Showing papers in "Psycho-oncology in 2010"

Review of the literature on the effects of caring for a patient with cancer.

Abstract: Objective: To adequately help family caregivers (FCs) of cancer patients, clinicians need to understand the complexity of the problems and responsibilities associated with cancer patients illness that FCs experience. Methods: This systematic review identified the types of problems and burdens that FCs of cancer patients experience during the patient's illness. We also analyzed the language caregivers use to communicate their problems and responsibilities related to caregiving for the cancer patient. Results: Of 2845 titles identified, 192 articles met the inclusion criteria and are included in this review. Of these, 164 were research-based. In addition to FC responsibilities and the impact of being a caregiver on daily life, a number of other physical, social, and emotional problems related to caregiving for these FCs were identified. Conclusion: A substantial evidence base supports the conclusion that FCs experience many difficult problems and increased responsibilities during and after the patient is undergoing treatment and rehabilitation for cancer. The insights gained from this review will help researchers and clinicians to understand the complexity of problems and responsibilities FCs experience. This understanding may encourage them to include support for FCs as part of total or holistic patient care. However, more research is needed to better understand the variations in caregiving experiences over time; how the caregiving perspective is influenced by different cultural, ethnic, or socioeconomic backgrounds as well as gender and age; and how problems and responsibilities related to caregiving interfere with daily life. Copyright © 2009 John Wiley & Sons, Ltd.

Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial

Abstract: Objectives An increasingly important concern for clinicians who care for patients at the end of life is their spiritual well-being and sense of meaning and purpose in life. In response to the need for short-term interventions to address spiritual well-being, we developed Meaning Centered Group Psychotherapy (MCGP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace and purpose in their lives, even as they approach the end of life.

Stress, coping, and hope

Abstract: Hope is discussed in many literatures and from many perspectives. In this essay hope is discussed from the vantage of psychology and stress and coping theory. Hope and psychological stress share a number of formal properties: both are contextual, meaning-based, and dynamic, and both affect well-being in difficult circumstances. Two assumptions underlie this essay: (1) hope is essential for people who are coping with serious and prolonged psychological stress; (2) hope is not a perpetually self-renewing resource; it has peaks and valleys and is at times absent altogether. The relationship between hope and coping is dynamic and reciprocal; each in turn supports and is supported by the other. This relationship is illustrated with two adaptive tasks common across situations that threaten physical or psychological well-being—managing uncertainty and coping with a changing reality. The essay describes ways in which coping fosters hope when it is at low ebb as well as ways in which hope fosters and sustains coping over the long term.

Psychosocial adjustment of siblings of children with cancer: a systematic review.

Abstract: Objectives: To promote a broader understanding of the psychosocial impact of childhood cancer on siblings, a systematic review was undertaken. Directions for future research are proposed and clinical strategies are suggested for addressing the needs of these children. Methods: Searches of Medline, PsycINFO and CINAHL revealed 65 relevant qualitative, quantitative, or mixed methods' papers published between 1997 and 2008. These papers were rated for scientific merit and findings were extracted for summary. Results: Siblings of children with cancer do not experience elevated mean rates of psychiatric disorders, but a significant subset experiences post-traumatic stress symptoms, negative emotional reactions (e.g. shock, fear, worry, sadness, helplessness, anger, and guilt), and poor quality of life in emotional, family, and social domains. In general, distress is greater closer to time of diagnosis. School difficulties are also evident within 2 years of diagnosis. Qualitative studies reveal family-level themes such as loss of attention and status as well as positive outcomes including increased sibling maturity and empathy. Conclusions: Research regarding siblings of children with cancer continues to be methodologically limited. The conclusions of qualitative and quantitative studies differ considerably. We propose a research agenda to propel this field forward including greater attention to alterations in normative development (as opposed to psychiatric conditions), development of more appropriate quantitative measures, examination of potential moderators of adaptation, and use of prospective longitudinal designs. Siblings of children with cancer are a psychosocially at-risk group and should be provided with appropriate supportive services. Copyright © 2009 John Wiley & Sons, Ltd.

Spirituality and well-being in cancer patients: A review

Abstract: Objective: Cancer places many demands on the patient and threatens the person's sense of meaning to life. It has been shown that cancer patients use their spirituality to cope with these experiences. The present literature review summarizes the research findings on the relationship between spirituality and emotional well-being. Special attention is given to the strength of the research findings. Methods: A literature search was performed in Pubmed and Web of Science. Spirituality does not necessarily coincide with religiosity. Therefore, studies were excluded that focused on religiosity. Forty publications met the inclusion criteria: Twenty-seven studies that investigated the relationship between spirituality and well-being, and 13 publications that explored the relationship between meaning in life and well-being. Results: The majority of the cross-sectional studies (31 of 36) found a positive association between spirituality and well-being. The four studies with a longitudinal design showed mixed results. The significance of the findings is challenged, because most spirituality questionnaires contain several items that directly refer to emotional well-being. Conclusions: Despite that the majority of the studies concluded that spirituality was associated with higher well-being, no definitive conclusions on this relationship can be drawn due to major methodological shortcomings of these studies. Longitudinal research utilizing spirituality and well-being measures that do not overlap in content is recommended. Copyright © 2009 John Wiley & Sons, Ltd.

Subjective cognitive dysfunction in breast cancer patients: a systematic review.

Abstract: Objective: Results from studies examining subjective cognitive dysfunctioning (SCD) in breast cancer (BC) patients are unclear. Therefore, this review examined (i) the prevalence of SCD, (ii) the differences between (treatment) groups in SCD, (iii) the course of SCD, (iv) the relationship of SCD with psychological factors, and (v) the relationship between SCD and objective cognitive dysfunctioning (OCD). Methods: Through a systematic literature search, we identified 27 studies concerning SCD in BC patients. The methodological quality of these studies was examined according to predefined criteria. The methodological limitations and heterogeneity across studies were taken into account. Results: Eight studies were graded of high, 12 of moderate, and seven of low quality. Twenty-one to 90% of the patients reported SCD. The comparison between different (treatment) groups, at different time points of the cancer trajectory, rendered inconclusive evidence regarding the relation of SCD to the cancer itself, chemotherapy, and hormonal therapy. SCD and OCD were unrelated, but SCD was associated with psychological distress, fatigue, and health status. Conclusions: SCD does exist in BC patients, but it remains unclear if this is more commonly found in BC patients than in the general population. It is inconclusive if SCD is developed post-treatment or already exists pretreatment. Since there is a relationship between SCD and anxiety and depression, SCD may be more indicative of emotional distress instead of OCD. Attention toward SCD in future research is warranted in order to draw valid conclusions regarding SCD in BC patients. Copyright © 2009 John Wiley & Sons, Ltd.

Type of social support matters for prediction of posttraumatic growth among cancer survivors

Abstract: Objective: Previous research in people with cancer on social support and psychological wellbeing has mainly focused on the short-term negative outcomes of adjustment. Little is known about the role of social support in the experience of positive outcomes in the long term. This study examined the relation between emotional support in the period following diagnosis and the experience of positive consequences of the illness, so called posttraumatic growth, at 8 years after diagnosis. We focused on three distinct types of emotional support: perceived availability, actual received, and dissatisfaction with received emotional support. Methods: This longitudinal study was conducted in a sample of 206 long-term cancer survivors. Social support was assessed with the Social Support List (SSL) at 3 months and 8 years after diagnosis. Positive consequences of the illness were assessed with the Silver Lining Questionnaire (SLQ) at 8 years after diagnosis. Correlation- and regression analyses were used to examine the associations of initial levels of emotional support with the long-term report of posttraumatic growth. Results: Regression analyses showed that more received emotional support at 3 months after diagnosis significantly predicted a greater experience of positive consequences of the illness at 8 years after diagnosis. This association remained significant, when controlling for concurrent levels of emotional support at 8 years after diagnosis. Conclusions: The findings suggest that getting support from family and friends, characterized by reassuring, comforting, and problem-solving, in the period following diagnosis is an important resource that may help cancer survivors to find positive meaning in the cancer experience. Copyright (C) 2009 John Wiley & Sons, Ltd.

Predictors of change in unmet supportive care needs in cancer

Abstract: Objective: Patient Reported Outcome (PRO) assessments can assist health professionals to tailor their health practices to the individual needs of patients and improve patient care over time. The present study assessed prospective predictors of unmet supportive care needs in cancer patients over a six-month period. Methods: Participants were recruited from a regional cancer treatment centre in Australia and completed the Supportive Care Needs Survey (SCNS) at recruitment (n=439; 61.4% response rate) and six months follow-up (n=396). Hierarchical logistic regression was used to identify predictors of change in unmet needs across each supportive care domain. Predictor variables were socio-demographic, treatment and psychosocial factors including depression, anxiety, social support, and patient satisfaction. Results: Unmet needs were reported by approximately two-thirds of patients at baseline and half of patients at six months follow-up. Having unmet needs at baseline was the strongest predictor of unmet needs at six months. Longer time since diagnosis was a consistent predictor of greater unmet needs, associated with change in physical/daily living, psychological and health system and information unmet needs over time. By contrast, a complex relationship was found in that patient satisfaction, psychosocial and treatment characteristics predicted higher needs in some domains and lower needs in others. Conclusions: Unmet supportive care needs persist over time and psychological needs may emerge later in the illness continuum. Interventions to meet the needs of longer term cancer survivors are needed and should closely articulate with reported supportive care needs.

Cancer patients' desire for psychological support: prevalence and implications for screening patients' psychological needs.

Abstract: Objectives: To investigate cancer patients' desire for psychological support and to identify patients' sociodemographic, disease-related and psychological factors associated with this desire. Methods: The study is part of a multicenter, cross-sectional study assessing cancer patients' needs and desire for psychological support. Patients completed the Hospital Anxiety and Depression Scale, the Ways of Coping Checklist, the Cancer Rehabilitation Evaluation System and reported their desire for psychological support. Results: Among the 381 included patients, women (26%) desired psychological support significantly more often than men (11%) (p<0.001). Patients' desire for psychological support was associated with being younger (OR=0.94; p<0.001 for women and OR=0.93; p=0.007 for men) and having a support-seeking coping (OR=1.10; p=0.010 for women and OR=1.36; p=0.003 for men). Other contextual factors such as difficulties encountered and treatment modalities were diversely associated with women and men's desire for psychological support. Neither women's, nor men's psychological distress was associated with their desire for psychological support. Conclusions: One female cancer patient out of four and one male cancer patient out of ten desire psychological support. Results emphasize the need to screen not only for cancer patients' distress but also for their desire for psychological support. This will allow implementing psychological interventions according to patients' needs and desire. Copyright © 2009 John Wiley & Sons, Ltd.

Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment.

Abstract: Objective: The aim of the study was to identify factors associated with worse physical and emotional functioning of breast cancer survivors with upper extremity lymphedema. Methods: 1250 sets of questionnaires consisting of WHO-DAS II, EORTC QLQ-C30, EORTC QLQ-BR23 and GHQ-30 were mailed to women who underwent a breast cancer surgery at the Lower Silesian Oncology Center in Poland between January 1998 and December 2005. Results and conclusions: The response rate was 33.47%. 117 women were included into a lymphedema group and 211 into a group without this complication. Women with lymphedema were more disabled (overall disability (DAS) score 39.78 versus 34.67; p<0.001), reported symptoms from the upper extremity (shoulder or arm pain and difficulties in arm movement) and from the operated breast (pain and swelling) 2–3 times more often, experienced poorer quality of life (global quality of life (QOL) score 0.50 versus 0.57; p=0.005) and higher psychological distress (GHQ score 10.61 versus 8.01; p=0.007) in comparison to breast cancer survivors without lymphedema. The factors associated with higher DAS score, higher GHQ score and lower QOL score in women with lymphedema were as following: pain in the upper limb (mainly shoulder and arm), pain in operated breast, difficulties with arm movement, localization of lymphedema within the hand or in operated breast, a history of dermatolymphangitis and of receiving chemotherapy. Severity of lymphedema, younger age, BMI and localization of lymphedema within the dominant limb were not considerably related to worse outcomes in these women. Copyright © 2009 John Wiley & Sons, Ltd.

Trajectories of psychological distress among Chinese women diagnosed with breast cancer.

Abstract: Background: The distinct trajectories of psychological distress over the first year of the diagnosis with breast cancer (BC) and its determinants have not been explored. Methods: 285 of 405 Chinese women receiving surgery for BC were assessed at 5-day, 1-month, 4-month, and 8-month post-surgery on measures of psychological distress, optimism, treatment decision-making (TDM) difficulties, satisfaction with treatment outcome, satisfaction with medical consultation, and physical symptom distress. Latent growth mixture modelling identified trajectories of psychological response to BC. Multinominal logistic regression compared TDM difficulties, satisfaction with treatment outcome, satisfaction with medical consultation, optimism, and physical symptom distress, by distress pattern adjusted for age, education, employment status, and stage of disease. Results: Four distinct trajectories of distress were identified, namely, resilience (66%), chronic distress (15%), recovered (12%), and delayed-recovery (7%). TDM difficulties, optimism, satisfaction with consultation, and physical symptom distress predicted distress trajectories. Psychologically resilient women had less physical symptom distress at early post-surgery compared with women with other distress patterns. Compared with the resilient group, women in the recovered or chronic distress groups experienced greater TDM difficulties, whereas women in the delayed-recovery group reported greater dissatisfaction with the initial medical consultation. Women in the chronic distress group reported greater pessimistic outlook. Conclusion: Optimism and better early post-operative treatment outcomes predicted resilience to distress. Pre-operative interventions helping women to establish a realistic expectation of treatment outcome may minimize disappointment with treatment outcome and resultant distress, whereas post-operative rehabilitation should focus on symptom management. Copyright © 2009 John Wiley & Sons, Ltd.

Supportive care needs in patients with lung cancer.

Abstract: Introduction: The goal of this study was to characterize the prevalence and intensity of supportive care needs and interest in specific supportive care services among individuals with lung cancer. Method: Participants (n=109) were recruited from two medical centers in Southern California to complete questionnaires on physical and psychological functioning following diagnosis of lung cancer. Results: Participants reported the greatest need in the physical and daily living domain, followed by psychological needs, health system and informational needs, and patient care support needs. The most common unmet need was a lack of energy and tiredness (75%). Higher levels of supportive care needs were associated with worse physical functioning (β=−0.30, p<0.001), greater symptom bother (β=0.25, p=0.008), lower satisfaction with health care (β=−0.24, p=0.002), and higher levels of intrusive thoughts about cancer (β=0.40, p<0.001). The sample was most interested in receiving additional information about their disease and treatment (61.0%), exercise-related information and support (54.3%), and assistance dealing with fatigue (46.7%). Over 91% expressed interest in at least one specific supportive care service, and 51.4% were interested in one or more psychological services. Conclusion and implications for cancer survivors: Our findings suggest that lung cancer survivors have many unmet needs. Patients who report higher physical distress and intrusive stress symptoms, or lower satisfaction with their health care, may experience the highest level of supportive care need and intervention. Copyright © 2009 John Wiley & Sons, Ltd.

Experiences and concerns about ‘returning to work’ for women breast cancer survivors: a literature review

Abstract: Objective: To explore how female breast cancer patients experience work incapacity during the treatment and return-to-work phases and how interactions between patients and stakeholders affect this experience. Method: Database search for full text articles published between January 1995 and January 2008 that focused on employed female breast cancer patients, factors related to work incapacity, and returning to work. Only results based on self-report data were included. Studies focusing on treatment, financial factors, rate of return, or absence were excluded. Results: Six articles met the inclusion criteria. Women with breast cancer receive varied reactions but little advice about returning to work. Women were primarily concerned with disclosing the diagnosis to their employer and to relatives. Uncertainties about physical appearance, ability to work, and possible job loss affected the women's decisions about working during the treatment phase. After treatment, most women wanted to regain their ‘normal life’, but concentration and arm or fatigue problems potentially interfered. Although supportive work environments were helpful, the individual needs of women differed. Employers and employees need to find a balance in defining accommodating work. Many women received favourable support, but some reported feeling discriminated against. Many women re-evaluated the role of work in their lives after being confronted with breast cancer. Conclusion: Work adjustments could help women to keep their jobs during illness and recovery. To resolve women's concerns about returning to work, employers, physicians, and insurance institutions should consider increasing and improving communication with breast cancer patients and playing a more active and supportive role. Copyright © 2009 John Wiley & Sons, Ltd.

Can the Distress Thermometer be improved by additional mood domains? Part I. Initial validation of the Emotion Thermometers tool

Abstract: Purpose: To examine the value of a new screening instrument in a visual-analogue format. Methods: We report the design and validation of a new five-dimensional tool called the Emotion Thermometers (ET). This is a combination of five visual-analogue scales in the form of four predictor domains (distress, anxiety, depression, anger) and one outcome domain (need for help). Between March and August 2007, 130 patients attending the chemotherapy suite for their first chemotherapy treatment were asked to complete several questionnaires with validation for distress, anxiety and depression. Results: Of 81 with low distress on the Distress Thermometer (DT), 51% recorded emotional difficulties on the new ET tool, suggesting added value beyond the DT alone. Of those with a broadly defined emotional complication, 93.3% could be identified using the Anxiety Thermometer (AnxT) alone, compared with 54.4% who would be recognized using the DT alone. Using a cut-off of 3v4 on all thermometers against the total Hospital Anxiety and Depression Scale (HADS) score (cut-off 14v15), the optimal thermometer was the Anger Thermometer (sensitivity 61%, specificity 92%). Against HADS anxiety scale, the optimal thermometer was AnxT (sensitivity 92%, specificity 61%) and against the HADS depression scale, the optimal thermometer was the Depression Thermometer (DepT; sensitivity 60%, specificity 78%). Finally, against DSM-IV major depression, the optimal thermometer was the DepT (sensitivity 80%, specificity 79%). Further improvements may be possible by using a combination of thermometers or by repeating the screen. Conclusion: The diagnostic accuracy of the DT can be improved by the inclusion of simple addition linear domains without substantially increasing the time needed to apply the test. Copyright © 2009 John Wiley & Sons, Ltd.

The risk of suicide in cancer patients: a review of the literature

Abstract: Objectives: This review investigates the risk of suicide in people diagnosed with cancer.Method: A literature search of PsycINFO, MEDLINE, EMBASE and CINAHL yielded 677 articles of which the abstracts were reviewed for their relevance. Seventy-one articles were identified as relevant and a further 3 were identified in a search of cited and citing articles; following application of inclusion and exclusion criteria, 39 articles were included in the review.Results: The reported incidence of completed suicide in cancer patients ranged from standardised mortality ratio of 1 to 11. The reported percentages of suicidal ideation in non-psychiatric populations of cancer patients ranged from 0.8 to 71.4%, compared to a reported prevalence of suicidal ideation in the general population, of between 1.1 and 19.8%. Risk factors identified for completed suicide and suicidal ideation in cancer patients include mental health, socio-demographic and illness factors. Some of these risk factors extend to the general population; however, some are specific to cancer such as cancer site, physical functioning and prognosis.Conclusions: Despite the prevalence of suicidal ideation in a cancer population being comparable to the general population, the prevalence of completed suicide is elevated. Although suicidal ideation does not necessarily result in completed suicide, it is important that adequate training be provided for cancer professionals on the risk factors for suicide in cancer patients. Language: en

Needs assessment of family caregivers of cancer survivors: three cohorts comparison

Abstract: Purpose/Background: Caregivers' quality of life (QOL) may be maximized when the caregivers' needs in the context of cancer care are met. Therefore, determining what needs are not being satisfied for family caregivers should be the first step in the development of programs designed to enhance caregivers' QOL. Method: The 28-item Needs Assessment of Family Caregivers-Cancer (NAFC-C) scale was developed and validated with caregivers at three different survivorship phases: at 2 months (n=162), 2 years (n=896), and 5 years (n=608) post-diagnosis. Results: The NAFC-C helped to identify caregivers whose needs were less likely to be met, based on their age and ethnicity. Furthermore, the extent to which caregivers' psychosocial needs were not being met was a consistent and strong predictor of poor mental health across all phases of survivorship, beyond the effects of a host of demographic characteristics. Conclusion: Findings suggest that interventions designed to help caregivers manage their own emotional distress as well as the survivors' distress, find meaning in the cancer caregiving experience, and foster supportive familial relationship will benefit caregivers by improving their QOL, not only during the time of diagnosis and treatment but years after. Copyright © 2009 John Wiley & Sons, Ltd.

Personality traits and psychosocial stress: quality of life over 2 years following breast cancer diagnosis and psychological impact factors.

Abstract: Objective: The aim of this study was to investigate changes in the quality of life (QoL) and body image among breast cancer patients over 2 years and to examine different predictive factors for QoL 2 years after the primary operation. Methods: A total of 203 women with a primary diagnosis of breast cancer completed the questionnaires 2 weeks and 6, 12, 18, and 24 months after surgery. Quality of Life Questionnaire (QLQ-C30), Breast Cancer Specific Quality of Life Questionnaire Module (QLQ-BR23), Questionnaire on Stress in Cancer Patients (QSC-R23), Freiburg Personality Inventory (FPI-R), Life Orientation Test (LOT) were used as standardized measures. Results: The overall QoL and most functional and symptom scales improved during the 2-year period. However, cognitive functioning, body image, and the three symptom scales of insomnia, constipation, and diarrhea did not change. Age was only capable of predicting physical functioning, whereas tumor size, axillary surgery, and adjuvant chemotherapy were not predictive of the long-term QoL functional scores. Initial distress was the most potent predictive factor for long-term QoL. Baseline functioning predicted functional QoL scores 2 years later. And higher scores for neuroticism were associated with a poorer QoL. However, optimism was not capable of predicting the QoL 2 years later. Conclusion: Screening measures should be implemented at the time when breast cancer is diagnosed, in order to identify psychologically vulnerable patients and offer them professional psycho-oncological help. Copyright © 2009 John Wiley & Sons, Ltd.

Women with advanced breast cancer and their spouses: diversity of support and psychological distress.

Abstract: Objective: The current study examines the effect of perceived support from different agents (spouse, family, friends, religion—spirituality) on psychological distress experienced by women with advanced breast cancer and their male spouses. Methods: In all, 150 couples consisting of women with advanced breast cancer and their spouses completed the Cancer Perceived Agent of Support Questionnaire and the Brief Symptom Inventory Scale. Results: Spouses reported more psychological distress (global, depression and anxiety) than patients. Both patients and spouses report a similar level of spousal support, and spouses reported a lower level of support provided from family and friends. Perceived support in the current study contributed significantly to the explanations of global psychological distress, depression and anxiety both for patients and their spouses. However, the specific agents of support that were significant in explaining these outcomes varied between patients and their spouses. For patients, family support received by both patient and partner was the most important source of support, protecting from psychological distress, while for the male partners, support from friends was most important. Religious-based support was found to contribute negatively to the psychological distress of the patient and spouse. Conclusions: This study emphasizes the role of breast cancer spouses as care receivers in parallel to their role as caregivers, which is especially important in light of the high psychological distress reported by the spouses. The findings support the buffering effect, which different agents of support have against psychological distress while facing cancer for both patients and spouses. Patients and spouses differ with regard to the agents of support possessing this buffering effect. Copyright © 2009 John Wiley & Sons, Ltd.

Psychological benefits for cancer patients and their partners participating in mindfulness-based stress reduction (MBSR).

Abstract: Objective: Cancer patients experience many negative psychological symptoms including stress, anxiety, and depression. This distress is not limited to the patient, as their partners also experience many psychological challenges. Mindfulness-based stress reduction (MBSR) programs have demonstrated clinical benefit for a variety of chronic illnesses, including cancer. This is the first study to report MBSR participation with partners of cancer patients. Methods: This study examined the impact of an 8-week MBSR program for 21 couples who attended the program together on outcomes of mood disturbance, symptoms of stress, and mindfulness. Results: Significant reductions for both patients and partners in mood disturbance (p<0.05) and the Calgary Symptoms of Stress Inventory (C-SOSI) subscales of muscle tension (p<0.01), neurological/GI (p<0.05), and upper respiratory (p<0.01) symptoms were observed after program participation. Significant increases in mindfulness (p<0.05) were also reported in both groups. No significant correlations were observed between patient and partner scores on any measures at baseline or on change scores pre- to post-intervention; however, after MBSR participation couple's scores on the Profile of Mood States and C-SOSI were more highly correlated with one-another. Post-intervention, partners' mood disturbance scores were significantly positively correlated with patients' symptoms of stress and negatively correlated with patients' levels of mindfulness. Conclusions: Overall, the MBSR program was helpful for improving psychological functioning and mindfulness for both members of the couple. Several avenues of future research are suggested to further explore potential benefits of joint couple attendance in the MBSR program. Copyright © 2010 John Wiley & Sons, Ltd.

Two different sides of 'chemobrain': determinants and nondeterminants of self-perceived cognitive dysfunction in a prospective, randomized, multicenter study.

Abstract: Objective: Complaints of cognitive dysfunction are frequent among cancer patients. Many studies have identified neuropsychological compromise associated with cancer and cancer therapy; however, the neuropsychological compromise was not related to self-reported cognitive dysfunction. In this prospective study, the authors examined if confounding factors masked an underlying association of self-perceived cognitive function with actual cognitive performance. Determinants of self-perceived cognitive dysfunction were investigated. Methods: Self-perceived cognitive function and cognitive performance were assessed before treatment, at the end of treatment, and 1 year after baseline in 101 breast cancer patients randomized to standard versus intensified chemotherapy. Linear mixed-effects models were applied to test the relationships of performance on neuropsychological tests, patient characteristics, and treatment variables to self-reported cognitive function. Change of cognitive performance was tested as a predictor of change in self-reports. Results: Self-perceived cognitive function deteriorated during chemotherapy and had partially recovered 1 year after diagnosis. The personality trait negative affectivity, current depression, and chemotherapy regimen were consistently related to cognitive self-reports. No significant associations with performance in any of the 12 cognitive tests emerged. Change of cognitive performance was not reflected in self-reports of cognitive function. Conclusions: Neuropsychological compromise and self-perceived cognitive dysfunction are independent phenomena in cancer patients. Generally, cancer-associated neuropsychological compromise is not noticed by affected patients, but negative affectivity and treatment burden induce pessimistic self-appraisals of cognitive functioning regardless of the presence of neuropsychological compromise. Clinicians should consider this when determining adequate therapy for patients who complain of ‘chemobrain’. Copyright © 2010 John Wiley & Sons, Ltd.

The Meaning‐Making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: a randomized controlled pilot study

Abstract: Objective: This pilot study aimed to provide supportive evidence for the acceptability and usefulness of the Meaning-Making intervention (MMi) in patients newly diagnosed with Stage III or IV ovarian cancer, and to provide estimates of parameters needed to design a full-scale study. Methods: A randomized controlled trial with 24 patients (12 experimental and 12 control) was conducted. Existential well-being (primary outcome), overall quality of life, distress, anxiety, depression and self-efficacy were measured. Results: Compared to the control group, patients in the experimental group had a better sense of meaning in life at one and three months post-intervention. Conclusion: The MMi seems a promising intervention for advanced cancer patients, and a full randomized controlled trial is warranted to further investigate its efficacy. Copyright © 2010 John Wiley & Sons, Ltd.

Post-traumatic growth: finding positive meaning in cancer survivorship moderates the impact of intrusive thoughts on adjustment in younger adults.

Abstract: Objective: We examined whether post-traumatic growth would moderate the impact of intrusive thoughts on a range of dimensions of well-being in a sample of younger adult survivors of various types of cancer. Methods: 167 participants completed questionnaires regarding intrusive thoughts, post-traumatic growth, mental and physical health-related quality of life, positive and negative affect, life satisfaction, and spiritual well-being. Multiple regression analyses controlling for relevant background and cancer-related variables tested the interaction effects of post-traumatic growth and intrusive thoughts. Results: Intrusive thoughts were related to poorer adjustment on all indices except physical health-related quality of life. However, post-traumatic growth moderated the effects of intrusive thoughts on positive and negative affect, life satisfaction, and spiritual well-being in a protective fashion. That is, for those higher in post-traumatic growth, higher levels of intrusive thoughts were related to better adjustment. Conclusions: The positive meaning that individuals assign to their cancer experience as reflected in their reports of post-traumatic growth appears to be important in determining the impact of intrusive thoughts on post-cancer adjustment. Copyright © 2009 John Wiley & Sons, Ltd.

Psychosocial interventions as part of breast cancer rehabilitation programs? Results from a systematic review

Abstract: Objective: This systematic review aimed to determine the effectiveness of psychoeducation, cognitive behavioural therapy (CBT) and social support interventions used in the rehabilitation of breast cancer (BC) patients. Methods: We conducted a systematic literature search to identify randomised controlled trials of female BC patients who underwent different psychosocial interventions during or after primary cancer treatment. The methodological quality of all studies was independently assessed by two reviewers. Studies with low quality, less than 20 participants in each group, patients with metastatic cancer, data not presented separately for BC and studies that included other cancer types were excluded. Results: Among 9617 identified studies, only 18 RCTs published between 1999 and 2008, including 3272 patients were finally included in this systematic evaluation. Outcome measures were categorised into quality of life (QoL), fatigue, mood, health behaviour and social function. Six trials examined psychoeducation had inconsistent results, both during and after the primary treatment. Seven trials examined the effect of CBT, four of which given after primary treatment (range 6–12 weeks) demonstrated improvements in QoL; the other three CBT studies given during primary treatment (range 9–20 weeks) had inconsistencies. Five studies addressed social support and showed no conclusive impacts of this intervention. Conclusions: Limited documentation exists on the efficacy of psychosocial rehabilitation interventions among BC patients. However, we found that patients might have QoL benefits from CBT given after primary BC treatment. More documentation is needed regarding the effects of CBT during primary treatment and the effects of psychoeducation and social support. Copyright © 2010 John Wiley & Sons, Ltd.

Quality of life of family caregivers at 2 years after a relative's cancer diagnosis

Abstract: Purpose: Although a growing body of research has documented the quality of life (QOL) of cancer survivors beyond the initial phase of the survivorship, similar knowledge about family caregivers of cancer survivors remains limited. Thus, the current study aimed: (a) to characterize the multidimensional aspects of the QOL of family caregivers of cancer survivors at 2 years after the diagnosis and (b) to predict certain aspects of caregivers' QOL by their demographic and caregiving characteristics. Methods: A total of 1635 caregivers of cancer survivors participated in the nationwide Quality of Life Survey for Caregivers. Multidimensional aspects of QOL were assessed, including mental and physical health, as well as psychological adjustment and spirituality at 2 years post-diagnosis of their relatives' cancer. Results: Family caregivers reported normal levels of QOL after 2 years post-diagnosis, except that they were more likely to experience increased awareness of spirituality than do individuals who personally experience a chronic illness. In addition, caregivers' age and income and care-recipients' poor mental and physical functioning were significant predictors of their QOL at 2 years post-diagnosis. Conclusions: The findings suggest that younger, relatively poor caregivers who are providing care to relatives with poor mental and physical functioning may benefit from interventions to help in their spirituality and psychological and physical adjustment, 2 years after the initial cancer diagnosis. In addition, older, relatively poor caregivers may benefit from programs to reduce the physical burden of caregiving. These findings have implications for advancing public health research and practice. Copyright © 2009 John Wiley & Sons, Ltd.

Disparities in mental health between rural and nonrural cancer survivors: a preliminary study.

Abstract: Cancer disparity research has focused primarily on identifying population-based characteristics linked to cancer incidence, survival, and treatment [1–4]. While the mental health (MH) of cancer survivors is of great significance [5–6], little research has examined the link between population-based characteristics and MH outcomes among cancer survivors. In particular, there is scant research examining whether geographic residence, that is whether an individual resides in a rural or nonrural area, has significant bearing on an individual’s MH following cancer diagnosis. Since over 10 million cancer survivors live in the United States (U.S.) [7], and roughly 20% of the population resides in rural areas, one can estimate the presence of approximately 2 million rural cancer survivors. With such a large number of rural cancer survivors, it is important to consider whether rural residence might be an important predictor of MH in cancer survivors. There are several reasons to believe residing in a rural area, characterized by low population density and geographic isolation [8–9], might influence adjustment after cancer diagnosis. First, disparate rates of comorbidity [9] and variation in cancer treatment received by rural and nonrural residents [10–11], may place rural cancer survivors at risk for poor physical functioning, which might have negative implications for MH. Second, few MH professionals (e.g., psychologists, psychiatrists), long travel distances to healthcare providers, low rates of insurance, and little anonymity for those seeking treatment from MH professionals in rural areas [8–9, 12–13], could contribute to rural residents consuming less MH treatment than nonrural residents [14–16]. Third, geographic isolation can make it difficult for rural cancer survivors to participate in cancer support groups and access information that could be helpful in coping with illness-related distress [17]. Fourth, a cancer diagnosis might be more difficult to discuss in rural areas [18–19] due to social norms regarding disclosure of one’s emotional or psychological problems to other individuals [19], including MH professionals [20]. In sum, unique aspects of rural residence may interact with the experience of cancer diagnosis, treatment, and recovery, such that rural cancer survivors experience poorer MH outcomes than nonrural cancer survivors. Despite the likelihood and potential importance of MH disparities between rural and nonrural cancer survivors, few studies have directly compared the MH of rural and nonrural cancer survivors [21–24]. In a sample of 191 female long-term cancer survivors, Kurtz and colleagues [21] found geographic residence was not a significant predictor of quality of life (QOL) outcomes, including “psychological state.” In contrast, in a study of 60 recently diagnosed breast and cervical cancer survivors, Lyons and Shelton [22] found rural survivors reported poorer QOL than nonrural survivors, despite no differences in the severity of depressive symptoms. Lancee and colleagues [23] reported rural residence was unrelated to the experience of distress among a sample of 1309 cancer survivors, the majority of whom were diagnosed with breast and genitourinary cancers. Finally, rural cancer survivors were not more likely than nonrural cancer survivors to report need for psychological assistance [24]. While these studies provide some information, they all evidence methodological limitations, including small sample sizes [22], not being designed to test for differences between rural and nonrural survivors [21, 23–24], examination of only 1 or 2 indices of MH [21–23], lack of any objective criterion for determining rural residence [21–23], and inclusion of only female participants [21–22, 24], most of whom were diagnosed with breast cancer. It could even be argued that some participants in Lyons and Shelton’s [22] sample are not cancer “survivors” per se, as many were still undergoing treatment. Considering all of the above, it is clear that no well-designed study of MH disparities between rural and nonrural cancer survivors currently exists. The present study aimed to identify the nature and magnitude of differences in MH outcomes in cancer survivors as a function of rural residence. Indices of both psychological distress and well-being were included to allow for a comprehensive assessment of participants’ MH functioning. It was hypothesized that rural cancer survivors would report poorer MH (i.e., greater psychological distress and less well-being) than nonrural cancer survivors.

Sexual functioning in young adult survivors of childhood cancer.

Abstract: Background—Studies of sexuality or sexual behavior in childhood cancer survivors tend to examine relationships or achievement of developmental milestones but not physiological response to cancer or treatment. The purpose of this study is to (1) identify prevalence and risk factors for sexual dysfunction in childhood cancer survivors, and (2) examine the extent to which sexual dysfunction may be associated with health-related quality of life (HRQOL) and psychosocial outcomes. Methods—Five hundred ninety-nine survivors age 18-39 years completed standardized measures of sexual functioning, HRQOL, psychological distress and life satisfaction. Descriptive statistics assessed prevalence of sexual symptoms. Bivariate analyses identified correlates of sexual symptoms and examined associations between symptoms and HRQOL/psychosocial outcomes. Results—Most survivors appear to be doing well, although 52% of female survivors and 32% of male survivors reported at least “a little of a problem” in one or more areas of sexual functioning. Mean symptom score for females was more than twice that of males. Sexual symptoms were associated with reporting health problems. Significant associations between sexual functioning and HRQOL outcomes were observed, with gender differences in strengths of association suggesting that males find sexual symptoms more distressing than do females. Conclusions—While most survivors appear to be doing well in this important life domain, some young adult survivors report sexual concerns. While female survivors may report more sexual symptoms than male survivors, males may experience more distress associated with sexual difficulties. Better specified measures of sexual function, behavior and outcomes are needed for this young adult population.

Meta-analyses of the effect of false-positive mammograms on generic and specific psychosocial outcomes

Abstract: Objectives: While a previous meta-analysis found that false-positive mammography results affect women’s likelihood of returning for screening, effects on well being have yet to be metaanalyzed. We investigated whether the effects of false-positive mammograms on women’s wellbeing are limited to outcomes specific to breast cancer. Methods: We searched MEDLINE for studies of the psychosocial effects of false-positive results of routine screening mammography. We pooled effect sizes using random effects metaanalysis. Results: Across 17 studies (n 5 20 781), receiving a false-positive mammogram the result was associated with differences in all eight breast-cancer-specific outcomes that we examined. These included greater anxiety and distress about breast cancer as well as more frequent breast self-exams and higher perceived effectiveness of screening mammography. False positives were associated with only one of six generic outcomes (i.e. generalized anxiety), and this effect size was small. Conclusions: False-positive mammograms influenced women’s well-being, but the effects were limited to breast-cancer-specific outcomes. Researchers should include disease-specific measures in future studies of the consequences of false-positive mammograms. Copyright r 2009 John Wiley & Sons, Ltd.

A randomized, controlled study of Internet peer-to-peer interactions among women newly diagnosed with breast cancer.

Abstract: Objective: Peer-to-peer interactions are associated with enhanced psychosocial adjustment among women with breast cancer. Millions of women with cancer and others with various health conditions use the Internet to establish peer relationships, usually without professional moderation. This paper reports findings from the first randomized, controlled study of the benefits of these types of Internet-based peer interactions. Methods: This pilot study involved seventy-eight women who were recently diagnosed with breast cancer. Participants were randomly assigned to either an Internet peer support condition or Internet-based educational control condition. Data were gathered at baseline and 4- and 12-months. Primary outcomes of interest were psychological distress and quality of life. Results: Contrary to hypotheses, participants in the Internet peer support condition tended to do worse over time on primary outcome measures. There were no differences between groups on secondary outcomes of perceived social support, self-efficacy, or hope. Paradoxically, many women in the Internet peer support condition actively participated and reported high levels of satisfaction, suggesting some self-perceived benefits. Conclusions: These results suggest that Internet based peer-to-peer interactions may not necessarily be universally beneficial despite the positive experiences reported by many participants. Further research is needed to understand the magnitude of this effect with a larger sample. Moreover, these results raise questions about the need to understand the comparative effectiveness of Internet-based communications by group structure (i.e., unstructured/structured; unmoderated/moderated) and the effect of content (i.e., expression of fear/anxiety, insightful disclosures, etc.) on outcomes. Copyright © 2009 John Wiley & Sons, Ltd.

Individual and dyadic predictors of body image in women with breast cancer

Abstract: Objective: Previous studies examining the body image among breast cancer (BC) patients have primarily focused on their psychosocial adjustment or on the predictive value of body image on quality of life. Little is known about predictors of body image. Methods: The present study investigated how much body image in women with BC is determined by individual factors (surgery type, medical treatments, disease stage, women's age, depressive symptoms) and by dyadic variables (relationship satisfaction and duration, dyadic coping). Furthermore, two different aspects of women's body image were assessed: self acceptance and perceptions of partners' acceptance. Ninety-eight German women with early stage BC and their partners participated. Results: Individual and dyadic aspects of body image were differentially related to body image. Women's depressive symptoms and men's marital satisfaction predicted women's self-acceptance, but not women's perceptions of their partners' acceptance of their appearance. Female's relationship satisfaction and perspective on common dyadic coping predicted women's perceptions of their partner's acceptance of their appearance. Conclusions: The findings suggest interventions that include strategies to reduce women's depressive symptoms and build relationship satisfaction, might reduce body image difficulties in women after BC. Copyright (C) 2009 John Wiley & Sons, Ltd.

Neuropsychological Functioning and Quality of Life During the First Year after Completing Chemotherapy for Breast Cancer

Abstract: Objective: Research has documented modest cognitive difficulties among women treated for breast cancer. The present study was designed to evaluate the effects of these subtle cognitive changes on quality of life after treatment. Methods: Data are presented from women breast cancer patients who completed neuropsychological tests and questionnaires regarding quality of life 6 and 12 months post-chemotherapy (n's=39 and 33). Neuropsychological test scores were examined for evidence of cognitive difficulties at each time point; repeated measures ANOVAs were used to identify changes over time. Regression analyses assessed relationships of quality of life outcomes with cognitive functioning, social support seeking, and fatigue. Results: Small percentages of participants (<20% across tests) evidenced deficits in delayed memory, processing speed, response inhibition, and verbal fluency (VF) at each time point. Reliable change index analyses suggested statistically reliable improvements in each cognitive domain for a modest portion of participants. Regressions revealed hesitation to seek social support and fatigue as the most consistent predictors of quality of life at 6 and 12 months post-chemotherapy. Cognitive complaints and VF difficulties were also significantly related to quality of life at 12 months. Conclusions: In addition to confirming the importance of fatigue and social support in quality of life, these data offer preliminary indications that weaker VF skills and self-reported cognitive complaints may be associated with poorer functional outcomes among cancer survivors. Further research is needed to validate these potential relationships, which suggest that cognitive difficulties among cancer survivors may warrant monitoring and possible intervention. Copyright © 2009 John Wiley & Sons, Ltd.