Showing papers in "Psycho-oncology in 2018"

One in two cancer patients is significantly distressed: Prevalence and indicators of distress.

Abstract: Objective Psychological distress is common in cancer patients and awareness of its indicators is essential We aimed to assess the prevalence of psychological distress and to identify problems indicative of high distress Methods We used the Distress Thermometer (DT) and its 34-item Problem List to measure psychological distress in 3,724 cancer patients (mean age 58 years; 57% women) across major tumor entities, enrolled in an epidemiological multicenter study To identify distress-related problems, we conducted monothetic analyses (MONA) Results We found high levels of psychological distress (DT≥5) in 52% of patients The most prevalent problems were fatigue (56%), sleep problems (51%), and problems getting around (47%) Sadness, fatigue and sleep problems were most strongly associated with the presence of other problems High distress was present in 814% of patients reporting all three of these problems (DT M=64) When analyzing only the subset of physical problems, fatigue, problems getting around and indigestion showed the strongest association with the remaining problems and 763% of patients with all three problems were highly distressed (DT M=61) Conclusions Our results show a high prevalence of psychological distress in cancer patients, as well as a set of problems that indicate the likely presence of other problems and high distress and can help clinicians identify distressed patients even if no routine distress screening is available

Predictors of adherence to exercise interventions during and after cancer treatment: A systematic review.

Abstract: Objective Exercise interventions benefit cancer patients. However, only low numbers of patients adhere to these interventions. This review aimed to identify predictors of exercise intervention adherence in patients with cancer, during and after multimodality cancer treatment. Methods A literature search was performed using electronic databases (PubMed, Embase, and Cochrane) to identify relevant papers published before February 1, 2017. Papers reporting randomized controlled trials, conducted in adult cancer patients who participated in an exercise intervention during and/or after multimodality cancer treatment, and providing outcome of factors predicting exercise adherence were included. Papers were assessed for methodological quality by using the Physiotherapy Evidence Database scale. Results The search identified 720 potentially relevant papers, of which 15 fulfilled the eligibility criteria. In these 15 studies, 2279 patients were included and 1383 of these patients were randomized to an exercise intervention. During cancer treatment, the factors predicting exercise adherence were as follows: location of the rehabilitation center, extensive exercise history, high motivation for exercise, and fewer exercise limitations. After cancer treatment, factors that predicted adherence were as follows: less extensive surgery, low alcohol consumption, high previous exercise adherence, family support, feedback by trainers, and knowledge and skills of exercise. Methodological quality of the included papers was rated "high". Conclusions The most prominent predictors of adherence to exercise interventions were location of the rehabilitation center, extensive exercise history, high motivation for exercise, and fewer exercise limitations. To increase the number of cancer patients who will benefit, these results should be considered into the development and implementation of future exercise interventions.

Prevalence of burnout syndrome in oncology nursing: A meta-analytic study.

Abstract: Objective To determine the prevalence of high levels of emotional exhaustion and depersonalization and low personal accomplishment in nursing professionals in oncology services. Methods A meta-analytical study was performed. The search was carried out in March 2017 in Pubmed, CINAHL, Scopus, Scielo, Proquest, CUIDEN, and LILACS databases. Studies using Maslach Burnout Inventory for the assessment of burnout were included. Results The total sample of oncology nurses was n = 9959. The total number of included studies was n = 17, with n = 21 samples for the meta-analysis of emotional exhaustion and n = 18 for depersonalization and low personal accomplishment. The prevalence of emotional exhaustion and of depersonalization was 30% (95% CI = 26%-33%) and 15% (95% CI = 9%-23%), respectively, and that of low personal performance was 35% (95% CI = 27%-43%). Conclusions The are many oncology nurses with emotional exhaustion and low levels of personal accomplishment. The presence and the risk of burnout among these staff members are considerable.

Psychosocial functioning and risk factors among siblings of children with cancer: An updated systematic review.

Abstract: Objectives Siblings' psychosocial adjustment to childhood cancer is poorly understood. This systematic review summarizes findings and limitations of the sibling literature since 2008, provides clinical recommendations, and offers future research directions. Method MEDLINE/Pubmed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO were searched for articles related to siblings, psychosocial functioning, and pediatric cancer. After systematic screening, studies meeting inclusion criteria were rated for scientific merit, and findings were extracted and synthesized. In total, 102 studies were included (63 quantitative, 35 qualitative, 4 mixed-methods). Results Methodological limitations are common. Mean levels of anxiety, depression, and general adjustment are similar across siblings and comparisons, but symptoms of cancer-related posttraumatic stress are prevalent. School-aged siblings display poorer academic functioning and more absenteeism but similar peer relationships as peers. Quality of life findings are mixed. Adult siblings engage in higher levels of risky health behaviors and may have poorer health outcomes than comparisons. Risk factors for poor sibling adjustment include lower social support, poorer family functioning, lower income, non-White race, and shorter time since diagnosis, but findings are inconsistent. Qualitative themes include siblings' maturity, compassion, and autonomy, but also strong negative emotions, uncertainty, family disruptions, limited parental support, school problems, altered friendships, and unmet needs. Conclusion Despite methodological limitations, research indicates a strong need for sibling support. Clinical recommendations include identifying at-risk siblings and developing interventions to facilitate family communication and increase siblings' social support, cancer-related knowledge, and treatment involvement. Future longitudinal studies focusing on mechanisms and moderators of siblings' adjustment would inform timing and targets of psychosocial care.

Perceived employer-related barriers and facilitators for work participation of cancer survivors: A systematic review of employers' and survivors' perspectives.

Abstract: Objective To identify employer-related barriers and facilitators for work participation of cancer survivors from the perspective of both employers and cancer survivors, and to synthesise these perceived barriers and facilitators to understand their perceived consequences. Methods A systematic review of qualitative studies focusing on employers' and cancer survivors' perspectives on the work participation of cancer survivors was performed. Four databases (MEDLINE, EMBASE, PsycINFO, and Business Source Premier) were systematically searched, and the quality of studies included was assessed using the CASP checklist. Perceived barriers and facilitators were extracted and synthesised to conduct a content analysis. Results Five studies representing the employers' perspectives and 47 studies representing the cancer survivors' perspectives were included. Employers perceived barriers and facilitators related to support, communication, RTW policies, knowledge about cancer, balancing interests and roles, and attitude. Survivors perceived barriers and facilitators related to support, communication, work environment, discrimination, and perception of work ability. The synthesis found that the employers' willingness to support can be understood by perceptions they have of the survivor, goals of the employer, and national or organisational policies. Employers require knowledge about cancer and RTW policies to be able to support survivors. Conclusions This review identified a plurality of and a large variety in perceived employer-related barriers and facilitators for work participation of cancer survivors, which can be understood to be related to both employers' willingness and ability to support. There is a need for interventions targeting employers, with the aim of enhancing the sustainable work participation of cancer survivors.

The Generalized Anxiety Disorder Screener (GAD-7) and the anxiety module of the Hospital and Depression Scale (HADS-A) as screening tools for generalized anxiety disorder among cancer patients.

Abstract: Objective Anxiety in cancer patients may represent a normal psychological reaction. To detect patients with pathological levels, appropriate screeners with established cut-offs are needed. Given that previous research is sparse, we investigated the diagnostic accuracy of 2 frequently used screening tools in detecting generalized anxiety disorder (GAD). Methods We used data of a multicenter study including 2141 cancer patients. Diagnostic accuracy was investigated for the Generalized Anxiety Disorder Screener (GAD-7) and the anxiety module of the Hospital Anxiety and Depression Scale (HADS-A). GAD, assessed with the Composite International Diagnostic Interview for Oncology, served as a reference standard. Overall accuracy was measured with the area under the receiver operating characteristics curve (AUC). The AUC of the 2 screeners were statistically compared. We also calculated accuracy measures for selected cut-offs. Results Diagnostic accuracy could be interpreted as adequate for both screeners, with an identical AUC of .81 (95% CI: .79-.82). Consequently, the 2 screeners did not differ in their performance (P = .86). The best balance between sensitivity and specificity was found for cut-offs ≥7 (GAD-7) and ≥8 (HADS-A). The officially recommended thresholds for the GAD-7 (≥ 10) and the HADS-A (≥11) showed low sensitivities of 55% and 48%, respectively. Conclusions The GAD-7 and HADS-A showed AUC of adequate diagnostic accuracy and hence are applicable for GAD screening in cancer patients. Nevertheless, the choice of optimal cut-offs should be carefully evaluated.

Sexual dysfunction and reproductive concerns in young women with breast cancer: Type, prevalence, and predictors of problems.

Abstract: OBJECTIVE A dearth of studies focusing on young women (<40 years) with breast cancer have hampered the understanding of the type, prevalence, and predictors of sexual dysfunction and reproductive concerns in this population. METHODS Data were collected from 181 women (response rate = 60%) diagnosed with breast cancer approximately 2 years previously (age 21-39) using the Swedish National Quality Registry for Breast Cancer and a survey including standardized measures of sexual dysfunction, reproductive concerns, body image, and health-related quality of life. Multivariable logistic binary regression analyses were used to identify predictors of sexual dysfunction and reproductive concerns. RESULTS Sexual dysfunction in at least one domain was reported by 68% of the women, and a high level of reproductive concerns in at least one dimension was reported by 58%. Model results showed that current endocrine treatment was a significant predictor of dysfunction related to lubrication (OR 3.8, 95% CI 1.2-12.1) and vaginal discomfort (OR 8.7, 95% CI 1.5-51.5). Negative body image was related to satisfaction with sex life (OR 1.1, 95% CI 1.0-1.2). A high level of reproductive concerns was predicted by a wish for (additional) children in the future (OR 3.4, 95% CI 1.1-10.2) and by previous chemotherapy (OR 2.5, 95% CI 1.1-5.9). CONCLUSIONS Sexual dysfunction and reproductive concerns are common in young women with breast cancer. Current endocrine treatment, previous chemotherapy, a negative body image, and a wish for children in the future predict higher level of problems.

Exploring cancer survivors' views of health behaviour change: "Where do you start, where do you stop with everything?"

Abstract: Objective Physical activity (PA) and a healthy diet can improve the well-being of cancer survivors. However, cancer survivors often do not engage in these behaviours. This study aimed to explore barriers and facilitators to engaging in these behaviours following cancer treatment. Methods During the development of a Web-based intervention to enhance health-related quality of life in cancer survivors, 32 people who had completed treatment for breast, colon, or prostate cancer were presented with an intervention for PA and healthy eating. In-depth think-aloud and semi-structured interviewing techniques were used to elicit perceptions of both behaviours. Data were analysed using thematic analysis. Results Some individuals reported implementing positive health behaviour changes to maintain health and prevent recurrence, or to help them to move forward after cancer. However, others reported feeling abandoned, and many did not report an intention to engage in lifestyle changes. Individuals discussed contextual and health-related barriers that were specifically linked to their situation as post-treatment cancer survivors: individuals described uncertainty about how to implement adaptive changes and perceived a lack of support from health care providers. Others viewed behaviour change as unnecessary or undesirable, with some arguing that non-modifiable factors contributed more to their cancer diagnosis than lifestyle-related factors. Conclusions For many participants in this study, the period that follows treatment for cancer did not represent a "teachable moment." A variety of complex and heterogeneous factors appeared to impact motivation and may limit cancer survivors from engaging with diet and PA changes.

Mind-body interventions for fear of cancer recurrence: A systematic review and meta-analysis.

Abstract: OBJECTIVE Fear of cancer recurrence (FCR) is a common existential concern and source of distress among adults with a cancer history. Multiple randomized controlled trials (RCTs) have examined mind-body approaches to mitigating FCR. We summarized characteristics of these trials and calculated their pooled effects on decreasing FCR. METHODS Six electronic databases were systematically searched from inception to May 2017, using a strategy that included multiple terms for RCTs, cancer, mind-body medicine, and FCR. Data extraction and reporting followed Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes on self-report measures of FCR were computed by using random-effects models. RESULTS Nineteen RCTs (pooled N = 2806) were included. Most studies (53%) were published since 2015 and targeted a single cancer type (84%; mostly breast). Intervention sessions (median = 6, mode = 4) tended to last 120 minutes and occur across 1.5 months. Delivery was predominantly in-person (63%) to either groups (42%) or individuals (42%). Most interventions incorporated multiple mind-body components (53%), commonly cognitive-behavioral skills (58%), or meditative practices (53%). Small-to-medium pooled effect sizes were observed postintervention (Hedges' g = -0.36, 95% CI = -0.49, -0.23, P < .001) and at follow-up assessments (median = 8 months, P < .001). Potential modifiers (control group design, group/individual delivery, use of cognitive-behavioral or mindfulness skills, number of mind-body components, cancer treatment status, and number of sessions) did not reach statistical significance. CONCLUSIONS Mind-body interventions are efficacious for reducing FCR, with small-to-medium effect sizes that persist after intervention delivery ends. Recommendations include testing effects among survivors of various cancers and exploring the optimal integration of mind-body practices for managing fundamental uncertainties and fears during cancer survivorship.

A systematic review of patient oncofertility support needs in reproductive cancer patients aged 14 to 45 years of age.

Abstract: Objective Decline in fertility potential brought about by a cancer diagnosis or cancer treatment is one of the biggest impacts to cancer patients' long term quality of life. As such, the current manuscript aimed to systematically review the literature on oncofertility support needs for cancer patients of a reproductive age (14-45 years of age). Methods A systematic review of the literature was conducted in May 2016 through the searching of electronic databases Medline, EMBASE, PSYCH Info, Web of Science and SCOPUS, alongside the screening of relevant reference lists. An initial search identified 351 potentially relevant studies. The papers were divided into two categories; papers on patient oncofertility support needs were reviewed for this systematic review and papers on clinician provision of oncofertility support were reviewed for a separate systematic review. Results A total of 30 studies were included within the final review. Support needs were categorised as information, service, clinician-patient interactions, psychological and family. A number of studies indicated that cancer patients place great important on their oncofertility care and have unmet support needs. Patients were satisfied and felt supported when additional care was taken to ensure fertility information and service needs were met. Conclusions Patients desire for clinicians to support their concerns through the provision of adequate information, access to oncofertility services, taking time to discuss oncofertility treatment and concerns, specialised psychological support and responsiveness to individual needs.

Predictors of emotional distress a year or more after diagnosis of cancer: A systematic review of the literature.

Abstract: Objective Why some people recover emotionally after diagnosis and treatment of cancer and others do not is poorly understood. To identify factors around the time of diagnosis that predict longer-term distress is a necessary step in developing interventions to reduce patients' vulnerability. This review identified the demographic, clinical, social, and psychological factors available at or within 3 months of diagnosis that are reliable predictors of emotional distress at least 12 months later. Methods A systematic search of literature for prospective studies addressing our research question and predicting a range of distress outcomes was conducted. Thirty-nine papers (reporting 36 studies) were subjected to narrative synthesis of the evidence. Results There was no consistent evidence that demographic, clinical, or social factors reliably predicted longer-term distress. Of the psychological factors examined, only baseline distress (significant in 26 of 30 relevant papers; 24 of 28 studies) and neuroticism (significant in all 5 papers/studies that examined it) consistently predicted longer-term distress. The heterogeneity of included studies, particularly in populations studied and methodology, precluded meta-analytic techniques. Conclusions This review supports current clinical guidance advising early assessment of distress as a marker of vulnerability to persistent problems. Additionally, neuroticism is also indicated as a useful marker of vulnerability. However, the review also highlights that more sophisticated research designs, capable of identifying the psychological processes that underlie the association between these marker variables and persistent distress, are needed before more effective early interventions can be developed.

A meta-analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients.

Abstract: OBJECTIVE The aim of this study was to examine the effect of cognitive behavior therapy (CBT) on quality of life (QOL) and psychological health of breast cancer survivors and patients. METHODS A total of 1289 references were examined from an overall literature search in PubMed, Embase, CINAHL, and the Cochrane Database of Systematic Reviews. Randomized controlled trials assessing the efficacy of CBT compared with a range of comparators in cancer survivors. We assessed the effect of CBT by using the standardized mean difference as effect size. RESULTS Among 1289 abstracts and 292 full-text articles reviewed, 10 studies were included. At the posttreatment period, the pooled effect size for CBT on QOL was 0.57 (95% CI, 0.44 to 0.69; P < .001), on depression was -1.11 (95% CI, -1.28 to -0.94; P < .001), on stress was -0.40 (95% CI, -0.53 to -0.26; P < .001), on anxiety was -1.10 (95% CI, -1.27 to -0.93; P < .001), and on hyperarousal cluster of symptoms was -0.18 (95% CI, -0.30 to -0.05; P < .001). The QOL was considered statistically medium effect sizes. The depression and anxiety were considered statistically large effect sizes. CONCLUSIONS Cognitive behavior therapy is an effective therapy for psychological symptoms of cancer survivors and patients, with meaningfully clinical effect sizes. These findings suggested that CBT should be used as the intervention for breast cancer survivors and patients when possible.

Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care: A systematic review and meta‐synthesis

Abstract: Objectives To explore the cancer care experiences and unmet needs of people who identify as a sexual or gender minority. Methods A qualitative systematic review and meta-synthesis was undertaken based on a registered protocol. Following literature searching and study selection, study quality was examined by using the Critical Appraisal Skill Programme Checklist. Qualitative data were extracted verbatim from included studies and synthesized by using thematic analysis. Results Fifteen studies that included lesbian, gay, and bisexual (LGB) people living with or beyond cancer were included in the review. Studies including gender minorities were not identified. Most of the study participants were sexual minority women with breast cancer or sexual minority men with prostate cancer. Meta-synthesis of 106 individual findings generated 6 overarching themes pertaining to sexual orientation disclosure, experiences and fear of homophobia, positive and negative health-care professional behaviors, heterocentric systems and care, inadequacy of available support groups, and unmet needs for patient-centered care and LGB-specific information. Lesbian, gay, and bisexual people often reported feelings of anxiety, invisibility, isolation, and frustration throughout the cancer care continuum. Conclusions Analysis of the experiences of LGB people with cancer care shows that LGB people face numerous challenges due to their sexual orientation and receive care that does not adequately address their needs. Training and education of health-care professionals are strongly recommended to address some of these challenges and practice gaps. Culturally appropriate care includes avoiding heterosexual assumptions, use of inclusive language, the provision of tailored information, and involving partners in care.

Quality of life among women diagnosed with breast Cancer: A randomized waitlist controlled trial of commercially available mobile app‐delivered mindfulness training

Abstract: OBJECTIVE The primary objective was to evaluate the efficacy of commercially available mobile app-delivered mindfulness training (AMT), compared with waitlist control (WC), on quality of life (QOL) among women diagnosed with breast cancer. The secondary outcome was dispositional mindfulness. Enrollment, app utilization, and study completion are reported as feasibility objectives. METHODS Women diagnosed with breast cancer ≤5 years (n = 112) were randomized to AMT (n = 57) or WC (n = 55), over 8 weeks, with 4 weeks of follow-up. We conducted linear mixed effects models to examine group by observation interactions on QOL and dispositional mindfulness at baseline, during intervention (5-weeks), post-intervention (9-weeks), and follow-up (12-weeks post-baseline). RESULTS Participants assigned to AMT reported higher QOL, compared with those assigned to WC, from baseline through follow-up t(258.40) = 3.09, P < 0.01, 95% CI [2.71, 11.90]. Participants assigned to AMT also reported higher dispositional mindfulness, compared with those assigned to WC, from baseline through follow-up t(268.44) = 2.04, P = 0.04, 95% CI [0.01, 0.57]. App utilization data was obtained from 34 participants. Fewer participants assigned to AMT completed all study assessments, compared with participants assigned to WC, (χ21 = 7.07, P = 0.008). CONCLUSIONS Findings suggest commercially available AMT may proffer some benefit to women seeking to enhance their QOL following breast cancer diagnosis.

Effects of existential interventions on spiritual, psychological, and physical well-being in adult patients with cancer: Systematic review and meta-analysis of randomized controlled trials.

Abstract: Objectives To synthesize the evidence of existential interventions in adult patients with cancer. Methods Embase, MEDLINE, CENTRAL, CINAHL, PsycINFO, PSYNDEX, and the WHO ICTRP were searched up until 26 January 2018. Eligibility criteria for studies were (1) adult patients with cancer, (2) evaluation of existential interventions, (3) compared with active/non-active control, (4) assessing relevant spiritual, psychological, or physical outcomes, and (5) conducted as randomized controlled trials. Standardized mean differences (Hedges' g) were calculated, and meta-analyses were conducted using random effects models. Effects were aggregated within four time horizons (post-treatment; ≤3 months; ≤6 months; >6 months). Heterogeneity was assessed by forest plots and I2 . Risk of bias was assessed using the Cochrane Risk of Bias Tool. This review has been registered with Prospero (CRD42016042895). Results A total of 3461 records were identified, of which 30 unique studies (3511 participants) were included in the review and 24 studies were included in meta-analyses. Existential interventions showed significant effects on existential well-being (g = 0.52; CI[0.13; 0.91; k = 10; I2 = 85%) and quality of life (g = 0.21; CI[0.01; 0.42]; k = 17; I2 = 75%) at post-treatment, on hope at post-treatment (g = 0.43; CI[0.12; 0.74]; k = 12; I2 = 86%) and after 6 months (g = 0.25; CI[0.02; 0.48]; k = 3; I2 = 0%) and on self-efficacy at post-treatment (g = 0.50; CI[0.09; 0.90]; k = 2; I2 = 0%). No significant effects were found on the remaining outcomes and time points. Significant moderator effects were found for professional background of therapists, intervention concept, number of sessions, and setting. Conclusions This systematic review and meta-analysis provides evidence that adult patients with cancer across all stages and types benefit from existential interventions. Future research should strive towards a higher standardization in particular with respect to outcome assessments.

Fear of cancer recurrence and death anxiety

Abstract: In 2013, 3 systematic reviews of fear of cancer recurrence (FCR) and its predictors were published. All 3 concurred that FCR is a highly prevalent problem and amongst the largest unmet needs of cancer survivors, even 5 or more years after treatment. However, between them they identified only 1 study that had investigated the relationship between death anxiety and FCR. This is surprising because it is well acknowledged that a diagnosis of cancer, a potentially life-threatening illness, is associated with a number of existential issues that give rise to psychological sequelae such as intrusive thoughts about death and other post-traumatic symptoms. Outside the cancer literature, there has recently been a call to identify death anxiety as a transdiagnostic construct that underlies many anxiety disorders even in healthy people. And yet, the relevance of death anxiety to FCR has not been studied. We explore the barriers to the study of death anxiety and FCR and the reasons that a potential link between the 2 might have important theoretical and clinical implications. We conclude that establishing the relationship between death anxiety, FCR and other existential issues is essential in order to fully understand FCR, particularly in the context of advanced disease. We further conclude that whether death anxiety underlies FCR has important clinical implications which would potentially allow us to optimise currently available evidence-based treatments.

Existential distress in cancer: Alleviating suffering from fundamental loss and change

Abstract: A severe life threatening illness can challenge fundamental expectations about security, interrelatedness with others, justness, controllability, certainty, and hope for a long and fruitful life. That distress and suffering but also growth and mastery may arise from confrontation with an existentially threatening stressor is a long-standing idea. But only recently have researchers studied existential distress more rigorously and begun to identify its distinct impact on health care outcomes. Operationalizations of existential distress have included fear of cancer recurrence, death anxiety, demoralization, hopelessness, dignity-related distress, and the desire for hastened death. These focus in varying emphasis on fear of death, concern about autonomy, suffering, or being a burden to others; a sense of profound loneliness, pointlessness or hopelessness; grief, regret, or embitterment about what has been missed in life; and shame if dignity is lost or expectations about coping are not met. We provide an overview of conceptual issues, diagnostic approaches, and treatments to alleviate existential distress. Although the two meta-analyses featured in this special issue indicate the progress that has been made, many questions remain unresolved. We suggest how the field may move forward through defining a threshold for clinically significant existential distress, investigating its comorbidity with other psychiatric conditions, and inquiring into adjustment processes and mechanisms underlying change in existential interventions. We hope that this special issue may inspire progress in this promising area of research to improve recognition and management of a central psychological state in cancer care.

Digital health interventions to help living with cancer: A systematic review of participants' engagement and psychosocial effects.

Abstract: Objective Digital health interventions (DI) open the possibility for cancer patients and survivors to manage the disease and its side effects when they return home after treatment This study aims to highlight the components of DI, investigate patient engagement with DI, and explore the effects of DI on psychosocial variables Methods In September 2017, we performed a systematic review of studies focusing on DI which target cancer patients or survivors Results A total of 29 articles (24 studies) were reviewed There was considerable heterogeneity in study methods, in outcome definitions, in measures for engagement with DI and in psychosocial variables assessed Results from the studies showed a high level of engagement Self-efficacy, psychological symptoms, and quality of life were the most commonly assessed psychosocial variables However, results for the effect of DI on psychosocial variables were inconsistent Regarding pain management, results were in line with what one would expect Conclusions The present review showed that despite the heterogeneity in the studies assessed and inconsistent results, DI may constitute an excellent means to help cancer patients and survivors cope better with the disease and with treatment side effects, as they can improve self-management and wellbeing In order to acquire a greater understanding of the mechanisms underlying cancer patients'/survivors' psychological and behavioral changes in terms of adopting DI, direct comparison between studies is needed However, this can only come about if methodological and conceptual standardization of DI is implemented

New Challenges in Psycho-Oncology Research IV: Cognition and cancer: Conceptual and methodological issues and future directions.

Abstract: Correspondence Tim Ahles, Department of Psychiatry and Behavioral Sciences, Neurocognitive Research Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Email: ahlest@mskcc.org Funding information National Cancer Institute, Grant/Award Number: R01 CA172119, R01 CA129769 and U54CA137788; National Cancer Institute, Cancer Center Core Grant, Grant/ Award Number: P30 CA008748; Breast Cancer Research Foundation, Grant/Award Number: R01 CA14063

Exploring the screening capacity of the Fear of Cancer Recurrence Inventory-Short Form for clinical levels of fear of cancer recurrence

Abstract: Objective : Fear of cancer recurrence (FCR) is a common concern among cancer survivors. Identifying survivors with clinically significant FCR requires validated screening measures and clinical cut-offs. We evaluated the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) clinical cut-off in 2 samples. Methods : Level of FCR in study 1 participants (from an Australian randomized controlled trial: ConquerFear) was compared with FCRI-SF scores. Based on a biopsychosocial interview, clinicians rated participants as having nonclinical, subclinical, or clinical FCR. Study 2 participants (from a Canadian FCRI-English validation study) were classified as having clinical or nonclinical FCR by using the semistructured clinical interview for FCR (SIFCR). Receiver operating characteristic analyses evaluated the screening ability of the FCRI-SF against clinician ratings (study 1) and the SIFCR (study 2). Results : In study 1, 167 cancer survivors (mean age: 53 years, SD = 10.1) participated. Clinicians rated 43% as having clinical FCR. In study 2, 40 cancer survivors (mean age: 68 years, SD = 7.0) participated; 25% met criteria for clinical FCR according to the SIFCR. For both studies 1 and 2, receiver operating characteristic analyses suggested a cut-off ≥22 on the FCRI-SF identified cancer survivors with clinical levels of FCR with adequate sensitivity and specificity. Conclusions : Establishing clinical cut-offs on FCR screening measures is crucial to tailoring individual care and conducting rigorous research. Our results suggest using a higher cut-off on the FCRI-SF than previously reported to identify clinically significant FCR. Continued evaluation and validation of the FCRI-SF cut-off is required across diverse cancer populations.

Feasibility of the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program for symptom improvement among breast cancer survivors.

Abstract: Objective The purpose of this pilot study was to test the feasibility of delivering the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program using an iPad and to evaluate its impact on symptom improvement. Methods A single group, pre-posttest design was implemented among female stages 0-III breast cancer survivors (BCS) who completed treatment. Data were collected at baseline and week 6 on measures of psychological and physical symptoms and quality of life. The mMBSR(BC) program is a standardized, stress-reducing intervention that combines sitting and walking meditation, body scan, and yoga and is designed to deliver weekly 2-hour sessions for 6 weeks using an iPad. Results The mean age of the 15 enrolled BCS was 57 years; one participant was non-Hispanic black, and 14 were non-Hispanic white. Of the 13 who completed the study, there were significant improvements from baseline to 6 weeks post-mMBSR(BC) in psychological and physical symptoms of depression, state anxiety, stress, fear of recurrence, sleep quality, fatigue, and quality of life (P's < .05). Effect sizes for improvements of multiple symptoms ranged from medium to large. Conclusions These results provide preliminary support that the mMBSR(BC) program may be feasible and acceptable, showing a clinical impact on decreasing psychological and physical symptoms. This mobile-based program offers a delivery of a standardized MBSR(BC) intervention to BCS that is convenient for their own schedule while decreasing symptom burden in the survivorship phase after treatment for breast cancer.

Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer : An individual patient data meta-analysis of 22 RCTs

Abstract: Objective: This individual patient data (IPD) meta-analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF) and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention-related characteristics. Methods: Relevant studies were identified via literature searches in four databases. We pooled IPD from 22 (n=4,217) of 61 eligible randomized controlled trials (RCTs). Linear mixed-effect model analyses were used to study intervention effects on the post-intervention values of QoL, EF, and SF (z-scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention-related characteristics, and conducted subsequent stratified analyses for significant moderator variables. Results: PSI significantly improved QoL (β=0.14,95%CI=0.06;0.21), EF (β=0.13,95%CI=0.05;0.20), and SF (β=0.10,95%CI=0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training (CST) were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on two RCTs with small sample sizes of some cancer types. Conclusions: PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention-related characteristics. Our study highlights the beneficial effects of CST in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.

Educational and vocational goal disruption in adolescent and young adult cancer survivors.

Abstract: Objective Cancer in adolescents and young adults (AYAs) can interrupt important developmental milestones. Absence from school and time lost from work, together with the physical impacts of treatment on energy and cognition, can disrupt educational and vocational goals. The purpose of this paper is to report on AYA cancer survivors' experiences of reintegration into school and/or work and to describe perceived changes in their educational and vocational goals. Methods AYAs recruited from seven hospitals in Australia, aged 15-26years and ≤24months post-treatment, were interviewed using the Psychosocial Adjustment to Illness Scale (PAIS). Responses were analysed to determine the extent of, and explanations for, cancer's effect on school/work. Results Forty-two AYA cancer survivors (50%female) participated. Compared with their previous vocational functioning, 12(28.6%) were scored as experiencing mild impairment, 14(33.3%) moderate impairment, and 3(7.1%) marked impairment. AYAs described difficulties reintegrating to school/work as a result of cognitive impacts such as concentration problems and physical impacts of their treatment, including fatigue. Despite these reported difficulties, the majority indicated that their vocation goals were of equal or greater importance than before diagnosis (26/42;62%), and most AYAs did not see their performance as compromised (23/42;55%). Many survivors described a positive shift in life goals and priorities. The theme of goal conflict emerged where AYAs reported compromised abilities to achieve their goals. Conclusions The physical and cognitive impacts of treatment can make returning to school/work challenging for AYA cancer survivors. AYAs experiencing difficulties may benefit from additional supports to facilitate meaningful engagement with their chosen educational/vocational goals.

Clinician provision of oncofertility support in cancer patients of a reproductive age: A systematic review.

Abstract: Objective The emerging discipline of oncofertility advocates for the timely provision of fertility information and referral for fertility preservation to all cancer patients of reproductive age (<45 years). A systematic review was undertaken on the clinician provision of oncofertility support to determine whether cancer patients are having their support needs adequately met by staff. Methods An initial search conducted in May 2016 identified 351 potentially relevant studies. The papers were divided into two categories; papers on the clinician provision of oncofertility support were reviewed for this study and papers on patient oncofertility support needs were reviewed for a separate systematic review. Results A total of 23 studies were included within the final review of this manuscript. Although many clinicians are broadly informed about the risk to their patients’ fertility brought about by cancer treatment, there are many factors which hinder the appropriate discussion, referral or service utilisation needed in order to provide adequate oncofertility support to patients of reproductive age. Conclusions Oncofertility support is often not delivered to the standard of current guidelines, with many clinicians not providing the recommended care to all eligible patients, and as such many patients may lack the oncofertility support that they require. The implementation of a clear procedural process would assist clinicians in the provision of oncofertility support for cancer patients of reproductive age.

Understanding acceptability of and engagement with Web-based interventions aiming to improve quality of life in cancer survivors: A synthesis of current research

Abstract: Copyright © 2017 John Wiley & Sons, Ltd. Objective: This review sought to summarize existing knowledge to inform the development of an online intervention that aims to improve quality of life after cancer treatment. Methods: To inform our intervention, we searched for studies relating to Web-based interventions designed to improve quality of life in adults who have completed primary treatment for breast, prostate, and colorectal cancer (as these are 3 of the most common cancers and impact a large number of cancer survivors). We included a variety of study designs (qualitative research, feasibility/pilot trials, randomized trials, and process evaluations) and extracted all available information regarding intervention characteristics, experiences, and outcomes. Data were synthesized as textual (qualitative) data and analyzed by using thematic analysis. Results: Fifty-seven full text articles were assessed for eligibility, and 16 papers describing 9 interventions were analyzed. Our findings suggest that cancer survivors value interventions that offer content specific to their changing needs and are delivered at the right stage of the cancer trajectory. Social networking features do not always provide added benefit, and behavior change techniques need to be implemented carefully to avoid potential negative consequences for some users. Conclusions: Future work should aim to identify appropriate strategies for promoting health behavior change, as well as the optimal stage of cancer survivorship to facilitate intervention delivery. Clinical Implications: The development of Web-based interventions for cancer survivors requires further exploration to better understand how interventions can be carefully designed to match this group's unique needs and capabilities. User involvement during development may help to ensure that interventions are accessible, perceived as useful, and appropriate for challenges faced at different stages of the cancer survivorship trajectory.

Advanced cancer caregiving as a risk for major depressive episodes and generalized anxiety disorder.

Abstract: OBJECTIVE Caregivers of advanced cancer patients provide extensive care associated with high levels of caregiver distress. The degree to which cancer caregiving increases caregivers' risk for a psychiatric disorder is unknown. The current study examines whether advanced cancer caregiving poses distinct risks for initial and recurrent major depressive episodes (MDEs) and generalized anxiety disorder (GAD) relative to the general population. METHODS Caregivers of advanced cancer patients (N = 540) from Coping with Cancer were compared to general population controls (N = 9282) from the National Comorbidity Survey Replication. The general population comparison sample was propensity-weighted to be demographically similar to the caregiver sample. RESULTS Caregivers of advanced cancer patients were more likely than individuals in the general population to have an initial MDE (OR = 7.7; 95% CI, 3.5-17.0; P < .001), but no more likely than the general population to have a recurrent MDE (OR = 1.1; 95% CI, 0.6-2.1; P = .662). Caregivers were also more likely than the general population to have GAD (OR = 3.0; 95% CI, 1.9-4.8; P < .001) and comorbid MDE and GAD (OR = 2.5; 95% CI, 1.1-5.9; P = .038). CONCLUSIONS The increased risk of meeting diagnostic criteria for current MDE and GAD and comorbid MDE and GAD associated with advanced cancer caregiving highlights the degree of emotional burden among cancer caregivers. Clinical services that assess, prevent, and treat depression and anxiety in cancer caregivers are needed to reduce the burden of caregiving and improve the mental health of this growing population.

Effect of aerobic exercise on cancer-associated cognitive impairment: A proof-of-concept RCT.

Abstract: Background Change in cognitive ability is a commonly reported adverse effect by breast cancer survivors. The underlying etiology of cognitive complaints is unclear and to date, there is limited evidence for effective intervention strategies. Exercise has been shown to improve cognitive function in older adults and animal models treated with chemotherapy. This proof-of-concept randomized controlled trial tested the effect of aerobic exercise versus usual lifestyle on cognitive function in postmenopausal breast cancer survivors. Methods Women, aged 40 to 65 years, postmenopausal, stages I to IIIA breast cancer, and who self-reported cognitive dysfunction following chemotherapy treatment, were recruited and randomized to a 24-week aerobic exercise intervention (EX; n = 10) or usual lifestyle control (CON; n = 9). Participants completed self-report measures of the impact of cognitive issues on quality of life (Functional Assessment of Cancer Therapy–Cognitive version 3), objective neuropsychological testing, and functional magnetic resonance imaging at baseline and 24 weeks. Results Compared to CON, EX had a reduced time to complete a processing speed test (trail making test-A) (-14.2 seconds, P < .01; effect size 0.35). Compared to CON, there was no improvement in self-reported cognitive function and effect sizes were small. Interestingly, lack of between-group differences in Stroop behavioral performance was accompanied by functional changes in several brain regions of interest in EX compared to CON at 24 weeks. Conclusion These findings provide preliminary proof-of-concept results for the potential of aerobic exercise to improve cancer-related cognitive impairment and will serve to inform the development of future trials.

The relationship between coping style and psychological distress in people with head and neck cancer: A systematic review.

Abstract: Objective Individuals diagnosed with head and neck cancer (HNC) are at an elevated risk of experiencing psychological distress and a reduced quality of life. The aim of this review was to systematically examine and assess the quality of empirical evidence on the associations between coping mechanisms and psychological distress among people with HNC. Methods CINAHL, MEDLINE, PsycINFO, EMBASE and Web of Science were accessed to conduct this review. Studies were included if they used reliable and valid measures to investigate the relationship between coping style and psychological distress. Study quality was assessed and rated according to pre-set criteria, and showed variability in relation to selection methods. Results 12 studies (nine cross-sectional and three prospective designs) involving 1281 patients were reviewed. There was considerable heterogeneity in study samples and coping measures. Moderate to large associations between disengagement coping mechanisms (e.g. avoidance) and psychological distress were observed. Engagement coping strategies (e.g. direct action) were not consistently associated with psychological distress across studies. Conclusions Several studies observed a significant relationship between coping styles aimed at disengaging and distancing from cancer and increased psychological distress. To understand directionality of these associations and further develop an understanding of temporal features of the relationship between coping styles and distress, longitudinal designs could be used in future research.

Does age matter? Comparing post-treatment psychosocial outcomes in young adult and older adult cancer survivors with their cancer-free peers.

Abstract: Objective Adolescents and young adult cancer survivors (AYA) are a unique subpopulation with high levels of distress and unmet need. To date, studies have not disentangled distress due to developmental life stage from distress due to cancer survivorship. This population-based study allowed a direct comparison between AYA cancer survivors, older adult (OA) cancer survivors, and their cancer-free peers. Methods We combined 4 annual cycles of the Canadian Community Health Survey (CCHS, 2007-2010) to obtain a final sample of 239 316 respondents. We dichotomized the total sample into AYA (15-39 years, n = 83 770) and OA (40+, n = 155 546). Two standardized questions identified cancer survivors (n = 14 592). The self-reported outcomes of interest included self-perceived health and mental health, and health care professional diagnosed mood and anxiety disorders. We used weighted logistic regression models to examine for associations, including an interaction term to assess for effect modification by age. Results After adjusting for confounders, cancer survivorship in AYAs was strongly associated with higher prevalence of both mood (OR 2.00, 95% CI 1.44-2.77) and anxiety (OR 2.20, 95% CI 1.70-2.86) disorders as compared to their cancer-free peers. OA survivors had a weaker association in the same direction (OR 1.10, 95% CI 1.01-1.21 and OR 1.15, 95% CI 1.02-1.30, respectively). AYA cancer survivors reported higher levels of poor self-perceived mental health than their cancer-free peers (OR 1.49, 95% CI 1.03-2.14), while there was no significant difference from cancer-free peers for OAs (OR 1.03, 95% CI 0.92-1.15). Conclusions AYA cancer survivors experience a significantly higher risk of psychosocial distress than both their cancer-free peers and OA survivors.

Modeling posttraumatic growth among cancer patients: The roles of social support, appraisals, and adaptive coping.

Abstract: Objective The purpose of the study was to build a model to explain the relationships between social support, uncontrollability appraisal, adaptive coping, and posttraumatic growth (PTG) among cancer patients in China. Methods The participants who were cancer patients in a cancer hospital in China filled out a survey. The final sample size was 201. Structural equation modeling was used to build a model explaining PTG. Results Structural equation modeling results indicated that higher levels of social support predicted higher levels of adaptive coping, higher levels of uncontrollability appraisal predicted lower levels of adaptive coping, and higher levels of adaptive coping predicted higher levels of PTG. Moreover, adaptive coping was a mediator between social support and growth, as well as a mediator between uncontrollability and growth. The direct effects of social support and uncontrollability on PTG were insignificant. Conclusions The model demonstrated the relationships between social support, uncontrollability appraisal, adaptive coping, and PTG. It could be concluded that uncontrollability appraisal was a required but not sufficient condition for PTG. Neither social support nor uncontrollability appraisal had direct influence on PTG. However, social support and uncontrollability might indirectly influence PTG, through adaptive coping. It implies that both internal factors (eg, cognitive appraisal and coping) and external factors (eg, social support) are required in order for growth to happen.