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Impact factor: 3.506 5-Year impact factor: 4.16 Print ISSN: 1057-9249 Online ISSN: 1099-1611 Publisher: Wiley Blackwell (John Wiley & Sons)

Subjects: Multidisciplinary Psychology, Biomedical Social Sciences

Most recent papers:

  • Exploring the relationship between the body self and the sense of coherence in women after surgical treatment for breast cancer.
    Marcin J. Jabłoński, Beata Mirucka, Joanna Streb, Agnieszka J. Słowik, Robert Jach.
    Psycho-Oncology. October 25, 2018
    --- - |2+ Abstract Objective Analysis of the relationship between the body self (BS) and the sense of coherence (SOC) in women after breast surgery due to cancer in comparison with a control group. Methods A cross‐sectional study in a group of 78 women using the body–self questionnaire (BS‐Q), and the life orientation questionnaire (SOC‐29). Statistics based on the IBM SPSS v.25. Results Multivariate analysis of variance (MANOVA) has shown significant differences based on groups in experiencing intimacy, manifesting femininity, body acceptance, and manageability. In particular, manifesting femininity and body acceptance showed a big effect size (0.30 < partial ɳ2 < 0.32). Correlation analysis between the BS‐Q and SOC‐29 subscales and Fisher's r to z transformation determines that the differences between groups were significant in favour of healthy women in two sets of variables: experiencing intimacy/meaningfulness and attitude to food and weight/manageability. Conclusions Breast cancer survivors are at greater risk of developing decreased body acceptance and problems in intimacy, and have less correlation than the healthy control group between manageability and meaningfulness with an appropriate attitude to food and intimate relationship with their partner, respectively. A higher manifestation of femininity in the treated group can be considered a positive but socioculturally conditioned coping strategy. - Psycho-Oncology, EarlyView.
    October 25, 2018   doi: 10.1002/pon.4909   open full text
  • Patient‐reported health‐related quality of life outcomes in supportive‐care interventions for adults with brain tumors: A systematic review.
    Tonya M. Pan‐Weisz, Maria Kryza‐Lacombe, Jeffrey Burkeen, Jona Hattangadi‐Gluth, Vanessa L. Malcarne, Carrie R. McDonald.
    Psycho-Oncology. October 25, 2018
    --- - |2+ Abstract Objectives The objectives of this systematic review were to (a) identify supportive‐care (psychosocial/behavioral, pharmacological, complementary, or alternative) interventions that have been evaluated via randomized controlled trials (RCTs) to improve patient‐reported health‐related quality of life (HRQoL) among adults with brain tumors, (b) evaluate the quality of the intervention studies, and (c) evaluate if developed interventions have been efficacious at improving HRQoL, as compared with control conditions in RCTs. Methods This systematic review was conducted using preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines. Four databases were searched for RCTs of supportive‐care interventions for adults with brain tumors, primary or metastatic, that included a patient‐reported HRQoL outcome. Quality of the included studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results Ten RCTs involving 640 patients with either a primary or metastatic brain tumor investigating supportive‐care interventions with a HRQoL outcome were identified. In terms of quality, three of the studies received a “strong” rating, three received a “moderate” rating, and four of the studies received a “weak” rating. Only two of the interventions (ie, a home‐based psychosocial intervention and individualized acupuncture with standard rehabilitation) demonstrated improvements in HRQoL over control conditions. Conclusions HRQoL is of the utmost importance when treating patients with brain tumors. Yet there is a notable paucity of research to inform clinical decisions and evidence‐based practice. More high‐quality studies of interventions aimed at improving HRQoL are needed. - Psycho-Oncology, EarlyView.
    October 25, 2018   doi: 10.1002/pon.4906   open full text
  • Plenary Abstracts.

    Psycho-Oncology. October 24, 2018
    --- - - Psycho-Oncology, Volume 27, Issue S3, Page 3-7, October 2018.
    October 24, 2018   doi: 10.1002/pon.4876   open full text
  • Author Index.

    Psycho-Oncology. October 24, 2018
    --- - - Psycho-Oncology, Volume 27, Issue S3, Page 220-231, October 2018.
    October 24, 2018   doi: 10.1002/pon.4879   open full text
  • Dyadic coping in specialized palliative care intervention for patients with advanced cancer and their caregivers: effects and mediation in a randomized controlled trial.
    Annika Heymann‐Horan, Pernille Envold Bidstrup, Christoffer Johansen, Nina Rottmann, Elisabeth Anne Wreford Andersen, Per Sjøgren, Hans Maase, Helle Timm, Jakob Kjellberg, Mai‐Britt Guldin.
    Psycho-Oncology. October 24, 2018
    --- - |2+ Abstract Objective Specialized palliative care (SPC) interventions increasingly include patient–caregiver dyads, but their effects on dyadic coping are unknown. We investigated whether an SPC and dyadic psychological intervention increased aspects of dyadic coping in patients with advanced cancer and their caregivers, whether dyad characteristics moderated effects and whether aspects of dyadic coping mediated significant intervention effects on caregivers’ anxiety and depression. Methods We randomized 258 patients with incurable cancer and their caregivers to care as usual or accelerated transition from oncological treatment to home‐based SPC and dyadic psychological support. In secondary outcome analyses, using mixed‐effects models, we estimated intervention effects and 95% confidence intervals (CIs) for communication of stress and common coping, and moderation by dyad type and demographics. In path analyses, we investigated whether stress communication and common coping mediated intervention effects on caregivers’ symptoms of anxiety and depression. ( NCT01885637) Results The intervention significantly increased common coping in patients and caregivers in couples (estimated difference, 0.68; 95% CI, 0.11 to 1.24) and stress communication by partner caregivers (0.97; 0.24 to 1.24). We found some support for different intervention effects for spouses and other dyads, but no evidence of mediation. Conclusions SPC and dyadic psychological intervention may affect aspects of dyadic coping. Common coping and stress communication did not mediate the previously found significant intervention effects on caregiver anxiety and depression, indicating that other mechanisms may have been - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 24, 2018   doi: 10.1002/pon.4932   open full text
  • Applying the Theory of Planned Behavior to Examine Adjuvant Endocrine Therapy Adherence Intentions.
    Alejandra Hurtado‐de‐Mendoza, Pilar Carrera, W. Gerrod Parrott, Sara Gómez‐Trillos, Robert A. Perera, Vanessa B. Sheppard.
    Psycho-Oncology. October 24, 2018
    --- - |2+ Abstract Objective Adherence to adjuvant endocrine therapy (AET) in breast cancer survivors is suboptimal. Using the theory of planned behavior (TPB), this study aimed to identify the strongest predictors from the TPB of AET intentions and past behavior and assessed whether ambivalence and anticipatory emotions increased the predictive capacity of TPB. Methods 280 women diagnosed with hormone positive (HR+) breast cancer who filled at least one prescription of AET responded to a survey measuring TPB constructs, attitudinal ambivalence, and anticipatory emotions. The outcomes were intentions to adhere to AET and past medication adherence (previous two weeks). Results The TPB explained 66% of intentions to adhere to AET (p<0.001). Ambivalence did not improve the TPB model's predictive value. When emotions were included with TPB, the model explained 70% of adherence intentions F(11,226)= 52.84, p <.001 (R2c= .70). This increase of 4% in predictability was statistically significant (ΔR2=0.04), F(6, 226)=7.90, p <.001. Women who self‐reported non‐adherence in the past two weeks differed significantly in the TPB variables, ambivalence, and anticipatory emotions from adherent women. Non‐adherent participants reported lower future intentions to adhere F (1, 236)=5.63, p=.018. Conclusions Results suggest key concepts, such as anticipatory positive emotions, that should be addressed in future interventions to enhance AET adherence and survivorship. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 24, 2018   doi: 10.1002/pon.4931   open full text
  • Efficacy of Musical Training on Psychological Outcomes and Quality of Life in Chinese Pediatric Brain Tumor Survivors.
    Ankie T. Cheung, William H.C. Li, Ka Yan Ho, Katherine K.K. Lam, Laurie L.K. Ho, S.Y. Chiu, Godfrey C.F. Chan, O.K. Chung.
    Psycho-Oncology. October 24, 2018
    --- - |2+ Abstract Background Evidence has shown that survivors of pediatric brain tumors have more negative psychological sequelae, particularly depression, than do survivors of other childhood cancers. This study examined the efficacy of a musical training program in reducing depressive symptoms, and enhancing self‐esteem and quality of life in Hong Kong Chinese pediatric brain tumor survivors. Methods A prospective randomized controlled trial, two‐group pretest and repeated post‐test, between‐subjects design was conducted to 60 pediatric brain tumor survivors (8‐ to 15‐year‐olds). Participants in the experimental group received a weekly 45‐minute lesson on musical training for 52 weeks. Participants in the control group received a placebo intervention. The primary outcome was depressive symptoms at 12 months. Secondary outcomes were self‐esteem and quality of life at 12 months. Data were collected at baseline, and 6 and 12 months after the intervention began. Results Participants in the experimental group reported statistically significant fewer depressive symptoms (P < .001), higher levels of self‐esteem (P < .001), and better quality of life (P < .001) than the control group at 12‐month follow‐up. Conclusions This study provides evidence that musical training is effective in reducing depressive symptoms, and enhancing self‐esteem and quality of life in Hong Kong Chinese pediatric brain tumor survivors. These results indicate that musical training is not only a leisure activity, but carries therapeutic effects in promoting psychological well‐being and quality of life in pediatric brain tumor survivors. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 24, 2018   doi: 10.1002/pon.4929   open full text
  • Delirium and its consequences in the specialized palliative care unit: Validation of the Korean version of Memorial Delirium Assessment Scale.
    Beodeul Kang, Yu Jung Kim, Seung Wan Suh, Kyung‐Lak Son, Grace Ahn, Hye Youn Park.
    Psycho-Oncology. October 24, 2018
    --- - |2+ Abstract Objectives Delirium is highly prevalent in patients with advanced cancer. This study aimed to investigate delirium rates and potential associated factors such as mortality in patients admitted to an acute palliative care unit (APCU). Our second aim was to validate the Korean version of the Memorial Delirium Assessment Scale (K‐MDAS). Methods A total of 102 patients with advanced cancer, and who were admitted to the APCU, were assessed. Demographic data were collected alongside clinical diagnosis, Eastern Cooperative Oncology Group (ECOG) performance status, clinical symptoms according to the Edmonton Symptom Assessment System (ESAS), history of smoking, alcohol use, hypnotic use, and daily dose of morphine were collected. The Confusion Assessment Method (CAM), the Delirium Rating Scale‐Revised 98 (DRS‐R98), and the K‐MDAS were measured at admission and 1 week later. Results Twenty‐four patients (23.52%) were diagnosed with delirium, and associated factors were old age (p = 0.007), higher ECOG (p = 0.011), and drowsiness (p < 0.001). The presence of delirium was an independent predictor of 1‐month mortality; male gender, higher body mass index, and hypnotic use were also related to 1‐month mortality. The K‐MDAS had reliable internal consistency (α = 0.942) and showed sensitivity of 0.958 and specificity of 0.921 at the optimal cutoff score for diagnosing delirium of 9. Conclusions Delirium was prevalent in patients admitted to the APCU, and was associated with 1‐month mortality. The K‐MDAS showed acceptable reliability and validity and can be used to screen for delirium in a palliative care setting. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 24, 2018   doi: 10.1002/pon.4926   open full text
  • Self‐Disclosure to Peers by Young Adult Cancer Survivors.
    Carolyn Rabin.
    Psycho-Oncology. October 24, 2018
    --- - |2+ Abstract Objective Given the potential benefits of self‐disclosure, the goal of this study was to learn more about how young adult cancer survivors navigate the process of disclosing their cancer history to peers. Methods A sample of 122 young adult cancer survivors completed a brief, online survey. Data were collected to assess how and why survivors self‐disclose to peers and how peers react. Results Participants endorsed a number of reasons for disclosing their cancer history to peers (e.g., felt it was important for them to know) or choosing not to disclose (e.g., to avoid upsetting/burdening them). 0Participants used a variety of strategies during the disclosure with the most frequently endorsed being humor and providing reassurance. Mediational analyses supported the study hypothesis: the relationship between peer reactions to self‐disclosure and the likelihood of future disclosure was mediated by survivors’ satisfaction with the self‐disclosure experience. Exploratory analyses provided some insight into which disclosure strategies were met with a more positive reaction from peers. Conclusions The actual and anticipated reactions from peers plays a crucial role in shaping young adult cancer survivors’ experience of self‐disclosure. Clinicians may use these findings to help young survivors optimize their self‐disclosure experiences. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 24, 2018   doi: 10.1002/pon.4930   open full text
  • Associations of functional, psychosocial, medical, and socio‐demographic factors with cognitive screening in chemotherapy naïve patients with breast cancer.
    Zev M. Nakamura, Allison M. Deal, Kirsten A. Nyrop, Seul Ki Choi, William A. Wood, Hyman B. Muss.
    Psycho-Oncology. October 24, 2018
    --- - |2+ Abstract Objective To describe associations of functional, psychosocial, medical, and socio‐demographic factors with performance on a cognitive screening test in chemotherapy naïve patients with breast cancer. Methods Women with breast cancer were recruited between 2009 and 2018. The Blessed Orientation Memory Concentration Test (BOMC) was administered prior to chemotherapy. Associations between baseline BOMC and functional (Karnofsky Self‐Reported Performance Rating Scale (KPS), Time Up and Go Test (TUG), Medical Outcomes Study (MOS) Physical Function, Instrumental Activities of Daily Living (IADL)), psychosocial (Mental Health Inventory‐13, MOS Social Activity Limitation and Social Support Survey), medical, and socio‐demographic variables were assessed using linear regression analysis. Results In a sample of 331 women with breast cancer, the mean age was 65.2 years and 68.6% were 65 and older. Mean BOMC score was 3.60 on a scale from 0 (best) to 28 (worst). After controlling for demographic factors, worse BOMC screening test results were associated with KPS < 80 (p=0.01), IADL< 14 (p=0.02), TUG ≥ 14 seconds (p=0.001), worse MOS Physical Function (p=0.0006), depressive symptoms (p=0.04), and social activity limitations (p=0.01). Conclusion In a sample of women with breast cancer, pre‐treatment cognitive screening scores did not reveal profound cognitive impairment. BOMC screening scores were associated with multiple measures of physical function, but further research is needed to determine a clinically meaningful cut point in the BOMC for screening of cancer‐related cognitive impairment. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 24, 2018   doi: 10.1002/pon.4928   open full text
  • Effects of depressive symptomatology on cancer‐related symptoms during oral oncolytic treatment.
    Veronica Decker, Alla Sikorskii, Charles W. Given, Barbara A. Given, Eric Vachon, John C. Krauss.
    Psycho-Oncology. October 24, 2018
    --- - |2+ Abstract Objective This manuscript assesses association between depressive symptoms and symptoms from cancer and its treatment during the first 12 weeks of a new oral oncolytic treatment. Methods This secondary analysis used data from a recently completed trial of an intervention to improve adherence to oral oncolytic treatment and manage symptoms. Following the initiation of the new oral oncolytic medication, 272 patients were interviewed at intake and weeks 4, 8, and 12 to assess depressive symptoms, and symptoms from cancer and its treatment. Depressive symptoms were measured using the Center for Epidemiologic Studies‐Depression (CES‐D20). The summed index of 18 cancer‐related and treatment‐related symptoms as well as the number of symptoms above threshold at intake, weeks 4, 8, and 12 were related to intake and time‐varying CES‐D20 using linear mixed effects models. Results Depressive symptomatology was a significant predictor of cancer‐related and treatment‐related symptoms at all‐time points, but the strength of this relationship was greatest at the time of oral oncolytic agent initiation and at week 4. The strength of this relationship was the same for both summed symptom severity index and the number of symptoms above threshold, and using either intake or time‐varying CES‐D20. Conclusion Introducing strategies to treat and manage symptoms of depression along with other symptoms might have added benefits among patients who start a new oral oncolytic treatment and report modest to higher levels of depressive symptoms. Assessments for the impact of strategies to lower depressive symptoms can be taken within the first 4 weeks. - Psycho-Oncology, EarlyView.
    October 24, 2018   doi: 10.1002/pon.4916   open full text
  • Issue Information.

    Psycho-Oncology. October 24, 2018
    --- - |2 No abstract is available for this article. - Psycho-Oncology, Volume 27, Issue S3, Page 1-2, October 2018.
    October 24, 2018   doi: 10.1002/pon.4875   open full text
  • Individual Abstracts.

    Psycho-Oncology. October 24, 2018
    --- - - Psycho-Oncology, Volume 27, Issue S3, Page 56-219, October 2018.
    October 24, 2018   doi: 10.1002/pon.4878   open full text
  • Symposium Abstracts.

    Psycho-Oncology. October 24, 2018
    --- - - Psycho-Oncology, Volume 27, Issue S3, Page 8-55, October 2018.
    October 24, 2018   doi: 10.1002/pon.4877   open full text
  • Perceived barriers to psychological treatment in Chinese cancer patients.
    Juan Xie, Ailan Liu, Liyang Wu, Hongmei Zhang, Juntao Yao, Lei Zhu.
    Psycho-Oncology. October 22, 2018
    --- - - Psycho-Oncology, EarlyView.
    October 22, 2018   doi: 10.1002/pon.4899   open full text
  • Patient‐reported outcome measures among breast cancer survivors: A cross‐sectional comparison between Malaysia and high income countries.
    Nadia Rajaram, Zhi Ying Lim, Chin Vern Song, Ranjit Kaur, Nur Aishah Mohd Taib, Maznah Muhamad, Wee Loon Ong, Maartje Schouwenburg, Mee Hoong See, Soo‐Hwang Teo, Christobel Saunders, Cheng Har Yip.
    Psycho-Oncology. October 22, 2018
    --- - |2 Abstract Objectives: Patient‐reported outcomes (PROs) in high income countries (HICs) suggest that physical, emotional, and psychological needs are important in cancer care. To date, there have been few, inconsistent descriptions of PROs in low and middle income Asian countries. Using a standard questionnaire developed by the International Consortium for Health Outcomes Measurement (ICHOM), we compared the perceived importance of PROs between patients in Malaysia and those in HICs, and between clusters of Malaysian women. Methods: Breast cancer patients were recruited from 3 Malaysian hospitals between June and November 2017. We compared the proportion of patients who rated PROs as very important (scored 7‐9 on a 9‐point Likert scale) between Malaysian patients and data collected from patients in HICs via the ICHOM questionnaire development process, using logistic regression. A two‐step cluster analysis explored differences in PROs among Malaysian patients. Results: The most important PROs for both cohorts were survival, overall well‐being and physical functioning. Compared to HIC patients (n=1,177), Malaysian patients (n=969) were less likely to rate emotional (78% vs 90%), cognitive (76% vs 84%), social (72% vs 81%) and sexual (30% vs 56%) functioning as very important outcomes (p<0.001). Cluster analysis suggests that older, parous Malaysian women, who were less likely to have received breast reconstructive surgery, were more likely to rate body image and satisfaction with the breast as very important outcomes. Conclusion: Taking into account the differences in PROs by cultural and socio‐economic settings could improve patient expectation of services and refine the assessment of cancer care outcomes. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 22, 2018   doi: 10.1002/pon.4924   open full text
  • Shared decision making in oncology: A model based on patients’, healthcare professionals’, and researchers’ views.
    Hanna Bomhof‐Roordink, Maarten J. Fischer, Nanny Duijn‐Bakker, Monique C. Baas‐Thijssen, Trudy Weijden, Anne M. Stiggelbout, Arwen H. Pieterse.
    Psycho-Oncology. October 22, 2018
    --- - |2+ Abstract Objective To construct a model of shared decision making (SDM) about cancer treatment by conducting an extensive consultation of stakeholders, informed by the literature. Methods We interviewed 76 stakeholders: cancer patients, potential future patients, oncologists, nurses, and SDM‐researchers. We asked: “If I say ‘Doctors and patients making decisions together about cancer treatment’, what does this make you think about?”. Ideas were further solicited by presenting 19 cards each describing a possible SDM‐element. Interviews were inductively coded and analysed, and the emerging themes were integrated into a model. Results The model that was based on participants’ views, assigns specific roles in SDM to both oncologists and patients. Oncologists determine possible treatments; emphasise the importance of patients’ opinion; explain treatment options; get to know patients; guide patients; and provide treatment recommendations. Patients ask questions; express thoughts and feelings; consider options; offer opinions; and decide or delegate decisions to oncologists. Outside consultations patients search for information, prepare questions, and consider options. Conclusions Next to oncologists’ role, cancer patients also have a clear role in SDM about cancer treatment, during and outside consultations. Patients should receive the support they need to fulfil this requirement. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 22, 2018   doi: 10.1002/pon.4923   open full text
  • Utilization of Integrated Psychosocial Care in a Pediatric Cancer Survivorship Clinic: A Retrospective Medical Record Review.
    Clara Hungr, Christopher J. Recklitis.
    Psycho-Oncology. October 22, 2018
    --- - - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 22, 2018   doi: 10.1002/pon.4922   open full text
  • Next of kin's motives for psychosocial consultation – Oncology social workers' perceptions of 54 next of kin cases.
    Joakim Isaksson, Lilliehorn Sara, Pär Salander.
    Psycho-Oncology. October 22, 2018
    --- - |2 Abstract Objective: Although oncology social workers (OSWs) have emerged as a core profession in the provision of psychosocial services, there is a lack of empirical studies that describe their daily clinical work with next of kin (NOK). The overall aim of this study was to explore NOK's motives for consulting an OSW. This can provide us with insights into what types of skills OSWs need to have in order to fulfil their duties. Methods: From a nationwide survey, we used data from 54 NOK cases that Swedish OSWs met face to face. Results: About half of the motives concerned help in dealing with personal grief connected to the patients' cancer and distressing symptoms, while the other half concerned needs for help in dealing with the position of being the NOK, relationship conflicts, and assistance with socioeconomic issues. Conclusions: The motives show that NOK do not just ask for help to come to terms with distress related to the patient's situation. Based on the diversity of motives, we suggest that OSWs (at least in Sweden) need a broad education in counselling psychology. Furthermore, healthcare personnel need to be attentive to the NOK's own voice and not reduce it to the voice of the patient and the patient's needs in referrals. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 22, 2018   doi: 10.1002/pon.4925   open full text
  • Psychological distress, role, and identity changes in mothers following a diagnosis of cancer: A systematic review.
    Carissa Nadia Kuswanto, Lesley Stafford, Jessica Sharp, Penelope Schofield.
    Psycho-Oncology. October 19, 2018
    --- - |2+ Abstract Objective To systematically review findings of the impact of cancer diagnosis and treatment on mothers' psychological well‐being, roles, and identity and to explore the psychosocial factors that contribute to mothers' psychological well‐being. Methods Six databases were searched for research articles and theses exploring the association between the impact of cancer diagnosis and treatment on mothers' psychological well‐being, identity, and role, and the psychosocial factors contributing to mothers' psychological distress regardless of their cancer type and stage. The Mixed‐Method Appraisal Bias Tool was used to assess the selected studies' methodological quality. Results A total of 30 qualitative, quantitative, and mixed‐method studies were deemed eligible for inclusion. Most studies reported that mothers experienced significant psychological distress, changes to or loss of parenting efficacy, maternal identity, and role. Psychosocial factors that contributed to mothers' distress included mothers' young age, presence of metastases, lower parenting efficacy, fear of cancer recurrence, higher illness intrusiveness, and lack of appropriate support. Four main themes emerged from the qualitative studies: psychological impact of cancer on mothers, changes in maternal identity and role, relationship changes and concerns for their children, and meaning‐making in cancer experience. Conclusions Changes in mothers' psychological well‐being, role, and identity occurred across cancer diagnoses, treatment, and recovery trajectories. The evidence suggests that mothers may benefit from continued and tailored psychosocial support to cope with these challenges, even after treatment is completed. Further studies with improved methodological quality are needed to explore these issues in depth. - Psycho-Oncology, EarlyView.
    October 19, 2018   doi: 10.1002/pon.4904   open full text
  • Body mass index and sexual function in women with gynaecological cancer.
    Hannah Donkers, Anke Smits, Antonio Eleuteri, Ruud Bekkers, Leon Massuger, Khadra Galaal.
    Psycho-Oncology. October 19, 2018
    --- - |2+ Abstract Objectives To investigate the association between body mass index (BMI) and sexual functioning in gynaecologic cancer patients. To determine the association between socio‐economic deprivation and sexual functioning. Methods This is a prospective cohort study on women undergoing surgery for suspected or proven gynaecological cancer between September 2014 and February 2016 in the Royal Cornwall Hospital Trust. Patients were invited to participate by completing the Female Sexual Function Index (FSFI) at three time points: preoperative, 3 months postoperative, and 1 year postoperative. A semiparametric model of the FSFI score was used to establish the association between BMI and sexual functioning. Results A total of 257 patients were approached of which 166 patients were included. Fifty‐two patients (33.8%) were overweight (BMI, 25‐29.9 kg/m2), 44 (28.6%) were obese (BMI, 30‐39.9 kg/m2), and a further 20 (13.0%) morbidly obese (BMI ≥ 40 kg/m2). Overweight and obese women reported improved sexual functioning compared with normal‐weight women in endometrial, ovarian, and vulvar cancers. Among cervical cancer, worse sexual functioning was seen in women with an increased BMI; however, this was not significant. Younger age was associated with improved sexual function, and sexual functioning was better postoperatively for all patients compared with preoperatively. There was no evidence of relationship between deprivation and sexual functioning in gynaecological cancer patients. Conclusion Higher BMI is associated with improved sexual functioning in endometrial, ovarian, and vulvar cancer; however, this was not seen in cervical cancer patients. There is no evidence of correlation between deprivation and sexual functioning. - Psycho-Oncology, EarlyView.
    October 19, 2018   doi: 10.1002/pon.4908   open full text
  • Psychosocial distress and utilization of professional psychological care in cancer patients: An observational study in National Comprehensive Cancer Centers (CCCs) in Germany.
    Joachim Weis, Klaus Hönig, Corinna Bergelt, Hermann Faller, Anette Brechtel, Beate Hornemann, Barbara Stein, Martin Teufel, Ute Goerling, Yesim Erim, Franziska Geiser, Alexander Niecke, Bianca Senf, Martin Wickert, Claudia Schmoor, Angelika Gerlach, Dieter Schellberg, Antje Büttner‐Teleaga, Katharina Schieber.
    Psycho-Oncology. October 19, 2018
    --- - |2+ Abstract Objective The study aimed to assess cancer patients' use of psychological care and its correlates in a large sample of cancer patients in Comprehensive Cancer Centers (CCCs) in Germany. Methods In a multicenter study in Germany, cancer patients with various diagnoses were evaluated for self‐reported use of psychological support. We measured psychological distress, depression and anxiety, quality of life, and social support with standardized questionnaires and analyzed its association with the utilization of psychological care using multivariable logistic regression. This paper focuses on a cross‐sectional analysis of the data assessed during inpatient care. Results Three thousand fifty‐four (50%) of hospitalized patients were asked for participation, and n = 1632 (53.6%) participated. We were able to analyze n = 1,398 (45.9%) patients. Three hundred ninety‐seven (28.4%) of the sample utilized psychological support. Users of psychological care were significantly younger than nonusers (odds ratio [OR]: 0.967, P < 0.001) and were more often female (OR: 1.878, P < 0.001), whereas educational level was not associated with the use of psychological care. In the multivariable analysis, effects on the use of psychological care were observed for Hospital Anxiety and Depression Scale (HADS) anxiety (OR: 1.106, P = 0.001) and both subscales of the 12‐item Short Form Health Survey (SF‐12) quality of life measure (mental, OR: 0.97, P = 0.002; physical, OR: 0.97, P = 0.002). Conclusion Psychological distress and anxiety are higher, and quality of life is lower in users of psychological care in comparison with nonusers during inpatient cancer treatment. Although psychooncological services should be provided to all patients who need them, special efforts should be made to reach populations that report low utilization. - Psycho-Oncology, EarlyView.
    October 19, 2018   doi: 10.1002/pon.4901   open full text
  • “Creating a family after battling cancer is exhausting and maddening”: Exploring real‐world experiences of young adult cancer survivors seeking financial assistance for family building after treatment.
    Catherine Benedict, Jody‐Ann McLeggon, Bridgette Thom, Joanne F. Kelvin, Michelle Landwehr, Samantha Watson, Jennifer S. Ford.
    Psycho-Oncology. October 19, 2018
    --- - |2+ Abstract Objective Young adult (YA) cancer survivors who received gonadotoxic therapy are at risk for impaired fertility and/or childbearing difficulties. This study explored the experiences and financial concerns of survivors pursuing family building through assisted reproductive technology (ART) and adoption. Methods Retrospective study of data collected from grant applications for financial assistance with family building. Grounded theory methodology using an inductive data‐driven approach guided qualitative data analysis. Results Participants (N = 46) averaged 32 years old (SD = 3.4) were primarily female (81%) and married/partnered (83%). Four main themes were identified representing the (1) emotional experiences and (2) financial barriers to family building after cancer, (3) perceived impact on partners, and (4) disrupted life trajectory. Negative emotions were pervasive but were balanced with hope and optimism that parenthood would be achieved. Still, the combination of high ART/adoption costs, the financial impact of cancer, and limited sources for support caused extreme financial stress. Further, in the face of these high costs, many survivors reported worry and guilt about burdening partners, particularly as couples failed to meet personal and societal expectations for parenthood timelines. Conclusion After cancer, YAs face numerous psychosocial and financial difficulties in their pursuits of family building when ART/adoption is needed to achieve parenthood. Survivors interested in future children may benefit from follow‐up fertility counseling post‐treatment including discussion of ART options, surrogacy, and adoption, as appropriate, and potential barriers. Planning for the financial cost and burden in particular may help to avoid or mitigate financial stress later on. - Psycho-Oncology, EarlyView.
    October 19, 2018   doi: 10.1002/pon.4898   open full text
  • Pilot Randomized controlled trial of a symptom cluster intervention in advanced cancer.
    Sharla M. Wells‐Di Gregorio, Donald R. Marks, Joseph DeCola, Juan Peng, Danielle Probst, Alexandra Zaleta, Don Benson, David Cohn, Maryam Lustberg, William Carson, Uly Magalang.
    Psycho-Oncology. October 18, 2018
    --- - |2+ Abstract Objective This study evaluated a three‐session acceptance‐based cognitive‐behavioral intervention (CBT‐ACT) targeting a common symptom cluster in advanced cancer – worry‐insomnia‐depression‐fatigue. Methods Twenty‐eight patients with advanced cancers were randomly assigned to the CBT‐ACT intervention or waitlist. At pre‐intervention, participants completed a psycho‐diagnostic interview, standardized questionnaires, and a sleep diary. Intervention and waitlist groups were re‐assessed after six weeks, at which point the waitlist group completed the intervention. Results Participants receiving the intervention demonstrated improved sleep efficiency (p = 0.0062, d = 1.08), sleep latency (p = 0.028, d = ‐0.86), insomnia severity (p = 0.0047, d = ‐1.18), and worry (p = 0.026, d = 0.89) compared to waitlist controls. They also demonstrated a 7‐point reduction on depression (p = 0.03, d = ‐0.88), reduced hyperarousal (p = 0.005, d = ‐1.51), and a decrease in distress (p = 0.032, d = ‐0.83). Effects were maintained for the whole sample in sensitivity analyses. Effects on uncertainty intolerance approached significance (p = 0.058). No effect was found on fatigue. Conclusions The CBT‐ACT group performed significantly better than the waitlist control group. CBT‐ACT yielded strong effects for worry, sleep, depression, emotional distress, total distress, and hyperarousal. Future studies will enhance the fatigue and uncertainty tolerance components of the intervention. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 18, 2018   doi: 10.1002/pon.4912   open full text
  • The influence of Malay cultural beliefs on breast cancer screening and genetic testing: A focus group study.
    Tarryn Shaw, Diana Ishak, Désirée Lie, Sapna Menon, Eliza Courtney, Shao‐Tzu Li, Joanne Ngeow.
    Psycho-Oncology. October 16, 2018
    --- - |2+ Abstract Objective Malays comprise an Asian cultural group reported to have low breast cancer screening uptake rates and poor cancer outcomes. Little is known about Malay cultural factors influencing beliefs and practice of cancer screening and genetic testing. Our study aims to explore health beliefs of Malay women around breast cancer screening and genetic testing. Methods We conducted focus groups among healthy English‐speaking Malay women in Singapore, aged 40 to 69 years, using a structured guide developed through literature review, expertise input and participant refinement. Thematic analysis was conducted to extract dominant themes representing key motivators and barriers to screening and genetic testing. We used grounded theory to interpret results and derive a framework of understanding, with implications for improving uptake of services. Results Five focus groups (four to six participants per group) comprising 27 women were conducted to theme saturation. Major themes were (a) spiritual and religious beliefs act as barriers towards uptake of screening and genetic testing; (b) preference for traditional medicine competes with Western medicine recommendations; (c) family and community influence health‐related decisions, complexed by differences in intergenerational beliefs creating contrasting attitudes towards screening and prevention. Conclusions Decisions to participate in breast cancer screening and genetic testing are influenced by cultural, traditional, spiritual/religious, and intergenerational beliefs. Strategies to increase uptake should include acknowledgement and integration of these beliefs into counseling and education and collaboration with key influential Malay stakeholders and leaders. - Psycho-Oncology, EarlyView.
    October 16, 2018   doi: 10.1002/pon.4902   open full text
  • The role of perceived dignity and control in the wish to hasten death among advanced cancer patients: A mediation model.
    Cristina Monforte‐Royo, Iris Crespo, Andrea Rodríguez‐Prat, Frederic Marimon, Josep Porta‐Sales, Albert Balaguer.
    Psycho-Oncology. October 16, 2018
    --- - |2+ Abstract Objective The objective of the study is to test a model in which perceived loss of dignity and control are proposed, along with symptoms of depression and functional impairment, as risk factors for the wish to hasten death (WTHD) in advanced cancer patients. Methods This was a cross‐sectional study of 193 patients in an oncology unit. Outcome measures included perceived control, performance status, symptoms of depression, perceived dignity, and the WTHD. Structural equation modeling was performed. Results Structural equation modeling showed that perceived loss of control (−0.402) and functional impairment (−0.21) were risk factors for perceived loss of dignity. Loss of control (−0.385) and functional impairment (−0.283) were also risk factors for symptoms of depression. Perceived loss of dignity and symptoms of depression were the most proximal determinants of the WTHD, on which they had a direct, positive, and significant effect (0.246 and 0.209, respectively). Therefore, both symptoms of depression and perceived loss of dignity independently predicted the WTHD and mediated the effects of perceived loss of control and functional impairment on this wish. Conclusions The hypothesized model provides evidence for the impact of the four aforementioned factors on the WTHD. Our results suggest that personalized care plans which are able to enhance the sense of dignity and control among advanced cancer patients could help to reduce the likelihood or intensity of a WTHD. - Psycho-Oncology, EarlyView.
    October 16, 2018   doi: 10.1002/pon.4900   open full text
  • The multidisciplinary pediatric psycho‐oncology workforce: A national report on supervision for staff and training opportunities.
    Anne E. Kazak, Michele A. Scialla, Andrea F. Patenaude, Kimberly Canter, Anna C. Muriel, Mary Jo Kupst, Fang Fang Chen, Lori Wiener.
    Psycho-Oncology. October 15, 2018
    --- - |2+ Abstract Objective This paper presents data on licensure/certification status, supervision of multidisciplinary pediatric psychosocial staff, and training opportunities in pediatric cancer programs in the United States, data that are critical to provide care aligned with the Standards of Psychosocial Care in Pediatric Cancer (Psychosocial Standards). Methods An online survey of psychosocial care consistent with the Psychosocial Standards was completed from a national sample of pediatric cancer programs (144/200). Licensure/certification status, availability and format of supervision for multidisciplinary staff (social workers, psychologists, psychiatrists, child life specialists/recreational therapists), and types and number of psychosocial trainees were reported. Results Nearly all pediatric psychosocial providers were licensed/certified. Peer consultation was the most frequently endorsed form of staff supervision although a sizeable group of centers reported no systematic ongoing supervision. Trainees in social work and child life were most common although the size of trainee cohorts is generally small. Psychosocial trainees are more prevalent in sites with pediatric hematology/oncology medical fellowship programs and in larger programs. Conclusions A properly trained and supported psychosocial workforce is essential to providing evidence‐based care consistent with the Psychosocial Standards. Psychosocial providers are appropriately licensed. However, supervision opportunities are variable and may be inadequate for the intensity of the work. It is important to address the limited opportunities for trainees in pediatric cancer programs, which may influence the pipeline for ongoing and future work in this area. - Psycho-Oncology, EarlyView.
    October 15, 2018   doi: 10.1002/pon.4892   open full text
  • The effects of anxiety on the receipt of treatments for esophageal cancer.
    Ting‐Yao Wang, Vincent Chin‐Hung Chen, Yao‐Hsu Yang, Chao‐Yu Chen, Chuan‐Pin Lee, Shu‐I Wu.
    Psycho-Oncology. October 15, 2018
    --- - |2+ Abstract Objective This study aimed to evaluate the association between anxiety and receipt of treatments for esophageal cancer. Methods We used a population‐based cohort to obtain information of patients with esophageal cancer. Baseline diagnoses of depression or anxiety were identified. Competing risk analyses were used to estimate hazard ratios for risk factors affecting the receipt of anticancer therapies. Subanalysis for the association of anxiety and anticancer therapy stratified by covariates were also performed. Results Ten thousand five hundred thirty‐seven patients with esophageal cancer were identified. Seven hundred thirty‐two patients (6.9%) had anxiety disorder before the diagnosis of esophageal cancer. Competing risk model showed that having anxiety disorder was positively associated with the receipt of anticancer treatments (hazard ratio 1.12, 95% CI 1.03–1.22, P = .011), while having depression did not affect patients' status of receiving treatments (hazard ratio 1.05, 95% CI 0.93–1.19, P = .462). Besides, older age, female gender, lower income, and having comorbidities of chronic renal failure and liver cirrhosis were associated with a decreased possibility of receiving anticancer therapy. Conclusions Our results indicate that esophageal cancer patient with anxiety disorder has higher possibility to receive anticancer therapy than patients without anxiety disorder. - Psycho-Oncology, EarlyView.
    October 15, 2018   doi: 10.1002/pon.4903   open full text
  • Gender in Psycho‐Oncology. Edited by Youngmee Kim and Matthew J. Loscalzo. New York: Oxford University press, 2018. 244 pp. $49.95 paperback.
    Cristiane Decat Bergerot.
    Psycho-Oncology. October 15, 2018
    --- - - Psycho-Oncology, EarlyView.
    October 15, 2018   doi: 10.1002/pon.4890   open full text
  • Neurocognitive Dysfunction in Adult Cerebellar Medulloblastoma.
    Rebecca A. Harrison, Shelli R. Kesler, Jason M. Johnson, Marta Penas‐Prado, Catherine M. Sullaway, Jeffrey S. Wefel.
    Psycho-Oncology. October 13, 2018
    --- - |2+ Abstract Objective Impaired neurocognitive function (NCF) is a well‐established consequence of pediatric medulloblastoma (MB) and its treatments. However, the frequency and features of neurocognitive dysfunction in adult‐onset MB patients is largely unknown. Methods Adult patients (> 18 years) with MB who had received formal neurocognitive evaluation (N=27) were identified. Demographic, medical, and treatment histories were extracted from the medical record. Lesion properties on MRI were analyzed and used to evaluate lesion‐symptom mapping further. Demographically‐adjusted z‐scores were calculated for each neurocognitive test and used to assess impairment frequency. Regression analyses were conducted to identify clinical and paraclinical factors associated with impaired NCF. Results Mean age of the patient sample was 33 years (SD=11) at the time of MB diagnosis. Prior therapy included surgical resection (89%), radiation (70%), and chemotherapy (26%). A significant proportion of patients were impaired on tests of verbal learning and memory (32%), executive function (29%), and naming (18%). Age, education, lesion size, time from surgery, and number of chemotherapy cycles had the greatest contribution to test performance in random‐forest regression models. Conclusion This study identifies frequent impairment of NCF in adult patients with MB, particularly in the domains of learning and memory and executive function. Neurocognitive impairment is influenced by patients’ demographic, disease, and treatment history. Further study is warranted to characterize the clinical impact of adult MB more fully. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 13, 2018   doi: 10.1002/pon.4920   open full text
  • Unmet supportive care needs and psychological distress among parents of children with cancer in Indonesia.
    Yulanticha Diaz Ahwalia Aziza, Shan‐Tair Wang, Mei‐Chih Huang.
    Psycho-Oncology. October 13, 2018
    --- - |2+ Abstract Objective The aim of this study was to investigate the needs and associating factors, psychological distress of parents when taking care of children with cancer in Indonesia. Methods A cross‐sectional study was conducted among 100 parents of children with cancer from the pediatric ward of two hospitals in Indonesia. The parents were assessed using the Indonesian version of the Supportive Care Needs Survey for Partner and Caregiver (unmet needs) and the Hospital Anxiety Depression Scale (psychological distress). The factors associated with unmet needs were analyzed using hierarchical linear regression. Results Among the surveyed parents, 83% had over ten unmet needs. Among these unmet needs, need for information was the highest one. In the self‐report measure using a clinical cut‐off, 49% of the parents reported signs of anxiety, and 25% had signs of depression. Parents reporting clinically relevant levels of anxiety had more unmet needs than parents without clinically relevant anxiety. Having fewer children was correlated with higher work and social needs, and higher levels of education were correlated with more psychological needs. However, the children's clinical variables were not associated with the overall needs in the regression model. Conclusions Most parents of children with cancer reported a need for more information and reported signs of anxiety and depression. Parents with fewer children and higher levels of education were identified as a vulnerable population due to having greater needs. The result of this study can be used to improve supportive care for parents of children with cancer in hospital settings. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 13, 2018   doi: 10.1002/pon.4914   open full text
  • Photographs of meaning: A novel social media intervention for adolescent and young adult cancer patients.
    Lynda K. Beaupin, Megan E. Pailler, Erin Brewer‐Spritzer, Eric Kishel, Pei C. Grant, Rachel M. Depner, Kelly E. Tenzek, Jennifer M. Breier.
    Psycho-Oncology. October 12, 2018
    --- - - Psycho-Oncology, EarlyView.
    October 12, 2018   doi: 10.1002/pon.4896   open full text
  • Development and Validation of the McGill Body Image Concerns Scale for Use in Head and Neck Oncology (MBIS‐HNC): A Mixed‐Methods Approach.
    Ana Maria Rodriguez, Saul Frenkiel, Justin Desroches, Avina De Simone, Francois Chiocchio, Christina MacDonald, Martin Black, Anthony Zeitouni, Michael Hier, Karen Kost, Alex Mlynarek, Clara Bolster‐Foucault, Zeev Rosberger, Melissa Henry.
    Psycho-Oncology. October 12, 2018
    --- - |2+ Abstract Objective The aim of this study was to develop and validate a patient‐reported outcome measure to evaluate body image concerns in head and neck cancer (HNC) patients. Methods Items were created using a combination of deductive (e.g., US Food and Drug Administration Qualification of Clinical Outcome Assessments, literature review) and inductive approaches (e.g., subject matter experts, HNC patients). Items were translated for use in both Canadian‐English and Canadian‐French using back‐translation. A two‐step empirical validation process using Classical Test Theory (CTT) and Rasch Measurement Theory (RMT) was conducted with 224 and 258 HNC patients, respectively, having undergone disfiguring surgery within the past three years. Results Analyses suggest two subscales for MBIS‐HNC: social discomfort (10 items) and negative self‐image (11 items). The MBIS‐HNC is reliable with high internal consistency (0.98), high test‐retest reliability over a two‐week period (ICC=0.88), moderate to high convergent validity (range r=0.43‐0.81), and divergent validity (range r=0.12‐0.15). RMT was used in addition to CTT. Disordered thresholds led to the modification of the number of response options, and items were deleted based on differential item functioning and high local dependency. Unidimensionality of both subscales and supporting a total score was confirmed. The measure was however characterized by the presence of an important floor effect, confirmed with poor targeting as demonstrated by the person‐item threshold distribution. Conclusion Evidence gathered from our theory‐driven validation study using CTT and RMT provides practitioners and researchers with a useful and easy to use self‐report measure. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 12, 2018   doi: 10.1002/pon.4918   open full text
  • The Experience of Medical Communication in Adults with Acute Leukemia: Impact of Age and Attachment Security.
    Brooke Fraser, Chana Korenblum, Kenneth Mah, Sarah Watt, Carmine Malfitano, Anne Rydall, Aaron Schimmer, Camilla Zimmermann, Gary Rodin.
    Psycho-Oncology. October 12, 2018
    --- - |2+ Abstract Background Healthcare providers’ (HCPs) communication with cancer patients provides both information and support. Younger patient age and greater difficulty accepting support (attachment security) have been linked to poorer communication experiences with HCPs. The present secondary data analysis examined the impact of age group and attachment security on perceived communication problems with HCPs in adults with acute leukemia (AL). Methods The sample included 95 younger (age <40 years) and 225 older (age >40 years) patients with newly‐diagnosed or relapsed AL. We assessed avoidant and anxious attachment security (reluctance to accept support and fear of its unavailability, respectively) with the modified Experiences in Close Relationships Scale. The impact of age group and attachment security on perceived communication problems, measured with the Cancer Rehabilitation Evaluation System‐Medical Interaction Subscale, was assessed based on the presence and extent of communication problems. Results Younger patients (OR=1.79–1.82, p=.030) and those with greater avoidant (OR=1.44, p=.001) or anxious attachment (OR=1.38, p=.009) were more likely to report communication problems. A similar relationship was found between age (β’s=‐.17‐.19, p=.015–.025), avoidant (β=.29, p=.013) or anxious attachment (β=.17, p=.031), and the extent of communication problems. A significant age‐group x avoidant‐attachment interaction (β=‐.31, p=.008) suggested that more avoidant attachment was associated with more perceived communication problems in the younger but not in the older group. Conclusions Younger patients with AL, especially those more reluctant to seek or accept support, perceive more communication problems with their HCPs than older patients. Greater attention by HCPs to their communication with younger patients is needed. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 12, 2018   doi: 10.1002/pon.4919   open full text
  • Contribution of Psychiatric Diagnoses to Extent of Opioid Prescription in the First Year Post‐Head and Neck Cancer Diagnosis: A Longitudinal Study.
    Melissa Henry, Ali Alias, Saul Frenkiel, Keith Richardson, Michael Hier, Anthony Zeitouni, Karen Kost, Alex Mlynarek, Martin Black, Christina MacDonald, Gabrielle Chartier, Zeev Rosberger.
    Psycho-Oncology. October 11, 2018
    --- - |2+ Abstract Purpose The purpose of this study was to determine, within the first‐year post–head and neck cancer (HNC) diagnosis, the contribution of past and upon HNC psychiatric diagnoses (i.e., substance use disorder (SUD), major depressive disorder (MDD), and anxiety disorder (AD)) to the extent (i.e., cumulated dose) of opioid prescription. Methods Prospective longitudinal study of 223 consecutive adults (on 313 approached; 72% participation) newly diagnosed (<2 weeks) with a first occurrence of primary HNC, including Structured Clinical Interviews for DSM‐IV disorders, validated psychometric measures, and medical chart reviews. Opioid doses were translated into standardized morphine milligram equivalents (MME) using CDC guidelines. A model of variables was tested using multiple linear regression. Results Fifty‐five percent (123/223) of patients received opioids at some point during the first 12 months post–HNC diagnosis, 37.7% (84/223) upon HNC diagnosis (pre‐treatment), 40.8% (91/223) during treatments, and 31.4% (70/223) post‐treatment. The multiple linear regression indicated that an AD (p=0.04) upon HNC diagnosis in early stage contributes to cumulated MME dose in the first year post‐HNC diagnosis. Conclusion This study underlines how anxiety has important repercussions on the management of pain and illustrates the importance of screening for AD upon HNC diagnosis to allow for early prophylactic treatment and support. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 11, 2018   doi: 10.1002/pon.4917   open full text
  • Existential distress in cancer: Alleviating suffering from fundamental loss and change.
    Sigrun Vehling, David W. Kissane.
    Psycho-Oncology. October 11, 2018
    --- - |2 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. - Psycho-Oncology, EarlyView.
    October 11, 2018   doi: 10.1002/pon.4872   open full text
  • Social Relationship Coping Efficacy: A New Construct in Understanding Social Support and Close Personal Relationships in Persons with Cancer.
    Thomas V. Merluzzi, Samantha Serpentini, Errol J. Philip, Miao Yang, Natalia Salamanca‐Balen, Carolyn A. Heitzmann Ruhf, Antonio Catarinella.
    Psycho-Oncology. October 10, 2018
    --- - |2+ Abstract Objective Social relationship coping efficacy (SRCE) is the confidence to engage in behaviors that can maintain or enhance close social relationships in the context of illness. This study focused on psychometric analyses of the SRCE Scale and its role in maintaining or enhancing personal relationships, social support, and quality of life (QOL). Method A mixed diagnosis sample (N=151) of cancer patients completed a variety of measures: physical debilitation, received emotional and instrumental support, SRCE, and QOL. Results The SRCE Scale is a 10‐item, one‐factor, internally reliable (α=0.965) measure with strong concurrent validity in relation to measures of social support. SRCE fully mediated the relationship between physical debilitation and both instrumental and emotional received support. SRCE also was directly related to both social/family well‐being and psychological distress, and this relationship was also partially mediated by social support. Conclusions The results corroborated that SRCE might account for changes in both instrumental and emotional support. Also, the direct and indirect relationship (mediated by social support) of SRCE with both social/family well‐being and distress indicated that interventions to increase SRCE with those at risk for social support loss may bolster social support in personal relationships as well as enhance emotional well‐being and quality of life. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 10, 2018   doi: 10.1002/pon.4913   open full text
  • Patient‐reported outcomes of breast reconstruction in older women: Audit of a large metropolitan public/private practice in Sydney, Australia.
    Daniel D. Oh, Kathy Flitcroft, Meagan E. Brennan, Kylie L. Snook, Andrew J. Spillane.
    Psycho-Oncology. October 10, 2018
    --- - |2+ Abstract Objective Older age is associated with lower rates of breast reconstruction (BR) for women requiring mastectomy. This study compared patient‐reported outcomes between women aged 60 years and older who had received mastectomy and BR with those who received no BR (NBR). Methods About 135 women aged 60 or over treated between 2009 and 2016 with mastectomy only (N = 87) or mastectomy with BR (N = 48) for primary breast cancer completed patient‐reported outcome measures using a set of validated questionnaires. Reasons for choosing or declining BR were also explored using a set of nonvalidated questionnaires. Results Patients who received BR were generally younger (P = <0.001) and reported greater satisfaction with their bodies (P = 0.048) than NBR patients. Patients with autologous reconstruction reported greater satisfaction with their breasts than implant‐based reconstruction patients. Both BR and NBR patients reported good quality of life, low pain scores, good body image, and low levels of decisional regret. Conclusions These data do not identify any quality of life‐related reasons to not offer clinically fit, well‐informed older women the option of BR. - Psycho-Oncology, EarlyView.
    October 10, 2018   doi: 10.1002/pon.4895   open full text
  • Preserving fertility in women with cancer (PreFer): Decision‐making and patient‐reported outcomes in women offered egg and embryo freezing prior to cancer treatment.
    Katharina S. Vogt, Jane Hughes, Anna Wilkinson, Neda Mahmoodi, Jonathan Skull, Hilary Wood, Sophia McDougall, Pauline Slade, Diana M. Greenfield, Allan Pacey, William Ledger, Georgina L. Jones.
    Psycho-Oncology. October 10, 2018
    --- - |2+ Abstract Objective Women of childbearing age with new cancer diagnoses have to make rapid decisions about fertility preservation (FP) before starting cancer treatment (CT). The aim of the PreFer study was to explore this FP decision‐making process and its impact on patient‐reported outcomes (PROMs) and health‐related quality of life (HRQoL). Methods A prospective, mixed‐methods design was used (questionnaires, in‐depth interviews). Interviews were analysed using thematic analysis. Fifty‐eight women with new cancer diagnoses were recruited. Comparisons were made between women who declined FP referral in oncology (Group1) and women who chose referral (Group2). Group 2 was further split into those who had some FP (2A) and those who did not (2B). Questionnaires and PROMs were administered prior to and after the fertility consultation, before the start of CT and 3 months post CT. Interviews were conducted with one participant from Group 2. Results HRQoL was negatively affected, particularly depression. Women's lack of understanding about the relationship between CT and fertility were evident. Five themes emerged from the interviews as barriers and facilitators to the FP decision‐making process. Conclusion The results indicate that better information and support resources aimed at women to support their decision making are needed, such as patient decision‐aids. Women from Group 1 were found to suffer significantly worse depression compared with the general UK population, highlighting the need for psychological support in the FP care‐pathway and for research exploring the contributions of depression and hopelessness to the decision‐making process. - Psycho-Oncology, EarlyView.
    October 10, 2018   doi: 10.1002/pon.4866   open full text
  • Barriers to psychosocial oncology service utilization in patients newly diagnosed with head and neck cancer.
    Alexandra Cohen, Lola E. Ianovski, Saul Frenkiel, Michael Hier, Anthony Zeitouni, Karen Kost, Alex Mlynarek, Keith Richardson, Martin Black, Christina MacDonald, Gabrielle Chartier, Zeev Rosberger, Melissa Henry.
    Psycho-Oncology. October 09, 2018
    --- - |2+ Abstract Objectives While patients with head and neck cancer (HNC) are known to experience higher levels of anxiety and depression, they do not always use psychosocial oncology (PSO) services when available. This study aimed to investigate barriers to PSO service utilization in this patient population, with the goal of appropriately targeting outreach interventions. Methods A conceptual model based on the Behavioral Model of Health Services Use was tested in 84 patients newly diagnosed with a first occurrence of HNC followed longitudinally over 1 year, including variables collected through self‐administered questionnaires, Structured Clinical Interviews for DSM (SCID‐I), and medical chart reviews. Results Within the first‐year post‐diagnosis, 42.9% of HNC patients experienced clinical levels of psychological distress, with only 50% of these consulting PSO services (29% total). A logistic regression indicated that PSO utilization was increased when patients presented with advanced cancer (P = 0.04) and a SCID‐I diagnosis of major depressive disorder, anxiety disorder, or substance use disorder (P = 0.02), while there was an inverse relationship with self‐stigma of seeking help (P = 0.03); these variables together successfully predicted 76.3% of overall PSO utilization, including 90.6% of non‐users. Conclusions Future outreach interventions in patients with HNC could address stigma in an attempt to enhance PSO integration into routine clinical care. - Psycho-Oncology, EarlyView.
    October 09, 2018   doi: 10.1002/pon.4889   open full text
  • Psychosocial impact of BRCA testing in young Black breast cancer survivors.
    Brian D. Gonzalez, Aasha I. Hoogland, Monica L. Kasting, Deborah Cragun, Jongphil Kim, Kimlin Ashing, Cheryl L. Holt, Chanita Hughes Halbert, Tuya Pal, Susan T. Vadaparampil.
    Psycho-Oncology. October 09, 2018
    --- - |2+ Abstract Objective Prior studies demonstrating minimal psychological consequences for women receiving genetic counseling/genetic testing (GC/GT) for hereditary breast and ovarian cancer rely on predominantly Caucasian women. We conducted a prospective follow‐up of a subset of participants from a population‐based study of Black breast cancer (BC) survivors receiving GC/GT for BRCA1 and BRCA2 mutations. Methods Black women with invasive BC at age ≤ 50 years diagnosed between 2009 and 2012 were recruited through the Florida Cancer Registry. Participants (n = 215, age M = 44.7, SD = 6.2) were offered telephone pre‐ and post‐test GC, a subset completed questionnaires assessing sociodemographic, clinical, and psychosocial variables. Results There were no baseline differences in cancer‐related distress, psychological distress, or quality of life between test result groups. Social well‐being improved in women receiving negative results (P = .01), but no other outcomes demonstrated significant changes over time between groups. Conclusions Our study is among the first to demonstrate minimal negative psychosocial outcomes following GC/GT among young Black BC survivors, irrespective of test results. - Psycho-Oncology, EarlyView.
    October 09, 2018   doi: 10.1002/pon.4887   open full text
  • Cancer and Aging: Reflections for Elders (CARE): A Pilot Randomized Controlled Trial of a Psychotherapy Intervention for Older Adults with Cancer.
    Christian J. Nelson, Rebecca M. Saracino, Andrew J. Roth, Elizabeth Harvey, Anne Martin, Mark Moore, Dana Marcone, Shannon R. Poppito, Jimmie Holland.
    Psycho-Oncology. October 08, 2018
    --- - |2+ Abstract Objective Cancer and Aging: Reflections for Elders (CARE), is a novel, telephone‐delivered intervention designed to alleviate distress in older cancer patients. This pilot randomized controlled trial tested the feasibility and initial efficacy of CARE, drawing from age‐appropriate developmental themes and well‐established coping theory. Method Eligible patients were ≥70 years old, ≥six months post‐diagnosis of lung, prostate, breast, lymphoma, or gynecological cancer, on active cancer treatment or within six months of ending cancer treatment, and had elevated scores on the Distress Thermometer (≥4) or Hospital Anxiety and Depression Scale (≥6). Participants completed five sessions of psychotherapy over seven weeks with assessments at study entry, post‐intervention, and 2 months post‐intervention. Primary outcomes were feasibility and initial efficacy on anxiety and depression; secondary outcomes included demoralization, coping, loneliness, and spiritual well‐being. Results Fifty‐nine participants were randomized to either the CARE arm (n=31) or the enhanced social work control arm (ESWC; n=28). The intervention was feasible and tolerable, meeting a priori criteria for rates of eligibility, acceptance, retention, assessment, and treatment fidelity. Upon completion of the intervention, participants in the CARE arm demonstrated lower mean depression scores (d=0.58 (CI: 0.04‐1.12), p=0.01) and trended towards increased coping‐planning (d=0.30 (CI: ‐0.83‐0.24), p=0.18). Promising trends in anxiety (d=0.41 (CI: ‐0.17‐0.98), p=0.10) emerged at 2 months post‐intervention; effects for coping‐planning dissipated. Conclusion These pilot data suggest the CARE intervention is feasibly delivered, potentially impacts important psychosocial variables and is accessible for older, frail patients with cancer. Future research will evaluate this intervention on a larger scale. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 08, 2018   doi: 10.1002/pon.4907   open full text
  • Corrigendum.

    Psycho-Oncology. October 05, 2018
    --- - - Psycho-Oncology, Volume 27, Issue 10, Page 2521-2521, October 2018.
    October 05, 2018   doi: 10.1002/pon.4860   open full text
  • Cover Image, Volume 27, Issue 10.
    Simon Dunne, Laura Coffey, Linda Sharp, Aileen Timmons, Deirdre Desmond, Rachael Gooberman‐Hill, Eleanor O'Sullivan, Ivan Keogh, Conrad Timon, Pamela Gallagher.
    Psycho-Oncology. October 05, 2018
    --- - - Psycho-Oncology, Volume 27, Issue 10, Page i-i, October 2018.
    October 05, 2018   doi: 10.1002/pon.4905   open full text
  • Issue Information.

    Psycho-Oncology. October 05, 2018
    --- - - Psycho-Oncology, Volume 27, Issue 10, Page 2303-2304, October 2018.
    October 05, 2018   doi: 10.1002/pon.4542   open full text
  • Special Issue on eHealth Innovations and Psycho‐Oncology.

    Psycho-Oncology. October 05, 2018
    --- - - Psycho-Oncology, Volume 27, Issue 10, Page 2520-2520, October 2018.
    October 05, 2018   doi: 10.1002/pon.4766   open full text
  • Interventions for prostate cancer survivorship: A systematic review of reviews.
    Fiona Crawford‐Williams, Sonja March, Belinda C. Goodwin, Nicholas Ralph, Daniel A. Galvão, Robert U. Newton, Suzanne K. Chambers, Jeff Dunn.
    Psycho-Oncology. October 05, 2018
    --- - |2+ Abstract Objective To systematically review the evidence for interventions addressing key domains of the American Cancer Society (ACS) and American Society of Clinical Oncology (ASCO) Prostate Cancer Survivorship Care Guidelines: health promotion, surveillance, physical side effects, psychosocial management, and care coordination. Methods We conducted a systematic review of systematic reviews and meta‐analyses of interventions targeting ACS/ASCO guideline domains. All titles and abstracts were independently assessed for inclusion based on predetermined criteria. Relevant data were extracted, and assessment of methodological quality was performed. Results Forty‐four systematic reviews of interventions targeting ACS prostate cancer guideline domains were included for review. Exercise and psychosocial interventions were effective for improving men's survivorship outcomes in the domains of health promotion, physical side effects, and psychosocial management. Across the domains, evidence quality varied and there was a limited diversity of participants. No reviews of interventions addressing surveillance and cancer care coordination were identified. Conclusions There are substantive knowledge gaps in prostate cancer survivorship research that are a barrier to real improvements in men's outcomes across the breadth of the survivorship experience. A targeted research and implementation agenda in prostate cancer survivorship is urgently needed if we are to meet the current and future burden of this disease on individuals, families, and communities. - Psycho-Oncology, Volume 27, Issue 10, Page 2339-2348, October 2018.
    October 05, 2018   doi: 10.1002/pon.4888   open full text
  • Risk of suicide attempts among colorectal cancer patients: A nationwide population‐based matched cohort study.
    Li‐Min Sun, Cheng‐Li Lin, Chung‐Y. Hsu, Chia‐Hung Kao.
    Psycho-Oncology. October 05, 2018
    --- - |2+ Abstract Objective Patients with colorectal cancer (CRC) have been found to have a higher risk of suicide in limited‐number studies. However, data on the actual incidence rate of suicide remain scarce. Methods Using Taiwan's National Health Insurance Research Database, we examined whether patients with CRC in Taiwan are at increased risk of suicide attempts. In this retrospective matched cohort study, data of 96 470 cases of CRC during 1 January 2000 to 31 December 2010 were collected. The control group was derived from general population by frequency matching 2 individuals without CRC for each individual with CRC by year of CRC diagnosis, age, and sex. The suicide risk in the CRC group compared with the control group was determined through Cox proportional hazard regression. We also compared the Kaplan‐Meier analyses to competing risk cumulative incidence curves using the Aalen‐Johansen estimator. Results A statistically significant 103% higher risk of suicide was observed in the CRC group compared with the control group (adjusted hazard ratio: 2.03; 95% confidence ratio: 1.60‐2.56). Additional stratified analyses revealed a significantly elevated risk across almost all demographic groups but limited to rectum location, short follow‐up time (<5 years), and without comorbidity. Conclusions Our study suggested that patients with CRC in Taiwan have an elevated risk of suicide. Oncologists should pay attention to these patients and should consider referring them for psychological consultation to prevent suicide. - Psycho-Oncology, EarlyView.
    October 05, 2018   doi: 10.1002/pon.4891   open full text
  • Predictive factors of treatment adherence in cancer outpatients.
    Manuela Polidoro Lima, Wagner de Lara Machado, Tatiana Quarti Irigaray.
    Psycho-Oncology. October 05, 2018
    --- - |2+ Abstract Objective Identify which variables are predictors of treatment adherence in cancer patients. Methods Two hundred twenty cancer outpatients were evaluated by the following instruments: questionnaire on sociodemographic and clinical data, NEO‐FFI Personality Inventory Revised (NEO‐FFI‐R), Multidimensional Health Locus of Control (MHLC) scale, Hospital Anxiety and Depression Scale (HADS), patient's knowledge about cancer disease questionnaire, and Adherence Determinants Questionnaire (ADQ). A logistic regression analysis was applied to verify the predictive power of the variables, and network analyses were conducted through the qgraph package. Results The sample was composed of 138 (62.7%) women and 82 (37.3%) men. The mean age of participants was 54.66 (SD = 13.30), and the education level mean was 8.32 (DP = 3.76) years of study. Powerful others locus of control (LOC) and the personality factors conscientiousness and agreeableness are presented as predictors of high treatment adherence. The variable family cancer history, on the other hand, was a predictor of lower adherence levels. Conclusions The powerful others LOC may be connected with more trust and dependence in the health team, leading to better adherence. Specific characteristics of personality factors can help individuals to cooperate with their caregivers and to follow medical orders. The evaluated factors are interrelated and should be taken into account by health professionals when developing interventions to modify health‐related behaviors and treatment adherence. - Psycho-Oncology, EarlyView.
    October 05, 2018   doi: 10.1002/pon.4897   open full text
  • Sexual dysfunction and phobic anxiety in breast cancer survivors.
    Ana Abril‐Requena, Francisco García‐Torres, Francisco J. Alós.
    Psycho-Oncology. October 05, 2018
    --- - - Psycho-Oncology, EarlyView.
    October 05, 2018   doi: 10.1002/pon.4894   open full text
  • Distress Predicts of Utilization of Psychosocial Health Services in Oncology Patients.
    Jessica Hamilton, Emily B. Kroska.
    Psycho-Oncology. October 04, 2018
    --- - |2+ Abstract Objective The prevalence of increased distress among cancer patients has been well‐established and is known to be associated with negative consequences. Limited research has examined the association between distress and utilization of services, however, which is critical to understanding whether measurements of distress are being used to optimize patient care in the context of cancer. Method 1213 adult cancer patients completed the Distress Thermometer and Patient Needs Assessment early in their cancer care. EMR abstracted data included psychosocial service utilization in the 12 months following the completion of these psychosocial metrics. Logistic regressions followed by t‐tests were completed to assess if distress or unmet needs were affiliated with service utilization rates. Results When controlling for age, distress significantly predicted service utilization rates overall. Follow‐up t‐tests suggest that use of social work and registered dietician services was higher among those with distress scores greater than 6. When assessing unmet needs, utilization rates were positively associated with number of unmet needs, specifically for social work and dieticians. Conclusions Distress and unmet needs were related to higher rates of psychosocial service utilization during the 12 months following assessment of symptoms. These results support the continued mandate for evaluation of distress and suggest that psychosocial screening may be assisting in directing referrals and enhancing comprehensive care for patients. As psychosocial services grow, the need for continued evaluation is recommended to determine if psychology and chaplaincy services are utilized at higher rates as available providers increase. - Psycho-Oncology, Volume 0, Issue ja, -Not available-.
    October 04, 2018   doi: 10.1002/pon.4910   open full text
  • Prevalence and sociodemographic factors associated with depression among hospitalized patients with head and neck cancer—Results from a national study.
    Rebecca L. Rohde, Eric Adjei Boakye, Sai Deepika Challapalli, Shivam H. Patel, Christian J. Geneus, Betelihem B. Tobo, Matthew C. Simpson, Kahee A. Mohammed, Teresa Deshields, Mark A. Varvares, Nosayaba Osazuwa‐Peters.
    Psycho-Oncology. October 04, 2018
    --- - |2+ Abstract Objective Depression is a significant problem for patients with head and neck cancer (HNC). This study explored the prevalence of and sociodemographic and clinical factors associated with depression, among patients with HNC. Methods We performed a retrospective analysis of 71 541 cases of HNC using a national dataset, the Nationwide Inpatient Sample, from 2008 to 2013. Weighted, multivariate logistic regression analysis estimated association between sociodemographic/clinical factors and tumor anatomical site with diagnosis of a major depressive disorder. Results Overall prevalence of major depressive disorder in HNC was 9.3%; highest prevalence was found in patients with laryngeal cancer (28.5%). Compared with laryngeal cancer, there were lower odds of depression among patients with oral cavity cancer (adjusted odds ratio [aOR] = 0.90; 95% CI, 0.84‐0.97) and other anatomic sites (aOR = 0.87; 95% CI, 0.81‐0.94), except oropharyngeal cancer (aOR = 1.00; 95% CI, 0.93‐1.08). For every unit increase in comorbidities, odds of depression increased by 20% (aOR = 1.20; 95% CI, 1.19‐1.23). Sociodemographic factors associated with increased odds of depression included being female (aOR = 1.77; 95% CI, 1.68‐1.87), white (aOR = 1.75; 95% CI, 1.59‐1.92), and having Medicaid (aOR = 1.09; 95% CI, 1.01‐1.19) or Medicare insurance (aOR = 1.19; 95% CI, 1.10‐1.27). Conclusions Depression odds vary depending on HNC anatomic site, and one in four patients with laryngeal cancer may be depressed. Since depression is prevalent in this survivor cohort, it is important that psychosocial assessment and intervention are integrated into mainstream clinical care for patients with HNC. - Psycho-Oncology, EarlyView.
    October 04, 2018   doi: 10.1002/pon.4893   open full text
  • Efficacy of psychosocial and physical activity‐based interventions to improve body image among women treated for breast cancer: A systematic review.
    Helena Lewis‐Smith, Phillippa Claire Diedrichs, Nichola Rumsey, Diana Harcourt.
    Psycho-Oncology. October 02, 2018
    --- - |2+ Abstract Objective Body image concerns warrant attention among women who have undergone treatment for breast cancer, due to their significant consequences for psychological and physical health, and interpersonal relationships. This paper systematically reviews the effectiveness of interventions on body image outcomes among this group, in order to inform health care provision and strategic directions for research. Methods Fourteen electronic databases were searched for articles published between 1992 and 2017 that evaluated interventions with women who had undergone treatment for breast cancer in controlled trials with at least one body image measure. Data were extracted and studies were assessed for their methodological quality using the Cochrane Collaboration tool for assessing risk of bias. Results Twenty‐one articles evaluating 26 interventions met inclusion criteria. Nine interventions significantly improved body image at either post‐test or follow‐up (ds = 0.15‐1.43), with none reporting sustained effects across all time points. Effective interventions comprised psychotherapy, psychoeducation, or physical activity, were delivered at different treatment stages and mostly adopted a multisession, face‐to‐face, group format. However, only 4 interventions were evaluated within methodologically rigorous studies and are therefore recommended for use by health professionals aiming to improve the body image of women at different stages of treatment for breast cancer. Conclusions To advance the field, we recommend a less biomedical disease‐ and treatment‐focused approach to interventions, and instead a more biopsychosocial theoretical approach targeting broader modifiable psychosocial influences upon body image. Replication and randomised controlled trials of greater rigour are also required to improve the methodological quality of studies. - Psycho-Oncology, EarlyView.
    October 02, 2018   doi: 10.1002/pon.4870   open full text
  • A fertility needs assessment survey of male cancer patients.
    Samara Perez, Sylvie D. Lambert, Virginia Lee, Carmen G. Loiselle, Peter Chan, Abha Gupta, Kirk Lo, Zeev Rosberger, Phyllis Zelkowitz.
    Psycho-Oncology. October 02, 2018
    --- - |2+ Abstract Objective To describe fertility‐related informational needs and practices, and to examine if demographic characteristics are related to these needs and practices. Methods A needs assessment survey was conducted at three Canadian cancer centres. Results 192 male cancer patients (Mage = 33.6) completed the survey. Most patients (70%) recalled having had a discussion with a health care provider regarding their fertility and 44% banked their sperm. Patients reported not getting all the information that they wanted, eg, the risk that a future child may have the same type of cancer (78%), and what was covered by insurance plans (71%). Barriers to sperm preservation were urgency to begin cancer treatment (49%), not planning to have a child in the future (47%) and worries that cancer could be passed on to future children (38%). Participants' age and being the parent of a child were significantly associated with having had a discussion about fertility. Participants' age, province, being the parent of a child and the desire for future children were significantly associated with fertility preservation. Conclusions Discussions with health care providers were more frequent, and fertility preservation rates were higher than in past studies, but still not all patients' questions were answered. Misconceptions about passing on cancer to one's child, and that sperm preservation will delay treatment, should be dispelled. Health care providers can ask patients if they have any desire to have children in the future as a way to initiate a discussion of fertility preservation. Key information gaps and psychosocial resource needs are suggested to fully meet male cancer patients' fertility‐related concerns. - Psycho-Oncology, EarlyView.
    October 02, 2018   doi: 10.1002/pon.4874   open full text
  • Adolescent and young adult cancer survivors' memory and future thinking processes place them at risk for poor mental health.
    Ursula M. Sansom‐Daly, Claire E. Wakefield, Eden G. Robertson, Brittany C. McGill, Helen L. Wilson, Richard A. Bryant.
    Psycho-Oncology. October 01, 2018
    --- - |2+ Abstract Objective Identity formation is a key developmental milestone for adolescents and young adults (AYAs). Autobiographical memory and future‐thinking are crucial cognitive processes underpinning this, which may be impacted by cancer experiences. We know little about how these processes might be related to AYAs' adjustment to cancer, quality of life (QoL), and mental health outcomes. Methods We examined autobiographical memory and future‐thinking processes, and their relationship with mental health outcomes, among 77 AYA cancer survivors (Mage = 22.3 years, 59.7% female), compared with 62 community‐based controls (Mage = 23.3 years, 50% female). Participants completed the Life Narratives Interview, Future Imaginings Task, measures assessing depression, anxiety, QoL, and cancer‐related identity. We coded two facets of autobiographical thinking: thematic content and specificity. Results Relative to controls, survivors recounted more negative life narratives (P = .000). Survivors' memories and future lives were more health/illness‐focused (P = .000) and they remembered past events with greater specificity (P = .007) than controls. In contrast, survivors imagined their future lives with less specificity than controls (P = .000). Regression analyses highlighted that being female, greater identification as a “cancer survivor,” worse depression, and recent cancer treatment‐completion significantly predicted maladaptive autobiographical thinking processes. Conclusions These findings point to key modifiable cognitive processes relevant to AYAs' cancer‐related adjustment and future mental health. To bolster resilience into longer‐term survivorship, clinicians could adapt existing evidence‐based, cognitive‐behavioural interventions to assist AYAs to imagine future events in greater detail. - Psycho-Oncology, EarlyView.
    October 01, 2018   doi: 10.1002/pon.4856   open full text
  • Roles of positive psychological outcomes in future health perception and mental health problems: A report from the Childhood Cancer Survivor Study.
    Aurélie G. Weinstein, Christopher C. Henrich, Gregory T. Armstrong, Kayla L. Stratton, Tricia Z. King, Wendy M. Leisenring, Kevin R. Krull.
    Psycho-Oncology. September 27, 2018
    --- - |2+ Abstract Objective Positive psychological outcomes among adolescent and young adult survivors of childhood cancer may influence long‐term health status. We examined posttraumatic growth (PTG) and Life satisfaction (LS) in adolescence, and their impact on future emotional and physical health status in young adulthood. Methods Survivors (n = 2802) from the Childhood Cancer Survivor Study were longitudinally analyzed across social, emotional, and physical factors during adolescence (12–17 years old), and PTG (PTG‐Inventory) and LS (Cantril‐Ladder‐of‐Life) during young adulthood (19–24 years old). The impact of PTG and LS on survivors' future long‐term mental health, physical health, and social skills was also examined (23–28 years old) using Structural Equation Modeling. Results Survivors reported high levels of LS (M = 7.43, range 1 to 10) and a positive impact from their cancer experience (M = 48.78, range 0 to 105). Adolescent predictors of higher PTG included older age at diagnosis (p = 0.001), experiencing more severe chronic health conditions (p = 0.01), cancer recurrence/relapse (p = 0.01), and being diagnosed with a non‐CNS cancer (p = 0.001). Higher perceived general health (p = 0.01), higher social skills (p = 0.001), and diagnosis with a non‐CNS cancer (p = 0.02) were associated with higher LS. Higher PTG during young adulthood predicted poorer perceived health (p = 0.04) and worse emotional health (p = 0.001) in later adulthood. Higher LS predicted better emotional health (p = 0.001) and better perceived health (p = 0.001). Conclusions While LS was found to help survivors have better perceived long‐term emotional and physical health outcomes, survivors with higher PTG fond both positive and negative impacts from cancer. Future therapeutic trials to improve LS should be considered. - Psycho-Oncology, EarlyView.
    September 27, 2018   doi: 10.1002/pon.4881   open full text
  • Towards the validation of a new, blended theoretical model of fear of cancer recurrence.
    Sophie Lebel, Christine Maheu, Christina Tomei, Lori J. Bernstein, Christine Courbasson, Sarah Ferguson, Cheryl Harris, Lynne Jolicoeur, Monique Lefebvre, Linda Muraca, Agnihotram V. Ramanakumar, Mina Singh, Julia Parrott, Danielle Figueiredo.
    Psycho-Oncology. September 27, 2018
    --- - |2+ Abstract Objective Fear of cancer recurrence (FCR) is defined as “fear, worry, or concern about cancer returning or progressing”. To date, only the seminal model proposed by Lee‐Jones and colleagues has been partially validated, so additional model testing is critical to inform intervention efforts. The purpose of this study is to examine the validity of a blended model of FCR that integrates Leventhal's Common Sense Model, Mishel's Uncertainty in Illness Theory, and cognitive theories of worry. Methods Participants (n = 106) were women diagnosed with stage I to III breast or gynecological cancer who were enrolled in a Randomized Controlled Trial of a group cognitive‐existential intervention for FCR. We report data from standardized questionnaires (Fear of Cancer Recurrence Inventory—Severity and Triggers subscales; Illness Uncertainty Scale; perceived risk of recurrence; Intolerance of Uncertainty Scale; Why do people Worry about Health questionnaire; Reassurance‐seeking Behaviors subscale of the Health Anxiety Questionnaire, and the Reassurance Questionnaire) that participants completed before randomization. Path analyses were used to test the model. Results Following the addition of four paths, the model showed an excellent fit (χ2 = 13.39, P = 0.20; comparative fit index = 0.99; root mean square error of approximation = 0.06). Triggers, perceived risk of recurrence, and illness uncertainty predicted FCR. FCR was associated with maladaptive coping. Positive beliefs about worrying and intolerance of uncertainty did not predict FCR but led to more maladaptive coping. Conclusions These results provide support for a blended FCR model. - Psycho-Oncology, EarlyView.
    September 27, 2018   doi: 10.1002/pon.4880   open full text
  • Brief spiritual well‐being screening is nonlinearly related to psychological distress in ambulatory cancer patients.
    James Gerhart, George Fitchett, Teresa A. Lillis, Timothy M. Kuzel, Shelly S. Lo, Frank Penedo, Christine B. Weldon, Aidnag Diaz.
    Psycho-Oncology. September 27, 2018
    --- - - Psycho-Oncology, EarlyView.
    September 27, 2018   doi: 10.1002/pon.4882   open full text
  • Randomized controlled trial of a brief cognitive‐behavioral strategies intervention for the pain, fatigue, and sleep disturbance symptom cluster in advanced cancer.
    Kristine Kwekkeboom, Yingzi Zhang, Toby Campbell, Christopher L. Coe, Erin Costanzo, Ronald C. Serlin, Sandra Ward.
    Psycho-Oncology. September 27, 2018
    --- - |2+ Abstract Objective Patients receiving treatment for advanced cancer suffer significant symptom burden, including co‐occurring pain, fatigue, and sleep disturbance. There is limited evidence for effective interventions targeting this common symptom cluster. Methods A randomized controlled trial of a brief cognitive‐behavioral strategies (CBS) intervention was conducted. A sample of 164 patients with advanced cancer receiving chemotherapy practiced imagery, relaxation, and distraction exercises or listened to cancer education recordings (attention‐control) to manage co‐occurring pain, fatigue, and sleep disturbance over a 9‐week period. Symptom cluster severity, distress, and interference with daily life were measured at baseline and 3, 6, and 9 weeks. We also evaluated the moderating influence of imaging ability and number of concurrent symptoms, and mediating effects of changes in stress, anxiety, outcome expectancy, and perceived control over symptoms. Results Compared with the cancer education condition, participants receiving the CBS intervention reported less symptom cluster distress at week 6 (M = 1.82 vs 2.15 on a 0‐4 scale, P < .05). No other group differences were statistically significant. The number of concurrent symptoms moderated the intervention effect on symptom cluster interference. Changes in stress, outcome expectancy, and perceived control mediated the extent of intervention effects on symptom outcomes, primarily at weeks 6 and 9. Conclusions The brief CBS intervention had limited effects in this trial. However, findings regarding potential mediators affirm hypothesized mechanisms and provide insight into ways to strengthen future interventions to reduce the suffering associated with co‐occurring pain, fatigue, and sleep disturbance. - Psycho-Oncology, EarlyView.
    September 27, 2018   doi: 10.1002/pon.4883   open full text
  • Sexual dysfunction and reproductive concerns in young women with breast cancer: Type, prevalence, and predictors of problems.
    Lisa Ljungman, Johan Ahlgren, Lena‐Marie Petersson, Kathryn E. Flynn, Kevin Weinfurt, Jessica R. Gorman, Lena Wettergren, Claudia Lampic.
    Psycho-Oncology. September 27, 2018
    --- - |2+ 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. - Psycho-Oncology, EarlyView.
    September 27, 2018   doi: 10.1002/pon.4886   open full text
  • Lifestyle behaviors and psychosocial outcomes among cancer survivors.
    Errol J. Philip, Natalia Salamanca‐Balen, Brian Lewis, Thomas V. Merluzzi.
    Psycho-Oncology. September 27, 2018
    --- - - Psycho-Oncology, EarlyView.
    September 27, 2018   doi: 10.1002/pon.4885   open full text
  • Assessment of distress and quality of life in rare cancers.
    Cristiane Decat Bergerot, Paulo Gustavo Bergerot, Errol J. Philip, Edvane Birelo Lopes De Domenico, Maria Fernanda Marcusso Manhaes, Renata Nunes Pedras, Meghan M. Salgia, Nazli Dizman, Kimlin Tam Ashing, Min Li, William Dale, Sumanta K. Pal.
    Psycho-Oncology. September 26, 2018
    --- - |2+ Abstract Objective Rare cancers are a heterogeneous group of conditions that can be associated with emotional and physical impairments. In view of the dearth of research in this area, we investigated the quality of life and prevalence of distress in a cohort of patients diagnosed with a rare cancer, classified by the RARECARE definition. Methods A cohort of rare cancer patients, treated in a Brazilian public cancer center, was assessed for distress (Distress Thermometer), anxiety/depression (Hospital Anxiety and Depression Scale), and quality of life (Functional Assessment of Cancer Therapy‐General Version). Descriptive statistics were generated, and multivariate analyses were used to identify factors associated with distress, anxiety/depression, and quality of life. Results A total of 137 patients (52.6% male, mean age of 50 years; range 18‐90) were identified. Nearly half (49.6%) of patients reported high levels of distress, with 19.7% endorsing anxiety and 15.3% depression. In multivariate analysis, demographic and clinical variables associated with worse psychosocial outcomes included younger age (P < 0.05), female gender (P < 0.01), advanced disease stage (P < 0.01), and engagement in active therapy (P < 0.05). Conclusions Patients diagnosed with rare cancer reported poorer psychosocial outcomes and impaired quality of life when compared to the general population of cancer patients. Certain demographic groups (eg, women and younger patients) may benefit from targeted psychosocial interventions. - Psycho-Oncology, EarlyView.
    September 26, 2018   doi: 10.1002/pon.4873   open full text
  • Caring for a child with cancer: The experience of the “lone” parent, and why it matters.
    Haven Battles, Sima Zadeh Bedoya, Maryland Pao, Larry L. Mullins, Lori Wiener.
    Psycho-Oncology. September 26, 2018
    --- - - Psycho-Oncology, EarlyView.
    September 26, 2018   doi: 10.1002/pon.4871   open full text
  • Issue Information.

    Psycho-Oncology. September 25, 2018
    --- - - Psycho-Oncology, Volume 27, Issue 9, Page 2061-2062, September 2018.
    September 25, 2018   doi: 10.1002/pon.4541   open full text
  • Digital health interventions to help living with cancer: A systematic review of participants' engagement and psychosocial effects.
    Géraldine Escriva Boulley, Tanguy Leroy, Camille Bernetière, Françoise Paquienseguy, Orélie Desfriches‐Doria, Marie Préau.
    Psycho-Oncology. September 24, 2018
    --- - |2+ 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. - Psycho-Oncology, EarlyView.
    September 24, 2018   doi: 10.1002/pon.4867   open full text
  • Dignity‐related existential distress in end‐of‐life cancer patients: Prevalence, underlying factors, and associated coping strategies.
    Andrea Bovero, Nader Alessandro Sedghi, Marta Opezzo, Rossana Botto, Manuela Pinto, Valentina Ieraci, Riccardo Torta.
    Psycho-Oncology. September 24, 2018
    --- - |2+ Abstract Objective Cancer patients often have to face increasing levels of existential distress (ED) during disease progression, especially when nearing death. This cross‐sectional study aimed to assess the prevalence of the dignity‐related existential distress (DR‐ED) in a sample of end‐of‐life cancer patients, and to explore the “existential distress” Patient Dignity Inventory (PDI‐IT) subscale internal structure and its associations with different coping strategies. Methods Two hundred seven cancer inpatients with a Karnofsky Performance Status ≤50 and a life expectancy of 4 months or less have been examined with the following self‐report measures: PDI‐IT, Demoralization Scale (DS‐IT) and Brief Coping Orientation to Problem Experienced (Brief‐COPE). The existential distress PDI‐IT subscale factor structure was explored through principal component analysis, and the DR‐ED associations with the other considered variables were examined through X2 tests, MANOVA, and multivariate regression analysis. Results Dignity‐related existential distress was a problem/major problem for 18.8% of the patients, especially for the younger (F(1, 205) = 3.40; P = 0.020) and more demoralized (F(1, 205) = 20.36; P < 0.001) individuals. Factor analysis supported 2 dimensions labeled “self‐discontinuity” and “loss of personal autonomy,” accounting for 58% of the variance. Positive reframing (β = −0.146, P < 0.05) and self‐blame (β = 0.247, P < 0.001) coping styles emerged as DR‐ED significant predictors. Conclusions This study showed how DR‐ED is a relevant problem for patients nearing death and furthermore highlighted 2 underlying factors. Finally, the research has shown that positive reframing and self‐blame coping styles might be clinically relevant elements for interventions on ED. - Psycho-Oncology, EarlyView.
    September 24, 2018   doi: 10.1002/pon.4884   open full text
  • The development and preliminary evaluation of the cancer peer support scale in adolescents living with cancer.
    Pandora Patterson, Fiona McDonald, Richard Tindle, Elizabeth Kelly‐Dalgety, Brad Zebrack, Daniel Costa.
    Psycho-Oncology. September 20, 2018
    --- - - Psycho-Oncology, EarlyView.
    September 20, 2018   doi: 10.1002/pon.4869   open full text
  • High prevalence of moral distress reported by oncologists and oncology nurses in end‐of‐life decision making.
    Katja Mehlis, Elena Bierwirth, Katsiaryna Laryionava, Friederike H.A. Mumm, Wolfgang Hiddemann, Pia Heußner, Eva C. Winkler.
    Psycho-Oncology. September 20, 2018
    --- - |2+ Abstract Objective Decisions to limit life‐prolonging treatment (DLT) are often accompanied by psychological and ethical difficulties. The aim of the study is to investigate prevalence and intensity of moral distress (MD) as well as potential causes experienced by oncology physicians and nurses in DLT situations. Methods This prospective study at a German university hospital included n = 100 advanced cancer inpatients with DLT. We surveyed their respective physicians and nurses to assess MD in DLT using an adapted distress thermometer and an open‐ended question to specify reasons of MD. We also collected data on the decision‐making process from the perspective of the clinicians. Results Physicians report MD in 67% (n = 51) and nurses in 74% (n = 67) of the cases. The MD level in nurses (mean 2.3; SD 2.3) is significantly higher (P = .005) than in physicians (mean 1.5; SD 1.4). Uncertainties concerning ethical aspects in DLT in a patient case are associated with MD in both physicians (P = .024) and nurses (P = .004). Involvement of nurses in DLT is the strongest predictor (P = .000) for MD as indicated by physicians. Nurses experience MD especially, if the patient has a low quality of life (P = .001). Conclusions Moral distress is experienced by both oncologists and nurses in DLT. Nurses report higher MD intensity compared with physicians although the ultimate responsibility for DLT lies with the physicians. Support for the challenging decisions may be provided through the implementation of an ethical guideline and enhanced interprofessional communication. - Psycho-Oncology, EarlyView.
    September 20, 2018   doi: 10.1002/pon.4868   open full text
  • Treatment preferences and decision‐making in patients diagnosed with indeterminate thyroid nodules.
    Lauren E. Stahl, Renee Stewart, Michele M. Carr, David Goldenberg, Jane R. Schubart.
    Psycho-Oncology. September 19, 2018
    --- - - Psycho-Oncology, EarlyView.
    September 19, 2018   doi: 10.1002/pon.4865   open full text
  • Participation in a prostate cancer support group and health literacy.
    Marius Haack, Christopher Kofahl, Silke Kramer, Gabriele Seidel, Olaf Knesebeck, Marie‐Luise Dierks.
    Psycho-Oncology. September 14, 2018
    --- - |2+ Abstract Background To cope with prostate cancer (PC) and its consequences and to be certain about therapeutic alternatives, some patients seek mutual help in prostate cancer support groups (PCSGs), where they share information and find social support. Our study was intended to assess whether group participation is associated with health literacy (HL). Methods We compared PCSG members (n = 441) with PC patients without support group experiences (n = 135) in a cross‐sectional design. For this purpose, HL was operationalized through PC‐specific knowledge, noncancer‐specific knowledge about health care, guideline awareness, and skills needed to apply health information to meet own needs. Binary logistic regression models were calculated. Socio‐demographic data and disease‐related characteristics were used as control variables. Results Knowledge about PC (OR, 2.2; CI, 1.3‐3.7), the fact of having heard of guidelines (OR, 3.7; CI, 2.1‐6.8) and having read one (OR, 5.1; CI, 2.8‐9.4), and competencies regarding health service navigation (OR, 1.8; CI, 1.0‐3.1) are associated with PCSG membership. No statistically significant associations could be found between PCSG membership and further skills questioned, as well as between membership and knowledge about noncancer‐specific health care. Conclusion PCSG membership is associated with HL in some areas only. In particular, the groups seem to provide an important platform for information exchange in the field of PC. The potentially conflicting results on PC knowledge and the application skills may arise from the different forms of measurement—knowledge was tested; skills were self‐assessed. - Psycho-Oncology, Volume 27, Issue 10, Page 2473-2481, October 2018.
    September 14, 2018   doi: 10.1002/pon.4854   open full text
  • Different dimensions of religiousness/spirituality are associated with health behaviors in breast cancer survivors.
    Crystal L. Park, Emily Waddington, Rachel Abraham.
    Psycho-Oncology. September 13, 2018
    --- - |2+ Abstract Objective Religiousness/spirituality (R/S) may influence cancer survivors' health through multiple pathways. We aimed to examine one potentially key pathway that has seldom been examined: relationships between survivors' R/S and their health behaviors. Methods The present study investigated links between four core dimensions of R/S (beliefs, behaviors, identity, and coping) and three health behaviors (fruit/vegetable consumption, physical activity, and maintenance of a healthy weight) in 172 breast cancer survivors. Results Both spiritual identity and use of religious coping were positively related to fruit and vegetable intake, while private prayer was marginally positively related. Both service attendance and religious identity (marginally) were related to engaging in less physical activity, while private prayer was positively related. Afterlife beliefs and private prayer were positively associated with BMI. Conclusions R/S has complex but meaningful associations with health behaviors in breast cancer survivors. More research is needed to understand these relationships and to determine whether different dimensions of R/S may play useful roles in lifestyle change interventions. - Psycho-Oncology, Volume 27, Issue 10, Page 2466-2472, October 2018.
    September 13, 2018   doi: 10.1002/pon.4852   open full text
  • Predictors of quality of life and depression among Korean‐American cancer patients and their family caregivers.
    Hyojin Yoon, Linda Chatters, Tsui‐sui Annie Kao, Denise Saint‐Arnault, Laurel Northouse.
    Psycho-Oncology. September 13, 2018
    --- - |2+ Abstract Objective This study examined social, cultural, and appraisal factors associated with Korean‐American cancer patients' and their family caregivers' quality of life (QOL) and depression. Methods Data were from Korean‐American cancer patients and their family caregivers (N = 60 dyads) living in the United States. Study aims were examined using descriptive statistics and multiple regression. Results For patients, higher social support and lower negative appraisal of illness predicted higher patient QOL; negative appraisal of illness also predicted higher patient depression. For caregivers, older age, having fewer traditional Korean values, and more modern (individualistic) values predicted higher caregiver QOL. Caregivers who held more modern values also had less depression. Conclusions Higher support and less negative appraisal predicted better QOL in patients. For caregivers however, the type of cultural values they held (tradition or modern) was a key factor that predicted level of QOL and depression. Assessment of support and appraisal as well as attention to cultural values may enhance their QOL and reduce depression. - Psycho-Oncology, EarlyView.
    September 13, 2018   doi: 10.1002/pon.4864   open full text
  • Comorbidities are associated with poorer quality of life and functioning and worse symptoms in the 5 years following colorectal cancer surgery: Results from the ColoREctal Well‐being (CREW) cohort study.
    Amanda Cummings, Chloe Grimmett, Lynn Calman, Mubarak Patel, Natalia Vadimovna Permyakova, Jane Winter, Jessica Corner, Amy Din, Deborah Fenlon, Alison Richardson, Peter W. Smith, Members of CREW Study Advisory Committee, Claire Foster.
    Psycho-Oncology. September 13, 2018
    --- - |2+ Abstract Objective More people are living with the consequences of cancer and comorbidity. We describe frequencies of comorbidities in a colorectal cancer cohort and associations with health and well‐being outcomes up to 5 years following surgery. Methods Prospective cohort study of 872 colorectal cancer patients recruited 2010 to 2012 from 29 UK centres, awaiting curative intent surgery. Questionnaires administered at baseline (pre‐surgery), 3, 9, 15, 24 months, and annually up to 5 years. Comorbidities (and whether they limit activities) were self‐reported by participants from 3 months. The EORTC QLQ‐C30 and QLQ‐CR29 assessed global health/quality of life (QoL), symptoms, and functioning. Longitudinal analyses investigated associations between comorbidities and health and well‐being outcomes. Results At baseline, the mean age of participants was 68 years, with 60% male and 65% colon cancer. Thirty‐two per cent had 1 and 40% had ≥2 comorbidities. The most common comorbidities were high blood pressure (43%), arthritis/rheumatism (32%), and anxiety/depression (18%). Of those with comorbidities, 37% reported at least 1 that limited their daily activities. Reporting any limiting comorbidities was associated with poorer global health/QoL, worse symptoms, and poorer functioning on all domains over 5‐year follow‐up. Controlling for the most common individual comorbidities, depression/anxiety had the greatest deleterious effect on outcomes. Conclusions Clinical assessment should prioritise patient‐reported comorbidities and whether these comorbidities limit daily activities, as important determinants of recovery of QoL, symptoms, and functioning following colorectal cancer. Targeted interventions and support services, including multiprofessional management and tailored assessment and follow‐up, may aid recovery of health and well‐being in these individuals. - Psycho-Oncology, Volume 27, Issue 10, Page 2427-2435, October 2018.
    September 13, 2018   doi: 10.1002/pon.4845   open full text
  • Burnout among early‐career oncology professionals and the risk factors.
    LiLi Tang, Ying Pang, Yi He, Zhishui Chen, JiaHua Leng.
    Psycho-Oncology. September 11, 2018
    --- - |2+ Abstract Background Health care professionals caring for cancer patients have a considerable risk of developing burnout. However, as burnout has been rarely investigated among early‐career oncology professionals. This study aims to investigate the presence of and risk factors linked to burnout in early‐career oncology professionals. Methods A cross‐sectional, hospital‐based survey was conducted. A web link for the survey was sent to all staff of Peking University Cancer Hospital. Measures included the Maslach Burnout Inventory (MBI), Effort‐Reward Inventory (ERI), and Big Five Personality Scale along with a questionnaire used to collect demographic, occupational, and social variables. Results In total, 862 (71%) clinical health professionals completed the questionnaire, including 290 (35%) early‐career professionals with work experiences as oncology professionals within 5 years. One hundred fourteen (39%) of them reported burnout in at least one domain. Lower scores on agreeableness (odds ratio [OR] = 0.77, P = 0.050) and neuroticism (OR = 0.69, P = 0.007) and high ERI ratio (OR = 103.67, P < 0.001) were associated with emotional exhaustion; lower scores on agreeableness (OR = 0.64, P < 0.001) and neuroticism (OR = 0.69, P = 0.007) and high ERI ratio (OR = 103.67, P < 0.001) were associated with depersonalization. Conclusions Chinese early‐career oncology professionals experience a high risk of burnout. The early‐career professionals with lower agreeableness and higher neuroticism in personality may have a higher risk of burnout. Imbalance between work efforts and work rewards is another significant risk factor of burnout. - Psycho-Oncology, Volume 27, Issue 10, Page 2436-2441, October 2018.
    September 11, 2018   doi: 10.1002/pon.4847   open full text
  • Psychosocial outcomes in cancer‐bereaved children and adolescents: A systematic review.
    Rahel Hoffmann, Julia Kaiser, Anette Kersting.
    Psycho-Oncology. September 11, 2018
    --- - |2+ Abstract Objective Due to the unique importance of parental and sibling relationships and concurrently existing developmental challenges, the loss of a parent or sibling due to cancer is a highly stressful event for children and adolescents. This is the first systematic review that integrates findings on psychosocial outcomes after parental or sibling cancer bereavement. Methods A systematic search of Web of Science, PubMed, PsycINFO, and PubPsych was conducted, last in December 2017. Quantitative studies on psychosocial outcomes of children and adolescents who lost a parent or sibling due to cancer were included. Results Twenty‐four studies (N = 10 parental and N = 14 sibling bereavement), based on 13 projects, were included. Ten projects had cross‐sectional designs. Only 2 projects used large, population‐based samples and nonbereaved comparison groups. Outcomes were partially measured by single‐item questions. Bereaved children and adolescents showed similar levels of depression and anxiety compared with nonbereaved or norms. Severe behavioral problems were found rarely. However, in 2 large, population‐based studies, about half of the bereaved individuals reported unresolved grief. Bereaved adolescents had a higher risk for self‐injury compared with the general population in one large, population‐based study. Communication with health‐care professionals, family, and other people; social support; distress during illness; age; gender; and time because loss were associated with psychosocial bereavement outcomes. Conclusions Results indicate a high level of adjustment in cancer‐bereaved children and adolescents. A modifiable risk factor for adverse psychosocial consequences is poor communication. Prospective designs, representative samples, and validated instruments, eg, for prolonged grief, are suggested for future research. - Psycho-Oncology, Volume 27, Issue 10, Page 2327-2338, October 2018.
    September 11, 2018   doi: 10.1002/pon.4863   open full text
  • A randomized phase II trial of MOVING ON: An intervention to increase exercise outcome expectations among breast cancer survivors.
    Rachel Hirschey, Gretchen Kimmick, Marilyn Hockenberry, Ryan Shaw, Wei Pan, Christina Page, Isaac Lipkus.
    Psycho-Oncology. September 11, 2018
    --- - |2+ Abstract Objective The objective of the study is to test theoretical intervention fidelity and feasibility of MOVING ON, a self‐directed, home‐based, randomized controlled trial to increase exercise outcome expectations (OEs) (what one expects to obtain or avoid as a result of a behavior or lack thereof), among breast cancer survivors. Method Stage Ia to IIb survivors (n = 60) were given the MOVING ON intervention or control booklet. Data were collected through online surveys and an accelerometer at baseline, 4, 8, and 12 weeks postintervention. Fidelity was measured by questions assessing participant perceptions of MOVING ON (score ≥2) and direction of intervention effects. Feasibility was measured by recruitment rate (target of 60 participants in 6 months), retention (total attrition <17%), and acquisition of accelerometer data (% ≥subjective exercise data obtained). Analyses consisted of descriptive statistics, mixed models, and content analysis. Results Fidelity met a priori criteria (mean = 3.31, SD = 0.87). Outcome expectations increased 0.01 points, and weekly steps increased by 970 every 4 weeks in the intervention arm compared to the control arm. All effect sizes were small, ranging from 0.01 to 0.09. Target enrollment, achieved in 17 weeks, met a priori feasibility criteria. Retention (66%) and accelerometer data acquisition (60%) (compared to 73% of subjective exercise data) did not. Conclusion MOVING ON influenced OEs as intended and was well received by participants. A fully powered study, of this low‐cost, easy‐to‐implement intervention, is warranted. Intervention and measurement strategies used in MOVING ON can be incorporated in any study targeting OEs as a mediator of exercise or collecting exercise data with an accelerometer. - Psycho-Oncology, Volume 27, Issue 10, Page 2450-2457, October 2018.
    September 11, 2018   doi: 10.1002/pon.4849   open full text
  • Bridging silos: Delivering integrated care to patients with cancer in Ontario, Canada.
    Sandy Buchman, Jenna M. Evans, Marnie Mackinnon, Sharon Gradin, Frances C. Wright.
    Psycho-Oncology. September 06, 2018
    --- - - Psycho-Oncology, EarlyView.
    September 06, 2018   doi: 10.1002/pon.4858   open full text
  • From evidence to implementation: The global challenge for psychosocial oncology.
    Gary Rodin.
    Psycho-Oncology. September 04, 2018
    --- - |2 Abstract The human dimensions of medical care were highlighted by such pioneering figures as Cicely Saunders, Elizabeth Kubler‐Ross, and Jimmie Holland and their tireless advocacy helped to build an evidence base for psychosocial and palliative interventions. In that spirit, we studied physical and psychological distress in advanced cancer and modeled pathways to distress in this population. We considered acute stress disorder as the prototype for psychological disturbances following the acute onset of life‐threatening disorders, showing that it occurred in one‐third of patients after the diagnosis of acute leukemia. To treat and prevent these symptoms, we developed Emotion and Symptom‐focused Engagement (EASE), an integrated psychotherapeutic and early palliative intervention. We showed that EASE reduced both traumatic stress and physical suffering in these patients and a large multi‐center trial is now underway. We also identified symptoms of depression and hopelessness n one quarter of patients with metastatic and advanced cancer, with worsening toward the end of life. To alleviate this distress, we developed a brief supportive‐expressive therapy, referred to as Managing Cancer and Living Meaningfully (CALM). We showed in a large RCT that CALM improves depression, distress related to dying and death, and preparation for the end of life. We have now launched a global initiative involving 20 sites to date across North and South America, Europe, Australia, and Asia to have CALM implemented routinely in cancer care. Such initiatives are needed to move psychosocial care in cancer from evidence to implementation and to fulfill the dream of Jimmie Holland that cancer care be as humanistic as it is effective. - Psycho-Oncology, Volume 27, Issue 10, Page 2310-2316, October 2018.
    September 04, 2018   doi: 10.1002/pon.4837   open full text
  • The impact of psychosocial characteristics in predicting smoking cessation in long‐term cancer survivors: A time‐to‐event analysis.
    Yael R. Symes, J. Lee Westmaas, Deborah K. Mayer, Marcella H. Boynton, Kurt M. Ribisl, Shelley D. Golden.
    Psycho-Oncology. September 04, 2018
    --- - |2+ Abstract Objective Smoking poses significant health risks to cancer survivors. Cancer survivorship may heighten psychological distress and reduce social support and health‐related quality of life (HRQOL) for years after diagnosis, which could inhibit long‐term successful smoking cessation. Understanding longitudinal associations between these psychosocial characteristics and successful cessation could help clinicians tailor cessation interventions for their patients. Methods Time‐to‐event analyses using data from the American Cancer Society Study of Cancer Survivors‐I (SCS‐I)—a longitudinal nationwide study—examined the relationship of psychosocial characteristics with cessation likelihood and amount of time from diagnosis to quitting in cancer survivors diagnosed 7 to 10 years prior. Results Cancer survivors with high physical HRQOL were more likely to quit smoking within 10 years from cancer diagnosis than survivors with low physical HRQOL, controlling for cancer type and number of comorbid conditions at baseline (HR = 1.96; 95% CI: 1.10‐2.70; P = .02). Survivors with high physical HRQOL also took less time to quit than survivors with low physical HRQOL. Survivors of tobacco‐related cancers with low physical HRQOL were the least likely group to quit. No significant relationships between other psychosocial predictors and cessation outcomes were observed. Conclusions Smoking cessation programs are needed for all cancer survivors who smoke, but survivors with low physical HRQOL 1 year after diagnosis may need more intensive long‐term smoking cessation interventions with multiple check‐in points after smoking relapses. Cessation interventions that include strategies to mitigate physical symptoms in those with poor physical HRQOL deserve consideration in research and practice. - Psycho-Oncology, Volume 27, Issue 10, Page 2458-2465, October 2018.
    September 04, 2018   doi: 10.1002/pon.4851   open full text
  • Depressive symptoms and actigraphy‐measured circadian disruption predict head and neck cancer survival.
    Elizabeth Cash, C. Riley Duck, Courtney Brinkman, Whitney Rebholz, Christy Albert, Mary Worthen, Mia Jusufbegovic, Liz Wilson, Jeffrey M. Bumpous.
    Psycho-Oncology. September 04, 2018
    --- - |2+ Abstract Objective Depressive symptoms have demonstrated prognostic significance among head and neck cancer patients. Depression is associated with circadian disruption, which is prognostic in multiple other cancer types. We hypothesized that depressive symptoms would be associated with circadian disruption in head and neck cancer, that each would be related to poorer 2‐year overall survival, and that relationships would be mediated by tumor response to treatment. Methods Patients (N = 55) reported on cognitive/affective and somatic depressive symptoms (PHQ‐9) and wore an actigraph for 6 days to continuously record rest and activity cycles prior to chemoradiation. Records review documented treatment response and 2‐year survival. Spearman correlations tested depressive symptoms and circadian disruption relationships. Cox proportional hazard models tested the predictive capability of depressive symptoms and circadian disruption, separately, on survival. Results Depressive symptoms were significantly associated with circadian disruption, and both were significantly associated with shorter survival (somatic: hazard ratio [HR] = 1.325, 95% confidence interval [CI] = 1.089‐1.611, P = .005; rest/activity rhythm: HR = 0.073, 95% CI = 0.009‐0.563, P = .012; nighttime restfulness: HR = 0.910, 95% CI = 0.848‐0.977, P = .009). Tumor response to treatment appeared to partly mediate the nighttime restfulness‐survival relationship. Conclusions This study replicates and extends prior work with new evidence linking a subjective measure of depression and an objective measure of circadian disruption—2 known prognostic indicators—to shortened overall survival among head and neck cancer patients. Continued examination should elucidate mechanisms by which depressive symptomatology and circadian disruption translate to head and neck cancer progression and mortality. - Psycho-Oncology, Volume 27, Issue 10, Page 2500-2507, October 2018.
    September 04, 2018   doi: 10.1002/pon.4862   open full text
  • The development of a template for psychological assessment of women considering risk‐reducing or contralateral prophylactic mastectomy: A national Delphi consensus study.
    Lucy Braude, Laura Kirsten, Jemma Gilchrist, Ilona Juraskova.
    Psycho-Oncology. September 04, 2018
    --- - |2+ Abstract Objective Risk‐reducing mastectomies (RRM) and contralateral prophylactic mastectomies (CPM) are increasingly prevalent strategies to reduce breast cancer risk. Given the associated physical and emotional challenges, presurgical psychological assessment is frequently recommended for this population, yet limited research exists to guide this. This study aimed to reach a consensus on the most relevant content and format of a psychological consultation prior to RRM/CPM. Methods A modified two‐round online Delphi study was conducted Australia‐wide. Expert participants (n = 25), including psychologists, surgeons, nurses, oncologists, genetic specialists, and researchers completed a round‐one survey, informed by a literature review, previous qualitative study and expert clinicians' input. This required participants to rate their agreement with 36 statements regarding potential content of a psychological consultation and provide feedback on format/structure. A round‐two survey comprised items that had not reached consensus and six new items suggested by participants. Parameters for statement consensus were set a priori at >75% agreement. Results Expert participants indicated agreement with the majority of statements (39/42, 92.8%), endorsing that the assessment should include (1) patient understanding of the RRM/CPM procedure/cancer risk, (2) potential physical/emotional impact of surgery, (3) informed decision‐making, and (4) past/current psychological issues (anxiety and body image). A provisional assessment template and user manual is provided. Conclusions This research culminated in a consensus‐based template to guide psychological assessment of women considering RRM/CPM. This enables health professionals to assess suitability for surgery and preempt challenges within a standardised framework. Future evaluation of the acceptability and effectiveness of the template in clinical settings is warranted. - Psycho-Oncology, Volume 27, Issue 10, Page 2349-2356, October 2018.
    September 04, 2018   doi: 10.1002/pon.4830   open full text
  • “The child is our focus”: On couple issues in child oncology treatment.
    An Hooghe, Paul C. Rosenblatt, Sofie De Jongh, Esther Bakker, Marjan Nijkamp, Peter Rober.
    Psycho-Oncology. September 04, 2018
    --- - |2+ Abstract Objective This study explored the perspectives of child oncology professionals and parents about the attention professionals should give to the parent couple relationship during treatment of the child. Methods We employed a qualitative research design, framed within the approach of consensual qualitative research (CQR), gathering data from four focus groups with 20 professionals and from nine in‐depth interviews with 16 parents. Thematic analysis of the focus group and interview data was done with MaxQda software, using two coders and member checks to strengthen confidence in the analysis. Findings Both professionals and parents talked about an elevated tension in the partner relationship during oncology treatment of the child. However, explicit attention to the partner relationship in this context felt inappropriate to professionals and parents. All emphasized the importance of the professional helpers' openness to conversation and an attuned response to the parental couple relationship. Conclusion During treatment, the child is the primary focus for parents and professionals. The parents' focus on supporting their child makes talking about their own emotions or about issues in the partner relationship potentially disruptive and unhelpful. Therefore, it is crucial for professionals to support the parents in their parents' role, but with an openness to converse about issues in the partner relationship at the moments when these issues might threaten their focus on the child. - Psycho-Oncology, Volume 27, Issue 10, Page 2482-2487, October 2018.
    September 04, 2018   doi: 10.1002/pon.4855   open full text
  • The experience of persistent pain and quality of life among women following treatment for breast cancer: An attachment perspective.
    Michelle D. Smith, Pamela J. Meredith, Siong Yin Chua.
    Psycho-Oncology. August 31, 2018
    --- - |2+ Abstract Objectives The aims of this study were to investigate associations between attachment and the presence of persistent pain in women following treatment for breast cancer and to investigate the relationship between attachment, pain, and quality of life (QOL) in women with persistent pain. Methods Women (N = 335) previously diagnosed with primary non‐metastatic breast cancer completed an online survey with measures of attachment, pain, QOL, demographics, and medical history. Variables were compared between women with (N = 128) and without (N = 207) persistent pain. For those reporting pain, regression analyses were conducted to investigate relationships between attachment, pain, and QOL. Results Higher attachment anxiety, but not attachment avoidance, was related to the presence of persistent pain. Among women with persistent pain, associations between attachment anxiety and avoidance and greater pain intensity were lost when pain catastrophizing was considered in analysis. Significant associations between attachment and diminished QOL and perceived effectiveness of pain management were identified in multivariate analysis. Conclusions These findings extend the available literature regarding associations between pain and attachment insecurity. In women with pain after breast cancer treatment, attachment anxiety and avoidance were associated with negative pain and QOL outcomes. Further attention regarding the use of attachment‐informed approaches in supporting women following breast cancer treatment is indicated. - Psycho-Oncology, Volume 27, Issue 10, Page 2442-2449, October 2018.
    August 31, 2018   doi: 10.1002/pon.4848   open full text
  • Symptom burden in adults with thyroid cancer.
    Anna M. Sawka, Sarah Watt, Gary Rodin, Shereen Ezzat, Doris Howell, Richard W. Tsang, James D. Brierley, Monika K. Krzyzanowska, David Goldstein, Madeline Li.
    Psycho-Oncology. August 31, 2018
    --- - - Psycho-Oncology, Volume 27, Issue 10, Page 2517-2519, October 2018.
    August 31, 2018   doi: 10.1002/pon.4853   open full text
  • Delivering problem‐solving therapy to family caregivers of people with cancer: A feasibility study in outpatient palliative care.
    Karla T. Washington, George Demiris, Debra Parker Oliver, David L. Albright, Kevin W. Craig, Paul Tatum.
    Psycho-Oncology. August 31, 2018
    --- - |2+ Abstract Objective In response to the well‐documented need for evidence‐based cancer caregiver support, we examined the feasibility of problem‐solving therapy for family caregivers of cancer patients receiving outpatient palliative care and investigated the impact of problem‐solving therapy on family caregivers' anxiety, depression, and quality of life. Methods We conducted a feasibility study of a structured problem‐solving therapy intervention delivered to family caregivers of cancer patients receiving outpatient palliative care from an academic health center in the Midwestern United States. Participants (N = 83) were randomly assigned to receive usual care or usual care plus a problem‐solving therapy intervention, which was delivered over three sessions via web‐based videoconferencing or telephone. Descriptive statistics were used to determine feasibility relative to recruitment, retention, and fidelity to core intervention components. Outcome data were analyzed using ordinary least squares multiple regression. Results Problem‐solving therapy for family caregivers of patients with cancer was found to be highly feasible in the outpatient palliative care setting. Caregivers who received problem‐solving therapy reported less anxiety than those who received only usual care (P = 0.03). No statistically significant differences were observed for caregiver depression (P = 0.07) or quality of life (P = 0.06). Conclusions Problem‐solving therapy is a feasible and promising approach to reducing cancer family caregivers' anxiety in the outpatient palliative care setting. Further testing in multiple sites is recommended. - Psycho-Oncology, Volume 27, Issue 10, Page 2494-2499, October 2018.
    August 31, 2018   doi: 10.1002/pon.4859   open full text
  • Decision‐making about cervical screening in a heterogeneous sample of nonparticipants: A qualitative interview study.
    Laura A.V. Marlow, Amanda J. Chorley, Lauren Rockliffe, Jo Waller.
    Psycho-Oncology. August 31, 2018
    --- - |2+ Abstract Objective According to the precaution adoption process model, cervical screening nonparticipants represent a heterogeneous group including those who are unaware of, unengaged with, or undecided about screening, as well as intenders and decliners. We aimed to explore beliefs about cervical screening among these different types of nonparticipant. Methods Semistructured interviews were carried out with women aged 26 to 65 years living in Britain (n = 29). Women were purposively sampled to represent different nonparticipant types. Interviews were transcribed verbatim, and data were analysed thematically using framework analysis. Results The salience of some barriers to screening varied between different types of nonparticipant. Bad experiences were prominent in the discussions of women who had decided not to attend, while practical barriers were more prominent among intenders. There was also some overlap between nonparticipant types. For example, many of the undecided women described not wanting to go for screening, but with less certainty than decliners. Some intenders (particularly those who had not been screened before) described not really wanting to attend but feeling they ought to. Women's views on the invitation/reminder process also varied; intenders and maintainers appreciated written reminders and general practitioner (GP) prompts but decliners sometimes perceived these as “badgering.” Throughout the interviews, women described changing views on screening in the wider context of ageing and motherhood. Conclusions The salience of screening barriers varies by nonparticipant type, offering possibilities for tailored interventions. However, the fluidity of women's stage of screening adoption might have implications for this approach to intervention design. - Psycho-Oncology, Volume 27, Issue 10, Page 2488-2493, October 2018.
    August 31, 2018   doi: 10.1002/pon.4857   open full text
  • Demoralization and death anxiety in advanced cancer.
    Ekaterina An, Christopher Lo, Sarah Hales, Camilla Zimmermann, Gary Rodin.
    Psycho-Oncology. August 20, 2018
    --- - |2+ Abstract Objective The circumstances of advanced cancer can cause considerable psychological distress, including death anxiety and demoralization. Although these states of existential distress have a negative impact on the quality of life of patients with advanced cancer, they are rarely evaluated as outcomes or targets of interventions in this population. In an effort to improve understanding of existential distress, a structural model of relationships among death anxiety, demoralization, symptom burden, and social relatedness was tested in patients with advanced cancer. Methods A total of 307 patients with advanced cancer completed baseline measures including the Death and Dying Distress Scale, the Demoralization Scale, the modified Experiences in Close Relationships Scale, the Life Completion subscale of the Quality of Life Evaluation—Cancer scale, the Memorial Symptom Assessment Scale, and Karnofsky Performance Status. A structural equation model of protective and risk factors for demoralization and death anxiety was tested. Results The final model had good fit (SRMR = 0.061; RMSEA = 0.077; CFI = 0.927; NNFI = 0.902) in which death anxiety was positively associated with demoralization (β = 0.71), and demoralization was positively associated with symptom burden (β = 0.31) and negatively associated with social relatedness (β = −0.74). Conclusions The findings of this study suggest that demoralization and death anxiety are closely linked in patients with advanced cancer. The contribution of both symptom burden and low social relatedness to demoralization suggests that an integrated intervention addressing both physical and psychosocial disease factors may be most effective at alleviating such states of existential distress. - Psycho-Oncology, EarlyView.
    August 20, 2018   doi: 10.1002/pon.4843   open full text
  • Oregon's Familias en Acción replicates benefits for underserved cancer co‐survivors through Un Abrazo Para la Familia.
    Catherine A. Marshall, Melissa A. Curran, Gail Brownmiller, Ambar Solarte, Julie Armin, Heidi A. Hamann, Janice D. Crist, Mika Niemelä, Terry A. Badger, Karen L. Weihs.
    Psycho-Oncology. August 15, 2018
    --- - |2+ Abstract Objective Our goal in this study was to determine if we could replicate initial findings when providing the intervention, Un Abrazo Para La Familia (“Abrazo”). Abrazo is a community‐focused psychoeducational preventive intervention addressing the cancer information and coping needs of low‐income, underserved family members of cancer survivors, developed and first implemented in Tucson, Arizona. Methods We used a preintervention and postintervention evaluation design to assess the effectiveness of replicating the Abrazo intervention with underserved Hispanic/Latino family members facing cancer as co‐survivors. We describe lessons learned in an expansion of Abrazo from one region of the United States to another. Results Portland promotoras demonstrated that when the Abrazo intervention is provided via a culturally congruent, accessible format, the significant gains in cancer knowledge and self‐efficacy reported by underserved co‐survivors can be replicated. This is important because Oregon represents a US region different from Abrazo's origins in the Southwest. Conclusion Our replication study provides a useful roadmap for others focusing on the psychosocial needs of Hispanic/Latino cosurviving family members of cancer. A manualized 12‐hour training program based on the initial discovery and efficacy work was developed to train promotoras as a part of this study. The manual provides a clear protocol for others to replicate our intervention and evaluation procedures. Abrazo may be particularly important for family‐centered care if the family does not have the cancer knowledge or self‐confidence needed to fully participate. - Psycho-Oncology, Volume 27, Issue 10, Page 2405-2411, October 2018.
    August 15, 2018   doi: 10.1002/pon.4841   open full text
  • Racial differences in responses to the NCCN Distress Thermometer and Problem List: Evidence from a radiation oncology clinic.
    Philip Reed McDonagh, Alexander N. Slade, Justin Anderson, Whitney Burton, Emma C. Fields.
    Psycho-Oncology. August 15, 2018
    --- - - Psycho-Oncology, Volume 27, Issue 10, Page 2513-2516, October 2018.
    August 15, 2018   doi: 10.1002/pon.4846   open full text
  • A systematic review of factors related to children's quality of life and mental health after brain tumor.
    Hayley Bell, Tamara Ownsworth, Owen Lloyd, Nicola Sheeran, Suzanne Chambers.
    Psycho-Oncology. August 15, 2018
    --- - |2+ Abstract Purpose Brain tumor has been found to have a major impact on children's quality of life (QOL); yet, the subjective impact of the illness is still not well understood. This review aimed to investigate factors related to children's subjective well‐being (SWB), or self‐reported QOL and mental health after brain tumor. A further aim was to determine the consistency between child and parent‐proxy ratings of children's SWB and common factors associated with both child and parent‐proxy ratings. Methods A systematic search of PsycINFO, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and Scopus was conducted from 1980 to May 2018 to identify eligible studies. Methodological quality of these studies was assessed by 2 independent reviewers. Results Twenty studies investigated factors related to children's self‐reported mental health or QOL. Fourteen studies examined these factors from the perspectives of both children and their parents. Overall, risk factors for poor QOL included infratentorial tumors, radiation, hydrocephalus, lower IQ, and behavioral problems. Only 5 studies examined mental health outcomes, the findings of which were mixed. Relatively few studies examined psychosocial variables related to children's SWB. Conclusions Although several risk factors for poor QOL were identified, further research investigating mental health outcomes and the influence of psychosocial factors on children's SWB is needed to guide support interventions for pediatric brain tumor. - Psycho-Oncology, Volume 27, Issue 10, Page 2317-2326, October 2018.
    August 15, 2018   doi: 10.1002/pon.4850   open full text
  • Examining the dimensionality of the Fear of Cancer Recurrence Inventory.
    Jacqueline Galica, Sarah Brennenstuhl, Christine Maheu, Carol Townsley, Kelly Metcalfe.
    Psycho-Oncology. August 09, 2018
    --- - |2+ Abstract Objective Fear of cancer recurrence (FCR) is a common concern among cancer survivors, and the Fear of Cancer Recurrence Inventory (FCRI) is a frequently used measure to assess FCR. Given that the dimensionality of FCR has received recent debate, the overall goal of this secondary analysis was to re‐examine the dimensionality of the FCRI using confirmatory factor analyses (CFA) to compare models of FCR, using data from a large sample of cancer survivors. Methods Three models of FCR (including unidimensional and multidimensional models of the FCRI) were informed by the literature and proposed a priori. Separate CFAs were conducted to test the fit of each model to the data, and models with acceptable fits were compared. Results Of all the tested FCR models, a multidimensional first‐order model aligned with the originally developed 7‐subscale FCRI revealed the best fit to the data (χ2 = 3359.135, P < .0001, df = 795, RMSEA = 0.057 [0.055, 0.059], CFI = 0.897, TLI = 0.888). When this 7‐factor structure was loaded onto a single, second‐order factor of overall FCR, the model fit statistics were slightly poorer (χ2 = 3459.632, P < .0001, df = 807, RMSEA = 0.058 [0.056, 0.060], CFI = 0.893, TLI = 0.886). However, the difference between the models was significant (chi‐square difference = 103.142, P < .0001, df = 12) indicating that the first‐order model was a better fit to the data. Conclusions These results align with empirical and theoretical literature that supports the use of the FCRI as a multidimensional scale. Implications of results are discussed in light of FCR conceptualization and measurement. - Psycho-Oncology, EarlyView.
    August 09, 2018   doi: 10.1002/pon.4839   open full text
  • Modality‐specific exercise guidelines and quality of life in kidney cancer survivors: A cross‐sectional study.
    Linda Trinh, Dominick A. Strom, Jaime N. Wong, Kerry S. Courneya.
    Psycho-Oncology. August 07, 2018
    --- - |2+ Abstract Objectives Few exercise oncology trials have compared aerobic with strength exercise or compared combined exercise (ie, aerobic and strength training) with aerobic only or strength only. It is unknown what single or combined exercise modality is optimal for quality of life (QoL) in cancer survivors. The purpose of this study is to estimate the prevalence of meeting the combined and independent aerobic and strength exercise guidelines in kidney cancer survivors (KCS) and determine any associations with QoL. Methods One thousand nine hundred eighty‐five KCS were identified through a provincial registry in Canada and mailed a survey including exercise and QoL scales. Results Completed surveys were received from 703 KCS. Only 10.1% of KCS reported meeting the combined exercise guidelines. Analyses of covariance indicated that, for most QoL outcomes (eg, Functional Assessment of Cancer Therapy—General and Functional Assessment of Cancer Therapy—Fatigue), meeting the combined exercise guideline was superior to meeting either single modality guideline that, in turn, were superior to meeting neither guideline. For the primary outcome of the Trial Outcome Index‐Fatigue, meeting the combined exercise guideline was superior to meeting (a) neither guideline (P < 0.001), (b) the strength‐only guideline (P = 0.021), and (c) the aerobic‐only guideline (P = 0.051). In turn, the aerobic and strength exercise only guidelines were superior to meeting neither guideline (P < 0.001 for aerobic; P = 0.045 for strength) but were not different from each other (P = 0.50). Conclusions Meeting the combined exercise guideline has favorable associations with QoL in KCS, however, very few KCS are meeting the combined guideline. - Psycho-Oncology, Volume 27, Issue 10, Page 2419-2426, October 2018.
    August 07, 2018   doi: 10.1002/pon.4844   open full text
  • Cancer survivors' experiences of return to work: A qualitative study.
    Vahid Zamanzadeh, Leila Valizadeh, Azad Rahmani, Mohammad Zirak, Huget Desiron.
    Psycho-Oncology. August 07, 2018
    --- - |2+ Abstract Objective The study aimed to explore Iranian cancer survivors' experiences of returning to work. Methods Semistructured interviews were conducted with 20 cancer survivors at their workplace and in a referral cancer center. Data were analyzed using a conventional content analysis technique. Results Three main categories were identified as important in cancer survivors' experiences of returning to work: (1) individual perspectives, (2) nature of disease, and (3) access to support system. Results showed that returning to work contained different meaning for men and women. Also, it was found that cancer survivors had limited information about the disease and return to work that made them doubtful about returning to work. Conclusion Cancer survivors have different individual perspectives that affect their decision about returning to work. Their perspectives should be assessed before returning to work, and necessary support should be provided for them in returning to work process. In this regard, health care systems and rehabilitation specialists should inform cancer survivors about the disease and return to work. Also, employers should prepare work places for cancer survivors' entrance. - Psycho-Oncology, Volume 27, Issue 10, Page 2398-2404, October 2018.
    August 07, 2018   doi: 10.1002/pon.4840   open full text
  • A model of identity grounded in the acute season of survivorship.
    Maclean Thiessen, Thomas F. Hack, Marshall Pitz, Marcia Anderson.
    Psycho-Oncology. August 07, 2018
    --- - |2+ Abstract Objective Survivorship literature generally focuses on the cancer experience after diagnosis and treatment. However, acute survivorship, beginning with diagnosis and ending at the completion of treatment, has a lasting impact on the well‐being of patients. The purpose of this study was to generate a theoretical understanding of how identity is affected during acute survivorship. Methods Using grounded theory and interviews with patients, their families, and their friends, the impact of the acute survivorship phase on the identity of patients was explored in Manitoba, Canada. Forty‐two interviews were carried out, involving 18 patients with early malignancies and 15 friends and family members. Results The theory which evolved suggests that identity can be viewed as a construct of 3 concepts: values, social domains, and routine. Following diagnosis identity is disrupted as patients face challenges integrating the health care recipient social domain into their established routine. Patients indicated that the impact of the cancer diagnosis on their identities could have been minimized through earlier provision of the necessary information to re‐establish routine. Conclusions The theory that emerged from this study articulates the impact of the early cancer experience on the identity of patients. It also provides a framework for predicting which interventions may improve the cancer experience. Exploring how to best provide information that helps patients re‐establish and maintain their routines after diagnosis is an important future direction. - Psycho-Oncology, Volume 27, Issue 10, Page 2412-2418, October 2018.
    August 07, 2018   doi: 10.1002/pon.4842   open full text
  • Relationship of demoralization with anxiety, depression, and quality of life: A Southern European study of Italian and Portuguese cancer patients.
    Maria Giulia Nanni, Rosangela Caruso, Luzia Travado, Cidalia Ventura, Alessandra Palma, Alejandra M. Berardi, Elena Meggiolaro, Federica Ruffilli, Cristina Martins, David Kissane, Luigi Grassi.
    Psycho-Oncology. August 06, 2018
    --- - |2+ Abstract Background Demoralization syndrome is a significant condition that has not been greatly studied in Southern European countries. Aims To extend the knowledge of demoralization in Southern Europe by examining its prevalence according to different methods of assessment, its relationship with anxiety and depression, and its impact on quality of life (QoL) among cancer patients. Methods A convenience sample of 195 cancer outpatients from two oncology centers (102 from Lisbon, Portugal, and 93 from Ferrara, Italy) participated in an observational, cross‐sectional study using the Diagnostic Criteria of Psychosomatic Research‐Demoralization interview (DCPR/D) and psychometric tools (Demoralization scale‐DS; Patient Health Questionnaire–9/PHQ‐9; Hospital Anxiety Depression Scale‐HADS; and European Quality of Life‐5‐EQ‐5D). Results A 25.1% prevalence (CI 95%, 0.19‐0.31) of clinically relevant demoralization was reported on the DCPR/D interview. A total demoralization score cutoff score ≥ 25 maximized sensitivity (81.6%), and specificity (72.6%) in identifying DCPR/D demoralized patients. The DCPR/D and DS were associated with poorer levels of QoL. About half of the patients who were demoralized were not clinically depressed (PHQ‐9). Self‐reported suicidal ideation (PHQ‐9 item 9) was found in a minority of patients (8.2%), most of whom (77%) were cases of depression (PHQ‐9), but one‐quarter (23%) were not depressed, yet moderately/severely demoralized (DCPR/D and DS). Conclusions This Southern European study confirms the importance of demoralization in cancer patients as a different condition with respect to depression and its relationship with poor QoL and suicidal ideation. - Psycho-Oncology, EarlyView.
    August 06, 2018   doi: 10.1002/pon.4824   open full text
  • 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.
    Natalie Bauereiß, Stefanie Obermaier, Selçuk Erol Özünal, Harald Baumeister.
    Psycho-Oncology. August 03, 2018
    --- - |2+ 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. - Psycho-Oncology, EarlyView.
    August 03, 2018   doi: 10.1002/pon.4829   open full text
  • Enhancing clinical practice in the management of distress: The Therapeutic Practices for Distress Management (TPDM) project.
    Deborah McLeod, Mary Jane Esplen, Jiahui Wong, Thomas F. Hack, Lise Fillion, Doris Howell, Margaret Fitch, Julie Dufresne.
    Psycho-Oncology. July 31, 2018
    --- - |2+ Abstract Objective The Therapeutic Practices for Distress Management (TPDM) project was carried out to support clinicians in integrating recommendations from four clinical practice guidelines (CPGs) in routine care at five Pan Canadian cancer care sites. Methods Using a concurrent, mixed‐method study design and knowledge translation (KT) activities, this project included two phases: phase I—a baseline/preparation phase and phase II—an intervention phase plus evaluation. The intervention phase (the focus of this report) included a one‐year education and supervision program (24 hours in virtual class; 12‐hour group supervision). Primary outcomes were knowledge and self‐efficacy in practicing CPGs as measured by a Knowledge and Self‐Efficacy Survey (KSES). A secondary outcome was observer‐rated performances with standardized patients (objective structured clinical exams). Participants included 80 (90%) nurses, and 9 (10%) social workers (N = 89). Results The TPDM program was effective in accomplishing change in knowledge, self‐efficacy, and performance. All measures demonstrated significant change pre and post module, with evidence of increasing knowledge (P < .01) and confidence (P < .01) over time. Further, there was evidence of a shift in barriers and enablers to practicing in alignment with the CPGs. Conclusions A tailored education program using case‐based learning and supervision over time improves knowledge and practice among front line clinicians. The findings have implications for quality improvement in cancer care. - Psycho-Oncology, Volume 27, Issue 9, Page 2289-2295, September 2018.
    July 31, 2018   doi: 10.1002/pon.4831   open full text
  • Social support and breast cancer screening in rural Appalachia.
    Brittany L. Smalls, Adaeze Aroh, Kristen McQuerry, Adebola Adegboyega, Nancy Schoenberg, Jennifer Hatcher.
    Psycho-Oncology. July 31, 2018
    --- - |2+ Abstract Purpose Women in the Appalachian region have a high mortality rate attributable to cancer in spite of lower incidence of cancer compared with the general US population. Empirical evidence suggests that social support influences cancer outcomes, including adherence to screening guidelines and treatment recommendations. The purpose of this study is to examine the impact of social support on breast cancer screening patterns in a sample of rural Appalachian women. Methods This paper reports the results of analyses of baseline cross‐sectional data on breast cancer screening collected during a community‐based group‐randomized trial. We used the 2010 National Health Institute Survey questionnaires and the Medical Outcomes Study Social Support Survey to assess screening behavior and perceived social support, respectively. Data were analyzed using ANCOVA and ANOVA to assess the mean social support on breast cancer screening patterns (frequently, irregularly, and rarely/never) and relevant sociodemographic variables. Findings Of the eligible participant records analyzed (N = 289), 50% were married, 36% were employed, 20% attended college, 40% had no mammogram in 6 years, and 20% never had mammograms. Overall social support score was high at 73.1 (SD = 18.2). Association between breast cancer screening patterns and social support scores was not statistically significant at α < 0.05 (P value = 0.09). Conclusions Although social support as it measured in this study does not show significant associations with screening patterns, it is important to understand how social network structures may influence screening patterns. Familial and social roles/responsibilities that result in reported social support may also be the barrier to cancer screening and other prevention health behaviors. - Psycho-Oncology, Volume 27, Issue 9, Page 2281-2288, September 2018.
    July 31, 2018   doi: 10.1002/pon.4828   open full text
  • Beyond the bucket list: Unfinished and business among advanced cancer patients.
    Melissa P. Masterson, Elizabeth Slivjak, Greta Jankauskaite, William Breitbart, Hayley Pessin, Elizabeth Schofield, Jason Holland, Wendy G. Lichtenthal.
    Psycho-Oncology. July 27, 2018
    --- - |2+ Abstract Objective The study aims to examine the prevalence and common themes of unfinished business (UB) and its associations with distress among advanced cancer patients. Methods A total of 223 patients from a larger randomized controlled trial of Individual Meaning‐Centered Psychotherapy (IMCP) completed self‐report questionnaires that assessed UB and UB‐related distress, hopelessness, desire for hastened death, anxiety and depression, quality of life, spiritual well‐being, and purpose/meaning. Unfinished business themes were identified by qualitative analysis of open‐ended data. Results A total of 161 (72%) patients reported the presence of UB. The mean UB‐related distress score was 7.01 (SD = 2.1) out of 10. Results of independent t tests showed that patients with UB reported significantly higher levels of anxiety and lower levels of existential transcendence than patients without UB. Linear regression equations indicated that UB‐related distress significantly predicted hopelessness (F1,154 = 9.54, P < 0.05, R2 = 0.058), anxiety (F1,154 = 4.31, P < 0.05, R2 = 0.027), personal meaning (F1,136 = 6.18, P < 0.05, R2 = 0.043), and existential transcendence (F1,119 = 6.7, P < 0.05, R2 = 0.053). Ten UB themes emerged from open‐ended responses; UB themes were not associated with UB‐related distress or psychological adjustment. Conclusions Unfinished business was both prevalent and distressing in our sample. Findings underscore the need to develop and implement interventions designed to help patients resolve or find solace with UB. - Psycho-Oncology, EarlyView.
    July 27, 2018   doi: 10.1002/pon.4821   open full text
  • Health literacy and the health status of men with prostate cancer.
    Belinda C. Goodwin, Sonja March, Leah Zajdlewicz, Richard H. Osborne, Jeff Dunn, Suzanne K. Chambers.
    Psycho-Oncology. July 27, 2018
    --- - |2+ Abstract Objective To test the Health Literacy Questionnaire (HLQ) in a sample of men with prostate cancer and examine the components of health literacy that are most strongly associated with mental and physical health‐related quality of life in men with prostate cancer. Method Members (N = 565) of a state‐wide prostate cancer support network in Queensland, Australia (Mage = 71.14, SD = 8.68) completed the HLQ along with the Medical Outcomes Study, 36‐item short‐form health survey (SF‐36). Confirmatory factor analysis was employed to assess the internal structure of the HLQ. The effects (bs) of each of the nine health literacy factors on mental and physical health status were graphed and compared using Fishers exact test for comparing parameter estimates. Results Fit indices including RMSEA (0.069, CI = 0.066‐0.072), CFI (.853), and TLI (.839), alongside item loadings and internal consistency (Cronbach alphas >0.80) for the nine‐factor model, supported the robustness of the HLQ for use in this prostate cancer sample. Health literacy factors reflecting social and health provider support, navigating health systems, finding and understanding health information, and active engagement with providers shared small to moderate associations with mental health status and little to no association with physical health status. Conclusion Findings provide support for the use of the HLQ as a valid and reliable measure of health literacy in men with prostate cancer. Although further research is required to establish causality, interventions that aim to improve skills in connecting and effectively communicating with health care services and providers might lead to better mental health related quality of life for men with prostate cancer. - Psycho-Oncology, Volume 27, Issue 10, Page 2374-2381, October 2018.
    July 27, 2018   doi: 10.1002/pon.4834   open full text
  • Factors moderating the mutual impact of benefit finding between Chinese patients with cancer and their family caregivers: A cross‐sectional study.
    Qiuping Li, Yi Lin, Huiya Zhou, Yinghua Xu, Liping Yang, Yongyong Xu.
    Psycho-Oncology. July 26, 2018
    --- - |2+ Abstract Objective With growing recognitions of the significance of benefit finding (BF) in cancer practice, research has increased to explore factors that may influence BF in the cancer context. Few studies have focused explicitly on factors influencing BF from the dyadic perspective of cancer patient (CP)‐family caregiver (FC) dyads. The objectives of the study were to examine BF relationship between CPs and FCs and to investigate factors that may modify the BF relationships between CPs and FCs. Methods Participants consisted of 772 dyads of CPs and FCs. Three types of variables were collected as potential modifying factors, including CP‐related variables, FC‐related variables, and psychological‐related variables. Descriptive statistics, T test, Pearson correlations, and subgroup analysis were applied to conduct the data analysis. Results Cancer patients and FCs experienced similar moderate to high BF ranging from 65% to 81%, with the exception of acceptance, in that CPs had higher levels of acceptance than did FCs (P < .05). Various factors modifying the BF relationships between CPs and FCs were identified, including dyads' gender, marital status, education level, employment status, level of being informed about the disease, and cancer type and treatment, anxiety, depression, and self‐efficacy. Conclusions Study findings call attention to the BF, as well as related factors, from the dyadic perspective of CP‐FC dyads. Health care professionals need to include FCs of the CPs in their care and provide them with support, to encourage the CP‐FC dyads to share their experience and improve BF together, and to develop a dyadic‐based intervention program to help enhancing dyads BF. - Psycho-Oncology, Volume 27, Issue 10, Page 2363-2373, October 2018.
    July 26, 2018   doi: 10.1002/pon.4833   open full text
  • Dyadic stress of breast cancer survivors and their caregivers: Are there differences by sexual orientation?
    Ulrike Boehmer, Jeffrey E. Stokes, Angela R. Bazzi, Michael Winter, Melissa A. Clark.
    Psycho-Oncology. July 26, 2018
    --- - |2+ Abstract Objective The objective of the study is to assess dyadic stress among sexual minority cancer survivor and caregivers compared to heterosexual cancer survivors and their caregivers. Methods We recruited 167 survivors of nonmetastatic breast cancer of different sexual orientations and their caregivers, who were interviewed via telephone after obtaining consent. We used inverse propensity score weighting to account for differences by sexual orientation in age and length of the survivor‐caregiver relationship and simultaneous equation models consistent with the needs for analyzing dyadic data. Results Survivors and caregivers reported stress levels consistent with population norms, irrespective of survivors' sexual orientation. Accounting for covariates, survivors' and caregivers' stress did not mutually influence one another overall. However, differences by sexual orientation were noted such that caregivers' stress was influential for sexual minority survivors' stress, but not for heterosexual survivors' stress. Conclusions Careful consideration should be given to caregivers of sexual minority survivors, an underserved group for whom currently no interventions exist. - Psycho-Oncology, Volume 27, Issue 10, Page 2389-2397, October 2018.
    July 26, 2018   doi: 10.1002/pon.4836   open full text
  • Psychosocial mediators of dietary change among Hispanic/Latina breast cancer survivors in a culturally tailored dietary intervention.
    Zaixing Shi, John M. Richardson, Ana Corina Aycinena, Heewon L. Gray, Rachel Paul, Pam Koch, Isobel Contento, Ann Ogden Gaffney, Heather Greenlee.
    Psycho-Oncology. July 25, 2018
    --- - |2+ Abstract Objective To examine psychosocial mediators of the effect of a culturally tailored dietary intervention on dietary change among Hispanic/Latina breast cancer survivors. Methods Hispanic/Latina breast cancer survivors (n = 70) were randomized to receive either a 12‐week theory‐based and culturally tailored dietary change program (intervention group, n = 34), or standard‐of‐care printed recommendations (control group, n = 36) ( NCT01414062). Fruit/vegetable intake (F/V), % calories from fat, and hypothesized psychosocial mediators were assessed at baseline, 6 and 12 months. Analysis of covariance assessed intervention effects on psychosocial mediators at 6 and 12 months. Mediation analysis using the bootstrap method evaluated the indirect intervention effects on dietary intake at 6 and 12 months through changes in psychosocial mediators at 6 and 12 months. Results Compared with controls, at 6 and 12 months, the intervention group reported greater improvements in stages of change (P < .001, P < .001, respectively), self‐efficacy (P = .009, P = .002, respectively), snack preference for F/snack preference for F/V (P = .045, P = .002, respectively); at 12 months, the intervention group reported a decrease in chance‐oriented external locus of control (P = .02). At 6 months, mediation analysis showed that the intervention effect was associated with an increase of 1.0 (95% CI, −0.1‐2.4) serving/day of F/V, compared with the control group, although no indirect effect through the hypothesized psychosocial mediators was observed. At 12 months, the intervention was associated with an increase in 0.5 serving/day F/V through improved taste/snack preference for F/V at 6 and 12 months (95% CIs, 0.1‐1.3, 0.0‐1.4, respectively). Conclusions Future programs can target improving taste/snack preference for F/V to promote dietary change in Hispanic/Latina breast cancer survivors. - Psycho-Oncology, Volume 27, Issue 9, Page 2220-2228, September 2018.
    July 25, 2018   doi: 10.1002/pon.4799   open full text
  • Does sharing good news buffer fear of bad news? A daily diary study of fear of cancer recurrence in couples approaching the first mammogram post‐diagnosis.
    Emily C. Soriano, Christine Perndorfer, Amy K. Otto, Scott D. Siegel, Jean‐Philippe Laurenceau.
    Psycho-Oncology. July 23, 2018
    --- - |2+ Abstract Objective The core of fear of cancer recurrence (FCR)—a top concern of couples after successful breast cancer (BC) treatment—is fear of death. Daily relationship processes may be instrumental in regulating FCR as triggers of existential distress are encountered. We tested the hypothesis that daily capitalization, the process of sharing good news (capitalization attempts) to a partner perceived as responsive (responsiveness), buffers patient and spouse FCR as they confront the first mammogram post‐diagnosis. Methods Fifty‐seven early‐stage BC survivors and their spouses reported daily FCR, capitalization, and positivity of the disclosed event during a 3‐week diary period beginning 2 weeks before the first annual mammogram post‐diagnosis. Dyadic multilevel path models estimated within‐person effects of patient and spouse capitalization on same‐day FCR, controlling for event positivity. Results Before the mammogram, capitalization attempts were unrelated to FCR, but for patients, responsiveness was predictive of greater same‐day FCR. After the mammogram, for both partners, attempts were predictive of greater same‐day FCR, yet responsiveness was predictive of lower FCR. Conclusions Findings were largely inconsistent with the hypothesis that capitalization buffers existential distress. However, results revealed novel insights about daily dyadic processes that may characterize within‐person adaptation to existential threat. Potential explanations for the differential links between capitalization and FCR based on timing (before versus after threat) and capitalization component (attempts versus responsiveness) are discussed. - Psycho-Oncology, EarlyView.
    July 23, 2018   doi: 10.1002/pon.4813   open full text
  • Depressive symptoms in relation to overall survival in people with head and neck cancer: A longitudinal cohort study.
    Femke Jansen, Irma M. Verdonck‐de Leeuw, Pim Cuijpers, C. René Leemans, Tim Waterboer, Michael Pawlita, Chris Penfold, Steven J. Thomas, Andrea Waylen, Andrew R. Ness.
    Psycho-Oncology. July 23, 2018
    --- - |2+ Abstract Objective The objective of the study is to investigate the relation between pretreatment depressive symptoms (DS) and the course of DS during the first year after cancer diagnosis, and overall survival among people with head and neck cancer (HNC). Methods Data from the Head and Neck 5000 prospective clinical cohort study were used. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) pretreatment, at 4 and 12‐month follow‐up. Also, socio‐demographic, clinical, lifestyle, and mortality data were collected. The association between before start of treatment DS (HADS‐depression > 7) and course (never DS, recovered from DS, or persistent/recurrent/late DS at 12‐month follow‐up) and survival was investigated using Cox regression. Unadjusted and adjusted analyses were performed. Results In total, 384 of the 2144 persons (18%) reported pretreatment DS. Regarding DS course, 63% never had DS, 16% recovered, and 20% had persistent/recurrent/late DS. People with pretreatment DS had a higher risk of earlier death than people without DS (hazard ratio (HR) = 1.65; 95% confidence interval (CI) 1.33‐2.05), but this decreased after correcting for socio‐demographic, clinical, and lifestyle‐related factors (HR = 1.21; 95% CI 0.97‐1.52). Regarding the course of DS, people with persistent/recurrent/late DS had a higher risk of earlier death (HR = 2.04; 95% CI 1.36‐3.05), while people who recovered had a comparable risk (HR = 1.12; 95% CI 0.66‐1.90) as the reference group who never experienced DS. After correcting for socio‐demographic and clinical factors, people with persistent/recurrent/late DS still had a higher risk of earlier death (HR = 1.66; 95% CI 1.09‐2.53). Conclusions Pretreatment DS and persistent/recurrent/late DS were associated with worse survival among people with HNC. - Psycho-Oncology, Volume 27, Issue 9, Page 2245-2256, September 2018.
    July 23, 2018   doi: 10.1002/pon.4816   open full text
  • Perceived doctor‐patient relationship and its association with demoralization in patients with advanced cancer.
    Leonhard Quintero Garzón, Susan Koranyi, Dorit Engelmann, Rebecca Philipp, Katharina Scheffold, Frank Schulz‐Kindermann, Martin Härter, Anja Mehnert.
    Psycho-Oncology. July 20, 2018
    --- - |2+ Abstract Background Advanced diseases pose a great burden on patients and go hand in hand with existential concerns. Demoralization is considered as a syndrome of existential distress with a perceived inability to cope with loss of meaning in life and feelings of helplessness and hopelessness. Professional health care providers play an important role in providing support for patients and unfavorable conversational styles in their relationship can increase patient's distress. In this study, we examine the association between the patient's perceived relationship to health care providers and demoralization. Methods We used baseline data of a randomized control trial intervention study for advanced cancer patients (UICC‐Stage ≥ III; PHQ ≥ 9 and/or Distress‐Thermometer ≥5). We used a subscale of the QUAL‐EC‐P for assessing doctor‐patient relationship, Beck Depression Inventory‐II for depressive symptoms, a modified version of the MSAS as physiological symptom checklist, and the Demoralization Scale to assess demoralization. A hierarchical regression analysis was calculated. Results In our sample of 187 patients with stage III or IV cancer (62% women), demoralization was present in 53.4% (16% moderate demoralization; 37.4% high demoralization) of the patients. Relationship to health care provider was an independent predictor (β = −.33, t(186) = −6.70, P < .001) of demoralization. Conclusions Our findings underline the importance of the physician‐patient relationship in the context of coping with existential challenges in advanced cancer patients. Trainings on how to communicate and build a sustainable relationship with patients and their specific needs may increase the buffering effect of social support by the physicians on patient's existential distress. - Psycho-Oncology, EarlyView.
    July 20, 2018   doi: 10.1002/pon.4823   open full text
  • Can cancer‐related cognitive impairment be considered in isolation from other cancer‐related symptoms?
    Tamara E. Lacourt, Richard De La Garza, Robert Dantzer.
    Psycho-Oncology. July 18, 2018
    --- - - Psycho-Oncology, Volume 27, Issue 10, Page 2511-2512, October 2018.
    July 18, 2018   doi: 10.1002/pon.4826   open full text
  • Barriers to active self‐management following treatment for head and neck cancer: Survivors' perspectives.
    Simon Dunne, Laura Coffey, Linda Sharp, Aileen Timmons, Deirdre Desmond, Rachael Gooberman‐Hill, Eleanor O'Sullivan, Ivan Keogh, Conrad Timon, Pamela Gallagher.
    Psycho-Oncology. July 18, 2018
    --- - |2+ Abstract Objective Active self‐management practices may help head and neck cancer (HNC) survivors to deal with challenges to their physical, functional, social, and psychological well‐being presented by HNC and its treatment. This study investigates the factors perceived by HNC survivors to act as barriers to their active self‐management following primary treatment. Methods In this qualitative study, 27 HNC survivors identified through 4 designated cancer centres in Ireland participated in face‐to‐face semistructured interviews. Interviews were audio‐recorded, transcribed, and analysed using thematic analysis. Results Four themes (and associated subthemes) describing barriers to survivors' active self‐management were identified: emotional barriers (eg, fear of recurrence), symptom‐related barriers (eg, loss of taste), structural barriers (eg, access to appropriate health services), and self‐evaluative barriers (eg, interpersonal self‐evaluative concerns). Conclusions This is the first study to describe HNC survivors' views about barriers to their active self‐management after treatment. The findings have important implications for self‐management research and intervention development concerning HNC survivorship. - Psycho-Oncology, Volume 27, Issue 10, Page 2382-2388, October 2018.
    July 18, 2018   doi: 10.1002/pon.4835   open full text
  • Quality of life after pelvic exenteration for gynecologic cancer: Findings from a qualitative study.
    Ashley M. Nelson, Alexandra Albizu‐Jacob, Alyssa L. Fenech, Hye Sook Chon, Robert M. Wenham, Kristine A. Donovan.
    Psycho-Oncology. July 18, 2018
    --- - |2+ Abstract Objective Pelvic exenteration (PE) in carefully selected gynecologic cancer patients has a 5‐year survival rate as high as 60%. Thus, there is a growing number of PE survivors dealing with the effects of this radical surgery. The current study sought to explore women's physical, psychological, and social quality of life (QOL) after PE. Methods Fourteen women who had undergone PE for recurrent gynecologic cancer at least 1 year previously completed semistructured qualitative interviews designed to elicit expectations and experiences of QOL following PE. Thematic analysis was used to code transcripts for both a priori and emergent themes. Results Themes included PE versus palliative care, preparedness, persistent symptoms, the not so normal new normal, new rules of social engagement, support, emotional diversity, and bouncing back through adaptive coping. Key differences with previous studies include the explicit acknowledgement of the need for palliative care, the chronic nature of multiple, seemingly unaddressed physical symptoms in survivorship, and the predominance of positive psychological symptoms. While a minority expressed emotional distress and regret for undergoing PE, most articulated a sense of resilience gained through a variety of adaptive coping strategies. Conclusions Findings underscore the persistent physical, psychological, and social effects of PE on QOL and the need for comprehensive, multidisciplinary patient care before and long after surgery. Findings should promote development of a best practice clinical pathway for the care and education of women who undergo PE with curative intent for gynecologic cancer. - Psycho-Oncology, Volume 27, Issue 10, Page 2357-2362, October 2018.
    July 18, 2018   doi: 10.1002/pon.4832   open full text
  • New challenges in psycho‐oncology: Neural regulation of the cancer genome.
    Steven W. Cole.
    Psycho-Oncology. July 18, 2018
    --- - - Psycho-Oncology, Volume 27, Issue 10, Page 2305-2309, October 2018.
    July 18, 2018   doi: 10.1002/pon.4838   open full text
  • Factors contributing to cancer‐related suicide: A study of root‐cause analysis reports.
    Maya Aboumrad, Brian Shiner, Natalie Riblet, Peter D. Mills, Bradley V. Watts.
    Psycho-Oncology. July 18, 2018
    --- - |2+ Abstract Objective Vast efforts are directed toward curing or prolonging the life of patients with cancer. However, less attention is given to mental health aspects of cancer care, and there is elevated incidence of death by suicide in this population. Evaluating Root Cause Analyses (RCAs) of cancer‐related suicides may further our understanding of system‐level factors that may contribute to suicide in patients with cancer and highlight strategies to mitigate this risk. Methods We searched the Veterans Health Administration National Center for Patient Safety RCA database for cancer‐related suicides between 2002 and 2017 to evaluate the context of the suicides and identify root causes and suggested actions. These variables were coded by consensus and evaluated using descriptive statistics. Results We identified 64 RCA reports involving cancer‐related suicide; 100% were males of older age. Many suicides occurred during treatment with palliative intent (44%, N = 28). Depression (59%, N = 38), medical comorbidities (59%, N = 38), and pain (47%, N = 30) were common suicide risk factors identified. Most suicides occurred within 7 days of a medical visit (67%, N = 43), especially within the first 24 hours (41%, N = 26). Root causes included a need to improve recognition of triggers for assessment and interdisciplinary communication. Conclusion This analysis uncovers opportunities to mitigate risk of death by suicide among patients with cancer. Suggested actions include use of comprehensive cancer centers and development of a distress checklist using information from the National Comprehensive Cancer Network Guidelines. Further studies should assess additional factors that may increase the risk of other adverse mental health outcomes in this population. - Psycho-Oncology, Volume 27, Issue 9, Page 2237-2244, September 2018.
    July 18, 2018   doi: 10.1002/pon.4815   open full text
  • Naturalistically observing noncancer conversations among couples coping with breast cancer.
    Megan L. Robbins, Alexander Karan, Ana María López, Karen L. Weihs.
    Psycho-Oncology. July 18, 2018
    --- - |2+ Abstract Objective This study revealed the landscape of noncancer conversations, identifying topics and types of everyday conversation, and examined links to psychological adjustment among couples coping with breast cancer. Methods Fifty‐two couples wore the Electronically Activated Recorder (EAR) over 1 weekend and self‐reported psychological adjustment while patients were on treatment. The EAR sampled 50 s of ambient sound every 9 minutes to estimate the frequency of noncancer conversation and reveal topics and types of conversation. Results Analyses revealed noncancer conversations comprised over 93% of conversations. The most common topic discussed was people. Substantive conversation was associated with better, while emotional disclosure was associated with worse, well‐being for patients, but not spouses. Conclusions Results revealed that ordinary conversations are frequent among couples who face breast cancer, and they are associated with patients' psychological adjustment, providing a foundation for potential interventions for coping with cancer that do not focus on illness. - Psycho-Oncology, Volume 27, Issue 9, Page 2206-2213, September 2018.
    July 18, 2018   doi: 10.1002/pon.4797   open full text
  • A randomized controlled trial of a supportive expressive group intervention for women with a family history of breast cancer.
    Mary Jane Esplen, Molyn Leszcz, Jonathan Hunter, Jiahui Wong, Yvonne W. Leung, Brenda Toner, Sandra Messner, Gord Glendon, Noreen Stuckless, Catherine Butler.
    Psycho-Oncology. July 17, 2018
    --- - |2+ Abstract Objective Women with a family history of breast cancer (BC) often overestimate their BC risk. Heightened psychological distress may interfere with risk comprehension and screening adherence. The primary purpose of this study was to test the efficacy of a 12‐week manual‐based supportive‐expressive (SE) group intervention for this population. Methods Using a randomized control trial design, this study compared two interventions: a standard risk‐counseling arm (RC) compared with that plus SE group intervention. The primary study outcome was BC anxiety. Secondary outcomes included psychosocial functioning, risk comprehension, BC knowledge, and screening behaviors. Results A total of 161 women with a family history of BC were randomized into SE (N = 108) or RC (N = 53). Participants in both study arms significantly improved on measures of BC anxiety, psychosocial functioning, risk comprehension, and BC knowledge, with no statistical difference between study arms. Benefits were sustained at 1 year. BC screening rates were high in both arms at baseline and follow‐up. Conclusions SE group therapy as an added intervention to the risk counseling was well‐received, however, did not demonstrate superiority to RC alone. Future studies on treatment matching are needed to further our understanding of interventions that can support women with a family history of BC to work through residual issues, including loss and grief. - Psycho-Oncology, EarlyView.
    July 17, 2018   doi: 10.1002/pon.4822   open full text
  • PROMIS and legacy measures compared in a supportive care intervention for breast cancer patients and caregivers: Experience from a randomized trial.
    Alla Sikorskii, David Victorson, Patrick O'Connor, Vered Hankin, Abolfazl Safikhani, Tracy Crane, Terry Badger, Gwen Wyatt.
    Psycho-Oncology. July 17, 2018
    --- - |2+ Abstract Objective Accurate and efficient measurement of patient‐reported outcomes is key in cancer symptom management trials. The newer Patient Reported Outcomes Measurement Information System (PROMIS) and previously developed measures of similar conceptual content (legacy) are available to measure symptoms and functioning. This report compares the performance of two sets of measures, PROMIS and legacy, in a recently completed trial of a supportive care intervention that enrolled breast cancer patients and their friend or family caregivers. Methods Patient‐caregiver dyads (N = 256) were randomized to either reflexology delivered by caregivers or usual care control. Post‐intervention, PROMIS and legacy measures of symptoms and functioning were analyzed in relation to trial arm, while adjusting for baseline values. Responsiveness of the two sets of measures was assessed using effect sizes and P‐values for the effect of trial arm on patients' and caregivers' symptom and functioning outcomes. Results Similar conclusions about intervention effects were found using PROMIS and legacy measures for pain, fatigue, sleep, anxiety, physical, and social functioning. Different conclusions were obtained for patient and caregiver depression: legacy measures indicated the efficacy of reflexology, while PROMIS depression measure did not. Conclusion Evidence of similar responsiveness supports the use of either set of measures for symptoms and functioning in clinical and general populations. Differences between PROMIS and legacy measures of depression need to be considered when choosing instruments for use in trials of supportive care interventions and in clinical practice. - Psycho-Oncology, Volume 27, Issue 9, Page 2265-2273, September 2018.
    July 17, 2018   doi: 10.1002/pon.4825   open full text
  • Are psychological interventions effective on anxiety in cancer patients? A systematic review and meta‐analyses.
    Saira Sanjida, Steven M. McPhail, Joanne Shaw, Jeremy Couper, David Kissane, Melanie A. Price, Monika Janda.
    Psycho-Oncology. July 16, 2018
    --- - |2+ Abstract Objective The aims of this meta‐analysis were to estimate the overall effect size (ES) of psychological interventions on anxiety in patients with cancer and extract sample and intervention characteristics that influence effectiveness. Methods PubMed, Scopus, PsycINFO, Embase, Medline, and CINAHL were searched using Medical Subject Heading keywords ‘cancer’ AND ‘anxiety’ AND ‘psychological intervention’ AND ‘counselling’ AND ‘psycho*’ AND ‘psychotherapy’ AND ‘psychosocial’ AND ‘therapy’ between January 1993 and June 2017. Results Seventy‐one studies were eligible for the systematic review; among them, 51 studies were included in the meta‐analysis calculations. The overall ES was −0.21 (95% confidence interval; −0.30 to −0.13) in favour of the intervention. From subgroup analyses, studies conducted in Asia, enrolling inpatients, focussing on relaxation, of <6‐week intervention duration, <30‐minute intervention dose per session, and <4 hours of total time of intervention showed moderate ESs ranging from −0.40 to −0.55. Only 2 studies restricted enrolment to prescreened patients with clinically elevated level of anxiety and showed moderate ES of −0.58. Conclusions Low psychological distress at baseline and nonevidence‐based interventions were the main factors identified for low effectiveness. Screening and assessment to determine clinical levels of anxiety in patients with cancer should be considered in future trials as an inclusion criterion before providing psychological interventions. Systematic review registration: PROSPERO: International Prospective Register of Systematic Reviews: CRD42017056132. - Psycho-Oncology, Volume 27, Issue 9, Page 2063-2076, September 2018.
    July 16, 2018   doi: 10.1002/pon.4794   open full text
  • Self‐reported chemotherapy‐related cognitive impairment compared with cognitive complaints following menopause.
    Jennifer N. Vega, Julie Dumas, Paul A. Newhouse.
    Psycho-Oncology. July 13, 2018
    --- - |2+ Abstract Objective Cancer‐related cognitive impairment (CRCI) is commonly reported following the administration of cancer treatment. Current longitudinal studies, primarily in women with breast cancer, suggest that up to 35% to 60% of patients exhibit persistent CRCI (pCRCI) following completion of chemotherapy. Complaints of subjective cognitive decline (SCD) are also commonly reported by women during and following the menopause transition in noncancer patients. Although the majority of evidence for cognitive difficulties in cancer patients and survivors is attributed to chemotherapy, there is growing evidence to suggest that menopausal status can also influence cognitive function in cancer patients. Methods Given that menopausal status may be contributing to pCRCI, we compared a group of primarily postmenopausal women with pCRCI to 2 groups of postmenopausal women: women who endorse menopause‐associated SCD (maSCD+) and women who do not (maSCD−) to explore the similarities/differences between maSCD and pCRCI and the potential role of menopause in pCRCI. Results Persistent CRCI participants report more severe SCD symptoms than women after natural menopause, despite being on average 2.5‐year postchemotherapy, supporting previous findings that CRCI can persist for months to years after completing treatment. Persistent CRCI participants not only endorsed greater SCD but also exhibited objective performance differences. In addition, pCRCI participants endorsed significantly greater menopausal symptoms compared with either maSCD group. Results were not related to menopausal status prior to chemotherapy or current endocrine therapy use. Conclusions These results suggest that while menopausal symptoms may contribute to SCD experienced by cancer patients after chemotherapy, they do not fully account for pCRCI. - Psycho-Oncology, Volume 27, Issue 9, Page 2198-2205, September 2018.
    July 13, 2018   doi: 10.1002/pon.4796   open full text
  • Self‐expression and identity after total laryngectomy: Implications for support.
    Jane M. Bickford, John Coveney, Janet Baker, Deborah Hersh.
    Psycho-Oncology. July 12, 2018
    --- - |2+ Abstract Objective To explore how individuals with a laryngectomy (IWL) from diverse backgrounds make meaning and adjust to the physical and functional changes from a total laryngectomy. To examine the extent primary supporters (PS) and health professionals (HP) are able to support IWL with the psychosocial and existential challenges rendered by a surgery that significantly impacts a person's talking, breathing, swallowing, and appearance. Methods A constructivist grounded theory approach and symbolic interactionism were used to guide data collection and analysis. Semi‐structured interviewing occurred. Results Twenty‐eight participants (12 IWL, 9 PS, and 7 HP) were interviewed. The findings suggest that IWL experience significant change to their self‐identity and there is evidence of a range of passive and active reframing patterns (destabilised, resigned, resolute, and transformed). The loss of self‐expression included changes to communicative participation, personal style, food preferences, and social roles. Short and longer‐term supports appear to influence outcomes but are often ill‐equipped to manage the psychosocial needs of IWL. Conclusions Loss of self‐expression after total laryngectomy influences self‐identity and adjustment. How individuals reframe their identity appears to be tied with how they view their disabilities and disfigurement. These perceptions also appear to be influenced by the reactions of others and the support available. Further resourcing, education, and training are needed so that PS and HP can provide holistic care. - Psycho-Oncology, EarlyView.
    July 12, 2018   doi: 10.1002/pon.4818   open full text
  • School performance of childhood cancer survivors in Korea: A multi‐institutional study on behalf of the Korean Society of Pediatric Hematology and Oncology.
    Meerim Park, Hyeon Jin Park, Jae Min Lee, Hee Young Ju, Byung Kiu Park, Eun‐Seung Yu, Hyung‐Kook Yang, Ji Yoon Kim, Sang Kyu Park, Young Ho Lee, Ye Jee Shim, Heung Sik Kim, Jun Ah Lee, Yeon‐Jung Lim, Hee Won Cheuh, Ji Kyoung Park, Mee Jeong Lee, Soon Ki Kim, Hyoung Soo Choi, Jeong Ok Hah, Kyung Duk Park, Hyoung Jin Kang, Hee Young Shin.
    Psycho-Oncology. July 12, 2018
    --- - |2+ Abstract Objective To investigate school performance of childhood cancer survivors focusing on the child's functioning, including peer relationships, school attendance, and academic achievement. Methods We studied 241 children from 15 institutions in Korea between 2015 and 2016. The self‐reported paper‐and‐pencil questionnaires were used. Results Approximately 22% of the survivors suffered from lack of friends. Bullying was reported by 30% of survivors. Survivors who returned to primary school reported a higher incidence of bullying compared with survivors who returned to middle or high school (P = 0.03). The percentage of children who missed classes more than 4 days in a month was higher in survivors with brain tumors than those with other tumors (P = 0.04). Approximately 41% of children reported learning difficulty. After returning to school, 53% of the patients reported that they had lower overall mark averages than they had before. Patients who returned to high school showed the highest rate of repeating a grade and the lowest rate of achieving high academic marks. The school marks in the Korean (P = 0.03), English (P = 0.04), and physical education (P = 0.04) were worse for the children with brain tumors than for the children with other tumors. Conclusion We found that 20% to 25% of survivors experienced peer‐related difficulties upon returning to school. Patients who return to school, especially high school, should be provided more educational support to overcome low academic achievement. Particular concern is needed to the patients with brain tumors, who are at risk for significant academic and social difficulties and therefore may require more intensive support in school. - Psycho-Oncology, Volume 27, Issue 9, Page 2257-2264, September 2018.
    July 12, 2018   doi: 10.1002/pon.4819   open full text
  • Examining the role of social support and spirituality on the general health perceptions of Hispanic cancer survivors.
    Carol Y. Ochoa, Regine Haardörfer, Cam Escoffery, Kevin Stein, Kassandra I. Alcaraz.
    Psycho-Oncology. July 12, 2018
    --- - |2+ Abstract Objective Although cancer survival rates continue to improve, overall disparities persist for ethnic minority survivors, who have a disproportionately high risk of experiencing poor quality of life, despite documented higher levels of self‐reported spirituality. Yet little is known about the relationship between spirituality and social support and health outcomes among Hispanic survivors. This study examined (1) differences between Hispanic and non‐Hispanic white survivors on health, social support, and spirituality and (2) the potential mediating roles of mental health and emotional distress on general health perceptions. Methods We analyzed data (N = 7778) from the American Cancer Society's Study of Cancer Survivors‐II, a national cross‐sectional study of adult cancer survivors. Preliminary analysis compared sociodemographic and medical characteristics between the 2 groups to identify significant covariates. Structural equation modeling assessed whether mental health and emotional distress mediate the impact of social support and spirituality on Hispanics' general health perceptions. Results Overall, 693 survivors were Hispanic and 7085 were non‐Hispanic whites. Hispanics reported poorer health and were more likely to have comorbid conditions such as diabetes and depression compared with non‐Hispanic whites. Structural equation modeling indicated that the impact of spirituality on general health perceptions was fully mediated through mental health. Emotional distress did not have a direct effect on general health perceptions nor did it mediate effects of spirituality and social support and on general health perceptions. There was a mediated effect of social support on general health perceptions. Conclusions Spirituality is an important factor in the health of Hispanic survivors. Future studies should explore the impact and effectiveness of spiritual interventions and the beneficial effect for mental health on general health perceptions. - Psycho-Oncology, Volume 27, Issue 9, Page 2189-2197, September 2018.
    July 12, 2018   doi: 10.1002/pon.4795   open full text
  • Suicide rates among patients with cancers of the digestive system.
    Chelsea Anderson, Eliza M. Park, Donald L. Rosenstein, Hazel B. Nichols.
    Psycho-Oncology. July 12, 2018
    --- - |2+ Abstract Objective Previous studies have suggested that suicide rates are elevated among cancer patients relative to the general population. In this analysis, we comprehensively evaluated characteristics associated with higher suicide rates among patients with cancers of the digestive system. Methods Using the United States Surveillance, Epidemiology, and End Results database, we identified all patients diagnosed with digestive system cancers during 2000 to 2014. Patients were classified as having died of suicide if their cause of death in Surveillance, Epidemiology, and End Results was listed as “suicide and self‐inflicted injury.” Suicide rates were compared to age‐, sex‐, and race‐adjusted rates in the general population. Results A total of 881 suicides were identified among 856 293 patients diagnosed with digestive system cancers. The suicide rate in this population was 32.8 per 100 000 person‐years and was nearly twice that in the general population (standardized mortality ratio [SMR] = 1.91; 95% CI, 1.79‐2.04). Suicide rates were significantly elevated for all cancer sites but were highest for esophageal (SMR = 5.03), pancreatic (SMR = 5.28), stomach (SMR = 2.84), and liver (SMR = 2.14) cancers. Standardized mortality ratios for suicide were highest within the first 5 years of diagnosis and increased with age at diagnosis for all sites except colon and stomach. Conclusions Patients with cancers of the digestive system have a higher incidence of suicide than the general population. Suicide rates among esophageal and pancreatic cancer patients are more than 5 times general population rates. The involvement of psychiatrists and other mental health professionals may be a critical component of cancer care for these high‐risk patient subgroups. - Psycho-Oncology, Volume 27, Issue 9, Page 2274-2280, September 2018.
    July 12, 2018   doi: 10.1002/pon.4827   open full text
  • Work‐specific cognitive symptoms and the role of work characteristics, fatigue, and depressive symptoms in cancer patients during 18 months post return to work.
    H.F. Dorland, F.I. Abma, C.A.M. Roelen, R.E. Stewart, B.C. Amick, U. Bültmann, A.V. Ranchor.
    Psycho-Oncology. July 12, 2018
    --- - |2+ Abstract Objective Cancer patients can experience work‐specific cognitive symptoms post return to work. The study aims to (1) describe the course of work‐specific cognitive symptoms in the first 18 months post return to work and (2) examine the associations of work characteristics, fatigue and depressive symptoms with work‐specific cognitive symptoms over time. Methods This study used data from the 18‐month longitudinal “Work Life after Cancer” cohort. The Cognitive Symptom Checklist‐Work Dutch Version (CSC‐W DV) was used to measure work‐specific cognitive symptoms. Linear mixed models were performed to examine the course of work‐specific cognitive symptoms during 18‐month follow‐up; linear regression analyses with generalized estimating equations were used to examine associations over time. Results Working cancer patients examined with different cancer types were included (n = 378). Work‐specific cognitive symptoms were stable over 18 months. At baseline, cancer patients reported more working memory symptoms (M = 32.0; CI, 30.0‐34.0) compared with executive function symptoms (M = 19.3; CI, 17.6‐20.9). Cancer patients holding a job with both manual and nonmanual tasks reported less work‐specific cognitive symptoms (unstandardized regression coefficient b = −4.80; CI, −7.76 to −1.83) over time, compared with cancer patients with a nonmanual job. Over time, higher depressive symptoms were related to experiencing more overall work‐specific cognitive symptoms (b = 1.27; CI, 1.00‐1.55) and a higher fatigue score was related to more working memory symptoms (b = 0.13; CI, 0.04‐0.23). Conclusions Job type should be considered when looking at work‐specific cognitive symptoms over time in working cancer patients. To reduce work‐specific cognitive symptoms, interventions targeted at fatigue and depressive symptoms might be promising. - Psycho-Oncology, Volume 27, Issue 9, Page 2229-2236, September 2018.
    July 12, 2018   doi: 10.1002/pon.4800   open full text
  • Culturally and linguistically diverse oncology patients' perspectives of consultation audio‐recordings and question prompt lists.
    Amelia Hyatt, Ruby Lipson‐Smith, Karla Gough, Phyllis Butow, Michael Jefford, Thomas F. Hack, Sandra Hale, Emiliano Zucchi, Shane White, Uldis Ozolins, Penelope Schofield.
    Psycho-Oncology. July 12, 2018
    --- - |2+ Abstract Objective Ethnicity and migrant status result in disparities with cancer burden and survival, with communication difficulties cited as the main barrier to access. Our research team tested a communication intervention package comprising consultation audio‐recordings (ARs) and question prompt lists (QPLs) for low English‐speaking (LES) patients with cancer. This study explored LES patient experiences, preferences, and recommendations regarding the communication package. Methods Participants completed a questionnaire and qualitative interview regarding ARs and QPLs. Eligibility criteria comprised aged ≥18 years old; a consultation with an oncologist between June 1, 2015 and April 1, 2016; an Arabic, Cantonese, Greek, or Mandarin professional interpreter booked for that consultation; and randomised to receive the communication intervention. Results Eighteen patients completed the qualitative interview and 17 completed the questionnaire. Fifteen reported listening to the AR at least once. Participants reported that QPLs and ARs provide support and assistance with remembering and understanding medical information. Both resources were seen as having applicability beyond the oncology setting in regards to improving health service delivery and continuity of care. However, patients felt that individual tailoring of the resources should be considered. Patients also found it useful to share ARs with family. Conclusions The LES participants in this study considered the ARs and QPLs useful for most, but not all contexts. Recommendations regarding delivery and use highlight that these resources should be tailored and patient‐driven. Further, patients foresaw a range of additional uses for consultation ARs within the broader healthcare context. - Psycho-Oncology, Volume 27, Issue 9, Page 2180-2188, September 2018.
    July 12, 2018   doi: 10.1002/pon.4789   open full text
  • An investigation of the relationship between social support and coping with stress in women with breast cancer.
    Deniz Ozdemir, Fatma Tas Arslan.
    Psycho-Oncology. July 11, 2018
    --- - |2+ Abstract Objectives Social support may play a role in effective stress management and make a positive contribution to the health of women with breast cancer. The aim of this study was to determine the ways of coping with stress and levels of perceived social support of women with breast cancer, as well as the associated factors. Methods The descriptive and cross‐sectional study was conducted with 100 women with breast cancer at a training and research hospital in Turkey. Data were collected using an information form including sociodemographic and disease characteristics, the Scale of Ways of Coping with Stress, and the Multidimensional Scale of Perceived Social Support. Results Effective ways of coping with stress were found to be significantly lower in women who were primary school graduates and who did not undergo surgery (P < .05). The women's levels of effective coping with stress decreased with increasing age, and as the score of perceived social support from family and total score of perceived social support increased, so did the levels of effective coping with stress (P < .05). It was determined that social support and age significantly predicted effective stress management (P < .05). Conclusions Social support given to women with breast cancer is a key reference point in effective stress management, and increased age also has an important effect on women's ability to cope with stress. - Psycho-Oncology, Volume 27, Issue 9, Page 2214-2219, September 2018.
    July 11, 2018   doi: 10.1002/pon.4798   open full text
  • Health‐related quality of life and psychological distress among cancer survivors in a middle‐income country.
    Shridevi Subramaniam, Yek‐Ching Kong, Karuthan Chinna, Merel Kimman, Yan‐Zheng Ho, Nadiah Saat, Rozita Abdul Malik, Nur Aishah Taib, Matin Mellor Abdullah, Gerard Chin‐Chye Lim, Nor‐Saleha Ibrahim Tamin, Yin‐Ling Woo, Kian‐Meng Chang, Pik‐Pin Goh, Cheng‐Har Yip, Nirmala Bhoo‐Pathy.
    Psycho-Oncology. July 06, 2018
    --- - |2+ Abstract Objectives Quality of life and psychological well‐being are important patient‐centered outcomes, which are useful in evaluation of cancer care delivery. However, evidence from low‐income and middle‐income countries remains scarce. We assessed health‐related quality of life (HRQoL) and prevalence of psychological distress (anxiety or depression), as well as their predictors, among cancer survivors in a middle‐income setting. Methods Through the Association of Southeast Asian Nations Costs in Oncology study, 1490 newly diagnosed cancer patients were followed‐up in Malaysia for 1 year. Health‐related quality of life was assessed by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30) and EuroQol‐5 (EQ‐5D) dimension questionnaires at baseline, 3 and 12 months. Psychological distress was assessed by using Hospital Anxiety and Depression Scale. Data were modeled by using general linear and logistic regressions analyses. Results One year after diagnosis, the mean EORTC QLQ‐C30 Global Health score of the cancer survivors remained low at 53.0 over 100 (SD 21.4). Fifty‐four percent of survivors reported at least moderate levels of anxiety, while 27% had at least moderate levels of depression. Late stage at diagnosis was the strongest predictor of low HRQoL. Increasing age, being married, high‐income status, hospital type, presence of comorbidities, and chemotherapy administration were also associated with worse HRQoL. The significant predictors of psychological distress were cancer stage and hospital type. Conclusion Cancer survivors in this middle‐income setting have persistently impaired HRQoL and high levels of psychological distress. Development of a holistic cancer survivorship program addressing wider aspects of well‐being is urgently needed in our settings. - Psycho-Oncology, Volume 27, Issue 9, Page 2172-2179, September 2018.
    July 06, 2018   doi: 10.1002/pon.4787   open full text
  • The risk factors for depression in Lithuanian breast cancer patients.
    Jurgita Kazlauskiene, Auguste Kaceniene, Giedre Smailyte, Kestutis Zagminas, Alvydas Navickas, Giedre Bulotiene.
    Psycho-Oncology. July 03, 2018
    --- - - Psycho-Oncology, Volume 27, Issue 10, Page 2508-2510, October 2018.
    July 03, 2018   doi: 10.1002/pon.4820   open full text
  • Help‐seeking behaviour in newly diagnosed lung cancer patients: Assessing the role of perceived stigma.
    Shiho Rose, Allison Boyes, Brian Kelly, Martine Cox, Kerrin Palazzi, Christine Paul.
    Psycho-Oncology. July 03, 2018
    --- - |2+ Abstract Objective This study explored help‐seeking behaviours, group identification, and perceived legitimacy of discrimination, and its potential relationship with perceived lung cancer stigma. Methods Consecutive consenting adults (n = 274) with a primary diagnosis of lung cancer within the previous 4 months were recruited at 31 outpatient clinics in Australia. A self‐report survey assessed help‐seeking, group identification, perceived legitimacy of discrimination, and perceived lung cancer stigma. Results Services providing assistance from health professionals (69.5%) and informational support (68.5%) were more frequently used than emotional‐based support. Only a small proportion (2.6%) of participants were unlikely to seek help from anyone, with the most popular sources of help being the general practitioner (91.0%), and oncologist/treating clinician (81.3%). One‐fifth (21.1%) indicated they identified with being a lung cancer patient, and most did not perceive discrimination against lung cancer patients. Higher perceived lung cancer stigma was significantly associated with greater perceived legitimacy of discrimination (P < 0.001), but not help‐seeking behaviours or group identification. Conclusions The relationship between lung cancer stigma and perceived legitimacy of discrimination may guide initiatives to reduce stigma for patients. It is encouraging that perceived stigma did not appear to inhibit help‐seeking behaviours. However, further research in this emerging field is needed to investigate patterns of perceived stigma and help‐seeking over time to identify how and when to offer support services most appropriate to the needs of lung cancer patients. - Psycho-Oncology, Volume 27, Issue 9, Page 2141-2147, September 2018.
    July 03, 2018   doi: 10.1002/pon.4779   open full text
  • Differences in health care professionals' and cancer patients' views on sexual health issues.
    Elfriede Greimel, Anne Lanceley, Anne Oberguggenberger, Andy Nordin, Karin Kuljanic, Claudia Schmalz, Juan I. Arraras, Weichu Chie, Pernille T. Jensen, Krzysztof A. Tomaszewski, Carien L. Creutzberg, Razvan Galalae, Hilde Toelen, Elisabeth C. Inwald, Vesna Bjelic‐Radisic, on behalf of the EORTC Quality of Life Group.
    Psycho-Oncology. July 03, 2018
    --- - - Psycho-Oncology, Volume 27, Issue 9, Page 2299-2302, September 2018.
    July 03, 2018   doi: 10.1002/pon.4814   open full text
  • The lived experience of head and neck cancer patients receiving curative radiotherapy: A systematic review and meta‐ethnography.
    Russell C. Fitchett, Edward J. Aldus, Lucy R. Fitchett, Jane Cross.
    Psycho-Oncology. June 29, 2018
    --- - |2+ Abstract Objective This review aims to explore, appraise, and synthesise the existing evidence of the meaning that head and neck cancer (HNC) patients assign to the experience of receiving curative radiotherapy. Methods Qualitative evidence synthesis was undertaken using meta‐ethnography. Published literature was identified using 7 databases: AMED, ASSIA, CINAHL, EMBASE, MEDLINE, PubMed, and PsycINFO. Databases were searched from January 2005 to April 2017. The strategy was supplemented by grey literature and citation searches. Results Out of 1403 titles, 57 abstracts and 35 full texts were screened. Ultimately, 8 studies were eligible for inclusion. The evidence base was moderate to strong in quality. Most of the studies showed that HNC patients undergoing radiotherapy have unmet needs. Four related concepts were identified: the disruption to life that the disease and radiotherapy treatment cause, patients' feelings of isolation, the need for patients to make sense of their situation, and the waiting and uncertainty that radiotherapy creates. Conclusions The current literature suggests that both HNC and radiotherapy cause disruption in patients' lives. Radiotherapy causes many unpleasant side effects, and in this difficult treatment period, HNC patients feel isolated, uncertain, and in need of coping strategies. Therapeutic radiographers are ideally placed to offer a supportive relationship. By having a deeper understanding of patients' lived experience, radiographers may form stronger relationships and more effectively help patients through their radiotherapy. - Psycho-Oncology, Volume 27, Issue 9, Page 2077-2086, September 2018.
    June 29, 2018   doi: 10.1002/pon.4790   open full text
  • Quality of life and psychological distress are differentially associated with distinct symptom‐functional states in terminally ill cancer patients' last year of life.
    Fur‐Hsing Wen, Jen‐Shi Chen, Wen‐Chi Chou, Chia‐Hsun Hsieh, Wen‐Cheng Chang, Wen Chi Shen, Siew Tzuh Tang.
    Psycho-Oncology. June 29, 2018
    --- - |2+ Abstract Objective Quality of life (QOL) and psychological distress at end of life (EOL) heavily depend on symptom distress and functional impairment, which may not deteriorate synchronously at EOL. Methods Using multivariate hierarchical linear modeling, we simultaneously evaluated the differential association of 5 previously identified, worsening conjoint symptom‐functional states with QOL, anxiety symptoms, and depressive symptoms over 317 terminally ill cancer patients' last year of life. Quality of life, anxiety symptoms, and depressive symptoms were measured by the McGill Quality of Life Questionnaire and the Hospital Anxiety and Depression Scale, respectively. Results Quality of life, anxiety symptoms, and depressive symptoms deteriorated significantly more for patients in the 4 worst symptom‐functional states (states 2‐5) than in the best state (state 1). Quality of life did not differ significantly among patients in states 2 to 5. However, patients in state 4 had significantly lower anxiety‐symptom levels than patients in states 2, 3, and 5, whose anxiety‐symptom levels did not differ significantly. In contrast, depressive‐symptom levels differed significantly between participants in any 2 of the worst symptom‐functional states, except between participants in states 3 and 5 as well as between those in states 2 and 4. Conclusion The 5 distinct symptom‐functional states contributed to worsening QOL, anxiety symptoms, and depressive symptoms, but each was negatively and uniquely associated with psychological well‐being in terminally ill cancer patients' last year of life. Clinical Implications The psychological well‐being and QOL of high‐risk patients in states 3 and 5 may be improved at EOL by targeting them with appropriate symptom management interventions and facilitating their functioning. - Psycho-Oncology, Volume 27, Issue 9, Page 2111-2118, September 2018.
    June 29, 2018   doi: 10.1002/pon.4775   open full text
  • Preferences for models of peer support in the digital era: A cross‐sectional survey of people with cancer.
    Allison Boyes, Heidi Turon, Alix Hall, Rochelle Watson, Anthony Proietto, Robert Sanson‐Fisher.
    Psycho-Oncology. June 29, 2018
    --- - |2+ Abstract Objective Many people with cancer report an unmet need for peer support, yet participation rates are low. This study examined cancer patients' preferences for participating in peer support, and the characteristics associated with having or wanting to participate in peer support. Methods Adult cancer patients were recruited from outpatient oncology clinics at 5 hospitals in Australia. Participants were invited to self‐complete 2 questionnaires: one at recruitment assessing their demographic and cancer characteristics, and another 4 weeks later assessing their preferences for participating in cancer‐related peer support. Results The peer support questionnaire was completed by 177/273 (65%) of participants. Most (59%, n = 104) had or wanted to participate in peer support. More than half reported that it was important the people they connected with had the same cancer treatment (56%, n = 99) or type of cancer (53%, n = 94) as themselves. Half had or wanted to participate in 1‐to‐1 peer support (52%, n = 92). Half had or wanted to connect with peers face‐to‐face (53%, n = 93). Only 13% (n = 23) were receptive to connecting with peers over the internet. Being aged ≤65 years was significantly associated (OR = 2.3; 95% CI: 1.1‐5.1) with reporting a preference for participating in peer support. Conclusions Cancer patients are interested in participating in peer support, particularly those who are younger. Despite the digital era, traditional forms of peer support continue to be important in supporting people with cancer. Greater understanding of the barriers to cancer patients' involvement in potentially low cost and high reach web‐based models of peer support is required. - Psycho-Oncology, Volume 27, Issue 9, Page 2148-2154, September 2018.
    June 29, 2018   doi: 10.1002/pon.4781   open full text
  • Recruitment problems in psychosocial oncology research.
    Jacques J.D.M. Lankveld, Joke Fleer, Maya J. Schroevers, Robbert Sanderman, Brenda L. Oudsten, Joost Dekker.
    Psycho-Oncology. June 29, 2018
    --- - - Psycho-Oncology, Volume 27, Issue 9, Page 2296-2298, September 2018.
    June 29, 2018   doi: 10.1002/pon.4792   open full text
  • Fear of cancer recurrence and death anxiety.
    L. Sharpe, L. Curran, P. Butow, B. Thewes.
    Psycho-Oncology. June 21, 2018
    --- - |2 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. - Psycho-Oncology, EarlyView.
    June 21, 2018   doi: 10.1002/pon.4783   open full text
  • Financial hardship associated with colorectal cancer survivorship: The role of asset depletion and debt accumulation.
    Paul Hanly, Rebecca Maguire, Alan O Ceilleachair, Linda Sharp.
    Psycho-Oncology. June 21, 2018
    --- - |2+ Abstract Objective To estimate the prevalence of financial objective stress and subjective strain among colorectal cancer survivors and assess associated financial coping factors in Ireland, which has a mixed public‐private health care system. Methods Colorectal cancer survivors were identified from the National Cancer Registry, and a sample of 496 respondents were included in the analysis. A postal survey collected information on survivor demographics, socio‐economic background, medical characteristics, cancer‐related financial hardship, debt accumulation, and asset depletion. Cancer‐related financial objective stress and subjective strain were used as dependent variables in logistic regression analysis. Results Approximately 2 in 5 survivors experienced objective stress (40.9%) or subjective strain (39.4%). Depletion of savings (49.1%) was the most prevalent form of financial coping strategy. Factors significantly associated with increased objective stress were having a stoma (OR = 2.1; 95% CI, 1.1‐3.9), using savings (OR = 9.4; 95% CI, 4.9‐18.0), formally borrowing money (OR = 3.1; 95% CI, 1.0‐9.6), and loans from family members/friends (OR = 3.8; 95% CI, 1.9‐7.8). Not working (excluding retirees) (OR = 0.44; 95% CI, 0.20‐0.96) was associated with decreased objective stress. Significant predictors of subjective strain included having dependents, a stoma, using savings (OR = 5.3; 95% CI, 2.9‐9.5), and loans from family members/friends (OR = 2.0; 95% CI, 1.1‐3.9) but excluded borrowing money. Conclusions Cancer‐related financial objective stress and subjective strain are common in colorectal cancer survivors, even where all citizens are entitled to publicly funded care, but the financial coping strategies significantly associated with these 2 measures differed. These findings will help inform targeted measures across disparate health care systems and survivor groups to alleviate financial hardship. - Psycho-Oncology, Volume 27, Issue 9, Page 2165-2171, September 2018.
    June 21, 2018   doi: 10.1002/pon.4786   open full text
  • The relationship between cancer‐related worry and posttraumatic growth in adolescent and young adult cancer survivors.
    Glynnis A. McDonnell, Alice W. Pope, Tammy A. Schuler, Jennifer S. Ford.
    Psycho-Oncology. June 21, 2018
    --- - |2+ Abstract Objectives To examine cancer‐related worry in adolescent and young adult (AYA) cancer survivors and its relationship with posttraumatic growth over time, as the relationship between these constructs has not been assessed longitudinally in this population. Methods A total of 153 AYA cancer survivors completed measures of cancer‐related worry and posttraumatic growth 3 times across approximately 1 year. Descriptive statistics were calculated for cancer‐related worry items, and mixed‐effects modeling assessed the relationship between cancer‐related worry and posttraumatic growth. Results Most participants reported at least moderate cancer‐related worry in at least 1 area at each assessment (88.2‐93.9% across time points). Worry about future health was the most prevalent concern (65.4%‐83.7% across time points). Cancer‐related worry was positively related to posttraumatic growth in the mixed‐effects model. However, post hoc analyses indicated that cancer‐related worry and posttraumatic growth were modestly related; there was no evidence that either construct predicted the other over time. Conclusions Cancer‐related worry appears to be a common psychosocial outcome in AYA cancer survivors. However, cancer‐related worry appears to be only modestly related to the development of posttraumatic growth, implying that these may be independent constructs despite theoretical literature suggesting that posttraumatic growth may stem from posttraumatic distress. Thus, it is necessary to assess AYA survivors for cancer‐related worry and posttraumatic growth, and develop interventions to target cancer‐related worry and foster posttraumatic growth. - Psycho-Oncology, Volume 27, Issue 9, Page 2155-2164, September 2018.
    June 21, 2018   doi: 10.1002/pon.4785   open full text
  • Course and predictors of supportive care needs among Mexican breast cancer patients: A longitudinal study.
    Adriana Pérez‐Fortis, Joke Fleer, Maya J. Schroevers, Patricia Alanís López, Juan José Sánchez Sosa, Christine Eulenburg, Adelita V. Ranchor.
    Psycho-Oncology. June 19, 2018
    --- - |2+ Abstract Objective This study examined the course and predictors of supportive care needs among Mexican breast cancer patients for different cancer treatment trajectories. Methods Data from 172 (66.4% response rate) patients were considered in this observational longitudinal study. Participants were measured after diagnosis, neoadjuvant treatment, surgery, adjuvant treatment, and the first post‐treatment follow‐up visit. Psychological, Health System and Information, Physical and Daily Living, Patient Care and Support, Sexual, and Additional care needs were measured with the Supportive Care Needs Survey (SCNS‐SF34). Linear mixed models with maximum‐likelihood estimation were computed. Results The course of supportive care needs was similar across the different cancer treatment trajectories. Supportive care needs declined significantly from diagnosis to the first post‐treatment follow‐up visit. Health System and Information care needs were the highest needs over time. Depressive symptoms and time since diagnosis were the most consistent predictors of changes in course of supportive care needs of these patients. Conclusions Health system and information care needs of Mexican breast cancer patients need to be addressed with priority because these needs are the least met. Furthermore, patients with high depressive symptoms at the start of the disease trajectory have greater needs for supportive care throughout the disease trajectory. - Psycho-Oncology, Volume 27, Issue 9, Page 2132-2140, September 2018.
    June 19, 2018   doi: 10.1002/pon.4778   open full text
  • A forbidden topic at the end of life: “What about you after I'm gone?”.
    Michiko Iwasaki, Michael S. Di Bianca, Donald R. Nicholas.
    Psycho-Oncology. June 14, 2018
    --- - - Psycho-Oncology, EarlyView.
    June 14, 2018   doi: 10.1002/pon.4772   open full text
  • Re‐validation and screening capacity of the 6‐item version of the Cancer Worry Scale.
    José A.E. Custers, Linda Kwakkenbos, Marieke Wal, Judith B. Prins, Belinda Thewes.
    Psycho-Oncology. June 14, 2018
    --- - |2+ Abstract Objective Fear of cancer recurrence (FCR) is one of the major existential unmet needs of cancer survivors. Due to growing availability of evidenced‐based interventions for high FCR, valid and reliable brief measures of FCR are needed. This study aimed to validate the 6‐item Cancer Worry Scale (CWS) and to establish a cut‐off score for high FCR. Methods Participants in this study were 1033 cancer survivors and patients recruited as part of 5 existing studies on FCR involving patients and survivors with gastro‐intestinal stromal tumors, colorectal, breast, and prostate cancer. De‐identified data of the CWS, Fear of Cancer Recurrence Inventory (FCRI), Impact of Event Scale, Hospital Anxiety and Depression Scale, and EORTC‐QLQ‐C30 were amalgamated for the analyses. Confirmatory factor analysis of the CWS was performed. Sensitivity and specificity were tested with the FCRI as gold standard. Results Results confirmed that the 6‐item version of the CWS maintained good construct validity, convergent and divergent validity, and high internal consistency (α 0.90). The optimal cut‐off for the 6‐item CWS was 9 versus 10 using the 12 vs 13 FCRI‐SF score (sensitivity 82%, specificity 83%) and the 15 vs 16 FCRI‐SF score (sensitivity 88%, specificity 73%). Using the highest FCRI‐SF cut‐off (21 vs 22), the optimal CWS cut‐off was 11 vs 12 (sensitivity 88%, specificity 81%). Conclusions The present results provide researchers and clinicians with a brief valid and reliable measure of FCR which is suitable for measuring FCR in cancer patients and survivors. - Psycho-Oncology, EarlyView.
    June 14, 2018   doi: 10.1002/pon.4782   open full text
  • “Spirituality” hardly facilitates our understanding of existential distress—But “everyday life” might.
    Pär Salander.
    Psycho-Oncology. June 14, 2018
    --- - - Psycho-Oncology, EarlyView.
    June 14, 2018   doi: 10.1002/pon.4784   open full text
  • Associations between the smoking‐relatedness of a cancer type, cessation attitudes and beliefs, and future abstinence among recent quitters.
    Úrsula Martínez, Thomas H. Brandon, Steven K. Sutton, Vani N. Simmons.
    Psycho-Oncology. June 14, 2018
    --- - |2+ Abstract Objective Smoking after a diagnosis of cancer can negatively impact treatment outcomes and quality of life. It is important that patients quit smoking and remain abstinent regardless of cancer type. Some cancer types (eg, lung) have stronger links to smoking as a cause than do others (eg, colorectal). The aims of this study were to (1) assess associations between smoking‐relatedness of the cancer type with beliefs and attitudes concerning smoking abstinence (eg, confidence, self‐efficacy), and (2) assess these variables as predictors of future abstinence. Methods In this secondary analysis, cancer patients (N = 357) who quit smoking within the previous 90 days were assigned a code of 3, 2, or 1 according to the cancer type's level of smoking‐relatedness: Very related (n = 134, thoracic and head and neck), Somewhat related (n = 93, acute myeloid leukemia, bladder, cervix, colorectal, esophageal, kidney, liver, pancreas, and stomach), and Unlikely related (n = 137, all other cancer types). Results Smoking‐relatedness was positively associated with plan to stay smoke‐free, maximum confidence in being smoke‐free in 6 months, higher abstinence self‐efficacy, and lower expected difficulty in staying smoke‐free. Each of the 4 beliefs and attitude variables predicted abstinence 2 months later. Smoking‐relatedness also predicted abstinence in a univariate model, but not in a multivariable model with the belief and attitude variables. Using backwards stepwise procedures, the final model included plan to stay smoke‐free, confidence in being smoke‐free, and abstinence self‐efficacy. Conclusion These results are consistent with our conceptualization of cessation motivation differing by smoking‐relatedness of the cancer type and predicting future abstinence. - Psycho-Oncology, Volume 27, Issue 9, Page 2104-2110, September 2018.
    June 14, 2018   doi: 10.1002/pon.4774   open full text
  • Predicting nonadherence to adjuvant endocrine therapy in women with early stage breast cancer.
    Arden L. Corter, Reuben Broom, David Porter, Vernon Harvey, Michael Findlay.
    Psycho-Oncology. June 14, 2018
    --- - |2+ Abstract Background Failing to take endocrine therapy (ET) as prescribed (nonadherence) increases risk of morbidity and mortality from breast cancer recurrence. We explored predictors of nonadherence, including demographic, clinical, treatment, and personal factors, among women newly prescribed ET for early stage breast cancer. We also examined predictors of their thoughts about stopping treatment (TST). Methods A baseline survey prior to ET assessed demographics, illness beliefs, beliefs about medicines, fear of recurrence, symptoms, and negative affect. A follow‐up survey at 3 months repeated these measures with additional questions about nonadherence and TST. Nonadherence and TST were analyzed using logistic and multiple regression, respectively. Patient record review provided clinical data. The baseline survey was completed by 125 women, with a 96% retention rate at follow‐up. Results Thirty‐six percent reported nonadherence, and 30% reported TST. Results of regression analyses showed that TST was most strongly associated with symptom severity at follow‐up, whereas, lower coherence beliefs, and the absence of comorbid conditions were the strongest predictors of actual nonadherence. Conclusion This is the first longitudinal study to examine concurrently the association of demographic, personal and treatment factors with nonadherence, and TST. Findings have potentially important clinical implications; interventions to improve adherence and reduce TST may need to target women's understanding of their diagnosis and treatment, illness beliefs, and symptoms prior to starting therapy. - Psycho-Oncology, Volume 27, Issue 9, Page 2096-2103, September 2018.
    June 14, 2018   doi: 10.1002/pon.4771   open full text
  • The effects of Self‐Book© art therapy on cancer‐related distress in female cancer patients during active treatment: A randomized controlled trial.
    Donna Radl, Maureen Vita, Nancy Gerber, Edward J. Gracely, Joke Bradt.
    Psycho-Oncology. June 10, 2018
    --- - |2+ Abstract Objective National attention on patients' cancer‐related emotional distress produced a need for evidence‐based, psychosocial interventions in oncology care. The purpose of this study was to evaluate the efficacy of Self‐Book© art therapy for emotional distress and psychological well‐being of female oncology patients during active oncology treatment. Methods Sixty consenting women with cancer were randomly assigned to either a 6‐session Self‐Book© art therapy program or standard care. A repeated measures randomized controlled trial design was employed. Data were collected by using the Distress Thermometer, Perceived Emotional Distress Inventory, Patient‐Reported Outcomes Measurement Information System Brief Psychological Well‐being test, and the Functional Assessment of Chronic Illness Therapy Spiritual Well‐being. Measurements were obtained at baseline, week 3, week 6, and 1 to 2 months post intervention. Results Forty participants were included in the final analysis. No significant differences between groups were found for the primary outcome measures: emotional distress and psychological well‐being. Greater improvements in Self‐Book© art therapy participants' spiritual well‐being were found compared with the standard care control participants (P = .02). Conclusions Although no statistically significant differences were present between the groups for the primary outcomes, several positive trends were noted. Thirty percent of Self‐Book© art therapy participants reported postintervention emotional distress scores that were below the abnormal range for emotional distress, compared with only 5% of standard care control participants, suggesting that Self‐Book© art therapy may have clinical value. Further studies are recommended to better understand the therapeutic mechanisms of Self‐Book© art therapy for enhancing psychological well‐being. - Psycho-Oncology, Volume 27, Issue 9, Page 2087-2095, September 2018.
    June 10, 2018   doi: 10.1002/pon.4758   open full text
  • Using generalized estimating equations and extensions in randomized trials with missing longitudinal patient reported outcome data.
    Melanie L. Bell, Nicholas J. Horton, Haryana M. Dhillon, Victoria J. Bray, Janette Vardy.
    Psycho-Oncology. June 08, 2018
    --- - |2+ Abstract Objective Patient reported outcomes (PROs) are important in oncology research; however, missing data can pose a threat to the validity of results. Psycho‐oncology researchers should be aware of the statistical options for handling missing data robustly. One rarely used set of methods, which includes extensions for handling missing data, is generalized estimating equations (GEEs). Our objective was to demonstrate use of GEEs to analyze PROs with missing data in randomized trials with assessments at fixed time points. Methods We introduce GEEs and show, with a worked example, how to use GEEs that account for missing data: inverse probability weighted GEEs and multiple imputation with GEE. We use data from an RCT evaluating a web‐based brain training for cancer survivors reporting cognitive symptoms after chemotherapy treatment. The primary outcome for this demonstration is the binary outcome of cognitive impairment. Several methods are used, and results are compared. Results We demonstrate that estimates can vary depending on the choice of analytical approach, with odds ratios for no cognitive impairment ranging from 2.04 to 5.74. While most of these estimates were statistically significant (P < 0.05), a few were not. Conclusions Researchers using PROs should use statistical methods that handle missing data in a way as to result in unbiased estimates. GEE extensions are analytic options for handling dropouts in longitudinal RCTs, particularly if the outcome is not continuous. - Psycho-Oncology, Volume 27, Issue 9, Page 2125-2131, September 2018.
    June 08, 2018   doi: 10.1002/pon.4777   open full text
  • Observers' response to facial disfigurement from head and neck cancer.
    Joowon Cho, Michelle Cororve Fingeret, Sheng‐Cheng Huang, Jun Liu, Gregory P. Reece, Mia K. Markey.
    Psycho-Oncology. June 08, 2018
    --- - |2+ Abstract Objective Our long‐term goal is to develop a normative feedback intervention to support head and neck cancer patients in forming realistic expectations about how other people in non‐social group settings will respond to their appearance. This study aimed to evaluate the relationship between observer ratings of facial disfigurement and observer ratings of emotional response when viewing photographs of faces of head and neck cancer patients. Methods Seventy‐five (75) observers rated their emotional response to each of 144 facial photographs of head and neck cancer patients using the Self‐Assessment‐Manikin and rated severity of facial disfigurement on a 9‐point scale. Body image investment of the observers was measured using the Appearance Schemas Inventory‐Revised. A standardized multiple regression model was used to assess the relationship between observer ratings of facial disfigurement and observer ratings of emotional response, taking into consideration the age and sex of the patient depicted in the stimulus photograph, as well as the age, sex, and body image investment of the observer. Results Observers who had a strong emotional response to a patient's facial photograph tended to rate the patient's facial disfigurement as more severe (standardized regression coefficient β = 0.328, P < 0.001). Sex and age of the observer had more influence on the rating of facial disfigurement than did the patient's demographic characteristics. Observers more invested in their own body image tended to rate the facial disfigurement as more severe. Conclusions This study lays the groundwork for a normative database of emotional response to facial disfigurement. - Psycho-Oncology, Volume 27, Issue 9, Page 2119-2124, September 2018.
    June 08, 2018   doi: 10.1002/pon.4776   open full text
  • Mind‐body interventions for fear of cancer recurrence: A systematic review and meta‐analysis.
    Daniel L. Hall, Christina M. Luberto, Lisa L. Philpotts, Rhayun Song, Elyse R. Park, Gloria Y. Yeh.
    Psycho-Oncology. June 06, 2018
    --- - |2+ 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. - Psycho-Oncology, EarlyView.
    June 06, 2018   doi: 10.1002/pon.4757   open full text
  • A developmental perspective on existential distress and adaptation to advanced disease.
    Chris Lo.
    Psycho-Oncology. June 06, 2018
    --- - - Psycho-Oncology, EarlyView.
    June 06, 2018   doi: 10.1002/pon.4767   open full text
  • Latent class analysis differentiation of adjustment disorder and demoralization, more severe depressive and anxiety disorders, and somatic symptoms in patients with cancer.
    I. Bobevski, D.W. Kissane, S. Vehling, D.P. McKenzie, H. Glaesmer, A. Mehnert.
    Psycho-Oncology. June 05, 2018
    --- - |2+ Abstract Objectives Demoralization as a form of existential distress involves poor coping, low morale, hopelessness, helplessness, and meaninglessness. In a secondary analysis of a cohort of German cancer patients, we aimed to explore latent class structure to assess the contribution that symptoms of demoralization make to anhedonic depression, anxiety, adjustment, and somatic disorders. Methods Measures of demoralization, depression, anxiety, physical symptoms, and functional impairment had been completed cross‐sectionally by 1527 patients with early or advanced cancer. Latent class analysis used maximum likelihood techniques to define the unobserved latent constructs that can be predicted as symptom clusters. Individual patients were assigned to the most probable class. Classes were compared on demographics, and logistic regression assessed the odds of individual items predicting each class. Results A 4‐class model provided the best fit. Class 1 (n = 829, 54.3%) was defined by the absence of distress; Classes 2 to 4 all carried functional impairment. Class 2 (n = 333, 21.8%) was differentiated by somatic symptoms (sleep, tiredness, and appetite); Class 3 (n = 163, 10.7%) by anhedonia, anxiety, and severe demoralization; and Class 4 (n = 202, 13.2%) by adjustment and moderate demoralization. Members of Class 3 were more likely to be younger, female, anhedonic, depressed, and anxious. In both Classes 3 and 4, functional impairment, physical symptom burden, and suicidal ideation were present. Conclusions In contrast with the severe symptom cluster carrying anhedonia, anxiety, and demoralization, the moderate symptom cluster was formed by patients with demoralization and impaired functioning, a clinical picture consistent with a unidimensional model of adjustment disorder. - Psycho-Oncology, EarlyView.
    June 05, 2018   doi: 10.1002/pon.4761   open full text
  • Cancer‐related suicide: A biopsychosocial‐existential approach to risk management.
    Alissa Banyasz, Sharla M. Wells‐Di Gregorio.
    Psycho-Oncology. June 05, 2018
    --- - - Psycho-Oncology, EarlyView.
    June 05, 2018   doi: 10.1002/pon.4768   open full text
  • A single‐session intervention (the Mini‐AFTERc) for fear of cancer recurrence: A feasibility study.
    J. Davidson, M. Malloch, G. Humphris.
    Psycho-Oncology. April 30, 2018
    --- - - Psycho-Oncology, EarlyView.
    April 30, 2018   doi: 10.1002/pon.4724   open full text
  • Trends in incidence and associated risk factors of suicide mortality among breast cancer patients.
    Apostolos Gaitanidis, Michail Alevizakos, Michail Pitiakoudis, Doreen Wiggins.
    Psycho-Oncology. October 21, 2017
    Objective Breast cancer patients are associated with an increased risk for committing suicide. The purpose of this study is to study the trends in the incidence of suicide mortality and identify pertinent risk factors among patients with breast cancer. Methods A retrospective examination of the Surveillance Epidemiology and End Results (SEER) database between years 1973 and 2013 was performed. Results Overall, 474,128 patients were identified of which 773 had committed suicide. There were no significant differences in the incidence of suicide mortality over the last three decades (1984‐1993: 0.14%, 1994‐2003: 0.16%, 2004‐2013: 0.17%, p=0.173). On logistic regression, younger age (<30 y: OR 6.34, 95% CI: 1.98‐20.33, p=0.002, 30‐49 y: OR 10.64, 95% CI: 7.97‐14.2, p<0.001, 50‐69 y: OR 4.7, 95% CI: 3.64‐6.07, p<0.001), male sex (OR 4.34, 95% CI: 2.57‐7.31, p<0.001), non‐white‐non‐black race (OR 1.39, 95% CI: 1.01‐1.91, p=0.046), marital status (single: OR 1.35, 95% CI: 1.04‐1.76, p=0.024, separated/divorced/widowed: OR 1.25, 95% CI: 1.01‐1.55, p=0.043), undergoing surgery (OR 2.13, 95% CI: 1.23‐3.67, p=0.007) and short time elapsed from diagnosis (1st year: OR 4.67, 95% CI: 3.39‐6.42, p<0.001, 2nd year: OR 2.35, 95% CI: 1.69‐3.27, p<0.001) were independent risk factors of suicide mortality. Conclusions There have been no identifiable improvements in preventing suicide mortality in the United States. Younger age, male sex, race, marital status and undergoing surgery are independent risk factors for committing suicide, especially in the first year after diagnosis.
    October 21, 2017   doi: 10.1002/pon.4570   open full text
  • Exploratory Study of Impact of Cancer‐Related Posttraumatic Stress Symptoms on Diabetes Self‐Management among Cancer Survivors.
    Janey James, Yael T. Harris, Ian M. Kronish, Juan P. Wisnivesky, Jenny J. Lin.
    Psycho-Oncology. October 21, 2017
    Objective Posttraumatic stress symptoms (PTSS) can be triggered by a diagnosis of a potentially life‐threatening illness such as cancer. Little is known about the impact of cancer‐related PTSS symptoms on self‐management behaviors for comorbid chronic medical conditions such as diabetes mellitus (DM). Methods We recruited patients with DM and a recent diagnosis of early‐stage cancer from two medical centers in New York City. Cancer‐related PTSS were assessed using the Impact of Events scale (IES, score ≥26). DM self‐management behaviors (medication adherence, exercise, healthy diet, and glucose testing) were measured 3 months later. Logistic regression was used to assess the association between cancer‐related PTSS symptoms and DM self‐management behaviors, adjusting for gender, marital status, and anxiety symptoms. Results Of 56 participants recruited, 33% reported cancer‐related PTSS symptoms. Elevated cancer‐related PTSS symptoms were associated with lack of healthy diet (Odds Ratio [OR]: 0.08, 95% confidence interval [CI]: 0.01‐0.62). Conclusions Early‐stage cancer survivors with cancer‐related PTSS symptoms were less likely to adhere to some DM self‐management behaviors. Providers should recognize the impact of cancer‐related PTSS symptoms to better support comorbid disease management in cancer survivors.
    October 21, 2017   doi: 10.1002/pon.4568   open full text
  • Cognition, quality‐of‐life and symptom clusters in breast cancer: using Bayesian networks to elucidate complex relationships.
    Selene Xu, Wesley Thompson, Sonia Ancoli‐Israel, Lianqi Liu, Barton Palmer, Loki Natarajan.
    Psycho-Oncology. October 20, 2017
    Objective Breast cancer patients frequently complain of cognitive dysfunction during chemotherapy. Patients also report experiencing a cluster of sleep problems, fatigue and depressive symptoms during chemotherapy. We aimed to understand the complex dynamic interrelationships of depression, fatigue, and sleep to ultimately elucidate their role in cognitive performance and quality of life among breast cancer survivors undergoing chemotherapy treatment. Methods Our study sample comprised 74 newly diagnosed stage I‐III breast cancer patients scheduled to receive chemotherapy, and followed them for one year. An objective neuropsychological test battery and self‐reported fatigue, mood, sleep quality, and quality of life were collected at three time points: before the start of chemotherapy (baseline: BL), at the end of cycle 4 chemotherapy (C4) and one year after the start of chemotherapy (Y1). We applied novel Bayesian network methods to investigate the role of sleep/fatigue/mood on cognition and quality of life prior to, during, and after chemotherapy. Results The fitted network exhibited strong direct and indirect links between symptoms, cognitive performance and quality of life. The only symptom directly linked to cognitive performance was C4 sleep quality; at C4, fatigue was directly linked to sleep, and thus indirectly influenced cognitive performance. Mood strongly influenced concurrent quality of life at C4 and Y1. Regression estimates indicated that worse sleep quality, fatigue and mood were negatively associated with cognitive performance or quality of life. Conclusions The Bayesian network identified local structure (e.g., fatigue‐mood‐QoL or sleep‐cognition), and possible intervention targets (e.g., a sleep intervention to reduce cognitive complaints during chemotherapy).
    October 20, 2017   doi: 10.1002/pon.4571   open full text
  • Is lower symptom recognition associated with socioeconomic inequalities in help‐seeking for potential breast cancer symptoms?
    Hilary Davies, Afrodita Marcu, Peter Vedsted, Katriina L. Whitaker.
    Psycho-Oncology. October 19, 2017
    Objective Socioeconomic inequalities in recognising signs and symptoms of cancer may result in inequalities in timely help‐seeking and subsequent prognosis of breast cancer. We explored the mediating role of symptom attribution and concern on the relationship between level of education and help‐seeking for potential breast cancer symptoms. Methods Women aged ≥47 years (n = 961) were purposively recruited (by education) to complete an online vignette‐based survey that included nipple rash and axillary lump (in separate vignettes) as potential symptoms of breast cancer. Women completed questions relating to medical help‐seeking (yes/no), cancer attribution, symptom concern, cancer avoidance, family history, and demographics. Results Women with low education and mid education attributed nipple rash less often to cancer (26% and 27% mentioned cancer) than women with a degree or higher (40%). However, women with a degree or higher (63%) or mid education (64%) were less likely to anticipate seeking help for the nipple rash than women with no formal qualifications (73%). This association was statistically significant in the 60‐ to 69‐year‐old age group. There was no significant association between education and help‐seeking for axillary lump. Mediation analysis adjusting for potential confounders confirmed that the association between education and help‐seeking for nipple rash was fully mediated by symptom concern. Conclusions Socioeconomic inequalities in stage at diagnosis and survival of breast cancer may not always be explained by lower likelihood of suspecting cancer and subsequent impact on help‐seeking. Reducing inequalities in stage at diagnosis will involve understanding a broader range of bio‐psycho‐social factors (eg, comorbidities and healthcare system factors).
    October 19, 2017   doi: 10.1002/pon.4557   open full text
  • Locus of control, optimism, and recollections of depression and self‐reported cognitive functioning following treatment for colorectal cancer.
    Carlene Wilson, Kristy Giles, Ted Nettelbeck, Amanda Hutchinson.
    Psycho-Oncology. October 18, 2017
    Objective To investigate the effects of disposition (locus of control, optimism, depression) on recollections of cognitive functioning following cancer treatment. Methods Participants were survivors of colorectal cancer (n = 88) and their spouses (n = 40). Survivors retrospectively rated their cognitive functioning and depression, as experienced following treatment; and currently rated their dispositions for optimism and locus of control. Survivors’ spouses likewise provided their recollections of survivors’ cognitive functioning and depression at time following treatment. Results Correlations between survivors’ and spouses’ ratings for cognitive functioning were statistically significant but not for depression. Results supported validity of survivors’ longer‐term retrospective reports. Although internal locus of control correlated positively with retrospectively self‐reported cognitive functioning, and negatively with retrospectively self‐reported depression, moderated hierarchical multiple regression found independent contribution of internal locus of control was limited to predicting quality of life; and that, among variables tested, depression correlated strongest with cognitive functioning. Conclusions Neither internal locus of control nor optimism in colorectal cancer survivors influences correlation between cognition and depression. Health care providers should note individual differences in responses to treatment and be alert to the impact of depression on perceived everyday functioning.
    October 18, 2017   doi: 10.1002/pon.4567   open full text
  • Understanding middle‐aged and older adults’ first associations with the word ‘cancer’: a mixed methods study in England.
    Edelyn Agustina, Rachael H. Dodd, Jo Waller, Charlotte Vrinten.
    Psycho-Oncology. October 18, 2017
    Objective Cancer is still widely feared and often associated with death. Fatalistic beliefs adversely affect help‐seeking for cancer symptoms and engagement in cancer prevention. This study aims to understand middle‐aged and older adults’ first association with the word ‘cancer’, and their relationship with sociodemographic factors, cancer fear, and cancer information avoidance. Methods We conducted a cross‐sectional survey of 1464 community‐based adults aged 50 to 70 living in England in April 2015. First associations with cancer were measured qualitatively and analysed using content analysis. We used binary logistic regression to analyse associations between the most common first association of cancer and sociodemographic characteristics, cancer fear and cancer information avoidance. Results Cancer was most commonly associated with ‘death’ (26%). Respondents with lower levels of education, living in the Midlands or North of England where cancer mortality is higher, or with close friends or family members with a cancer history, were more likely to associate cancer with death. Cancer fear was significantly associated with death associations, but cancer information avoidance was not. Conclusions Despite improved cancer outcomes, middle‐aged and older adults often associate cancer with death. Further efforts to decrease fatalistic associations in this age group may be needed.
    October 18, 2017   doi: 10.1002/pon.4569   open full text
  • Perceived influence of psychological consultation on psychological well‐being, body image, and intimacy following bilateral prophylactic mastectomy: A qualitative analysis.
    Rachael Glassey, Sarah J. Hardcastle, Moira O'Connor, Angela Ives, , Christobel Saunders.
    Psycho-Oncology. October 16, 2017
    Objective This study explored whether psychological consultation offered to women prior to bilateral prophylactic mastectomy (BPM) appeared to provide psychosocial benefit to younger women (<35 years) at high risk of developing breast cancer due to a mutation or family history. Methods Qualitative interviews guided by interpretative phenomenological analysis were conducted retrospectively with 26 women who had undergone BPM. Participants were recruited from New Zealand and Australia, via a genetics clinic, registry, research cohort, and online. Results Three themes were identified: psychological well‐being and adjustment, satisfaction with intimacy, and body image. Participants that had seen a psychologist reported being more prepared for BPM and appeared to adjust positively post‐surgery. They appeared to have improved psychological well‐being, reported satisfaction with intimacy, and a more positive body image, compared with those who had no support. Conclusions Women who undergo psychological consultation prior to BPM appear to adjust positively after surgery. Implications for practice include standard psychological consultation for younger women (>35 years) considering BPM.
    October 16, 2017   doi: 10.1002/pon.4558   open full text
  • Clustering of prevention behaviours in patients with high‐risk primary melanoma.
    Adèle C. Green, Maria Celia B. Hughes, Lena A. Schuckmann, Kiarash Khosrotehrani, B. Mark Smithers.
    Psycho-Oncology. October 16, 2017
    Objective Because melanoma patients are at high risk of further disease, we aimed to study their melanoma prevention behaviours. Methods In a large cohort of patients newly diagnosed with high‐risk melanoma in Queensland, Australia, we assessed clustering of preventive behaviours using latent class analysis. We assessed associated factors with prevalence proportion ratios (PPRs) and 95% confidence intervals (CIs) estimated by Poisson regression, and also if preventive behaviour was associated with better tumour prognosis at diagnosis. Results Among 789 primary melanoma patients (57% male; 21% with previous melanoma), we identified 4 different behaviour clusters: “no/ low prevention” (34% of cohort), “sun protection only” (25%), “skin checks only” (25%) and “sun protection and skin checks” (16%). Prevalence of clusters differed between males and females and also the component behaviours. Preventive behaviours were associated with having skin that burned and past cutaneous cancer, and for males, combined sun protective and skin checking behaviour was associated with higher education and non‐smoking. In patients with no past history of cutaneous cancer, males in the “skin checks only” cluster had significantly reduced chances of a thick (poor prognosis) melanoma (PPR = 0.79, 95% CI 0.68, 0.91) and females in the “sun protection and skin checks” cluster were significantly less likely to have an ulcerated melanoma (PPR = 0.85, 95% CI 0.74, 0.98) compared with the “no/ low prevention” cluster. Conclusion These findings allow tailoring of preventive advice to melanoma patients to reduce their risk of future primary and recurrent disease.
    October 16, 2017   doi: 10.1002/pon.4565   open full text
  • Social constraints and psychological well‐being after prostate cancer: a follow‐up at 12 and 24 months after surgery.
    Karin Stinesen Kollberg, Thordis Thorsteinsdottir, Ulrica Wilderäng, Jonas Hugosson, Peter Wiklund, Anders Bjartell, Stefan Carlsson, Johan Stranne, Eva Haglind, Gunnar Steineck.
    Psycho-Oncology. October 12, 2017
    Objective Studies indicate that social constraints (barriers to emotional expression) may be a risk factor for psychological morbidity. We aimed to investigate the association between prostate cancer‐ related social constraints and psychological well‐being following prostate cancer surgery. Methods In a group of 3478 partnered patients, participating in the Laparoscopic Prostatectomy Robot Open (LAPPRO) trial, a prospective multicenter comparative study of robot‐assisted laparoscopic and retropubic radical prostatectomy for prostate cancer, we used log‐binomial regression analysis to investigate the links between prostate cancer‐related social constraints at 3 months after surgery and psychological well‐being at 12 and 24 months. Results 1086 and 1093 men reported low well‐being at 12 and 24 months, respectively. Prostate cancer‐related social constraints by partner predicted low psychological well‐being at 12 months (adjusted RR: 1.4; 95% CI, 1.1‐1.9) and by others (adjusted RR: 1.9; 95% CI, 1.1‐3.5). Intrusive thoughts mediated the association. Conclusions Negative responses from the social environment, especially from partner to talking about the prostate cancer experience affected patients' psychological well‐being two years after radical prostatectomy. Results emphasize the importance of helping patients mobilize psychosocial resources within their social network, especially among those with a lack of quality psychosocial support.
    October 12, 2017   doi: 10.1002/pon.4561   open full text
  • The psychological impact of prostate biopsy: Prevalence and predictors of procedure‐related distress.
    Linda Sharp, Eileen Morgan, Frances J. Drummond, Anna Gavin.
    Psycho-Oncology. October 11, 2017
    Objective Many men undergo prostate biopsies each year. Most data on consequences of prostate biopsy for men pertain to physical after‐effects and/or come from clinical trial populations. We quantified prevalence of, and identified factors associated with, procedure‐related distress in men having prostate biopsies in routine clinical practice. Methods Men who had undergone prostate biopsy for follow‐up of a raised prostate specific antigen test result and/or abnormal digital rectal examination in 6 centres in Ireland completed questionnaires. Biopsy‐related psychological distress was measured using the Impact of Event Scale. An Impact of Event Scale score ≥ 9 was considered significant biopsy‐related distress. Logistic regression was used to identify predictors of significant distress. Results Three hundred thirty‐five men completed questionnaires. Overall, 49% had significant biopsy‐related distress; this was higher in men whose biopsy result indicated cancer (59%) and those who did not have a definitive result (54%) than those with a negative result (35%; P < .001). In multivariable analyses, the odds of significant distress were 3 times higher in men with cancer (OR = 3.33, 95% CI, 1.83‐6.04) and more than twice as high in men without a definitive result (OR = 2.61, 95% CI, 1.43‐4.78) compared to men with a negative result. Men with intermediate (OR = 3.19, 95% CI, 1.85‐5.53) or high (OR = 7.10, 95% CI, 3.45‐14.57) health anxiety (propensity to worry about one's health) also had significantly increased odds of biopsy‐related distress. Conclusions Significant distress is common after prostatic biopsy. Some men, including those who are highly health anxious and those awaiting definitive results, may benefit from additional support around the time of and/or following prostate biopsy.
    October 11, 2017   doi: 10.1002/pon.4521   open full text
  • How are Multifactorial Beliefs about the Role of Genetics and Behavior in Cancer Causation associated with Cancer Risk Cognitions and Emotions in the U.S. Population?
    Jada G. Hamilton, Erika A. Waters.
    Psycho-Oncology. October 10, 2017
    Objective People who believe that cancer has both genetic and behavioral risk factors have more accurate mental models of cancer causation and may be more likely to engage in cancer screening behaviors than people who do not hold such multifactorial causal beliefs. This research explored possible health cognitions and emotions that might produce such differences. Methods Using nationally representative cross‐sectional data from the U.S. Health Information National Trends Survey (N=2,719), we examined whether endorsing a multifactorial model of cancer causation was associated with perceptions of risk and other cancer‐related cognitions and affect. Data were analyzed using linear regression with jackknife variance estimation and procedures to account for the complex survey design and weightings. Results Bivariate and multivariable analyses indicated that people who endorsed multifactorial beliefs about cancer had higher absolute risk perceptions, lower pessimism about cancer prevention, and higher worry about harm from environmental toxins that could be ingested or that emanate from consumer products (ps<0.05). Bivariate analyses indicated that multifactorial beliefs were also associated with higher feelings of risk, but multivariable analyses suggested that this effect was accounted for by the negative affect associated with reporting a family history of cancer. Multifactorial beliefs were not associated with believing that everything causes cancer or that there are too many cancer recommendations to follow (ps>0.05). Conclusion Holding multifactorial causal beliefs about cancer are associated with a constellation of risk perceptions, health cognitions, and affect that may motivate cancer prevention and detection behavior.
    October 10, 2017   doi: 10.1002/pon.4563   open full text
  • Dyadic effects of coping strategies, time perspectives, and personality on the quality of life of cancer patients and their caregivers.
    Zeinab Hamidou, Pascal Auquier, Tanguy Leroy, Fabrice Barlesi, Sébastien Salas, Olivier Chinot, Karine Baumstarck.
    Psycho-Oncology. October 06, 2017
    Objective Researchers are interested in studying whether the quality of life (QoL) of cancer patients and caregivers is influenced by internal psychobehavioral processes (temporality and coping strategies) and the personality traits that they or their relatives experience. We examined these associations in a sample of patient‐caregiver dyads by using the actor‐partner interdependence model. Methods This cross‐sectional study involved 156 cancer patient‐caregiver dyads. The self‐reported data included QoL (Short‐Form 36), coping strategies (Brief Coping Orientation to Problems Experienced Scale), time perspectives (Zimbardo Time Perspective Inventory), and personality (Big Five Inventory). The actor‐partner interdependence model was used to test the dyadic effect individualizing actor (degree to which the individual's characteristics were associated with their QoL) and partner (degree to which the individual's characteristics were associated with the QoL of the other dyad member) effects. Results Actor effects were found for patients and caregivers: The use of positive thinking and future/present‐hedonistic perspectives were associated with higher QoL; the use of avoidance and past‐negative perspective were associated with lower QoL. Partner effects were also found highlighting the specific mechanisms of the interconnections in the patient‐caregiver dyad. The patient's QoL was higher when the caregiver used social support and experienced openness. The caregiver's QoL was lower when the patient used social support and avoidance strategies and experienced future perspective. Conclusions The examination of the relationships between individuals' QoL and their internal psychobehavioral processes and personality traits will have several applications in the routine clinical management. Individual‐level and dyad‐level interventions should be proposed: cognitive‐rehabilitation, emotional and cognitive self‐regulation for time perspectives, and personality constructs.
    October 06, 2017   doi: 10.1002/pon.4553   open full text
  • Patterns of unmet supportive needs and relationship to quality of life in Chinese cancer patients.
    Lei Zhu, Juntao Yao, Maya J. Schroevers, Hongmei Zhang, Juan Xie, Ailan Liu, Joke Fleer, Adelita V. Ranchor, Zhangjun Song.
    Psycho-Oncology. October 06, 2017
    Objective This study aimed to (1) identify distinct patterns of unmet needs in Chinese cancer patients; (2) examine whether sociodemographic and medical characteristics distinguished these patterns; and (3) examine whether people with distinct patterns reported differential quality of life (QoL). Methods This cross‐sectional study recruited 301 cancer patients from 2 hospitals in China. The 34‐item Supportive Care Needs Survey Short‐Form was used to measure unmet needs across 5 domains: physical and daily living, psychological, patient care and support, health systems and information, and sexuality. Latent class analysis was performed to identify patterns of unmet needs across these domains. Results Four patterns of unmet needs were identified, differing in levels and nature of unmet needs. Participants in class 1 (47%) reported few unmet needs. Patients in class 2 (15%) had moderate levels of unmet needs, displaying similar levels across 5 domains. People in class 3 (25%) and class 4 (13%) reported similarly high levels on “psychological,” “health care system and information,” “physical and daily living,” and “patient care,” but differing in “sexuality,” with class 3 reporting low levels while class 4 high on “sexuality.” None of sociodemographic and medical characteristics distinguished these patterns significantly. Compared to other classes, people in class 1 reported highest levels of QoL. Conclusions This study demonstrates the existence of 4 patterns of unmet supportive needs in Chinese cancer patients. Patients with few unmet needs reported the best QoL.
    October 06, 2017   doi: 10.1002/pon.4554   open full text
  • Cognitive reactions of nurses exposed to cancer patients' traumatic experiences: A qualitative study to identify triggers of the onset of compassion fatigue.
    Takaki Fukumori, Atsuko Miyazaki, Chihiro Takaba, Saki Taniguchi, Mariko Asai.
    Psycho-Oncology. October 06, 2017
    Objective Nurses in cancer care are considered to be at risk for compassion fatigue because they are frequently exposed to patients' traumatic experiences. However, only a few effective empirical studies have been conducted in this field, and cognitive factors in particular have not been sufficiently studied. This study aims to describe the components of nurses' cognitive reactions from their exposure to cancer patients' traumatic experience to the onset of compassion fatigue. Methods In this qualitative study, 30 nurses in cancer care were purposively selected. Data were collected through semistructured interviews and analyzed by using content analysis and the constant comparative method. Results Forty attributes were identified from 613 statements and classified into 11 categories: sense of professional inadequacy, compassion for patients and their families, desire to support patients and their families, rumination on oneself or one's family, sense of professional mission, dissatisfaction with medical staff, desire to integrate with colleagues, desire to avoid one's duties, conflict between one's belief and reality, reconsideration of the meaning of life, and sense of powerlessness over cancer. Conclusions This study identified important components of cognitive reactions of nurses who encounter the traumatic experiences of cancer patients in Japan. This information can contribute to the understanding of the onset of compassion fatigue and provide the foundation for nurses in cancer care to avoid and recover from compassion fatigue.
    October 06, 2017   doi: 10.1002/pon.4555   open full text
  • Anxiety during cancer diagnosis: examining the influence of monitoring coping style and treatment plan.
    Madelon B. Bronner, Minh Hao Nguyen, Ellen M.A. Smets, Anthony W.H. Ven, Julia C.M. Weert.
    Psycho-Oncology. October 04, 2017
    Objective Studies on anxiety within oncology show a high prevalence of anxiety both during and after the course of the disease. However, little is known about factors that influence the level of anxiety in the diagnostic phase. This study examines the presence of anxiety during diagnosis and treatment planning and explores how a monitoring (i.e., information‐seeking) coping style and the suggested treatment plan (i.e., with or without chemotherapy) interact with anxiety. Methods Anxiety scores (STAI‐6) were collected from 81 colorectal cancer patients before and after their visit to the outpatient Gastro‐Intestinal Oncological Center Amsterdam (GIOCA). A cutoff score (>44) was used to indicate highly anxious patients. Results More than half (59%) of the patients were classified as highly anxious before consultation. Although anxiety scores significantly decreased after consultation (t = 3.149, p = .002), 37% of the patients remained highly anxious. Reductions in anxiety were specifically observed for patients with a higher monitoring coping style and patients for whom a treatment plan without chemotherapy was proposed. Interestingly, high monitors for whom treatment without chemotherapy was proposed showed a major decrease in anxiety, whereas low monitors for whom treatment starting with chemotherapy was proposed showed a great increase in anxiety. Conclusions The diagnostic phase is associated with high levels of anxiety. Distinct patterns of anxiety were identified, depending on patients’ coping style and the suggested treatment plan. Remarkably, patients with a lower monitoring coping style became particularly anxious when they were advised to start treatment with chemotherapy.
    October 04, 2017   doi: 10.1002/pon.4560   open full text
  • Physical activity and exercise self‐regulation in cancer survivors: A qualitative study.
    Edward Tsai, Michael C. Robertson, Elizabeth J. Lyons, Maria C. Swartz, Karen Basen‐Engquist.
    Psycho-Oncology. September 29, 2017
    Objective Despite the benefits of physical activity, many cancer survivors do not adhere to clinically recommended levels. This qualitative study investigated factors of self‐regulation contributing to survivor physical activity patterns. Methods Participants attended focus groups with prompts on exercise habits and self‐regulation on the basis of social cognitive theory, self‐determination theory, and self‐regulation theory. Content analysis with a priori codes was conducted to identify emergent themes. Results Participants (n = 35) were predominately older (63.7 y ± 10.8), female (69%), white (71%), and breast cancer (60%) survivors, with 41% not meeting activity guidelines. Emergent themes included exercise goal development, selection, and attainment; exercise planning; and self‐reward. Participants tended to develop values‐based, general goals rather than action‐based, measurable goals. Goal attainment success emerged as a facilitator of future goal performance; completing a current goal facilitated subsequent goal attainment, while failure hindered future goal completion. Rather than having deliberate intentions to schedule exercise, participants exercised if expedient in the context of normal daily activities. Food consumption emerged as a major mechanism for self‐reward. Conclusions Our findings suggest that values‐based goals, unplanned activity, influence from previous goal attempts, and self‐reward were important factors related to self‐regulation. Interventions designed to improve self‐regulation may consider facilitating development of autonomous, value‐based goals, assisting in development of strategies for future goals if current goals are not met, endorsing exercise as a scheduled activity, and introducing healthy self‐reward alternatives.
    September 29, 2017   doi: 10.1002/pon.4519   open full text
  • Patterns of stress coping and depression among patients with head and neck cancer: A Japanese cross‐sectional study.
    Kanako Ichikura, Aya Yamashita, Taro Sugimoto, Seiji Kishimoto, Eisuke Matsushima.
    Psycho-Oncology. September 27, 2017
    Objective Patients with head and neck cancer (HNC) experience many stressful problems with breathing, eating, swallowing, and/or speaking. The aim of this study was to (a) identify the clusters of HNC patients based on their stress coping strategies and (b) evaluate the differences in clinical data and depression among the identified HNC patients' coping clusters. Methods We conducted a single‐center, cross‐sectional study with self‐completed questionnaires for patients with HNC between April and August 2013. We measured stress coping (an abbreviated version of the COPE Inventory: Brief COPE) and depression (the Japanese version of the Beck Depression Inventory‐II: BDI‐II). Results Of the 116 patients who completed all the questionnaires, 81 (69.8%) participants were 60 to 79 years old and 105 (90.5%) were men. Cluster analysis based on the standardized z score of Brief COPE showed that patients were classified into 3 clusters, labeled “dependent coping,” “problem‐focused coping,” and “resigned coping.” The ANOVA revealed that depression (BDI score) was significantly higher in the dependent‐coping cluster compared with the problem‐focused coping. Conclusions This study indicates that patients with a dependent‐coping pattern may account for the largest HNC population and are likely to suffer from depression. Dependent coping includes smoking, drinking, seeking support, or engaging self‐distraction. In the future, we should develop psychological intervention programs focused on coping strategies and enhancement of the support system for patients with HNC.
    September 27, 2017   doi: 10.1002/pon.4549   open full text
  • Factors influencing time to seeking medical advice and onset of treatment in women who are diagnosed with breast cancer in Serbia.
    L. Stamatovic, S. Vasovic, J. Trifunovic, N. Boskov, Z. Gajic, A. Parezanovic, M. Icevic, A. Cirkovic, N. Milic.
    Psycho-Oncology. September 27, 2017
    Objective Streamlining the diagnosis is a key factor in improving the treatment outcomes for breast cancer. The aim of this study was to determine factors influencing time to seeking medical advice and treatment onset in women who are diagnosed with breast cancer in Serbia. Methods The study was a multicenter, cross‐sectional national survey, performed at 10 oncology centers in Serbia. Time intervals spent throughout the complex diagnostic pathway were evaluated using a validated questionnaire administered to women with breast cancer (n = 800). Total interval (TI) was determined using predefined time scales, including one referring to patient interval (PI), and several related to health care system interval (SI). Results Mean PI, SI, and TI were 4.5, 9.2, and 12.9 weeks, respectively; 20% of patients had a PI>12 weeks. Based on the multivariate regression model, longer PI was associated with perceived lack of time and personal disregard or trivialization of detected symptoms and signs. Women who were supported by family members or friends and had at least a secondary level education tended to have a shorter PI. Longer PI was correlated with a longer SI, while regular self‐examination, having been diagnosed by an oncologist, and living in a major city were associated with shorter SI. Conclusions Several factors, related to psychological, demographic, behavioral, and health system characteristics, determined both the time to seeking medical advice and treatment onset for breast cancer. These findings support review and refining of national strategies and policies to promote early detection, diagnosis, and treatment of breast cancer.
    September 27, 2017   doi: 10.1002/pon.4551   open full text
  • Does depression decrease the moderating effect of self‐efficacy in the relationship between illness perception and fear of progression in breast cancer?
    Eun‐Jung Shim, Jong Won Lee, Yul Ha Min.
    Psycho-Oncology. September 27, 2017
    Objective Fear of progression (FOP) is a prevalent concern among breast cancer patients that affect their adjustment to disease. This study examined whether self‐efficacy moderates the effect of illness perception (IP) on FOP and whether the moderating effect of self‐efficacy depends on the level of depressive symptoms. Methods A cross‐sectional survey including brief illness perception questionnaire (BIPQ), FOP short form, general self‐efficacy scale, and the center for epidemiologic studies depression scale were administered to 245 patients with breast cancer in Korea. Results Self‐efficacy moderated the negative impact of the patients' perception of chronic timeline and a greater emotional impact of the illness on FOP. However, the moderating effect of self‐efficacy of the BIPQ timeline and emotions on FOP depended on level of depressive symptoms. Conclusions The findings underscore the importance of considering the IP as determinants of FOP, as well as of self‐efficacy and depression as the moderating factors in the relationship between IP and FOP, suggesting the need to enhance self‐efficacy and depressive symptoms in order to compensate the negative impact of IP on FOP in breast cancer patients.
    September 27, 2017   doi: 10.1002/pon.4532   open full text
  • Correlates of concealment behavior among couples coping with cancer: Actor partner model.
    Reut Wertheim, Gil Goldzweig, Michal Mashiach‐Eizenberg, Noam Pizem, Einat Shacham‐Shmueli, Ilanit Hasson‐Ohayon.
    Psycho-Oncology. September 21, 2017
    Objectives Contextual self‐concealment in the psychooncology literature has been found to be associated with elevated distress. The current study aimed to understand the dyadic relationships of an individual's perception of spousal support and dispositional perspective‐taking with own and partner's levels of self‐concealment behavior, among couples coping with cancer. Methods A subsample of 61 heterosexual couples coping with cancer was taken from a large‐scale cross‐sectional study. Patients and their spouses independently completed measures of perceived spousal support, perspective‐taking, and contextual self‐concealment. Dyadic data were analyzed by using the actor‐partner interdependence model both for couples in which the woman was the patient and also for couples in which the man was the patient. Results Perceived spousal support negatively predicted contextual self‐concealment, regardless of gender and role. Implications of perspective‐taking for concealment behavior were dependent on role and gender. A female patient's perspective‐taking was associated with a reduction in her own and her spouse's concealment behavior. A male spouse's perspective‐taking was associated with an increase in his own and his spouse's concealment behavior. A female spouse's perspective‐taking negatively predicted patient's concealment behavior, but not her own. Conclusions Findings stress the important roles played by spousal support and perspective‐taking in communication patterns between couples affected by cancer. Although the perception of support from one's spouse seems to reduce the need to conceal cancer‐related issues, interventions that focus on couples' communication should address the differential implications of perspective‐taking, as they can lead to either more or less self‐concealment among couples, depending on role and gender.
    September 21, 2017   doi: 10.1002/pon.4552   open full text
  • A cross‐cultural convergent parallel mixed methods study of what makes a cancer‐related symptom or functional health problem clinically important.
    Johannes M. Giesinger, Neil K. Aaronson, Juan I. Arraras, Fabio Efficace, Mogens Groenvold, Jacobien M. Kieffer, Fanny L. Loth, Morten Aa. Petersen, John Ramage, Krzysztof A. Tomaszewski, Teresa Young, Bernhard Holzner,.
    Psycho-Oncology. September 21, 2017
    Objective In this study, we investigated what makes a symptom or functional impairment clinically important, that is, relevant for a patient to discuss with a health care professional (HCP). This is the first part of a European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group project focusing on the development of thresholds for clinical importance for the EORTC QLQ‐C30 questionnaire and its corresponding computer‐adaptive version. Methods We conducted interviews with cancer patients and HCPs in 6 European countries. Participants were asked to name aspects of a symptom or problem that make it clinically important and to provide importance ratings for a predefined set of aspects (eg, need for help and limitations of daily functioning). Results We conducted interviews with 83 cancer patients (mean age, 60.3 y; 50.6% men) and 67 HCPs. Participants related clinical importance to limitations of everyday life (patients, 65.1%; HCPs, 77.6%), the emotional impact of a symptom/problem (patients, 53.0%; HCPs, 64.2%), and duration/frequency (patients, 51.8%; HCPs, 49.3%). In the patient sample, importance ratings were highest for worries by partner or family, limitations in everyday life, and need for help from the medical staff. Health care professionals rated limitations in everyday life and need for help from the medical staff to be most important. Conclusions Limitations in everyday life, need for (medical) help, and emotional impact on the patient or family/partner were found to be relevant aspects of clinical importance. Based on these findings, we will define anchor items for the development of thresholds for clinical importance for the EORTC measures in a Europe‐wide field study.
    September 21, 2017   doi: 10.1002/pon.4548   open full text
  • Why do oncologists hide the truth? Disclosure of cancer diagnoses to patients in China: A multisource assessment using mixed methods.
    Yiqun Gan, Lei Zheng, Nancy Xiaonan Yu, Guangyu Zhou, Miao Miao, Qian Lu.
    Psycho-Oncology. September 18, 2017
    Objective In the United States and most European countries, cancer diagnoses are disclosed to patients. In China, however, the trend toward full disclosure has progressed slowly. The present study aimed to explore attitudes toward truth‐telling practice among physicians, patients, patients' family members, and the general population, and reasons for nondisclosure. Methods We administered a short survey to 212 physicians, 143 patients with cancer, 413 family members of patients with cancer, and 1415 members of the general population. A MANOVA was performed to examine group differences in attitudes toward cancer disclosure. In addition, we interviewed 20 oncologists. Interview data were analyzed using NVivo10. After the interview, we administered another short survey to 143 patients with cancer. Results Quantitative data indicated that physicians were the least, and patients the most, in favor of disclosure. Qualitative data among physicians and follow‐up surveys among cancer patients revealed 5 reasons for the concealment of cancer diagnoses by physicians, including lack of awareness of patients' right to knowledge, cultural influences, insufficient medical resources and training, families' financial concerns, and the need to protect doctors from violence. Conclusion There is a discrepancy between the needs of patients and those in medical practice. These results deepen our understanding regarding the reasons for oncologists' attitudes toward nondisclosure.
    September 18, 2017   doi: 10.1002/pon.4545   open full text
  • A closer lens: Cancer survivors' supportive intervention preferences and interventions received.
    Joanna J. Arch, Rachel Vanderkruik, Alex Kirk, Alaina L. Carr.
    Psycho-Oncology. September 18, 2017
    Objective Cancer survivor preferences for formal interventions designed to provide psychological support remain relatively unknown. To address this gap, we evaluated cancer survivors' preferences for psychological intervention, whom they preferred to recommend such intervention, and how their preferences compared with what they currently received. Methods US cancer survivors (n = 345) who were at least 2 months post‐treatment for diverse forms of cancer were recruited online to complete a survey study. Results Based on Wilcoxon signed‐rank tests to distinguish among ranked preferences, cancer survivors rated individual professional counseling as their most‐preferred form of psychological intervention (among 6 choices), p < .001, followed by professionally led cancer support groups and individual peer counseling. Anti‐depressant or other psychiatric medication represented their least‐preferred intervention, ps < .001, but was the one they were most likely to currently receive. Preference for individual professional counseling over psychiatric medication was evident even among the subgroups of cancer survivors screening positively for probable anxiety disorder (n = 188) or major depression (n = 137), ps < .001. Cancer survivors most preferred to learn about psychological interventions from their medical oncologist, p < .001, followed by primary care physician, cancer nurse, or another cancer survivor; they least preferred to learn from a social worker or on their own, ps < .001. Conclusions Cancer survivors reported significant unmet need for psychological intervention, preference for non‐pharmacological forms of such support, and a gap between their preferred forms of support and what they currently receive.
    September 18, 2017   doi: 10.1002/pon.4526   open full text
  • Ambiguity in a masculine world: Being a BRCA1/2 mutation carrier and a man with prostate cancer.
    C. Moynihan, E.K. Bancroft, A. Mitra, A. Ardern‐Jones, E. Castro, E.C. Page, R.A. Eeles.
    Psycho-Oncology. September 18, 2017
    Objective Increased risk of prostate cancer (PCa) is observed in men with BRCA1/BRCA2 mutations. Sex and gender are key determinants of health and disease although unequal care exists between the sexes. Stereotypical male attitudes are shown to lead to poor health outcomes. Methods Men with BRCA1/2 mutations and diagnosed with PCa were identified and invited to participate in a qualitative interview study. Data were analysed using a framework approach. “Masculinity theory” was used to report the impact of having both a BRCA1/2 mutation and PCa. Results Eleven of 15 eligible men were interviewed. The umbrella concept of “Ambiguity in a Masculine World” was evident. Men's responses often matched those of women in a genetic context. Men's BRCA experience was described, as “on the back burner” but “a bonus” enabling familial detection and early diagnosis of PCa. Embodiment of PCa took precedence as men revealed stereotypical “ideal” masculine responses such as stoicism and control while creating new “masculinities” when faced with the vicissitudes of having 2 gendered conditions. Conclusion Health workers are urged to take a reflexive approach, void of masculine ideals, a belief in which obfuscates men's experience. Research is required regarding men's support needs in the name of equality of care.
    September 18, 2017   doi: 10.1002/pon.4530   open full text
  • Men's perspectives on cancer prevention behaviors associated with HPV.
    Serena FitzGerald, Nicola Cornally, Josephine Hegarty.
    Psycho-Oncology. September 13, 2017
    Background The human papillomavirus (HPV) is associated with the diagnosis of anal, penile, and oropharyngeal cancers in men. Evidence indicates that correct condom use in addition to obtaining the HPV vaccine provides the greatest protection from HPV infections. Objective To explore young men's beliefs and behavioral intention in relation to receiving the HPV vaccine and using a condom correctly and consistently for sexual contact. Methods A cross‐sectional study underpinned by the theory of planned behavior (TPB) was conducted with male participants (n = 359, 18‐28 years) who completed an online survey. Descriptive, correlational, and hierarchical regression analyses were performed on both status variables and variables of the TPB. Results Subjective norms (β = 0.519, P < .001) was identified as the most influential predictor in relation to men's intention to receive the HPV vaccine, while relationship status (β = −0.215, P < .001) and attitudes (β = 0.394, P < .001) presented as the most significant predictors of intention to use a condom. Summarily, 51% of the variance in intention to receive the HPV vaccine and 44% in intention to use a condom were explained by the TPB model. Conclusion Results from this study will impact on future sexual health research, education programs, and interventions for both HPV preventative behaviors towards the elimination of HPV‐related cancers in men.
    September 13, 2017   doi: 10.1002/pon.4515   open full text
  • Educational and vocational goal disruption in adolescent and young adult cancer survivors.
    Janine Vetsch, Claire E. Wakefield, Brittany C. McGill, Richard J. Cohn, Sarah J. Ellis, Natalie Stefanic, Susan M. Sawyer, Brad Zebrack, Ursula M. Sansom‐Daly.
    Psycho-Oncology. September 11, 2017
    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 Adolescents and young adults recruited from 7 hospitals in Australia, aged 15 to 26 years and ≤24 months posttreatment, were interviewed using the psychosocial adjustment to illness scale. 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. Adolescents and young adults 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. Adolescents and young adults experiencing difficulties may benefit from additional supports to facilitate meaningful engagement with their chosen educational/vocational goals.
    September 11, 2017   doi: 10.1002/pon.4525   open full text
  • Regret about surgical decisions among early‐stage breast cancer patients: Effects of the congruence between patients' preferred and actual decision‐making roles.
    Ashley Wei‐Ting Wang, Su‐Mei Chang, Cheng‐Shyong Chang, Shou‐Tung Chen, Dar‐Ren Chen, Fang Fan, Michael H. Antoni, Wen‐Yau Hsu.
    Psycho-Oncology. September 11, 2017
    Objective Early‐stage breast cancer patients generally receive either a mastectomy or a lumpectomy, either by their own choice or that of their surgeon. Sometimes, there is regret about the decision afterward. To better understand regret about surgical decisions, this study examined 2 possibilities: The first is that women who take a dominant or collaborative role in decision making about the surgery express less regret afterward. The second is that congruence between preferred role and actual role predicts less regret. We also explored whether disease stage moderates the relationship between role congruence and decisional regret. Methods In a cross‐sectional design, 154 women diagnosed with breast cancer completed a survey assessing decisional role preference and actual decisional role, a measure of post‐decision regret, and a measure of disturbances related to breast cancer treatment. Hierarchical regression was used to investigate prediction of decisional regret. Results Role congruence, not actual decisional role, was significantly associated with less decisional regret, independent of all the control variables. The interaction between disease stage and role congruence was also significant, showing that mismatch relates to regret only in women with more advanced disease. Conclusions Our findings suggest that cancer patients could benefit from tailored decision support concerning their decisional role preferences in the complex scenario of medical and personal factors during the surgical decision.
    September 11, 2017   doi: 10.1002/pon.4522   open full text
  • Prevalence and predictors of conflict in the families of patients with advanced cancer: A nationwide survey of bereaved family members.
    Jun Hamano, Tatsuya Morita, Masanori Mori, Naoko Igarashi, Yasuo Shima, Mitsunori Miyashita.
    Psycho-Oncology. September 06, 2017
    Objectives Family conflict has several adverse impacts on caregivers. Thus, there is significant value in determining the prevalence and predictors of family conflict, which can enable the health care provider to intervene if family conflict arises during end‐of‐life care. Accordingly, we aimed to explore the prevalence and predictors of conflict among the families of patients with advanced cancer who died in palliative care units. Methods This study was a nationwide multicenter questionnaire survey of bereaved family members of cancer patients who died in Japanese palliative care units participating in evaluation of the quality of end‐of‐life care. Results We sent out 764 questionnaires, and 529 questionnaires (69.2%) were returned. As 70 family members refused to participate and we could not identify the answers in one questionnaire, we analyzed a total of 458 responses. The average Outcome‐Family Conflict score was 13.5 ± 4.9 (maximum score: 39.5), and 42.2% of family members reported at least one family conflict during end‐of‐life care. Greater family conflict was significantly associated with younger family age, with family members asserting control over decision making for patient care and with communication constraints among family members, although absent family members “coming out of the woodwork” reduced family conflict. Conclusions Many families of patients with advanced cancer experienced conflict during end‐of‐life care. Family members asserting control over decision making and communication constraints among family members after diagnosis of cancer can predict the occurrence of family conflict. Absent family members “coming out of the woodwork” might reduce family conflict in particular cultures.
    September 06, 2017   doi: 10.1002/pon.4508   open full text
  • Patients with established cancer cachexia lack the motivation and self‐efficacy to undertake regular structured exercise.
    David Wasley, Nichola Gale, Sioned Roberts, Karianne Backx, Annmarie Nelson, Robert Deursen, Anthony Byrne.
    Psycho-Oncology. September 06, 2017
    Objectives Patients with advanced cancer frequently suffer a decline in activities associated with involuntary loss of weight and muscle mass (cachexia). This can profoundly affect function and quality of life. Although exercise participation can maintain physical and psychological function in patients with cancer, uptake is low in cachectic patients who are underrepresented in exercise studies. To understand how such patients' experiences are associated with exercise participation, we investigated exercise history, self‐confidence, and exercise motivations in patients with established cancer cachexia, and relationships between relevant variables. Methods Lung and gastrointestinal cancer outpatients with established cancer cachexia (n = 196) completed a questionnaire exploring exercise history and key constructs of the Theory of Planned Behaviour relating to perceived control, psychological adjustment, and motivational attitudes. Results Patients reported low physical activity levels, and few undertook regular structured exercise. Exercise self‐efficacy was very low with concerns it could worsen symptoms and cause harm. Patients showed poor perceived control and a strong need for approval but received little advice from health care professionals. Preferences were for low intensity activities, on their own, in the home setting. Regression analysis revealed no significant factors related to the independent variables. Conclusions Frequently employed higher intensity, group exercise models do not address the motivational and behavioural concerns of cachectic cancer patients in this study. Developing exercise interventions which match perceived abilities and skills is required to address challenges of self‐efficacy and perceived control identified. Greater engagement of health professionals with this group is required to explore potential benefits of exercise.
    September 06, 2017   doi: 10.1002/pon.4512   open full text
  • Mediating burden and stress over time: Caregivers of patients with primary brain tumor.
    Maija Reblin, Brent Small, Heather Jim, Jason Weimer, Paula Sherwood.
    Psycho-Oncology. August 31, 2017
    There is a growing literature on the effects of cancer caregiving on the well‐being of informal family caregivers. However, there has been little longitudinal research on caregivers of patients with the complex, rapidly‐changing disease of primary malignant brain tumor. Objective Our objective was to model longitudinal relationships between caregiver burden, social support, and distress within caregivers of patients with primary brain tumor. Methods Caregiver participants were recruited from a neuro‐oncology clinic. Caregiver questionnaire data, including sociodemographics, social support, depression, anxiety, and caregiving burden, were collected at 4 time points (diagnosis, +4, +8, and +12 mo). Using the stress process model as a guide, we hypothesized that early burden would predict later depression and anxiety, and this would be mediated by social support. Results Using data from 147 participants, we found support for the stress process model in caregivers of patients with primary brain tumor. Greater burden at diagnosis was associated with lower social support at 4 months, and lower social support was related to higher depression and anxiety at 8 months, as well as to changes in anxiety between 8 and 12 months. Conclusion We found evidence of the stress process model in caregivers of primary brain tumor patients unfolding over the course of a year after diagnosis. Our findings emphasize the potential importance of early programs for caregivers to ensure low initial levels of burden, which may have a positive effect on social support, depression, and anxiety.
    August 31, 2017   doi: 10.1002/pon.4527   open full text
  • Factors associated with physical activity among adolescent and young adult survivors of early childhood cancer: A report from the childhood cancer survivor study (CCSS).
    Katie A. Devine, Ann C. Mertens, John A. Whitton, Carmen L. Wilson, Kirsten K. Ness, Jordan Gilleland Marchak, Wendy Leisenring, Kevin C. Oeffinger, Leslie L. Robison, Gregory T. Armstrong, Kevin R. Krull.
    Psycho-Oncology. August 31, 2017
    Objective To evaluate concurrent and longitudinal associations between psychosocial functioning and physical activity in adolescent and young adult survivors of early childhood cancer. Methods Adolescent survivors of early childhood cancer (diagnosed before age four) participating in the Childhood Cancer Survivor Study completed the Coping Health and Illness Profile–Adolescent Edition (CHIP‐AE; n = 303; mean age at survey: 17.6 years). A subset of these survivors (n = 248) completed a follow‐up survey an average of 6.0 years later (range: 4‐10). Logistic regression identified associations between psychosocial functioning in adolescence and physical activity levels in adolescence and young adulthood. Results Survivors reported low physical activity as adolescents (46.1% scored below CHIP‐AE cut‐point) and young adults (40.8% below Centers for Disease Control guidelines). Poor physical activity during adolescence was associated with female sex (OR = 2.06, 95% CI, 1.18‐3.68), parents with less than a college education (OR = 1.91, 95% CI, 1.11‐3.32), previous treatment with cranial radiation (OR = 3.35, 95% CI, 1.69‐6.88), TV time (OR = 1.77, 95% CI, 1.00‐3.14), and limitations of activity due to health or mobility restrictions (OR = 8.28, 95% CI, 2.87‐30.34). Poor diet (OR = 1.84, 95% CI, 1.05‐3.26) and low self‐esteem (OR = 1.80, 95% CI, 0.99‐3.31) during adolescence were associated with lower odds of meeting Centers for Disease Control physical activity guidelines in young adulthood. Conclusion These findings provide targets for future interventional studies to improve physical activity in this high‐risk population.
    August 31, 2017   doi: 10.1002/pon.4528   open full text
  • Profiling sedentary behavior in breast cancer survivors: Links with depression symptoms during the early survivorship period.
    Catherine M. Sabiston, Jason Lacombe, Guy Faulkner, Jennifer Jones, Linda Trinh.
    Psycho-Oncology. August 31, 2017
    Objective Depression symptoms are prevalent among breast cancer survivors (BCS). Reducing sedentary behavior (SED) may be a non‐pharmaceutical strategy for alleviating depression symptoms. However, little is known about SED among BCS. The present study aimed to: (i) describe SED behaviors among BCS and identify unique SED groups based on different SED dimensions; (ii) identify personal and cancer‐specific factors that discriminate SED clusters; and (iii) examine the association between SED clusters and depression symptoms. Methods Baseline self‐report demographic and medical information was collected from 187 BCS. SED and physical activity were assessed over seven days using an accelerometer. Self‐reported depression symptoms were reported three months later. Multiple dimensions of SED were identified and examined in cluster analysis. The clusters were examined for differences using multivariate analysis of variance and chi‐square analyses. The difference in depression symptoms among SED groups was assessed using an analysis of covariance. Results High and low SED groups were identified. Survivors in the high SED cluster were significantly older, heavier, less physically active, reported less education, and were more likely to have undergone lymph/axial node dissection. Women in the high SED cluster reported significantly higher depression symptoms prospectively (M = 9.50, SD = 6.07) compared to women in the low SED group (M = 6.89, SD = 5.18), F(8,179) = 4.97, p = 0.03, R2 = 0.34. Conclusions The importance of understanding multiple dimensions of SED among BCS was highlighted. Reducing SED during the early survivorship period may alleviate depression symptoms.
    August 31, 2017   doi: 10.1002/pon.4520   open full text
  • Relationship between Physicians' Perceived Stigma toward Depression and Physician Referral to Psycho‐oncology services on an Oncology/Hematology Ward.
    Won‐Hyoung Kim, Jae‐Nam Bae, Joo‐Han Lim, Moon‐Hee Lee, Bong‐Jin Hahm, Hyeon Gyu Yi.
    Psycho-Oncology. August 30, 2017
    OBJECTIVE This study was performed to identify relationships between physician's perceived stigma toward depression and psycho‐oncology service utilization on an oncology/hematology ward. METHODS The study participants were 235 patients in an oncology/hematology ward and 14 physicians undergoing an internal medicine residency training program in Inha University Hospital (Incheon, South Korea). Patients completed the Patient Health Questionnaire‐9 (PHQ‐9) and residents completed the Perceived Devaluation‐Discrimination (PDD) scale that evaluates perceived stigma toward depression. A total PHQ‐9 score of ≥5 was defined as clinically significant depression. Physicians decided on referral based on their and patient's opinions. The correlates of physicians' recommendation for referral to psycho‐oncology services and real referrals psycho‐oncology services were examined. RESULTS Of the 235 patients, 143 had PHQ‐9 determined depression, and of these 143 patients, 61 received psycho‐oncology services. Physician's recommended that 87 patients consult psycho‐oncology services. Multivariate analyses showed lower physician's perceived stigma regarding depression was significantly associated with physicians' recommendation for referral, and that real referral to psycho‐oncology services was significantly associated with presence of a hematologic malignancy and lower physician's perceived stigma toward depression. CONCLUSION Physician's perceived stigma toward depression was found to be associated with real referral to psycho‐oncology services and with physician recommendation for referral to psycho‐oncology services. Further investigations will be needed to examine how to reduce physicians' perceived stigma toward depression.
    August 30, 2017   doi: 10.1002/pon.4546   open full text
  • Physicians' self‐reported practice behaviour regarding fertility‐related discussions in paediatric oncology in Sweden.
    G.M. Armuand, J. Nilsson, K.A. Rodriguez‐Wallberg, J. Malmros, J. Arvidson, C. Lampic, L. Wettergren.
    Psycho-Oncology. August 25, 2017
    Objective The aim of this study was to investigate practice behaviours of Swedish physicians with regard to discussing the impact of cancer treatment on fertility with paediatric oncology patients and their parents, and to identify factors associated with such discussions. Methods A cross‐sectional survey study was conducted targeting all physicians in Sweden working in paediatric oncology care settings. Participants responded to a questionnaire measuring practice behaviour, attitudes, barriers, and confidence in knowledge. Multivariable logistic regression was used to determine factors associated with seldom discussing fertility. Results More than half of the physicians routinely talked with their patients/parents about the treatment's potential impact on fertility (male patients: 62%; female patients: 57%; P = 0.570). Factors associated with less frequently discussing fertility with patients/parents were working at a non‐university hospital (male patients: OR 11.49, CI 1.98–66.67; female patients: OR 33.18, CI 4.06–271.07), concerns that the topic would cause worry (male patients: OR 8.23, CI 1.48–45.89; female patients: OR 12.38, CI 1.90–80.70), and perceiving the parents as anxious (male patients: OR 7.18, CI 1.20–42.85; female patients: OR 11.65, CI 1.32–103.17). Conclusions Based on our findings, we recommend structured training in how to communicate about fertility issues in stressful situations, which in turn might increase fertility‐related discussions in paediatric oncology.
    August 25, 2017   doi: 10.1002/pon.4507   open full text
  • The course of fear of cancer recurrence: Different patterns by age in breast cancer survivors.
    Daniëlle E.J. Starreveld, Sabine E. Markovitz, Gerard Breukelen, Madelon L. Peters.
    Psycho-Oncology. August 22, 2017
    Objective To examine the time course and predictors of fear of cancer recurrence (FCR) in breast cancer survivors over a period of 18 months after initial surgery. Methods Breast cancer patients (n = 267) were followed until 18 months after primary breast surgery. Shortly after surgery, participants completed the Life Orientation Test‐Revised to measure optimism and the Concerns about Recurrence Scale to measure FCR. Mixed regression analysis was performed with age, optimism, marital status, education, type of surgery, with or without lymphectomy, chemotherapy, hormonal therapy, or radiotherapy, time since surgery, and all interactions with time as predictors of FCR. Results The final model included a significant interaction between age and time since surgery and a main effect for optimism. Conclusion These results suggest that the course of FCR depends on the age of breast cancer survivors. Younger survivors showed an increase of fear during the first 1.5 years after breast surgery, whereas older survivors showed stable levels during the first 6 months after which it declined. Also, less optimistic survivors reported higher levels of FCR. Health care providers should pay (extra) attention to FCR in younger and less optimistic patients and offer psychological help when needed.
    August 22, 2017   doi: 10.1002/pon.4505   open full text
  • A revised model for coping with advanced cancer. Mapping concepts from a longitudinal qualitative study of patients and carers coping with advanced cancer onto Folkman and Greer's theoretical model of appraisal and coping.
    Diane Roberts, Lynn Calman, Paul Large, Lynda Appleton, Gunn Grande, Mari Lloyd‐Williams, Catherine Walshe.
    Psycho-Oncology. August 18, 2017
    Objective To explore whether the Folkman and Greer theoretical model of appraisal and coping reflects the processes used by people living with advanced cancer. Methods Interview data from a longitudinal qualitative study with people with advanced (stage 3 or 4) cancer (n = 26) were mapped onto the concepts of the Folkman and Greer theoretical model. Qualitative interviews conducted in home settings, 4‐12 weeks apart (n = 45) examined coping strategies, why people thought they were effective, and in what circumstances. Interviews were coded and analysed using techniques of constant comparison. Results Mapping coping strategies clearly onto the problem‐ or emotion‐focused elements of the model proved problematic. Fluctuating symptoms, deterioration over time, and uncertain timescales in advanced cancer produce multiple events simultaneously or in quick succession. This demands not only coping with a single event but also frequent repositioning, often to an earlier point in the coping process. In addition, there is substantial ongoing potential for some degree of distress rather than purely “positive emotion” as the final stage in the process is death with several points of permanent loss of capability in the interim. Conclusions The Folkman and Greer theoretical model is helpful in deconstructing the discrete “problem‐focused” or “emotion‐focused” coping mechanisms participants describe, but its formulation as a linear process with a single, positive, outcome is insufficiently flexible to capture the evolution of coping for people with advanced cancer.
    August 18, 2017   doi: 10.1002/pon.4497   open full text
  • Exploring the screening capacity of the Fear of Cancer Recurrence Inventory‐Short Form for clinical levels of fear of cancer recurrence.
    Joanna E. Fardell, Georden Jones, Allan Ben Smith, Sophie Lebel, Belinda Thewes, Daniel Costa, Kerry Tiller, Sébastien Simard, Andrea Feldstain, Sara Beattie, Megan McCallum, , Phyllis Butow.
    Psycho-Oncology. August 18, 2017
    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.
    August 18, 2017   doi: 10.1002/pon.4516   open full text
  • Prevalence and initial prescription of psychotropics in patients with common cancers in Japan, based on a nationwide health insurance claims database.
    Izumi Sato, Hideki Onishi, Shuhei Yamada, Koji Kawakami.
    Psycho-Oncology. August 18, 2017
    Objective To investigate the prevalence of psychotropic medication use and identify factors affecting the prescription of psychotropics among patients newly diagnosed with any of 8 common types of cancer. Methods This retrospective descriptive study examined data for patients newly diagnosed with breast, colorectal, liver, lung, ovarian, pancreatic, prostate, or stomach cancer between July 2009 and May 2014. The data were derived from a nationwide health claims database. The proportion of initial prescriptions for all oral psychotropics within 13 months of cancer diagnosis was analyzed by cancer type; the odds ratio (OR) for prescribing psychotropics was calculated using multivariable logistic regression models. Results A total of 14 661 patients were newly diagnosed with cancer. Psychotropics were prescribed for 6593 (45%) patients. The highest and lowest proportions of psychotropic prescriptions were recorded for patients with lung cancer (62.6%) and prostate cancer (35.1%), respectively. The strongest predictors for psychotropic prescriptions were chemotherapy (OR, 2.59; 95% confidence interval [CI], 2.31–2.91; P < .001), lung cancer (OR, 2.47; 95% CI, 2.16–2.83; P < .001), and surgery (OR, 2.12; 95% CI, 1.97–2.28; P < .001). Conclusions The prevalence of and predictors for an initial prescription of psychotropics identified a potential target population of cancer patients requiring psychiatric treatment, particularly soon after a diagnosis of cancer.
    August 18, 2017   doi: 10.1002/pon.4511   open full text
  • A mixed‐methods study to explore the supportive care needs of breast cancer survivors.
    K.K.F. Cheng, H.L. Cheng, W.H. Wong, C. Koh.
    Psycho-Oncology. August 18, 2017
    Objective Needs assessment is the essence of quality cancer survivorship care. The aim of this study was to explore the supportive care needs of breast cancer survivors (BCS) in the first 5 years post treatment. Methods A mixed‐methods approach was employed. A quantitative study included a Supportive Care Needs Survey, which was completed by 250 BCS to identify the level of their needs for help. The quantitative data informed semistructured qualitative interviews undertaken with 60 BCS to explore in detail their posttreatment needs and experiences. Results 32.4% and 16.8% reported 1 to 5 and greater than or equal to 6 needs for help, respectively. The regression analyses revealed that women within 2 years posttreatment and with higher educational level had higher levels of Psychological and Health Care System/Information needs. The qualitative data revealed “continuity of care” and “lifestyle advice and self‐management” as prominent survivorship concerns. It was shown that determination to continue normal life, social support, and feeling overwhelmed by information were all experienced as important influences on survivors' need for help. Conclusions Posttreatment needs vary with BCS characteristics and to the domains concerned. The approach to posttreatment care needs to be personalized and viable.
    August 18, 2017   doi: 10.1002/pon.4503   open full text
  • Comparison of fatigue, depression, and anxiety as factors affecting posttreatment health‐related quality of life in lung cancer survivors.
    Ju Youn Jung, Jong Mog Lee, Moon Soo Kim, Young Mog Shim, Jae Ill Zo, Young Ho Yun.
    Psycho-Oncology. August 17, 2017
    Objective To compare the effects of fatigue, anxiety, and depression on health‐related quality of life (HRQoL) in survivors of surgically resectable lung cancer. Methods In total, 830 lung cancer survivors participated in the study. They completed a questionnaire consisting of items pertaining to sociodemographic characteristics, clinical variables, and HRQoL. We calculated prevalence rates for fatigue, anxiety, and depression and performed multiple logistic regression and general linear modeling to determine the main factors affecting HRQoL. Results The prevalence rates for moderate fatigue (Brief Fatigue Inventory mean score: ≥4), borderline depression (Hospital Anxiety and Depression Scale‐Depression score: ≥8), and borderline anxiety (Hospital Anxiety and Depression Scale‐Anxiety score: ≥8) were 42.2%, 38.9%, and 20.9%, respectively. The main factor was fatigue, which demonstrated the strongest explanatory power for HRQoL including all 5 functional HRQoL components (ie, physical, role, emotional, cognitive, and social functioning) and global health status (partial R2 range: .13 to .19). However, anxiety (partial R2 = .21) and fatigue (partial R2 = .19) both demonstrated strong explanatory power for emotional HRQoL. In addition, depression demonstrated weak explanatory power for HRQoL including emotional HRQoL. Conclusions Relative to depression and anxiety, fatigue exerted a stronger effect on lung cancer survivors' HRQoL. Health professionals should consider the reduction of fatigue a priority in improving cancer patients' HRQoL following the completion of cancer treatment.
    August 17, 2017   doi: 10.1002/pon.4513   open full text
  • The effectiveness of a group intervention to facilitate posttraumatic growth among women with breast cancer.
    Catarina Ramos, Pedro Alexandre Costa, Tânia Rudnicki, Ana Lúcia Marôco, Isabel Leal, Raquel Guimarães, José Luís Fougo, Richard G. Tedeschi.
    Psycho-Oncology. August 16, 2017
    Objective This longitudinal study tested the effectiveness of a group intervention designed to facilitate posttraumatic growth (PTG). Methods Sample consisted of 205 women diagnosed with non‐metastatic breast cancer who were either assigned to an intervention group (n = 58) or to a control group (n = 147). PTG, challenge to core beliefs, and rumination (intrusive and deliberate) were assessed at baseline (T1), at 6 months (T2), and at 12 months after baseline (T3). Results Results from the Latent Growth Modeling suggested that participants from the intervention group have higher levels of PTG. The challenge to core beliefs and the intrusive rumination have a moderator role on PTG, since group intervention is also linked to the enhancement of both variables. Conclusions Participation in the intervention group increase PTG. Challenge to core beliefs and intrusive rumination are improved by group intervention, which to a certain extent facilitate PTG.
    August 16, 2017   doi: 10.1002/pon.4501   open full text
  • Protection motivation theory in predicting intention to receive cervical cancer screening in rural Chinese women.
    Yang Bai, Qing Liu, Xinguang Chen, Yanduo Gao, Huiyun Gong, Xiaodong Tan, Min Zhang, Jiyu Tuo, Yuling Zhang, Qunying Xiang, Fenghua Deng, Guiling Liu.
    Psycho-Oncology. August 15, 2017
    Objective Despite the significance of cervical cancer screening, motivating more women to participate remains a challenge in resource‐limited settings. In this study, we tested the protection motivation theory (PMT) in predicting screening intentions. Methods Participants were women from Wufeng, a typical rural county in China. Participants (n = 3000) with no cervical cancer history were recruited from 10 randomly selected villages. As mediating variables, 6 PMT constructs (Perceived Risk, Fear Arousal, Perceived Severity, Response Efficacy, Response Cost, and Self‐Efficacy) were measured using the standardized questionnaire. Structural equation modeling (SEM) method was employed to test PMT‐based prediction models. Results Of the total sample, 57.77% believed that regular screening may reduce cervical cancer risk, and 45.26% agreed that women should be screened regularly. Our data fit the PMT model well (GFI = 0.95, AGFI = 0.93, CFI = 0.90, RMSEA = 0.06, SRMR = 0.04, Chi‐square/df = 2.47). Knowledge of screening was directly and positively associated with screening intention. Age, annual income, and awareness of and prior experience with screening were significantly associated with screening intention by enhancing cervical cancer risk perception and by reducing response cost (P<0.05 for both). Conclusion PMT can be used as guidance to investigate cervical cancer screening intentions among rural women in China with focus on cancer knowledge, some demographic factors, and awareness of and previous experience with screening. These findings, if verified with longitudinal data, can be used for intervention program development.
    August 15, 2017   doi: 10.1002/pon.4510   open full text
  • End‐of‐life experiences of family caregivers of deceased patients with cancer: A nation‐wide survey.
    Kayo Hirooka, Hiroyuki Otani, Tatsuya Morita, Tomofumi Miura, Hiroki Fukahori, Maho Aoyama, Yoshiyuki Kizawa, Yasuo Shima, Satoru Tsuneto, Mitsunori Miyashita.
    Psycho-Oncology. August 15, 2017
    Objectives The purpose of this study was (a) to describe the end‐of‐life experience of family caregivers of cancer patients, (b) to describe talking about death and dying of the patient to minor children, and (c) to examine the association of family caregivers' experiences by their characteristics and talking about death and dying of the patient. Methods A cross‐sectional nationwide survey of bereaved family caregivers was conducted. In total, 968 questionnaires were sent to bereaved family caregivers, and 711 were completed and returned. Fifty‐three responses indicating patients had minor children were analyzed. Univariate analysis and principal component analysis were performed. Results Family caregivers' experiences were divided into 3 domains by principal component analysis: protect children from the patient's imminent death, little regard for the children, and worry and concern about the children's emotional reaction. Family caregivers' common experiences were as follows: “I wanted to know how the children felt,” “I wanted to avoid making the children confused,” and “I did not have much time to talk with and/or play with the children.” About 30% of family caregivers reported that they “did not talk” about death and dying of patients to minor children. Spouses of patients and family caregivers who did not talk about death tended to experience distress and worry. Conclusions Most family caregivers experienced worry and fear regarding minor children's emotional reaction; therefore, clinicians need to explain children's emotional and psychological reactions to family caregivers when a patient is at the end‐of‐life.
    August 15, 2017   doi: 10.1002/pon.4504   open full text
  • Traumatic stress in patients with acute leukemia: A prospective cohort study.
    Gary Rodin, Amy Deckert, Eryn Tong, Lisa W. Le, Anne Rydall, Aaron Schimmer, Charles R. Marmar, Chris Lo, Camilla Zimmermann.
    Psycho-Oncology. August 10, 2017
    Objective Acute leukemia (AL) is associated with an immediate threat to life, an unpredictable clinical course, and substantial physical suffering. Traumatic stress symptoms that may meet criteria for acute stress disorder (ASD) may be common and disabling in this context, but have received little clinical attention. We investigated the incidence over time and risk factors for traumatic stress symptoms and ASD in the 3 months following diagnosis or relapse of AL. Methods Individuals with AL were recruited at a tertiary cancer center in Canada within one month of diagnosis or relapse. Participants (N = 230) completed self‐report measures, including the Stanford Acute Stress Reaction Questionnaire, at baseline and monthly over 3 months. The incidence of traumatic stress symptoms over time was examined, and a generalized logistic model was used to identify factors associated with ASD. Results Participants were 60% male, with a mean age of 48.9 ± 15.2 years. Symptoms of ASD were identified on ≥1 assessment over the study period in 24.4% of participants at baseline and in an additional 12.6% at a subsequent follow‐up. Of these, 55.3% reported symptoms on ≥2 assessments. ASD was associated with having young children, being unmarried, acute lymphocytic leukemia, and greater physical symptom burden. Persistent or recurrent ASD was associated with female sex, acute lymphocytic leukemia, greater attachment anxiety, less spiritual well‐being, and less satisfactory patient‐clinician communication. Conclusions Symptoms of ASD are common and often persist or recur following diagnosis or relapse of AL. Research is urgently needed to determine the impact of interventions to prevent and treat psychological distress in this population.
    August 10, 2017   doi: 10.1002/pon.4488   open full text
  • Sexual life after mastectomy in breast cancer survivors: A qualitative study.
    Nasrin Fouladi, Farhad Pourfarzi, Negin Dolattorkpour, Sara Alimohammadi, Elham Mehrara.
    Psycho-Oncology. August 08, 2017
    Objective Mastectomy is a highly frequent form of breast cancer treatment in Iran, and sexual dysfunction after mastectomy has been reported in the majority of breast cancer survivors in Iran. In this qualitative study, an attempt was made to examine the stages that patients go through in their sexual lives after mastectomy. Method and materials Using purposeful sampling, 30 married women, who had undergone surgery and had completed an adjuvant treatment period, participated in the study. Data collection was done using in‐depth, open, and semistructured interviews. Content analysis was used. Results Two main categories were identified in the stages the patients go through following mastectomy: sexual function breakdown and restoration of sexual function, each of which involved 3 subcategories, in turn. Subcategories of the first category were perceived physical changes by the survivor and altered sexual behaviors. These 2 factors lead to sexual function breakdown. The third subcategory includes the factors exacerbating the sexual function breakdown. The subcategories of the second category were modification in sexual behaviors, effort for physical restoration, and striving to gain support. Conclusion It was found that in Iranian society, due to cultural context, some taboos, and patriarchal structure, the patients are placed under added pressure following mastectomy. As a consequence, they suffer emotional problems, in addition to physical complications of the disease and its treatments.
    August 08, 2017   doi: 10.1002/pon.4479   open full text
  • An investigation of support services available by Internet searching to families impacted by a parent's cancer.
    Julia N. Morris, Jeneva Ohan, Angelita Martini.
    Psycho-Oncology. August 08, 2017
    Objective Throughout a parent's cancer diagnosis and treatment, families are likely to turn to the Internet to find social, emotional, and informational support services. It is important that professionals understand the content and availability of support discoverable through Web searches. This study identified and described Web‐based information regarding support services offered to families when a parent has cancer. Methods Predefined key search terms were searched across 2 public Web browsers for a period of 3 months. Web‐based information of support services (n = 25) was abstracted, and their key criteria examined. Results Of services offering face‐to‐face support (n = 22), more were founded by persons impacted by cancer (n = 10) (patients, parents, and offspring) than professionals (n = 4). Services offered online were created by health organisations and universities (n = 3). It appeared several service programs were delivered by volunteers, support staff, or facilitators, rather than registered health professionals or those with professional qualifications. Few services supported young children (under 5 years) or the parents themselves. Conclusion Support services for families affected by a parent's cancer is relatively difficult to find through Web searches. Ambiguity around staff qualifications or evidence‐base of support may hinder layperson engagement. Services offering face‐to‐face support were often founded by those directly affected by cancer; conversely, services founded by persons with assumable expertise (health organisation and university staff) were limited to online support. Such findings highlight a possible discrepancy in consumer and provider priorities and have implications for current understandings of psychosocial support needs and service development for families affected by a parent's cancer.
    August 08, 2017   doi: 10.1002/pon.4478   open full text
  • Feasibility of the mobile mindfulness‐based stress reduction for breast cancer (mMBSR(BC)) program for symptom improvement among breast cancer survivors.
    Cecile A. Lengacher, Richard R. Reich, Sophia Ramesar, Carissa B. Alinat, Manolete Moscoso, Lakeshia Cousin, Victoria R. Marino, Maya N. Elias, Carly L. Paterson, Michelle L. Pleasant, Carmen S. Rodriguez, Hsiao‐Lan Wang, Kevin E. Kip, Hongdao Meng, Jong Y. Park.
    Psycho-Oncology. August 08, 2017
    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.
    August 08, 2017   doi: 10.1002/pon.4491   open full text
  • SSRIs associated with decreased risk of hepatocellular carcinoma: A population‐based case‐control study.
    Hsiang‐Lin Chan, Wei‐Che Chiu, Vincent Chin‐Hung Chen, Kuo‐You Huang, Tsu‐Nai Wang, Yena Lee, Roger S. McIntyre, Tsai‐Ching Hsu, Charles Tzu‐Chi Lee, Bor‐Show Tzang.
    Psycho-Oncology. August 08, 2017
    Background Hepatocellular carcinoma (HCC) is the second leading cancer‐related cause of mortality worldwide. Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are commonly used worldwide. Available evidence investigating the association between SSRIs use and HCC risk is limited. Objective The present study aimed to investigate if the effect of all kinds of SSRIs on HCC was the same or not using population‐based study. Methods The nationwide population‐based study herein using Taiwan's National Health Insurance Research Database included a total of 59 859 cases with HCC and 285 124 matched controls. Conditional logistic regression analyses were adjusted for confounding variables. Results All common kinds of SSRIs including fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and fluvoxamine were associated with lower HCC risk, and the findings were dose‐dependent (eg, fluoxetine: 1‐28 DDD [defined daily dose]: adjusted odds ratio [aOR]: 0.81, 95% confidence interval [CI], 0.73‐0.89; 29‐365 DDD: aOR: 0.71, 95% CI, 0.64‐0.79; and ≥366 DDD: aOR: 0.55, 95% CI, 0.45‐0.67) (P for trend < .001). Conclusions All kinds of SSRIs were associated with decreased risk of HCC.
    August 08, 2017   doi: 10.1002/pon.4493   open full text
  • Validation of the modified Chinese Cancer Survivor's Unmet Needs (CaSUN‐C) for women with breast cancer.
    Su‐Ying Fang, Hsiu‐Rong Cheng, Chung‐Ying Lin.
    Psycho-Oncology. August 07, 2017
    Objective The aims of the study were to modify the Cancer Survivor's Unmet Need (CaSUN) Scale into a short form and then test its psychometric scale‐specific properties for breast cancer survivors in Taiwan. Methods Using convenience sampling, recruited breast cancer survivors were separated into 2 samples (sample 1, n = 150, and sample 2, n = 162). First, we translated and modified the CaSUN to ensure cultural adaptation. Second, we used statistical methods to eliminate some items and conducted an exploratory factor analysis (EFA) using sample 1 to explore the factor structure of the CaSUN‐C. Finally, we conducted a confirmatory factor analysis using sample 2 to confirm the structure suggested by the EFA and tested the criterion validity and known‐group validity of the CaSUN‐C. Results Twenty items within 4 factors (information, physical /psychological, medical care, and communication needs) were identified for the CaSUN‐C. Each factor had acceptable internal consistency (Cronbach's Alpha = .61 to .82). The criterion validity was supported by the significant correlations between the CaSUN‐C scores and scores on fear of recurrence and depression. Known‐group comparisons revealed that women who survived more than 60 months had fewer physical/psychological needs than those less 60 months, which supported the validity of CaSUN‐C. Conclusion The CaSUN‐C demonstrated acceptable reliability and validity for assessing unmet needs among breast cancer survivors in Taiwan. Using this simple assessment to target the individual needs of these survivors can help healthcare professionals provide personalized care efficiently.
    August 07, 2017   doi: 10.1002/pon.4499   open full text
  • Cancer‐related disease factors and smoking cessation treatment: Analysis of an ongoing clinical trial.
    Allison J. Carroll, Anna K. Veluz‐Wilkins, Sonja Blazekovic, Ravi Kalhan, Frank T. Leone, E. Paul Wileyto, Robert A. Schnoll, Brian Hitsman.
    Psycho-Oncology. August 04, 2017
    Objective Smoking cessation treatment should be an important aspect of cancer care. In this study, we evaluated whether cancer‐related disease factors adversely influence smoking cessation treatment. Methods Smokers with cancer (within 5 years of diagnosis, any tumor site) were recruited for an ongoing trial of varenicline for smoking cessation. Disease factors, assessed at baseline, included tumor site, cancer treatment, time since diagnosis, and health‐related quality of life. Medication adherence was defined by 132 of 165 pills taken and counseling adherence was defined by 4 of 4 behavioral counseling sessions attended. Abstinence was bioverified at Week 12. Using logistic regression analysis, we assessed the relationship between disease factors and 12‐week medication adherence, counseling adherence, and abstinence. Results Of 144 participants, 56% were medication adherent, 74% were counseling adherent, and 39% were abstinent. Health‐related quality of life predicted medication adherence (OR: 1.08, 95% CI, 1.01‐1.16, P = .019, d = 0.20) but not counseling adherence or 12‐week abstinence. Tumor site, cancer treatment, and time since diagnosis did not predict any smoking cessation treatment outcomes. Conclusions Cancer‐related disease factors did not predict cancer survivors' engagement or success in smoking cessation treatment. Findings support National Comprehensive Cancer Network Clinical Practice guidelines that recommend smoking cessation treatment for all smokers with cancer, regardless of time since diagnosis.
    August 04, 2017   doi: 10.1002/pon.4483   open full text
  • Changes in spiritual well‐being and psychological outcomes in ovarian cancer survivors.
    Lauren Z. Davis, Michaela Cuneo, Premal H. Thaker, Michael J. Goodheart, David Bender, Susan K. Lutgendorf.
    Psycho-Oncology. August 04, 2017
    Objective Because of the poor prognosis of ovarian cancer and concomitant distress, understanding contributors to positive well‐being is critical. This study examines spiritual growth as a domain of posttraumatic growth and its contribution to longitudinal emotional outcomes in ovarian cancer. Methods Ovarian cancer patients (N = 241) completed measures assessing spirituality (Functional Assessment of Chronic Illness Therapy–Spiritual Well‐being−12; subscales: faith, meaning, and peace), depression (Center for Epidemiologic Studies Depression Scale), cancer‐specific anxiety (Impact of Event Scale), and total mood disturbance (TMD; Profile of Mood States) prior to surgery and 1‐year postsurgery. Stressful life events in the year after diagnosis were measured at 1‐year postsurgery. Regressions examined the association between changes in spirituality and depression, anxiety, and TMD at 1‐year postsurgery. Additionally, spiritual change was examined as a moderator of the effect of recent life events on mood. Results Increases in peace were related to lower depression (β = −.40, P < .001), anxiety (β = −.20, P = .004), and TMD (β = −.41, P < .001) at 1 year. Changes in meaning and faith were unrelated to all outcomes. Additionally, changes in peace moderated the effect of stressful life events on depression (β = −.14, P = .027), anxiety (β = −.16, P = .05), and TMD (β = −.17, P = .01), such that those with a high number of life events paired with a decrease in peace experienced the worst psychological outcomes at 1 year. Conclusion These findings suggest that the quality of peace may be the most adaptive facet of spiritual growth in cancer patients. Furthermore, changes in peace appear to moderate the effect of life events on psychological well‐being.
    August 04, 2017   doi: 10.1002/pon.4485   open full text
  • Does age matter? Comparing post‐treatment psychosocial outcomes in young adult and older adult cancer survivors with their cancer‐free peers.
    Michael J. Lang, Janine Giese‐Davis, Scott B. Patton, David J.T. Campbell.
    Psycho-Oncology. August 04, 2017
    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.
    August 04, 2017   doi: 10.1002/pon.4490   open full text
  • Body image mediates the effect of cancer‐related stigmatization on depression: A new target for intervention.
    Peter Esser, Anja Mehnert, Christoffer Johansen, Beate Hornemann, Andreas Dietz, Jochen Ernst.
    Psycho-Oncology. August 01, 2017
    Objective Because cancer‐related stigmatization is prevalent but difficult to change, research on its impact on psychological burden and respective intervening variables is needed. Therefore, we investigated the effect of stigmatization on depressive symptomatology and whether body image mediates this relationship. Methods This bicentric study assessed patients of 4 major tumor entities. We measured stigmatization (SIS‐D), depressive symptomatology (PHQ‐9), and body image (FKB‐20). Applying multiple mediator analyses, we calculated the total effect of stigmatization on depressive symptomatology and the indirect effects exerted via the 2 body image scales rejecting body evaluation and vital body dynamics. Results Among the 858 cancer patients recruited (breast: n = 297; prostate: n = 268; colorectal: n = 168; lung: n = 125), stigmatization showed total effects on depressive symptomatology across all stigma dimensions (all ptotal sample < .001). Except for lung cancer patients, this result was replicated for each cancer group. Body image as a whole was shown to mediate the effect across all samples (γtotal sample = .04, 95%‐CI: 0.03‐0.06). Among the total sample and prostate cancer patients, the mediating effect of rejecting body evaluation was significantly larger than the effect of vital body dynamics (dtotal sample = .02, 95%‐CI: 0.01‐0.04). Conclusions Perceived stigmatization is an important and generalizable risk factor for depressive symptomatology among cancer patients. Apart from interventions addressing stigmatization, improving body image could additionally help to reduce the psychological burden in stigmatized patients.
    August 01, 2017   doi: 10.1002/pon.4494   open full text
  • Limitations in the inverse association between psychological resilience and depression in prostate cancer patients experiencing chronic physiological stress.
    Christopher F. Sharpley, David R.H. Christie, Vicki Bitsika, Linda L. Agnew, Nicholas M. Andronicos, Mary E. McMillan, Timothy M. Richards.
    Psycho-Oncology. August 01, 2017
    Objective To investigate the effect of chronic stress as measured in cortisol concentrations upon the association between psychological resilience (PR) and depression in prostate cancer (PCa) patients. Methods A total of 104 men with PCa completed inventories on PR, depression, and background factors, plus gave a sample of their saliva for cortisol assay. Results The inverse correlation between PR and depression was present only for PCa patients with low or moderate concentrations of salivary cortisol (when classified as more than 1.0 SD below the mean vs within 1.0 SD of the group mean) but not for those men whose cortisol was >1.0 SD from the group mean. Specific PR factors and behaviours that made the greatest contribution to depression were identified for the low and moderate cortisol groups. Conclusions These results suggest that there are particular aspects of PR that are most strongly related to depression, but that PR's inverse association with depression may be absent in participants with extreme chronic physiological stress.
    August 01, 2017   doi: 10.1002/pon.4496   open full text
  • Positive aspects of having had cancer: A mixed‐methods analysis of responses from the American Cancer Society Study of Cancer Survivors‐II (SCS‐II).
    Gail Adorno, Ellen Lopez, Mary Ann Burg, Victoria Loerzel, Michael Killian, Amy B. Dailey, Joanne D. Iennaco, Cara Wallace, Dinghy Kristine B. Sharma, Kevin Stein.
    Psycho-Oncology. July 31, 2017
    Objective This study focused on understanding positive aspects of cancer among a large, national sample of survivors, 2, 5, and 10 years' postcancer diagnosis, who responded to the American Cancer Society Study of Cancer Survivors ‐ II (SCS‐II) survey “Please tell us about any positive aspects of having cancer.” Methods A sequential mixed methods approach examined (1) thematic categories of positive aspects from cancer survivors (n = 5149) and (2) variation in themes by sociodemographics, cancer type, stage of disease, and length of survivorship. Results Themes comprised 21 positive aspects within Thornton's typology of benefits that cancer survivors attribute to their illness: life perspectives, self, and relationships. New themes pertaining to gratitude and medical support during diagnosis and treatment, health‐related changes, follow‐up/surveillance, and helping others emerged that are not otherwise included in widely used existing benefit finding cancer scales. Gratitude and appreciation for life were the most frequently endorsed themes. Sociodemographics and stage of disease were associated with positive aspect themes. Themes were not associated with survivor cohorts. Conclusions No differences in perceived positive aspects across survivor cohorts suggest that positive aspects of cancer may exist long after diagnosis for many survivors. However, variation across sociodemographics and clinical variables suggests cancer survivors differentially experience positive aspects from their cancer diagnosis. Implications for cancer survivors This analysis provides new information about cancer survivors' perceptions of positive aspects from their cancer and factors associated with benefit finding and personal growth. This information can be useful in further refining quality‐of‐life measures and interventions for cancer survivors.
    July 31, 2017   doi: 10.1002/pon.4484   open full text
  • Randomized controlled trial of a peer led multimodal intervention for men with prostate cancer to increase exercise participation.
    Daniel A. Galvão, Robert U. Newton, Afaf Girgis, Stephen J. Lepore, Anna Stiller, Cathrine Mihalopoulos, Robert A. Gardiner, Dennis R. Taaffe, Stefano Occhipinti, Suzanne K. Chambers.
    Psycho-Oncology. July 27, 2017
    Objective Exercise may reduce morbidity, increase survival, and improve quality of life (QoL) in prostate cancer patients. However, effective ways to encourage exercise outside carefully controlled clinical trials remain uncertain. We evaluated the effectiveness of peer‐led self‐management for increasing exercise participation in men with localized prostate cancer. Methods Four hundred and sixty‐three prostate cancer patients from Queensland, Australia were randomized to a monthly telephone‐based group peer support for 6 months supported by self‐management materials and exercise equipment (INT, n = 232) or usual care (UC, n = 231). Participants were assessed at baseline, 3, 6, and 12 months. Primary outcomes were compliance with exercise guidelines; secondary outcomes were psychological distress and QoL. Results Patients in INT engaged in more resistance exercise than UC at 3 months (19.4 [95% CI 6.52 to 32.28] min/wk, P = .003) and 6 months (14.6 [95% CI 1.69 to 27.58] min/wk, P = .027); more men achieved sufficient physical activity levels at 3 months (χ2 = 8.89, P = 0.003). There was no difference between groups for aerobic‐based activity at any time point nor for resistance exercise time at 12‐month follow‐up. INT had higher QoL Relationships scores at 3 months (.03 [95% CI .00 to .06], P = .038) compared with UC. Limitation included self‐reported assessment of exercise. Conclusions Peer‐led intervention was effective in increasing patients' resistance exercise participation in the short‐to‐medium term and in the number of men achieving sufficient activity levels in the short‐term; however, this was not accompanied by overall improvements in QoL or psychological distress. Methods to increase effectiveness and maintain long‐term adherence require further investigation.
    July 27, 2017   doi: 10.1002/pon.4495   open full text
  • Predicting future major depression and persistent depressive symptoms: Development of a prognostic screener and PHQ‐4 cutoffs in breast cancer patients.
    Karen L. Weihs, Joshua F. Wiley, Catherine M. Crespi, Jennifer L. Krull, Annette L. Stanton.
    Psycho-Oncology. July 26, 2017
    Objective Create a brief, self‐report screener for recently diagnosed breast cancer patients to identify patients at risk of future depression. Methods Breast cancer patients (N = 410) within 2 ± 1 months after diagnosis provided data on depression vulnerability. Depression outcomes were defined as a high depressive symptom trajectory or a major depressive episode during 16 months after diagnosis. Stochastic gradient boosting of regression trees identified 7 items highly predictive for the depression outcomes from a pool of 219 candidate depression vulnerability items. Three of the 7 items were from the Patient Health Questionnaire 4 (PHQ‐4), a validated screener for current anxiety/depressive disorder that has not been tested to identify risk for future depression. Thresholds classifying patients as high or low risk on the new Depression Risk Questionnaire 7 (DRQ‐7) and the PHQ‐4 were obtained. Predictive performance of the DRQ‐7 and PHQ‐4 was assessed on a holdout validation subsample. Findings DRQ‐7 items assess loneliness, irritability, persistent sadness, and low acceptance of emotion as well as 3 items from the PHQ‐4 (anhedonia, depressed mood, and worry). A DRQ‐7 score of ≥6/23 identified depression outcomes with 0.73 specificity, 0.83 sensitivity, 0.68 positive predictive value, and 0.86 negative predictive value. A PHQ‐4 score of ≥3/12 performed moderately well but less accurately than the DRQ‐7 (net reclassification improvement = 10%; 95% CI [0.5–16]). Interpretation The DRQ‐7 and the PHQ‐4 with a new cutoff score are clinically accessible screeners for risk of depression in newly diagnosed breast cancer patients. Use of the screener to select patients for preventive interventions awaits validation of the screener in other samples.
    July 26, 2017   doi: 10.1002/pon.4472   open full text
  • Understanding how coping strategies and quality of life maintain hope in patients deliberating phase I trial participation.
    Diane A. Biessen, Peer G. Helm, Dennis Klein, Simone Burg, Ron H. Mathijssen, Martijn P. Lolkema, Maja J. Jonge.
    Psycho-Oncology. July 26, 2017
    Objective This study aimed to understand how hope and motivation of patients considering phase I trial participation are affected by psychological factors such as coping strategies and locus of control (LoC) and general well‐being as measured by the quality of life (QoL). Methods An exploratory cross‐sectional study was performed in patients with incurable cancer (N = 135) referred to our phase I unit for the first time. Patients were potentially eligible for phase I trial participation and participated in our study while deliberating phase I trial participation. We used questionnaires on hope, motivation to participate, coping, LoC, and QoL. To investigate the nature and magnitude of the relationships between the scales, a structural equation modeling (SEM) was fitted to the data. Results Hope significantly predicted the motivation to participate in phase I trials. Predictors of hope were a combination of flexible and tenacious goal pursuit (both P < .01), internal LoC (P < .01), and QoL (P < .01). The SEM showed an exact fit to the data, using a null hypothesis significance test: chi‐square (8) = 9.30, P = .32. Conclusions Patients considering phase I trial participation seem to use a pact of tenacious and flexible coping and control to stay hopeful. Furthermore, hope and QoL positively affected each other. The psychological pact may promote an adaptation enabling them to adjust to difficult circumstances by unconsciously ignoring information, called dissonance reduction. This mechanism may impair their ability to provide a valid informed consent. We suggest including a systematic exploration of patients' social context and values before proposing a phase I trial.
    July 26, 2017   doi: 10.1002/pon.4487   open full text
  • Experience and psychological impact of anal cancer screening in gay, bisexual and other men who have sex with men: a qualitative study.
    S. Russo, K. Mccaffery, J. Ellard, M. Poynten, G. Prestage, D.J. Templeton, R. Hillman, C. Law, A.E. Grulich.
    Psycho-Oncology. July 24, 2017
    Objective Human papillomavirus–related anal cancer rates are increasing and are particularly high in gay, bisexual and other men who have sex with men (GBM/MSM), especially HIV‐positive individuals. Although screening programs for high‐risk populations have been advocated, concerns about possible adverse psychological consequences exist. This study aimed to investigate GBM/MSM's experience, understanding and emotional response to screening techniques for anal cancer to determine how best to minimise psychological distress in future programs. Methods In‐depth qualitative face‐to‐face interviews were conducted with 21 GBM/MSM participating in the “Study of the Prevention of Anal Cancer” in Sydney, Australia, between June 2013 and June 2014. Nonrandom, purposive sampling was used to ensure heterogeneity with respect to HIV status and screening test results. Framework analysis method was used to organise the data and identify emerging themes. Results Knowledge about anal cancer, human papillomavirus and the link between them was limited. Abnormal screening results affected participants' sense of well‐being and were associated with anxiety and concern about developing anal cancer. HIV‐negative men receiving abnormal results showed higher levels of distress compared to their HIV‐positive counterparts. Consultations with general practitioners about abnormal results had an important role in increasing participants' understanding and in moderating their anxiety. Conclusion Anal cancer screening should be accompanied by health education around anal cancer, its aetiology and the meaning of associated test results. Simple and effective communication strategies should be encouraged. Collaboration with general practitioners could assist the process of education and reporting test results.
    July 24, 2017   doi: 10.1002/pon.4480   open full text
  • Verbal communication of families with cancer patients at end of life: A questionnaire survey with bereaved family members.
    Kazuhiro Nakazato, Mariko Shiozaki, Kei Hirai, Tatsuya Morita, Ryuhei Tatara, Kaori Ichihara, Shinichi Sato, Megumi Simizu, Satoru Tsuneto, Yasuo Shima, Mitsunori Miyasita.
    Psycho-Oncology. July 24, 2017
    Objective To clarify the verbal communication of feelings between families and patients in Japanese palliative care units from the perspective of bereaved family members by examining (1) proportions of families' and patients' verbalization of six feelings (gratitude, love, seeking forgiveness, giving forgiveness, wishes after death, and continuing bonds), (2) recognition of receiving these feelings through verbalization from the family's perspective, and (3) the specific attitudes of family members that influence their verbalizations. Methods In 2010, a cross‐sectional survey was conducted with 968 bereaved families of cancer patients in palliative care units across Japan. Results Five hundred thirty‐seven responses were analyzed. (1) “Gratitude” was verbalized most often (families: 47%; patients: 61%), and “expressing forgiveness” least often (families: 16%; patients: 11%). (2) Even if the words were not used, 81.2% to 88.2% of families answered that they had received the patient's feelings, and 71.8% to 85.4% of families felt the patient had received their feelings. (3) Multiple logistic regression analyses indicated that the strongest attitudes determining verbalizing were “not wanting to say farewell without conveying feelings,” “a daily basis of expressing,” and “heart‐to‐heart communication” (ishin‐denshin). Conclusions For both families and patients, verbalizing feelings was difficult. Our results showed that families' and patients' verbalizing and receiving of feelings must be aligned to understand their communication at the end of life in Japan. Future research is needed to verify how attitude helps promote or inhibit verbalization.
    July 24, 2017   doi: 10.1002/pon.4482   open full text
  • Effects of stepped psychooncological care on referral to psychosocial services and emotional well‐being in cancer patients: A cluster‐randomized phase III trial.
    Susanne Singer, Helge Danker, Julia Roick, Jens Einenkel, Susanne Briest, Henning Spieker, Andreas Dietz, Isabell Hoffmann, Kirsten Papsdorf, Jürgen Meixensberger, Joachim Mössner, Franziska Schiefke, Anja Dietel, Hubert Wirtz, Dietger Niederwieser, Thomas Berg, Anette Kersting.
    Psycho-Oncology. July 20, 2017
    Objective Emotional distress in cancer patients often goes unnoticed in daily routine; therefore, distress screening is now recommended in many national guidelines. However, screening alone does not necessarily translate into better well‐being. We examined whether stepped psychooncological care improves referral to consultation‐liaison (CL) services and improves well‐being. Methods In a cluster‐randomized trial, wards were randomly allocated to stepped versus standard care. Stepped care comprised screening for distress, consultation between doctor and patient about the patient's need for CL services, and provision of CL service. Primary outcomes were referral to psychosocial services and emotional well‐being half a year after baseline, measured with the Hospital Anxiety and Depression Scale. A secondary endpoint was uptake of outpatient health care. Analysis employed mixed‐effects multivariate regression modeling. Results Thirteen wards were randomized; 1012 patients participated. With stepped care (N = 570; 7 wards), 22% of the patients were referred to CL services and 3% with standard care (N = 442; 6 wards; odds ratio [OR] 10.0; P < .001). Well‐being 6 months after baseline was 9.5 after stepped care (N = 341) and 9.4 after standard care (N = 234, β −0.3; P = .71). After stepped care, patients with psychiatric comorbidity went more often to psychotherapists (OR 4.0, P = .05) and to psychiatrists (OR 2.3, P = .12), whereas patients without comorbidity used psychiatrists less often (OR 0.4, P = .04) than in standard care. Conclusions Stepped care resulted in better referral to CL services. The patients' emotional well‐being was not improved, but uptake of outpatient psychiatric help was increased in patients with psychiatric comorbidity and decreased in patients without.
    July 20, 2017   doi: 10.1002/pon.4492   open full text
  • Symptom appraisal, help seeking, and lay consultancy for symptoms of head and neck cancer.
    J.A. Queenan, B.H. Gottlieb, D. Feldman‐Stewart, S.F. Hall, J. Irish, P.A. Groome.
    Psycho-Oncology. July 13, 2017
    Objective Early diagnosis is important in head and neck cancer (HNC) patients to maximize the effectiveness of the treatments and minimize the debilitation associated with both the cancer and the invasive treatments of advanced disease. Many patients present with advanced disease, and there is little understanding as to why. This study investigated patients' symptom appraisal, help seeking, and lay consultancy up to the time they first went to see a health care professional (HCP). Methods We interviewed 83 patients diagnosed with HNC. The study design was cross sectional and consisted of structured telephone interviews and a medical chart review. We gathered information on the participant's personal reactions to their symptoms, characteristics of their social network, and the feedback they received. Results We found that 18% of the participants thought that their symptoms were urgent enough to warrant further investigation. Participants rarely (6%) attributed their symptoms to cancer. Eighty‐nine percent reported that they were unaware of the early warning signs and symptoms of HNC. Fifty‐seven percent of the participants disclosed their symptoms to at least one lay consultant before seeking help from an HCP. The lay consultants were usually their spouse (77%), and the most common advice they offered was to see a doctor (76%). Lastly, 81% of the participants report that their spouse influenced their decision to see an HCP. Conclusions The results of this study suggest that patients frequently believe that their symptoms were nonurgent and that their lay consultants influence their decision to seek help from an HCP.
    July 13, 2017   doi: 10.1002/pon.4458   open full text
  • Oncologists', nurses', and social workers' strategies and barriers to identifying suicide risk in cancer patients.
    Leeat Granek, Ora Nakash, Merav Ben‐David, Shahar Shapira, Samuel Ariad.
    Psycho-Oncology. July 13, 2017
    Objective To identify oncologists', nurses', and social workers' strategies and barriers in identifying suicide risk in cancer patients. Methods Sixty‐one oncology healthcare professionals (HCPs) at 2 cancer centers were interviewed. We used the grounded theory method (GT) of data collection and analysis. Analysis involved line‐by‐line coding, and was inductive, with codes and categories emerging from participants' narratives. Results The majority of oncologists and nurses reported that they had encountered at least 1 patient who had committed suicide during their careers (56% and 55%, respectively) and/or had suicidal ideation (65% and 75%, respectively). Social workers reported having fewer suicides in their practices (22%), but similar rates of suicidal ideation among patients (66%). Strategies to identifying suicide risk included paying attention to patients' verbal indicators, explicit actions, and mental health distress. In addition HCPs reported that mental health disorders and other patient characteristics increased their likelihood to assess suicidality among patients. Reported barriers to identification included patient factors such as patients giving no warning, patients concealing suicidality, and patients failing to come in. HCP barriers to identification included lack of training and awareness, difficulty in differentiating suicidality from mental health distress, lack of time with patients, fear of asking about suicidality, and lack of coping resources to deal with suicidal patients. Conclusions HCPs reports of their lack of training and awareness on identifying suicide risk is alarming given the higher risk of suicide among cancer patients. Training programs should incorporate the successful strategies used by HCPs and overcome barriers to identifying suicide risk.
    July 13, 2017   doi: 10.1002/pon.4481   open full text
  • Decision‐making processes among men with low‐risk prostate cancer: A survey study.
    Richard M. Hoffman, Stephen K. Van Den Eeden, Kimberly M. Davis, Tania Lobo, George Luta, Jun Shan, David Aaronson, David F. Penson, Amethyst D. Leimpeter, Kathryn L. Taylor.
    Psycho-Oncology. July 13, 2017
    Objective To characterize decision‐making processes and outcomes among men expressing early‐treatment preferences for low‐risk prostate cancer. Methods We conducted telephone surveys of men newly diagnosed with low‐risk prostate cancer in 2012 to 2014. We analyzed subjects who had discussed prostate cancer treatment with a clinician and expressed a treatment preference. We asked about decision‐making processes, including physician discussions, prostate‐cancer knowledge, decision‐making styles, treatment preference, and decisional conflict. We compared the responses across treatment groups with χ2 or ANOVA. Results Participants (n = 761) had a median age of 62; 82% were white, 45% had a college education, and 35% had no comorbidities. Surveys were conducted at a median of 25 days (range 9‐100) post diagnosis. Overall, 55% preferred active surveillance (AS), 26% preferred surgery, and 19% preferred radiotherapy. Participants reported routinely considering surgery, radiotherapy, and AS. Most were aware of their low‐risk status (97%) and the option for AS (96%). However, men preferring active treatment (AT) were often unaware of treatment complications, including sexual dysfunction (23%) and urinary complications (41%). Most men (63%) wanted to make their own decision after considering the doctor's opinion, and about 90% reported being sufficiently involved in the treatment discussion. Men preferring AS had slightly more uncertainty about their decisions than those preferring AT. Conclusions Subjects were actively engaged in decision making and considered a range of treatments. However, we found knowledge gaps about treatment complications among those preferring AT and slightly more decisional uncertainty among those preferring AS, suggesting the need for early decision support.
    July 13, 2017   doi: 10.1002/pon.4469   open full text
  • Anxiety and depression in Spanish‐speaking Latina cancer patients prior to starting chemotherapy.
    Morgan S. Lee, Dinorah Martinez Tyson, Brian D. Gonzalez, Brent J. Small, Suzanne C. Lechner, Michael H. Antoni, Andrea Vinard, Madeline Krause, Cathy Meade, Paul B. Jacobsen.
    Psycho-Oncology. July 13, 2017
    Objective Anxiety and depression can substantially impact the life of a cancer patient, but literature on emotional distress in the Hispanic cancer population is sparse. Additionally, the influence of psychosocial variables including age, acculturation, and spiritual well‐being on emotional distress in this population remains unclear. The purpose of the present report was to assess the prevalence of anxiety and depression in Spanish‐speaking Latina cancer patients preparing to begin chemotherapy and to explore the predictors and correlates of these outcomes. Methods Participants were 198 Spanish‐speaking Latina cancer patients who completed measures of anxiety, depression, acculturation, and spiritual well‐being prior to starting chemotherapy. Results Prevalence of clinically significant anxious symptomatology was 52%, and prevalence of clinically significant depressive symptomatology was 27%. Longer time since diagnosis and less acculturation predicted more severe anxiety, while longer time since diagnosis, less acculturation, and older age predicted more severe depression (Ps < .05). In multivariable analyses, only time since diagnosis emerged as a significant predictor of anxiety and depression when accounting for the influence of other variables. Greater spiritual well‐being was correlated with both less severe anxiety and less severe depression (Ps < .001). Conclusions The present findings document the high prevalence of emotional distress, particularly anxiety, in this patient population prior to chemotherapy initiation and identify several demographic and clinical factors associated with increased risk for heightened distress. Additionally, these findings suggest that interventions to address distress in this patient population would benefit from including components that seek to improve patients' spiritual well‐being.
    July 13, 2017   doi: 10.1002/pon.4462   open full text
  • Patients' and family caregivers' understanding of the cancer stage, treatment goal, and chance of cure: A study with patient‐caregiver‐physician triad.
    Dong Wook Shin, Juhee Cho, So Young Kim, Hyung Kook Yang, Keeho Park, Sun‐Seog Kweon, Dai Ha Koh, Hae‐Sung Nam, Jong‐Hyock Park.
    Psycho-Oncology. July 13, 2017
    Objective Accurate understanding of the extent of disease, treatment goal, and prognosis is a prerequisite for patients with cancer and their caregivers to make informed decision. We sought to evaluate patients' and family caregivers' understanding of the cancer stage, treatment goal, and chance of cure taking their own physician's evaluation as reference. Methods A national survey was performed with 750 patient‐caregiver dyads (75.5% participation rate) recruited by 134 oncologists in 13 cancer centers (93% participation rate) in South Korea. Both patients and caregivers were asked to report their knowledge of patient's cancer stage, treatment goal, and chance of cure. Concordance was evaluated with percentage agreement and weighted κ, and predictors of discordance of patient and caregiver's response with that of physician's were explored by multivariate regression analyses with mixed effect model. Results The agreement rates between patient‐physician and caregiver‐physician were 63.0% and 65.9% for disease stage, 69.0% and 70.0% for treatment goal, and 41.4% and 45.1% for chance of cure. When discordance occurs, patients and caregivers often had an optimistic view. Distant stage, older age, female sex, and absence of depression were associated with optimistic view of patients, and there was significant between‐physician variance for all 3 outcomes. Conclusion The discordance revealed that our study suggests the need for better communication between physician and patients, as well as the caregivers. Research is needed to develop a comprehensive strategy to improve the understanding of the patients and family so that treatment decisions are made based on realistic estimation.
    July 13, 2017   doi: 10.1002/pon.4467   open full text
  • Rates and predictors of psychotherapy utilization after psychosocial evaluation for stem cell transplant.
    Valentina Penalba, Yasmin Asvat, Teresa L. Deshields, Jessica R. Vanderlan, Nyadow Chol.
    Psycho-Oncology. July 13, 2017
    Objective Although standard of care prior to hematopoietic stem cell transplantation (HSCT) includes a psychosocial evaluation, little is known about the rate and predictors of psychotherapy utilization among patients presenting for pre‐HSCT evaluations. This study aimed to examine the proportion of patients undergoing pre‐HSCT evaluations who subsequently utilize psychotherapy services and to explore predictive factors, including distress, anxiety, depression, and quality of life (QoL). Methods Participants were a cross‐sectional sample of 351 HSCT candidates at an NCI‐designated comprehensive cancer center. Questionnaires assessing distress, anxiety, depression, and QoL were administered using validated instruments. Results A subset of patients, representing 14% of the sample, utilized psychotherapy services. Relative to patients who did not utilize psychological services, patients who followed‐up with psychotherapy reported significantly more depressive and anxious symptoms (P < .001) and endorsed worse QoL on the Functional Assessment of Cancer Therapy—General. (P = .04). Of note, a subset of patients who utilized psychotherapy services reported low levels of distress (67%), depression (13%), or anxiety (13%); on the other hand, a subset of patients reported moderate‐to‐high levels of distress (25%), depression (71%), or anxiety (60%) but did not utilize services. Conclusions Results indicate that only a small subset of patients presenting for pre‐HSCT psychosocial evaluation subsequently utilized psychotherapy services. Most patients who reported psychosocial concerns and who could potentially benefit from intervention did not use psychotherapy services. Further research is necessary to help clarify barriers to psychotherapy service utilization among HSCT patients and to help improve uptake among high‐need patients.
    July 13, 2017   doi: 10.1002/pon.4473   open full text
  • Clinician perspectives on symptom and quality of life experiences of patients during cancer therapies: Implications for eHealth.
    Donna L. Berry, Manan M. Nayak, Janet L. Abrahm, Ilana Braun, Michael S. Rabin, Mary E. Cooley.
    Psycho-Oncology. July 03, 2017
    Objective The purpose of this study was to explore clinician experiences with cancer symptom and quality of life (SQL) management from diagnosis throughout therapy in the ambulatory setting, plus identify preferences for a future SQL decision support system. Methods Eligible clinicians worked in ambulatory cancer care with responsibility for direct patient care. Focus groups were conducted to discuss symptom management throughout the treatment experience and features desired in a future decision support system. Each group was audio‐recorded, transcribed, de‐identified, and entered into NVivo 9 for analysis. Open and axial coding was completed, grouping common concepts into nodes; large constructs among the nodes were identified and main messages were synthesized. Results A total of 118 clinicians were contacted by email resulting in a final sample of 51 attending 1 of 9 focus groups. Clinicians described a standard face‐to‐face approach to assessment of SQL, before and throughout therapy. Preparing patients for expected symptoms and approaches to management included paper‐based patient education materials and referrals. Communicating with patients between visits was covered in detail, notably use of telephone and email. Future system features desired by the clinicians included an electronic, Web‐based system with real‐time, trended data, reasonable alerts, and tailored information for patients. Conclusions Cancer care specialists reported strategies to assess and manage cancer SQL in ambulatory care including patient‐reported outcome measures, contact communication modes, face‐to‐face interviews, and paper‐based patient education materials. Future system features desired by clinicians included an electronic, Web‐based system with real‐time, trended data, reasonable alerts, and tailored information for patients.
    July 03, 2017   doi: 10.1002/pon.4455   open full text
  • Depression profile in cancer patients and patients without a chronic somatic disease.
    Christoph Nikendei, Valentin Terhoeven, Johannes C. Ehrenthal, Imad Maatouk, Beate Wild, Wolfgang Herzog, Hans‐Christoph Friederich.
    Psycho-Oncology. July 03, 2017
    Background To investigate whether depressed oncology patients show a specific depressive symptom profile, we compared depression symptoms in depressed cancer patients (CANCER‐DEP) and depressed patients without a chronic somatic disease (NONCANCER‐DEP). Methods Of a total of 2493 outpatients from a comprehensive cancer center and a center for psychosocial medicine, 1054 (42.3%) met the DSM‐5 criteria for depression, measured with the Patient Health Questionnaire 9. Based on the Patient Health Questionnaire 9 scores, differences in severity of each of the 9 individual DSM‐5 depression symptoms between CANCER‐DEP (n = 542) and NONCANCER‐DEP (n = 512) were examined. Non‐depressed cancer patients (CANCER‐NONDEP; n = 1216) served as a comparison group for somatic symptoms independent of depression in cancer. To control for depression severity, group comparisons were performed separately for patients with major depression and any depressive disorders. Results Depressed cancer patients reported significantly lower levels of the cognitive‐emotional depression symptoms “worthlessness” and “suicidal thoughts” than NONCANCER‐DEP. Only 1 out of 5 somatic depression symptoms (“changes in appetite”) was more pronounced in CANCER‐DEP than in NONCANCER‐DEP. Confirming previous research, somatic depression symptoms occurred more frequently in CANCER‐DEP than in CANCER‐NONDEP. Conclusions The lower level of cognitive‐emotional symptoms in CANCER‐DEP than in NONCANCER‐DEP is discussed in relation to different psychosocial phenomena. Our results indicate that somatic depression symptoms are similarly pronounced in CANCER‐DEP and NONCANCER‐DEP, and that CANCER‐DEP show greater somatic depression symptoms than CANCER‐NONDEP. The presence of high levels of somatic symptoms should alert clinicians to investigate for a potential comorbid depression in cancer patients.
    July 03, 2017   doi: 10.1002/pon.4465   open full text
  • Patient and caregiver perspectives on decision support for symptom and quality of life management during cancer treatment: Implications for eHealth.
    Mary E. Cooley, Manan M. Nayak, Janet L. Abrahm, Ilana M. Braun, Michael S. Rabin, Jane Brzozowski, Christopher Lathan, Donna L. Berry.
    Psycho-Oncology. July 03, 2017
    Objectives Adequate symptom and quality‐of‐life (SQL) management is a priority during cancer treatment. eHealth is a timely way to enhance patient‐engagement, facilitate communication, and improve health outcomes. The objectives of this study were to describe patient and caregivers' perspectives for providing, processing, and managing SQL data to enhance communication and identify desired components for decision support. Methods Data were collected from 64 participants through questionnaires and focus groups. Analysis was conducted using NVivo. Open and axial coding was completed, grouping commonalities and large constructs into nodes to identify and synthesize themes. Results Face‐to‐face meetings with clinicians were the prime time to communicate, and patients strove to understand treatment options and the effect on SQL by bringing caregivers to their visits, taking notes, tracking symptoms, and creating portable health records. Patients/caregivers struggled to self‐manage their symptoms and were uncertain when to contact clinicians when experiencing uncontrolled symptoms. Most participants identified eHealth solutions for decision support. However, 38% of participants (n = 24) rarely used computers and identified non‐eHealth options for decision support. Core components for both eHealth and non‐eHealth systems were access to (1) cancer information, (2) medical records, (3) peer support, and (4) improved support and understanding on when to contact clinicians. Conclusions Patients were faced with an overwhelming amount of information and relied on their caregivers to help navigate the complexities of cancer care and self‐manage SQL. Health technologies can provide informational support; however, decision support needs to span multiple venues to avoid increasing disparities caused by a digital divide.
    July 03, 2017   doi: 10.1002/pon.4442   open full text
  • Effect of androgen deprivation therapy on sexual function and bother in men with prostate cancer: A controlled comparison.
    Kristine A. Donovan, Brian D. Gonzalez, Ashley M. Nelson, Mayer N. Fishman, Babu Zachariah, Paul B. Jacobsen.
    Psycho-Oncology. June 27, 2017
    Objectives The adverse sexual effects of androgen deprivation therapy (ADT) on men with prostate cancer have been well described. Less well known is the relative degree of sexual dysfunction and bother associated with ADT compared to other primary treatment modalities such as radical prostatectomy. We sought to describe the trajectory and relative magnitude of changes in sexual function and bother in men on ADT and to examine demographic and clinical predictors of ADT's adverse sexual effects. Methods Prostate cancer patients treated with ADT (n = 60) completed assessments of sexual function and sexual bother 3 times during a 1‐year period after the initiation of ADT. Prostate cancer patients treated with radical prostatectomy only and not receiving ADT (n = 85) and men with no history of cancer (n = 86) matched on age and education completed assessments at similar intervals. Results Androgen deprivation therapy recipients reported worsening sexual function and increasing bother over time compared to controls. Effect sizes for the differences in sexual function were large to very large, and for bother were small to very large. Age younger than 83 years predicted relatively poorer sexual function, and age younger than 78 years predicted greater sexual bother at 12 months in men on ADT compared to men not on ADT. Conclusions Most men on ADT for prostate cancer will never return to baseline levels of sexual function. Interventions focused on sexual bother over function and designed to help couples build and maintain satisfying relationship intimacy are likely to more positively affect men's psychological well‐being while on ADT than medical or sexual aids targeting sexual dysfunction.
    June 27, 2017   doi: 10.1002/pon.4463   open full text
  • Attachment and posttraumatic growth after breast cancer: A dyadic approach.
    Marisa Ávila, Joaquim L. Coimbra, Crystal L. Park, Paula M. Matos.
    Psycho-Oncology. June 18, 2017
    Objective Cancer poses unique challenges for the couple relationship. From a relational perspective, successful adaptation may be less dependent on the circumstances of being the “patient” or the “caregiver” than on how couples successfully integrate cancer into their relationship. In this article, we study posttraumatic growth through attachment theory, which provides a useful framework to explore the role of intimate processes dyadically. Method The sample comprised 84 heterosexual married and cohabitating couples. Women were in adjuvant treatment for breast cancer or in the posttreatment phase. Both members of the couple completed measures of attachment and posttraumatic growth. Path models were used to examine associations between the constructs through the application of the actor‐partner interdependent model. Moreover, time since diagnosis was examined within the actor‐partner interdependent model as a possible moderator affecting the attachment‐posttraumatic growth associations. Results Partners' attachment security was an important predictor of individual posttraumatic growth for both members of the couple, while individuals' own attachment security was not associated with their posttraumatic growth for either member of the couple. The partner's effects were equal across gender. Additionally, time since breast cancer diagnosis did not affect the pattern of results. Conclusion Findings support the assessment of the couple dyadically and corroborate an attachment approach of the couple as an interdependent unit. Implications of the study for interventions assisting couples in oncological setting are discussed.
    June 18, 2017   doi: 10.1002/pon.4409   open full text
  • One in two cancer patients is significantly distressed: Prevalence and indicators of distress.
    A. Mehnert, T.J. Hartung, M. Friedrich, S. Vehling, E. Brähler, M. Härter, M. Keller, H. Schulz, K. Wegscheider, J. Weis, U. Koch, H. Faller.
    Psycho-Oncology. June 16, 2017
    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 3724 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. 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 81.4% of patients reporting all 3 of these problems (DT M = 6.4). When analyzing only the subset of physical problems, fatigue, problems getting around, and indigestion showed the strongest association with the remaining problems and 76.3% of patients with all 3 problems were highly distressed (DT M = 6.1). 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.
    June 16, 2017   doi: 10.1002/pon.4464   open full text
  • Negative psychological consequences of breast cancer among recently diagnosed ethnically diverse women.
    Silvia Tejeda, Melinda R. Stolley, Ganga Vijayasiri, Richard T. Campbell, Carol Estwing Ferrans, Richard B. Warnecke, Garth H. Rauscher.
    Psycho-Oncology. June 16, 2017
    Objective Breast cancer has psychological consequences that impact quality of life. We examined factors associated with negative psychological consequences of a breast cancer diagnosis, in a diverse sample of 910 recently diagnosed patients (378 African American, 372 white, and 160 Latina). Methods Patients completed an in‐person interview as part of the Breast Cancer Care in Chicago study within an average of 4 months from diagnosis. The Cockburn negative psychological consequences of breast cancer screening scale was revised to focus on a breast cancer diagnosis. Path analysis assessed predictors of psychological consequences and potential mediators between race/ethnicity and psychological consequences. Results Compared to white counterparts, bivariate analysis showed African American (β = 1.4, P < .05) and Latina (β = 3.6, P < .001) women reported greater psychological consequences. Strongest predictors (P < .05 for all) included unmet social support (β = .38), and provider trust (β = .12), followed by stage at diagnosis (β = .10) and perceived neighborhood social disorder (β = .09).The strongest mediator between race/ethnicity and psychological consequences was unmet social support. Conclusions African American and Latina women reported greater psychological consequences related to their breast cancer diagnosis; this disparity was mediated by differences in unmet social support. Social support represents a promising point of intervention.
    June 16, 2017   doi: 10.1002/pon.4456   open full text
  • The relationship between symptom prevalence, body image, and quality of life in Asian gynecologic cancer patients.
    Irene Teo, Yin Bun Cheung, Timothy Yong Kuei Lim, Rama Padmavathi Namuduri, Victoria Long, Komal Tewani.
    Psycho-Oncology. June 16, 2017
    Objective Gynecologic cancer is associated with long‐term effects that can be both physical and emotional. We examined symptom prevalence and body image disturbance in patients with gynecologic cancer and their association with quality of life. Predictors of clinically‐relevant body image disturbance were examined. Methods A sample of patients in Singapore (n = 104) was assessed for symptom prevalence, quality of life, and body image dissatisfaction. Clinical factors were extracted from medical records. Results The most frequently reported symptoms were fatigue, abdominal bloatedness, weight gain, constipation, hot flashes, and pelvic pain. Approximately one quarter patients reported feeling less physically attractive and dissatisfied with their body. Ordinary least squares regression indicated that symptom prevalence alone predicted physical well‐being, b = −1.09, P < .001, 95% CI, −1.45 to −0.73, and functional well‐being, b = −0.88, P < .001, 95% CI, −1.32 to −0.45. Body image dissatisfaction alone significantly predicted emotional well‐being, b = −0.21, P < .01, 95% CI, −0.35 to −0.06. Younger age was a significant risk factor for clinically‐relevant score of body image distress, OR = 0.95 per year older, 95% CI, 0.92 to 0.99, P = .02. Conclusions Symptom prevalence and body image dissatisfaction were associated with different domains of quality of life. Emotional well‐being of patients was better explained by body image, rather than extent of symptoms experienced. Patients who are younger appear particularly susceptible to body image disturbance.
    June 16, 2017   doi: 10.1002/pon.4457   open full text
  • When trust is threatened: Qualitative study of parents' perspectives on problematic clinical relationships in child cancer care.
    Sarah Davies, Peter Salmon, Bridget Young.
    Psycho-Oncology. June 08, 2017
    Objective We explored parents' accounts of the parent‐clinician relationship in childhood cancer to understand how parents who perceive threats to the relationship can be supported. Methods Multicentre longitudinal qualitative study, with 67 UK parents of children (aged 1‐12 years) receiving treatment for acute lymphoblastic leukaemia. Analyses drew on the wider sample but focussed on 50 semistructured interviews with 20 parents and were informed by constant comparison. Results All 20 parents described problems with clinical care such as inadequate information or mistakes by staff but varied in how much the problems threatened their sense of relationship with clinicians. Some parents saw the problems as having no relevance to the parent‐clinician relationship. Others saw the problems as threats to the clinical relationship but worked to “contain” the threat in ways that preserved a trusting relationship with at least one senior clinician. Parents' containment work protected the security they needed from the parent‐clinician relationship, but containment was a tenuous process for some. A few parents were unable to contain the problems at all; lacking trust in clinicians, these parents suffered considerably. Conclusions Given the complexity of childhood cancer care, problems with clinical care are inevitable. By engaging in containment work, parents met their needs to feel secure in the face of these problems, but the extent to which parents should have to do this work is debatable. Parents could benefit from support to seek help when problems arise which threaten their trust in clinicians. Attachment theory can guide clinicians in giving this support.
    June 08, 2017   doi: 10.1002/pon.4454   open full text
  • First use of antidepressant medication in male partners of women with breast cancer in Denmark from 1998 to 2011.
    Pernille F. Cromhout, Kristine M. Latocha, Maja H. Olsen, Nis P. Suppli, Jane Christensen, Christoffer Johansen, Susanne O. Dalton.
    Psycho-Oncology. May 31, 2017
    Objective A diagnosis of breast cancer disrupts the life of the patient, but also the partner may experience adverse psychological effects. We examined partners' risk for first use of antidepressant medication, as a proxy for pharmacologically treated depression. Methods By linkage of national registers, we identified 1 420 592 depression‐free men living with a cancer‐free female partner in 1998 to 2011. During follow‐up, breast cancer was diagnosed in female partners of 26 256 men. In Poisson regression models, we estimated the rate ratios for first use of antidepressant medication compared to partners of breast cancer‐free women. Cox regression analyses examined associations between exposed partners' sociodemographic characteristics, somatic comorbidity, death of female partner, and first use of antidepressant medication. Results Male partners of women with breast cancer had an increased rate ratio of 1.08 (95% CI, 1.03‐1.13) for first use of antidepressant medication compared to the background population, corresponding to excess absolute risk of 12 cases per 10 000 person‐years. This increased risk persisted throughout 14 years of follow‐up. Higher age, shorter education, somatic comorbidity, and death of female partner were associated with increased risk among men whose partner had breast cancer. Conclusion The modest, but long term, increased risk for first use of antidepressant medication calls for attention by health care professionals to symptoms of depression among partners of breast cancer patients.
    May 31, 2017   doi: 10.1002/pon.4459   open full text
  • Depressive symptoms are found to be potential adverse effects of androgen deprivation therapy in older prostate cancer patients: A 15‐month prospective, observational study.
    Zhiqiang Zhang, Linlin Yang, Dongdong Xie, Haoqiang Shi, Guangyuan Li, Dexin Yu.
    Psycho-Oncology. May 31, 2017
    Objectives To evaluate the association between androgen deprivation therapy (ADT) and depression and to identify the risk factors for depressive symptoms among prostate cancer (PCa) patients who received ADT. Methods We conducted a prospective, longitudinal, controlled study and assessed 3 groups of older patients: the ADT group (men who were presented with maximum androgen block); the radical prostatectomy (RP) group (PCa control group: men who underwent RP without ADT); and the benign prostatic hyperplasia (BPH) group (men who had BPH). All patients completed the demographic questionnaire at baseline and the Zung Self‐Rating Depression Scale (SDS) at pretreatment baseline, 1 month, 6 months, 9 months, 12 months and 15 months. Results A total of 146 patients completed the study during the 15‐month follow‐up. The Self‐Rating Depression Scale scores of the 3 groups showed significant differences at 1 month (P < .001), 6 months (P = .009), 9 months (P < .001), 12 months (P < .001), and 15 months (P < .001). At 9 months, 12% of the men in the ADT group, 4.3% in the RP group, and 2% in the BPH group showed depressive symptoms, and there were no significant differences (P = .095). However, there were significant differences among the 3 groups relative to the incidence of depressive symptoms at 12 and 15 months (P < .001, P = .007, respectively). The analysis of the ADT subgroup indicated that alcohol consumption (odds ratio = 6.868; P = .046; 95% CI, 1.038‐45.443) and smoking (odds ratio = 13.661; P = 0.013; 95% CI, 1.722‐108.386) increased the risk for developing depressive symptoms. Conclusions Androgen deprivation therapy use does significantly increase the depressive scores and enhance the incidence of depression among PCa patients who received ADT. Smoking and alcohol consumption are associated with depressive symptoms among PCa patients receiving ADT.
    May 31, 2017   doi: 10.1002/pon.4453   open full text
  • The role of body image dissatisfaction in the association between treatment‐related scarring or disfigurement and psychological distress in adult survivors of childhood cancer.
    Stefanie C. Vuotto, Rohit P. Ojha, Chenghong Li, Cara Kimberg, James L. Klosky, Kevin R. Krull, Deo Kumar Srivastava, Leslie L. Robison, Melissa M. Hudson, Tara M. Brinkman.
    Psycho-Oncology. May 31, 2017
    Objective To examine the potential mediating role of body image dissatisfaction on the association between treatment‐related scarring/disfigurement and psychological distress in adult survivors of childhood cancer. Methods Participants included 1714 adult survivors of childhood cancer (mean [SD] age at evaluation = 32.4 [8.0] years, time since diagnosis = 24.1 [8.1] years) enrolled in the St. Jude Lifetime Cohort Study. Survivors completed measures of body image, emotional distress, and posttraumatic stress symptoms (PTSS). Body image dissatisfaction (BID) was categorized into 2 groups (cancer‐related and general) based on factor analysis. Using causal mediation analysis, we estimated the proportion of psychological distress associated with treatment‐related scarring/disfigurement that could be eliminated by resolving BID through a hypothetical intervention. Results Among survivors with scarring/disfigurement of the head, a sizable proportion of the relative excess of psychological distress could be eliminated if BID was successfully treated (males: [cancer‐related BID: depression: 63%; anxiety: 100%; PTSS: 52%]; [general BID: depression: 70%; anxiety: 100%; PTSS: 42%]; females: [cancer‐related BID: depression: 20%; anxiety; 36%; PTSS: 23%]; [general BID: depression: 32%; anxiety: 87%; PTSS: 38%]). The mediating effect of BID was less pronounced for the association between scarring/disfigurement of the body and psychological distress for both males and females. Conclusions Body image dissatisfaction mediates the association treatment‐related scarring/disfigurement and psychological distress among adult survivors of childhood cancer, particularly among survivors with scarring/disfigurement of the head and male survivors. Successful treatment of body image dissatisfaction has the potential to eliminate a substantial proportion of psychological distress related to scarring/disfigurement among adult survivors of childhood cancer.
    May 31, 2017   doi: 10.1002/pon.4439   open full text
  • Mindfulness‐based cognitive therapy (MBCT) is cost‐effective compared to a wait‐list control for persistent pain in women treated for primary breast cancer—Results from a randomized controlled trial.
    M. Johannsen, J. Sørensen, M. O'Connor, A.B. Jensen, R. Zachariae.
    Psycho-Oncology. May 31, 2017
    Objective To investigate the cost‐effectiveness of mindfulness‐based cognitive therapy (MBCT) compared to a wait‐list control group for pain in women treated for breast cancer. Methods A total of 129 women were randomly allocated to MBCT or a wait‐list control group. The primary outcome was the minimal clinically important difference (MCID) on pain intensity (≥2 point reduction on an 11‐point Numeric Rating Scale). Analyses were conducted from the health care system perspective and included data on health care utilization and pain medication retrieved from national registries for the period from baseline (T1) to 6 months postintervention (T4). Bootstrap simulations were used to estimate confidence intervals for the incremental cost and effect measures, and cost‐effectiveness acceptability curves. In sensitivity analyses, we replaced dropouts with last‐observation‐carried‐forward and tested consequences of higher costs of the intervention. Results The intervention cost was 240€ per participant. The average total cost from T1 to T4 in the MBCT group was 1706€ compared with 2436€ in the control group (mean difference: 729€, P = .07). More women in the MBCT group (N:19/36; 52.8%) than in the control group (N:14/48; 29.2%) achieved an MCID in pain intensity (OR=2.71, P = .03). The MBCT was cost‐effective with a probability of 85% with a value of an additional women achieving MCID set to zero remained cost‐effective with a probability of 70% to 82% when smaller effect and higher MBCT costs were assumed. Conclusions Our results suggest that MBCT is a cost‐effective pain intervention for women treated for breast cancer. Future studies could include utility measures, indirect costs, and active control groups to increase the generalizability and pragmatic value of the results.
    May 31, 2017   doi: 10.1002/pon.4450   open full text
  • Individual training at the undergraduate level to promote competence in breaking bad news in oncology.
    Alexandre Berney, Valérie Carrard, Marianne Schmid Mast, Raphael Bonvin, Friedrich Stiefel, Céline Bourquin.
    Psycho-Oncology. May 31, 2017
    Objective Training medical students in breaking bad news (BBN) in oncology may be key to improve patient care in an area where many physicians tend to be uncomfortable. Given the lack of evidence in the literature, this study aimed to assess empirically the impact of 2 teaching strategies to prepare students for the task of BBN in oncology: one‐to‐one simulated patient (SP) training with individual feedback (intervention group) vs small‐group SP training with collective feedback (comparison group). Methods Fourth‐year students (N = 236) were randomly assigned to the intervention or comparison group. The SP videotaped interviews were analyzed with respect to BBN communication performance, rated using the Calgary‐Cambridge checklist of teaching objectives for BBN; verbal interaction behaviors, coded with the Roter interaction analysis system; and 7 nonverbal behaviors. Results Students in the intervention group scored significantly higher after than before the training on the overall evaluation of the interview (P < .001) as well as on process skills (P < .001); they also obtained significantly higher scores compared to students in the comparison group on the overall evaluation of the interview (P < .001) and on process skills (P < .001). Conclusions This study supports an individualized BBN teaching strategy and contributes to efforts to find the best way to train and reach the largest number of future physicians to improve communication competences in oncology.
    May 31, 2017   doi: 10.1002/pon.4452   open full text
  • Feasibility and acceptability of “healthy directions” a lifestyle intervention for adults with lung cancer.
    Amanda C. Blok, Traci M. Blonquist, Manan M. Nayak, Darryl Somayaji, Scott E. Crouter, Laura L. Hayman, Yolonda L. Colson, Raphael Bueno, Karen M. Emmons, Mary E. Cooley.
    Psycho-Oncology. May 31, 2017
    Objective The aims of this feasibility study of an adapted lifestyle intervention for adults with lung cancer were to (1) determine rates of enrollment, attrition, and completion of 5 nurse‐patient contacts; (2) examine demographic characteristics of those more likely to enroll into the program; (3) determine acceptability of the intervention; and (4) identify patient preferences for the format of supplemental educational intervention materials. Methods This study used a single‐arm, pretest and posttest design. Feasibility was defined as ≥20% enrollment and a completion rate of 70% for 5 nurse‐patient contact sessions. Acceptability was defined as 80% of patients recommending the program to others. Data was collected through electronic data bases and phone interviews. Descriptive statistics, Fisher's exact test and Wilcoxon rank sum test were used for analyses. Results Of 147 eligible patients, 42 (28.6%) enrolled and of these, 32 (76.2%) started the intervention and 27 (N = 27/32; 84.4%; 95% CI, 67.2%‐94.7%) completed the intervention. Patients who were younger were more likely to enroll in the study (P = .04) whereas there were no significant differences by gender (P = .35). Twenty‐three of the 24 (95.8%) participants' contacted posttest recommended the intervention for others. Nearly equal numbers of participants chose the website (n = 16, 50%) vs print (n = 14, 44%). Conclusion The intervention was feasible and acceptable in patients with lung cancer. Recruitment rates were higher and completion rates were similar as compared to previous home‐based lifestyle interventions for patients with other types of cancer. Strategies to enhance recruitment of older adults are important for future research.
    May 31, 2017   doi: 10.1002/pon.4443   open full text
  • Quality of death, rumination, and posttraumatic growth among bereaved family members of cancer patients in home palliative care.
    Kayo Hirooka, Hiroki Fukahori, Kanako Taku, Taisuke Togari, Asao Ogawa.
    Psycho-Oncology. May 30, 2017
    Objective The current study was designed to test the hypothesis that quality of death (QOD) and intrusive and deliberate rumination are associated with posttraumatic growth (PTG) among bereaved family members of cancer patients in home palliative care. Methods Data were collected from 805 bereaved family members of cancer patients who died at home in Japan. We used a cross‐sectional design and participants completed Good Death Inventory, Event‐Related Rumination Inventory, and PTG Inventory. Structural equation modeling was used to test the hypothesized relationships. Results A direct pathway from QOD to PTG was significant. We also found significant indirect pathways between QOD and PTG via deliberate rumination soon after the death and recent deliberate rumination. Conclusions Clinicians should provide high‐quality end‐of‐life care with the goals of achieving a good death for terminally ill cancer patients and supporting the experience of PTG in bereaved family members after their loss.
    May 30, 2017   doi: 10.1002/pon.4446   open full text
  • Relationships between dispositional mindfulness, self‐acceptance, perceived stress, and psychological symptoms in advanced gastrointestinal cancer patients.
    Wei Xu, Yuyang Zhou, Zhongfang Fu, Marcus Rodriguez.
    Psycho-Oncology. May 30, 2017
    Objective Previous studies have shown that dispositional mindfulness is associated with less psychological symptoms in cancer patients. The present study investigated how dispositional mindfulness is related to psychological symptoms in advanced gastrointestinal cancer patients by considering the roles of self‐acceptance and perceived stress. Methods A total of 176 patients with advanced gastrointestinal cancer were recruited to complete a series of questionnaires including Mindfulness Attention Awareness Scale, Self‐acceptance Questionnaire, Chinese Perceived Stress Scale, and General Health Questionnaire. Results Results showed that the proposed model fitted the data very well (χ2 = 7.564, df = 7, P = .364, χ2/df = 1.094, Goodness of Fit Index (GFI) = 0.986, Comparative Fit Index (CFI) = 0.998, Tucker Lewis Index (TLI) = 0.995, Root Mean Square Error of Approximation (RMSEA) = 0.023). Further analyses revealed that, self‐acceptance and perceived stress mediated the relation between dispositional mindfulness and psychological symptoms (indirect effect = −0.052, 95% confidence interval = −0.087 ~ −0.024), while self‐acceptance also mediated the relation between dispositional mindfulness and perceived stress (indirect effect = −0.154, 95% confidence interval = −0.261 ~ −0.079). Conclusions Self‐acceptance and perceived stress played critical roles in the relation between dispositional mindfulness and psychological symptoms. Limitations, clinical implications, and directions for future research were discussed.
    May 30, 2017   doi: 10.1002/pon.4437   open full text
  • Self‐management strategies used by head and neck cancer survivors following completion of primary treatment: A directed content analysis.
    Simon Dunne, Orla Mooney, Laura Coffey, Linda Sharp, Aileen Timmons, Deirdre Desmond, Rachael Gooberman‐Hill, Eleanor O'Sullivan, Ivan Keogh, Conrad Timon, Pamela Gallagher.
    Psycho-Oncology. May 26, 2017
    Objective Head and neck cancer (HNC) survivors encounter unique challenges following treatment. This study aimed to identify self‐management strategies that HNC survivors use to overcome these posttreatment challenges. Methods Twenty‐seven individuals from 4 designated cancer centres in Ireland were interviewed about self‐management strategies that helped them overcome challenges following HNC treatment. Interviews were audio‐recorded, transcribed, and analysed using directed content analysis. Results Twenty self‐management strategy types (encompassing 77 specific strategies) were identified. The most frequently used self‐management strategy types were self‐sustaining (used by 26 survivors), self‐motivating (n = 25), and proactive problem solving (n = 25). The most frequently used specific strategies were adaptive approaches to ongoing physical consequences of HNC and its treatment (n = 24), customising dietary practices (n = 24), and maintaining a positive outlook (n = 22). Conclusions The study identified strategies that helped HNC survivors to self‐manage posttreatment challenges. This information could inform the design/development of self‐management interventions tailored towards HNC survivors.
    May 26, 2017   doi: 10.1002/pon.4447   open full text
  • Who are the support persons of haematological cancer survivors and how is their performance perceived?
    Alix Hall, Marita Lynagh, Mariko Carey, Rob Sanson‐Fisher, Elise Mansfield.
    Psycho-Oncology. May 26, 2017
    Objective To explore: (1) how haematological cancer survivors and their support persons perceive the overall performance of the support person; (2) disagreement between survivor and support person ratings; and (3) characteristics associated with support persons rating their performance poorly. Methods This is a substudy of a larger project of Australian haematological cancer survivors and their support persons. For this substudy, haematological cancer survivors were recruited from 4 Australian population‐based cancer registries and asked to pass on a questionnaire package to their support persons. Survivors who passed on a questionnaire package to their support person were asked to answer questions about the support person and how they perceived the support person's performance. Similarly, support persons answered questions on their own performance as a support person. Results A total of 924 haematological cancer survivors and 821 support persons were eligible for this study. Most survivors rated their support person as performing very well (84%) while less than half (48%) of support persons rated their own performance as very well. There was significant disagreement between survivor and their support person (dyad) ratings of the support person's performance. Support persons with above normal levels of depression (vs those with normal levels) had significantly higher odds of rating their own performance as “not well/somewhat well.” Conclusions Health care providers should consider providing additional education and skills‐based interventions to support persons who experience increased symptoms of depression.
    May 26, 2017   doi: 10.1002/pon.4449   open full text
  • Psychosocial outcomes in active treatment through survivorship.
    Sarah C. Reed, Janice F. Bell, Robin Whitney, Rebecca Lash, Katherine K. Kim, Richard J. Bold, Jill G. Joseph.
    Psycho-Oncology. May 18, 2017
    Objective The objective of the study is to understand potential differences in psychosocial outcomes from active treatment to survivorship. Methods Using the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement (n = 1360), we examined and compared psychosocial outcomes among respondents in active treatment with survivors by year(s) since treatment ended. Survey‐weighted regression models were used to test associations between year(s) since treatment and depressive symptoms (Patient Health Questionnaire‐2), psychological distress (K6), and cancer‐specific worry related to recurrence. Results Unadjusted estimates showed no significant differences in depressive symptoms or psychological distress between those in active treatment and cancer survivors at any time posttreatment. In contrast, the prevalence of cancer‐specific worry was lowest among survivors more than 5 years since treatment (10%), slightly higher among those with less than 1 year since treatment (15%), and highest among those in active treatment (32%). In models controlled for sociodemographic and health‐related covariates, the year(s) since treatment ended was inversely associated with the odds of cancer‐specific worry but was not associated with depressive symptoms or psychological distress. Conclusions In this population‐based sample, worry about cancer recurrence may diminish with years since treatment ended, while depressive symptoms and distress are persistent across the trajectory. These findings highlight unmet psychosocial needs among cancer survivors and demonstrate the importance of targeted interventions across the survivorship continuum.
    May 18, 2017   doi: 10.1002/pon.4444   open full text
  • Cognitive compensatory processes of older, clinically fit patients with hematologic malignancies undergoing chemotherapy: A longitudinal cohort study.
    Yves Libert, Cindy Borghgraef, Yves Beguin, Nicole Delvaux, Martine Devos, Chantal Doyen, Stéphanie Dubruille, Anne‐Marie Etienne, Aurore Liénard, Isabelle Merckaert, Christine Reynaert, Jean‐Louis Slachmuylder, Nicole Straetmans, Eric Van Den Neste, Dominique Bron, Darius Razavi.
    Psycho-Oncology. May 16, 2017
    Objective Despite the well‐known negative impacts of cancer and anticancer therapies on cognitive performance, little is known about the cognitive compensatory processes of older patients with cancer. This study was designed to investigate the cognitive compensatory processes of older, clinically fit patients with hematologic malignancies undergoing chemotherapy. Methods We assessed 89 consecutive patients (age ≥ 65 y) without severe cognitive impairment and 89 age‐, sex‐, and education level‐matched healthy controls. Cognitive compensatory processes were investigated by (1) comparing cognitive performance of patients and healthy controls in novel (first exposure to cognitive tasks) and non‐novel (second exposure to the same cognitive tasks) contexts, and (2) assessing psychological factors that may facilitate or inhibit cognitive performance, such as motivation, psychological distress, and perceived cognitive performance. We assessed cognitive performance with the Trail‐Making, Digit Span and FCSR‐IR tests, psychological distress with the Hospital Anxiety and Depression Scale, and perceived cognitive performance with the FACT‐Cog questionnaire. Results In novel and non‐novel contexts, average cognitive performances of healthy controls were higher than those of patients and were associated with motivation. Cognitive performance of patients was not associated with investigated psychological factors in the novel context but was associated with motivation and psychological distress in the non‐novel context. Conclusions Older, clinically fit patients with hematologic malignancies undergoing chemotherapy demonstrated lower cognitive compensatory processes compared to healthy controls. Reducing distress and increasing motivation may improve cognitive compensatory processes of patients in non‐novel contexts.
    May 16, 2017   doi: 10.1002/pon.4424   open full text
  • Advanced cancer caregiving as a risk for major depressive episodes and generalized anxiety disorder.
    Kelly M. Trevino, Holly G. Prigerson, Paul K. Maciejewski.
    Psycho-Oncology. May 16, 2017
    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.
    May 16, 2017   doi: 10.1002/pon.4441   open full text
  • A qualitative study of doctors' and nurses' barriers to communicating with seriously ill patients about their dependent children.
    Annemarie Dencker, Bo Andreassen Rix, Per Bøge, Tine Tjørnhøj‐Thomsen.
    Psycho-Oncology. May 11, 2017
    Objective Research indicates that health personnel caring for seriously ill patients with dependent children aged 0 to 18 years often avoid discussing with them the challenges of being a family with a parent in treatment. Children of seriously ill patients risk serious trauma and emotional difficulty later in life and depend on adult support to minimize these consequences. Patients suffer anxiety about supporting their children during their illness. Because of their potentially pivotal role in supporting patients in enabling parent‐child communication, we examined HP's structural and emotional barriers to communicating with patients about their children. Methods The study was based on 49 semi‐structured, in‐depth interviews with doctors and nurses working with haematology, gynaecological cancer, and neurointensive care. Both interviews and analysis addressed emotional and structural barriers, drawing on the theoretical framework of Maturana's domains. Results The study found structural barriers (eg, lack of space in the medical recording system, professional code, time pressure, and lack of training) and emotional barriers (eg, the painful nature of the situation and the perceived need of keeping professional distance). We found that emotional barriers tended to grow when structural barriers were not addressed. Conclusions Our study indicates (1) the need to use templates and manual procedures to gather and process information about children in medical records; (2) the need for managerial backing for addressing children of seriously ill patients and time spent on it; and (3) the need for future HP training programmes to include how to implement procedures and how to address all barriers.
    May 11, 2017   doi: 10.1002/pon.4440   open full text
  • Mind‐body medicine and lifestyle modification in supportive cancer care: A cohort study on a day care clinic program for cancer patients.
    Michael Jeitler, Jessica Jaspers, Christel Scheidt, Barbara Koch, Andreas Michalsen, Nico Steckhan, Christian S. Kessler.
    Psycho-Oncology. May 09, 2017
    Objective We developed an integrative day care clinic program for cancer patients focusing on mind‐body techniques and health‐promoting lifestyle modification (7‐hour once‐per‐week group sessions over 12 weeks). Methods A cohort study design with a waiting group was implemented. Outcome parameters were assessed at the beginning, at the end of the active program, and at a 6‐month follow‐up. Patients waiting >4 and <12 weeks before treatment start were allocated to the waiting group and additionally assessed at the start of their day care program. Outcome measures included quality of life (FACT‐G, FACT‐B/C, WHO‐5), fatigue (FACIT‐F), depression/anxiety (HADS), and mood states (ASTS). A per protocol analysis using mixed linear models was performed. Results One hundred patients were screened on‐site for eligibility. Eighty‐six cancer survivors (83% female; mean age 53.7 ± 9.7 years; 49% breast cancer) were included into the study. Sixty‐two patients were allocated to the intervention group and 24 patients, to the waiting group (mean waiting time 5 ± 1 weeks). Sixty‐six data sets were included in the final analysis. Significant improvements were observed in favor of the intervention group after 12 weeks compared with the waiting group at the end of the waiting period for quality of life, anxiety/depression, and fatigue. Results from the 6‐month follow‐up for the whole study population showed lasting improvement of quality of life. Conclusions The program can be considered as an effective means to improve quality of life, fatigue, and mental health of cancer patients. Moreover, it appears to have a sustainable effect, which has to be proved in randomized trials.
    May 09, 2017   doi: 10.1002/pon.4433   open full text
  • Protecting young children against skin cancer: Parental beliefs, roles, and regret.
    Kyra Hamilton, Aaron Kirkpatrick, Amanda Rebar, Katherine M. White, Martin S. Hagger.
    Psycho-Oncology. April 26, 2017
    Objective To examine the role of parental beliefs, roles, and anticipated regret toward performing childhood sun‐protective behaviours. Methods Parents (N = 230; 174 mothers, 56 fathers), recruited using a nonrandom convenience sample, of at least 1 child aged between 2 and 5 years completed an initial questionnaire assessing demographics and past behaviour as well as theory of planned behaviour global (attitude, subjective norm, and perceived behavioural control) and belief‐based (behavioural, normative, and control beliefs) measures, role construction, and anticipated regret regarding their intention and behaviour to protect their child from the sun. Two weeks later, participants completed a follow‐up questionnaire assessing their sun protection of their child during the previous 2 weeks. Results Hierarchical multiple regression analysis identified attitude, perceived behavioural control, role construction, anticipated regret, past behaviour, and a normative belief (“current partner/other family members”) as significant predictors of parents' intention to participate in sun‐protective behaviour for their child. Intention and past behaviour were significant predictors of parents' follow‐up sun‐protective behaviour. The regression models explained 64% and 36% of the variance in intention and behaviour, respectively. Conclusions The findings of this study highlight the importance of anticipated regret and role‐related beliefs alongside personal, normative, and control beliefs in determining parents' intentional sun‐protective behaviour for their children. Findings may inform the development of parent‐ and community‐based sun protection intervention programs to promote parents' sun‐safety behaviours for their children to prevent future skin cancer incidence.
    April 26, 2017   doi: 10.1002/pon.4434   open full text
  • Dual role as a protective factor for burnout‐related depersonalization in oncologists.
    Yi He, Ying Pang, Yening Zhang, Richard Fielding, Lili Tang.
    Psycho-Oncology. April 26, 2017
    Purpose This study compared self‐reported burnout between dual‐role oncologists (oncologists who also do psychosocial work) and single‐role oncologists, to explore if dual role is protective against or a risk factor for burnout. Methods Dual‐role oncologists from across China (n = 131) were consecutively recruited via the Chinese Psychosocial Oncology Society and asked to identify single‐role oncologist peers (n = 168) working in the same institution. Participants completed an anonymous online questionnaire, which included measures of demographic and work characteristics, Maslach Burnout Inventory–Human Services Survey, the Short Version Effort‐Reward Inventory, the Job Demands‐Resources (JD‐R) Scales, and Work and Meaning Inventory. Fully adjusted multivariate analyses compared burnout scores for the 2 groups. Results Group analysis revealed single‐role participants' scores indicated significantly poorer performance than dual‐role participants for depersonalization (DP), work‐family conflict (JD‐R demands scale), and decision authority (JD‐R scale). Single‐role participants showed an increased risk of DP. Higher effort‐reward imbalance ratio predicted greater DP in single‐, dual‐role and pooled participants, and emotional exhaustion (EE) in pooled‐ and dual‐role participants. Overcommitment was independently associated with EE in all 3 groupings, with JD‐R scores among pooled‐ and dual‐role groups, while higher decision authority scores were associated with decreased EE. Work and Meaning Inventory was associated with a decreased risk of DP among pooled and dual‐role participants. Conclusion Differences in burnout‐related DP scores between dual‐ and single‐role oncologists are consistent with a protective effect from a psychosocial orientation in oncologists.
    April 26, 2017   doi: 10.1002/pon.4425   open full text
  • Mindfulness‐based stress reduction added to care as usual for lung cancer patients and/or their partners: A multicentre randomized controlled trial.
    M.P.J. Schellekens, D.G.M. Hurk, J.B. Prins, A.R.T. Donders, J. Molema, R. Dekhuijzen, M.A. Drift, A.E.M. Speckens.
    Psycho-Oncology. April 26, 2017
    Objective Lung cancer patients report among the highest distress rates of all cancer patients. Partners report similar distress rates. The present study examined the effectiveness of additional mindfulness‐based stress reduction (care as usual [CAU] + MBSR) versus solely CAU to reduce psychological distress in lung cancer patients and/or their partners. Methods We performed a multicentre, parallel‐group, randomized controlled trial. Mindfulness‐based stress reduction is an 8‐week group‐based intervention, including mindfulness practice and teachings on stress. Care as usual included anticancer treatment, medical consultations, and supportive care. The primary outcome was psychological distress. Secondary outcomes included quality of life, caregiver burden, relationship satisfaction, mindfulness skills, self‐compassion, rumination, and posttraumatic stress symptoms. Outcomes were assessed at baseline, post‐intervention, and 3‐month follow‐up. Linear mixed modeling was conducted on an intention‐to‐treat sample. Moderation (gender, disease stage, baseline distress, participation with/without partner) and mediation analyses were performed. Results A total of 31 patients and 21 partners were randomized to CAU + MBSR and 32 patients and 23 partners to CAU. After CAU + MBSR patients reported significantly less psychological distress (p = .008, d = .69) than after CAU. Baseline distress moderated outcome: those with more distress benefitted most from MBSR. Additionally, after CAU + MBSR patients showed more improvements in quality of life, mindfulness skills, self‐compassion, and rumination than after CAU. In partners, no differences were found between groups. Conclusion Our findings suggest that psychological distress in lung cancer patients can be effectively treated with MBSR. No effect was found in partners, possibly because they were more focused on patients' well‐being rather than their own.
    April 26, 2017   doi: 10.1002/pon.4430   open full text
  • Levels of unmet needs and distress amongst adolescents and young adults (AYAs) impacted by familial cancer.
    P. Patterson, F.E.J. McDonald, K.J. White, A. Walczak, P.N. Butow.
    Psycho-Oncology. April 25, 2017
    Objective To describe levels of, and relationships between, distress and psychosocial unmet needs in adolescents and young adults (AYAs) with a family member with cancer. Methods Adolescents and young adults (12‐24 years old) with a living sibling or parent with cancer participated. Participants completed demographics, the Kessler 10 (K10) distress scale and the Sibling or Offspring Cancer Needs Instruments. Descriptive statistics were obtained for all measures, item‐level frequencies were examined to identify common unmet needs, and relationships between distress and unmet needs were explored. Results Average sibling (N = 106) and offspring (N = 256) distress levels were in the high range (K10total = 22‐30), with 29.6% and 31.6% in the very high range (K10total = 31‐50), respectively. Siblings had mean = 19.7 unmet needs (range 0‐45), 66% had ≥10 unmet needs, and 44% of the 45 needs were unmet on average. Offspring had mean = 22.4 unmet needs (range 0‐47), 77% had ≥10 unmet needs, and 48% of the 47 needs were unmet on average. Strong positive correlations were found between K10 distress and the number of sibling/offspring unmet needs (r = 0.599 and r = 0.522, respectively, P = .00). Conclusions Australian AYA siblings and offspring impacted by familial cancer experience high levels and numbers of unmet needs and substantial distress. Strong associations were found between increased distress and more unmet needs. Distress levels were comparable to AYAs seeking treatment for mental health issues. Insights into the type and number of needs experienced by AYA siblings and offspring will facilitate development and delivery of targeted, age‐appropriate interventions, and resources for these vulnerable and underserved young people.
    April 25, 2017   doi: 10.1002/pon.4421   open full text
  • Shared decision‐making and providing information among newly diagnosed patients with hematological malignancies and their informal caregivers: Not “one‐size‐fits‐all”.
    J.A.J. Rood, I.H. Nauta, B.I. Witte, F. Stam, F.J. Zuuren, A. Manenschijn, P.C. Huijgens, I.M. Verdonck‐de Leeuw, S. Zweegman.
    Psycho-Oncology. April 17, 2017
    Objective To optimize personalized medicine for patients with hematological malignancies (HM), we find that knowledge on patient preferences with regard to information provision and shared decision‐making (SDM) is of the utmost importance. The aim of this study was to investigate the SDM preference and the satisfaction with and need for information among newly diagnosed HM patients and their informal caregivers, in relation to sociodemographic and clinical factors, cognitive coping style, and health related quality of life. Methods Newly diagnosed patients and their caregivers were asked to complete the Hematology Information Needs Questionnaire, the Information Satisfaction Questionnaire, and the Threatening Medical Situations Inventory. Medical records were consulted to retrieve sociodemographic and clinical factors and comorbidity by means of the ACE‐27. Results Questionnaires were completed by 138 patients and 95 caregivers. Shared decision‐making was preferred by the majority of patients (75%) and caregivers (88%), especially patients treated with curative intent (OR = 2.7, P = .041), and patients (OR = 1.2, P < .001) and caregivers (OR = 1.2, P = .001) with a higher monitoring cognitive coping style (MCCS). Among patients, total need for information was related to MCCS (P = .012), and need for specific information was related to MCCS and several clinical factors. Importantly, dissatisfaction with the information they received was reported by a third of the patients and caregivers, especially patients who wanted SDM (χ2 = 7.3, P = .007), and patients with a higher MCCS (OR = 0.94, P = .038). Conclusion The majority of HM patients want to be involved in SDM, but the received information is not sufficient. Patient‐tailored information is urgently needed, to improve SDM.
    April 17, 2017   doi: 10.1002/pon.4414   open full text
  • Information needs and decision‐making preferences of older women offered a choice between surgery and primary endocrine therapy for early breast cancer.
    Maria Burton, Karen Kilner, Lynda Wyld, Kate Joanna Lifford, Frances Gordon, Annabel Allison, Malcolm Reed, Karen Anna Collins.
    Psycho-Oncology. April 17, 2017
    Objectives To establish older women's (≥75 years) information preferences regarding 2 breast cancer treatment options: surgery plus adjuvant endocrine therapy versus primary endocrine therapy. To quantify women's preferences for the mode of information presentation and decision‐making (DM) style. Methods This was a UK multicentre survey of women, ≥75 years, who had been offered a choice between PET and surgery at diagnosis of breast cancer. A questionnaire was developed including 2 validated scales of decision regret and DM preferences. Results Questionnaires were sent to 247 women, and 101 were returned (response rate 41%). The median age of participants was 82 (range 75 to 99), with 58 having had surgery and 37 having PET. Practical details about the impact, safety, and efficacy of treatment were of most interest to participants. Of least interest were cosmetic outcomes after surgery. Information provided verbally by doctors and nurses, supported by booklets, was preferred. There was little interest in technology‐based sources of information. There was equal preference for a patient‐ or doctor‐centred DM style and lower preference for a shared DM style. The majority (74%) experienced their preferred DM style. Levels of decision regret were low (15.73, scale 0‐100). Conclusions Women strongly preferred face to face information. Written formats were also helpful but not computer‐based resources. Information that was found helpful to women in the DM process was identified. The study demonstrates many women achieved their preferred DM style, with a preference for involvement, and expressed low levels of decision regret.
    April 17, 2017   doi: 10.1002/pon.4429   open full text
  • Fear of cancer recurrence: a significant concern among partners of prostate cancer survivors.
    Marieke Wal, Simône Langenberg, Marieke Gielissen, Belinda Thewes, Inge Oort, Judith Prins.
    Psycho-Oncology. April 17, 2017
    Objectives The aims of the study were to (1) describe the prevalence of fear of cancer recurrence (FCR) in partners of prostate cancer (PCa) survivors; (2) to compare the proportions of high FCR in partners with high FCR in PCa survivors; (3) to explore partners' demographic and survivors' clinical characteristics associated with high FCR in partners; and (4) to identify the relationship between high FCR and health‐related quality of life (HRQoL) in partners. Methods Questionnaires were sent to partners of disease‐free PCa survivors. Outcomes included FCR severity (Cancer Worry Scale [CWS]) and HRQoL (RAND‐36). The t and chi‐square tests were used to compare partner FCR with survivor FCR. Regression analyses were performed to determine if demographic and clinical characteristics were significantly associated with partner FCR. The multivariate analysis of variance identified differences in HRQoL between partners with high and low FCR. Results Questionnaires were completed by 168 partners. Mean levels of FCR were comparable between partners and survivors (P = .144). Thirty‐five percent of partners reported high FCR (CWS ≥ 14) compared to 38% of PCa survivors (CWS ≥ 13) (P = .542). Higher survivor FCR and younger partner age were significantly associated with higher partner FCR. Partners with high FCR scored significantly lower on social functioning, emotional role functioning, mental health, general health, and vitality than those with low FCR (all P < .05). Conclusions Findings from this study illustrate that FCR is a significant concern for partners of PCa survivors. Clinicians should be aware of partner FCR when delivering care to men with PCa.
    April 17, 2017   doi: 10.1002/pon.4423   open full text
  • The construction of help during radiotherapy: Redefining informal care.
    Lynda Appleton, Elizabeth Perkins.
    Psycho-Oncology. April 05, 2017
    Objectives This study will explore how help is constructed during and following radiotherapy for patients with cancer. Methods Grounded theory methods were used in the study to explore the way in which family members and friends constructed a role for themselves in relation to patients receiving radiotherapy. A total of 22 helpers were interviewed. Patients were being treated for a range of cancers including breast, prostate, colorectal, and head and neck. Results Respondents in this study consistently defined themselves as “helpers” rather than “carers.” While radiotherapy as a treatment modality was mostly seen as noninvasive, the cancer diagnosis cast a long shadow over the lives of helpers and patients creating a separation in longstanding relationships. Helpers experienced this separation as “otherness.” Help became an important vehicle for bridging this separation. Individuals developed different ways of knowing about the patient as the basis for providing help. Two different types of help were identified in this study: the behind the scenes, largely invisible work that helpers undertook to help the patient without their knowledge and the explicit visible help that was much more commonly negotiated and discussed between helpers and patients. Conclusions The study provides the basis for a greater understanding on the part of professionals into the impact of diagnosis and radiotherapy treatment on family and friends. In doing so, the study identifies opportunities for the experience of helpers to be recognised and supported by professionals.
    April 05, 2017   doi: 10.1002/pon.4420   open full text
  • Practice requirements for psychotherapeutic treatment of cancer patients in the outpatient setting—A survey among certified psychotherapists in Germany.
    Susanne Singer, Erika Kojima, Jutta Beckerle, Bernhard Kleining, Erhard Schneider, Katrin Reuter.
    Psycho-Oncology. April 05, 2017
    Objective The aim of this study was to delineate the challenges that psychotherapists encounter when they treat cancer patients and how they organise their practices to be able to treat them. Methods A random sample of certified psychotherapists, licensed by the health authorities, with training in psycho‐oncology, was asked to complete a questionnaire covering the following issues: therapists' qualifications, organisation of the practice, dealing with appointment cancellations, financing, and networking. Practices with ≥50% cancer patients in their patient load were defined as “practices specialising in cancer” (PSC) and were compared to practices with a smaller proportion of cancer patients (non‐PSC). Results Of 120 contacted therapists, 83 replied and 77 were eligible. The median waiting time for a first consultation was 10 days in PSC and 14 days in non‐PSC (P = .05). Seventy‐five of PSC and 56% of non‐PSC can offer psychotherapy within 4 weeks. Time spent on dealing with the social problems of the patients was higher in PSC than in non‐PSC (P = .04). They spent also more time communicating with other health care professionals such as private practice oncologists (P = .001). Cancer patients need to cancel appointments more frequently than noncancer patients (58% vs 48% cancel ≥1× per quarter). Sixty‐six percent of the psychotherapists do not ask for financial reimbursement of these sessions. Conclusion Psychotherapy for cancer patients in the outpatient setting requires different organisation of the practice. Sessions are cancelled more frequently, waiting time is considerably shorter, and psychotherapists communicate more often with other health care providers than in general psychotherapy.
    April 05, 2017   doi: 10.1002/pon.4427   open full text
  • Psychological morbidity among Australian rural and urban support persons of haematological cancer survivors: Results of a national study.
    Mariko Carey, Rob Sanson‐Fisher, Christine Paul, Kenneth Bradstock, Anna Williamson, H. Sharon Campbell.
    Psycho-Oncology. March 30, 2017
    Objective To compare the prevalence of anxiety, depression, and stress among rural and urban support persons of haematological cancer survivors and explore factors associated with having one or more of these outcomes. Methods Haematological cancer survivors were identified via 1 of 5 state‐based cancer registries and invited to take part in a survey. Those who agreed were asked to pass on a questionnaire package to their support person. Measures included the Depression, Anxiety, and Stress Scale, Support Persons' Unmet Need Survey, and sociodemographic questions. Results Nine‐hundred and eighty‐nine (66%) participating survivors had a participating support person. There were no significant differences in the proportion of urban versus rural support persons who reported elevated levels of depression (21% vs 23%), anxiety (16% vs 17%), or stress (16% vs 20%), P > .05. Odds of reporting at least 1 indicator of psychological morbidity increased by 10% to 17% for each additional high or very high unmet need and by 2% for those who had relocated from their usual place of residence for the survivor to receive treatment and was decreased by 5% to 54% for those support persons who reported that they had no chronic health conditions. Conclusions Psychological outcomes for rural and urban support persons are similar. Those who have poor health, have had to relocate, and who have multiple unmet needs are particularly vulnerable to poor psychological outcomes. These factors should be assessed to enable early intervention for those at risk of poor outcomes.
    March 30, 2017   doi: 10.1002/pon.4411   open full text
  • Preloss grief in family caregivers during end‐of‐life cancer care: A nationwide population‐based cohort study.
    Mette Kjaergaard Nielsen, Mette Asbjoern Neergaard, Anders Bonde Jensen, Peter Vedsted, Flemming Bro, Mai‐Britt Guldin.
    Psycho-Oncology. March 28, 2017
    Objective Severe grief symptoms in family caregivers during end‐of‐life cancer trajectories are associated with complicated grief and depression after the loss. Nevertheless, severe grief symptoms during end‐of‐life caregiving in caregivers to cancer patients have been scarcely studied. We aimed to explore associations between severe preloss grief symptoms in caregivers and modifiable factors such as depressive symptoms, caregiver burden, preparedness for death, and end‐of‐life communication. Methods We conducted a population‐based prospective study of caregivers to 9512 patients registered with drug reimbursement due to terminal illness, and 3635 caregivers responded. Of these, 2865 caregivers to cancer patients completed a preloss grief scale (Prolonged Grief 13, preloss version). Associations with factors measured during end‐of‐life caregiving were analyzed using logistic regression. Results Severe preloss grief symptoms were reported by 432 caregivers (15.2%). These symptoms were associated with depressive symptoms (adjusted odds ratio [OR] = 12.4; 95% CI, 9.5‐16.3), high caregiver burden (adjusted OR = 8.3; 95% CI, 6.3‐11.1), low preparedness for death (adjusted OR = 3.3; 95% CI, 2.5‐4.4), low level of communication about dying (adjusted OR = 3.2; 95% CI, 2.2‐4.4), and “too much” prognostic information (adjusted OR = 2.8; 95%, 1.7‐4.6). Conclusions Severe preloss grief symptoms were significantly associated with distress, low preparedness, and little communication during caregiving. Thus, severe preloss grief symptoms may be a key indicator for complications in caregivers of cancer patients in an end‐of‐life trajectory. Targeted interventions are needed to support family caregivers with severe preloss grief symptoms. Development of preloss grief assessment tools and interventions should be a priority target in future research.
    March 28, 2017   doi: 10.1002/pon.4416   open full text
  • The relationship between cancer patients' place of death and bereaved caregivers' mental health status.
    Yutaka Hatano, Maho Aoyama, Tatsuya Morita, Takuhiro Yamaguchi, Isseki Maeda, Yoshiyuki Kizawa, Satoru Tsuneto, Yasuo Shima, Mitsunori Miyashita.
    Psycho-Oncology. March 27, 2017
    Background Although place of death has been recognized as a risk factor in caregivers' bereavement adjustment, the estimation of the effect of the place of death needs careful consideration about many potential cofounders. Patients and methods This study was a nationwide cross‐sectional questionnaire survey for bereaved family caregivers of patients with cancer who died in 3 settings: (1) hospice at home; (2) palliative care units (PCUs); and (3) acute hospitals. We assessed bereaved caregivers' depression, grief, insomnia, and the quality of dying of deceased patients across the 3 groups using propensity score weighting. Results A total of 8968 responses were analyzed. According to scores on Patient Health Questionnaire 9, depressive symptoms were significantly higher in bereaved caregivers of patients who had died in acute hospitals (5.7; 95% confidence interval [CI]: 5.3‐6.2) than for those of patients who had died in hospice at home (4.8; 95% CI: 4.4‐5.1) or PCU (5.1; 95% CI: 5.0‐5.2). Grief symptoms measured by Brief Grief Questionnaire were also significantly higher in caregivers of patients who had died in acute hospitals (5.0; 95% CI: 4.8‐5.2) than those of patients who had died in hospice at home (4.7; 95% CI: 4.5‐4.9) or PCU (4.7; 95% CI: 4.7‐4.8). Deceased patients' quality of dying was highest in hospice at home, and worst in acute hospital. Conclusions The place where a cancer patient dies influences not only their quality of dying and death but also the mental health of their family caregivers. However, the absolute difference is not large after adjustment of multiple variables.
    March 27, 2017   doi: 10.1002/pon.4412   open full text
  • The factor structure and use of the Demoralization Scale (DS‐IT) in Italian cancer patients.
    Luigi Grassi, Anna Costantini, David Kissane, Serena Brunetti, Rosangela Caruso, Giulia Piazza, Paolo Marchetti, Silvana Sabato, Maria Giulia Nanni.
    Psycho-Oncology. March 27, 2017
    Objective Demoralization is a commonly observed syndrome in cancer patients, deserving to be carefully assessed in cross‐cultural contexts. Aims To examine the factor structure and concurrent and divergent validity of the Italian version of the Demoralization Scale (DS‐IT) in cancer patients. Methods The sample included 194 Italian cancer outpatients who were assessed by using the DS‐IT and the Diagnostic Criteria of Psychosomatic Research–Demoralization module to examine demoralization. The Patient Health Questionnaire–9 (PHQ‐9) to explore depression and the Mini‐Mental Adjustment‐to‐Cancer–Hopelessness/Helplessness scale (Mini‐MAC‐HH) to explore maladaptive coping were also administered. Results Four factors were extracted by exploratory factor analysis on the DS‐IT (disheartenment, α = .87; sense of failure, α = .77; dysphoria, α = .73; loss of meaning/purpose, α = .72; total = 0.91), accounting for 57.1% of the variance. The DS‐IT factors shared between 17% and 36% of the variance. Patients reporting a diagnosis of demoralization on the Diagnostic Criteria of Psychosomatic Research–Demoralization module (23.7%) had higher scores on DS‐IT loss of meaning/purpose, sense of failure, dysphoria, and DS‐IT total. About half of those who were highly demoralized were not depressed and among those who had moderate or moderately severe demoralization, about 80% were not depressed on the PHQ‐9. The DS‐IT was significantly associated with PHQ‐9 and Mini‐MAC‐HH. Conclusions The study presents further evidence that demoralization is a significant clinical condition and that the DS‐IT demonstrates satisfactory levels of validity and reliability to support its use in patients in the ambulatory cancer setting.
    March 27, 2017   doi: 10.1002/pon.4413   open full text
  • Modeling posttraumatic growth among cancer patients: The roles of social support, appraisals, and adaptive coping.
    Weidan Cao, Xiaona Qi, Deborah A. Cai, Xuanye Han.
    Psycho-Oncology. March 20, 2017
    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.
    March 20, 2017   doi: 10.1002/pon.4395   open full text
  • Psychological and Clinical Correlates of Posttraumatic Growth in Cancer. A Systematic and Critical Review.
    Anna Casellas‐Grau, Cristian Ochoa, Chiara Ruini.
    Psycho-Oncology. March 20, 2017
    Objective To describe major findings on posttraumatic growth (PTG) in cancer, by analyzing its various definitions, assessment tools, and examining its main psychological and clinical correlates. Methods A search in relevant databases (PsycINFO, Pubmed, ProQuest, Scopus and Web of Science) was performed using descriptors related to the positive reactions in cancer. Articles were screened by title, abstract and full‐text. Results Seventy‐two met the inclusion criteria. Most articles (46%) focused on breast cancer, used the Post‐traumatic Growth Inventory (76%), and had a cross‐sectional design (68%). PTG resulted inversely associated with depressive and anxious symptoms, and directly related to hope, optimism, spirituality and meaning. Illness‐related variables have been poorly investigated compared to psychological ones. Articles found no relationship between cancer site, cancer surgery, cancer recurrence and PTG. Some correlations emerged with the elapsed time since diagnosis, type of oncological treatment received and cancer stage. Only few Studies differentiated illness‐related life threatening stressors from other forms of trauma, and the potentially different mechanisms connected with PTG outcome in cancer patients. Conclusions The evaluation of PTG in cancer patients is worthy, since it may promote a better adaption to the illness. However, many investigations do not explicitly refer to the medical nature of the trauma, and they may have not completely captured the full spectrum of positive reactions in cancer patients. Future research should better investigate issues such as health attitudes; the risks of future recurrences; and the type, quality, and efficacy of medical treatments received and their influence on PTG in cancer patients.
    March 20, 2017   doi: 10.1002/pon.4426   open full text
  • Who are happy survivors? Physical, psychosocial, and spiritual factors associated with happiness of breast cancer survivors during the transition from cancer patient to survivor.
    Danbee Kang, Im‐Ryung Kim, Eun‐Kyung Choi, Jung Hee Yoon, Se‐Kyung Lee, Jeong Eon Lee, Seok Jin Nam, Wonshik Han, Dong‐Young Noh, Juhee Cho.
    Psycho-Oncology. March 20, 2017
    Objective This study aims to evaluate physical, psychosocial, and spiritual factors associated with happiness in breast cancer survivors during the reentry period. Methods It is a cross‐sectional study with 283 nonmetastatic breast cancer survivors who completed treatment within 1 year. We included survivors who completed questionnaires on happiness and health‐related quality of life (QoL) 2 years after cancer diagnosis. Happiness and QoL was measured using the Subjective Happiness Scale and EORTC QLQ‐C30, respectively. Multivariable logistic regression was used to find factors associated with happiness. Results The mean age of the study participants was 48.5 ± 7.8 years. Among the 283 survivors, 14.5%, 43.8%, 32.5%, and 2.1% reported being “very happy,” “happy,” “neutral,” and “not happy at all,” respectively. Happy survivors reported a better general health status and QoL (67.6 vs 49.6; P < .01), and fewer symptoms compared to unhappy survivors. Happy survivors were more likely to feel certain about the future (27.2% vs 11.9%, P < .01), have a strong purpose in life (22.4% vs 9.3%, P < .01), and feel hopeful (36.4% vs 8.5%, P < .01) compared to unhappy survivors. In a multivariate model, having purpose (OR = 2.50, 95% CI 1.42‐4.40) and hope (OR = 4.07, 95% CI 2.23‐7.45) in life were found to be associated with happiness. Conclusions During the reentry period, breast cancer survivors who are hopeful and have a clear purpose in life are more likely to be happy than those who are not. Setting proper life goals might be beneficial to help breast cancer survivors who experience persistent QoL issues.
    March 20, 2017   doi: 10.1002/pon.4408   open full text
  • Exploring human papillomavirus vaccination refusal among ethnic minorities in England: A comparative qualitative study.
    Alice S. Forster, Lauren Rockliffe, Laura A.V. Marlow, Helen Bedford, Emily McBride, Jo Waller.
    Psycho-Oncology. March 15, 2017
    Objectives In England, uptake of human papillomavirus (HPV) vaccination to prevent HPV‐related cancer is lower among girls from ethnic minority backgrounds. We aimed to explore the factors that prevented ethnic minority parents from vaccinating, compared to White British nonvaccinating parents and vaccinating ethnic minority parents. Methods Interviews with 33 parents (n = 14 ethnic minority non‐vaccinating, n = 10 White British nonvaccinating, and n = 9 ethnic minority vaccinating) explored parents' reasons for giving or withholding consent for HPV vaccination. Data were analysed using Framework Analysis. Results Concerns about the vaccine were raised by all nonvaccinating ethnic minority parents, and they wanted information to address these concerns. External and internal influences affected parents' decisions, as well as parents' perceptions that HPV could be prevented using means other than vaccination. Reasons were not always exclusive to nonvaccinating ethnic minority parents, although some were, including a preference for abstinence from sex before marriage. Only ethnic minority parents wanted information provided via workshops. Conclusions Ethnic differences in HPV vaccination uptake may be partly explained by concerns that were only reported by parents from some ethnic groups. Interventions to improve uptake may need to tackle difficult topics like abstinence from sex before marriage, and use a targeted format.
    March 15, 2017   doi: 10.1002/pon.4405   open full text
  • Personality, coping, and social support as predictors of long‐term quality‐of‐life trajectories in older breast cancer survivors: CALGB protocol 369901 (Alliance).
    Estrella Durá‐Ferrandis, Jeanne S. Mandelblatt, Jonathan Clapp, George Luta, LeighAnne Faul, Gretchen Kimmick, Harvey Jay Cohen, Rachel L. Yung, Arti Hurria.
    Psycho-Oncology. March 09, 2017
    Background To determine long‐term quality‐of‐life (QOL) trajectories among breast cancer survivors aged 65+ (older) evaluating the effects of personality and social support. Methods Older women (N = 1280) newly examined with invasive, nonmetastatic breast cancer completed baseline assessments. Follow‐up data were collected 6 and 12 months later and then annually for up to 7 years (median 4.5 years). Quality of life was assessed using EORTC‐QLQ‐C30 emotional, physical, and cognitive scales. Optimism (Life Orientation Test), Coping (Brief COPE), and social support (Medical Outcomes Study) were assessed at baseline. Group‐based trajectory modeling identified QOL trajectories; multinomial regression evaluated effects of predictors on trajectory groups. Age, education, systemic therapy, comorbidity, and reported precancer function (SF‐12) were considered as controlling variables. Results Three trajectories were identified for each QOL domain: “maintained high,” “phase shift” (lower but parallel scores to “maintained high” group), and “accelerated decline” (lowest baseline scores and steepest decline). Accelerated decline in emotional, physical, and cognitive function was seen in 6.9%, 31.8%, and 7.6% of older survivors, respectively. Maladaptive coping and lower social support increased adjusted odds of being in the accelerated decline group for all QOL domains; lower optimism was only related to decline in emotional function. Chemotherapy was related to physical and cognitive but not emotional function trajectories. Conclusions Personality and social resources affect the course of long‐term emotional well‐being of older breast cancer survivors; treatment is more important for physical and cognitive than emotional function. Early identification of those vulnerable to deterioration could facilitate clinical and psychological support.
    March 09, 2017   doi: 10.1002/pon.4404   open full text
  • Cancer survivors' activation to self‐management and its relationship with participation in paid work and work‐related problems.
    Pomme Maarschalkerweerd, Jany Rademakers, Mieke Rijken.
    Psycho-Oncology. March 07, 2017
    Objective This study aimed to explore cancer survivors' level of patient activation, ie, their knowledge, skills, and confidence for self‐management, and to examine its relations to their participation in paid work and work‐related problems. Methods A total of 524 Dutch cancer survivors, 208 younger than 65 years, completed the Patient Activation Measure (PAM‐13) and the Research and Development (RAND‐36) General Health scale. Cancer survivors younger than 65 years also reported on their participation in paid work and work‐related problems. Results The mean PAM‐13 score of cancer survivors was 58.1, and of those younger than 65 years 58.7. Patient activation was not associated with participation in paid work. Employed cancer survivors with a low level of patient activation experienced more problems working accurately (34% vs 17%), finishing their work (47% vs 22%), and concentrating (59% vs 31%) than those with a higher level of patient activation. The former group also reported more work stress (62% vs 28%). Conclusions Patient activation of cancer survivors deserves more attention, as a substantial proportion of these survivors have low activation levels, which relate to more work‐related problems. Longitudinal studies are needed to explore the development of patient activation over time and its potential to improve important outcomes for people living with cancer in both the health and work domains.
    March 07, 2017   doi: 10.1002/pon.4400   open full text
  • A pilot study evaluation of psychosocial competency training for junior physicians working in oncology and hematology.
    Stefanie Mache, Karin Vitzthum, Inka Hauschild, David Groneberg.
    Psycho-Oncology. March 07, 2017
    Background This pilot and feasibility study evaluated a work‐related self‐care competency training in oncology and hematology medicine for junior physicians working in oncology and hematology medicine. Methods A pilot study was conducted with 80 physicians working in oncology and hematology hospital departments in Germany. Physicians were distributed to either the intervention group receiving competency training or a comparison group. The intervention took place in groups over a period of 12 weeks. Training content included work‐related self‐care strategies, problem‐solving techniques solution‐focused counselling. The outcomes studied were changes in work‐related stress, emotional exhaustion, emotion regulation, and job satisfaction. Follow‐up assessments were arranged after 12 weeks (T1), after 24 weeks (T2), and after 36 weeks (T3). Results Intervention group reached a decrease in perceived job stress and emotional exhaustion. Self‐perceived improvements were also obvious regarding enhanced emotion regulation skills. Future oncologists valued the intervention with high scores for training design, content, received outcome, and overall training satisfaction. Conclusions This study provided first indications that an innovative self‐care competency training might be a supportive approach for junior physicians starting work in oncology and hematology. However, replication studies are needed to verify the results in the medical working context.
    March 07, 2017   doi: 10.1002/pon.4403   open full text
  • Predictors of satisfaction and quality of life following post‐mastectomy breast reconstruction.
    Hannah Matthews, Natalie Carroll, Derek Renshaw, Andrew Turner, Alan Park, Jo Skillman, Kate McCarthy, Elizabeth A. Grunfeld.
    Psycho-Oncology. March 06, 2017
    Objective Breast reconstruction is associated with multiple psychological benefits. However, few studies have identified clinical and psychological factors associated with improved satisfaction and quality of life. This study examined factors, which predict satisfaction with breast appearance, outcome satisfaction and quality of life following post‐mastectomy breast reconstruction. Methods Women who underwent post‐mastectomy breast reconstruction between 2010 and 2016 received a postal questionnaire consisting of The BREAST‐Q Patient Reported Outcomes Instrument, The European Organisation for Research and Treatment of Cancer QLQ‐30 Questionnaire, The Patient and Observer Scar Assessment Scale, and a series of Visual‐Analogue Scales. One hundredforty‐eight women completed the questionnaire, a 56% response rate. Results Hierarchical multiple regression analyses revealed psychosocial factors accounted for 75% of the variance in breast satisfaction, 68% for outcome satisfaction, and 46% forquality of life. Psychosocial well‐being emerged as a significant predictor of satisfaction with breast appearance (β = .322) and outcome satisfaction (β = .406). Deep inferior epigastric perforator flap patients reported greater satisfaction with breast appearance (β = .120) and outcome satisfaction (β = .167). Conclusions This study extends beyond the limited research by distinguishing between satisfaction with breast appearance and outcome satisfaction. The study provides evidence for the role of psychosocial factors predicting key patient reported outcomes and demonstrates the importance of psychosocial well‐being and reconstruction type. The findings also highlight the need for healthcare providers to consider the psychosocial well‐being of patients both preoperatively and post operatively and provide preliminary evidence for the use of deep inferior epigastric perforator reconstructions over other types of reconstructive procedures.
    March 06, 2017   doi: 10.1002/pon.4397   open full text
  • Impact of universal health coverage on suicide risk in newly diagnosed cancer patients: Population‐based cohort study from 1985 to 2007 in Taiwan.
    Po‐Hsien Lin, Shih‐Cheng Liao, I‐Ming Chen, Po‐Hsiu Kuo, Jia‐Chi Shan, Ming‐Been Lee, Wei J. Chen.
    Psycho-Oncology. March 02, 2017
    Background National Health Insurance (NHI), launched in 1995 in Taiwan, lightens patient's financial burdens but its effect on the suicide risk in cancer patients is unclear. We aimed to investigate the impacts of the NHI on the suicide in newly diagnosed cancer patients. Methods We identified patients with newly diagnosed cancer from the nationwide Taiwan Cancer Registration from 1985 to 2007, and ascertained suicide deaths from the national database of registered deaths between 1985 and 2009. Standardized mortality ratio (SMR) of suicide risk among patients with cancer was calculated, and the suicide risk ratios were examined by gender, age group, and prognosis. Results For the 916 337 registered cancer patients with 4 300 953 person‐years, 2 543 died by suicide, with a suicide rate of 59.1 per 100 000 person‐years. Compared to the general population, cancer patients had an SMR of 2.47 for suicide, with a higher figure for males (2.73), age 45 to 64 (2.89), and cancer of poor prognosis (3.19). The suicide risk was highest in the first 2 years after the initial diagnosis. Comparing the cohorts of the period before (1985 to 1992) and after (1996 to 2007) the launch of NHI, we saw a reduction in the SMR within the first 2 years after cancer diagnosis (20%), with more prominent reduction for females (29%), age under 45 (69%), and cancer of good prognosis (33%). Conclusions A universal health coverage relieving both physical and psychological distress may account for the post‐NHI reduction of immediate suicide risk in patients of newly diagnosed cancer.
    March 02, 2017   doi: 10.1002/pon.4396   open full text
  • Predicting changes in adaptive functioning and behavioral adjustment following treatment for a pediatric brain tumor: A report from the Brain Radiation Investigative Study Consortium.
    Kristen R. Hoskinson, Kelly R. Wolfe, Keith Owen Yeates, E. Mark Mahone, Kim M. Cecil, M. Douglas Ris.
    Psycho-Oncology. March 02, 2017
    Background Children are at risk for behavioral and adaptive difficulties following pediatric brain tumor. This study explored whether familial/demographic, developmental, diagnostic, or treatment‐related variables best predict posttreatment behavioral and adaptive functioning. Methods Participants included 40 children (mean age = 12.76 years, SD = 4.01) posttreatment (mean time since diagnosis = 1.99 years, SD = 0.21) for pediatric brain tumor. Parents rated children's behavioral adjustment and adaptive functioning and provided demographic and developmental histories. Diagnostic and treatment‐related information was abstracted from medical records. Results Ratings of adaptive and behavioral functioning approximately 2 years postdiagnosis were within the average range, although the percentage of children exceeding clinical cutoffs for impairment in adaptive skills exceeded expectation, particularly practical skills. Premorbid behavior problems and tumor size predicted posttreatment adaptive functioning. After accounting for adaptive functioning near diagnosis, premorbid behavior problems predicted declines in adaptive functioning 2 years postdiagnosis. After accounting for adjustment near diagnosis, no variables predicted declines in behavioral adjustment. Conclusions Children may be vulnerable to reduced adaptive functioning following pediatric brain tumor treatment, especially in practical skills. Assessing prediagnosis functioning and diagnostic and treatment‐related variables may improve our ability to predict those at greatest risk, although those factors may be less helpful in identifying children likely to develop behavioral difficulties. Screening of these factors in tertiary care and long‐term follow‐up settings may improve identification of those at greatest need for support services.
    March 02, 2017   doi: 10.1002/pon.4394   open full text
  • Depression and religiosity and their correlates in Lebanese breast cancer patients.
    Sandra Abou Kassm, Sani Hlais, Christina Khater, Issam Chehade, Ramzi Haddad, Johnny Chahine, Mohammad Yazbeck, Rita Abi Warde, Wadih Naja.
    Psycho-Oncology. March 02, 2017
    Background Breast cancer bears considerable morbidity and mortality and is well known to increase the risk of major depression, whereas religiosity has been reported to be protective. We searched for an association between depression and religiosity in breast cancer patients. We also sought to find an association between depression and various sociodemographic and disease variables. Methods One hundred two patients were interviewed. Sociodemographic, cancer profile, and religiosity questionnaires were administered. We screened for depressive disorders by using the Mini‐International Neuropsychiatric Interview and the Beck Depression Inventory. Results Most of our participants (n = 79; 77.4%) had high religiosity score. The prevalences of lifetime major depression, current major depression, and major depression after cancer diagnosis were 50.9%, 30.1%, and 43.1%, respectively. We could not find a correlation between religiosity and current depression, while the association with depression after cancer diagnosis was close to but did not reach statistical significance (P = .055) and in favor of a deleterious role of religiosity. Depression was only linked to marital status and insurance coverage. No association was found with disease‐related variables. Conclusions Religiosity does not seem to be protective against depression development. The stress of cancer appears to be the main culprit in increasing the risk of depression.
    March 02, 2017   doi: 10.1002/pon.4386   open full text
  • Isolation and prayer as means of solace for Arab women with breast cancer: An in‐depth interview study.
    Ghada Najjar Assaf, Eleanor Holroyd, Violeta Lopez.
    Psycho-Oncology. March 02, 2017
    Objective This study explored Arab women's experiences following the diagnosis and treatment of breast cancer. Methods Face‐to‐face in‐depth interviews were conducted with 20 Arab women attending a public hospital in Abu Dhabi, United Arab Emirates, following a recent diagnosis of breast cancer. All interviews were transcribed verbatim and analysed using the thematic method. Results Arab women's experiences following their breast cancer diagnoses and treatments included the themes of (1) protecting one's self from stigma, (2) facing uncertainties and prayers, and (3) getting on with life. Overall, the ways to find solace were through isolation and prayer, which are heavily influenced by religion and spiritual practices. They recommended that to help women with breast cancer, a campaign to raise awareness for early screening is needed as well the need to form a peer‐led support group for women with breast cancer consisting of breast cancer survivors so that they can learn from each other's experiences. Conclusions Arab women with breast cancer experienced a myriad of social, cultural, psychological, and relationship difficulties that impacted their overall health and well‐being. The findings also found that these women were not passive agents. They sought to solve problem, move forward, and recreate the meanings in their lives in their own unique ways. Action is needed for possible ways to implement religion‐health partnerships between breast cancer nurses, peer‐led support groups, palliative care services, and religious institutions.
    March 02, 2017   doi: 10.1002/pon.4402   open full text
  • Determinants of patient activation in a community sample of breast and prostate cancer survivors.
    Denalee O'Malley, Asa A. Dewan, Pamela A. Ohman‐Strickland, Daniel A. Gundersen, Suzanne M. Miller, Shawna V. Hudson.
    Psycho-Oncology. February 28, 2017
    Background Patient activation—the knowledge, skills, and confidence to manage one's health—is associated with improved self‐management behaviors for several chronic conditions. This study assesses rates of patient activation in breast and prostate cancer survivors and explores the characteristics associated with patient activation. Methods A cross‐sectional study of survivors with localized (Stage I or II) breast and prostate cancers who were post‐treatment (between 1‐10+ years) were recruited from 4 community hospital sites in New Jersey. Survey data on patient characteristics (demographic and psychosocial) and clinical factors were assessed to explore the relationships with patient activation using the Patient Activation Measure–13. Results Among 325 survivors (112 prostate; 213 breast), overall patient activation was high (M = 3.25). Activation was significantly lower among prostate survivors when compared with breast cancer survivors (M = 3.25 [SD, 0.38] vs M = 3.34 [SD, 0.37], P<.05). For prostate survivors, race (P < .05), marital status (P < .001), employment status (P < .01), household income (P < .05), and fear of recurrence (P < .01) were significantly associated with patient activation. For both groups, ease of access to oncology team and primary care physicians (PCPs) (all P values < .001) and perceptions of time spent with oncologists' team and PCPs (all P values < .01) were positive predictors of activation. Conclusions In both breast and prostate survivors, access to providers (both PCPs and oncologists) and perception that adequate time spent with providers were associated with activation. Therefore, clinical interventions maybe a promising avenue to improve patient activation. Research is needed to develop and test tailored patient activation interventions to improve self‐management among cancer survivors.
    February 28, 2017   doi: 10.1002/pon.4387   open full text
  • Treatment decision making in early‐stage papillary thyroid cancer.
    Thomas A. D'Agostino, Elyse Shuk, Erin K. Maloney, Rebecca Zeuren, R. Michael Tuttle, Carma L. Bylund.
    Psycho-Oncology. February 27, 2017
    Objective The purpose of this study was to develop an in‐depth understanding of papillary microcarcinoma (PMC) patients' decision‐making process when offered options of surgery and active surveillance. Methods Fifteen PMC patients and 6 caregivers participated in either a focus group or individual interview. Focus groups were segmented by patients' treatment choice. Primary themes were identified in transcripts using thematic text analysis. Results Four themes emerged from the surgery subsample: (1) Decision to undergo thyroidectomy quickly and with a sense of urgency; (2) Perception of PMC as a potentially life‐threatening disease; (3) Fear of disease progression and unremitting uncertainty with active surveillance; and (4) Surgery as a means of control and potential cure. Three themes emerged from the active surveillance subsample: (1) View of PMC as a common, indolent, and low‐risk disease; (2) Concerns about adjusting to life without a thyroid and becoming reliant on hormone replacement medication; and (3) Openness to reconsidering surgery over the long run. Two themes were identified that were shared by participants from both subsamples: (1) Deep level of trust and confidence in physician and cancer center; and (2) Use of physician and internet as primary sources of disease and treatment‐related information. Conclusions Several factors influenced participants' treatment choice, with similarities and differences noted between surgery and active surveillance subsamples. Many of the emergent themes are consistent with research on decision making among localized prostate cancer patients. Findings suggest that participants from both PMC treatment subsamples are motivated to reduce illness and treatment‐related uncertainty.
    February 27, 2017   doi: 10.1002/pon.4383   open full text
  • Using cluster analysis of anxiety‐depression to identify subgroups of prostate cancer patients for targeted treatment planning.
    Christopher F. Sharpley, Vicki Bitsika, Amelia K. Warren, David R.H. Christie.
    Psycho-Oncology. February 23, 2017
    Background To explore any possible subgroupings of prostate cancer (PCa) patients based upon their combined anxiety‐depression symptoms for the purposes of informing targeted treatments. Methods A sample of 119 PCa patients completed the GAD7 (anxiety) and PHQ9 (depression), plus a background questionnaire, by mail survey. Data on the GAD7 and PHQ9 were used in a cluster analysis procedure to identify and define any cohesive subgroupings of patients within the sample. Results Three distinct clusters of patients were identified and were found to be significantly different in the severity of their GAD7 and PHQ9 responses, and also by the profile of symptoms that they exhibited. Conclusions The presence of these 3 clusters of PCa patients indicates that there is a need to extend assessment of anxiety and depression in these men beyond simple total score results. By applying the clustering profiles to samples of PCa patients, more focussed treatment might be provided to them, hopefully improving outcome efficacy.
    February 23, 2017   doi: 10.1002/pon.4391   open full text
  • Regret and fear in prostate cancer: The relationship between treatment appraisals and fear of recurrence in prostate cancer survivors.
    Rebecca Maguire, Paul Hanly, Frances J. Drummond, Anna Gavin, Linda Sharp.
    Psycho-Oncology. February 20, 2017
    Objective Fear of recurrence (FOR) is a key concern among survivors of all cancers. In prostate cancer, FOR varies with health and treatment type, but little is known about how survivors' appraisals of their treatment, and in particular, their level of regret over treatment decisions may affect this. Methods A total of 1229 prostate cancer survivors between 2‐ and 5‐years postdiagnosis were invited to complete a postal questionnaire including a FOR scale, Decisional Regret Scale, and the European Organization for Research and Treatment of Cancer QLQ C30 health‐related quality of life (HRQoL) instrument. Multiple regression analysis explored the impact of 3 blocks of factors on FOR: (1) demographic characteristics and disease extent, (2) primary treatment received and health status (treatment side effects and HRQoL), and (3) treatment appraisals, specifically satisfaction with information received regarding treatment and level of regret experienced over treatment decisions. Results The final multivariable model explained 27% of variance on FOR. Significant correlates of lower FOR included having localised disease, having undergone an invasive treatment, as well as health status (higher HRQoL and fewer ongoing side effects). Beyond this, appraisals of treatment significantly contributed to the model: More decisional regret and lower satisfaction with information received were associated with higher FOR. Conclusion These findings suggest that FOR may be mitigated by providing survivors with more information regarding treatment choices and the treatment itself so that men can make well‐informed decisions and experience less future regret. Sensitivity analysis for variables predicting FOR among prostate cancer survivors is not suspected of having a recurrence.
    February 20, 2017   doi: 10.1002/pon.4384   open full text
  • A randomized control intervention trial to improve social skills and quality of life in pediatric brain tumor survivors.
    Maru Barrera, Eshetu G. Atenafu, Lillian Sung, Ute Bartels, Fiona Schulte, Joanna Chung, Danielle Cataudella, Kelly Hancock, Laura Janzen, Amani Saleh, Douglas Strother, Andrea Downie, Shayna Zelcer, Juliette Hukin, Dina McConnell.
    Psycho-Oncology. February 20, 2017
    Background To determine if a group social skills intervention program improves social competence and quality of life (QOL) in pediatric brain tumor survivors (PBTS). Methods We conducted a randomized control trial in which PBTS (8‐16 years old, off therapy for over 3 months) were allocated to receive social skills training (eg, cooperation, assertion, using social cognitive problem solving strategies, role playing, games, and arts and crafts) in 8 weekly 2‐hour sessions, or an attention placebo control (games and arts and crafts only). Outcomes were self‐reported, proxy‐reported (caregiver), and teacher‐reported using the Social Skills Rating System (SSRS), to measure social competence, and the Pediatric Quality of Life (PedsQL4.0, generic) to measure QOL at baseline, after intervention, and at 6 months follow‐up. At baseline, SSRS were stratified into low and high scores and included as a covariate in the analysis. Results Compared to controls (n = 48), PBTS in the intervention group (n = 43) reported significantly better total and empathy SSRS scores, with improvements persisting at follow‐up. The PBTS in the intervention group who had low scores at baseline reported the greatest improvements. Proxy and teacher reports showed no intervention effect. Conclusions Participating in group social skills intervention can improve self‐reported social competence that persisted to follow up. The PBTS should be given the opportunity to participate in social skills groups to improve social competence.
    February 20, 2017   doi: 10.1002/pon.4385   open full text
  • Examining the sustainability of Screening for Distress, the sixth vital sign, in two outpatient oncology clinics: A mixed‐methods study.
    Shannon Groff, Jayna Holroyd‐Leduc, Deborah White, Barry D. Bultz.
    Psycho-Oncology. February 10, 2017
    Background Research indicates that cancer patients experience significant multifactorial distress during their journey. To address this, cancer centers are implementing Screening for Distress programs; however, little is known about the sustainability of these programs. This study sought to examine the sustainability of a Screening for Distress program in 2 cancer clinics 6 months post implementation. Methods A mixed‐methods cross‐sectional design was utilized. To determine if screening rates, screening conversations and appropriate interventions occurred and the charts of 184 consecutive patients attending the head and neck or neuro‐oncology clinics over a 3 week period were reviewed. To examine the barriers and facilitators of sustainability, 16 semi‐structured interviews with administrators, physicians, and nurses were conducted. Results Of the 184 charts reviewed, 163 (88.6%) had completed screening tools. Of these 163, 130 (79.8%) indicated that a conversation occurred with the patient about the identified distress as reported on the screening tool. Of the 89 (54.6%) charts where the need for an intervention was indicated, 68 (76.4%) had an intervention documented. Six oncologists, 7 nurses, and 3 administrators were interviewed, and 5 themes which influenced the sustainability of the program emerged: (1) attitudes, knowledge, and beliefs about the program; (2) implementation approach; (3) outcome expectancy of providers; (4) integration with existing practices; and (5) external factors. Conclusions This study suggests that Screening for Distress was largely sustained, possibly due to positive attitudes and outcome expectancy. However, sustainability may be enhanced by formally integrating screening with existing practices, addressing potential knowledge gaps, and ensuring engagement with all stakeholder groups.
    February 10, 2017   doi: 10.1002/pon.4388   open full text
  • Testing a novel account of the dissociation between self‐reported memory problems and memory performance in chemotherapy‐treated breast cancer survivors.
    Lise Paquet, Shailendra Verma, Barbara Collins, Anne Chinneck, Marc Bedard, Xinni Song.
    Psycho-Oncology. February 10, 2017
    Background A puzzling observation pertaining to the impact of breast cancer on memory is the frequently reported dissociation between breast cancer survivors' self‐reported memory problems and memory performance. We evaluated the hypothesis that the dissociation is related to the fact that the objective memory measures previously used assessed retrospective memory (RM) and did not tap prospective memory (PM), a domain about which survivors are complaining. Methods In a case‐healthy‐control (N = 80) cross‐sectional study, the Memory for Intention Screening Test was used to assess PM and the Wechsler Logical Memory Test was used to evaluate RM. Self‐reported problems were assessed with the Prospective and Retrospective Memory Questionnaire. Measures of depression (Center for Epidemiologic Studies Depression Scale) and fatigue (Functional Assessment of Cancer Therapy: Fatigue) were also administered. Results Both groups reported more PM than RM problems (P < .001). Survivors reported more fatigue and depression symptoms and more memory problems than controls (all P < .001). Importantly, the group difference in self‐reported problems was no longer observed after adjusting for depression and fatigue. Survivors performed worse than controls on both PM and RM tasks. In neither group, however, were associations between self‐reported RM and PM problems and RM and PM objective performance observed. Conclusions Breast cancer survivors exhibit PM and RM deficits, which do not correlate with self‐reported memory problems. Although unrelated to performance, memory complaints should not be dismissed, as they are closely associated with depression and fatigue and reveal an important facet of the cancer experience.
    February 10, 2017   doi: 10.1002/pon.4389   open full text
  • Exploring characteristics, predictors, and consequences of fear of cancer recurrence among Asian‐American breast cancer survivors.
    Kimlin Tam Ashing, Dalnim Cho, Lily Lai, Sophia Yeung, Lucy Young, Christina Yeon, Yuman Fong.
    Psycho-Oncology. February 10, 2017
    Background To address the fear of cancer recurrence (FCR) research gap, we used prospective data to explore FCR predictors and FCR associations with health‐related quality of life among Asian‐American breast cancer survivors (BCS). Methods A total of 208 diverse Asian‐American BCS completed T1 survey, and 137 completed T2 survey after 1 year. Results Fear of cancer recurrence scores (range = 0‐4) were 2.01 at T1 and 1.99 at T2 reflecting low‐to‐moderate FCR. Scores of FCR were stable over the 1‐year period (t(126) = .144, P = .886). Multiple regression analyses showed that Chinese women reported lower FCR both at T1 (t(193) = −2.92, P = .004) and T2 (t(128) = −2.56, P = .012) compared to other Asian women. Also, more positive health care experience at T1 predicted lower FCR at T2 (β = −.18, P = .041). Controlling for other covariates, greater FCR at T1 predicted poorer outcomes 1 year later including lower physical (β = −.31, P < .001), emotional (β = −.37, P < .001) and functional (β = −.16, P = .044) well‐being and health‐related quality of life specific to breast cancer at T2 (β = −.31, P < .001). Conclusions We found substantial consistencies and some divergences between our findings with Asian‐American BCS and the existing literature. This prospective investigation reveals new information suggesting that Asian‐American subgroup variation exists and health care system factors may influence FCR. Thus, FCR studies should consider Asian subgroupings, cultural aspects, ie, level of acculturation and health care system factors including provider‐patient communication and treatment setting. Future research may benefit from contextualizing FCR within a broader distress framework to advance the science and practice of patient‐centered and whole‐person care.
    February 10, 2017   doi: 10.1002/pon.4350   open full text
  • Effect of aerobic exercise on cancer‐associated cognitive impairment: A proof‐of‐concept RCT.
    K.L. Campbell, J.W.Y. Kam, S.E. Neil‐Sztramko, T. Liu Ambrose, T.C. Handy, H.J. Lim, S. Hayden, L. Hsu, A.A. Kirkham, C.C. Gotay, D.C. McKenzie, L.A. Boyd.
    Psycho-Oncology. February 10, 2017
    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.
    February 10, 2017   doi: 10.1002/pon.4370   open full text
  • Key messages for communicating information about BRCA1 and BRCA2 to women with breast or ovarian cancer: Consensus across health professionals and service users.
    Chris Jacobs, Gabriella Pichert, Jackie Harris, Kathy Tucker, Susan Michie.
    Psycho-Oncology. February 10, 2017
    Background Genetic testing of cancer predisposing genes will increasingly be needed in oncology clinics to target cancer treatment. This Delphi study aimed to identify areas of agreement and disagreement between genetics and oncology health professionals and service users about the key messages required by women with breast/ovarian cancer who undergo BRCA1/BRCA2 genetic testing and the optimal timing of communicating key messages. Methods Participants were 16 expert health professionals specialising in oncology/genetics and 16 service users with breast/ovarian cancer and a pathogenic BRCA1/BRCA2 variant. Online questionnaires containing 53 inductively developed information messages were circulated to the groups separately. Participants rated each message as key/not key on a Likert scale and suggested additional messages. Questionnaires were modified according to the feedback and up to 3 rounds were circulated. Consensus was reached when there was ≥75% agreement. Results Thirty key messages were agreed by both groups with 7 of the key messages agreed by ≥95% of participants: dominant inheritance, the availability of predictive testing, the importance of pretest discussion, increased risk of breast and ovarian cancer, and the option of risk‐reducing mastectomy and bilateral salpingo‐oophorectomy. Both groups agreed that key messages should be communicated before genetic testing and once a pathogenic variant has been identified. Conclusions There was a high level of agreement within and between the groups about the information requirements of women with breast/ovarian cancer about BRCA1/BRCA2. These key messages will be helpful in developing new approaches to the delivery of information as genetic testing becomes further integrated into mainstream oncology services.
    February 10, 2017   doi: 10.1002/pon.4379   open full text
  • Perceived needs for the information communication technology (ICT)‐based personalized health management program, and its association with information provision, health‐related quality of life (HRQOL), and decisional conflict in cancer patients.
    Jin Ah Sim, Yoon Jung Chang, Aesun Shin, Dong‐Young Noh, Wonshik Han, Han‐Kwang Yang, Young Whan Kim, Young Tae Kim, Seoung‐Yong Jeong, Jung‐Hwan Yoon, Yoon Jun Kim, Daesuk Heo, Tae‐You Kim, Do‐Youn Oh, Hong‐Gyun Wu, Hak Jae Kim, Eui Kyu Chie, Keon Wook Kang, Ju Han Kim, Young Ho Yun.
    Psycho-Oncology. February 10, 2017
    Objective The use of information communication technology (ICT)–based tailored health management program can have significant health impacts for cancer patients. Information provision, health‐related quality of life (HRQOL), and decision conflicts were analyzed for their relationship with need for an ICT‐based personalized health management program in Korean cancer survivors. Methods The health program needs of 625 cancer survivors from two Korean hospitals were analyzed in this cross‐sectional study. Multivariate logistic regression was used to identify factors related to the need for an ICT‐based tailored health management system. Association of the highest such need with medical information experience, HRQOL, and decision conflicts was determined. Furthermore, patient intentions and expectations for a web‐ or smartphone‐based tailored health management program were investigated. Results Cancer survivors indicated high personalized health management program needs. Patients reporting the highest need included those with higher income (adjusted odds ratio [aOR], 1.70; 95% [confidence interval] CI, 1.10‐2.63), those who had received enough information regarding helping themselves (aOR, 1.71; 95% CI, 1.09‐2.66), and those who wished to receive more information (aOR, 1.59; 95% CI, 0.97‐2.61). Participants with cognitive functioning problems (aOR, 2.87; 95%CI, 1.34‐6.17) or appetite loss (aOR, 1.77; 95% CI, 1.07‐2.93) indicated need for a tailored health care program. Patients who perceived greater support from the decision‐making process also showed the highest need for an ICT‐based program (aOR, 0.49; 95% CI, 0.30‐0.82). Conclusions We found that higher income, information provision experience, problematic HRQOL, and decisional conflicts are significantly associated with the need for an ICT‐based tailored self‐management program.
    February 10, 2017   doi: 10.1002/pon.4367   open full text
  • Care‐related predictors for negative intrusive thoughts after prostate cancer diagnosis—data from the prospective LAPPRO trial.
    Thordis Thorsteinsdottir, Heiddis Valdimarsdottir, Arna Hauksdottir, Johan Stranne, Ulrica Wilderäng, Eva Haglind, Gunnar Steineck.
    Psycho-Oncology. February 10, 2017
    Objective Negative intrusive thoughts about one's prostate cancer have been associated with depressive mood and impaired quality of life among prostate cancer patients. However, little is known about possible predictors for negative intrusive thoughts among this group. We aimed to identify health‐ and care‐related predictors for such thoughts among a population of men newly diagnosed with prostate cancer and undergoing radical prostatectomy. Methods In the LAPPRO‐trial, 3154 men (80%) answered study‐specific questionnaires at admission and 3 months after surgery. Questions concerned socio‐demographics, health, uncertainty, preparedness for symptoms, and the outcome—negative intrusive thoughts. Associations between variables were analyzed by log‐binominal and multivariable approach. Results The strongest predictor of negative intrusive thoughts at admission to surgery was uncertainty of cure, followed by binge drinking, poor physical health, antidepressant medication, not being prepared for urinary symptoms, age under 55, and physical pain. Reporting it not probable to obtain urinary symptoms after surgery lowered the odds. Negative intrusive thoughts before surgery were the strongest predictor for such thoughts 3 months later followed by uncertainty of cure, physical pain, younger age, living alone, and poor self‐reported physical health. Conclusions Our findings showed an association of preoperative uncertainty of cure as well as low preparedness for well‐known surgery‐induced symptoms with higher occurrence of negative intrusive thoughts about prostate cancer. Future studies should examine if interventions designed to have healthcare professionals inform patients about their upcoming prostatectomy reduce patients' negative intrusive thoughts and thereby, improve their psychological well‐being.
    February 10, 2017   doi: 10.1002/pon.4359   open full text
  • Caregiver, patient, and nurse visit communication patterns in cancer home hospice.
    Maija Reblin, Margaret F. Clayton, Jiayun Xu, Jennifer M. Hulett, Seth Latimer, Gary W. Donaldson, Lee Ellington.
    Psycho-Oncology. February 10, 2017
    Objective Few studies have examined the triadic communication between patients, spouse caregivers, and nurses in the home hospice setting. Thus, little is known about the types of communication patterns that unfold. The goals of the study were to, first, identify common patterns of communication in nurse‐patient‐caregiver home hospice visits and, second, to identify nurse, caregiver‐patient dyad, and visit characteristics that predict visit communication patterns. Method Nurses (N = 58) and hospice cancer patient and spouse caregiver dyads (N = 101; 202 individuals) were recruited from 10 hospice agencies. Nurses audio recorded visits to patient/caregiver homes from study enrollment until patient death. All patient, caregiver, and nurse utterances from the audio recordings were coded using an adapted Roter interaction analysis system. Using identified codes, cluster analysis was conducted to identify communication patterns within hospice visits. Logistic regression was used with demographic variables to predict visit communication patterns. Results Six visit communication patterns were identified and were defined largely by 2 dimensions: (1) either the patient, the caregiver, or the patient and caregiver dyad interacting with the nurse and (2) the relatively high or low expression of distress during the visit. Time until death significantly predicted several clusters. Conclusion This study leads the way in outlining triadic communication patterns in cancer home hospice visits. Our findings have implications for nursing education, letting future nurses know what to expect, and lays the foundation for future research to determine effectiveness and interventions to improve health care communication.
    February 10, 2017   doi: 10.1002/pon.4361   open full text
  • Balancing give and take between patients and their spousal caregivers in hematopoietic stem cell transplantation.
    Sara Beattie, Sophie Lebel, Danielle Petricone‐Westwood, Keith G. Wilson, Cheryl Harris, Gerald Devins, Lothar Huebsch, Jason Tay.
    Psycho-Oncology. February 02, 2017
    Objective Hematopoietic stem cell transplantation (HSCT) is a demanding treatment. Spouses of HSCT patients assume caregiving responsibilities that can induce feelings of burden and disrupt relationship equity. On the basis of equity theory, we propose a conceptual framework examining the individual and dyadic experience of HSCT patients and their caregivers. The model includes feelings of inequity, patient self‐perceived burden, caregiver burden, and distress. Methods The HSCT patients and their spousal caregivers were recruited prior to HSCT between March 2011 and September 2012. Each member of the dyad self‐administered a questionnaire package. Results Seventy‐two dyads were included in the path analyses. Our model demonstrated an inadequate statistical fit; however, with one modification, an adequate to good fit was obtained: χ2(df) = 6.01(5), normed χ2 = 1.20, standardized root mean square residual = 0.048, comparative fit index = 0.99, Tucker‐Lewis index = 0.96, and root‐mean‐square error of approximation = 0.05 (90% CI, 0.00‐0.18). As hypothesized, pre‐HSCT caregiver burden mediates the relationship between caregiver underbenefit and caregiver distress. However, patient self‐perceived burden was not associated with patient distress; rather, patient perception of overbenefit was related to patient distress. In our modified model, the results demonstrate that patient overbenefit influenced caregiver burden; however, there was not a reciprocal influence, because caregiver variables did not affect patient variables. Conclusions Our proposed theoretical framework describes patients' and caregivers' individual experience of distress before HSCT but does not as clearly encompass the dyadic experience. Addressing perceived imbalances and providing psycho‐education on role changes within HSCT dyads before transplantation may be a useful prehabilitation strategy for preventing distress.
    February 02, 2017   doi: 10.1002/pon.4340   open full text
  • Effects of stress appraisal on the quality of life of adult patients with multiple myeloma and their primary family caregivers in Korea.
    In Seo La, Eun Kyoung Yun.
    Psycho-Oncology. February 02, 2017
    Background Modern treatment for multiple myeloma (MM) has improved disease control and prolonged survival; thus, maintenance of quality of life (QoL) is considered a great concern for MM patients and their caregivers. The purpose of this study was to identify dyadic associations between stress appraisal and the QoL of patients with MM and their caregivers in Korea. Methods A total of 102 MM patient‐caregiver dyads participated in this study. They independently reported their stress appraisal and QoL. The study was guided by a transactional model of stress and coping, and analyzed by using the actor‐partner interdependence model. Results The results revealed good data adjustment with acceptable indices: χ2 = 6.211 (df = 6), CFI = 0.999, TLI = 0.994, RMSEA = 0.019, and SRMR = 0.043. MM patients' QoL were significantly correlated with caregivers' QoL. The stress appraisals of patients and caregivers mutually influenced each other's QoL. The patients' illness perception and the caregivers' burden were strong predictors for their QoL. The self‐efficacy of patients and caregivers was also associated with their QoL. Conclusions Our findings suggest that the way patients and caregivers perceive and respond to stress plays a significant role in their QoL during the treatment experience. Interventions designed to reconstruct negative perspectives and improve self‐efficacy may help both patients and caregivers to improve their QoL.
    February 02, 2017   doi: 10.1002/pon.4348   open full text
  • Fear of new or recurrent melanoma after treatment for localised melanoma.
    Katy J.L. Bell, Yachna Mehta, Robin M. Turner, Rachael L. Morton, Mbathio Dieng, Robyn Saw, Pascale Guitera, Kirsten McCaffery, Donald Low, Cynthia Low, Marisa Jenkins, Les Irwig, Angela C. Webster.
    Psycho-Oncology. February 02, 2017
    Objective To estimate the amount of fear of new or recurrent melanoma among people treated for localised melanoma in an Australian specialist centre. Methods We randomly selected 400 potential participants from all those treated for localised melanoma at the Melanoma Institute Australia during 2014 (n = 902). They were asked to complete an adapted version of the Fear of Cancer Recurrence Inventory (FCRI). We calculated summary statistics for demographics, clinical variables and total FCRI and subscale scores. Results Two hundred fifteen people (54%) completed the FCRI questionnaire. The overall mean severity subscale score was 15.0 (95% CI 14.0‐16.1). A high proportion of participants had scores above a proposed threshold to screen for clinical fear of cancer recurrence (77% and 63% of participants with and without new or recurrent melanoma had severity subscale scores ≥13). Most participants also had scores above a threshold found to have high specificity for clinical fear of cancer recurrence (65% and 48% of participants with and without new or recurrent melanoma had severity subscale scores ≥16). The severity subscale appeared to discriminate well between groups with differing levels of risk of new or recurrent melanoma. Conclusions There is a substantial amount of fear of new or recurrent melanoma among this population, despite most having a very good prognosis.
    February 02, 2017   doi: 10.1002/pon.4366   open full text
  • Intraindividual variability in reaction time before and after neoadjuvant chemotherapy in women diagnosed with breast cancer.
    Christie Yao, Jill B. Rich, Kattleya Tirona, Lori J. Bernstein.
    Psycho-Oncology. February 01, 2017
    Objective Women treated with chemotherapy for breast cancer experience subtle cognitive deficits. Research has focused on mean performance level, yet recent work suggests that within‐person variability in reaction time performance may underlie cognitive symptoms. We examined intraindividual variability (IIV) in women diagnosed with breast cancer and treated with neoadjuvant chemotherapy. Methods Patients (n = 28) were assessed at baseline before chemotherapy (T1), approximately 1 month after chemotherapy but prior to surgery (T2), and after surgery about 9 months post chemotherapy (T3). Healthy women of similar age and education (n = 20) were assessed at comparable time intervals. Using a standardized regression‐based approach, we examined changes in mean performance level and IIV (eg, intraindividual standard deviation) on a Stroop task and self‐report measures of cognitive function from T1 to T2 and T1 to T3. Results At T1, women with breast cancer were more variable than controls as task complexity increased. Change scores from T1 to T2 were similar between groups on all Stroop performance measures. From T1 to T3, controls improved more than women with breast cancer. IIV was more sensitive than mean reaction time in capturing group differences. Additional analyses showed increased cognitive symptoms reported by women with breast cancer from T1 to T3. Specifically, change in language symptoms was positively correlated with change in variability. Conclusions Women with breast cancer declined in attention and inhibitory control relative to pretreatment performance. Future studies should include measures of variability, because they are an important sensitive indicator of change in cognitive function.
    February 01, 2017   doi: 10.1002/pon.4351   open full text
  • The relationship between risk factors and medication adherence among breast cancer survivors: What explanatory role might depression play?
    Louis C. Markovitz, Nicholas J. Drysdale, B. Ann Bettencourt.
    Psycho-Oncology. January 30, 2017
    Objective Despite the efficacy of clinical treatments (eg, adjuvant hormonal therapy) for breast cancer survivors (BCS), nonadherence rates remain high, increasing the risk of recurrence and mortality. The current study tested a theoretical model of medical nonadherence that proposes depression to be the most proximal predictor of medical nonadherence among BCS. Methods Breast cancer survivors were recruited from radiation clinics in Missouri. Survey data were collected 12 months after the end of primary treatment. The sample size included 133 BCS. Results Findings show substantial support for the model, demonstrating that depression mediated the relation between physical symptoms, cognitive symptoms, social support, and adherence to medication. This finding was replicated with a measure of mood disturbance. Conclusions These findings support the prediction that medication nonadherence among BCS multiply determined process and have compelling implications for healthcare providers and interventions designed to increase medication adherence among BCS.
    January 30, 2017   doi: 10.1002/pon.4362   open full text
  • Telephone‐delivered individual cognitive behavioural therapy for cancer patients: An equivalence randomised trial.
    M. Watson, C. White, A. Lynch, K. Mohammed.
    Psycho-Oncology. January 30, 2017
    Objective To evaluate Telephone‐Delivered Cognitive Behavioural Therapy (T‐CBT) compared to CBT face to face treatment as usual (TAU‐CBT), in cancer patients with high psychological needs, in terms of mental health and coping. Method A prospective randomised equivalence trial with Patient Reported Outcome (PRO's), measured pre‐ and post‐therapy including; Hospital Anxiety and Depression Scale (HADS), Mental Adjustment to Cancer Scale: Helpless/Hopeless subscale only (MAC H/H), Checklist of Cancer Concerns (CLCC) and the Cancer Coping Questionnaire (CCQ). A study‐specific Service Evaluation Questionnaire (SEQ) was include. Results Assessment of change scores, in n = 118 randomised patients referred for psychological care, indicate significant improvements (P < 0.01 or greater) for both therapy groups pre‐ and post‐therapy in HADS anxiety, depression and total scores and cancer concerns (CLCC). Overall, for the groups combined, there is a significant shift towards reduction of CCQ stress (P = 0.028) and worry (P = 0.003) post‐therapy when compared to baseline levels. Median number of therapy sessions was four. For cancer coping (CCQ) and for Mental Adjustment to Cancer (MAC) there were significant change scores only for Positive Focus and Helpless/hopeless scores respectively, in the TAU‐CBT group. Although equivalence was not observed, the data demonstrate that T‐CBT was non‐inferior to TAU‐CBT. Conclusions Delivery of CBT to patients with clinician identified high need can be offered according to patient choice without loss of mental health benefit. Both TAU‐CBT and T‐CBT are effective at reducing mental health problems on the specific outcome measures.
    January 30, 2017   doi: 10.1002/pon.4338   open full text
  • Qualitatively understanding patients' and health professionals' experiences of the BRECONDA breast reconstruction decision aid.
    Kerry A. Sherman, Laura‐Kate Shaw, Lone Jørgensen, Diana Harcourt, Linda Cameron, John Boyages, Elisabeth Elder, Judy Kirk, Katherine Tucker.
    Psycho-Oncology. January 30, 2017
    Objective Women diagnosed with breast cancer or ductal carcinoma in situ and those with a genetic susceptibility to developing this disease face the challenging decision of whether or not to undergo breast reconstruction following mastectomy. As part of a large randomized controlled trial, this qualitative study examined women's experiences of using the Breast RECONstruction Decision Aid (BRECONDA) and health professionals' feedback regarding the impact of this resource on patients' knowledge and decision making about breast reconstruction. Method Semistructured interviews were conducted with women who accessed the BRECONDA intervention (N = 36) and with their healthcare providers (N = 6). All interviews were transcribed verbatim and subjected to thematic analysis by 3 independent coders. Results Participants reported an overall positive impression, with all interviewees endorsing this decision aid as a useful resource for women considering reconstructive surgery. Thematic analysis of patient interviews revealed 4 themes: overall impressions and aesthetics; personal relevance and utility; introducing BRECONDA; and advantages and suggested improvements. Analysis of health professionals' interviews also revealed 4 themes: need for BRECONDA, impact of BRECONDA, potential difficulties that may arise in using the decision aid, and recommending BRECONDA to patients. Patients indicated that they derived benefit from this resource at all stages of their decision‐making process, with the greatest perceived benefit being for those early in their breast reconstruction journey. Conclusion These findings support the use of BRECONDA as an adjunct to clinical consultation and other information sources.
    January 30, 2017   doi: 10.1002/pon.4346   open full text
  • The prospective relationship between satisfaction with information and symptoms of depression and anxiety in breast cancer: A structural equation modeling analysis.
    Hermann Faller, André Strahl, Matthias Richard, Christiane Niehues, Karin Meng.
    Psycho-Oncology. January 30, 2017
    Objective Previous research has demonstrated associations between satisfaction with information and reduced emotional distress in cancer patients. However, as most studies were cross‐sectional, the direction of this relationship remained unclear. We therefore aimed to test whether information satisfaction predicted subsequent depression and anxiety levels, and, reciprocally, depression and anxiety levels predicted subsequent information satisfaction, thus clarifying the direction of impact. Methods We performed a secondary analysis of a prospective cohort study with 436 female breast cancer patients (mean age 51 years). We measured information satisfaction with 2 self‐developed items, symptoms of depression with the 2‐item Patient Heath Questionnaire and symptoms of anxiety with the 2‐item Generalized Anxiety Disorder Scale. We created 2 structural equation models, 1 for depression and 1 for anxiety, that examined the prediction of 1‐year depression (or anxiety) levels by baseline information satisfaction and, in the same model, 1‐year information satisfaction by baseline depression (or anxiety) levels (cross‐lagged panel analysis). Results Baseline information satisfaction predicted 1‐year levels of both depression (beta = −0.17, P < .01) and anxiety (beta = −0.13, P < .01), adjusting for the baseline scores of the outcome variables. Conversely, baseline levels of depression (beta = −0.12, P < .05) and anxiety (beta = −0.16, P < .01) predicted 1‐year information satisfaction, adjusting for its baseline score. Conclusion Our results suggest a bidirectional relationship between information satisfaction and symptoms of depression and anxiety. Thus, provision of information may reduce subsequent depression and anxiety, while reducing depression and anxiety levels may increase satisfaction with received information. Combining the provision of information with emotional support may be particularly beneficial.
    January 30, 2017   doi: 10.1002/pon.4358   open full text
  • Risk of depression following uterine cancer: A nationwide population‐based study.
    Chao‐Yu Chen, Yao‐Hsu Yang, Chuan‐Pin Lee, Ting‐Yao Wang, Bi‐Hua Cheng, Yin‐Cheng Huang, Pau‐Chung Chen, Sophie Hsin‐Yi Liang, Michael Dewey, Vincent Chin‐Hung Chen.
    Psycho-Oncology. January 27, 2017
    Background Depression happens commonly in cancer patients. However, there is limited literature on uterine cancer. In this study, we aimed to evaluate the association between uterine cancer and depression as well as the moderating effect of age and hormone replacement therapy (HRT). Methods This was a population‐based study using Taiwan's National Health Insurance Research Database. We conducted a matched cohort study and identified 6526 patients with uterine cancer and 65 260 controls. We adopted the competing risk analysis model as the statistical method and adjusted for potential confounding factors. Results From 1997 to 2008, 71 786 patients were included (6526 patients with uterine cancer and 65 260 controls). In the study, uterine cancer was not linked to depression. However, when we stratified the different age groups, those cancer patients aged <40 and 40 to 49 years showed significant higher risk of developing depression (subdistribution hazard ratio 1.64 and 1.41, respectively). In addition, among uterine cancer patients, 4602 patients had never used HRT and 1921 patients were prescribed HRT. The analysis of time‐dependent Cox model showed that, compared with no use of HRT, patients with cumulative doses ≥168 DDD had significant lower risk of depression (hazard ratio 0.49, 95% confidence interval = 0.26‐0.92). Conclusions An increased risk of depression among younger uterine cancer patients was observed. Our preliminary finding suggests a possible protective factor for developing depression after HRT usage.
    January 27, 2017   doi: 10.1002/pon.4360   open full text
  • Experts' perspectives on the role of medical marijuana in oncology: A semistructured interview study.
    I.M. Braun, F.L. Meyer, J.J. Gagne, L. Nabati, D.P. Yuppa, M.A. Carmona, H.J. Burstein, J. Suzuki, M.M. Nayak, Y. Martins.
    Psycho-Oncology. January 26, 2017
    Background Expansion of medical marijuana (MM) laws in the United States may offer oncology new therapeutic options. However, the scientific evidence for MM remains in infancy. This study qualitatively explored professional opinion around the role of MM in cancer care. Methods Semistructured interviews were administered to a sample of individuals with expertise at the interface of MM and oncology nationally. Key informant criteria included an oncologic clinical or research background and any of the following: publications, research, or lectures on cannabinoids or cancer symptoms; involvement in the development of MM dispensaries or legislation; and early adoption of state MM certification procedures. A gold standard, grounded, inductive approach was used to identify underlying themes. Results Participants (N = 15) were predominantly male, in their sixth decade, working in academic settings. Themes ranged from strong beliefs in marijuana's medical utility to reservations about this notion, with calls for expansion of the scientific evidence base and more stringent MM production standards. All participants cited nausea as an appropriate indication, and 13 of 15 pain. Over one‐third believed MM to have a more attractive risk profile than opioids and benzodiazepines. Conclusions Expert opinion was divided between convictions in marijuana's medicinal potential and guardedness in this assertion, with no participant refuting MM's utility outright. Emergent themes included that MM ameliorates cancer‐related pain and nausea and is safer than certain conventional medications. Participants called for enhanced purity and production standards, and further research on MM's utility.
    January 26, 2017   doi: 10.1002/pon.4365   open full text
  • The emotion regulation questionnaire in women with cancer: A psychometric evaluation and an item response theory analysis.
    Tânia Brandão, Marc S. Schulz, James J. Gross, Paula Mena Matos.
    Psycho-Oncology. January 26, 2017
    Objective Emotion regulation is thought to play an important role in adaptation to cancer. However, the emotion regulation questionnaire (ERQ), a widely used instrument to assess emotion regulation, has not yet been validated in this context. This study addresses this gap by examining the psychometric properties of the ERQ in a sample of Portuguese women with cancer. Methods The ERQ was administered to 204 women with cancer (mean age = 48.89 years, SD = 7.55). Confirmatory factor analysis and item response theory analysis were used to examine psychometric properties of the ERQ. Results Confirmatory factor analysis confirmed the 2‐factor solution proposed by the original authors (expressive suppression and cognitive reappraisal). This solution was invariant across age and type of cancer. Item response theory analyses showed that all items were moderately to highly discriminant and that items are better suited for identifying moderate levels of expressive suppression and cognitive reappraisal. Support was found for the internal consistency and test‐retest reliability of the ERQ. The pattern of relationships with emotional control, alexithymia, emotional self‐efficacy, attachment, and quality of life provided evidence of the convergent and concurrent validity for both dimensions of the ERQ. Conclusion Overall, the ERQ is a psychometrically sound approach for assessing emotion regulation strategies in the oncological context. Clinical implications are discussed.
    January 26, 2017   doi: 10.1002/pon.4356   open full text
  • A culturally adapted survivorship programme for Asian early stage breast cancer patients in Singapore: A randomized, controlled trial.
    Alexandre Chan, Yan Xiang Gan, Suan Kai Oh, Terence Ng, Maung Shwe, Raymond Chan, Raymond Ng, Brandon Goh, Yee Pin Tan, Gilbert Fan.
    Psycho-Oncology. January 25, 2017
    Background As cancer mortality rates improve in Singapore, there is an increasing need to improve the transition to posttreatment survivorship care. This study aimed to evaluate the effectiveness of a psychoeducation group (PEG) intervention program compared with usual care to reduce distress for physical symptom and psychological aspects in Asian breast cancer survivors who have completed adjuvant chemotherapy. Methods This was a randomized, controlled trial comprising 72 Asian early stage breast cancer survivors who were randomized into the PEG (n = 34) or the control (n = 38) arm. The participants in the PEG arm underwent a weekly multidisciplinary PEG program delivered in a group format over 3 weeks coupled with cultural adaptation. Both arms were assessed at baseline and 2 months after intervention using the Rotterdam Symptom Checklist, Beck Anxiety Inventory, and EORTC QLQ‐C30. A satisfaction questionnaire was also conducted among those survivors who have participated in the PEG program. Effective sizes were calculated using Cohen d. Results The mean age ± SD of all participants was 53.0 ± 8.9 years, with the majority being Chinese (84.7%) and Malay (6.9%), and clinical characteristics were well balanced in both arms. Compared to the control arm, the PEG arm showed a significantly greater reduction in physical symptom distress (d = 0.76, P = .01) and fatigue (d = 0.49, P = .04). The 82.4% of the participants in the intervention group responded to the satisfaction questionnaire, and the majority (92.9%) agreed that the overall duration of the PEG intervention program was appropriate. Conclusions A culturally adapted PEG program was effective in reducing physical symptom distress in Asian breast cancer survivors. ( NCT02600299)
    January 25, 2017   doi: 10.1002/pon.4357   open full text
  • Incidence of depression and anxiety among women newly diagnosed with breast or genital organ cancer in Germany.
    Louis Jacob, Matthias Kalder, Karel Kostev.
    Psycho-Oncology. January 24, 2017
    Background To analyze the incidence of depression and anxiety among women newly diagnosed with breast or genital organ cancer (BC or GOC) in Germany. Methods A total of 29 366 women initially diagnosed with BC or GOC between 2005 and 2014 were available for analysis. The main outcome measure was the incidence of depression and anxiety among women newly diagnosed with BC or GOC within 5 years after the first cancer diagnosis in German gynecologist practices. Demographic and clinical data included age, type of cancer, and presence of metastases at diagnosis. The incidence rate of depression and anxiety per 100 person‐years was calculated. We performed a multivariate regression model to analyze the association between depression and the variables of interest. Results In total, 7994 women were diagnosed with depression/anxiety (81.3% had BC and 18.7% had GOC). The incidence of depression and anxiety was 8.8 per 100 person‐years in women with BC. In individuals with GOC, the incidence of depression/anxiety was 5.9 per 100 person‐years. Breast cancer was associated with a 1.41‐fold increase in the risk of developing depression or anxiety as compared with GOC. Patients with metastases also had a higher risk of being depressed and anxious than others (odds ratio = 1.40). Finally, women in the age groups of 41 to 50, 51 to 60, and 61 to 70 years were at a higher risk of depression/anxiety than women in the age group of 71 to 80 years (odds ratios equal to 1.50, 1.38, and 1.22). Conclusions Women diagnosed with BC were at a higher risk of developing depression or anxiety than women with GOC.
    January 24, 2017   doi: 10.1002/pon.4328   open full text
  • What cancer means to the patients and their primary caregivers in the family‐accounted Korean context: A dyadic interpretation.
    Ansuk Jeong, Ji Yeong An, Jong Hyock Park, Keeho Park.
    Psycho-Oncology. January 24, 2017
    Objective When cancer hits a family, the entire family members start to adapt to the new status. This study aimed to investigate the main issue of the family with cancer patient and their way of solving it. Methods In‐depth interviews were conducted as a qualitative research. Thirty‐three participants described their experience either as cancer patients or as family caregivers. Results Guided by the grounded theory, we identified the main concern of the families being primary caregiver selection. The primary caregiver was determined by the conditions of the patient and the family, but the primary caregiver accepted his/her role believing no alternative was plausible in the family. The processes of the entire family have change since cancer showed their “adapting living,” which was identified as the core variable. Conclusions On the basis of the current study's limitations, suggestions were made for future studies in which cultural attributes are distinguished from the medical system attributes.
    January 24, 2017   doi: 10.1002/pon.4364   open full text
  • Depression treatment and healthcare expenditures among elderly Medicare beneficiaries with newly diagnosed depression and incident breast, colorectal, or prostate cancer.
    Monira Alwhaibi, Usha Sambamoorthi, Suresh Madhavan, James T. Walkup.
    Psycho-Oncology. January 24, 2017
    Objectives Depression is associated with high healthcare expenditures, and depression treatment may reduce healthcare expenditures. However, to date, there have not been any studies on the effect of depression treatment on healthcare expenditures among cancer survivors. Therefore, this study examined the association between depression treatment and healthcare expenditures among elderly with depression and incident cancer. Methods The current study used a retrospective longitudinal study design, the linked Surveillance, Epidemiology, and End Results–Medicare database. Elderly (≥66 years) fee‐for‐service Medicare beneficiaries with newly diagnosed depression and incident breast, colorectal, or prostate cancer (N = 1502) were followed for a period of 12 months after depression diagnosis. Healthcare expenditures were measured every month for a period of 12‐month follow‐up period. Depression treatment was identified during the 6‐month follow‐up period. The adjusted associations between depression treatment and healthcare expenditures were analyzed with generalized linear mixed model regressions with gamma distribution and log link after controlling for other factors. Results The average 1‐year total healthcare expenditures after depression diagnosis were $38 219 for those who did not receive depression treatment; $42 090 for those treated with antidepressants only; $46 913 for those treated with psychotherapy only; and $51 008 for those treated with a combination of antidepressants and psychotherapy. As compared to no depression treatment, those who received antidepressants only, psychotherapy only, or a combination of antidepressants and psychotherapy had higher healthcare expenditures. However, second‐year expenditures did not significantly differ among depression treatment categories. Conclusions Among cancer survivors with newly diagnosed depression, depression treatment did not have a significant effect on expenditures in the long term.
    January 24, 2017   doi: 10.1002/pon.4325   open full text
  • Sharing information about cancer with one's family is associated with improved quality of life.
    Carlo Lai, Beatrice Borrelli, Paola Ciurluini, Paola Aceto.
    Psycho-Oncology. January 24, 2017
    Objective The aim of this study was to investigate the association between cancer patients' ability to share information about their illness with their social network and attachment style dimensions, alexithymia, and quality of life. We hypothesised that ability to share information about one's cancer with family, friends, and medical teams would be positively associated with quality of life and secure attachment and negatively associated with alexithymia. Methods Forty‐five cancer patients were recruited from the Psycho‐oncology Unit of the San Camillo‐Forlanini Hospital in Rome. We collected anamnestic data and self‐report data on social sharing ability, quality of life, alexithymia, and attachment. Results Sharing with family (B = 4.66; SE = 1.82; β = .52; SE = 0.20; t(41) = 2.6; P = .0143) was the only predictor of global health status, and attachment security was the only predictor of mean social sharing (B = 0.25; SE = 0.06; β = .63; SE = 0.14; t(41) = 4.4; P < .0001). Conclusions Encouraging patients to share information about their experience of cancer may help to improve their quality of life. Attachment security seems to promote social sharing. Psychological assessments of cancer patients should cover both ability to share information about one's cancer with family and attachment security.
    January 24, 2017   doi: 10.1002/pon.4334   open full text
  • A comparison of attitudes toward length and quality of life between community‐dwelling older adults and patients with advanced cancer.
    Chetna Malhotra, Ling Xiang, Semra Ozdemir, Ravindran Kanesvaran, Noreen Chan, Eric Andrew Finkelstein.
    Psycho-Oncology. January 22, 2017
    Objective Applying prospect theory to end‐of‐life decision making, we hypothesize that community‐dwelling older adults (CDOAs) will be relatively less inclined towards extending length over improving quality of life compared with patients. We also hypothesize that differences in relative inclination for length over quality of life between the 2 groups will decrease with advancing age. Methods We tested these hypotheses by administering the quality‐quantity questionnaire to 1067 CDOAs and 320 stage IV cancer patients and applying a linear regression model to assess whether relative inclination for length over quality of life, as estimated by the questionnaire, differed between CDOAs and patients after controlling for differences in sociodemographic characteristics. We also assessed the effect of interaction between age and participant status (CDOA compared to patient) on relative inclination for length over quality of life. Results Consistent with prospect theory, a lower proportion of CDOAs (26%) than patients (42%) were relatively more inclined towards length over quality of life. Results were significant even after adjusting for differences in sociodemographics (P < .01). With increasing age, the difference in relative inclination between CDOAs and patients increased (P = .01). Conclusions Findings indicate that attitudes towards length and quality of life differ by life stage. This has implications for end‐of‐life care decisions made by CDOAs, such as purchasing health or disability insurance and signing advance directives or care plans.
    January 22, 2017   doi: 10.1002/pon.4344   open full text
  • Posttraumatic growth in breast cancer survivors and their husbands based on the actor‐partner interdependence model.
    MyoSuk Lee, Kyunghee Kim, Changwon Lim, Ji‐Su Kim.
    Psycho-Oncology. January 17, 2017
    Objective This study aimed to verify actor and partner effects, by examining the effects of self‐esteem, relationship quality, and subjective distress on posttraumatic growth in breast cancer survivors and their spouses, and involved a structural analysis of descriptive cause‐and‐effect relationships to verify the suitability of the actor‐partner interdependence model. Methods A structured questionnaire was used to collect data from breast cancer survivors and their spouses at outpatient centers, wards, and patient meetings in 4 general hospitals in Seoul between April 13 and September 20, 2015. Data for 336 individuals (168 couples) were analyzed. The suitability of the hypothetical model was assessed via SPSS Win 21.0 and AMOS 21.0. Actor and partner effects on posttraumatic growth in breast cancer survivors and their spouses were examined. Results Self‐esteem, relationship quality, and subjective distress exerted significant actor effects, and subjective distress exerted a significant partner effect on posttraumatic growth in breast cancer survivors. Relationship quality and support exerted significant actor effects, and self‐esteem, relationship quality, and subjective distress exerted significant partner effects on posttraumatic growth in spouses. Conclusions Posttraumatic growth in breast cancer survivors was influenced by not only relationship quality and spouses' self‐ esteem but also subjective distress; therefore, solidarity between breast cancer survivors and their spouses was important and should be maintained to provide healthy relationship support and enhance posttraumatic growth. Further, health care providers should include spouses in health‐related education and involve them in interventions and family support programs for couples.
    January 17, 2017   doi: 10.1002/pon.4343   open full text
  • Cycles of silence: First Nations women overcoming social and historical barriers in supportive cancer care.
    Chad Hammond, Roanne Thomas, Wendy Gifford, Jennifer Poudrier, Ryan Hamilton, Carolyn Brooks, Tricia Morrison, Tracy Scott, Doris Warner.
    Psycho-Oncology. January 16, 2017
    Background First Nations people with cancer in Canada confront several critical inequities in physical and psychosocial domains. First Nations women are at a particular disadvantage as they are disproportionately affected by social determinants of health, but how they navigate these challenges within their communities is poorly understood. Objective Our study explores survivorship experiences of First Nations women with cancer and their caregivers. Drawing from a larger data set on survivorship, we identify several major barriers to cancer communication and support in First Nations communities. Methods Our team conducted a participatory, arts‐based study using several data collection methods (interviews, sharing sessions, photovoice, and other creative activities) with 43 participants (24 cancer survivors and 19 caregivers) from four First Nations communities in Canada. Results Two major themes have emerged out of our data analyses: (1) suffering without support leads to cycles of silence and (2) community‐based supports can disrupt these cycles. We identified several social, historical, and institutional barriers to speaking about cancer and finding/providing support; however, communities met the challenge of silence through voluntary and unsolicited provision of support. Conclusions Widespread silence around cancer reflects both the limited access First Nations people have to formal, supportive programs and services, as well as the creative ways they provide emotional, social, and financial support within their informal networks. Beyond the support of their communities, they also required institutional provision of care that is culturally safe, addressing the colonial impacts on cancer communication and the disproportionate burdens of disease in First Nations communities.
    January 16, 2017   doi: 10.1002/pon.4335   open full text
  • Trajectories of quality of life, life satisfaction, and psychological adjustment after prostate cancer.
    Suzanne K. Chambers, Shu Kay Ng, Peter Baade, Joanne F. Aitken, Melissa K. Hyde, Gary Wittert, Mark Frydenberg, Jeff Dunn.
    Psycho-Oncology. January 11, 2017
    Background To describe trajectories of health‐related quality of life (QoL), life satisfaction, and psychological adjustment for men with prostate cancer over the medium to long term and identify predictors of poorer outcomes using growth mixture models. Methods One‐thousand sixty‐four (82.4% response) men diagnosed with prostate cancer were recruited close to diagnosis and assessed over a 72‐month (6‐year) period with self‐report assessment of health‐related QoL, life satisfaction, cancer‐related distress, and prostate specific antigen anxiety. Urinary, bowel, and sexual function were also assessed using validated questionnaires. Results Poorer physical QOL was predicted by older age, lower education, lower income, comorbidities, and receiving hormone therapy. Lower life satisfaction was related to younger age, lower income, not being partnered, and comorbidities. Poorer psychological trajectories were predicted by younger age, lower income, comorbidities, and receiving radical prostatectomy or brachytherapy. Better urinary, bowel, and sexual function were related to better global outcomes over time. Anxiety about prostate specific antigen testing was rare. Conclusions Distinct trajectories exist for medium‐ to long‐term QoL, life satisfaction, and psychological adjustment after prostate cancer; with age and socioeconomic deprivation playing a differential role in men's survivorship profile and the impact of functional status on outcomes increasing over time. These results reinforce the need for an appraisal of men's life course in addition to treatment side effects when planning survivorship care after cancer.
    January 11, 2017   doi: 10.1002/pon.4342   open full text
  • Dog ownership and physical activity among breast, prostate, and colorectal cancer survivors.
    Cynthia C. Forbes, Chris M. Blanchard, W. Kerry Mummery, Kerry S. Courneya.
    Psycho-Oncology. January 11, 2017
    Background Dog ownership has been associated with higher rates of physical activity (PA) in several populations but no study to date has focused on cancer survivors. The purpose of this study was to examine the associations between dog ownership and PA among cancer survivors and to examine correlates of dog ownership. Methods A stratified random sample of 2062 breast cancer survivors, prostate cancer survivors, and colorectal cancer survivors was mailed a questionnaire assessing PA, social cognitive, dog ownership, demographic, and medical variables. Results Overall, 25% of the sample was dog owners (DOs). There were no significant differences in moderate, vigorous, or total PA minutes between DOs and non–dog owners. There was a significant difference in light PA minutes in favor of DOs (153 vs 112 minutes; 95% CI = 4 to 77; P = .030), however, this was largely restricted to breast cancer survivors (143 vs 79 minutes; 95% CI = 25 to 102; P = .001) who also reported fewer vigorous PA minutes (18 vs 39 minutes; 95% CI = −42 to −1; P = .042). Survivors were more likely to be DOs if they had breast cancer (P = .054), a higher income (P = .021), radiation therapy (P = .029), chemotherapy (P = .010), were younger (P < .001), employed (P < .001), and a current smoker (P = .015). Few social cognitive variables were associated with DO. Conclusions Dog ownership among cancer survivors was not associated with moderate‐to‐vigorous PA but was associated with light PA. Further research is necessary to determine if promoting dog ownership and dog walking among cancer survivors may increase PA and possibly improve health outcomes.
    January 11, 2017   doi: 10.1002/pon.4324   open full text
  • Facing spousal cancer during child‐rearing years: The short‐term effects of the Cancer‐PEPSONE programme—a single‐center randomized controlled trial.
    Mette Senneseth, Atle Dyregrov, Jon Laberg, Stig B. Matthiesen, Mariana Pereira, May A. Hauken.
    Psycho-Oncology. January 02, 2017
    Objective To measure the short‐term effects of the Cancer‐PEPSONE programme (CPP) on the partners' received and perceived social support, psychological distress, and quality of life (QOL), as well as explore the role of received social support as a mediator of the intervention effects. Methods Open single‐center randomized controlled trial, trial number 15982171(ISRCTN). Eligible participants were the partners of cancer patients who were concomitantly caring for minors (the well parents). The sample consisted of 35 participants randomly allocated to receive either intervention (n = 17) or support as usual (n = 18). At the 3‐month follow‐up (approximately 1 month after intervention), 24 continued to participate (intervention n = 13, control n = 11). The intervention group selected supporters to participate in CPP (N = 130). Data were obtained using validated questionnaire. Results The multivariate analysis of covariance revealed significant intervention effects (P = .03, η2p = 0.42), with main effects on received and perceived social support. A mediational analysis suggested that CPP may have indirect effects on QOL through received social support. Conclusions Even though the long‐term effects are yet to be studied, CPP seems to increase social support for the well parents' short term, which in turn may improve their QOL. Given the study's low sample size, further replications in larger samples are required.
    January 02, 2017   doi: 10.1002/pon.4329   open full text
  • Group therapy processes and treatment outcomes in 2 couple‐focused group interventions for breast cancer patients.
    Sharon L. Manne, Deborah Kashy, Scott D. Siegel, Carolyn J. Heckman.
    Psycho-Oncology. December 28, 2016
    Background There has been little attention paid to the role of therapeutic processes in group therapy outcomes for cancer patients participating in group. The goal was to evaluate the contribution of 3 group processes—group climate (conflict, engagement, and avoidance) working alliance and therapeutic realizations—to the outcomes of 2 couple‐focused approaches to group treatment. Methods Three hundred and two women with early stage breast cancer and their partners were randomized to one of 2 conditions: an 8‐session enhanced couple‐focused group (ECG) intervention or a couples' support group participated. Couples completed measures of depressive symptoms and well‐being before and 6 months after group. Group process measures were completed after sessions 4 and 8. Results Support group participants (both patients and partners) perceived higher engagement and less avoidance than ECG participants. Conflict, working alliance, and therapeutic realizations did not differ. Group engagement, working alliance, and therapeutic realizations increased, and group conflict decreased over the course of both treatments. Greater conflict was associated with more posttreatment anxiety and lower well‐being, and engagement was associated with higher posttreatment well‐being. Patients whose partners reported higher conflict reported greater posttreatment anxiety. Working alliance was associated with posttreatment anxiety for ECG patients and with well‐being among participants whose partners reported higher working alliance. Conclusions Fostering a positive group environment bolsters treatment efficacy for women with early stage breast cancer and their partners attending couple‐focused groups. Facilitating the leader‐member alliance bolsters treatment efficacy. Improving engagement with one member of a couple impacts the other member.
    December 28, 2016   doi: 10.1002/pon.4323   open full text
  • A randomized pilot trial of a positive affect skill intervention (lessons in linking affect and coping) for women with metastatic breast cancer.
    Elaine O. Cheung, Michael A. Cohn, Laura B. Dunn, Michelle E. Melisko, Stefana Morgan, Frank J. Penedo, John M. Salsman, Dianne M. Shumay, Judith T. Moskowitz.
    Psycho-Oncology. December 27, 2016
    Background We conducted a randomized pilot trial to examine the feasibility, acceptability, and preliminary efficacy of a 5 week positive affect skills intervention (LILAC: lessons in linking affect and coping) for women with metastatic breast cancer. Additionally, we examined whether online delivery of the intervention would offer comparable benefits as in‐person delivery. Methods Women with metastatic breast cancer (N = 39) were randomized to an in‐person intervention, online intervention, or in‐person attention‐matched control. Psychological well‐being (depression [Center for Epidemiologic Studies Depression Scale], positive and negative affect [Differential Emotions Scale], cancer‐specific quality of life [Multidimensional Quality of Life Scale—Cancer Version]), and positive coping (mindfulness, positive‐affect skill use, and self‐compassion [Self‐Compassion Scale: Short‐Form]) were assessed at baseline, 1 week post‐intervention, and 1 month post‐intervention follow‐up. Results The LILAC intervention showed good feasibility, acceptability, and retention. Although the study was not adequately powered to detect between‐group differences in change on preliminary efficacy outcomes, within‐group comparisons revealed that LILAC participants (in‐person and online combined) showed reductions in depression and negative affect by the 1 month follow‐up (d = −0.81). Notably, LILAC participants fell below the clinical threshold for depression (Center for Epidemiologic Studies Depression Scale = 16) by the 1 month follow‐up (t[17] = −2.22, P = .04, d = −0.52), whereas control participants did not differ from threshold (t[9] = 0.45, P = .66, d = 0.14). Conclusions The LILAC intervention, regardless of delivery method, shows feasibility, acceptability, and preliminary efficacy for promoting psychological well‐being in women with metastatic breast cancer. This research provides support for a larger randomized trial to test more definitively the potential benefits of LILAC. A strength of the LILAC intervention includes its innovative focus on positive affect. The efficacy of the online delivery suggests the potential for widespread Internet dissemination.
    December 27, 2016   doi: 10.1002/pon.4312   open full text
  • Therapy processes, progress, and outcomes for 2 therapies for gynecological cancer patients.
    Sharon L. Manne, Shannon Myers‐Virtue, Deborah A. Kashy, Melissa Ozga, David Kissane, Carolyn Heckman, Mark Morgan.
    Psycho-Oncology. December 22, 2016
    Objective Although a number of effective psychotherapies have been identified for cancer patients, little is known about therapy processes, as they unfold the course of treatment and the role of therapy processes in treatment outcome. We used growth curve modeling to evaluate the associations between therapy processes and outcomes among gynecological cancer patients participating in 2 types of therapy. Methods Two hundred twenty five women newly diagnosed with gynecological cancer were randomly assigned to receive 8 sessions of a coping and communication intervention or a client‐centered supportive therapy. Participants completed measures of preintervention and postintervention depression, working alliance after Session 2, and postsession progress and depressive symptoms after each session. Therapists completed measures of perceived patient progress. Results Both patients and therapists reported a steady increase in session progress and patients reported a steady decrease in depressive symptoms over the course of both the coping and communication intervention and client‐centered supportive sessions. Perceived progress in one session predicted progress in the subsequent session. Early working alliance predicted improved session progress and reductions in postsession depressive symptoms over sessions. Working alliance did not predict prepost treatment changes in depression. Patient‐rated session progress predicted greater reductions in pretreatment to posttreatment depression, but therapist‐rated progress did not. Conclusions For 2 types of treatment delivered to women diagnosed with gynecological cancer, patient‐rated session progress and depressive symptoms rated over therapy sessions may serve as a yardstick that can be useful to therapists to gauge patient's response to treatment.
    December 22, 2016   doi: 10.1002/pon.4310   open full text
  • Patient experiences of acute myeloid leukemia: A qualitative study about diagnosis, illness understanding, and treatment decision‐making.
    Thomas W. LeBlanc, Laura J. Fish, Catherine T. Bloom, Areej El‐Jawahri, Debra M. Davis, Susan C. Locke, Karen E. Steinhauser, Kathryn I. Pollak.
    Psycho-Oncology. December 19, 2016
    Background Patients with acute myeloid leukemia (AML) face a unique, difficult situation characterized by sudden changes in health, complex information, and pressure to make quick treatment decisions amid sizeable tradeoffs. Yet, little is known about patients' experiences with AML. We used qualitative methods to learn about their experiences with diagnosis and treatment decision‐making to identify areas for improvement. Methods We recruited hospitalized patients with AML to participate in semi‐structured qualitative interviews about their experiences being diagnosed with AML, receiving information, and making a treatment decision. Interviews were conducted during their hospitalization for induction chemotherapy. We analyzed data by using a constant comparison approach. Results Thirty‐two patients completed an interview. Four main themes emerged: (a) shock and suddenness, (b) difficulty processing information, (c) poor communication, and (d) uncertainty. Patients frequently described their diagnosis as shocking. They also felt that the amount of information was too great and too difficult to process, which negatively impacted their understanding. Patients frequently described a lack of emotional support from clinicians and described uncertainty about their prognosis, the number and nature of available treatments, and what to expect from treatment. Conclusions Acute myeloid leukemia poses a sudden, emotionally challenging, information‐laden situation, where little time is available to make important decisions. This results in difficulty processing information and is sometimes complicated by a lack of emotive communication from clinicians. Results indicate a need for targeted interventions to improve AML patients' understanding of illness and treatment options and to address their traumatic experiences around diagnosis.
    December 19, 2016   doi: 10.1002/pon.4309   open full text
  • Factors predicting emotional cue‐responding behaviors of nurses in Taiwan: An observational study.
    Mei‐Feng Lin, An‐Yu Lee, Cheng‐Chen Chou, Tien‐Yu Liu, Chia‐Chun Tang.
    Psycho-Oncology. December 19, 2016
    Objective Responding to emotional cues is an essential element of therapeutic communication. The purpose of this study is to examine nurses' competence of responding to emotional cues (CRE) and related factors while interacting with standardized patients with cancer. Methods This is an exploratory and predictive correlational study. A convenience sample of registered nurses who have passed the probationary period in southern Taiwan was recruited to participate in 15‐minute videotaped interviews with standardized patients. The Medical Interview Aural Rating Scale was used to describe standardized patients' emotional cues and to measure nurses' CRE. The State‐Trait Anxiety Inventory was used to evaluate nurses' anxiety level before the conversation. We used descriptive statistics to describe the data and stepwise regression to examine the predictors of nurses' CRE. Results A total of 110 nurses participated in the study. Regardless of the emotional cue level, participants predominately responded to cues with inappropriate distancing strategies. Prior formal communication training, practice unit, length of nursing practice, and educational level together explain 36.3% variances of the nurses' CRE. Conclusions This study is the first to explore factors related to Taiwanese nurses' CRE. Compared to nurses in other countries, Taiwanese nurses tended to respond to patients' emotional cues with more inappropriate strategies. We also identified significant predictors of CRE that show the importance of communication training. Future research and education programs are needed to enhance nurses' CRE and to advocate for emotion‐focused communication.
    December 19, 2016   doi: 10.1002/pon.4330   open full text
  • Avoidant conversations about death by clinicians cause delays in reporting of neutropenic sepsis: Grounded theory study.
    Catherine Oakley, Cath Taylor, Emma Ream, Alison Metcalfe.
    Psycho-Oncology. December 19, 2016
    Background Evidence suggests that patients delay reporting symptoms of neutropenic sepsis (NS) despite the risk to their life. This study aimed to elicit factors that contribute to delayed patient reporting of NS symptoms. Methods A constructivist grounded theory study used observations of chemotherapy consultations (13 h) and 31 in‐depth interviews to explore beliefs, experiences, and behaviors related to NS. Participants included women with breast cancer, their carers (partners, family, or friends), and clinicians. An explanation for patient delays was developed through theoretical sampling of participants to explore emerging areas of interest and through constant comparison of data and their coding. This entailed iterative and concurrent data collection and analysis. Data were collected until saturation. Results All patients who developed NS‐type symptoms delayed presenting to hospital (2.5 h‐8 days), sometimes repeatedly. Moderators of delay included metastatic disease, bereavement, fatalism, religious beliefs, and quality of relationships with clinicians. There was an interplay of behaviors between clinicians, patients, and carers where they subconsciously conspired to underplay the seriousness and possibility of NS occurring. Conclusions Findings have implications for health risk communication and development of holistic service models.
    December 19, 2016   doi: 10.1002/pon.4320   open full text
  • Survival prediction of anxious emotion in advanced cancer patients receiving palliative care.
    Weiwei Zhao, Zhenyu Wu, Jianhua Chen, Huixun Jia, Zhe Huang, Menglei Chen, Xiaoli Gu, Minghui Liu, Zhe Zhang, Huaping Wang, Peng Wang, Wenwu Cheng.
    Psycho-Oncology. December 15, 2016
    Background This study was carried out to investigate the prognostic value of baseline and dynamic changes in anxious emotion in advanced cancer patients undergoing palliative care. Methods The association between anxious emotion and survival was investigated in a retrospective sample of 377 consecutive advanced cancer patients receiving palliative care from August 2013 to October 2015 and in an extended follow‐up study of 106 of those patients. Results The prevalence of anxious emotion was 24.93% (94/377) overall, 22.48% (47/209) in men and 27.97% (47/168) in women. Significant associations between baseline anxious emotion and overall survival (OS) were not found in the whole sample or in women. However, univariate and multivariate analyses showed that anxious emotion was an independent prognostic indicator of OS in men (hazard ratio [HR]: 1.811, P = .003). Moreover, findings showed that newly developed anxious emotion was significantly associated with poor OS in all readmitted patients (HR: 5.568, P < .001), in men (HR: 5.104, P = .006) and women (HR: 5.820, P = .004). Conclusions Our study suggests that anxious emotion, especially dynamic changes in anxious emotion, needs to be monitored in advanced cancer patients; whether targeted interventions would prolong survival requires further studies.
    December 15, 2016   doi: 10.1002/pon.4314   open full text
  • The perceived influence of childhood cancer on the parents' relationship.
    L. Wiener, H. Battles, S. Zadeh, W. Pelletier, M.N.F. Arruda‐Colli, Anna C. Muriel.
    Psycho-Oncology. December 15, 2016
    Objective When a child is diagnosed with cancer, parents are faced with many practical and emotional challenges that can significantly affect their relationship. This study explores how having a child with cancer affects the quality of the parents' relationship, categorizes time points and events during the child's treatment when the relationship becomes most stressed and/or strengthened, identifies factors that help couples remain emotionally engaged throughout their child's cancer treatment, and assesses parental interest in a counseling intervention. Methods This is a cross‐sectional, multicenter study conducted via a semistructured self‐administered questionnaire that included the Revised Dyadic Adjustment Scale. Results One hundred ninety‐two parents of children diagnosed between the ages of 1 and 21 participated. Forty percent felt their relationship moved in a negative direction. Diagnosis and relapse of disease were cited as the most individually stressful time points in the disease trajectory, with hospitalizations and relapse being most stressful on the relationship. Participants felt most emotionally connected at diagnosis and least emotionally connected at the start and end of treatment. The majority of couples indicated interest in counseling to address ways to support their relationship. Soon after diagnosis and during treatment was reported as the preferred time to offer these interventions. Conclusion This study identified specific events and parent behaviors that strain the couples' relationship during the childhood cancer trajectory. This information can inform the development of a couple's intervention. Prospective research is needed to better understand how childhood cancer affects caregivers' partnerships through survivorship and beyond.
    December 15, 2016   doi: 10.1002/pon.4313   open full text
  • Development of practice guidelines for psychological interventions in the rehabilitation of patients with oncological disease (breast, prostate, or colorectal cancer): Methods and results.
    Christina Reese, Joachim Weis, Dieter Schmucker, Oskar Mittag.
    Psycho-Oncology. December 15, 2016
    Objective The goal of this project was to develop evidence‐ and consensus‐based practice guidelines for psychological interventions in the rehabilitation of patients with oncological disease (breast, prostate, or colorectal cancer). Methods First of all, we conducted a literature search and survey of all oncological rehabilitation centers in Germany (N = 145) to obtain a thorough perspective of the recent evidence, guidelines, the structural framework, and practice of psychological services in oncological rehabilitation. Next, an expert workshop was held with national experts from scientific departments, clinicians from rehabilitation centers, and patients. In this workshop, we drafted and agreed upon an initial version of the practice guidelines. Afterwards, the practice guidelines were sent to all head physicians and senior psychologists at oncological rehabilitation centers in Germany for approval (N = 280 questionnaires). In addition, key recommendations were discussed with a group of rehabilitation patients. Finally, the practice guidelines were revised by the expert panel and made available online to the public. Results The practice guidelines have been widely accepted by both the expert panel and the surveyed clinicians and patients. They include recommendations for psycho‐oncological interventions that should be offered to all rehabilitation patients with breast, prostate, or colorectal cancer. They also comprise recommendations for specific problem areas concerning psychological functions, body functions, and environmental and personal factors. Conclusions The practice guidelines provide detailed recommendations for high‐quality psychosocial care in an oncological rehabilitation context. It is their aim to guide the multidisciplinary team, especially psychologists and physicians, in their daily practice.
    December 15, 2016   doi: 10.1002/pon.4322   open full text
  • Association between change in employment participation and quality of life in middle‐aged colorectal cancer survivors compared with general population controls.
    Vanessa L. Beesley, Jeff K. Vallance, Gabor Mihala, Brigid M. Lynch, Louisa G. Gordon.
    Psycho-Oncology. December 15, 2016
    Objective This study aimed to examine the association between change in employment participation for a 12‐month period and quality of life among individuals with colorectal cancer compared with general population controls. Methods This was a prospective, registry‐based study that enrolled middle‐aged (45‐64 years) residents of Queensland, Australia, who were in the paid workforce, and newly diagnosed with colorectal cancer. Participants completed structured telephone interviews at 6 and 12 months after diagnosis assessing quality of life and employment status (“retired/ceased work,” “increased work,” “decreased work,” and “maintained work”). Survivors were matched on demographic and occupation characteristics in a 1:2 ratio with individuals from the general population who had participated in both Wave 10 (2010) and 11 (2011) of the Household, Income and Labour Dynamics in Australia survey. Results Almost half (66/148, 45%) of colorectal cancer survivors ceased or decreased work during the study period, compared with 27% in the control group (79/295, P = .001). Physical and mental well‐being did not fluctuate over time in the general population. However, there were significant improvements in physical well‐being, functional well‐being, and overall quality of life during the study period for participants with colorectal cancer. At 12 months postdiagnosis, participants with colorectal cancer who maintained or increased work had significantly better functional well‐being and overall quality of life compared with those who decreased work or retired. Conclusions A diagnosis of colorectal cancer often impairs the ability of a person to maintain work. The impairments are predominantly physical and functional. Interventions to assist with occupational rehabilitation should be trialed.
    December 15, 2016   doi: 10.1002/pon.4306   open full text
  • Information Needs of the Chinese Community Affected by Cancer: A Systematic Review.
    Bee Teng Lim, Phyllis Butow, Jill Mills, Annie Miller, David Goldstein.
    Psycho-Oncology. December 14, 2016
    Objective The information needs of patients and carers from culturally‐ and linguistically‐diverse (CALD) backgrounds, including from the Chinese community, are not well understood, and there has been no previous synthesis of the literature. We conducted a systematic review of the information needs of the Chinese community affected by cancer. Methods Database, reference list and author searches were conducted to identify studies reporting information needs of the Chinese community affected by cancer. Data synthesis was undertaken to define categories of information needs. Results Initial searches yielded 2558 articles. Out of the 40 full‐text articles reviewed, 26 met all the eligibility criteria. Cancer‐specific, treatment and prognosis information were the most frequently reported information needs across the cancer care continuum. Similarly, these information were the most commonly reported information needs across different health systems, migration statuses and Chinese cultural values. Though less frequent, information needs related to interpersonal/social, financial/legal, and body image/sexuality were also raised. 13 studies quantified the prevalence of unmet needs, and the most frequently reported unmet needs were related to the health system and information, followed by psychological, patient care and support, and sexuality needs. Language and cultural factors were identified in all studies involving Chinese migrants living in English‐speaking countries. Conclusions Failing to meet the information needs of the Chinese community members affected by cancer increases the risk for poor cancer outcomes. Potential interventions such as translated resources, bilingual advocates, an online information portal and communication aids can be helpful in addressing the unmet needs for this community.
    December 14, 2016   doi: 10.1002/pon.4347   open full text
  • A Systematic Review of Dyadic Studies Examining Relationship Quality inCouples Facing Colorectal Cancer Together.
    Chiara Acquati, Jennifer Barsky Reese, Eli Karam, Karen Kayser, Kristen Mark, Daniela Wittmann.
    Psycho-Oncology. December 10, 2016
    Background Despite the adverse effects that treatment for colorectal cancer can have on patients’ quality of life and, in particular, their intimate relationships, very little research has been conducted on the psychosocial adjustment for both patients and their partners/spouses. Objectives The aim of this systematic review was to examine dyadic studies of adjustment in couples in which one partner has been diagnosed with colorectal cancer. Methods Pub Med, PsychINFO, MEDLINE, Social Sciences Abstracts (EBSCO) and the Cochrane Library were systematically searched for studies reporting quality of life outcomes for colorectal cancer patients and their partners/spouses. Only studies that included dyads in the sample were eligible for inclusion. The Quality Assessment Tool for Quantitative Studies was used to evaluate each study. Results A total of 277 studies were identified, of which 9 studies met the inclusion criteria (N = 388 couples). The methodological quality of the studies was high in that they used standardized instruments validated with their samples, conducted dyadic data analyses (when appropriate), and utilized longitudinal designs. A synthesis of the studies revealed that 1) relationship factors (e.g., support, communication, dyadic coping, and relationship satisfaction) affect adjustment to cancer; 2) cancer‐related distress impacts each partner's adjustment or the relationship; 3) gender, role (patient/caregiver), and clinical characteristics (treatment, mental health) can mediate adjustment to cancer. Conclusion The quality of relationships can influence patients’ and their partners’ adjustment to colorectal cancer. Psychosocial interventions that address relationship issues may be beneficial to couples facing the challenges of colorectal cancers.
    December 10, 2016   doi: 10.1002/pon.4339   open full text
  • The role of social support, family identification, and family constraints in predicting posttraumatic stress after cancer.
    Samantha Swartzman, Fabio Sani, Alastair J. Munro.
    Psycho-Oncology. December 07, 2016
    Objective We compared social support with other potential psychosocial predictors of posttraumatic stress after cancer. These included family identification, or a sense of belonging to and commonality with family members, and family constraints, or the extent to which family members are closed, judgmental, or unreceptive in conversations about cancer. We also tested the hypothesis that family constraints mediate the relationship between family identification and cancer‐related posttraumatic stress. Methods We used a cross‐sectional design. Surveys were collected from 205 colorectal cancer survivors in Tayside, Scotland. Results Both family identification and family constraints were stronger independent predictors of posttraumatic stress than social support. In multivariate analyses, social support was not a significant independent predictor of posttraumatic stress. In addition, there was a significant indirect effect of family identification on posttraumatic stress through family constraints. Conclusions Numerous studies demonstrate a link between social support and posttraumatic stress. However, experiences within the family may be more important in predicting posttraumatic stress after cancer. Furthermore, a sense of belonging to and commonality with the family may reduce the extent to which cancer survivors experience constraints on conversations about cancer; this may, in turn, reduce posttraumatic stress.
    December 07, 2016   doi: 10.1002/pon.4304   open full text
  • Sexual distress and associated factors among cervical cancer survivors: A cross‐sectional multicenter observational study.
    R.M. Bakker, G.G. Kenter, C.L. Creutzberg, A.M. Stiggelbout, M. Derks, W. Mingelen, C.D. Kroon, W.M. Vermeer, M.M. Kuile.
    Psycho-Oncology. December 06, 2016
    Background To assess whether sexual distress among cervical cancer (CC) survivors is associated with frequently reported vaginal sexual symptoms, other proposed biopsychosocial factors and whether worries about painful intercourse mediate the relation between vaginal sexual symptoms and sexual distress. Methods A cross‐sectional study was conducted among 194 sexually active partnered CC survivors aged 25 to 69 years. Sexual distress, vaginal sexual symptoms, sexual pain worry, anxiety, depression, body image concerns, and relationship dissatisfaction and the sociodemographic variables age, time since treatment, and relationship duration were assessed by using validated self‐administrated questionnaires. Results In total, 33% (n = 64) of the survivors scored above the cut‐off score for sexual distress. Higher levels of sexual distress were shown to be associated with higher levels of vaginal sexual symptoms, sexual pain worry, relationship dissatisfaction, and body image concerns. Furthermore, the results showed that sexual pain worry partly mediated the association between vaginal sexual symptoms and sexual distress, when controlling for relationship dissatisfaction and body image concerns. Conclusions Appropriate rehabilitation programs should be developed for CC survivors to prevent and reduce not only vaginal sexual symptoms but also sexual pain worry, relationship dissatisfaction, and body image concerns to reduce sexual distress.
    December 06, 2016   doi: 10.1002/pon.4317   open full text
  • Pro‐ and anti‐inflammatory cytokine associations with major depression in cancer patients.
    Madeline Li, Ekaterina Kouzmina, Megan McCusker, Danielle Rodin, Paul C. Boutros, Christopher J. Paige, Gary Rodin.
    Psycho-Oncology. December 06, 2016
    Objective Cytokines may be linked to depression, although it has been challenging to demonstrate this association in cancer because of the overlap between depressive symptoms and other sickness behaviors. This study investigates the relationship between cytokines and depression in cancer patients, accounting for confounding clinical and methodological factors. Methods The GRID Hamilton Rating Scale for Depression and Neurotoxicity Rating Scale (NRS) for cytokine‐induced sickness behaviors were administered to 61 cancer patients and 38 healthy controls. The cancer group was of mixed type and largely of late stage, with a recruitment rate of 35% and completion rate of 47%. Major depression was diagnosed in 19 of 61 (31%) cancer patients. Multiplexed cytokine assays for inflammatory and anti‐inflammatory cytokines were conducted in plasma samples using electrochemiluminescence. Results All cancer patients had high NRS scores and elevated levels of most cytokines. Cancer patients with major depression had higher NRS scores than those without major depression. IL‐1rα was positively associated with the GRID scores of depressive symptoms (regression coefficient, 3.52 ± 1.18; P = .004), but not with major depression. Major depression was negatively associated with the anti‐inflammatory cytokine IL‐4 (regression coefficient, −0.65 ± 0.26; P = .013), but not with IL‐1rα. Conclusions Depressive symptoms in cancer patients may represent sickness behaviors, which may have distinct cytokine associations from major depression. Sickness behaviors may be associated with an increase in inflammatory cytokines, whereas major depression may be induced by a failure to adequately resolve inflammation. Our findings suggest that cytokine‐mediated interventions may be of value to treat depression in this population.
    December 06, 2016   doi: 10.1002/pon.4316   open full text
  • Communication about melanoma and risk reduction after melanoma diagnosis.
    Vivian M. Rodríguez, Marianne Berwick, Jennifer L. Hay.
    Psycho-Oncology. December 06, 2016
    Background Melanoma patients are advised to perform regular risk‐reduction practices, including sun protection as well as skin self‐examinations (SSEs) and physician‐led examinations. Melanoma‐specific communication regarding family risk and screening may promote such behaviors. To this end, associations between patients' melanoma‐specific communication and risk reduction were examined. Methods Melanoma patients (N = 169) drawn from a population‐based cancer registry reported their current risk‐reduction practices, perceived risk of future melanoma, and communication with physicians and relatives about melanoma risk and screening. Results Patients were, on average, 56 years old and 6.7 years' post diagnosis; 51% were male, 93% reported “fair/very fair” skin color, 75% completed at least some college, and 22% reported a family history of melanoma. Patients reported varying levels of regular (always/nearly always) sun protection: sunscreen use (79%), shade seeking (60%), hat use (54%), and long‐sleeve shirt use (30%). Only 28% performed thorough SSE regularly, whereas 92% reported undergoing physician‐led skin examinations within the past year. Participants who were female, younger, and had a higher perceived risk of future melanoma were more likely to report past communication. In adjusted analyses, communication remained uniquely associated with increased sunscreen use and SSE. Conclusions Encouraging melanoma patients to have a more active role in discussions concerning melanoma risk and screening with relatives and physicians alike may be a useful strategy to promote 2 key risk‐reduction practices post melanoma diagnosis and treatment. Future research is needed to identify additional strategies to improve comprehensive risk reduction in long‐term melanoma patients.
    December 06, 2016   doi: 10.1002/pon.4315   open full text
  • Health literacy and physical activity in women diagnosed with breast cancer.
    Leigh C. Plummer, Kerry A. Chalmers.
    Psycho-Oncology. December 06, 2016
    Objective Physical activity after a diagnosis of breast cancer is associated with many health benefits. Health literacy has been shown to relate to physical activity, but there is limited research on this relationship. The aim of this study was to explore the relationship between health literacy and physical activity in women diagnosed with breast cancer. Specifically, we examined which of Nutbeam's 3 levels of health literacy (functional, interactive, and critical health literacy) predicted physical activity in women who have completed treatment for breast cancer. Methods Participants were women (N = 36) who had attended a local cancer care centre for breast cancer treatment. During a telephone interview conducted 6 to 18 months after completion of treatment, women completed a measure of health literacy and reported on their engagement in physical activity. Results Results showed that health literacy predicted physical activity after breast cancer treatment. Of the 3 levels of health literacy proposed by Nutbeam, functional health literacy was shown to be the most important predictor of physical activity. Conclusions These findings highlight the role of health literacy in physical activity in women diagnosed with breast cancer and have implications for targeted supportive physical activity interventions.
    December 06, 2016   doi: 10.1002/pon.4318   open full text
  • Psychosocial effects of a skin camouflage program in female survivors with head and neck cancer: A randomized controlled trial.
    Shu‐Ching Chen, Bing‐Shen Huang, Chien‐Yu Lin, Kang‐Hsing Fan, Joseph Tung‐Chien Chang, Shu‐Chen Wu, Yeur‐Hur Lai.
    Psycho-Oncology. December 02, 2016
    Objective The purpose of this study was to evaluate the effects of a skin camouflage program on disfigurement, self‐esteem, social interaction, and body image in female head and neck cancer (HNC) survivors. Methods A prospective, repeated‐measures, randomized controlled therapeutic intervention design was used. A total of 66 participants were randomly assigned to each group, with 32 in the experimental group and 34 in the control group. The experimental group received a 4‐session skin camouflage program, and the control group received routine care. Patients were assessed at 3 time points: baseline assessment (T0) and then at 1, 2, and 3 months (T1, T2, and T3, respectively) after participating in the skin camouflage program. Results Patients in the experimental group had significantly less facial disfigurement, depression, fear of social interaction, and anxiety regarding social interaction compared with those in the control group. Participants in both groups had significantly lower levels of facial disfigurement, depression, fear of social interaction, anxiety of social interaction, and body image at the final posttest assessment than at the pretest assessment. There were no differences between the groups and within groups with respect to self‐esteem. Conclusions The 3‐month skin camouflage program effectively improved facial disfigurement, fear of social interaction, anxiety of social interaction, and body image of female HNC survivors. A survival care plan should include a skin camouflage program to improve body image perception and decrease anxiety after treatment of HNC.
    December 02, 2016   doi: 10.1002/pon.4308   open full text
  • Effects of a health education and telephone counseling program on patients with a positive fecal occult blood test result for colorectal cancer screening: A randomized controlled trial.
    Hui‐Chuan Chiu, Hsin‐Yuan Hung, Hsiu‐Chen Lin, Shu‐Ching Chen.
    Psycho-Oncology. December 02, 2016
    Objective Our purpose was to evaluate the effects of a health education and telephone counseling program on knowledge and attitudes about colorectal cancer and screening and the psychological impact of positive screening results. Methods A randomized controlled trial was conducted with 2 groups using a pretest and posttest measures design. Patients with positive colorectal cancer screening results were selected and randomly assigned to an experimental (n = 51) or control (n = 51) group. Subjects in the experimental group received a health education and telephone counseling program, while the control group received routine care only. Patients were assessed pretest before intervention (first visit to the outpatient) and posttest at 4 weeks after intervention (4 weeks after first visit to the outpatient). Results Patients in the experimental group had a significantly better level of knowledge about colorectal cancer and the psychological impact of a positive screening result than did the control group. Analysis of covariance revealed that the health education and telephone counseling program had a significant main effect on colorectal cancer knowledge. Conclusions A health education and telephone counseling program can improve knowledge about colorectal cancer and about the psychological impact in patients with positive colorectal cancer screening results. The health education and telephone counseling program is an easy, simple, and convenient method of improving knowledge, improving attitudes, and alleviating psychological distress in patients with positive colorectal cancer screening results, and this program can be expanded to other types of cancer screening.
    December 02, 2016   doi: 10.1002/pon.4319   open full text
  • Factors associated with posttraumatic growth among parents of children with cancer.
    Nao Nakayama, Naoko Mori, Sae Ishimaru, Wataru Ohyama, Yuki Yuza, Takashi Kaneko, Eiichiro Kanda, Eisuke Matsushima.
    Psycho-Oncology. November 30, 2016
    Background Parents of children with cancer are susceptible to psychological distress; however, many parents also report posttraumatic growth (PTG). The objective of this study was to explore the variables associated with PTG in parents of children with cancer who were either on treatment or off treatment. Methods One hundred and nineteen parents (71 mothers and 48 fathers) of children with cancer completed self‐report questionnaires, including the PTG Inventory, Center for Epidemiologic Studies Depression Scale, State‐Trait Anxiety Inventory, and Impact of Event Scale‐Revised. Demographic data and children's medical information were also collected. Multivariate linear regression analyses were conducted to investigate the variables associated with PTG. Results The mean age of participants was 41.4 years (SD = 6). Higher PTG Inventory scores were associated with parents' lower trait anxiety (P = .028), parents' sex (female; P = .004), treatment status (within 12 months from treatment end compared with on‐treatment; P = .048), surgery (P = .007), and late effects (P = .01). Conclusions Parents' PTG was associated with children's clinical characteristics, parents' sex, and parents' anxiety levels. When dealing with PTG, the parents' psychological characteristics and children's clinical characteristics should be considered. Particularly for parents with high trait anxiety, it is important to reduce anxiety first before addressing PTG.
    November 30, 2016   doi: 10.1002/pon.4307   open full text
  • Anxiety and serum catecholamines as predictors of survival and recurrence in hepatocellular carcinoma.
    Jinxia Liu, Guijuan Zong, Chengliang Zhang, Chunsun Li, Xudong Chen, Yixin Zhang.
    Psycho-Oncology. November 24, 2016
    Objective Increasing evidence suggests that psychological factors are involved in tumor progression. This study investigated the influence of anxiety and serum catecholamines (CAs) on the prognosis of hepatocellular carcinoma (HCC). Method We enrolled 110 HCC patients who underwent tumor resection at the Affiliated Hospital of Nantong University, China, in this long‐term investigation between 2005 and 2009. We evaluated anxiety using the Hamilton Anxiety Rating Scale (HAMA) and analyzed CA levels using an ELISA kit. We then assessed the association of each of them with overall survival (OS) and time to recurrence (TTR), as well as with other clinical variables. Results The HAMA scores significantly correlated with metastasis (P = 0.015), hepatitis B surface antigens (HBsAg) (P = 0.045), and the tumor‐node‐metastasis stage (P = 0.032), whereas the CA levels also significantly associated with tumor differentiation (P < 0.001). Univariate and multivariate analyses revealed that HAMA scores and CA levels were significant predictors of OS and TTR in HCC patients, with high levels of each being strongly correlated with poor prognosis. Conclusion The HAMA scores and the CA levels were elevated in HCC patients and correlated with OS and TTR, suggesting that they are candidate prognostic markers of HCC.
    November 24, 2016   doi: 10.1002/pon.4305   open full text
  • Examining the relationship between multiple primary cancers and psychological distress: A review of current literature.
    Sarah M. Belcher, Emilie A. Hausmann, Susan M. Cohen, Heidi S. Donovan, Elizabeth A. Schlenk.
    Psycho-Oncology. November 21, 2016
    Objective The incidence of multiple primary cancers (MPCs) is increasing, but little is known about psychological distress in this population. The purpose of this study is to review and synthesize the literature regarding what is known about psychological distress in adults who have experienced MPC diagnoses. Methods All potentially eligible studies identified in PubMed and CINAHL were reviewed by 2 independent evaluators, and each relevant article was assessed for methodological quality. Data were extracted, organized, and recorded using a coding log, PRISMA flow diagram, and a standardized table of evidence. Effect size (ES) values were calculated using Cohen's d. Results Five of the 562 potentially relevant articles were selected for final analysis. MPC survivors, when compared with single cancer survivors, had lower global quality of life (d = 0.32–0.37), poorer emotional role function and stress (d = 0.08–0.20), greater and more frequent distress (d = 0.11–0.37), and greater subclinical anxiety (d = 0.15). Depressive symptoms were variable (d = 0.01–0.22), and no differences between MPC and single cancer groups were identified for sleep and suicidal ideation. Conclusion There is a substantial lack of evidence focused on psychological distress among the growing MPC survivor population. ES noted in the 5 studies reflect small but potentially significant increases in psychological distress in survivors of MPC compared with survivors of a single cancer. Clinicians should be aware of this at‐risk population when screening for distress in cancer survivors. Suggestions for future research are provided.
    November 21, 2016   doi: 10.1002/pon.4299   open full text
  • Choosing a miracle: Impoverishment, mistrust, and discordant views in abandonment of treatment of children with cancer in El Salvador.
    Nuria Rossell, Julia Challinor, Roy Gigengack, Ria Reis.
    Psycho-Oncology. November 21, 2016
    Objective In El Salvador, at the only hospital offering pediatric oncology care, the number of children abandoning treatment for cancer has decreased in recent years (13%‐3%). An investigation of caregivers' motives for abandonment was performed over 15 months from 2012 to 2014. Caregiver and health team perspectives on abandonment are reported using the explanatory model (EM) framework. Method Semistructured in‐depth interviews and in hospital participant observations were conducted with caregivers of children diagnosed with cancer, who abandoned their child's treatment or were considering abandoning, and with members of the medical team. Results Of the 41 caregivers interviewed, 26 caregivers (of 19 children) abandoned their child's treatment, returned from a series of missed appointments, or showed a risk of abandoning. Caregivers of 8 children stated that a miraculous cure was the main reason for abandoning; increasing impoverishment and misgivings toward treatment and outcomes were also mentioned. The responses of the medical team demonstrated a discordant EM for the child's cancer and treatment effects and that only biomedical treatment was effective for cure. Conclusions The caregivers' increasing impoverishment (not only financial) and misgivings about the child's treatment caused them to reconsider their therapeutic choices and rely on their belief in a miraculous cure, thus abandoning. The caregivers and medical team's discordant EM about the child's cancer and treatment must be acknowledged and shared decision making considered, together with consistency in the strategies that currently demonstrate to be effective decreasing abandonment.
    November 21, 2016   doi: 10.1002/pon.4302   open full text
  • Psychological distress and cognitive coping in pregnant women diagnosed with cancer and their partners.
    Tineke Vandenbroucke, Sileny N. Han, Kristel Van Calsteren, Tom F. Wilderjans, Bea R.H. Van den Bergh, Laurence Claes, Frédéric Amant.
    Psycho-Oncology. November 21, 2016
    Objective A cancer diagnosis during pregnancy may be considered as an emotional challenge for pregnant women and their partners. We aimed to identify women and partners at risk for high levels of distress based on their coping profile. Methods Sixty‐one pregnant women diagnosed with cancer and their partners filled out the Cognitive Emotion Regulation Questionnaire (CERQ) and the newly constructed Cancer and Pregnancy Questionnaire (CPQ). K‐means cluster analysis was performed on the CERQ scales. Scores on the CPQ were compared between the women and their partners and between the CERQ‐clusters. Results Comparison of women and partners on the CPQ did not reveal significant differences on distress about the child's health, the cancer disease, and the pregnancy or on information satisfaction (P = .16, P = .44, P = .50, and P = .47, respectively). However, women were more inclined to maintain the pregnancy than their partners (P = .011). Three clusters were retrieved based on the CERQ scales, characterized by positive coping, internalizing coping, and blaming. Women and partners using internalizing strategies had significantly higher scores on concerns about the child's health (P = .039), the disease and treatment (P < .001), and the pregnancy and delivery (P = .009) compared with positive and blaming strategies. No cluster differences were found for information satisfaction (P = .71) and tendency to maintain the pregnancy (P = .35). Conclusion Women and partners using internalizing coping strategies deal with the highest levels of distress and may benefit from additional psychosocial support.
    November 21, 2016   doi: 10.1002/pon.4301   open full text
  • Perceived impact of cancer among adolescents and young adults: Relationship with health‐related quality of life and distress.
    O. Husson, B.J. Zebrack.
    Psycho-Oncology. November 21, 2016
    Objective To examine whether perceptions of the impact of cancer are related to health‐related quality of life (HRQoL) and psychological distress among survivors of cancer in adolescence and young adulthood (AYA). Methods One hundred seventy‐three AYA cancer survivors (aged 18‐35 and 15‐29 years at time of diagnosis) completed a mailed survey assessing impact of cancer (IOC‐AYA), HRQoL (SF‐36), and distress (BSI‐18). Hierarchical linear regression models analyzed the independent effects of perceived impacts of cancer on HRQoL and distress after controlling for clinical and sociodemographic characteristics. Multivariate analyses also examined the extent to which positive and negative perceptions attenuated the effects of control variables on HRQoL and distress. Results Being unemployed or not in school, and self‐reported health problems were significantly associated with worse physical HRQoL. Mental HRQoL and psychological distress appeared as a function of reporting both positive and negative impacts of cancer; mental health outcomes were better in AYAs reporting more positive and less negative impact of cancer in their lives. Perceived impact of cancer, in both positive and negative ways, attenuated the effects of sociodemographic and clinical factors on mental HRQoL and psychological distress. Conclusion Results suggest that mental HRQoL and psychological distress, but not physical HRQoL, are a function of survivors' perceptions of how cancer has affected them and continues to affect them in both positive and negative ways. Findings suggest that opportunities for AYA cancer survivors to reframe or better understand the context of cancer in their lives may result in improved mental health outcomes.
    November 21, 2016   doi: 10.1002/pon.4300   open full text
  • A descriptive survey of cancer helplines in the United Kingdom: Who they are, the services offered, and the accessibility of those services.
    Geraldine M. Leydon, Beth Stuart, Lisa Danquah, Katie Ekberg, Lucy Brindle, Sue Latter, Clare Moynihan, Peter Salmon, Sonia Howe, Elizabeth Stokoe, Paul Little.
    Psycho-Oncology. November 17, 2016
    Background There are more than 1500 UK health helplines in operation, yet we have scant knowledge about the resources in place to support the seeking and delivering of cancer‐related telephone help and support. This research aimed to identify and describe cancer and cancer‐related helpline service provision: the number of helplines available, the variety of services provided, and the accessibility of those services. Method This study used online national questionnaire survey sent to 95 cancer and cancer‐related helplines in the United Kingdom. Results A total of 69 (73%) of 95 surveyed cancer and cancer‐related helplines completed the survey. Most helplines/organizations were registered charities, supported by donations; 73.5% of helplines had national coverage. Most helplines served all age‐groups, ethnic groups, and men and women. Only 13.4% had a number that was free from landlines and most mobile networks, and 56.6% could only be contacted during working hours. More than 50% of helplines reported no provisions for callers with additional needs, and 55% had no clinical staff available to callers. Ongoing support and training for helpline staff was available but variable. Conclusion Although cancer helplines in the United Kingdom offer reasonably broad coverage across the country, there are still potential barriers to accessibility. There are also opportunities to optimize the training of staff/volunteers across the sector. There are further prospects for helplines to enhance services and sustain appropriate and realistic quality standards.
    November 17, 2016   doi: 10.1002/pon.4293   open full text
  • Active Surveillance for Favourable‐Risk Prostate Cancer: Is there a Greater Psychological Impact than Previously Thought? A Systematic, Mixed Studies Literature Review.
    Eimear Ruane‐McAteer, Sam Porter, Joe M. O'Sullivan, Olinda Santin, Gillian Prue.
    Psycho-Oncology. November 15, 2016
    Objective Active Surveillance (AS) allows men with favourable‐risk prostate cancer (PCa) to avoid or postpone active treatment and hence spares potential adverse side effects for a significant proportion of these patients. Active surveillance may create an additional emotional burden for these patients. The aim of the review was to determine the psychological impact of AS to inform future study in this area and to provide recommendations for clinical practice. Methods Studies were identified through database searching from inception to September 2015. Quantitative or qualitative non‐interventional studies published in English that assessed the psychological impact of AS were included. The Mixed Methods Appraisal Tool was used to assess methodological quality. Results Twenty‐three papers were included (20 quantitative, 3 qualitative). Quantitatively, the majority of patients do not report psychological difficulties, however when appropriateness of study design is considered, the conclusion that AS has minimal impact on wellbeing, may not be accurate. This is due to small sample sizes, inappropriately timed baseline, and inappropriate/lack of comparison groups. In addition, a mismatch in outcome was noted between the outcome of quantitative and qualitative studies in uncertainty, with qualitative studies indicating a greater psychological impact. Conclusions Due to methodological concerns, many quantitative studies may not provide a true account of the burden of AS. Further mixed‐methods studies are necessary to address the limitations highlighted and to provide clarity on the impact of AS. Practitioners should be aware that despite findings of previous reviews, patients may require additional emotional support.
    November 15, 2016   doi: 10.1002/pon.4311   open full text
  • Cancer‐and‐treatment–specific distress and its impact on posttraumatic stress in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT).
    Katharina Kuba, Peter Esser, Angela Scherwath, Lena Schirmer, Frank Schulz‐Kindermann, Andreas Dinkel, Friedrich Balck, Uwe Koch, Nicolaus Kröger, Heide Götze, Anja Mehnert.
    Psycho-Oncology. November 14, 2016
    Background In this prospective multicenter study, we investigated cancer‐and‐treatment–specific distress (CTXD) and its impact on symptoms of posttraumatic stress disorder (PTSD) in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Methods Patients were consulted before (T0, N = 239), 3 (T1, N = 150), and 12 months (T2, N = 102) after HSCT. Medical (eg, diagnosis and pretreatment) and demographic information, CTXD and PTSD (PCL‐C) were assessed. Results Random intercept models revealed that the sum score of CTXD was highest pre‐HSCT (T0), decreased by T1 (γ = −.18, 95% CI [−.26/−.09]), and by T2 (γ = −.10, 95% CI [−.20/−.00]). Uncertainty, family strain, and health burden were rated most distressing during HSCT. Uncertainty and family strain decreased from T0 to T1 (γ = −.30, 95% CI [−.42/−.17]; γ = −.10, 95% CI [−.20/−.00]) and health burden from T1 to T2 (γ = −.21, 95% CI [−.36/.05]). Women were more likely to report uncertainty (γ = .38, 95% CI [.19/.58]), family strain (γ = .38, 95% CI [.19/.58]), and concerns regarding appearance and sexuality (γ = .31, 95% CI [.14/.47]) than men. Uncertainty (γ = .18, 95% CI [.12/.24]), appearance and sexuality (γ = .09, 95% CI [.01/.16]), and health burden (γ = .21, 95% CI [.14/.27]) emerged as predictors of PTSD symptomatology across the 3 assessment points. Conclusions Our data provide first evidence regarding the course of 6 dimensions of CTXD during HSCT and their impact on PTSD symptomatology. Specifically, results emphasize the major burden of uncertainty pre‐HSCT and the impact of uncertainty and concerns regarding appearance and sexuality on PTSD symptomatology.
    November 14, 2016   doi: 10.1002/pon.4295   open full text
  • Development and validation of a self‐efficacy scale for postoperative rehabilitation management of lung cancer patients.
    Fei‐Fei Huang, Qing Yang, Xuan Ye Han, Jing‐Ping Zhang, Ting Lin.
    Psycho-Oncology. November 08, 2016
    Objective The purpose of this study was to develop a Self‐Efficacy Scale for Rehabilitation Management designed specifically for postoperative lung cancer patients (SESPRM‐LC) and to evaluate its psychometric properties. Patients and methods Based on the concept of self‐management of chronic disease, items were developed from literature review and semistructured interviews of 10 lung cancer patients and screened by expert consultation and pilot testing. Psychometric evaluation was done with 448 postoperative lung cancer patients recruited from 5 tertiary hospitals in Fuzhou, China, by incorporating classical test theory and item response theory methods. Results A 6‐factor structure was illustrated by exploratory factor analysis and confirmed by confirmatory factor analysis, explaining 60.753% of the total variance. The SESPRM‐LC achieved Cronbach's α of 0.694 to 0.893, 2‐week test‐retest reliability of 0.652 to 0.893, and marginal reliability of 0.565 to 0.934. The predictive and criterion validities were demonstrated by significant association with theoretically supported quality‐of‐life variables (r = 0.211–0.392, P < .01), and General Perceived Self‐efficacy Scale (r = 0.465, P < .01), respectively. Item response theory analysis showed that the SESPRM‐LC offers information about a broad range of self‐efficacy measures and discriminates well between patients with high and low levels of self‐efficacy. Conclusions We demonstrated initial support for the reliability and validity of the 27‐item SESPRM‐LC, as a developmentally appropriate instrument for assessing self‐efficacy among lung cancer patients during postoperative rehabilitation.
    November 08, 2016   doi: 10.1002/pon.4296   open full text
  • Structural equation modeling of the relationship between posttraumatic growth and psychosocial factors in women with breast cancer.
    Makiko Tomita, Miyako Takahashi, Nobumi Tagaya, Miyako Kakuta, Ichiro Kai, Takashi Muto.
    Psycho-Oncology. November 07, 2016
    Objective Posttraumatic growth (PTG) is a positive psychological change occurring after struggling with a highly challenging experience. The purposes of this study were to investigate how women's demographic and clinical characteristics as well as psychosocial factors are associated with PTG and to reveal the influence of PTG on depressive symptoms. Methods Participants were 157 women with breast cancer (BC) who attended a breast oncology clinic at a university hospital in Japan. The questionnaire included demographic and clinical characteristics, social support, coping strategies, depressive symptoms, and PTG. Structural equation modeling was conducted. Results Coping was directly related to PTG, and social support and having a religion were partially related to PTG. There was a moderate association between social support and coping. PTG mediated the effect of coping on depressive symptoms. PTG as well as a high level of perceived social support and using positive coping decreased depressive symptoms, whereas using self‐restraining coping increased depressive symptoms. Conclusion This study indicated the role of coping strategies and social support in enhancing PTG in Japanese women with BC. Furthermore, perceived social support, a positive approach coping style, and PTG may reduce depressive symptoms. Our results suggest that health care professionals should consider whether patients receive enough support from others, and whether the patients are using the appropriate coping style to adapt to stressors associated with the diagnosis and treatment of BC.
    November 07, 2016   doi: 10.1002/pon.4298   open full text
  • Systematic review of psychosocial outcomes for patients with advanced melanoma.
    Jeff Dunn, Maggie Watson, Joanne F. Aitken, Melissa K. Hyde.
    Psycho-Oncology. November 07, 2016
    Background New advanced melanoma therapies are associated with improved survival; however, quality of survivorship, particularly psychosocial outcomes, for patients overall and those treated with newer therapies is unclear. Objective Synthesize qualitative and quantitative evidence about psychosocial outcomes for advanced (stage III/IV) melanoma patients. Methods Five databases were searched (01/01/1980 to 31/01/2016). Inclusion criteria were as follows: advanced melanoma patients or sub‐group analysis; assessed psychosocial outcomes; and English language. Results Fifty‐two studies met review criteria (4 qualitative, 48 quantitative). Trials comprise mostly medical not psychosocial interventions, with psychosocial outcomes assessed within broader quality of life measures. Patients receiving chemotherapy or IFN‐alpha showed decreased emotional and social function and increased distress. Five trials of newer therapies appeared to show improvements in emotional and social function. Descriptive studies suggest that patients with advanced, versus localized disease, had decreased emotional and social function and increased distress. Contributors to distress were largely unexplored, and no clear framework described coping/adjustment trajectories. Patients with advanced versus localized disease had more supportive care needs, particularly amount, quality, and timing of melanoma‐related information, communication with and emotional support from clinicians. Limitations included: lack of theoretical underpinnings guiding study design; inconsistent measurement approaches; small sample sizes; non‐representative sampling; and cross‐sectional design. Conclusions Quality trial evidence is needed to clarify the impact of treatment innovations for advanced melanoma on patients' psychosocial well‐being. Survivorship research and subsequent translation of that knowledge into programs and services currently lags behind gains in the medical treatment of advanced melanoma, a troubling circumstance that requires immediate and focused attention.
    November 07, 2016   doi: 10.1002/pon.4290   open full text
  • Improving anxiety regulation in patients with breast cancer at the beginning of the survivorship period: a randomized clinical trial comparing the benefits of single‐component and multiple‐component group interventions.
    Isabelle Merckaert, Florence Lewis, France Delevallez, Sophie Herman, Marie Caillier, Nicole Delvaux, Yves Libert, Aurore Liénard, Jean‐Marie Nogaret, David Ogez, Pierre Scalliet, Jean‐Louis Slachmuylder, Paul Van Houtte, Darius Razavi.
    Psycho-Oncology. November 07, 2016
    Objective To compare in a multicenter randomized controlled trial the benefits in terms of anxiety regulation of a 15‐session single‐component group intervention (SGI) based on support with those of a 15‐session multiple‐component structured manualized group intervention (MGI) combining support with cognitive‐behavioral and hypnosis components. Methods Patients with nonmetastatic breast cancer were randomly assigned at the beginning of the survivorship period to the SGI (n = 83) or MGI (n = 87). Anxiety regulation was assessed, before and after group interventions, through an anxiety regulation task designed to assess their ability to regulate anxiety psychologically (anxiety levels) and physiologically (heart rates). Questionnaires were used to assess psychological distress, everyday anxiety regulation, and fear of recurrence. Group allocation was computer generated and concealed till baseline completion. Results Compared with patients in the SGI group (n = 77), patients attending the MGI group (n = 82) showed significantly reduced anxiety after a self‐relaxation exercise (P = .006) and after exposure to anxiety triggers (P = .013) and reduced heart rates at different time points throughout the task (P = .001 to P = .047). The MGI participants also reported better everyday anxiety regulation (P = .005), greater use of fear of recurrence–related coping strategies (P = .022), and greater reduction in fear of recurrence–related psychological distress (P = .017) compared with the SGI group. Conclusions This study shows that an MGI combining support with cognitive‐behavioral techniques and hypnosis is more effective than an SGI based only on support in improving anxiety regulation in patients with breast cancer.
    November 07, 2016   doi: 10.1002/pon.4294   open full text
  • Emotion regulation and emotional distress: The mediating role of hope on reappraisal and anxiety/depression in newly diagnosed cancer patients.
    Chao Xu Peh, Jianlin Liu, George D. Bishop, Hui Yu Chan, Shi Min Chua, Ee Heok Kua, Rathi Mahendran.
    Psycho-Oncology. October 24, 2016
    Purpose A proportion of newly diagnosed cancer patients may experience anxiety and depression. Emotion suppression has been associated with poorer psychoemotional outcomes, whereas reappraisal may be an adaptive emotion regulation strategy. Few studies have examined potential mechanisms linking reappraisal to psychoemotional outcomes in cancer patients. This study aims to replicate findings on reappraisal and suppression and further examines if hope mediates the association between reappraisal and anxiety/depression in patients newly diagnosed with cancer. Methods Participants were 144 adult cancer patients (65.3% female, mean age = 48.96 years, SD = 9.23). Patients completed a set of study questionnaires, including the Emotion Regulation Questionnaire, Adult Hope Scale, and the Hospital Anxiety and Depression Scale. Path analysis was used to examine if hope mediated the association between reappraisal and anxiety/depression. Results Prevalence of anxiety was 39.6% and depression was 25.0%. Reappraisal and hope were correlated with lower anxiety and depression, whereas suppression was correlated with higher anxiety and depression. The hypothesized mediation model provided fit to the data, comparative fit index = 0.95, Tucker‐Lewis index = 0.94, root‐mean‐square‐error of approximation = 0.05. There was a significant indirect effect of reappraisal on anxiety and depression via hope, b = −0.95, SE = 0.42, 95% confidence interval = −1.77 to −0.12, whereas the direct effect of reappraisal was nonsignificant. Conclusion The study findings suggest that hope mediated the association between reappraisal and anxiety/depression outcomes. Moreover, the high prevalence of anxiety and depression implies a need for healthcare providers to attend to the psychoemotional needs of newly diagnosed cancer patients.
    October 24, 2016   doi: 10.1002/pon.4297   open full text
  • Background factors associated with problem avoidance behavior in healthy partners of breast cancer patients.
    Mariko Shiozaki, Makiko Sanjo, Kei Hirai.
    Psycho-Oncology. October 24, 2016
    Objective We evaluated avoidance behaviors of healthy partners of breast cancer patients and sought to (1) describe men's perception of their own avoidance behavior and (2) identify the background factors associated with such behavior. Methods An Internet‐based survey was conducted, and analysis was performed on the responses of 368 male spouses of female breast cancer patients. Results Thirty to forty percent of spouses had some type of problem avoidance behavior toward their wives. There was a high correlation (r = 0.70, P < .001) between problem avoidance behavior at the time of diagnosis and subsequent problem behavior (mean follow‐up period after diagnosis: 1.3 + 1.1 years). The characteristics of spouses with avoidant behaviors included having wives with recurrence, having wives treated with anticancer drug therapy or total resection, and having their own experience of cancer. Covariance structure analysis revealed 2 factors related to the background of spouses with problem avoidance behavior: (1) having a sense of difficulty in coping (beta = 0.68, P < .001) and (2) having a poor marital relationship (beta = ‐0.27, P < .001). Conclusions Our findings suggest that problem avoidance behavior among healthy male partners of breast cancer patients is common and correlates with difficulty coping and a poor marital relationship. It is important to address both the problem avoidance behavior itself and to support couples early, before this behavior surfaces.
    October 24, 2016   doi: 10.1002/pon.4292   open full text
  • A multicenter study on the validation of the Burnout Battery: a new visual analog scale to screen job burnout in oncology professionals.
    Yao‐tiao Deng, Jie Liu, Jie Zhang, Bo‐yan Huang, Ting‐wu Yi, Yu‐qing Wang, Bo Zheng, Di Luo, Pei‐xin Du, Yu Jiang.
    Psycho-Oncology. October 17, 2016
    Objectives The objective of the study is to develop a novel tool—the Burnout Battery—for briefly screening burnout among oncology professionals in China and assessing its validity. Methods A multicenter study was conducted in doctors and nurses of the oncology departments in China from November 2014 to May 2015. The Burnout Battery was administered with the Maslach Burnout Inventory‐Human Services Survey (MBI‐HSS) and the Doctors' Job Burnout Questionnaire. Results Of 538 oncology doctors and nurses who completed all the survey, using MBI‐HSS as the standard tool for measuring burnout, 52% had emotional exhaustion, 39.4% had depersonalization, and 59.3% had a low sense of personal accomplishment. Receiver operating characteristic curve analyses showed that the best cut‐off of the Burnout Battery was the battery with 3 bars, which yielded best sensitivity and specificity against all the 3 subscales of MBI‐HSS. With this cut‐off, nearly half of Chinese oncology professionals (46.8%) had burnout. The Burnout Battery correlated significantly with subscales of the MBI‐HSS and the Doctors' Job Burnout Questionnaire. In multiple logistic regression analysis, those who worked more than 60 hours per week and who thought clinical work was the most stressful part of their job were more likely to experience burnout. Conclusion Chinese oncology professionals exhibit high levels of burnout. The Burnout Battery appears to be a simple and useful tool for screening burnout. Working long hours and perceiving clinical work as the most stressful part of the job were the main factors associated with burnout.
    October 17, 2016   doi: 10.1002/pon.4291   open full text
  • Oncologists' communication about end of life: the relationship among secondary traumatic stress, compassion satisfaction, and approach and avoidance communication.
    Leeat Granek, Ora Nakash, Michal Cohen, Merav Ben‐David, Samuel Ariad.
    Psycho-Oncology. October 17, 2016
    Background Oncologists must communicate effectively with patients and their families about end of life (EOL). Despite the importance of communicating on this topic, many oncologists avoid these conversations. The objective of this study was to examine the associations between secondary traumatic stress and compassion satisfaction and approach and avoidant communication about EOL with cancer patients. Methods A convenience sample of 79 oncologists (n = 27 men, n = 52 women) participated in the study. Oncologists completed a survey that included a sociodemographic and clinical information questionnaire, the Professional Quality of Life Scale, and Communication about End of Life Survey. To examine the effect of secondary traumatic stress and compassion satisfaction on approach and avoidant communication, while controlling for gender and age, 2 hierarchical linear regression analyses were computed. Results Oncologists reported high levels of secondary traumatic stress and high compassion satisfaction. Scores on the approach and avoidant communication scales were in the mid‐range of the scale. Lower reports of secondary traumatic stress and higher compassion satisfaction were associated with higher approach communication strategies: however, only higher secondary traumatic stress was associated with higher avoidant communication strategies. Conclusions Our findings indicate that there is an association between emotional factors and approach communication. The findings have clinical implications in designing effective communication skills training. Further research and training should take secondary traumatic stress and compassion satisfaction into consideration to be able to ensure that terminal patients and their families receive the best quality EOL care.
    October 17, 2016   doi: 10.1002/pon.4289   open full text
  • Symptom experiences in metastatic breast cancer patients: relationships to activity engagement, value‐based living, and psychological inflexibility.
    Catherine E. Mosher, Danielle B. Tometich, Adam Hirsh, Kevin L. Rand, Shelley A. Johns, Marianne S. Matthias, Samantha D. Outcalt, Jonathan Bricker, Bryan Schneider, Lida Mina, Anna Maria Storniolo, Erin Newton, Kathy Miller.
    Psycho-Oncology. October 11, 2016
    Objective This study examined symptom‐based subgroups of metastatic breast cancer (MBC) patients and the extent to which they differed across key constructs of acceptance and commitment therapy (ACT). Methods Eighty women with MBC completed self‐report surveys assessing 10 common symptoms and several ACT variables (ie, activity engagement, psychological inflexibility, value obstruction, and value progress) during a single time point. Results A cluster analysis yielded 3 patient subgroups: low symptoms, low‐moderate symptoms, and moderate‐high symptoms. Relative to the subgroup with low symptoms, the other subgroups reported less activity engagement. In addition, compared with patients with low symptoms, the subgroup with moderate‐high symptoms reported greater psychological inflexibility (ie, avoidance of unwanted internal experiences) and greater difficulty living consistently with their values. Conclusions Women with MBC show heterogeneity in their symptom profiles, and those with higher symptom burden are more likely to disengage from valued activities and avoid unwanted experiences (eg, thoughts, feelings, and bodily sensations). Findings are largely consistent with the ACT model and provide strong justification for testing ACT to address symptom interference in MBC patients.
    October 11, 2016   doi: 10.1002/pon.4283   open full text
  • A qualitative insight into self‐management experience among Chinese breast cancer survivors.
    Huilin Cheng, Janet W.H. Sit, Karis K.F. Cheng.
    Psycho-Oncology. October 11, 2016
    Background With increasing awareness in the chronic nature of cancer, promoting the engagement of breast cancer survivors in self‐management has become a priority of cancer care reform initiatives. This study aimed to reveal Chinese breast cancer survivors' views and experiences of self‐management in extended survivorship. Methods Archived interview transcripts from 19 breast cancer survivors (<5 years since diagnosis) were subjected to a secondary analysis. Each transcript was re‐examined through qualitative content analysis. Results Three categories were established to represent the perceptions of the participants on their self‐management tasks related to health and well‐being, emotions, and roles and relationships. Managing health and well‐being covers modifying lifestyle, taking traditional Chinese medicine, attending regular follow‐ups, managing symptoms, and adhering to hormonal therapy. Managing emotions involves maintaining a positive attitude and utilizing supportive resources. Managing roles and relationships comprises adjusting to life as cancer survivors, maintaining marital relationships, and performing familial and other social roles. Conclusions Most participants actively participated in various self‐management tasks and behaviors that can help improve their health and prevent cancer recurrence. They may exhibit optimal self‐management in their emotions and most health aspects but may exert limited efforts in managing their different roles during survivorship.
    October 11, 2016   doi: 10.1002/pon.4279   open full text
  • Factors influencing participation in health behaviors in endometrial cancer survivors.
    Sarah J. Hardcastle, Rachael Glassey, Stuart Salfinger, Jason Tan, Paul Cohen.
    Psycho-Oncology. October 10, 2016
    Background The study purpose was to investigate endometrial cancer survivors' health perceptions following cessation of active cancer treatment and to explore factors influencing participation in health‐promoting behaviors. Methods Face‐to‐face interviews were conducted with participants who had completed active treatment of cancer within the previous 3 years. Participants were 22 endometrial cancer survivors (mean age = 62.55 years, SD = 7.08) at risk of cardiovascular disease who were recruited from 2 oncologists in Perth, Western Australia. Interview transcripts were analyzed using thematic analysis. Results Five main themes emerged: physical activity knowledge and advice; authority of oncologists; accountability and external motivation; monitoring and barriers to healthy eating; and physical activity. Participants recalled that specific recommendations for physical activity or body weight were rarely made by the oncologists, but felt they would have followed such lifestyle advice if it had been given. The overarching theme was the need for accountability and monitoring to successfully change health behaviors. Conclusions Interventions aimed at promoting health behaviors in endometrial cancer survivors should include referral and advice from oncologists, provision of monitoring, and promotion of planning and self‐control. Implications for endometrial cancer survivors at risk of cardiovascular disease: these women are likely to benefit most from interventions aimed at promoting planning, self‐regulation and problem solving and regular follow‐up.
    October 10, 2016   doi: 10.1002/pon.4288   open full text
  • Development and validation of the National Cancer Center Psychological Symptom Inventory.
    Eun‐Jung Shim, Bong‐Jin Hahm, Eun‐Seung Yu, Ha Kyoung Kim, Seong Jin Cho, Sung Man Chang, Jong‐Chul Yang, Jong‐Heun Kim.
    Psycho-Oncology. October 10, 2016
    Objective To report the development and validation of the National Cancer Center Psychological Symptom Inventory (NCC‐PSI). Methods Psychometric properties of the NCC‐PSI were examined by using multicenter surveys involving 400 patients with cancer in 5 cancer‐treatment hospitals throughout Korea. Related measures including the Mini‐International Neuropsychiatric Interview were administered. Results Convergent validity was supported by NCC‐PSI's significant associations with related measures. Known‐group validity was proven with higher scores of helplessness/hopelessness and anxious preoccupation on the Mini‐Mental Adjustment to Cancer in the depression and anxiety diagnosis group, defined by the NCC‐PSI. Cutoff scores for insomnia, anxiety, and depression were identified. Overall, the screening performance of the NCC‐PSI was comparable to that of the distress thermometer and Patient Health Questionnare‐2. Conclusions The NCC‐PSI represents a meaningful effort to develop a distress screening tool that addresses specific psychological symptoms common in cancer, which are tailored to the local oncology care system with varying degrees of psychosocial care resources.
    October 10, 2016   doi: 10.1002/pon.4277   open full text
  • What do people fear about cancer? A systematic review and meta‐synthesis of cancer fears in the general population.
    Charlotte Vrinten, Lesley M. McGregor, Małgorzata Heinrich, Christian Wagner, Jo Waller, Jane Wardle, Georgia B. Black.
    Psycho-Oncology. October 06, 2016
    Background Cancer has long inspired fear, but the effect of fear is not well understood; it seems both to facilitate and to deter early diagnosis behaviours. To elucidate fear's behavioural effects, we systematically reviewed and synthesised qualitative literature to explore what people fear about cancer. Methods We searched Medline, Embase, PsycInfo, Web of Science, AnthroSource, and Anthrobase for studies on cancer fear in breast, cervical, and colorectal cancer screening and analysed 102 studies from 26 countries using thematic synthesis. Results Fears of cancer emanated from a core view of cancer as a vicious, unpredictable, and indestructible enemy, evoking fears about its proximity, the (lack of) strategies to keep it at bay, the personal and social implications of succumbing, and fear of dying from cancer. Conclusions This view of cancer as ‘an enemy’ reprises the media's ‘war on cancer’ theme and may affect the acceptance of cancer early detection and prevention messages, since cancer's characteristics influenced whether ‘fight’ or ‘flight’ was considered appropriate.
    October 06, 2016   doi: 10.1002/pon.4287   open full text
  • Factors associated with oncology patients' involvement in shared decision making during chemotherapy.
    Alexis Colley, Jodi Halpern, Steven Paul, Guy Micco, Maureen Lahiff, Fay Wright, Jon D. Levine, Judy Mastick, Marilyn J. Hammer, Christine Miaskowski, Laura B. Dunn.
    Psycho-Oncology. October 05, 2016
    Objective Oncology patients are increasingly encouraged to play an active role in treatment decision making. While previous studies have evaluated relationships between demographic characteristics and decision‐making roles, less is known about the association of symptoms and psychological adjustment characteristics (eg, coping styles and personality traits) and decision‐making roles. Methods As part of a larger study of symptom clusters, patients (n = 765) receiving chemotherapy for breast, gastrointestinal, gynecological, or lung cancer provided information on demographic, clinical, symptom, and psychological adjustment characteristics. Patient‐reported treatment decision‐making roles (ie, preferred role and role actually played) were assessed using the Control Preferences Scale. Differences among patients, who were classified as passive, collaborative, or active, were evaluated using χ2 analyses and analyses of variance. Results Over half (56.3%) of the patients reported that they both preferred and actually played a collaborative role. Among those patients with concordant roles, those who were older, those with less education and lower income, and those who were less resilient were more likely to prefer a passive role. Several psychological adjustment characteristics were associated with decision‐making role, including coping style, personality, and fatalism. Conclusions Oncology patients' preferences for involvement in treatment decision making are associated with demographic characteristics as well as with symptoms and psychological adjustment characteristics, such as coping style and personality. These results reaffirm the complexities of predicting patients' preferences for involvement in decision making. Further study is needed to determine if role or coping style may be influenced by interventions designed to teach adaptive coping skills.
    October 05, 2016   doi: 10.1002/pon.4284   open full text
  • The psychosocial experiences of women with breast cancer across the lifespan: a systematic review.
    Heather J. Campbell‐Enns, Roberta L. Woodgate.
    Psycho-Oncology. October 04, 2016
    Objective To summarize the psychosocial experience of women with breast cancer from a lifespan perspective by examining the findings of qualitative studies. Methods A meta‐aggregate review of 24 qualitative studies was undertaken. To be included, studies must include women with a breast cancer diagnosis and focus on younger or older women (as defined by the study), or compare a psychosocial issue across the lifespan. Eight databases were searched systematically. Results Study participants ranged in age from 26 to 91 years. Sixteen studies focused on younger women, six focused on older women, and two included women across the lifespan. A total of 155 findings were extracted from the studies and were aggregated into 11 categories. These were synthesized into four synthesized findings: (a) dealing with cancer, (b) the importance of caring, (c) the aftermath of cancer, and (d) fertility and infertility. Conclusions Further research is required to explore these findings, and to examine the needs of older women in particular. Delineating the similarities and differences in the needs of women across the lifespan will inform the development of psychosocial interventions for all women with breast cancer.
    October 04, 2016   doi: 10.1002/pon.4281   open full text
  • Quality of life in patients with skin tumors: the mediator role of body image and social support.
    M. Graça Pereira, Mafalda Ponte, Gabriela Ferreira, José C. Machado.
    Psycho-Oncology. September 27, 2016
    Objective This study analyzed the relationships between illness representations, psychological morbidity, family stress, and quality of life and whether these variables were mediated by body image and social support. Methods The sample consisted of 106 patients with skin tumors, who answered the following measures: Dermatology Life Quality Index, Illness Perception Questionnaire–Brief, Medical Outcomes Study Social Support Survey, Index of Family Relations, Hospital Anxiety and Depression Scales, and the Body Image Scale. Results Patients with poor quality of life showed more threatening cognitive and emotional illness representations, less perceived social support, higher psychological morbidity, and higher concern with body image. Body image mediated the relationship between cognitive and comprehension illness representations, family stress, psychological morbidity, and quality of life. Social support mediated the relationship between family stress/psychological morbidity and quality of life. Conclusions Psychological intervention should focus on body image and social support, particularly in patients with melanoma, less disease duration, tumors in the face, head or neck, in an active professional status, and with lower education.
    September 27, 2016   doi: 10.1002/pon.4236   open full text
  • Facading in transcultural interactions: examples from pediatric cancer care in Sweden.
    Pernilla Pergert.
    Psycho-Oncology. September 26, 2016
    Objective The aims of the study were to generate a grounded theory explaining the latent pattern of behavior in transcultural care interactions in the context of pediatric cancer care and to unify previously performed studies. Methods The basic tenets of classic grounded theory were applied on a theoretical sample of data from previous studies that included 5 focus group interviews with health care professionals (n = 35) and individual interviews with nurses (n = 12) and foreign‐born parents (n = 11). Results Facading emerged as the core category and is the act of showing an outer appearance that will influence other people's interpretations. In transcultural interactions, facading might be misinterpreted related to different obstacles. Examples are given of different facades explored in pediatric cancer care including strength facading. Facading is a strategy aiming to protect oneself and others emotionally in care and includes: emotional facading and facading‐sensitive issues. Conclusions This grounded theory could help make health care professionals aware of different meanings of facading across cultures in health care. Also, awareness is needed of different views on emotional facading and facading‐sensitive issues to provide a congruent care.
    September 26, 2016   doi: 10.1002/pon.4274   open full text
  • Development and implementation of a comprehensive psychosocial screening program in a Brazilian cancer center.
    Cristiane Decat Bergerot, Errol J. Philip, Tammy A. Schuler, Karen Lynn Clark, Matthew Loscalzo, Marco Murilo Buso, João Nunes Matos Neto, Jorge Vaz Pinto Neto, Alexandre Nonino, Tereza Cristina Cavalcanti Ferreira Araujo.
    Psycho-Oncology. September 26, 2016
    Objective International guidelines recommend routine screening for distress as part of care practices. Accordingly, a Brazilian cancer center developed and implemented a distress screening program (DS) in 2007, which was enhanced in 2009 through the inclusion of a psychosocial care meeting group (DS + PCM) regarding patients' psychosocial needs. The current paper will provide an overview of the development and pilot implementation of this program and initial analyses to assess patient outcomes and report initial results to extend international research on this key aspect of cancer care. Method Patients were assessed for distress, anxiety and depression, and in the DS+PCM phase for quality of life at the first day of chemotherapy infusion, at midpoint, and at treatment end. We compared data from program phases (DS vs DS + PCM), with a sequential cohort design and mixed effects modeling. Results Clinical and demographic characteristics were similar between groups. Patients receiving DS + PCM showed significantly lower distress and depression/anxiety upon chemotherapy initiation (Ps < .001). While both groups reported significantly lowered distress and total depression/anxiety scores across time (Ps < .003), patients receiving DS + PCM maintained the lowest distress and total anxiety/depression at all assessments. Patients from DS + PCM group also reported improvements in quality of life over time. Conclusions The current study provides preliminary evidence that a multidisciplinary structured screening program utilizing validated measures and team meetings is associated with reduced impairment in patients' psychological well being. This program provided more opportunities for collaboration among providers with increased multidisciplinary meetings, enabled patients to more easily report problems, and ensured rapid access to relevant resources.
    September 26, 2016   doi: 10.1002/pon.4275   open full text
  • “Our organs have a purpose”: body image acceptance in Latina breast cancer survivors.
    Lydia P. Buki, Micaela Reich, Emaan N. Lehardy.
    Psycho-Oncology. September 26, 2016
    Objective Studies examining body image concerns among breast cancer survivors have primarily captured the experiences of non‐Latina white women. Thus, little is known about body image concerns among Latinas. To address this gap, we examined Latina breast cancer survivors' lived experiences related to body image. Methods Twenty‐seven Latina breast cancer survivors provided data through focus groups and individual interviews as part of a larger study conducted by the first author. In the current paper, we conducted a secondary thematic analysis to uncover women's experiences unique to body image concerns. Results We identified 2 themes related to women's experiences with body image: (a) perceptions of loss and reconstruction and (b) process of achieving body image acceptance. The salience of these themes varied as a function of survivorship stage and type of surgery. Conclusions Body image concerns are distressing for Latina breast cancer survivors. Accepting their altered appearance was an ongoing and complex process. Clinical implications include the need for psychoeducational programs and tailored interventions to enhance women's body image acceptance.
    September 26, 2016   doi: 10.1002/pon.4270   open full text
  • An online psychological intervention can improve the sexual satisfaction of men following treatment for localized prostate cancer: outcomes of a Randomised Controlled Trial evaluating My Road Ahead.
    Addie C. Wootten, Denny Meyer, Jo‐Anne M. Abbott, Katherine Chisholm, David W. Austin, Britt Klein, Marita McCabe, Declan G. Murphy, Anthony J. Costello.
    Psycho-Oncology. September 26, 2016
    Background Prostate cancer treatment often results in significant psycho‐sexual challenges for men following treatment; however, many men report difficulty in accessing appropriate care. Methods A randomized controlled trial was undertaken to assess the efficacy of a 10‐week self‐guided online psychological intervention called My Road Ahead (MRA) for men with localized prostate cancer in improving sexual satisfaction. Participants were randomized to 1 of 3 conditions MRA alone or MRA plus online forum, or forum access alone. Pre, post, and follow‐up assessments of overall sexual satisfaction were conducted. Mixed models and structural equation modeling were used to analyze the data. Results One hundred forty‐two men (mean age 61 y; SD = 7) participated. The majority of participants had undergone radical prostatectomy (88%) and all men had received treatment for localized prostate cancer. Significant differences were obtained for the 3 groups (P = .026) and a significant improvement in total sexual satisfaction was observed only for participants who were allocated to MRA + forum with a large effect size (P = .004, partial η2 = 0.256). Structural equation modeling indicated that increases in sexual function, masculine self‐esteem, and sexual confidence contributed significantly to overall sexual satisfaction for the MRA + forum plus forum condition. Conclusions This study is the first, to our knowledge, that has evaluated a self‐guided online psychological intervention tailored to the specific needs of men with prostate cancer. The findings indicate the potential for MRA to deliver support that men may not otherwise receive and also highlight the importance of psychological intervention to facilitate improved sexual outcomes.
    September 26, 2016   doi: 10.1002/pon.4244   open full text
  • Japanese childhood cancer survivors' readiness for care as adults: a cross‐sectional survey using the Transition Scales.
    Yasushi Ishida, Mari Tezuka, Mitsue Hayashi, Fumiko Inoue.
    Psycho-Oncology. September 26, 2016
    Background Childhood cancer survivors' (CCSs') readiness for adult care has not been evaluated in Japan. We conducted a survey to examine transition barriers and facilitators in CCSs and compared the results with those of CCSs in Canada. Methods Participants were selected from the Heart Link mutual‐aid health insurance membership directory and the Millefeuille Childhood Cancer Frontiers. We conducted a cross‐sectional survey (self‐report questionnaire) via mail, using the Transition Scales. Results In total, 268 questionnaires were collected by January 2016 (response rate, 42.5%). After confirming the reliability and validity of the Transition Scales, we analyzed 242 questionnaires. After excluding questionnaires for CCSs younger than 15 or older than 26 years, we compared scales scores between Japanese and Canadian CCSs. Relative to that of Japanese CCSs, Canadian CCSs showed greater cancer‐related worry for 4 items (P < .001) and preference for self‐management in 3 items (P < .001). Japanese CCSs showed greater preference for self‐management, relative to that of Canadian CCSs, in 5 items (P < .001). In the expectation scale, Japanese CCSs showed lower levels of expectation concerning adult care in 6 of 12 items (P < .001). Relative to that of Canadian CCSs, a significantly higher number of Japanese CCSs preferred to visit the same doctor for long‐term care as adults (P < .001). Conclusions The results confirmed the reliability and validity of the Transition Scales and showed that Japanese CCSs expressed fewer cancer concerns, but a higher number of Japanese CCSs preferred to visit the same doctor for long‐term care as adults.
    September 26, 2016   doi: 10.1002/pon.4276   open full text
  • Experiences of “openness” between mothers and daughters during breast cancer: implications for coping and healthy outcomes.
    Carla L. Fisher, Bianca M. Wolf, Craig Fowler, Mollie Rose Canzona.
    Psycho-Oncology. September 20, 2016
    Objective Mother‐daughter communication is central to how women adjust to breast cancer. They may be aided by models of healthy communication that illustrate both women's perspectives. Families establish normative communication patterns that inform how they cope. We used family communication patterns theory to examine correlations between openness/avoidance and health. We extended this by capturing mother‐daughter open/avoidant narratives to illustrate how these behaviors function in helpful (health‐promoting) and unhelpful ways. Methods Phase 1 of this mixed‐method study involved 41 patients and 37 mothers/daughters (N = 78) completing surveys on mother‐daughter openness, avoidant coping, and quality of life. Phase 2 involved interviews with 40 patients and 38 mothers/daughters (N = 78) to ascertain what diagnosed women share (or do not share) with their mother/daughter and their reasons. Results Diagnosed women reporting more open mother‐daughter bonds had better relational health (r = .730, P < .001). Those who engaged in more avoidant coping reported poorer physical health (r = −.431, P = .01). Mothers and daughters talked about treatment side effects and procedures, disease risk and prevention, and medical decisions. They avoided discussions about distressing emotions and topics as well as uncertainty about the future. Motivations to disclose/avoid centered on protecting themselves and/or their mother/daughter. Qualitative findings illustrate the tension between openness and avoidance. Developmental differences and relational role perspectives illustrate women's diverse needs. Conclusions A history of openness is linked with relational health, but coping is not as simple as “be open.” Both openness/avoidance are helpful and unhelpful depending on age, topic, and responses.
    September 20, 2016   doi: 10.1002/pon.4253   open full text
  • Qigong/tai chi for sleep and fatigue in prostate cancer patients undergoing radiotherapy: a randomized controlled trial.
    Jennifer L. McQuade, Sarah Prinsloo, David Z. Chang, Amy Spelman, Qi Wei, Karen Basen‐Engquist, Carol Harrison, Zonghao Zhang, Debra Kuban, Andrew Lee, Lorenzo Cohen.
    Psycho-Oncology. September 20, 2016
    Objectives Sleep disturbances and fatigue are common in prostate cancer patients undergoing radiotherapy. Prior research suggests mind‐body techniques may improve these outcomes. We conducted a randomized controlled trial of qigong/tai chi (QGTC) in men with prostate cancer undergoing radiotherapy. Methods Men with prostate cancer starting definitive radiation were randomized to 1 of 3 groups: (1) QGTC; (2) light exercise (LE); or (3) waiting list control. Sleep disturbances (Pittsburgh Sleep Quality Index) and fatigue (Brief Fatigue Inventory) were assessed at baseline, midway through radiotherapy (T2), during the last week of radiotherapy (T3), and at 1 (T4) and 3 months (T5) after the end of radiotherapy. Patients in the QGTC and LE groups attended three 40‐minute classes per week throughout radiotherapy. Results Ninety patients were randomized to the 3 groups (QGTC = 26; LE = 26; waiting list control = 24). The QGTC group reported longer sleep duration midway through radiotherapy (QGTC = 7.01 h; LE = 6.42; WL = 6.50; P = .05), but this difference did not persist over time. There were no group differences in other domains of sleep or fatigue. Exploratory analyses conducted to examine the effect of health‐related quality of life (Expanded Prostate Cancer Index Composite and American Urological Association Symptom score) on sleep and fatigue showed significant correlations across multiple domains. Conclusions Qigong/tai chi during radiation for prostate cancer resulted in superior sleep duration midway through radiation, but this effect was not durable, and there were no differences in other domains of sleep or fatigue. Exploratory analysis demonstrated that both sleep and fatigue were highly correlated with prostate cancer–related physical symptoms. Future mind‐body intervention studies should incorporate multimodal therapy focused on improving physical symptoms in this population.
    September 20, 2016   doi: 10.1002/pon.4256   open full text
  • Post‐traumatic growth in breast cancer: how and when do distress and stress contribute?
    AnnMarie Groarke, Ruth Curtis, Jenny M. Groarke, Michael J. Hogan, Andrea Gibbons, Michael Kerin.
    Psycho-Oncology. September 20, 2016
    Objective While several theoretical models provide explanation for the genesis and development of post‐traumatic growth (PTG) in the aftermath of stressful events, empirical evidence regarding the predictors and consequences of PTG in breast cancer patients in active treatment and early survivorship is inconclusive. This study, therefore, examines the role of distress and stress as predictors and outcomes of PTG in women with breast cancer over an 18‐month period. Methods These effects are tested in two structural equation models that track pathways of PTG in a sample of 253 recently diagnosed women. Questionnaires were completed at diagnosis and at 4 follow‐up time points assessing cancer‐specific stress (Impact of Events Scale), global stress (Perceived Stress Scale), and depression and anxiety (Hospital Anxiety and Depression Scale). Post‐traumatic growth (Silver Lining Questionnaire) was assessed at follow‐up time points. Results Cancer‐specific stress was related to higher PTG concurrently and longitudinally. Anxiety was related concurrently to higher PTG, but overall general distress had minimal impact on PTG. Global stress was inversely related to PTG. Positive growth at 6 months was associated with subsequent reduction in stress. Conclusions This study showing that early stage higher cancer‐specific stress and anxiety were related to positive growth supports the idea that struggle with a challenging illness may be instrumental in facilitating PTG, and findings show positive implications of PTG for subsequent adjustment.
    September 20, 2016   doi: 10.1002/pon.4243   open full text
  • Patient‐oncologist alliance and psychosocial well‐being in Chinese society strongly affect cancer management adherence with cancer of unknown primary.
    Yifei Ma, Wei Xu, Zhigao Liang, Yiming Li, Hongyu Yu, Chunshan Yang, Jidong Li, Shuang Liang, Tielong Liu, Jianru Xiao.
    Psycho-Oncology. September 20, 2016
    Background Patient‐oncologist alliance and psychosocial well‐being have strong associations with adherence to cancer management. For patients with cancer of unknown primary (CUP), adherence is crucial to treatment or occult primary screening plans. There has been no study investigating the relationship between alliance, psychosocial factors, and adherence in such patients or in Chinese sociocultural settings. Methods The measures of alliance, psychosocial well‐being, and adherence willingness were administered to patients with CUP, with a mean age of 58.33 ± 11.24 years. Multiple linear regression models were applied to investigate the independent relationship between alliance and adherence by controlling for socioeconomic and psychosocial confounders. Results Alliance was found to be independently and positively associated with greater adherence willingness and adherence to treatment and follow‐up screening after controlling for significant confounders, including medical conditions, psychosocial well‐being variables, and socioeconomic factors. Conclusion Stronger patient‐oncologist alliance may foster enhanced adherence to treatment and follow‐up screening in patients with CUP. Patient‐oncologist alliance seems affected by socioeconomic factors and psychosocial well‐being in the Chinese sociocultural settings.
    September 20, 2016   doi: 10.1002/pon.4245   open full text
  • Towards understanding problems in the parent‐practitioner relationship when a child has cancer: meta‐synthesis of the qualitative literature.
    Sarah Davies, Bridget Young, Peter Salmon.
    Psycho-Oncology. September 19, 2016
    Objective This review aimed to synthesise qualitative research on problems in the parent‐practitioner relationship in childhood cancer, to understand how these problems arise, how they are conceptualised and how they might be resolved. Methods A systematic search of five electronic databases identified 2,863 articles. After screening, 81 full text papers were assessed for eligibility, and four were included in the review. Six further papers were identified through searching reference lists and citation tracking. Synthesis of these 10 papers drew on the meta‐study approach, involving analysis, comparison and integration of findings, methods and theoretical influences. Results All papers but one conceptualised problems in the parent‐practitioner relationship as conflict or relational problems, attributing these to differences between parents and practitioners in roles and perspectives, or in power and authority. The remaining paper focussed on parents’ emotional needs as the basis for relationship problems. Our approach to synthesis exposed researchers’ prior assumptions and the influence of these on the methods, analysis and findings of the studies. Conclusions The current literature gives little attention to how interpersonal problems with practitioners may reflect the emotional needs of parents. Understanding these problems as an expression of the distress and fear parents experienced because of their child's condition may offer new ways of helping parents. Future research needs to address the limitations of previous studies, including ensuring that the study design and analysis allow contextual factors and intrapersonal factors to be explored, and that researchers are open to their perspectives being altered by their data.
    September 19, 2016   doi: 10.1002/pon.4285   open full text
  • Systematic review and meta‐analysis of collaborative care interventions for depression in patients with cancer.
    Madeline Li, Erin B. Kennedy, Nelson Byrne, Caroline Gérin‐Lajoie, Mark R. Katz, Homa Keshavarz, Scott Sellick, Esther Green.
    Psycho-Oncology. September 19, 2016
    Objective Previous systematic reviews have found limited evidence for the effectiveness of pharmacological and psychological interventions for the management of depression in patients with cancer. This paper provides the first meta‐analysis of newer collaborative care interventions, which may include both types of treatment, as well as integrated delivery and follow‐up. Meta‐analyses of pharmacological and psychological interventions are included as a comparison. Methods A search of MEDLINE, EMBASE, PsycINFO, and the Cochrane Library from July 2005 to January 2015 for randomized controlled trials of depression treatments for cancer patients diagnosed with a major depressive disorder, or who met a threshold on a validated depression rating scale was conducted. Meta‐analyses were conducted using summary data. Results Key findings included 8 reports of 4 collaborative care interventions, 8 pharmacological, and 9 psychological trials. A meta‐analysis demonstrated that collaborative care interventions were significantly more effective than usual care (standardized mean difference = ‐0.49, p = 0.003), and depression reduction was maintained at 12 months. By comparison, short‐term (up to 12 weeks), but not longer‐term effectiveness was demonstrated for both pharmacological and psychological interventions. Conclusions Collaborative care interventions have newly emerged as multi‐disciplinary care delivery models, which may result in more long‐term depression remission. This review also updates previous findings of modest evidence for the effectiveness of both pharmacological and psychological interventions for threshold depression in cancer patients. Research designs focusing on combined treatments and delivery systems may best further the limited evidence‐base for the management of depression in cancer. This article is protected by copyright. All rights reserved.
    September 19, 2016   doi: 10.1002/pon.4286   open full text
  • Attitudes Toward Family Involvement in Cancer Treatment Decision Making: The Perspectives of Patients, Family Caregivers, and Their Oncologists.
    Dong Wook Shin, Juhee Cho, Debra L. Roter, So Young Kim, Hyung Kook Yang, Keeho Park, Hyung Jin Kim, Hee‐Young Shin, Tae Gyun Kwon, Jong Hyock Park.
    Psycho-Oncology. September 15, 2016
    Background To investigate how cancer patients, family caregiver, and their treating oncologist view the risks and benefits of family involvement in cancer treatment decision making (TDM) or the degree to which these perceptions may differ. Patients and Methods A nationwide, multicenter survey was conducted with 134 oncologists and 725 of their patients and accompanying caregivers. Participant answered to modified Control Preferences Scale and investigator‐developed questionnaire regarding family involvement in cancer TDM. Results Most participants (>90%) thought that family should be involved in cancer TDM. When asked if the oncologist should allow family involvement if the patient did not want them involved, most patients and caregivers (>85%) thought they should. However, under this circumstance, only 56.0% of oncologists supported family involvement. Patients were significantly more likely to skew their responses toward patient rather than family decisional control than were their caregivers (P < .003); oncologists were more likely to skew their responses toward patient rather than family decisional control than caregivers (P < .001). Most respondents thought that family involvement is helpful and neither hamper patient autonomy nor complicate cancer TDM process. Oncologists were largely positive, but less so in these ratings than either patients or caregivers (P < .002). Conclusions Patients, family caregivers, and, to a lesser degree, oncologists expect and valued family involvement in cancer TDM. These findings support a reconsideration of traditional models focused on protection of patient autonomy to a more contextualized form of relational autonomy, whereby the patient and family caregivers can be seen as a unit for autonomous decision.
    September 15, 2016   doi: 10.1002/pon.4226   open full text
  • Spirituality is associated with less treatment regret in men with localized prostate cancer.
    Michelle A. Mollica, Willie Underwood, Gregory G. Homish, D. Lynn Homish, H. Orom.
    Psycho-Oncology. September 15, 2016
    Background Some patients with prostate cancer regret their treatment choice. Treatment regret is associated with lower physical and mental quality of life. We investigated whether, in men with prostate cancer, spirituality is associated with lower decisional regret 6 months after treatment and whether this is, in part, because men with stronger spiritual beliefs experience lower decisional conflict when they are deciding how to treat their cancer. Methods One thousand ninety three patients with prostate cancer (84% white, 10% black, and 6% Hispanic; mean age = 63.18; SD = 7.75) completed measures of spiritual beliefs and decisional conflict after diagnosis and decisional regret 6 months after treatment. We used multivariable linear regression to test whether there is an association between spirituality and decisional regret and structural equation modeling to test whether decisional conflict mediated this relationship. Results Stronger spiritual beliefs were associated with less decisional regret (b = −0.39, 95% CI = −0.53, −0.26, P < .001, partial η2 = 0.024, confidence interval = −0.55, 39%, P < .001, partial η2 = 0.03), after controlling for covariates. Decisional conflict partially (38%) mediated the effect of spirituality on regret (indirect effect: b = −0.16, 95% CI = −0.21, −0.12, P < .001). Conclusions Spirituality may help men feel less conflicted about their cancer treatment decisions and ultimately experience less decisional regret. Psychosocial support post‐diagnosis could include clarification of spiritual values and opportunities to reappraise the treatment decision‐making challenge in light of these beliefs.
    September 15, 2016   doi: 10.1002/pon.4248   open full text
  • Caregiving and social support for gay and bisexual men with prostate cancer.
    Benjamin D. Capistrant, Beatriz Torres, Enyinnaya Merengwa, William G. West, Darryl Mitteldorf, B.R. Simon Rosser.
    Psycho-Oncology. September 15, 2016
    Objective Prostate cancer, the second most common cancer among men, typically onsets in middle or older age. Gay/bisexual men have different social networks and unique social support needs, particularly as it pertains to health care access and prostate side effects. Few studies have investigated the availability and provision of social support for gay and bisexual men with prostate cancer (GBMPCa). Methods This study used qualitative data from in‐depth, semistructured, one‐on‐one telephone interviews with 30 GBMPCa recruited from a national cancer support group network, Malecare. Inductive and deductive codes were used to identify themes about social support provided to GBMPCa during diagnosis and treatment. Results GBMPCa reported help from friends, family (parents and siblings), ex‐partners, and paid caregivers. Men in relationships reported varying levels of reliance on their partners for support, in part due to relationship dynamics and living arrangements. Single men showed a theme of independence (“I turned down all help,” “My friends don't want to be bothered”). After diagnosis, many men reported seeking informational and emotional support from prostate cancer support groups; most expressed wanting more support groups specifically for GBMPCa. During or after treatment, men reported receiving a range of instrumental support, largely a function of relationship status and treatment type. Conclusions GBMPCa received variable, but generally low, social support during diagnosis and treatment and from a diverse social network, including a prominence of friends and family. Clinicians should be aware of GBMPCa's distinct patterns of social support needs and providers.
    September 15, 2016   doi: 10.1002/pon.4249   open full text
  • Psychosocial outcomes of an electronic self‐report assessment and self‐care intervention for patients with cancer: a randomized controlled trial.
    Jesse R. Fann, Fangxin Hong, Barbara Halpenny, Traci M. Blonquist, Donna L. Berry.
    Psycho-Oncology. September 15, 2016
    Background The use of Web‐based technology to facilitate self‐care and communication with health care providers has the potential to improve psychosocial outcomes for patients undergoing cancer treatment. This study reports an analysis of psychosocial outcomes of the electronic self‐report assessment for cancer study. Methods Adult patients starting cancer therapy were randomized to receive usual education about symptoms and quality of life topics (control) or usual education plus self‐care instruction for symptoms and quality of life issues, communication coaching, and the opportunity to track symptoms and quality of life between clinic visits (intervention). Depression (Patient Health Questionnaire‐9) and social, emotional, and role functioning (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Core 30 subscales) were measured before treatment (T1), 3 to 6 weeks after starting treatment (T2), 2 weeks later (T3), and 2 to 4 weeks after treatment ended or at the next restaging visit for participants who continued to receive treatment (T4). Clinicians received summaries of participant reports at each time point in both groups. Results In multivariable analysis, the depression scores were significantly lower (P = .04) and there was a trend to higher social and role functioning (P = .07) in the intervention group compared with the control. Working status was significantly associated with lower depression and better social and role functioning. Conclusions A patient‐centered, Web‐based intervention that facilitates self‐care and communication can improve psychosocial outcomes in the cancer setting.
    September 15, 2016   doi: 10.1002/pon.4250   open full text
  • Does a peer‐led exercise intervention affect sedentary behavior among breast cancer survivors?
    Bernardine Pinto, Shira Dunsiger, Kevin Stein.
    Psycho-Oncology. September 15, 2016
    Objective Sedentary behavior is recognized as an independent risk factor for chronic diseases. Cancer survivors report high levels of sedentary behavior. In secondary analyses, we examined the effects of an exercise intervention on sedentary behavior (sitting time) among breast cancer survivors. Methods Seventy‐six breast cancer survivors (mean age = 55.62 y, mean 1.1 y since diagnosis) were randomized to receive either a 12‐week telephone‐delivered exercise intervention from peer volunteers or a contact control condition. The intervention did not specifically address sitting time. Participants' sedentary behavior was assessed for 7 days at baseline, 12 weeks, and 24 weeks via self‐report and objective measurement (accelerometer). Results At baseline, our sample reported sitting for 7.75 hours/day (10.98 h/d by accelerometer data). Spearman rank correlations showed significant positive correlations at baseline between sitting time measured by self‐report and accelerometer (ρ = 0.37; P = .002) in the entire sample. There were no significant changes over time within group nor were there any significant intervention effects on sitting time (self‐report and objective) at 12 and 24 weeks (all P's > .05). Conclusions An exercise intervention that did not focus specifically on sitting time did not affect sedentary behavior among breast cancer survivors. Intervention components that specifically target sitting behavior are needed to reduce this risk behavior among survivors.
    September 15, 2016   doi: 10.1002/pon.4255   open full text
  • Oncologist, patient, and companion questions during pretreatment consultations about adjuvant cancer treatment: a shared decision‐making perspective.
    A.H. Pieterse, M. Kunneman, E.G. Engelhardt, N.J. Brouwer, J.R. Kroep, C.A.M. Marijnen, A.M. Stiggelbout, E.M.A. Smets.
    Psycho-Oncology. September 15, 2016
    Objectives To assess the occurrence of questions that foster shared decision making, in particular cancer patients' understanding of treatment decisions and oncologists' understanding of patients' priorities, during consultations in which preference‐sensitive decisions are discussed. Specifically, (a) regarding patient understanding, do oncologists ask about patients' preexisting knowledge, information preferences, and understanding and do patients and companions ask about the disease and treatment, and (b) regarding patient priorities, do oncologists ask about patients' treatment‐ and decision‐related preferences and do patients and companions ask about the decision? Methods Audiotaped pretreatment consultations of 100 cancer patients with 32 oncologists about (neo)adjuvant treatment were coded and analyzed to document question type, topic, and initiative. Results The oncologists ascertained prior knowledge in 50 patients, asked 24 patients about preferred (probability) information, and invited questions from 56 patients. The oncologists asked 32 patients about treatment preferences and/or for consent. Respectively, one‐third and one‐fifth of patients and companions asked about treatment benefits compared with three‐quarters of them who asked about treatment harms and/or procedures. Conclusions It would be helpful to patients if oncologists more often assessed patients' existing knowledge to tailor their information provision. Also, patients could receive treatment recommendations that better fit their personal situation if oncologists collected information on patients' views about treatments. Moreover, by educating patients to ask about treatment alternatives, benefits, and harms, patients may gain a better understanding of the choice they have.
    September 15, 2016   doi: 10.1002/pon.4241   open full text
  • “Our people has got to come to terms with that”: changing perceptions of the digital rectal examination as a barrier to prostate cancer diagnosis in African‐Caribbean men.
    Sarah Seymour‐Smith, David Brown, Georgina Cosma, Nicholas Shopland, Steven Battersby, Andy Burton.
    Psycho-Oncology. September 14, 2016
    Objective African‐Caribbean men in the United Kingdom in comparison with other ethnicities have the highest incidence rate of prostate cancer. Psychosocial aspects related to screening and presentation impact on men's behavior, with previous studies indicating a range of barriers. This study explores one such barrier, the digital rectal examination (DRE), due to its prominence within UK African‐Caribbean men's accounts. Methods African‐Caribbean men with prostate cancer (n = 10) and without cancer (n = 10) were interviewed about their perceptions of DRE. A synthetic discursive approach was employed to analyze the data. Results Findings illustrate that an interpretative repertoire of homophobia in relation to the DRE is constructed as having an impact upon African‐Caribbean men's uptake of prostate cancer screening. However, the discursive focus on footing and accountability highlight deviations from this repertoire that are built up as pragmatic and orient to changing perceptions within the community. Conclusions Health promotion interventions need to address the fear of homophobia and are best designed in collaboration with the community.
    September 14, 2016   doi: 10.1002/pon.4219   open full text
  • Truth telling in Taiwanese cancer care: patients' and families' preferences and their experiences of doctors' practices.
    Woung‐Ru Tang, Ji‐Hong Hong, Kun‐Ming Rau, Cheng‐Hsu Wang, Yeong‐Yuh Juang, Chien‐Hong Lai, Maiko Fujimori, Chun‐Kai Fang.
    Psycho-Oncology. September 13, 2016
    Objective Despite the significant role played by cancer patients' families in medical decision‐making in Asian countries, inconsistencies have hitherto not been evaluated between patients' and families' preferences and doctors' actual practices with regard to cancer truth telling. Methods For this quantitative comparative study of cancer patients' and families' truth‐telling preferences and their experiences of doctors' practices, 532 patients, 551 family members, and 127 doctors (N = 1 210) were enrolled from five hospitals across Taiwan over 2 years. Truth telling was assessed using the Taiwanese version of a modified Japanese truth‐telling scale. Results Patients' truth‐telling preferences and their experiences of doctors' truth‐telling practices differed significantly in scores on the overall truth‐telling scale and each subscale, including method of disclosure, emotional support, additional information, and setting (P < .001). Similar findings were obtained for families' preferences and doctors' actual practices (P < .001). Patients' and families' truth‐telling preference scores were higher than doctors' actual practice scores. Multiple regression analysis revealed a dose‐dependent effect of doctors' monthly truth‐telling frequency on their truth‐telling preferences, but this effect was only borderline significant (P = .08). This multiple regression model explained 30% of the total variance in doctors' truth‐telling preferences (F = 1.38, P = .22). Conclusions Taiwanese medical educational policies need to be revised to better equip doctors to practice truth telling in accordance with the preferences of cancer patients and families. Communication skills training should be prioritized for doctors who refrain from truth telling in actual practice.
    September 13, 2016   doi: 10.1002/pon.4257   open full text
  • The Associations of Age and Ethnicity on Substance Use Behaviors of Adolescent and Young Adult Childhood Cancer Survivors.
    Maritza E. Ruiz, Leonard Sender, Lilibeth Torno, Michelle A. Fortier.
    Psycho-Oncology. September 07, 2016
    Objective The aim of this study was to examine the associations between age and ethnicity on the development of substance use behaviors among Hispanic and non‐Hispanic White (NHW) adolescent and young adult (AYA) childhood cancer survivors. Methods Participants were recruited from a single institution through the CHOC Children's Hospital Cancer Registry and included 55 Hispanic and 61 NHW AYA childhood cancer survivors, ages 12 to 33 years (Mean age ± SD: 19 ± 4.2). Smoking, alcohol, and drug use were measured using the Child Health Illness Profile – Adolescent Edition. Results Hispanic AYA survivors were less likely to be medically insured and reported lower household income than their NHW counterparts (P < 0.001 and P < 0.001, respectively). After controlling for socioeconomic differences and gender, age and ethnicity were significant predictors of substance use among AYA survivors. Hispanic survivors reported less lifetime use of cigarette smoking compared with NHW survivors (OR 0.17, 95% CI, 0.03‐0.80). Older age, for both Hispanic and NHW survivors, was found to be a risk factor for lifetime substance use and current alcohol/hard liquor consumption and binge drinking (P < 0.05). Conclusions Young adult childhood cancer survivors and NHW survivors are at greatest risk for developing substance use behaviors. The frequency of substance use among AYA survivors appears to increase as they transition into adulthood. These findings emphasize the need to improve long‐term health behavior screening and develop effective interventions on reducing substance use behaviors in this vulnerable population.
    September 07, 2016   doi: 10.1002/pon.4225   open full text
  • Predicting changes in quality of life and emotional distress in Chinese patients with lung, gastric, and colon‐rectal cancer diagnoses: the role of psychological resilience.
    Zeng Jie Ye, Hong Zhong Qiu, Peng Fei Li, Mu Zi Liang, Yun Fei Zhu, Zhen Zeng, Guang Yun Hu, Shu Ni Wang, Xiao Ming Quan.
    Psycho-Oncology. September 07, 2016
    Background Patients with cancer often experience considerable emotional distress, which decreases their quality of life (QOL). Resilience is defined as the psychological characteristics that promote positive adaptation in the face of stress and adversity; however, the relationships among QOL, resilience, and emotional distress in patients with cancer, especially Chinese patients with cancer, are under‐researched in the literature. Methods Quality of Life Questionnaire Core 30 items, Zung Self‐Rating Anxiety Scale, and the Zung Self‐Rating Depression Scale were applied in this study. Univariate correlated analysis and multivariate logistic regression analysis were used to test the associations among resilience, emotional distress, and QOL with a sample of 276 participants. A Sobel test was conducted to determine whether the indirect effect of resilience was significant. Results The mean ratings of QOL (59.2), resilience (20.8), anxiety (43.1), and depression (47.7) were reported. The correlations between resilience and QOL in patients with lung cancer were significantly increased compared with patients with gastric or colorectal cancer (Spearman coefficient squares of 0.284, 0.189, and 0.227, respectively). The highest quartile of the resilience level was associated with a 64% (odds ratio = 0.36, 95% confidence interval = 0.17‐0.75, P = .006), 70% (odds ratio = 0.30, 95% confidence interval = 0.14‐0.63), and 90% (odds ratio = 0.10, 95% confidence interval = 0.04‐0.26, P < .001) reduction in the risk of emotional distress compared with the lowest quartile. The Sobel test indicated a buffering effect of resilience that was significant for depression (Sobel value = 2.002, P = .045) but not anxiety (Sobel value = 1.336, P = .182). Conclusions The present study suggests that psychological resilience is positively associated with QOL and may comprise a robust buffer between depression and QOL in Chinese patients with cancer.
    September 07, 2016   doi: 10.1002/pon.4237   open full text
  • Effects of a multicomponent physical activity behavior change intervention on fatigue, anxiety, and depressive symptomatology in breast cancer survivors: randomized trial.
    Laura Q. Rogers, Kerry S. Courneya, Philip M. Anton, Steven Verhulst, Sandra K. Vicari, Randall S. Robbs, Edward McAuley.
    Psycho-Oncology. September 06, 2016
    Objectives To determine the effects of the 3‐month multicomponent Better Exercise Adherence after Treatment for Cancer (BEAT Cancer) physical activity behavior change intervention on fatigue, depressive symptomatology, and anxiety. Methods Postprimary treatment breast cancer survivors (n = 222) were randomized to BEAT Cancer or usual care. Fatigue Symptom Inventory and Hospital Anxiety and Depression Scale were assessed at baseline, postintervention (month 3; M3), and follow‐up (month 6; M6). Results Adjusted linear mixed‐model analyses demonstrated significant effects of BEAT Cancer vs usual care on fatigue intensity (M3 mean between group difference [M] = −0.6; 95% confidence interval [CI] = −1.0 to −0.2; effect size [d] = −0.32; P = .004), fatigue interference (M3 M = −0.8; CI = −1.3 to −0.4; d = −0.40; P < .001), depressive symptomatology (M3 M = −1.3; CI = −2.0 to −0.6; d = −0.38; P < .001), and anxiety (M3 M = −1.3; CI = −2.0 to −0.5; d = −0.33; P < .001). BEAT Cancer effects remained significant at M6 for all outcomes (all P values <.05; d = −0.21 to −.35). Clinically meaningful effects were noted for fatigue intensity, fatigue interference, and depressive symptomatology. Conclusions BEAT Cancer reduces fatigue, depressive symptomatology, and anxiety up to 3 months postintervention in postprimary treatment breast cancer survivors. Further study is needed to determine sustainable methods for disseminating and implementing the beneficial intervention components.
    September 06, 2016   doi: 10.1002/pon.4254   open full text
  • How Preconceptions About Lung Cancer Treatment Interact With Medical Discourse for Patients Who Accept Chemotherapy?
    Jean‐Louis Pujol, Jean‐Pierre Mérel, Caroline Roth.
    Psycho-Oncology. September 04, 2016
    Objective Chemotherapy is widely prescribed for lung cancer with palliation as primary end point. This study aimed at determining how preconceptions about lung cancer and its treatment interact with medical discourse into acceptance of chemotherapy. Methods Twenty‐three purposively selected patients who recently accepted chemotherapy were invited to participate in this survey consisting of semi‐structured in‐depth interviews. Grounded theory was applied to investigate participants' perceptions of the context that have surrounded their decision to undergo chemotherapy. Results Major drivers of social representation of illness were linked with stigma. Participants also evoked the disease itself as a stereotype representation of incurable disease. Significant others' experiences were major components of participants' knowledge of chemotherapy. Searching for information regarding lung cancer actively confronted participants with the disease and its prognosis. However, the searching process was self‐limited because of the poor prognosis of the disease, insofar as complete information would have precluded from any hope. We therefore identified 3 domains that provide insights into the participant's views and attitude toward chemotherapy: (i) synthesizing preconceptions of disease and chemotherapy with personal medical case; (ii) slowly constructing complex knowledge of cancer and treatment; and (iii) accepting chemotherapy as a surrogate for acknowledging incurable disease. Conclusion Patients have preconceptions about chemotherapy that result from complex features involving social perception, stigma, and significant others' experiences. In this context, developing a personal knowledge about lung cancer and its treatment is a slow construction. This process needs time to be explained and reformulated, so that patients might give their informed consent.
    September 04, 2016   doi: 10.1002/pon.4231   open full text
  • Patient satisfaction and alliance as a function of the physician's self‐regulation, the physician's stress, and the content of consultation in cancer care.
    A.M.M. De Vries, M.M. Gholamrezaee, I.M. Verdonck‐de Leeuw, J. Passchier, J.‐N. Despland, F. Stiefel, Y. Roten.
    Psycho-Oncology. September 04, 2016
    Objective To investigate which characteristics of the physician and of the consultation are related to patient satisfaction with communication and working alliance. Methods Real‐life consultations (N = 134) between patients (n = 134) and their physicians (n = 24) were audiotaped. All of the patients were aware of their cancer diagnosis and consulted their physician to discuss the results of tests (CT scans, magnetic resonance imaging, or tumor markers) and the progression of their cancer. The consultations were transcribed and coded with the “Defense Mechanisms Rating Scale—Clinician.” The patients and physicians completed questionnaires about stress, satisfaction, and alliance, and the data were analyzed using robust linear modeling. Results Patient satisfaction with communication and working alliance was high. Both were significantly (negatively) related to the physician's neurotic and action defenses—in particular to the defenses of displacement, self‐devaluation, acting out, and hypochondriasis—as well as to the physician's stress level. The content of the consultation was not significantly related to the patient outcomes. Conclusions Our study shows that patient satisfaction with communication and working alliance is not influenced by the content of the consultation but is significantly associated with the physician's self‐regulation (defense mechanisms) and stress. The results of this study might contribute to optimizing communication skills training and to improving communication and working alliance in cancer care.
    September 04, 2016   doi: 10.1002/pon.4233   open full text
  • The protective effect of a satisfying romantic relationship on women's body image after breast cancer: a longitudinal study.
    Sarah Cairo Notari, Luca Notari, Nicolas Favez, Jean‐François Delaloye, Paolo Ghisletta.
    Psycho-Oncology. September 04, 2016
    Objective To examine the protective role of relationship satisfaction on body image in women with breast cancer throughout the first year post‐surgery. Methods Seventy‐four Swiss patients engaged in a relationship filled out a questionnaire assessing body image disturbance 2 weeks, 3 months, and 1 year after surgery. A univariate latent change score model was used to analyze the evolution of body image disturbance and the contribution of relationship satisfaction to body image disturbance. Results Women who were satisfied with their relationship reported less body image disturbance than did dissatisfied women at 2 weeks post‐surgery. Being married was also associated with less body image disturbance at that time. The protective effect of these relational variables was still observable 1 year later. Changes in body image disturbance over time were explained by the negative impacts of mastectomy and chemotherapy. Conclusions How women perceive the impact of breast cancer treatment on their body may be partly determined by the quality of the relational context in which they live.
    September 04, 2016   doi: 10.1002/pon.4238   open full text
  • Real‐world implementation of electronic patient‐reported outcomes in outpatient pediatric cancer care.
    Sasja A. Schepers, Simone M. Sint Nicolaas, Lotte Haverman, Michel Wensing, Antoinette Y.N. Schouten van Meeteren, Margreet A. Veening, Huib N. Caron, Peter M. Hoogerbrugge, Gertjan J.L. Kaspers, Christianne M. Verhaak, Martha A. Grootenhuis.
    Psycho-Oncology. September 04, 2016
    Objective The KLIK method is an online tool that monitors and discusses electronic patient‐reported outcomes (ePROs), which has been shown to enhance outcomes. This study aimed (1) to determine the fidelity (ie, extent to which used as intended) of the KLIK method as implemented in outpatient pediatric cancer care and (2) to study health care professional (HCP)‐reported barriers and facilitators for implementation. Methods Two hundred five children with newly diagnosed cancer (enrollment rate 85%) participated. At 1 (T1), 3 (T2), and 6 (T3) months after diagnosis, patients (8‐18 years) or parents (of patients 0‐7 years) completed health‐related quality of life (HRQoL) questionnaires, which were transformed into an ePROfile and discussed by their HCP during consultations. Fidelity was determined by the following: percentage of website registrations, HRQoL questionnaires completed, and ePROfiles discussed. Implementation determinants were assessed with HCPs after the final T3 with the Measurement Instrument for Determinants of Innovations. Results Depending on the time point (T1‐T3), fidelity was 86% to 89% for website registration, 66‐85% for completed HRQoL questionnaires, and 56% to 62% for ePROfile discussion. Barriers were mainly related to organizational issues (eg, organizational change) and less frequently to users (eg, motivation to comply) or the intervention (compatibility). Facilitators were related to the user (eg, positive outcome expectations) and intervention (simplicity) but not to the organization. Conclusions When implementing ePROs in outpatient pediatric oncology practice, HCPs report determinants that influence ePRO integration. To improve implementation and outcomes, tailored organizational (eg, formal ratification by management and time) and specific local (eg, individualized assessments) strategies should be developed to achieve optimal ePRO discussion.
    September 04, 2016   doi: 10.1002/pon.4242   open full text
  • Randomized controlled trial of the Valencia model of waking hypnosis plus CBT for pain, fatigue, and sleep management in patients with cancer and cancer survivors.
    M.E. Mendoza, A. Capafons, J.R. Gralow, K.L. Syrjala, J.M. Suárez‐Rodríguez, J.R. Fann, M.P. Jensen.
    Psycho-Oncology. August 31, 2016
    Background This study evaluated the efficacy of an intervention combining the Valencia model of waking hypnosis with cognitive‐behavioral therapy (VMWH‐CBT) in managing cancer‐related pain, fatigue, and sleep problems in individuals with active cancer or who were post‐treatment survivors. We hypothesized that four sessions of VMWH‐CBT would result in greater improvement in participants' symptoms than four sessions of an education control intervention. Additionally, we examined the effects on several secondary outcome domains that are associated with increases in these symptoms (depression, pain interference, pain catastrophizing, and cancer treatment distress). Methods The study design was a randomized controlled crossover clinical trial comparing the VMWH‐CBT intervention with education control. Participants (N = 44) received four sessions of both treatments, in a counterbalanced order (n = 22 per order condition). Results Participants were 89% female (N = 39) with mean age of 61 years (SD = 12.2). They reported significantly greater improvement after receiving the active treatment relative to the control condition in all the outcome measures. Treatment gains were maintained at 3‐month follow‐up. Conclusions This study supports the beneficial effects of the VMWH‐CBT intervention relative to a control condition and that treatment gains remain stable. VMWH‐CBT–trained clinicians should be accessible for managing symptoms both during and after cancer treatment, though the findings need to be replicated in larger samples of cancer survivors.
    August 31, 2016   doi: 10.1002/pon.4232   open full text
  • Dyadic associations between psychological distress and sleep disturbance among Chinese patients with cancer and their spouses.
    Jessie S.M. Chan, Nancy Xiaonan Yu, Amy Y.M. Chow, Cecilia L.W. Chan, Ka‐Fai Chung, Rainbow T.H. Ho, Siu‐man Ng, L.P. Yuen, Celia H.Y. Chan.
    Psycho-Oncology. August 31, 2016
    Background Patients with cancer and their spouses usually both suffer, but the dyadic effects have not been thoroughly investigated. This study examined the dyadic effects of psychological distress on sleep disturbance in Chinese couples affected by cancer. Methods Patients with cancer and their spouses (N = 135) participated in this study. The Hospital Anxiety and Depression Scale and Pittsburgh Sleep Quality Index were used to measure anxiety, depression, and sleep disturbance. Results There were significant patient‐spouse associations on anxiety (r = 0.48, P < .01), depression (r = 0.55, P < .01), and sleep disturbance (r = 0.30, P < .01). Analyses using the actor‐partner interdependence model showed that anxiety had significant actor effects, rather than partner effects, on sleep disturbance in both patients and their spouses, but depression had both actor and partner effects. In addition to providing evidence for the concordance in distress and sleep disturbance in patients with cancer and their spouses, the findings indicate a mutual influence of depression on sleep disturbance among the couples. Conclusions Clinicians and health care providers are suggested to integrate depression management as a component of sleep therapies and involve both patients and their spouses in treatment programs.
    August 31, 2016   doi: 10.1002/pon.4240   open full text
  • Ethnicity and the prostate cancer experience: a qualitative metasynthesis.
    Carol Rivas, Lauren Matheson, Johana Nayoan, Adam Glaser, Anna Gavin, Penny Wright, Richard Wagland, Eila Watson.
    Psycho-Oncology. August 23, 2016
    Objectives To summarize black and minority ethnic (BME) patients' and partners experiences of prostate cancer by examining the findings of existing qualitative studies. Methods We undertook a systematic metasynthesis of qualitative studies using a modified version of Noblit and Hare's “meta‐ethnography” approach, with a 2000‐2015 search of 7 databases. Results Thirteen studies of men from US and UK BME groups were included. We explored constructs with BME‐specific features. Health care provider relationships, formation of a spiritual alliance with God (which enhanced the participants' feeling of empowerment and ability to cope with the cancer), and living on for others (generally to increase cancer awareness), often connected to spiritual regrowth, were the 3 constructs most commonly reported. A magnified effect from erectile dysfunction was also common. Initially, this affected men's disclosure to others about their cancer and their sexual problems, but eventually men responded by shifting their conceptualizations of masculinity to sustain self and social identities. There was also evidence of inequality resulting from financial constraints and adversity that necessitated resilience in coping. Conclusions The prostate cancer experience of BME men and their partners is affected by a complex intersection of ethnicity with other factors. Health care services should acknowledge this. If providers recognize the men's felt masculinities, social identities, and spiritual beliefs and their shifting nature, services could be improved, with community as well as individual benefits. More studies are needed in diverse ethnic groups.
    August 23, 2016   doi: 10.1002/pon.4222   open full text
  • Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta‐analysis.
    Emma M. Richardson, Natalie Schüz, Kristy Sanderson, Jennifer L. Scott, Benjamin Schüz.
    Psycho-Oncology. August 21, 2016
    Objective Cancer is associated with negative health and emotional outcomes in those affected by it, suggesting the need to better understand the psychosocial determinants of illness outcomes and coping. The common sense model is the leading psychological model of self‐regulation in the face of illness and assumes that subjective illness representations explain how people attempt to cope with illness. This systematic review and meta‐analysis examines the associations of the common sense model's illness representation dimensions with health and coping outcomes in people with cancer. Methods A systematic literature search located 54 studies fulfilling the inclusion criteria, with 38 providing sufficient data for meta‐analysis. A narrative review of the remaining studies was also conducted. Results Random‐effects models revealed small to moderate effect sizes (Fisher Z) for the relations between illness representations and coping behaviors (in particular between control perceptions, problem‐focused coping, and cognitive reappraisal) and moderate to large effect sizes between illness representations and illness outcomes (in particular between identity, consequences, emotional representations, and psychological distress). The narrative review of studies with insufficient data provided similar results. Conclusions The results indicate how illness representations relate to illness outcomes in people with cancer. However, more high‐quality studies are needed to examine causal effects of illness representations on coping and outcomes. High heterogeneity indicates potential moderators of the relationships between illness representations and health and coping outcomes, including diagnostic, prognostic, and treatment‐related variables. This review can inform the design of interventions to improve coping strategies and mental health outcomes in people with cancer.
    August 21, 2016   doi: 10.1002/pon.4213   open full text
  • Exploring stigma as a barrier to cancer service engagement with breast cancer survivors in Kampala, Uganda.
    Elizabeth Meacham, Jackson Orem, Gertrude Nakigudde, Jo Anne Zujewski, Deepa Rao.
    Psycho-Oncology. August 21, 2016
    Objective To understand the role of stigma in the delay of cancer service engagement by women with breast cancer in Kampala, Uganda. Background Women in Sub‐Saharan African countries are twice as likely to die from cancer as women in high‐income countries, which is largely attributable to late diagnosis. While breast cancer‐related stigma has been identified in Sub‐Saharan Africa, limited research focuses on how stigma impacts the behavior of breast cancer patients in Uganda. Methods This qualitative study used a grounded theory approach to examine illness narratives from 20 breast cancer survivors in Uganda, gathered through semistructured interviews. Results Thematic analysis showed that perceived and internalized stigma associated with breast cancer influenced care engagement throughout illness, delaying engagement and inhibiting treatment completion. Women identified key factors for overcoming stigma including acceptance of diagnosis, social support, and understanding of breast cancer. Conclusion The growing burden of mortality associated with breast cancer in Uganda can be mitigated by improving early detection and treatment engagement through interventions which account for key psychosocial barriers such as stigma.
    August 21, 2016   doi: 10.1002/pon.4215   open full text
  • Financial cost of lymphedema borne by women with breast cancer.
    John Boyages, Ying Xu, Senia Kalfa, Louise Koelmeyer, Bonny Parkinson, Helen Mackie, Hector Viveros, Paul Gollan, Lucy Taksa.
    Psycho-Oncology. August 21, 2016
    Objective Our study examines the financial cost of lymphedema following a diagnosis of breast cancer and addresses a significant knowledge gap regarding the additional impact of lymphedema on breast cancer survivors. Methods An online national survey was conducted with 361 women who had either breast cancer without lymphedema (BC) (group 1, n = 209) or breast cancer with lymphedema (BC+LE) (group 2, n = 152). Participant recruitment was supported by the Breast Cancer Network Australia and the Australasian Lymphology Association. Results Both breast cancer and lymphedema result in significant out‐of‐pocket financial costs borne by women. Of patients with BC+LE, 80% indicated that their breast cancer diagnosis had affected them financially compared with 67% in the BC group (P < .020). For patients with lymphedema, over half (56%) indicated that this specific additional diagnosis to their breast cancer affected them financially and that costs increased with lymphedema severity. The cost of compression garments formed a large proportion of these costs (40.1%). The average number of attendances to a therapist each year was 5.8 (range, 0‐45). Twenty‐five patients (16.4%) had an episode of cellulitis in the past year. The incidence of cellulitis was 7.7% in 91 patients with subclinical or mild lymphedema compared with 29.5% of 61 patients with more extensive lymphedema (P < .001). The average out‐of‐pocket financial cost of lymphedema care borne by women was A$977 per annum, ranging from A$207 for subclinical lymphedema to over A$1400 for moderate or severe lymphedema. Conclusions This study identifies an additional detrimental effect of lymphedema on women in terms of financial costs.
    August 21, 2016   doi: 10.1002/pon.4239   open full text
  • Barriers to physical activity participation in colorectal cancer survivors at high risk of cardiovascular disease.
    Chloe Maxwell‐Smith, Nik Zeps, Martin S. Hagger, Cameron Platell, Sarah J. Hardcastle.
    Psycho-Oncology. August 18, 2016
    Background Lifestyle factors including inadequate physical activity may contribute to increased risk of developing cardiovascular disease in colorectal cancer survivors. Identification of the barriers to physical activity is important for forming an evidence base of factors to target in future physical activity programs aimed at improving cardiovascular health in this population. Methods Colorectal cancer survivors (N = 24) from St. John of God Subiaco Hospital participated in semi‐structured interviews about their current physical activity behaviors and perceived barriers to physical activity. Results Inductive thematic analysis of interviews revealed 5 overarching themes relating to barriers to physical activity: psychological barriers, environmental barriers, knowledge of guidelines, lack of practitioner support, and energy/age barriers. Conclusions Novel findings revealed participants' dependence on practitioner support, including a reliance on practitioners to recommend lifestyle change. Survivors also revealed that regular checkups to monitor cardiovascular risk replaced the need for healthy lifestyle changes. Implications: With survivors holding the advice of clinicians in high regard, an opportunity exists for clinicians to facilitate lifestyle change. Health care professionals such as nurses can implement motivational strategies and provide additional health information during follow‐up visits, to ensure long‐term adherence. Individuals who reported psychological, motivational, and environmental barriers may benefit from interventions to improve self‐regulation, planning, and problem‐solving skills.
    August 18, 2016   doi: 10.1002/pon.4234   open full text
  • The effect of mode of detection of breast cancer on stress and distress.
    Andrea Gibbons, AnnMarie Groarke, Ruth Curtis, Jenny Groarke.
    Psycho-Oncology. August 12, 2016
    Objective The number of women with screen‐detected breast cancer is increasing, but it is not clear if these women experience the same levels of distress as women with symptomatic breast cancer. The current study compared stress and distress in women with screen‐detected or symptomatic breast cancer at diagnosis and 12 months post‐diagnosis. Methods Ninety‐two women with screen‐detected breast cancer and 129 women with symptomatic breast cancer completed measures of perceived stress, anxiety, and depression at diagnosis and 12 months post‐diagnosis. Women also completed a measure of cancer‐related stress 12 months post‐diagnosis. Results Both groups reported similar levels of perceived stress, anxiety, and depression at diagnosis. A third of women in both groups reported clinical levels of anxiety at diagnosis, which decreased over time. There were no differences in depression. Analyses revealed that at 12 months post‐diagnosis, the symptomatic group reported a significant reduction in anxiety, but the screen‐detected group reported a nonsignificant trend for a reduction over time. The screen‐detected group reported significantly higher cancer‐related stress at 12 months than the symptomatic group. Conclusions Screen‐detected women report similar distress at diagnosis but may be more at risk for greater distress requiring further psychological support 1 year after diagnosis. Future interventions that focus on preparation for screening may help to reduce ongoing levels of anxiety and cancer‐related stress for this group.
    August 12, 2016   doi: 10.1002/pon.4227   open full text
  • Morbidity of curative cancer surgery and suicide risk.
    Thejus T. Jayakrishnan, Yurie Sekigami, Rahul Rajeev, T. Clark Gamblin, Kiran K. Turaga.
    Psycho-Oncology. August 12, 2016
    Importance Curative cancer operations lead to debility and loss of autonomy in a population vulnerable to suicide death. The extent to which operative intervention impacts suicide risk is not well studied. Objective To examine the effects of morbidity of curative cancer surgeries and prognosis of disease on the risk of suicide in patients with solid tumors. Design Retrospective cohort study using Surveillance, Epidemiology, and End Results data from 2004 to 2011; multilevel systematic review. Setting General US population. Participants Participants were 482 781 patients diagnosed with malignant neoplasm between 2004 and 2011 who underwent curative cancer surgeries. Main outcomes and measures Death by suicide or self‐inflicted injury. Results Among 482 781 patients that underwent curative cancer surgery, 231 committed suicide (16.58/100 000 person‐years [95% confidence interval, CI, 14.54‐18.82]). Factors significantly associated with suicide risk included male sex (incidence rate [IR], 27.62; 95% CI, 23.82‐31.86) and age >65 years (IR, 22.54; 95% CI, 18.84‐26.76). When stratified by 30‐day overall postoperative morbidity, a significantly higher incidence of suicide was found for high‐morbidity surgeries (IR, 33.30; 95% CI, 26.50‐41.33) vs moderate morbidity (IR, 24.27; 95% CI, 18.92‐30.69) and low morbidity (IR, 9.81; 95% CI, 7.90‐12.04). Unit increase in morbidity was significantly associated with death by suicide (odds ratio, 1.01; 95% CI, 1.00‐1.03; P = .02) and decreased suicide‐specific survival (hazards ratio, 1.02; 95% CI, 1.00‐1.03, P = .01) in prognosis‐adjusted models. Conclusions In this sample of cancer patients in the Surveillance, Epidemiology, and End Results database, patients that undergo high‐morbidity surgeries appear most vulnerable to death by suicide. The identification of this high‐risk cohort should motivate health care providers and particularly surgeons to adopt screening measures during the postoperative follow‐up period for these patients.
    August 12, 2016   doi: 10.1002/pon.4221   open full text
  • Sociodemographic inequalities in barriers to cancer pain management: a report from the American Cancer Society's Study of Cancer Survivors‐II (SCS‐II).
    Kevin D. Stein, Kassandra I. Alcaraz, Chelsey Kamson, Elizabeth A. Fallon, Tenbroeck G. Smith.
    Psycho-Oncology. August 12, 2016
    Objective Research has increasingly documented sociodemographic inequalities in the assessment and management of cancer‐related pain. Most studies have focused on racial/ethnic disparities, while less is known about the impact of other sociodemographic factors, including age and education. We analyzed data from a large, national, population‐based study of cancer survivors to examine the influence of sociodemographic factors, and physical and mental health comorbidities on barriers to cancer pain management. Methods The study included data from 4707 cancer survivors in the American Cancer Society's Study of Cancer Survivors‐II, who reported experiencing pain from their cancer. A multilevel, socioecological, conceptual framework was used to generate a list of 15 barriers to pain management, representing patient, provider, and system levels. Separate multivariable logistic regressions for each barrier identified sociodemographic and health‐related inequalities in cancer pain management, controlling for years since diagnosis, disease stage, and cancer treatment. Results Two‐thirds of survivors reported at least 1 barrier to pain management. While patient‐related barriers were most common, the greatest disparities were noted in provider‐ and system‐level barriers. Specifically, inequalities by race/ethnicity, education, age, and physical and mental health comorbidities were observed. Conclusion Findings indicate survivors who were nonwhite, less educated, older, and/or burdened by comorbidities were most adversely affected. Future efforts in research, clinical practice, and policy should identify and/or implement new strategies to address sociodemographic inequalities in cancer pain management.
    August 12, 2016   doi: 10.1002/pon.4218   open full text
  • Pushing boundaries—culture‐sensitive care in oncology and palliative care: a qualitative study.
    Beate Schrank, Tamara Rumpold, Michaela Amering, Eva Katharina Masel, Herbert Watzke, Sophie Schur.
    Psycho-Oncology. August 12, 2016
    Objective In increasingly globalized societies, patient‐centered cancer care requires culture‐sensitive approaches in order to ensure patients well‐being. While migrant patients' needs are frequently reported in the literature, staff members' perception of work with migrant patients, associated challenges, or individual work approaches are largely unknown. This study addresses this research gap through qualitative exploration of experiences of multicultural health care professionals in supportive oncology and palliative care, working with patients from different cultural backgrounds. This study aims to understand staff experience of the impact of culture on cancer care. Methods This study was conducted at the Medical University of Vienna, including staff from different settings of oncology and palliative care, in different professional positions, and with a range of individual migration backgrounds. Semistructured interviews were conducted with 21 staff members working with patients from different cultural backgrounds. Interviews explored views on the impact of culture on care were audio‐taped, transcribed, and analyzed using a rigorous method of thematic analysis, enhanced with grounded theory techniques. Results Interviews revealed 4 key topics: culture‐specific differences, assumed reasons for differences, consequences of multicultural care, and tools for culture‐sensitive care. Strategies to better deal with migrant patients and their families were suggested to improve work satisfaction amongst staff. Conclusions This study identifies relevant staff challenges in work with migrant patients. Concrete suggestions for improvement include measures on an organizational level, team level, and personal tools. The suggested measures are applicable to improve work satisfaction and culture‐sensitive care not only in cancer care but also in other areas of medicine.
    August 12, 2016   doi: 10.1002/pon.4217   open full text
  • Randomized, double‐blind, placebo‐controlled study of methylphenidate for the treatment of depression in SSRI‐treated cancer patients receiving palliative care.
    Donald R. Sullivan, Solange Mongoue‐Tchokote, Motomi Mori, Elizabeth Goy, Linda Ganzini.
    Psycho-Oncology. August 12, 2016
    Objective To determine the effectiveness of methylphenidate for depression treatment in patients with advanced cancer. Design An 18‐day randomized, double‐blind, placebo‐controlled clinical trial of methylphenidate for treatment of depression in selective serotonin reuptake inhibitor‐treated patients with advanced cancer in hospice or receiving palliative care. The primary outcome was depression remission, defined as a ≥50% reduction in score on the Montgomery‐Asberg Depression Rating Scale. Results Among 47 enrolled participants, 34 were randomized. At study day 18, 85% of the methylphenidate and 60% of the placebo group were in depression remission (P = .22). Mean time to depression remission was 10.3 days [standard error (SE) 1.8] in the methylphenidate and 8.1 (SE 1.3) in the placebo group (P = .48). The mean baseline score for the Hospital Anxiety and Depression Scale (HADS) was 10.4 in each group and decreased by 3.6 (SE 1.1) in the methylphenidate and 2.3 (SE 1.2) in the placebo group (P = .51) by day 18. Once in remission, 1 methylphenidate and 5 placebo participants relapsed to depression (P = .18). There was no difference in mortality between the groups during the trial. Trial results were limited by small sample size attributed to difficulties in recruiting terminally ill patients. Conclusions This trial failed to demonstrate that methylphenidate treatment in selective serotonin reuptake inhibitor‐treated patients had a significant effect on depression remission in patients with advanced cancer. This study underscores the difficulties in conducting trials for symptom management in patients with shortened life expectancy.
    August 12, 2016   doi: 10.1002/pon.4220   open full text
  • The relationship between cancer patient's fear of recurrence and radiotherapy: a systematic review and meta‐analysis.
    Yuan Yang, Josie Cameron, Gerry Humphris.
    Psycho-Oncology. August 10, 2016
    Objective This review aims to provide an overview of the current knowledge available on the nature and extent of the relationship between external‐beam radiotherapy (RT) and fear of cancer recurrence (FoR). Methods PubMed, MEDLINE, and EMBASE databases were searched to identify relevant studies. Systematic review procedures were followed including a quality assessment. Meta‐analysis of suitable studies was conducted. Results Twenty‐five eligible studies were included in the systematic review, and 15 of them were included in further meta‐analysis. Meta‐analysis of the available data confirmed a weak relationship between RT and FoR (15 studies, 9567 patients, overall r = 0.053, 95% confidence interval, 0.021‐0.085, P = .001). Subgroup analysis based on cancer site (breast cancer versus other types of cancer) revealed that the correlation between RT and FoR was statistically significant in “other cancer” group (P < .001) but was nonsignificant in “breast cancer” group (P = .538). Conclusions While meta‐analysis reports a statistically significant association between cancer patient's FoR and the receipt of RT, these results should be interpreted with caution owing to significant variability between studies. Further longitudinal studies should be conducted to address the trajectory of FoR over RT in greater detail.
    August 10, 2016   doi: 10.1002/pon.4224   open full text
  • Group‐based trajectory modeling of fear of disease recurrence among women recently diagnosed with gynecological cancers.
    Sharon L. Manne, Shannon Myers‐Virtue, David Kissane, Melissa L. Ozga, Deborah A. Kashy, Stephen C. Rubin, Norman G. Rosenblum, Carolyn J. Heckman.
    Psycho-Oncology. August 09, 2016
    Objective Fear of cancer recurrence is an important clinical phenomenon and is associated with decrements in life domains. The study goals were to characterize patterns of global fear of recurrence (FOR) and 4 domains of fear (health, role, womanhood, and death worry) over time in women who were diagnosed with gynecological cancer and to identify demographic, medical, and psychological predictors of FOR. Method One hundred eighteen women participating in the usual care arm of a randomized trial completed the Concerns about Recurrence scale as well as measures of depressive symptoms, cancer‐specific distress, coping, coping efficacy, and social network responses at 4 time points. The majority of the sample was diagnosed with stage 3 ovarian cancer. Results Group‐based trajectory modeling identified subgroups of women with high‐stable (49.1%), high‐decreasing (25.3%), and low‐stable (25.5%) trajectories for global FOR. For role worries, 3 similar group trajectories were identified. For health worries, modeling identified subgroups with high‐decreasing (19.1%) and low‐increasing (80.9%) trajectories. For womanhood worries, modeling identified subgroups with high‐increasing (15.7%) and low‐decreasing (84.2%) trajectories. Young age, metastatic cancer, depression, cancer distress, holding back, and lower coping efficacy were associated with the high‐stable global FOR and at least 1 domain of FOR. Conclusion Almost half of the women recently diagnosed with gynecological cancer evidence persistently elevated FOR over the 6‐month period postdiagnosis. Psychological interventions to reduce FOR may be more effective if they focus on teaching patients coping skills, as well as greater comfort expressing cancer‐specific concerns to others.
    August 09, 2016   doi: 10.1002/pon.4223   open full text
  • Cancer and dementia: an exploratory study of the experience of cancer treatment in people with dementia.
    Nick Courtier, Rebecca Milton, Amanda King, Rosie Tope, Susan Morgan, Jane Hopkinson.
    Psycho-Oncology. August 09, 2016
    Objective Patients with comorbid cancer and dementia have poorer outcomes than those without dementia. We observe oncology teams managing patients with dementia and memory loss and explore these patients' needs and experiences of outpatient cancer services. Methods A single site investigation of case study design to examine practices in four clinics using multi‐methods of data collection: retrospective note review, observation, interviews, and recorded consultations. A framework analytic approach identifies themes within and across cases. Results Thirty‐three clinical encounters with patients with memory loss were observed. Ten consultations were audio‐recorded and 16 individuals interviewed (n = 6 patients‐carer dyads, n = 1 lone patient, and n = 5 staff). Medical records were reviewed for 338 cases. Cancer referrals did not document memory health, so clinicians rely on patient/carer disclosure to identify patients with memory problems. In practice, the problem often remains hidden. Treating teams who do become aware of memory difficulties are unsure how to support patients, but marked memory loss can limit treatment options and preclude radical intent. Carers are key facilitators of successful cancer consultations and management. Their support needs are largely unrecognized. Conclusions Training that educates cancer teams on how to identify and support individuals with memory problems before and during treatment and recognize the carer role may facilitate complex cancer care and help reduce inequalities of outcomes.
    August 09, 2016   doi: 10.1002/pon.4212   open full text
  • Cancer disclosure—account from a pediatric oncology ward in Egypt.
    Hanan El Malla, Gunnar Steineck, Nathalie Ylitalo Helm, Ulrica Wilderäng, Yasser El Sayed Elborai, Mohammad Elshami, Ulrika Kreicbergs.
    Psycho-Oncology. August 05, 2016
    Objective Informing the child about his/her diagnosis and treatment plan is essential; research has shown that it is related to the patient's quality of life and adherence to medication. Methods For 7 months during 2008 (February to September), 2 study‐specific questionnaires were constructed and administered to 304 parents of children diagnosed with cancer at the Children's Cancer Hospital Egypt. Results Among the 313 eligible parents of children diagnosed with cancer, 304 (97%) answered the first questionnaire and 281 (92%) answered the second questionnaire. We found that nearly three‐quarters (72%) of the parents had their child's cancer diagnosis communicated by the physician. Among the 72%, the rate of the children present with the parent or parents during the disease disclosure conversation was 39% (n = 85/219). The majority of the children were in the age group 5‐18 years (55%). Conclusions Our findings indicate that cancer disclosure at the Children's Cancer Hospital is to a certain degree common; yet even when disclosure does take place, it is mainly in the absence of the child. Moreover, the information provided during the conversation may not be fully comprehended by the parent or the child because of the physician's misleading use of terms when disclosing the disease. Therefore, better practice should be developed for disease disclosure, and proper communication should be established between the patients and the provider; patient autonomy should also have an influence in the clinical practice.
    August 05, 2016   doi: 10.1002/pon.4207   open full text
  • Couple functioning after pediatric cancer diagnosis: a systematic review.
    Marieke Van Schoors, Line Caes, Melissa A. Alderfer, Liesbet Goubert, Lesley Verhofstadt.
    Psycho-Oncology. August 04, 2016
    Objectives A systematic review was conducted to (1) investigate couple functioning after a pediatric cancer diagnosis and (2) examine theoretical and methodological tendencies and issues in this literature. Methods Searches of Web of Science, PubMed, Cochrane, PsycINFO, and Embase resulted in inclusion of 32 qualitative, quantitative, or mixed‐method papers. Findings of these papers were extracted for summary. Results Most couples adapt well to the crisis of a pediatric cancer diagnosis in domains such as emotional closeness, support, marital satisfaction, and general marital adjustment. However, most experience difficulties in the domain of sexual intimacy, and reports on conflict are mixed across qualitative and quantitative studies. Conclusions This review illustrates the need for future research with a greater focus on the impact of a pediatric cancer diagnosis on the couple's functioning, conducted with the use of appropriate theoretical frameworks and based on both partners' reports. Improvements in research are needed to best inform couple‐based interventions.
    August 04, 2016   doi: 10.1002/pon.4204   open full text
  • Religious beliefs and mammography intention: findings from a qualitative study of a diverse group of American Muslim women.
    Aasim I. Padela, Milkie Vu, Hadiyah Muhammad, Farha Marfani, Saleha Mallick, Monica Peek, Michael T. Quinn.
    Psycho-Oncology. August 04, 2016
    Objective Studies suggest that American Muslim women underutilize mammography. While religion has a strong influence upon Muslim health behaviors, scant research has examined how religion‐related beliefs inform Muslim women's intention for mammography. Our study identifies and examines such beliefs. Methods Muslim women aged 40 years and older sampled from mosques participated in focus groups and individual interviews. Drawing upon the theory of planned behavior, interviews elicited salient behavioral, normative, and control beliefs regarding mammography and the influence of Islam upon screening intention. Results Fifty women participated in 6 focus groups and 19 in semistructured interviews, with near‐equal numbers of African American, South Asian, and Arab Muslims. Forty‐two percent of participants had not had a mammogram within the past 2 years. Across differences in race/ethnicity and mammography status, women voiced four religion‐related salient beliefs that inform mammography intention: (1) the perceived duty to care for one's health, (2) religious practices as methods of disease prevention, (3) fatalistic notions about health, and (4) comfort with gender concordant health care. Conclusions Religious beliefs influence decisions to pursue mammography across the ethnic/racial diversity of Muslim women. Notions about duty to God and the stewardship of one's body appear to enhance mammography intention. Theocentric notions of cure and illness and varied views regarding personal agency also inform decisional frames that impact mammography intention. Given the salience of religion among our participants, religiously tailored messages in interventions have the potential to enhance cancer screening.
    August 04, 2016   doi: 10.1002/pon.4216   open full text
  • Cost‐effectiveness of a pragmatic exercise intervention for women with breast cancer: results from a randomized controlled trial.
    Louisa G. Gordon, Tracey DiSipio, Diana Battistutta, Patsy Yates, John Bashford, Chris Pyke, Elizabeth Eakin, Sandra C. Hayes.
    Psycho-Oncology. August 02, 2016
    Objective To report on the cost‐effectiveness of the Exercise for Health trial, comparing an exercise intervention with usual care during and following treatment for women with breast cancer. Methods Women with breast cancer were randomized to an 8‐month exercise intervention (involving regular contact with an exercise physiologist over the phone, n = 67, or home delivered face to face, n = 67) or usual care (n = 60) group and were assessed pre‐intervention (5 weeks post‐surgery), mid‐intervention (6 months post‐surgery), and 10 weeks post‐intervention (12 months post‐surgery). The benefit measures were “number of improvers” in quality of life (FACT‐B+4) and quality‐adjusted life years (QALYs). Data on provider, patient, and government costs were used to consider 2 cost scenarios: (1) a service provider model and (2) a private model. Results There were 69 improvers in the intervention group compared with 21 in the usual care group (odds ratio 2.09, 95% confidence interval 1.08, 4.01; P = .033). The incremental cost per improver was A$2282 to A$2644. Quality‐adjusted life years gain for the intervention group versus the usual care group was 0.009, with incremental cost per QALY gain for models 1 and 2 being A$105 231 and A$90 842, respectively. However, sensitivity analyses indicate that incremental cost per QALY gained was volatile to EuroQol‐5D‐3L weights. Conclusions Findings suggest that a pragmatic exercise intervention yields more women with markedly improved quality of life after breast cancer than usual care and may be cost‐effective. The results are less certain in terms of incremental cost per quality‐adjusted life years; however, this may be an inappropriate measure for reflecting exercise benefit for women with breast cancer.
    August 02, 2016   doi: 10.1002/pon.4201   open full text
  • The efficacy of interventions to improve psychosocial outcomes following surgical treatment for breast cancer: a systematic review and meta‐analysis.
    Hannah Matthews, Elizabeth A. Grunfeld, Andrew Turner.
    Psycho-Oncology. August 02, 2016
    Objective Breast cancer is the most commonly diagnosed cancer in women across the world. The majority of women diagnosed with the disease undergo surgery, which is often associated with significant psychosocial morbidity. The aim of this meta‐analysis was to identify the efficacy of psychosocial interventions for women following breast cancer surgery. Method A comprehensive literature search was undertaken using keyword and subject headings within 7 databases. Included studies employed a quantitative methodology presenting empirical findings focusing on interventions for female breast cancer patients following surgery. Results Thirty‐two studies were included and based on conventional values of effect sizes. Small effects emerged for the efficacy of psychosocial interventions in relation to anxiety (Hedges g = 0.31), depression (0.38), quality of life (0.40), mood disturbance (0.31), distress (0.27), body image (0.40), self‐esteem (0.35), and sexual functioning (0.22). A moderate to large effect emerged for the efficacy of interventions in promoting improvements in sleep disturbance (0.67). Clear evidence emerged for the efficacy of cognitive behavioral therapy in promoting improvements in anxiety, depression, and quality of life. Conclusion This is the first meta‐analysis to demonstrate the efficacy of interventions on a range of psychosocial outcomes following breast cancer surgery. The meta‐analysis highlighted that cognitive behavioral therapy was consistently the most effective psychosocial intervention promoting improvements in anxiety, depression, and quality of life. However, there are shortcomings in existing studies; the length of the follow‐up period is typically short and the generalizability of findings was limited by small samples, both of which should be addressed in future studies.
    August 02, 2016   doi: 10.1002/pon.4199   open full text
  • Physical and psychological correlates of high somatic symptom severity in Chinese breast cancer patients.
    Rainer Leonhart, Lili Tang, Ying Pang, Jinjiang Li, Lili Song, Irmela Fischer, Maike Koch, Alexander Wuensch, Kurt Fritzsche, Rainer Schaefert.
    Psycho-Oncology. August 02, 2016
    Objective: We researched associations between somatic symptom severity (SSS), and physical and psychological factors in Chinese breast cancer patients. Methods: This multicenter cross‐sectional study enrolled 255 Chinese breast cancer patients of different stages and treatment phases. They answered standard instruments assessing SSS (Patient Health Questionnaire [PHQ]‐15), depression (PHQ‐9), anxiety (General Anxiety Disorder [GAD]‐7), health anxiety (Whiteley‐7 [WI‐7]), illness perception (Brief‐Illness Perception Questionnaire [IPQ]), illness attribution (Illness Perception Questionnaire‐Revised [IPQ‐R]), and sense of coherence (Sense of Coherence [SOC]‐9). Logistic regression was applied to identify the strongest correlates with SSS. Results: Our sample of high (PHQ‐15 ≥ 10) and low SSS differed significantly in the following physical and psychological variables: symptom duration (r = 0.339, P < .001), symptom‐related disability (Karnofsky Index) (r = 0.182, P < .001), depression (r = 0.556, P < .001), anxiety (r = 0.433, P < .001), health anxiety (r = 0.400, P < .001), illness perception (r = 0.349, P < .001), psychological illness attributions (r = 0.217, P < .01), and sense of coherence (r = −0.254, P < .001). In an adjusted stepwise multiple binary logistic regression analysis, higher health anxiety (WI‐7, B = 0.388, P = .002), higher depression (PHQ‐9, B = 0.158, P < .001), younger age (B = −0.042, P = .048), higher impairment in daily life (B = 1.098, P = .010), and longer symptom duration (Wald = 18.487, P = .001) showed a significant association with high SSS; the model explained 55.1% of the variance. Conclusions: High somatic symptom burden in breast cancer is associated with physical and psychosocial features. The results are a basis for further research to evaluate the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, SSD concept in cancer patients and to better operationalize psychobehavioral factors in this patient group.
    August 02, 2016   doi: 10.1002/pon.4203   open full text
  • The psychosocial experiences of breast cancer amongst Black, South Asian and White survivors: do differences exist between ethnic groups?
    Geeta Patel‐Kerai, Diana Harcourt, Nichola Rumsey, Habib Naqvi, Paul White.
    Psycho-Oncology. August 02, 2016
    Background Very little UK‐based research has examined breast cancer‐related experiences of Black and Minority Ethnic populations, and we do not know whether the psychosocial impact of diagnosis and treatment in this group is any different to that of White women. Therefore, this study examined similarities and differences amongst Black, South Asian and White breast cancer survivors. Methods A quantitative, cross‐sectional survey was conducted; 173 breast cancer survivors (80 White, 53 South Asian and 40 Black) completed a questionnaire, which assessed psychological functioning, social support, body image and beliefs about cancer. Results Significant differences (p < 0.05) were reported between White and South Asian participants: compared with White women, South Asian participants reported higher levels of anxiety and depression, poorer quality of life and held higher levels of internal and fatalistic beliefs pertaining to cancer. Black and South Asian women reported higher levels of body image concerns than White women, and held stronger beliefs that God was in control of their cancer. South Asian women turned to religion as a source of support more than Black and White women. Conclusion This study enhances current understanding of the experience and impact of breast cancer amongst Black and South Asian women, and demonstrates similarities and differences between the ethnic groups. The findings highlight implications for healthcare professionals, particularly in relation to providing culturally sensitive care and support to their patients. Copyright © 2016 John Wiley & Sons, Ltd.
    August 02, 2016   doi: 10.1002/pon.4187   open full text
  • “You don't know what's wrong with you”: an exploration of cancer‐related experiences in people with an intellectual disability.
    Samantha Flynn, Nicholas J. Hulbert‐Williams, Lee Hulbert‐Williams, Ros Bramwell.
    Psycho-Oncology. August 02, 2016
    Objective Few empirical studies have explored cancer‐related experiences of people with an intellectual disability (ID), despite rising cancer incidence in this population. The present research aims to better understand the experiences of this population from multiple perspectives, generating theory and further research questions. Methods Six people with ID and cancer, alongside 12 participants from their supportive network (including family and social and health care professionals), were interviewed; transcripts were analyzed using grounded theory. Results People with ID were often overlooked within cancer consultations and excluded from conversations about their care and treatment‐related decisions. Caregivers (family and paid) were relied upon to facilitate communication and understanding and supplement health care professional knowledge. Caregivers' attempts to protect the patient from distress harmed communication further; our interviewees suggest that increased involvement and empowerment mediated cancer‐related distress. Where health care professionals possessed good patient‐centered skills, and additional support was offered, people with ID were more likely to engage meaningfully in their cancer‐related experience. Conclusions Interestingly, emergent concepts were consistent with general psycho‐oncology literature; however, incidence and severity of difficulty was substantially greater in this sample. This disparity warrants further exploration, with a need for intervention research to develop effective ways of supporting health care professionals in enhancing patient‐centered skills with this population. In the clinical setting, patient involvement in health care decisions (despite problems associated with comorbidity) is imperative to optimize engagement.
    August 02, 2016   doi: 10.1002/pon.4211   open full text
  • Predictors of baseline cancer‐related cognitive impairment in cancer patients scheduled for a curative treatment.
    Michelle Lycke, Lies Pottel, Hans Pottel, Lore Ketelaars, Karin Stellamans, Koen Van Eygen, Philippe Vergauwe, Patrick Werbrouck, Laurence Goethals, Patricia Schofield, Tom Boterberg, Philip R. Debruyne.
    Psycho-Oncology. August 01, 2016
    Introduction Recent research in the field of cancer‐related cognitive impairments (CRCI) has shown CRCI presentation prior to treatment initiation. Some have attributed these problems to worry and fatigue, whereas others have suggested an influence of age, IQ, and other psychosocial and medical factors. Methods Patients (≥18 years) with a histologically confirmed diagnosis of a solid cancer or hematological malignancy, scheduled for a curative treatment, were evaluated with a baseline neuropsychological assessment including Patient‐Reported Outcome Measures (PROMs). PROMs entailed distress, anxiety and depression, fatigue, and cognitive complaints. The neuropsychological assessment comprised several cognitive domains such as premorbid IQ, attention, processing speed, flexibility, verbal and visual episodic memory, and verbal fluency. Results Cross‐sectional data of 125 patients were collected. Patients had a mean age of 60.9 years (range: 30.0‐85.0) and comprised primarily females (65.6%). Patients presented with cancer of following sites: breast (44.0%), digestive (28.8%), urological (11.2%), gynecologic (8.0%), hematologic malignancy (4.8%), and lung (3.2%). Patients presented with a premorbid IQ of 105.3 (range: 79.0‐124.0). In 29.6% of patients, a CRCI was detected. Binary logistic regression analyses showed that a lower premorbid IQ (β = −.084, P < .01) and a higher level of fatigue (β = −.054, P < .05) predicted baseline CRCI. Premorbid IQ also predicted performance on individual cognitive domains. Some domains were also influenced by age, gender, having a breast cancer diagnosis, and an active treatment for hypertension. Conclusion Premorbid IQ and fatigue are important predictors of baseline CRCI. Therefore, we advise researchers to implement a short IQ test when conducting clinical trials on CRCI.
    August 01, 2016   doi: 10.1002/pon.4200   open full text
  • Cancer beliefs and patient activation in a diverse, multilingual primary care sample.
    Jennifer L. Hay, Emily C. Zabor, Julie Kumar, Debra Brennessel, Margaret M. Kemeny, Erica I. Lubetkin.
    Psycho-Oncology. August 01, 2016
    Objectives Greater patient activation, defined as having the knowledge, skills, and confidence to manage one's health, is associated with cancer control behaviors. Cancer risk beliefs may be associated with patient activation, and delineating this relationship could inform cancer control interventions across diverse patient subgroups. This study examines associations between cancer risk beliefs, language preference, and patient activation within a multilingual urban primary care setting. Design Patients 18 years and older within a New York City public hospital serving a large proportion of non–native‐born Americans were surveyed regarding their cancer risk beliefs and patient activation in Haitian Creole, Spanish, or English based on language preference during a health care visit. Results The sample (N = 460) included 150 Haitian Creole speakers, 159 Spanish speakers, and 151 English speakers and was primarily non‐White (92%). Most participants (84%) had not been born in the United States. Cancer risk beliefs differed across language preference. Beliefs that cancer could be avoided by minimizing thoughts about cancer risk were significantly higher in Haitian Creole speakers than in others; reported negative emotion when thinking about cancer risk was higher in Spanish and English than in Haitian Creole speakers. These cancer risk beliefs were positively related to patient activation, even when controlling for language preference. Conclusion Cancer risk beliefs differ across language preference and are related to patient activation, making them potentially important in cancer control. Consideration of language represents important demographic stratification for understanding the frequency and relevance of different beliefs about cancer and patient activation.
    August 01, 2016   doi: 10.1002/pon.4196   open full text
  • Hope as determinant for psychiatric morbidity in family caregivers of advanced cancer patients.
    T. Rumpold, S. Schur, M. Amering, A. Ebert‐Vogel, K. Kirchheiner, E. Masel, H. Watzke, B. Schrank.
    Psycho-Oncology. August 01, 2016
    Objective Home care of advanced cancer patients often has adverse effects on physical and mental health of family caregivers. Little is known about the long‐term effects of continuous caregiving on mental health as compared with the effects of bereavement. The objectives of this study were to describe the course of psychiatric morbidity in family caregivers over time, to identify the impact of the patients' death on caregivers, and to explore possible predictor variables for psychiatric morbidity. Methods This multi‐institutional, prospective study included 80 family caregivers of 80 advanced cancer patients for baseline and 9 months follow‐up assessment. Possible psychiatric disorders (ie, depression, anxiety, posttraumatic stress disorder, and alcohol abuse/dependence) as well as potentially predictive factors (ie, sociodemographic factors, burden, hope, and coping mechanisms) were assessed. Results Follow‐up assessment was conducted on average 9.2 months (±2.9) after baseline assessment. Prevalence rates of anxiety and posttraumatic stress disorder decreased significantly over time, whereas depression and alcoholism remained stable. Bereavement was experienced by 53% of caregivers in the follow‐up period. The patients' death had no influence on psychiatric morbidity at follow‐up. Predictors for the development of a psychiatric disorder varied according to condition, with hope and emotion‐oriented coping identified as important influences, especially for anxiety and depression. Conclusion Family caregivers with certain psychiatric disorders might need targeted psychosocial support to ensure their mental well‐being and prevent long‐term disability. Supporting hope and functional coping strategies early after the patient's diagnosis might limit development and extent of psychiatric morbidity.
    August 01, 2016   doi: 10.1002/pon.4205   open full text
  • Cancer diagnosis disclosure preferences of family caregivers of cancer patients in Egypt.
    Samy A. Alsirafy, Shady S. Abdel‐Kareem, Noha Y. Ibrahim, Mohamed A. Abolkasem, Dina E. Farag.
    Psycho-Oncology. July 28, 2016
    Objective Family caregivers (FCs) of cancer patients are frequently seen as a barrier to honest communication with patients in Egypt. This study was conducted to investigate the attitude of FCs of cancer patients toward cancer diagnosis disclosure (CDD) and its determinants. Methods A structured interview was used to assess the preferences of 288 FCs regarding CDD. Results According to the FCs, 85% of patients were aware of their diagnosis. The majority (81%) of FCs preferred CDD to patients. In case they developed cancer, 92% of FCs wanted to know their diagnosis and 88% wanted to inform their families. In a univariate analysis, factors associated with FCs' negative attitude toward CDD to patients were as follows: patient's lower level of education (P = .001), patient's rural residence (P < .001), hematological malignancies (P < .001), FC's belief that the patient is unaware of diagnosis (P < .001), FC's unwillingness to know his/her own cancer diagnosis (P < .001), and FC's unwillingness to inform his/her family about his/her cancer diagnosis (P < .001). Only 2 factors predicted independently the negative attitude of FCs toward CDD, the FC's belief that the patient is unaware of diagnosis (P < .001), and the FC's unwillingness to know his/her own cancer diagnosis (P = .049). Conclusions The results suggest that the majority of FCs of Egyptian cancer patients prefer CDD to patients. The finding that the vast majority of FCs of aware patients preferred CDD suggests that the reaction of Egyptian patients to CDD is acceptable by FCs. Family caregivers with a negative attitude toward CDD may be reflecting their own fears.
    July 28, 2016   doi: 10.1002/pon.4206   open full text
  • The Distress Thermometer for screening for severe fatigue in newly diagnosed breast and colorectal cancer patients.
    H.J.G. Abrahams, M.F.M. Gielissen, M. Lugt, E.F.W. Kleijer, W.K. Roos, E. Balk, C.A.H.H.V.M. Verhagen, H. Knoop.
    Psycho-Oncology. July 28, 2016
    Objective Internationally, the Distress Thermometer and associated Problem List are increasingly used in oncology as screening tools for psychological distress. Cancer‐related fatigue is common but often overlooked in clinical practice. We examined if severe fatigue in cancer patients can be identified with the fatigue item of the Problem List. Methods Newly diagnosed breast (N = 334) and colorectal (N = 179) cancer patients were screened for severe fatigue, which was defined as having a positive score on the fatigue item of the Problem List. The Fatigue Severity subscale of the Checklist Individual Strength was used as gold standard measure for severe fatigue. Results In total, 78% of breast cancer patients and 81% of colorectal cancer patients were correctly identified with the fatigue item. The sensitivity was 89% in breast cancer patients and 91% in colorectal cancer patients. The specificity was 75% in breast cancer patients and 77% in colorectal cancer patients. The positive predictive value was 53% in breast cancer patients and 64% in colorectal cancer patients, whereas the negative predictive value was 95% in both tumor types. Conclusions The fatigue item of the Problem List performs satisfactorily as a quick screening tool for severe fatigue. However, a positive screen should be followed up with a more thorough assessment of fatigue, ie, a questionnaire with a validated cutoff point. Given time pressure of clinicians, this already implemented and brief screening tool may prevent severe fatigue from going undetected in clinical practice.
    July 28, 2016   doi: 10.1002/pon.4208   open full text
  • Psychological adjustment after breast cancer: A systematic review of longitudinal studies.
    Tânia Brandão, Marc S. Schulz, Paula Mena Matos.
    Psycho-Oncology. July 20, 2016
    Objectives Breast cancer (BC) can be a traumatic and stressful experience for women but there are wide‐ranging differences in the ways in which women respond and adapt to BC. This systematic review examines which sociodemographic, disease‐related, and psychosocial factors near diagnosis predict later psychological adjustment to BC. Methods Database searches were conducted in nine different health‐related databases from 2000 to December 2015 using relevant search terms. Full‐text, peer‐reviewed articles in English that analyzed potential predictors of psychological adjustment in longitudinal studies were considered for inclusion. Results Of 1780 abstracts 41 studies fulfilled inclusion criteria. Consistent sociodemographic and disease‐related variables predictors of adjustment were income, fatigue, cancer stage, and physical functioning. Psychosocial factors, particularly optimism and trait‐anxiety, as well as perceived social support, coping strategies, and initial levels of psychological functioning were found to be predictive of later depressive and anxiety symptoms, psychological distress, and quality of life for women with BC, in predictable ways. Other psychosocial variables, such as cognitive and body image factors, predicted psychological adjustment but were explored only by a few studies. Conclusions The majority of studies showed a significant relationship between psychosocial factors and psychological adjustment. These results point to specific sociodemographic, disease‐related, and psychosocial factors that can help to identify women at the time of diagnosis who are at risk for long‐term psychological challenges so they can be referred for psychological support that targets their specific needs and can improve their quality of life and mood, and decrease indicators of anxiety, depression and psychological distress.
    July 20, 2016   doi: 10.1002/pon.4230   open full text
  • Living under a cloud of threat: the experience of Iranian female caregivers with a first‐degree relative with breast cancer.
    Masoumeh Hashemi‐Ghasemabadi, Fariba Taleghani, Shahnaz Kohan, Alireza Yousefy.
    Psycho-Oncology. July 14, 2016
    Backgrounds Breast cancer is a global threat to all women, especially those having close relatives with breast cancer. Women who were caregivers to relatives with breast cancer are more vulnerable to stress caused by the perception of heightened risk of cancer. Because health measures and breast health are affected by cultural beliefs and social status, information about breast cancer should consider the cultural beliefs and values of the society. Objectives This study explored the experiences of Iranian women who were caregivers to relatives with breast cancer. Methods In this qualitative content analysis study, 21 female caregivers of breast cancer patients were chosen by purposive sampling. Data were collected through interviews and analyzed using content analysis. Results Data analysis developed 3 categories: perception of the concept of risk, changing views about femininity, and management of perceived threat. Perception of the risk of breast cancer increased in caregivers, and they tried to manage the perceived threat. They considered the breast to be an important part of women's lives, and breast cancer in relatives changed their view of femininity. Conclusion Understanding the experiences of breast cancer family caregivers in different cultures can help in planning, counseling, and effective intervention.
    July 14, 2016   doi: 10.1002/pon.4198   open full text
  • Inequalities in cancer screening participation: examining differences in perceived benefits and barriers.
    S.G. Smith, L.M. McGregor, R. Raine, J. Wardle, C. Wagner, K.A. Robb.
    Psycho-Oncology. July 14, 2016
    Objective Inequalities exist in colorectal cancer (CRC) screening uptake, with people from lower socioeconomic status backgrounds less likely to participate. Identifying the facilitators and barriers to screening uptake is important to addressing screening disparities. We pooled data from 2 trials to examine educational differences in psychological constructs related to guaiac fecal occult blood testing. Methods Patients (n = 8576) registered at 7 general practices in England, within 15 years of the eligible age range for screening (45‐59.5 years), were invited to complete a questionnaire. Measures included perceived barriers (emotional and practical) and benefits of screening, screening intentions, and participant characteristics including education. Results After data pooling, 2181 responses were included. People with high school education or no formal education reported higher emotional and practical barriers and were less likely to definitely intend to participate in screening, compared with university graduates in analyses controlling for study arm and participant characteristics. The belief that one would worry more about CRC after screening and concerns about tempting fate were strongly negatively associated with education. In a model including education and participant characteristics, respondents with low emotional barriers, low practical barriers, and high perceived benefits were more likely to definitely intend to take part in screening. Conclusions In this analysis of adults approaching the CRC screening age, there was a consistent effect of education on perceived barriers toward guaiac fecal occult blood testing, which could affect screening decision making. Interventions should target specific barriers to reduce educational disparities in screening uptake and avoid exacerbating inequalities in CRC mortality.
    July 14, 2016   doi: 10.1002/pon.4195   open full text
  • Objective–subjective disparity in cancer‐related cognitive impairment: does the use of change measures help reconcile the difference?
    Erin O'Farrell, Andra Smith, Barbara Collins.
    Psycho-Oncology. July 14, 2016
    Objective Studies to date have found little correlation between subjective and objective measures of cognitive function in cancer patients, making it difficult to interpret the significance of their cognitive complaints. The purpose of this study was to determine if a stronger correlation would be obtained using measures of cognitive change rather than static scores. Methods Sixty women with early stage breast cancer underwent repeated cognitive assessment over the course of chemotherapy with a neuropsychological test battery (objective measure) and with the FACT‐Cog (subjective measure). Their results were compared to 60 healthy women matched on age and education and assessed at similar intervals. We used multilevel modeling, with FACT‐Cog as the dependent measure and ordinary least squares slopes of a neuropsychological summary score as the independent variable, to evaluate the co‐variation between the subjective and objective measures over time Results Measures of both objective and subjective cognitive function declined over the course of chemotherapy in the breast cancer patients but there was no significant relationship between them, even when using change measures. Change in objective cognitive function was not related to change in anxiety or fatigue scores but the decline in perceived cognitive function was associated with greater anxiety and fatigue. Conclusions The discrepancy in objective and subjective measures of cognition in breast cancer patients cannot be accounted for in terms of a failure to use change measures. Although the results are negative, we contend that this is the more appropriate methodology for analyzing cancer‐related changes in cognition.
    July 14, 2016   doi: 10.1002/pon.4190   open full text
  • People with dementia: what is known about their experience of cancer treatment and cancer treatment outcomes? A systematic review.
    J. B. Hopkinson, R. Milton, A. King, D. Edwards.
    Psycho-Oncology. July 13, 2016
    Objective The objective of the study is to report a systematic review of what is currently known about the experience of cancer treatment and cancer treatment in adults with dementia. Methods The analytic plan and inclusion/exclusion criteria were specified in advance of the search process in a protocol. Searches were conducted in MEDLINE, CINAHL, PsycINFO and the Cochrane Library for publications about people with cancer and a pre‐existing dementia. Limits were English language; 2000 to 12/2015; adults; >18 years old. The search identified 5214 titles and abstracts that were assessed against eligibility criteria and 101 were selected for full‐text examination by two researchers who agreed inclusion of nine papers, extracted data independently then conducted a content analysis and narrative synthesis. Results Nine studies conducted in four resource rich countries were included in the review. These studies evidence that when compared with other cancer patients, those with dementia are diagnosed at a later stage, receive less treatment, are more likely to experience complications from treatment and have poorer survival. The experience of supportive care and preferences of people with dementia receiving cancer services and cancer treatment have not been investigated. Research into how the cancer team manage the particular needs of people with dementia and their family members has been limited to one study that reported how a cancer team managed the particular needs of seven people with dementia. Conclusion Further work is needed to establish practice guidelines for the management of cancer in people with dementia. Copyright © 2016 John Wiley & Sons, Ltd.
    July 13, 2016   doi: 10.1002/pon.4185   open full text
  • Utilization of professional psychological care in a large German sample of cancer patients.
    Hermann Faller, Joachim Weis, Uwe Koch, Elmar Brähler, Martin Härter, Monika Keller, Holger Schulz, Karl Wegscheider, Anna Boehncke, Bianca Hund, Katrin Reuter, Matthias Richard, Susanne Sehner, Hans‐Ulrich Wittchen, Anja Mehnert.
    Psycho-Oncology. July 13, 2016
    Objective Although one‐third of cancer patients are perceived to have a need for psychological support based on the percentage of mental disorders, little is known about the actual utilization of psychological care in cancer. We aimed to assess cancer patients' reported use of psychological care and its correlates in a large, representative sample. Methods In a multicenter, cross‐sectional study in Germany, 4020 cancer patients (mean age 58 years, 51% women) were evaluated. We obtained self‐reports of use of psychotherapy and psychological counseling. We measured distress with the Distress Thermometer, symptoms of depression with the Patient Health Questionnaire, anxiety with the Generalized Anxiety Disorder Scale, and social support with the Illness‐specific Social Support Scale. In a subsample of 2141, we evaluated the presence of a mental disorder using the Composite International Diagnostic Interview. Results In total, 28.9% (95% confidence interval 27.4%‐30.4%) reported having used psychotherapy or psychological counseling or both because of distress due to cancer. Independent correlates of utilization included age (odds ratio [OR] = 0.97 per year], sex (male, OR = 0.55), social support (OR = 0.96), symptoms of depression (OR = 1.04) and anxiety (OR = 1.08), the diagnosis of a mental disorder (OR = 1.68), and a positive attitude toward psychosocial support (OR = 1.27). Less than half of those currently diagnosed with a mental disorder reported having taken up psychological support offers. Conclusion Special efforts should be made to reach populations that report low utilization of psychological care in spite of having a need for support.
    July 13, 2016   doi: 10.1002/pon.4197   open full text
  • Links between personality, time perspective, and intention to practice physical activity during cancer treatment: an exploratory study.
    Charlène Villaron, Tanguy Marqueste, François Eisinger, Maria‐Antonietta Cappiello, Pierre Therme, François Cury.
    Psycho-Oncology. July 13, 2016
    Objective The purpose of the study was to analyze links between personality, time perspective, and intention to practice physical activity during cancer treatment. Method One hundred forty‐three patients participated in survey by questionnaire. Intention to practice physical activity, time perspective using Zimbardo Time Perspective Inventory, and personality with the Big Five Inventory were measured. Structural equation models using Lisrel were developed to examine hypothetical links between the variables. Results The adjusted model evidenced an excellent fit (comparative fit index = 0.92; root‐mean‐square error of approximation = 0.076; P = .014). Results showed that intention to practice exercise was positively linked with openness to experience and negatively with present fatalist time perspective. Moreover, conscientiousness and neuroticism were found to be linked with future time perspective, which was positively related with intention to practice physical activity. Conclusion The present exploratory study with patients suffering from cancer underlined the importance of considering jointly time perspective dimensions and personality factors for health behavior recommendations. Based on our results, we propose some reflections on practice to help nurses and physicians increase patient's motivation to be physically active. Taking into account patients' personality and time perspective, we would be able to propose specific awareness messages and offer short interventions to have an impact on patients' motivation to practice.
    July 13, 2016   doi: 10.1002/pon.4194   open full text
  • Relationship between self‐reported and objectively measured physical activity and subjective memory impairment in breast cancer survivors: role of self‐efficacy, fatigue and distress.
    Siobhan M. Phillips, Gillian R. Lloyd, Elizabeth A. Awick, Edward McAuley.
    Psycho-Oncology. July 08, 2016
    Purpose Many breast cancer survivors report cancer and cancer treatment‐associated cognitive change. However, very little is known about the relationship between physical activity and subjective memory impairment (SMI) in this population. The purpose of this study is to examine the relationship between physical activity and SMI and longitudinally test a model examining the role of self‐efficacy, fatigue and distress as potential mediators. Methods Post‐treatment breast cancer survivors (N = 1477) completed measures of physical activity, self‐efficacy, distress (depression, concerns about recurrence, perceived stress, anxiety), fatigue and SMI at baseline and 6‐month follow‐up. A subsample (n = 362) was randomly selected to wear an accelerometer. It was hypothesized that physical activity indirectly influences SMI via exercise self‐efficacy, distress and fatigue. Relationships were examined using panel analysis within a covariance modeling framework. Results The hypothesized model provided a good fit in the full sample (χ2 = 1462.5, df = 469, p = <0.001; CFI = 0.96; SRMR = 0.04) and the accelerometer subsample (χ2 = 961.8, df = 535, p = <0.001, CFI = 0.94, SRMR = 0.05) indicating increased physical activity is indirectly associated with reduction in SMI across time, via increased exercise self‐efficacy and reduced distress and fatigue. Conclusions Higher levels of physical activity, lower levels of fatigue and distress and higher exercise self‐efficacy may play an important role in understanding SMI in breast cancer survivors across time. Future research is warranted to replicate and explore these relationships further. Copyright © 2016 John Wiley & Sons, Ltd.
    July 08, 2016   doi: 10.1002/pon.4156   open full text
  • Perceptions of cancer treatment decision making among American Indians/Alaska Natives and their physicians.
    Arden M. Morris, Ardith Z. Doorenbos, Emily Haozous, Alexa Meins, Sara Javid, David R. Flum.
    Psycho-Oncology. July 06, 2016
    Objective American Indian/Alaska Native (AI/AN) patients are significantly less likely than non‐Hispanic whites to receive guideline‐concordant cancer care. Our objective was to examine cancer treatment decision making among AI/AN patients and their providers. Methods From 2011 to 2014, AI/AN cancer patients and their surgeons were identified through a hospital registry in Washington State. Patients were invited to participate in a mailed survey that queried socio‐demographics, cultural affiliation, everyday perceived discrimination, and trust in providers. Both patients and surgeons were queried about decision‐making quality (collaboration and satisfaction). The primary outcome was association between patient and provider assessments of decision‐making quality. The secondary outcome was non‐adherence to treatment. Results Forty‐nine patients (62% response rate) and 14 surgeons (37% response rate) returned surveys. Half of patients had not completed high school; 41% were living in poverty. Half of patients reported a strong tribal affiliation and most reported experiencing some form of discrimination. Patients endorsed high trust in surgeons and a high quality decision‐making process; and surgeons' rated decision‐making quality even more highly than patients did in every domain. Non‐adherence to treatment recommendations was common (26%) and was significantly associated with lower patient‐reported collaboration and satisfaction with decision making. Conclusions Given the importance of adherence to cancer treatment for survival, the many non‐clinical reasons for non‐adherence, and the currently demonstrated association between decision‐making quality and adherence, it would be worthwhile to investigate how to increase AI/AN patient satisfaction with decision making and whether improving satisfaction yields improved adherence to the cancer treatment plan. Copyright © 2016 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.
    July 06, 2016   doi: 10.1002/pon.4191   open full text
  • Spirituality, emotional distress, and post‐traumatic growth in breast cancer survivors and their partners: an actor–partner interdependence modeling approach.
    Amanda N. Gesselman, Silvia M. Bigatti, Justin R. Garcia, Kathryn Coe, David Cella, Victoria L. Champion.
    Psycho-Oncology. July 04, 2016
    Background The association between spirituality and emotional health has been well documented in healthy individuals. A small literature has shown that spirituality plays a role in well‐being for some breast cancer (BC) survivors; however, this link is virtually unexplored in partners/spouses of survivors. The current study aimed to assess the relationship between spirituality, emotional distress, and post‐traumatic growth for BC survivors and their partners using a dyadic analyses approach. Methods A total of 498 couples who were 3–8 years post‐BC diagnosis were recruited from the Eastern Oncology Group database. Results For BC survivors and their partners, greater levels of spirituality were associated with increases in their own post‐traumatic growth. There was no relation between BC and partner spirituality and their own emotional distress, but partner's spirituality was associated with reduced occurrence of intrusive thoughts in the BC survivor. In contrast, BC survivors' spirituality was found to be wholly unrelated to partner's mental health and adjustment. Conclusions Following diagnosis and treatment, spirituality appears to associate with positive growth in BC survivors and their partners. However, BC survivor and partner spirituality seem to be ineffective at impacting the other's post‐traumatic growth or emotional distress, with the exception of intrusive thoughts. Dyadic analysis takes into account the reciprocal influence of close relationships on health and is an important and under‐utilized methodology in behavioral oncology research and clinical practice. Copyright © 2016 John Wiley & Sons, Ltd.
    July 04, 2016   doi: 10.1002/pon.4192   open full text
  • A 2‐year dyadic longitudinal study of mothers' and fathers' marital adjustment when caring for a child with cancer.
    W. Burns, K. Péloquin, S. Sultan, A. Moghrabi, S. Marcoux, M. Krajinovic, D. Sinnett, C. Laverdière, P. Robaey.
    Psycho-Oncology. June 30, 2016
    Objective Studies examining interrelationships within parental couples confronted with pediatric cancer are scarce. This study explored dyadic longitudinal associations between both partners' family functioning and mood at diagnosis, and marital adjustment 2 years later. Method Parents of children (n = 47 couples) with acute lymphoblastic leukemia (ALL) completed the Family Well‐Being Assessment and Profile of Mood States‐Bipolar Form at diagnosis, and the Locke–Wallace Marital Adjustment Test 2 years post diagnosis. Multilevel linear models using the actor–partner interdependence model (APIM) and controlling for baseline marital adjustment were conducted to evaluate within subject and dyadic longitudinal effects. Results For mothers, better marital adjustment 2 years post diagnosis was associated with perception of greater family support and less role conflict and role overload at diagnosis. For fathers, better marital adjustment 2 years post‐diagnosis was associated with perception of less role conflict, greater role ambiguity, and being more tired at diagnosis, as well as their partner's perception of less role conflict at diagnosis. Conclusions These findings highlight the importance of considering both partners' perspectives in understanding marital adjustment across treatment phases in parents of children with ALL. Early interventions for couples should be tailored to meet each partner's needs in order to foster resilience within the couple.
    June 30, 2016   doi: 10.1002/pon.4189   open full text
  • Caregiver distress and patient health‐related quality of life: psychosocial screening during pediatric cancer treatment.
    Lisa Pierce, Matthew C. Hocking, Lisa A. Schwartz, Melissa A. Alderfer, Anne E. Kazak, Lamia P. Barakat.
    Psycho-Oncology. June 20, 2016
    Background Reports of acceptability of psychosocial screening are limited, and the utility of screening in identifying risk factors for health‐related quality of life (HRQL) of children with cancer has not been established. This study aimed to assess acceptability of screening for parents and evaluate associations between family risk factors and patient HRQL in the first year post‐diagnosis. Procedure Sixty‐seven parents of children with cancer completed the Psychosocial Assessment Tool (family risk), Distress Thermometer (caregiver distress), Posttraumatic Stress Disorder Checklist‐Civilian 6 (caregiver traumatic stress), PedsQL 4.0 (parent‐proxy report of patient HRQL) and four acceptability questions via a tablet (iPad). Results Patients (Mage = 9.5 SD = 5.5 years) were equally distributed across major pediatric cancer diagnoses. The majority of parents endorsed electronic screening as acceptable (70%–97%). Patient gender, diagnosis, intensity of treatment and time since diagnosis were not significantly correlated with family risk, caregiver distress, traumatic stress, or patient HRQL. The full regression model predicting total HRQL was significant (R2 = .42, F(4,64) = 10.7, p = .000). Age (older) was a significant covariate, family risk and caregiver distress were significant independent predictors of poorer total HRQL. The full regression models for physical and psychosocial HRQL were significant; age and caregiver distress were independent predictors of physical HRQL, and age and family risk were independent predictors of psychosocial HRQL. Conclusions Screening is acceptable for families and important for identifying risk factors associated with poorer patient HRQL during childhood cancer treatment. Targeted interventions addressing family resource needs as well as parent distress identified through screening may be effective in promoting patient HRQL. Copyright © 2016 John Wiley & Sons, Ltd.
    June 20, 2016   doi: 10.1002/pon.4171   open full text
  • Interest in initiating an early phase clinical trial: results of a longitudinal study of advanced cancer patients.
    Laura B. Dunn, Jim Wiley, Sarah Garrett, Fay Hlubocky, Christopher Daugherty, Laura Trupin, Pamela Munster, Daniel Dohan.
    Psycho-Oncology. June 20, 2016
    Objective Enhanced recruitment of patients with advanced cancer (ACP) to early phase (EP) trials is needed. However, selective recruitment may affect the kinds of patients who are recruited. To address whether ACP who initiate EP trial enrollment differ from those who do not, we prospectively surveyed ACP well in advance of potential trial recruitment and followed them over time to identify those who initiated the recruitment process. Methods EP trial initiation was defined as a patient being referred for screening to an active EP trial. Depression and anxiety were assessed with the Patient Health Questionnaire (PHQ‐9) and Generalized Anxiety Disorder Scale (GAD‐7), respectively. Demographic and disease characteristics, functional status, and patient preferences regarding decision making were examined as possible predictors of EP trial initiation. Results Of the 78 advanced cancer patients in the cohort studied, 21 (27%) initiated EP trial participation, while 57 (73%) did not. Of those who initiated this process, 14 (67%) went on to enroll in an EP study. Level of depression severity was associated with EP trial initiation, with rates of initiation nearly three times higher (35% vs. 12%, p = 0.054) among patients with minimal to mild levels of depression compared to those with moderate or higher levels of depression. EP trial initiation was not associated with demographic or socioeconomic variables, cancer type, functional status, quality of life, or decision‐making variables. Conclusions The presence of elevated depressive symptoms may be associated with the EP trial recruitment and enrollment processes. This possible relationship warrants further study. Copyright © 2016 John Wiley & Sons, Ltd.
    June 20, 2016   doi: 10.1002/pon.4179   open full text
  • Cancer negatively impacts on sexual function in adolescents and young adults: The AYA HOPE study.
    Lena Wettergren, Erin E. Kent, Sandra A. Mitchell, Brad Zebrack, Charles F. Lynch, Mara B. Rubenstein, Theresa H. M. Keegan, Xiao‐Cheng Wu, Helen M. Parsons, Ashley Wilder Smith,.
    Psycho-Oncology. June 20, 2016
    Objective This cohort study examined the impact of cancer on sexual function and intimate relationships in adolescents and young adults (AYAs). We also explored factors predicting an increased likelihood that cancer had negatively affected these outcomes. Methods Participants (n = 465, ages 15–39) in the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) study completed two surveys approximately 1 and 2 years post‐cancer diagnosis. We used multivariable logistic regression to determine factors negatively affected by perceptions of sexual function at 2 years post‐diagnosis. Results Forty‐nine percent of AYAs reported negative effects on sexual function at 1 year post‐cancer diagnosis and 70% of those persisted in their negative perceptions 2 years after diagnosis. Those reporting a negative impact at 2 years were more likely to be 25 years or older (OR, 2.53; 95% CI, 1.44–4.42), currently not raising children (OR, 1.81; 95% CI, 1.06–3.08), experiencing fatigue (OR, 0.99; 95% CI, 0.975–0.998) and more likely to report that their diagnosis has had a negative effect on physical appearance (OR, 3.08; 95% CI, 1.97–4.81). Clinical factors and mental health were not significant predictors of negative effects on sexual function. Conclusions Many AYAs diagnosed with cancer experience a persistent negative impact on sexual life up to 2 years following diagnosis. The findings underscore the need to develop routine protocols to assess sexual function in AYAs with cancer and to provide comprehensive management in the clinical setting. Copyright © 2016 John Wiley & Sons, Ltd.
    June 20, 2016   doi: 10.1002/pon.4181   open full text
  • Intellectual development of childhood ALL patients: a multicenter longitudinal study.
    Charlotte Sleurs, Jurgen Lemiere, Trui Vercruysse, Nathalie Nolf, Ben Van Calster, Sabine Deprez, Marleen Renard, Els Vandecruys, Yves Benoit, Anne Uyttebroeck.
    Psycho-Oncology. June 20, 2016
    Background In childhood acute lymphoblastic leukemia (ALL), radiotherapy for CNS prophylaxis is not used in frontline therapy anymore. Standard treatment for ALL nowadays consists of polychemotherapy. Therefore, assessment of potential chemotherapy‐induced cognitive side effects becomes important. Although neurotoxicity was demonstrated in cross‐sectional studies, longitudinal studies remain scarce. Procedure We evaluated intellectual development of 94 pediatric ALL patients between 1990 and 1997, diagnosed before the age of 12 years, treated according to the European Organisation for Research and Treatment of Cancer Children's Leukemia Group 58881 protocol. Three assessments of the Wechsler Intelligence Scale for Children Revised were performed since diagnosis, according to age. Using repeated measures regression analysis, we investigated the effect of gender (low versus increased) risk group, parents' education, age at diagnosis, intelligence quotient (IQ) subscale (verbal (VIQ) versus performance (PIQ) intelligence), and test session. Results PIQ scores were lower than VIQ at baseline (−5.3 points on average, p = 0.0032), yet PIQ increased more strongly (PIQ: +3.9 points per test session; VIQ: +0.8, p = 0.0079), so this baseline difference disappeared (p = 0.0079). There were no clear effects of gender (girls: +0.6 points; p = 0.78) or risk group (low risk: +1.5 points; p = 0.49), but IQ scores were higher when one parent had followed higher education (+9.5 points, p < 0.0001). Finally, diagnosis at younger age predicted lower IQ scores (−1.3 points per year, p = 0.0009). Conclusion Given that IQ scores did not decline, our findings demonstrate a stable pattern. However, the lower PIQ scores at baseline may indicate that performance functioning is vulnerable to acute neurotoxicity. Also, lower scores for younger patients highlight the stronger impact of the disease and/or treatment at younger age.Copyright © 2016 John Wiley & Sons, Ltd.
    June 20, 2016   doi: 10.1002/pon.4186   open full text
  • Educational differences in likelihood of attributing breast symptoms to cancer: a vignette‐based study.
    Afrodita Marcu, Georgios Lyratzopoulos, Georgia Black, Peter Vedsted, Katriina L. Whitaker.
    Psycho-Oncology. June 16, 2016
    Background Stage at diagnosis of breast cancer varies by socio‐economic status (SES), with lower SES associated with poorer survival. We investigated associations between SES (indexed by education), and the likelihood of attributing breast symptoms to breast cancer. Method We conducted an online survey with 961 women (47–92 years) with variable educational levels. Two vignettes depicted familiar and unfamiliar breast changes (axillary lump and nipple rash). Without making breast cancer explicit, women were asked ‘What do you think this […..] could be?’ After the attribution question, women were asked to indicate their level of agreement with a cancer avoidance statement (‘I would not want to know if I have breast cancer’). Results Women were more likely to mention cancer as a possible cause of an axillary lump (64%) compared with nipple rash (30%). In multivariable analysis, low and mid education were independently associated with being less likely to attribute a nipple rash to cancer (OR 0.51, 0.36–0.73 and OR 0.55, 0.40–0.77, respectively). For axillary lump, low education was associated with lower likelihood of mentioning cancer as a possible cause (OR 0.58, 0.41–0.83). Although cancer avoidance was also associated with lower education, the association between education and lower likelihood of making a cancer attribution was independent. Conclusion Lower education was associated with lower likelihood of making cancer attributions for both symptoms, also after adjustment for cancer avoidance. Lower likelihood of considering cancer may delay symptomatic presentation and contribute to educational differences in stage at diagnosis. Copyright © 2016 John Wiley & Sons, Ltd.
    June 16, 2016   doi: 10.1002/pon.4177   open full text
  • Effects of supportive‐expressive discussion groups on loneliness, hope and quality of life in breast cancer survivors: a randomized control trial.
    Fatemeh Moghaddam Tabrizi, Moloud Radfar, Zeynab Taei.
    Psycho-Oncology. June 15, 2016
    Purpose Evaluation of the effect of supportive expressive discussion groups on loneliness, hope and quality of life in breast cancer survivors. Methods A randomized control trial including breast cancer patients who had completed chemotherapy and randomly allocated into two groups: intervention (n = 41) and control (n = 40). The intervention consisted of twelve weekly 90‐min sessions for groups of six to eight breast cancer survivors. Data were obtained pre‐to ‐post the intervention and at 8‐week follow‐up. The data were analyzed using a repeated‐measures analysis of variance (ANOVA). Results The findings revealed a significant reduction in loneliness scores (F = 69.85, p < 0.001), promotion in total hope (F = 20.8, p < 0.05) and enhancement in quality of life from pre‐ to post‐intervention, and then over the 8‐week follow‐up period in the intervention group, while scores of control participants did not show this pattern during the study. The strongest effects were found for global quality of life (effect size) = 0.59), for future perspectives (effect size = 0.51), emotional functioning (effect size = 0.35) and social functioning (effect size = 0.31). Conclusion The intervention was effective on loneliness, hope and quality of life in the intervention group. The intervention needs further evaluation in a larger study and with other cancer types. Copyright © 2016 John Wiley & Sons, Ltd.
    June 15, 2016   doi: 10.1002/pon.4169   open full text
  • Psychosocial morbidity in women with abnormal cervical cytology managed by cytological surveillance or initial colposcopy: longitudinal analysis from the TOMBOLA randomised trial.
    S. Fielding, K. Rothnie, N. M. Gray, J. Little, M. E. Cruickshank, K. Neal, L. G. Walker, D. Whynes, S. C. Cotton, L. Sharp,.
    Psycho-Oncology. June 14, 2016
    Objective To compare psychosocial outcomes (follow‐up related worries and satisfaction with follow‐up related information and support) over 30 months of two alternative management policies for women with low‐grade abnormal cervical cytology. Methods Women aged 20–59 years with low‐grade cytological abnormalities detected in the National Health Service Cervical Screening Programme were randomised to cytological surveillance or initial colposcopy. A total of 3399 women who completed psychosocial questionnaires at recruitment were invited to complete questionnaires at 12, 18, 24 and 30 months. Linear mixed models were used to investigate differences between arms in the two psychosocial outcomes. Each outcome had a maximum score of 100, and higher scores represented higher psychosocial morbidity. Results On average, over 30 months, women randomised to colposcopy scored 2.5 points (95%CI −3.6 to −1.3) lower for follow‐up related worries than women randomised to cytological surveillance. Women in the colposcopy arm also scored significantly lower for follow‐up related satisfaction with information and support (−2.4; −3.3 to −1.4) over 30 months. For both outcomes, the average difference between arms was greatest at 12th‐ and 18th‐month time points. These differences remained when the analysis was stratified by post‐school education. Conclusions Women with low‐grade cytology, irrespective of their management, have substantial initial psychosocial morbidity that reduces over time. Implementation of newer screening strategies, which include surveillance, such as primary HPV screening, need to consider the information and support provided to women. © 2016 The Authors. Psycho‐Oncology published by John Wiley & Sons Ltd.
    June 14, 2016   doi: 10.1002/pon.4163   open full text
  • Physical activity, self‐efficacy and self‐esteem in breast cancer survivors: a panel model.
    Elizabeth A. Awick, Siobhan M. Phillips, Gillian R. Lloyd, Edward McAuley.
    Psycho-Oncology. June 14, 2016
    Purpose Physical activity (PA) has been consistently associated with improved self‐esteem in breast cancer survivors. However, this relationship is poorly understood. The purpose of this study was to examine whether changes in PA and self‐efficacy influenced changes in self‐esteem in breast cancer survivors across 6 months. Increases in PA were hypothesized to result in increases in self‐efficacy, which were hypothesized to influence increases in physical self‐worth (PSW) and global self‐esteem. Methods Breast cancer survivors (n = 370; Mage = 56.04) wore accelerometers to measure PA and completed measures of self‐efficacy (e.g., exercise and barriers self‐efficacy), PSW, and global self‐esteem at baseline and 6 months. Results The hypothesized model provided a good fit to the data (χ2 = 67.56, df = 26, p < 0.001; comparative fit index (CFI) = 0.98; standardized root mean residual = 0.05). Women with higher activity at baseline reported significantly higher levels of barrier (β = 0.29) and exercise (β = 0.23) self‐efficacy. In turn, more efficacious women reported significantly higher PSW (β = 0.26, 0.16). Finally, higher PSW was significantly associated with greater global self‐esteem (β = 0.47). Relationships were similar among changes in model constructs over 6 months. After controlling for covariates, the hypothesized model provided an excellent fit to the data (χ2 = 59.93, df = 33, p = 0.003; comparative fit index = 0.99; standardized root mean residual = 0.03). Conclusion Our findings provide support for the role played by PA and self‐efficacy in positive self‐esteem, a key component of well‐being. Highlighting successful PA mastery experiences is likely to enhance self‐efficacy and improve self‐esteem in this population. Copyright © 2016 John Wiley & Sons, Ltd.
    June 14, 2016   doi: 10.1002/pon.4180   open full text
  • Using Mechanical Turk for research on cancer survivors.
    Joanna J. Arch, Alaina L. Carr.
    Psycho-Oncology. June 10, 2016
    Objective The successful recruitment and study of cancer survivors within psycho‐oncology research can be challenging, time‐consuming, and expensive, particularly for key subgroups such as young adult cancer survivors. Online crowdsourcing platforms offer a potential solution that has not yet been investigated with regard to cancer populations. The current study assessed the presence of cancer survivors on Amazon's Mechanical Turk (MTurk) and the feasibility of using MTurk as an efficient, cost‐effective, and reliable psycho‐oncology recruitment and research platform. Methods During a <4‐month period, cancer survivors living in the United States were recruited on MTurk to complete two assessments, spaced 1 week apart, relating to psychosocial and cancer‐related functioning. The reliability and validity of responses were investigated. Results Within a <4‐month period, 464 self‐identified cancer survivors on MTurk consented to and completed an online assessment. The vast majority (79.09%) provided reliable and valid study data according to multiple indices. The sample was highly diverse in terms of U.S. geography, socioeconomic status, and cancer type, and reflected a particularly strong presence of distressed and young adult cancer survivors (median age = 36 years). A majority of participants (58.19%) responded to a second survey sent one week later. Conclusions Online crowdsourcing represents a feasible, efficient, and cost‐effective recruitment and research platform for cancer survivors, particularly for young adult cancer survivors and those with significant distress. We discuss remaining challenges and future recommendations. Copyright © 2016 John Wiley & Sons, Ltd.
    June 10, 2016   doi: 10.1002/pon.4173   open full text
  • Biopsychosocial problem‐related distress in cancer: examining the role of sex and age.
    Karen Clark, Cristiane Decat Bergerot, Errol J. Philip, Sorin Buga, Richard Obenchain, Matthew J. Loscalzo.
    Psycho-Oncology. June 07, 2016
    Background The current study explores how sex and age relate to biopsychosocial distress by applying a large‐scale analysis among individuals diagnosed with a variety of cancers. Methods A retrospective study was conducted involving 6462 patients treated for cancer at a National Cancer Institute‐designated comprehensive cancer center between 2009 and 2014. Patients were asked to complete the biopsychosocial problem‐related distress touchscreen instrument prior to starting treatment as part of their routine clinical care. Results There was a significant interaction of age and sex on the total number of problems rated as high distress and the total number of problems that prompted a request to talk with a member of the team. Male patients between 18 and 39 reported significantly more problems as high distress than female patients in the same age group (mean = 5.34 and mean = 4.92, respectively; p = 0.005). A similar trend was found where male patients between 18–39 and 40–64 requested to talk with a member of the team significantly more often than female patients in these same age groups (mean = 3.25 and mean = 3.22 vs. mean = 2.70 and mean = 3.07, respectively; p = 0.016). Conclusions The results of the current study serve to refute generalizations regarding age or gender demographics and support preferences and thus reinforce the need to offer services in the context of cancer in flexible and varied ways. Copyright © 2016 John Wiley & Sons, Ltd.
    June 07, 2016   doi: 10.1002/pon.4172   open full text
  • Great expectations: racial differences in outcome