley & Sons, Ltd.

An evidence-based review of yoga as a complementary intervention for patients with cancer.

Abstract: Objective: To conduct an evidence-based review of yoga as an intervention for patients with cancer. Specifically, this paper reviewed the impact of yoga on psychological adjustment among cancer patients. Methods: A systematic literature search was conducted between May 2007 and April 2008. Data from each identified study were extracted by two independent raters; studies were included if they assessed psychological functioning and focused on yoga as a main intervention. Using a quality rating scale (range = 9–45), the raters assessed the methodological quality of the studies, and CONSORT guidelines were used to assess randomized controlled trials (RCTs). Effect sizes were calculated when possible. In addition, each study was narratively reviewed with attention to outcome variables, the type of yoga intervention employed, and methodological strengths and limitations. Results: Ten studies were included, including six RCTs. Across studies, the majority of participants were women, and breast cancer was the most common diagnosis. Methodological quality ranged greatly across studies (range = 15.5–42), with the average rating (M = 33.55) indicating adequate quality. Studies also varied in terms of cancer populations and yoga interventions sampled. Conclusions: This study provided a systematic evaluation of the yoga and cancer literature. Although some positive results were noted, variability across studies and methodological drawbacks limit the extent to which yoga can be deemed effective for managing cancer-related symptoms. However, further research in this area is certainly warranted. Future research should examine what components of yoga are most beneficial, and what types of patients receive the greatest benefit from yoga interventions. Copyright © 2008 John Wiley & Sons, Ltd.

Cognitive effects of chemotherapy in post-menopausal breast cancer patients 1 year after treatment

Abstract: Objective: Studies in breast cancer patients indicate that chemotherapy may cause subtle cognitive disturbances in some women, but the course is unclear. The current study evaluated the cognitive effects of adjuvant chemotherapy in post-menopausal breast cancer patients 1 year following completion of treatment. Patients and methods: Breast cancer patients scheduled to receive adjuvant chemotherapy (n=53) completed comprehensive neuropsychological testing before commencing chemotherapy (T1), 1 month after completing chemotherapy (T2), and again 1 year later (T3). A control group of women receiving adjuvant hormonal therapy (n=40) was tested at comparable intervals. A standardized regression-based approach was used to identify cognitive decline, and incidence of decline was compared across treatment groups. Results: Whereas at T2, chemotherapy patients were more likely to show cognitive decline than hormonal patients, by T3, the frequency of reliable cognitive decline was the same in both groups (11 and 10%, respectively). However, those chemotherapy patients receiving hormonal therapy at T3 were inferior to the chemotherapy patients not receiving hormonal treatment on composite measures of processing speed and verbal memory. Conclusion: These data suggest that there is a subtle negative impact of chemotherapy on cognitive function in breast cancer patients shortly following completion of treatment, but that this resolves within 1 year. However, given that our control group comprises breast cancer patients receiving hormonal therapy, and indications that hormonal therapy may also adversely affect cognition, such conclusions must be considered tentative. Copyright © 2008 John Wiley & Sons, Ltd.

Fear of recurrence in long-term testicular cancer survivors.

Abstract: Objective: To explore fear of recurrence (FoR) in long-term testicular cancer survivors (TCSs) since FoR hardly has been examined in TCSs. Methods: In a cross-sectional questionnaire study, 1336 TCSs at a mean of 11.4 years (SD 4.2) after diagnosis gave information about their medical and social situation, and completed measures on mental distress, fatigue, quality of life, coping, self-esteem and neuroticism. FoR during the last week was explored with one question, with the response categories rated on a 4-point Likert scale. Nine percent of the TCSs had a structured psychiatric interview. Results: Twenty-four percent of the TCSs reported ‘quite a bit’ FoR and 7% reported ‘very much’ FoR during the last week. The FoR question showed moderate correlations (0.22–0.51) with established psychological measures. The level of FoR was significantly positively correlated with mental distress, fatigue and neuroticism and significantly negatively correlated with quality of life, self-esteem and coping. In univariate analyses, neurotoxic side effects and somatic symptoms, but not treatment modality, were significantly associated with level of FoR. In a multivariate analysis, a medium educational level, increasing levels of traumatic cancer-related stress symptoms and of neuroticism were significantly associated with rising FoR. Among those who had a psychiatric interview, the presence of at least one current mental disorder was significantly associated with FoR. Conclusions: High levels of FoR in long-term TCSs are not uncommon. Levels of mental and somatic problems are associated with the levels of FoR. Clinical consequences of these findings for TCSs are discussed. Copyright © 2008 John Wiley & Sons, Ltd.

Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue.

Abstract: Background: To determine whether sleep quality and fatigue associated with breast cancer adjuvant chemotherapy treatments can be improved with behavioral therapy (BT) [Individualized Sleep Promotion Plan (ISPP©)] including modified stimulus control, modified sleep restriction, relaxation therapy, and sleep hygiene. Methods: Randomized-controlled trial based on Piper Integrated Fatigue Model, 219 stages I–IIIA breast cancer patients. Prior to the initial chemotherapy treatment, BT participants developed an ISPP plan that was regularly reinforced and revised. Controls received healthy eating information and attention. Pittsburgh Sleep Quality Index (PSQI), daily diary, actigraph, and Piper Fatigue Scale (PFS) data were collected 2 days prior, during the 7 days after each treatment, and 30 days after the last treatment. Repeated measures analysis of variance was used. Results: Prior to chemotherapy, participants reported mild fatigue and fairly poor sleep quality. All variables changed over time. A group by time interaction was found for sleep quality (PSQI) improving in the BT group. Diary revealed group differences on number of awakenings, minutes awake after sleep onset, and sleep efficiency. Fatigue (PFS) was similar between groups. Conclusions: The BT group showed improved sleep quality over time and better sleep (diary). Perceptions of improved sleep quality over time are not consistently associated with diary or actigraph, or result in lower fatigue. Copyright © 2008 John Wiley & Sons, Ltd.

Exercise and quality of life during and after treatment for breast cancer: results of two randomized controlled trials

Abstract: Objective: To determine the effect of exercise on quality of life in (a) a randomized controlled trial of exercise among recently diagnosed breast cancer survivors undergoing adjuvant therapy and (b) a similar trial among post-treatment survivors. Methods: Fifty newly diagnosed breast cancer survivors were recruited through a hospital-based tumor registry and randomized to a 6-month, home-based exercise program (n=25) or a usual care group (n=25). In a separate trial, 75 post-treatment survivors were randomized to a 6-month, supervised exercise intervention (n=37) or to usual care (n=38). Participants in both studies completed measures of happiness, depressive symptoms, anxiety, stress, self-esteem, and quality of life at baseline and 6 months. Results: Forty-five participants completed the trial for newly diagnosed survivors and 67 completed the trial for post-treatment survivors. Good adherence was observed in both studies. Baseline quality of life was similar for both studies on most measures. Exercise was not associated with quality of life benefits in the full sample of either study; however exercise was associated with improved social functioning among post-treatment survivors who reported low social functioning at baseline (p<0.05). Conclusions: Exercise did not affect quality of life in either recently diagnosed or post-treatment breast cancer survivors; however this may be due in part to relatively high baseline functioning among participants in both studies. Strategies for future research include limiting enrollment to survivors who report reduced quality of life on screening questionnaires and targeting survivor subgroups known to be at particular risk for quality of life impairment. Copyright © 2009 John Wiley & Sons, Ltd.

Cognitive and mood changes in men undergoing intermittent combined androgen blockade for non-metastatic prostate cancer.

Abstract: Purpose Men with PSA-only relapse of prostate cancer after primary therapy are generally fully functional and asymptomatic with a life expectancy of up to ten or more years. Androgen deprivation therapy (ADT) is a common treatment option. This study examined mood and cognitive changes in otherwise healthy men with prostate cancer prior to, during and after ADT.

Burnout in nurses and physicians working at an oncology department.

Abstract: Purpose: Burnout is associated with decreased job performance and commitment, predicts stress-related health problems, and low career satisfaction. The specific objectives in our study were to assess the levels of burnout and to investigate the interrelationships between demographic characteristics and burnout health-care professionals working with cancer patients in Turkey. Methods: A questionnaire-based study was conducted in 77 physicians and 56 nurses working in an oncology clinic at the university hospital. We used quantitative survey to assess burnout levels in participants as well as sociodemographic variables. Data were collected using a Turkish version of the Maslach Burnout Inventory (MBI). Results: Nurses had significantly higher scores of emotional exhaustion (EE) when compared with the physicians, but no significant difference was found between two groups regarding other burnout components. Significant correlations were found in three different components of the MBI, as well as between each component, age and work experience in nurses and physicians. There were statistical significant differences for each of MBI subscales according to age groups in physicians. EE and depersonalization (D) were significantly higher in the ⩽29 years of age group than in the older age groups, while personal accomplishment (PA) score was significantly lower in this age group. EE, D, PA were significantly higher in single physicians compared with married physicians. Conclusions: Low level of PA was relatively high among Turkish physicians and nurses working in oncology department compared with previous studies. Younger and single physicians had higher burnout levels compared with older and married ones. Copyright © 2008 John Wiley & Sons Ltd.

The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study

Abstract: Background: Many women with breast cancer need psychological help to cope more effectively after treatment. Cognitive and behavioural techniques are not yet well established in France. A multi-site randomized study was conducted to evaluate the effects of a psycho-educational group intervention in this population. Methods: Two hundred and three patients, recruited after primary treatment, were randomly assigned either to a treatment group (psycho-educational intervention) or to a waiting-list control group. The 8-week programme of 2 h sessions comprised of thematic discussions, information and training in stress management techniques. Evaluation at baseline, after 8 sessions, and 1 month after programme completion, included evaluations using the STAI, POMS, MAC, EORTC QLQ-C30 and EORTC QLQ-BR23 breast module scales. Results: We observed a significant reduction in anxiety (STAI, POMS) among group participants, a reduction in anger, depression and fatigue (POMS), a significant improvement in vigor and interpersonal relationships (POMS), in emotional and role functioning, in health status and fatigue level (EORTC QLQ-C30). In contrast, coping strategies (MAC) were not significantly different between groups. No group-related negative effects were observed and the global satisfaction levels were very high. Conclusion: This study demonstrates the feasibility and effectiveness of a psycho-educational intervention, which can accelerate the reduction of those negative affects which are present at the end of treatment. It represents an excellent complement or an alternative to individual psycho-oncologic therapeutic support, widely proposed in France, and should now be tested in groups with other types of cancer and at other disease phases.

Home-based exercise among cancer survivors: adherence and its predictors.

Abstract: Objective—Evidence of the benefits of exercise for those treated for cancer has led to several exercise interventions for this population. Some have questioned whether cancer patients offered a home-based intervention adhere to the exercise prescribed. Method—We examined exercise adherence in a randomized controlled trial of a 12-week, homebased exercise trial for breast cancer patients. Three adherence outcomes were examined: minutes of exercise participation during each week of the intervention, number of steps taken during planned exercise during each intervention week, and whether the participant met her weekly exercise goal. Predictors of adherence (e.g., demographic and medical variables, Transtheoretical Model variables, history of exercise) were examined. Results—Findings indicate that participants significantly increased their minutes of exercise and steps taken during planned exercise from the first to the last week of the intervention. The percentage of participants achieving exercise goals was highest in the first few weeks of the intervention. Exercise self-efficacy significantly predicted each adherence outcome. Baseline PA predicted mean exercise session steps over the 12 weeks. Conclusion—Adherence to a home-based exercise intervention for breast cancer patients changes over time and may be related to baseline levels of self-efficacy for exercise.

Depression screening using the Patient Health Questionnaire-9 administered on a touch screen computer

Abstract: Objective: To (1) evaluate the feasibility of touch screen depression screening in cancer patients using the Patient Health Questionnaire-9 (PHQ-9), (2) evaluate the construct validity of the PHQ-9 using the touch screen modality, and (3) examine the prevalence and severity of depression using this screening modality. Methods: The PHQ-9 was placed in a web-based survey within a study of the clinical impact of computerized symptom and quality of life screening. Patients in medical oncology, radiation oncology, and hematopoietic stem cell transplantation (HSCT) clinics used the program on a touch screen computer in waiting rooms prior to therapy (T1) and during therapy (T2). Responses of depressed mood or anhedonia (PHQ-2 cardinal depression symptoms) triggered additional items. PHQ-9 scores were provided to the oncology team in real time. Results: Among 342 patients enrolled, 33 (9.6%) at T1 and 69 (20.2%) at T2 triggered the full PHQ-9 by endorsing at least one cardinal symptom. Feasibility was high, with at least 97% completing the PHQ-2 and at least 96% completing the PHQ-9 when triggered and a mean completion time of about 2 min. The PHQ-9 had good construct validity. Medical oncology patients had the highest percent of positive screens (12.9%) at T1, while HSCT patients had the highest percent (30.5%) at T2. Using this method, 21 (6.1%) at T1 and 54 (15.8%) at T2 of the total sample had moderate to severe depression. Conclusions: The PHQ-9 administered on a touch screen computer is feasible and provides valid depression data in a diverse cancer population. Copyright © 2008 John Wiley & Sons, Ltd.

How children cope when a parent has advanced cancer.

Abstract: Objective: When parents are diagnosed with cancer, children experience significant distress. There is little information regarding the nature of this distress and how children cope, particularly when a parent is diagnosed with advanced cancer. This study aimed to explore how children cope, and to identify areas where there may be barriers to children accessing support to enable them to cope. Methods: Semi-structured interviews were conducted with ill parents with advanced cancer and well parents and/or any children above the age of 7. Interviews were recorded and transcribed fully, and analysed using a constructionist grounded theory approach. Results: Twenty-eight family participants were interviewed. Four major themes emerged from the data including response to diagnosis, mechanisms of coping, life changes, and positive aspects. Children described being distressed by their parents diagnosis and having concerns related to their parents and their own health. Distraction and maintaining normality were described as the dominant strategies of coping for children, and increased responsibilities and decreased social activity were considered to be the most noticeable of life changes. Parents did not recognise the impact on children to the same degree as described by children and focused on limiting the impact by maintaining normality. Positive aspects described by children and parents included strengthening of relationships and learning to value family members and the important things in life. Conclusions: Open communication within the family may lead to more effective coping and a positive experience for children whose parents have been diagnosed with advanced cancer. Copyright © 2009 John Wiley & Sons, Ltd.

Cognitive effects of hormonal therapy in early stage breast cancer patients: a prospective study

Abstract: Objective: The primary purpose of this study was to evaluate the cognitive effects of adjuvant hormonal therapies in breast cancer patients. Participants and Methods: Post-menopausal breast cancer patients scheduled to receive tamoxifen (n=31) or anastrozole (n=14) completed neuropsychological testing around the time of commencement of treatment (T1), and again 5–6 months later (T2). A sample of healthy female volunteers (n=28) was tested at comparable intervals. A standardized regression-based approach was used to assess cognitive change. This method uses test/retest scores of the healthy control group to generate an equation that predicts T2 scores from T1 scores. The difference between the predicted and obtained T2 scores divided by the standard error of the estimate produces a deviation score that reflects the discrepancy from the T1–T2 difference scores that would be expected on the basis of practice and error alone. Results: Analysis of individual deviation scores revealed that both the patients taking tamoxifen and those taking anastrozole were more likely than healthy controls to show reliable cognitive decline from T1 to T2 (39, 64, and 7%, respectively). Processing speed and verbal memory were the cognitive domains most affected. Conclusion: These data suggest that hormonal therapies exert a subtle negative influence on cognition in breast cancer patients. Further analyses indicated that this effect was not fully accounted for by demographic factors or fatigue. Methodological limitations of the current study are addressed, along with recommendations for future studies in this area. Copyright © 2008 John Wiley & Sons, Ltd.

Effects of a nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers

Abstract: Objective: Women with gynecological cancers have reported poor health-related quality of life (QOL), with complex physical and psychological needs post-surgery and during chemotherapy treatment. There are no studies reporting interventions addressing these needs post-hospital discharge in this population. Methods: Patients were randomized into two groups. The intervention group received 6 months of specialized care by an Advanced Practice Nurse (APN); in addition, women with high distress were evaluated and monitored by a psychiatric consultation–liaison nurse (PCLN). The attention control group was assisted with symptom management by a research assistant. The effects of the 6-month intervention were evaluated using self-report questionnaires at baseline (24–48 h after surgery), 1, 3, and 6 months post- surgery. QOL assessments included the Center for Epidemiological Studies–Depression Scale , the ambiguity subscale of the Mishel Uncertainty in Illness Scale , the Symptom Distress Scale, and the Short-Form Health Survey (SF-12). The sample for the longitudinal analysis included 123 who completed QOL outcome measures across three occasions post-surgery. Results: The APN intervention resulted in significantly less uncertainty than the attention control intervention 6 months after surgery. When the sub-group who received the APN plus PCLN intervention was compared with the total attention control group, the sub-group had significantly less uncertainty, less symptom distress, and better SF-12 mental and physical QOL over time. Conclusion: Nurse tailored interventions that target both physical and psychological aspects of QOL in women recovering from cancer surgery and undergoing chemotherapy produce stronger outcomes than interventions that target solely one QOL aspect. Copyright © 2008 John Wiley & Sons, Ltd.

Improving patient outcomes through the routine use of patient-reported data in cancer clinics: future directions.

Abstract: Objectives: Recent reviews suggest that the routine use of patient-reported outcome measures (PROMs) in cancer clinics improves the processes of care but not patient outcomes such as quality of life or satisfaction. We set out to identify future strategies for (1) interventions to impact patient outcomes and (2) trials to identify treatment effects. Methods: MEDLINE and PsycINFO were systematically searched to identify reports of relevant randomized controlled trials. Intervention and trial designs were compared and contrasted along the parameters identified by previous reviews and the rationales reported in each article. Results were cross-referenced with evidence for impact to develop recommendations. Results: Six articles were identified. Evidence for impact on patient outcomes was limited. Interventions varied according to the PROMs used, the frequency, content and presentation of feedback, and the training offered to medical teams. Trials varied in their unit of randomization, outcome measures, control of contamination, monitoring of PROM use, and length of follow-up. Our analysis identified the need for future interventions to ensure that PROM data are used to optimum effect and for trials to control for contamination and monitor use of PROMs to link this with outcomes. Conclusions: Future interventions should motivate and equip health professionals to use PROM data in managing patients, train patients in self-efficacy, use more specific PROMs in clinic, improve the interpretability of feedback for both medical staff and patients, and monitor the use of PROMs to intervene when problems arise. Future trials should use a cluster-randomized design to control for contamination and enable systems-based interventions. Copyright © 2009 John Wiley & Sons, Ltd.

Measuring attachment security in patients with advanced cancer: psychometric properties of a modified and brief Experiences in Close Relationships scale.

Abstract: Objective: Attachment security has been identified as an important buffer of distress in patients with cancer and other medical illnesses but current measures have not been adapted for this population who may be older, in long-term stable relationships, and suffering from considerable disease burden. This study reports on (1) the psychometric properties of a modified 36-item Experiences in Close Relationships scale (ECR), adapted for this population; and (2) the validity of a brief 16-item version of our modified scale. Methods: A modified ECR (ECR-M36) was constructed by rephrasing relevant items to refer more generally to people with whom one feels close, instead of specifically in relation to one's romantic partner(s). Patients with metastatic gastrointestinal (GI) and lung cancer completed the ECR-M36 and other scales tapping self-esteem, social support, and depressive symptoms on two occasions within a period of 4–6 months. Based on factor analyses of the ECR-M36, 16 items were selected to form a brief measure (ECR-M16). Results: Factor analyses of both ECR forms revealed a higher-order factor structure in which four first-order factors (Worrying about Relationships, Frustration about Unavailability, Discomfort with Closeness, Turning Away from Others) loaded onto two second-order factors tapping Attachment Anxiety and Avoidance. Both ECR forms were reliable and valid. Conclusion: The ECR-M36 and ECR-M16 are good measures of attachment orientations for use with medically ill, older populations. Copyright © 2008 John Wiley & Sons, Ltd.

Beyond the psychotherapy and survival debate: the challenge of social disparity, depression and treatment adherence in psychosocial cancer care.

Abstract: The psychotherapy and cancer survival debate generated great interest in the psychoneuroimmunological and bio-behavioral mechanisms that might mediate any gain in survival. Recent methodologically-improved cognitive-existential, supportive-expressive and psycho-educational group interventions for patients with breast cancer and melanoma have not extended survival times. Shorter survival has been associated with social disparity and untreated clinical depression, potentially mediated by poorer adherence to anti-cancer treatments. Group therapy both prevents and treats depression. Future research could address these bio-behavioral mechanisms.