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. (Clinicaltrials.gov 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) (ClinicalTrials.gov 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. (ClinicalTrials.gov: 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 expectations for a weight lifting intervention among black and white breast cancer survivors with or without lymphedema.
  Lorraine T. Dean, Justin Brown, Morgan Coursey, Kathryn H. Schmitz.
  Psycho-Oncology. June 01, 2016
  Background Black breast cancer survivors are less likely to engage in physical activity than are White survivors. This is unfortunate because physical activity may be especially beneficial given Black breast cancer survivors' higher rates of obesity and adverse treatment effects related to obesity, such as breast cancer‐related lymphedema (BCRL). The analysis explored outcome expectations for a weight lifting intervention by sedentary Black or White female breast cancer survivors and assessed the role of BCRL on outcome expectations for exercise. Methods Chi‐squared tests compared mean outcome expectation values for Black and White breast cancer survivors who completed baseline surveys for the Physical Activity and Lymphedema trial (n = 281). With race as the independent variable, multivariable analysis compared results for women without BCRL with those with BCRL, separately. Results Across the entire sample, Black survivors (n = 90) had significantly higher (p < 0.05) outcome expectations than White survivors (n = 191) for improvements in sleep, appearance, mental health, affect, energy, and eating habits, with small to moderate effect sizes. When stratified by BCRL status, differences by race were robust only among those with BCRL. Conclusions Black cancer survivors had greater expectations than White cancer survivors for how a weight lifting intervention would improve their physical and mental states; these differences were most apparent among women with BCRL. Improving outcomes in Black breast cancer survivors rests on the development of interventions that are appropriately tailored to address the expectations of this population and account for differences in persistent adverse effects of cancer such as BCRL. Copyright © 2016 John Wiley & Sons, Ltd.

  June 01, 2016   doi: 10.1002/pon.4175   open full text
• Partner interfering behaviors affecting cancer quality of life.
  Ann L. Coker, Diane R. Follingstad, Lisandra S. Garcia, Heather M. Bush.
  Psycho-Oncology. June 01, 2016
  Objective Because partners are an important and unpaid resource in cancer care, understanding how destructive, controlling or interfering partner behaviors influence women's cancer care may be particularly relevant for health care providers seeking to provide cancer care and enhance recovery. Using a new measure of partner interfering behaviors in cancer care (PIB‐C), we investigated whether women with a recent cancer diagnosis who additionally endorsed any PIB‐C would report (a) more symptoms of depression and stress, and (b) lower Functional Assessment of Cancer Therapy (FACT‐G) and lower Functional Assessment of Chronic Illness Therapy‐Spiritual Well‐being (FACIT‐SP) scale scores indicating poorer quality of life (QOL). Methods Women aged 18–79 included in cancer registries as having an incident, primary, biopsy‐confirmed cancer in the past 12 months were eligible for this study. Consenting women completed a phone interview 9–12 months following cancer diagnosis between 2009 and 2015. Interviews provided data to measure outcomes (perceived stress and depressive symptoms, FACIT‐SP and FACT‐G scores), partner supportive and interfering behaviors, and other potentially confounding factors. Results Of the 2376 women in a relationship at cancer diagnosis, 14.7% endorsed one or more of 14 PIB‐C items. Women endorsing any PIB‐C item reported more symptoms of depression and stress and lower FACT‐G and FACIT‐SP scores than partnered women reporting no PIB‐C even when controlling for partner supportive behaviors and lifetime intimate partner violence. Increasing PIB‐C scores were also correlated, in a dose–response pattern, with these same outcomes. Conclusions Partner interfering behaviors during cancer care impact patients' QOL across multiple domains. © 2016 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.

  June 01, 2016   doi: 10.1002/pon.4157   open full text
• Patients with oesophageal cancer report elevated distress and problems yet do not have an explicit wish for referral prior to receiving their medical treatment plan.
  M. Jacobs, M. C. J Anderegg, A. Schoorlemmer, D. Nieboer, E. W. Steyerberg, E. M. A. Smets, M. A. G. Sprangers, M. I. Berge Henegouwen, J. C. J. M. Haes, J. H. Klinkenbijl.
  Psycho-Oncology. June 01, 2016
  Objective This study aims to identify patients with oesophageal cancer's level of distress, type of problems, and wish for referral prior to treatment. To identify the clinical relevance of patients with oesophageal cancer's level of distress and type of problems, we build models to predict elevated distress, wish for referral, and overall survival. Methods We implemented the Distress Thermometer and Problem List in daily clinical practice. A score of ≥5 on the Distress Thermometer reflected elevated distress. We first created an initial model including predictors based on the literature. We then added predictors to the initial model to create an extended model based on the sample data. We used the ‘least absolute shrinkage and selection operator’ to define our final model. Results We obtained data from 187 patients (47.9%, of 390 eligible patients with oesophageal cancer) which were similar to non‐respondents in their demographic and clinical characteristics. One‐hundred thirteen (60%) patients reported elevated distress. The five most frequently reported problems were as follows: eating, tension, weight change, fatigue, and pain. Most patients did not have a wish for referral. Predictors for elevated distress were as follows: being female, total number of practical, emotional, and physical problems, pain, and fatigue. For referral, we identified age, the total number of emotional problems, the level of distress, and fear. The level of distress added prognostic information in a model to predict overall survival. Conclusions Patients with oesophageal cancer report elevated distress and a myriad of problems yet do not have an explicit wish for referral prior to receiving their medical treatment plan. Copyright © 2016 John Wiley & Sons, Ltd.

  June 01, 2016   doi: 10.1002/pon.4161   open full text
• Measuring Personal and Functional Changes in Prostate Cancer Survivors: Development and validation of the FADE: Data from the TROG 03.04 RADAR trial.
  Vicki Bitsika, Christopher F. Sharpley, David R. H. Christie, Rosemary Bradford, Allison Steigler, James W. Denham.
  Psycho-Oncology. May 30, 2016
  There is no abstract available for this paper.

  May 30, 2016   doi: 10.1002/pon.4182   open full text
• Hospitalization and other risk factors for depressive and anxious symptoms in oncological and non‐oncological patients.
  Pasquale De Fazio, Gregorio Cerminara, Stefania Ruberto, Mariarita Caroleo, Maurizio Puca, Ornella Rania, Elina Suffredini, Leonardo Procopio, Cristina Segura‐Garcìa.
  Psycho-Oncology. May 27, 2016
  Objective Depression and anxiety are common in hospitalized patients. In particular, oncological patients might be vulnerable to depression and anxiety. The aim of this study is to assess and compare different variables and the prevalence of anxiety and depression symptoms between oncological and medically ill inpatients and to identify variables that can influence depressive and anxious symptoms during hospitalization of patients. Methods A total of 360 consecutive hospitalized patients completed the following questionnaires: Hospital Anxiety and Depression Scale (HADS), Patients Health Questionnaire‐9, General Health Questionnaire (GHQ‐12), 12‐Item Short‐Form Survey: physical component summary (PCS), and mental component summary (MCS). Patients were divided into oncological patients and non‐oncological patients: groups 1 and 2. Results Only two significant differences were evident between the groups: the PCS of 12‐item Short‐form Survey was higher in non‐oncological patient (p < 0.000), and the GHQ total score was higher in oncological patients. Variables significantly associated with HADS‐D ≥ 8 were lower MCS, higher GHQ‐12 score, lower PCS, more numerous previous hospitalizations, longer duration of hospitalization, and positive psychiatric family history. Variables significantly associated with HADS‐A ≥ 8 were lower MCS, higher GHQ‐12 score, positive psychiatric family history, longer duration of hospitalization, and younger age. Conclusions Anxiety and depression symptoms in concurrent general medical conditions were associated with a specific sociodemographic profile, and this association has implications for clinical care. Copyright © 2016 John Wiley & Sons, Ltd.

  May 27, 2016   doi: 10.1002/pon.4170   open full text
• The relevance of experiential avoidance in breast cancer distress: insights from a psychological group intervention.
  Aldo Aguirre‐Camacho, Guy Pelletier, Ana González‐Márquez, Luis M. Blanco‐Donoso, Paula García‐Borreguero, Bernardo Moreno‐Jiménez.
  Psycho-Oncology. May 26, 2016
  Background Research on the implication of experiential avoidance in the aetiology and maintenance of diverse forms of psychopathology has grown considerably over the last 10 years. However, the potential contribution of experiential avoidance to cancer‐related distress has received limited attention. Accordingly, the objective of this study was to examine the association between experiential avoidance, symptoms of anxiety and depression, and quality of life (QoL) during the course of a psychological group intervention for women with breast cancer. Methods Fifty‐four women with breast cancer participated in a psychological group intervention designed to reduce distress and improve QoL. Participants completed measures of experiential avoidance, anxiety and depressive symptoms, and QoL upon the first and last sessions. Results A path analysis revealed that, after controlling for baseline measures, smaller reductions in experiential avoidance during the course of the intervention predicted smaller reductions in anxiety and depressive symptoms. Also, experiential avoidance had a negative indirect effect on QoL via depressive symptoms. Conclusions Experiential avoidance may perpetuate the emotional problems commonly found in women with breast cancer and attenuate improvements associated with participation in psychological interventions. Implications for clinical practice in psycho‐oncology are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

  May 26, 2016   doi: 10.1002/pon.4162   open full text
• High rate of thiamine deficiency among inpatients with cancer referred for psychiatric consultation: results of a single site prevalence study.
  Elie Isenberg‐Grzeda, Megan Johnson Shen, Yesne Alici, Jonathan Wills, Christian Nelson, William Breitbart.
  Psycho-Oncology. May 26, 2016
  Objective Thiamine deficiency (TD) is increasingly recognized in medically ill patients. The prevalence of TD among cancer patients is unknown. This study aims to characterize the prevalence of TD among inpatients with cancer. Methods Retrospective chart review of patients admitted to a large cancer center who were referred for psychiatric consultation and whose serum thiamine concentration was measured. Patients with alcohol use were excluded. Results Among 217 patients with various cancer types, TD was found in 55.3%. Risk factors included fluorouracil‐based chemotherapy, significant weight loss, and undergoing active cancer treatment. Almost all patients were normal weight, overweight, or obese, and few had concomitant vitamin B12 or folate deficiency. A total of 17.5% were receiving multivitamin supplementation. Nearly half (49.8%) did not receive empiric treatment with thiamine and among those who did, treatment delay occurred in the majority of cases (59.6%). Measurement of serum thiamine concentration preceded psychiatric consultation in only 10.6% of cases. Conclusions Our findings suggest that TD is highly prevalent among inpatients with cancer, even among normal and overweight individuals, in the absence of other vitamin deficiencies, and while receiving multivitamin supplements. Several potential risk factors were identified, including active cancer treatment. Evaluation of TD was most commonly not initiated by oncologists. Failure to treat and treatment delay were common. Given these findings, oncologists must be vigilant about detecting TD among inpatients with cancer. Copyright © 2016 John Wiley & Sons, Ltd.

  May 26, 2016   doi: 10.1002/pon.4155   open full text
• Concerns underlying treatment preferences of advanced cancer patients with children.
  Devon K. Check, Eliza M. Park, Katherine E. Reeder‐Hayes, Deborah K. Mayer, Allison M. Deal, Justin M. Yopp, Donald L. Rosenstein, Laura C. Hanson.
  Psycho-Oncology. May 26, 2016
  Background Decision‐making about advanced cancer treatment is complex and may be influenced by patients' family context, including the presence of children. We explored how parental values and concerns motivate patients' preferences about aggressiveness of advanced cancer treatment as well as preferences for palliative care and hospice services. Methods We conducted semi‐structured interviews with 42 patients with advanced cancer who had at least one child under 18 years. We created and applied thematic codes. Descriptive analyses were used to report the number of participants who mentioned each code. Results The majority of participants (29/42) reported that having children influenced their preferences for advanced cancer care. For most parents, extending life to maximize the time they had left to parent their children was important in guiding treatment preferences. Others prioritized preserving their physical condition and parental functioning and remaining physically close to their children. Many parents discussed life extension and parental functioning preservation as competing priorities. Most of the sample expressed interest in palliative care services and hospice, but responses by several participants reflected concerns about dying at home and lack of clarity about the role of early palliative care. Conclusions Parents in our sample expressed that maximizing time with their children and preserving parental functioning were important concerns underlying their preferences for advanced cancer care. Future research should assess the palliative and end‐of‐life care needs and preferences of parents with advanced cancer, which may differ from those of non‐parents. Copyright © 2016 John Wiley & Sons, Ltd.

  May 26, 2016   doi: 10.1002/pon.4164   open full text
• The use of varenicline to treat nicotine dependence among patients with cancer.
  Sarah Price, Brian Hitsman, Anna Veluz‐Wilkins, Sonja Blazekovic, Tarah R. Brubaker, Frank Leone, Anita Hole, E. Paul Wileyto, Corey Langer, Ravi Kalhan, Jyoti Patel, Robert Schnoll.
  Psycho-Oncology. May 24, 2016
  Background Continuing to smoke after a cancer diagnosis can adversely influence the prognosis for patients with cancer. However, remarkably few studies have carefully examined the use of first‐line FDA‐approved medications for nicotine dependence in patients with cancer. This study evaluated the feasibility, safety, and effect on cessation of varenicline for smoking cessation in patients with cancer. Methods Data from 132 treatment‐seeking smokers who received 12 weeks of open‐label varenicline and five brief behavioral counseling sessions were used to evaluate the feasibility, safety, and impact on cessation of varenicline. The effects of abstinence on cognitive function and affect were also explored. Results Of 459 patients screened, 306 were eligible for the study (66.7%) and 132 entered treatment (43.1%). Retention was 84.1% over 12 weeks. The rate of biochemically verified abstinence at week 12 was 40.2%. Expected side effects were reported (e.g. sleep problems, nausea), but there were no reports of elevated depressed mood, suicidal thoughts, or cardiovascular events. Abstinence was associated with improved cognitive function and reduced negative affect over time (p < 0.05). Conclusions Although many patients with cancer who smoke did not enroll in treatment, the side effect profile of varenicline and its effect on short‐term cessation converge with what is seen in the general population. Further, as with the general population, abstinence while taking varenicline may lead to improved cognitive function and reduced negative affect. The present data support the use of varenicline to help patients with cancer to quit smoking.

  May 24, 2016   doi: 10.1002/pon.4166   open full text
• Resilience of internal medicine house staff and its association with distress and empathy in an oncology setting.
  Daniel C. McFarland, Andrew Roth.
  Psycho-Oncology. May 24, 2016
  Context Resilience is a beneficial trait for resident physicians who are exposed to adversity through their work with patients. Inpatient hematology–oncology produces vicarious trauma for physicians in training. Physician distress and empathy influence patient care and may be associated with respectively lower and greater levels of resilience. Methods We collected measures of resilience (Connor–Davidson Resilience Scale), distress (Impact of Events Scale – Revised), and rotation‐specific information (e.g., number of death encounters, death stress, and meaning) at the end of a routine hematology–oncology ward rotation. Empathy (Interpersonal Reactivity Index) was measured both before and after the rotation. Results Fifty‐six out of 96 residents completed the study with an overall response rate of 58%. Resilience was negatively correlated with distress (r = −0.306, p = 0.023) but not with empathy (r = 0.172, p = 0.204) and nor with change in empathy over the course of the rotation (r = −0.122, p = 0.374). When separated by sex, male resilience was negatively correlated with distress (r = −0.389, p = 0.04), but female resilience was not. Resident distress levels were in a clinically significant (76%) or posttraumatic stress disorder range (17%), and resident empathy decreased during the rotation (p = 0.018). Resilience levels were similar in those who reported that death events were the most stressful experiences of the rotation and those who derived a sense of meaning from working with dying patients. Conclusions Resident physicians experienced clinically relevant distress and a decrease in empathy. Resilient resident physicians were less likely to experience distress. This study provides evidence for the salutary effects of resilience on physician distress. Copyright © 2016 John Wiley & Sons, Ltd.

  May 24, 2016   doi: 10.1002/pon.4165   open full text
• Improving outcomes in cancer diagnosis, prevention and control: barriers, facilitators and the need for health literacy in Ibadan Nigeria.
  Adebola A. Adedimeji, David Lounsbury, Oluwafemi Popoola, Chioma Asuzu, Akinmayowa Lawal, V. Oladoyin, Cassandra Crifase, Ilir Agalliu, Viswanathan Shankar, Akindele Adebiyi.
  Psycho-Oncology. May 24, 2016
  Background Cancers constitute a significant public health problem in Nigeria. Breast, cervix and prostate cancers are leading causes of cancer‐related deaths. Changing diets, lifestyles, HIV/AIDS and macro‐structural factors contribute to cancer morbidity and mortality. Poor health information linking cancer risk to individual behaviors, environmental pollutants and structural barriers undermine prevention/control efforts. Studies suggest increasing health literacy and empowering individuals to take preventive action will improve outcomes and mitigate impact on a weak health system. Methods We obtained qualitative data from 80 men, women, and young adults in 11 focus groups to assess beliefs, risk‐perceptions, preventive behaviors and perceptions of barriers and facilitators to cancer control in Ibadan, Nigeria and conducted thematic analysis. Results Participants demonstrated awareness of cancers and mentioned several risk factors related to individual behaviors and the environment. Nonetheless, myths and misconceptions as well as micro, meso and macro level barriers impede prevention and control efforts. Conclusion Developing and implementing comprehensive context‐relevant health literacy interventions in community settings are urgently needed.Copyright © 2016 John Wiley & Sons, Ltd.

  May 24, 2016   doi: 10.1002/pon.4158   open full text
• Co‐morbidity of depression, anxiety and fatigue in cancer patients receiving psychological care.
  Lei Zhu, Adelita V. Ranchor, Marije Lee, Bert Garssen, Josué Almansa, Robbert Sanderman, Maya J. Schroevers.
  Psycho-Oncology. May 19, 2016
  Objectives This study aimed to examine (1) subgroups of cancer patients with distinct co‐morbidity patterns of depression, anxiety and fatigue; (2) how individuals transitioned between these patterns; and (3) whether socio‐demographic, clinical and psychological care characteristics distinguished patients' transitions. Method This naturalistic, longitudinal study focused on 241 cancer patients receiving psycho‐oncological care in the Netherlands. Data were collected before initiation of psychological care (T1), 3 months (T2), and 9 months thereafter (T3). Latent transition analysis was performed examining research questions. Results Three distinct co‐morbidity patterns were identified: class 1 (‘mood disturbances and fatigue’), class 2 (‘mood disturbances’) and class 3 (‘few symptoms of mood disturbances and fatigue’). Half of those in class 1 remained in this group from T1 to T3, a quarter transitioned to class 2 and another quarter to class 3. Baseline physical symptoms distinguished these transitions: those with more physical symptoms tended to remain stable. Half of patients in class 2 remained stable from T1 to T3, 46% moved into class 3 and 8% into class 1. Baseline physical symptoms and years after cancer diagnosis significantly distinguished these transitions: the 8% moving to class 1 had more physical symptoms and were longer after cancer diagnosis. Most patients in class 3 remained stable from T1 to T3, and predictors of transitions could not be examined. Conclusions Three distinct co‐morbidity patterns of depression, anxiety and fatigue were identified and exhibited different symptom courses longitudinally. Those with poor physical health tended to report elevated mood disturbances and fatigue during psychological care. Copyright © 2016 John Wiley & Sons, Ltd.

  May 19, 2016   doi: 10.1002/pon.4153   open full text
• Randomized‐controlled trial of mindfulness‐based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long‐term follow‐up results.
  Linda E. Carlson, Rie Tamagawa, Joanne Stephen, Elaine Drysdale, Lihong Zhong, Michael Speca.
  Psycho-Oncology. May 18, 2016
  Background Mindfulness‐based cancer recovery (MBCR) and supportive expressive group therapy (SET) are two well‐validated psychosocial interventions, but they have not been directly compared, and little is known about long‐term outcomes. This comparative effectiveness study measured the effects of these two interventions immediately following the groups and for 1 year thereafter in distressed breast cancer survivors. Methods Two hundred fifty‐two distressed Stage I–III breast cancer survivors were randomized into either MBCR or SET. Women completed questionnaires addressing mood, stress symptoms, quality of life, social support, spirituality and post‐traumatic growth before and after the interventions, and 6 and 12 months later. Results Immediately following the intervention, women in MBCR reported greater reduction in mood disturbance (primarily fatigue, anxiety and confusion) and stress symptoms including tension, sympathetic arousal and cognitive symptoms than those in SET. They also reported increased emotional and functional quality of life, emotional, affective and positive social support, spirituality (feelings of peace and meaning in life) and post‐traumatic growth (appreciation for life and ability to see new possibilities) relative to those in SET, who also improved to a lesser degree on many outcomes. Effect sizes of the time × group interactions were small to medium, and most benefits were maintained over 12 months of follow‐up. Conclusions This study is the first and largest to demonstrate sustained benefits of MBCR in distressed breast cancer survivors relative to an active control. MBCR was superior to SET for improving psychological well‐being with lasting benefits over 1 year, suggesting these women gained long‐lasting and efficacious tools to cope with cancer. Trial Registration Registered on clinicaltrials.gov number NCT00390169, October 2006. Copyright © 2016 John Wiley & Sons, Ltd.

  May 18, 2016   doi: 10.1002/pon.4150   open full text
• Coping and resiliency enhancement program (CARE): a pilot study for interpreters in cancer care.
  Elyse R. Park, Jan E. Mutchler, Giselle Perez, Roberta E. Goldman, Halsey Niles, Vivian Haime, Cheyenne Fox Tree‐McGrath, Mai See Yang, Daniel Woolridge, July Suarez, Karen Donelan, William F. Pirl.
  Psycho-Oncology. May 16, 2016
  Objective There is a growing demand for interpreters in the cancer setting. Interpreters, the link to quality care for limited English proficiency patients, face many psychosocial stressors in their work. This project assessed interpreters' experiences of stress and piloted a resiliency program to help interpreters cope with stressors. Methods From 2013 to 2014, we pilot tested a targeted resiliency program with interpreters from three Boston‐based hospitals. In Phase 1, we conducted five focus groups (n = 31) to identify interpreters' psychosocial needs. In Phase 2, we developed and tested a 4‐h group program with 29 interpreters (response rate = 90%; 69% female, 54% Hispanic, 85% born outside of the U.S.). Results Phase 1. Stressors were patient‐based (seeing young patients decline), interactions with medical team (unsure of role), and systems‐based (appointment unpredictability). Phase 2. At baseline interpreters reported low abilities to cope with stress (measured by the Measure of Current Status (MOCS‐A)). At 4‐week follow‐up we found improvements in job satisfaction (p = .02; Cohen's d = .41) and declines in sick days (p = .08; Cohen's d = .38). Stress reactivity (MOCS‐A) improved; specifically participants reported feeling more assertive about their needs (p = .10; Cohen's d = .30) and more able to relax at will (p = .10; Cohen's d = .35)—important mechanisms to lower distress. Conclusions We piloted a resiliency program for medical interpreters in cancer care. We found that interpreters experience distress and have low coping skills. This program resulted in improved work factors and stress reactivity. Future research should include further implementation and testing in a larger, randomized trial. Copyright © 2016 John Wiley & Sons, Ltd.

  May 16, 2016   doi: 10.1002/pon.4137   open full text
• Spiritual well‐being and spiritual distress predict adjustment in adolescent and young adult cancer survivors.
  Crystal L. Park, Dalnim Cho.
  Psycho-Oncology. May 16, 2016
  Objective Spirituality is related to many aspects of cancer survivors' physical and psychological adjustment. Given their unique developmental issues, spiritual issues may be especially important to adolescent and young adult (AYA) survivors, yet little research has been conducted on spirituality with AYA survivors. The present study examines how two aspects of spirituality, spiritual well‐being (comprising faith and meaning/peace), and spiritual struggle relate to later post‐cancer adjustment. Methods At Time 1 (T1), 120 AYA survivors completed questionnaires on spirituality and adjustment (fear of recurrence, post‐traumatic stress symptoms, perceived post‐traumatic growth, psychological distress, and health‐related quality of life). Eighty‐three of these participants also completed these questionnaires at Time 2 (T2), one year later. Results Our sample reported fairly low spiritual well‐being (meaning/peace, faith) and spiritual struggle. As expected, T1 spiritual well‐being was positively correlated with some aspects of psychological adjustment at T2, whereas T1 spiritual struggle was inversely correlated with T2 psychological adjustment. Both dimensions of T1 spiritual well‐being, but not struggle, were positively associated with perceived T2 posttraumatic growth. In general, T1 spiritual well‐being and struggle correlated with T2 psychological adjustment even when demographics and cancer‐related variables were controlled. Conclusions These results suggest that while spirituality is not important to all AYA survivors, both spiritual well‐being and struggle have important associations with adjustment and may warrant clinical attention. Future research is needed to more fully understand the role of spirituality in AYA survivors' adjustment in more depth. Copyright © 2016 John Wiley & Sons, Ltd.

  May 16, 2016   doi: 10.1002/pon.4145   open full text
• Assessing depression in a geriatric cancer population.
  Rebecca M. Saracino, Mark I. Weinberger, Andrew J. Roth, Arti Hurria, Christian J. Nelson.
  Psycho-Oncology. May 16, 2016
  Objective To examine the ability of three popular self‐report measures of depression to assess depression in a geriatric cancer setting. Method Cancer patients 70 years or older and on active treatment completed the Geriatric Depression Scale‐Short Form, the Hospital Anxiety and Depression Scale, and the Center for Epidemiological Studies Depression Scale—Revised, and were interviewed using the depression module of the Structured Clinical Interview for DSM disorders (SCID) as the ‘gold standard.’ Analyses included calculating internal consistency, ROC curves, and the sensitivity and specificity to detect major depression (MDD) or minor depression (i.e. subthreshold depression). Results In a sample of 201 cancer patients (85% White; 64% completed college degree or higher), all three of the self‐report measures produced adequate internal consistency and predicted depression greater than chance. However, the published cutoff scores for detecting MDD produced inadequate sensitivity, suggesting these scores will miss as many as 33%–83% of geriatric cancer patients who are depressed. Revised cutoff scores were lower than published cutoff scores. Conclusion Although these measures produced good internal consistency and were better than chance at predicting depression in a geriatric cancer sample, the published cutoff scores for these measures did not perform well in predicting MDD nor minor depression. Of the three measures, the CES‐D appeared to have the most utility. This data suggests that these popular screening measures may be inadequate for reliably identifying depression in a geriatric cancer population. Researchers and clinicians, therefore, should use caution when selecting depression measures for geriatric cancer patients and consider using the lower cut‐off scores presented here.

  May 16, 2016   doi: 10.1002/pon.4160   open full text
• Intimacy after prostate cancer: A brief couples' workshop is associated with improvements in relationship satisfaction.
  Lauren M. Walker, Ngaire King, Zoe Kwasny, John W. Robinson.
  Psycho-Oncology. May 16, 2016
  Objective Prostate cancer (PCa) treatments often leave men with erectile dysfunction (ED). Even when ED treatments are effective in restoring men's ability to have an erection sufficient for intercourse, couples continue to struggle sexually. Effective treatments to help couples recover sexually are needed. Method PCa patients and partners (N = 59 couples) attending a one‐time couples' intimacy workshop, participated in an evaluation. The workshop, offered eight times over a 2‐year period, emphasized a couples‐based approach to treatment that enhances direct communication about sexuality and implementation of sexual recovery strategies that are consistent with the couple's values. Couples completed pre and post questionnaires (at baseline and 2 months later) assessing the primary outcome of relationship adjustment (Revised Dyadic Adjustment Scale) and secondary outcome of sexual function (Sexual Function Questionnaire). T‐tests were employed to examine pre‐post changes in scores. A small qualitative sub‐study was conducted on the use of a Commitment to Change goal‐setting exercise, completed during the workshop. Results Results provide insight into the specific nature of improvements. Patients and partners showed improvements in relationship satisfaction. Improvements with small‐to‐medium effect sizes were observed for patients and partners sexual function; however, after adjusting for multiple comparisons, these changes were no longer statistically significant. The specific goals set by couples, and their achievement status, are presented. Conclusions The workshop offers a comprehensive, one‐session intervention to help couples implement a treatment plan to promote sexual recovery after PCa treatment. Given the observed improvements, progression to a randomized control trial is warranted. Copyright © 2016 John Wiley & Sons, Ltd.

  May 16, 2016   doi: 10.1002/pon.4147   open full text
• Body image and psychological distress in nipple‐sparing mastectomy: the roles of self‐compassion and appearance investment.
  K. A. Sherman, S. Woon, J. French, E. Elder.
  Psycho-Oncology. May 11, 2016
  Objective Women with breast cancer face threats to body image following surgery. Nipple‐sparing mastectomy with immediate breast reconstruction (NSM + IBR) may minimise body image disturbance as this preserves the woman's skin and areola complex. We assessed levels of body image disturbance and psychological distress in women undergoing NSM + IBR. To further understand the body image–distress relationship, we investigated the potential moderating effect of self‐compassion and appearance investment on this relationship. Methods Women diagnosed with breast cancer (N = 75) who had undergone NSM + IBR completed online questionnaires including the Body Image Scale, general (Depression, Anxiety and Stress Scales) and cancer‐specific (Impact of Event Scale) psychological distress and Self‐Compassion Scale and Appearance Schemas Inventory – Revised. Results Mean general and cancer‐specific psychological distress scores were within normal ranges, and body image disturbance was moderately low. Body image was positively correlated with depression, stress, Impact of Event Scale scores and appearance investment and negatively correlated with self‐compassion. MANCOVA analyses indicated a significant moderating effect of self‐compassion and appearance investment on the body image disturbance–distress relationship (for depression, stress and intrusion), such that participants with high self‐compassion and low appearance investment experienced lower distress than individuals with low self‐compassion and high appearance investment. Conclusions Moderately low levels of psychological distress and body image disturbance suggest NSM + IBR may minimise adverse psychological impacts of mastectomy. Increased body image disturbance was associated with psychological distress and moderated by self‐compassion and appearance investment, suggesting a potential role for these characteristics as the focus of psychological interventions to minimise the negative impacts of mastectomy. Copyright © 2016 John Wiley & Sons, Ltd.

  May 11, 2016   doi: 10.1002/pon.4138   open full text
• Effectiveness of case management as a cross‐sectoral healthcare provision for women with breast cancer.
  Christiane Bleich, Cathrin Büscher, Hanne Melchior, Anna Grochocka, Andrea Thorenz, Holger Schulz, Uwe Koch, Birgit Watzke.
  Psycho-Oncology. May 06, 2016
  Objective Case management (CM) programs are intended to improve care coordination for cancer patients. This quasi‐experimental, controlled study evaluated whether such a program was effective in improving health‐related quality of life and reducing the psychological distress of breast cancer patients. Methods For the study, 126 patients with CM and 118 patients with treatment as usual (TAU) were surveyed at baseline, a 6‐month follow‐up and a 12‐month follow‐up. Comparisons of the two groups with regard to quality of life (Short Form‐8, European Organization for Research and Treatment of Cancer‐11; primary outcome) and psychological distress (Hospital Anxiety and Depression Scale, distress thermometer; secondary outcome) were conducted. Results Univariate t‐tests regarding the primary and secondary outcomes demonstrated improvements in the relevant outcomes at the 6‐month and 12‐month follow‐ups for the intervention group as well as for the control group. An analysis of covariance revealed that the controls showed a higher level of physical quality of life at the 12‐month follow‐up than the other time points and no differences at 6 months after the baseline. Conclusions The tested CM model did not improve the quality of life or psychological well‐being of the patients beyond treatment as usual. Possible reasons include that the treatment was already of high standards in the control group or that there are possibly different impacts than found in the literature regarding different forms of organization in CM. The need for and the tailoring of this CM model as well as the transfer of CM to other oncological indications remain to be clarified. Copyright © 2016 John Wiley & Sons, Ltd.

  May 06, 2016   doi: 10.1002/pon.4139   open full text
• Infancy and pediatric cancer: an exploratory study of parent psychological distress.
  L. Vernon, D. Eyles, C. Hulbert, L. Bretherton, M. C. McCarthy.
  Psycho-Oncology. May 05, 2016
  Background Research on the psychological experiences of parents of infants within pediatric oncology is sparse. This study examined rates and indicative risk factors for psychological distress in parents where there is either an infant patient or infant sibling of a patient. Methods Participants were mothers (n = 41) and fathers (n = 25) of infants under 2 years who either had a cancer diagnosis (n = 37; infant patients) or was an infant sibling of an older child with cancer (n = 29; infant siblings) recruited from a single oncology center. There were 21 couple dyads. Parents completed the Depression Anxiety Stress Scales short form and the Posttraumatic Stress Disorder Checklist. Results Mothers (47.5%) and fathers (37.5%) reported elevated, cancer‐related posttraumatic stress symptoms. Rates of depression (12.2% of mothers and 12.0% of fathers) and anxiety symptoms (17.1% of mothers and 8.0% of fathers) were lower. Compared with parents of infant patients, parents of infant siblings reported significantly higher rates of depressive symptoms and trends toward higher rates of posttraumatic stress symptoms and anxiety symptoms. Parent anxiety was higher with increased time post diagnosis. No demographic or illness‐related variables were associated with psychological distress, with the exception of the number of children in the family. Conclusions Parent–child relationships are of fundamental importance during infancy. This study provides novel data highlighting the psychological impact for parents when a cancer diagnosis is made during this critical developmental period, including the contribution of family structure to parental distress. Results provide further support for applying a traumatic stress framework when exploring parent experiences of pediatric cancer. Copyright © 2016 John Wiley & Sons, Ltd.

  May 05, 2016   doi: 10.1002/pon.4141   open full text
• Cognitive behavioral therapies for informal caregivers of patients with cancer and cancer survivors: a systematic review and meta‐analysis.
  Mia S. O'Toole, Robert Zachariae, Megan E. Renna, Douglas S. Mennin, Allison Applebaum.
  Psycho-Oncology. May 05, 2016
  Objective Informal caregivers (ICs) of patients with cancer and cancer survivors report a number of psychological and physical complaints because of the burden associated with providing care. Given the documented effect of Cognitive Behavioral Therapy (CBT) on ICs' common psychological complaints, such as anxiety and depression, the objective was to conduct a meta‐analysis on the effect of CBTs for adult ICs. Methods A literature search was conducted in order to identify all intervention studies on adult ICs that employed at least one therapeutic component defined as a CBT component. Results Literature searches revealed 36 unique records with sufficient data. These studies were subjected to meta‐analyses using random effects models. A small, statistically significant effect of CBTs (Hedge's g = 0.08, p = 0.014) was revealed, which disappeared when randomized controlled trials were evaluated alone (g = 0.04, p = 0.200). A number of variables were explored as moderators. Only the percentage of female participants was positively associated with the effect size. Conclusions Based on the negligible effect of CBTs across outcomes, future studies should consider moving beyond traditional CBT methods as these do not appear efficacious. It is suggested that future interventions orient towards advances in the basic affective sciences and derived therapies in order to better understand and treat the emotional struggles experienced by ICs. © 2016 The Authors. Psycho‐Oncology published by John Wiley & Sons Ltd.

  May 05, 2016   doi: 10.1002/pon.4144   open full text
• Meaning‐based coping, chronic conditions and quality of life in advanced cancer & caregiving.
  Katrina R. Ellis, Mary R. Janevic, Trace Kershaw, Cleopatra H. Caldwell, Nancy K. Janz, Laurel Northouse.
  Psycho-Oncology. May 05, 2016
  Objective This study examined the relationship between the number of co‐existing health problems (patient comorbidities and caregiver chronic conditions) and quality of life (QOL) among patients with advanced cancer and their caregivers and assessed the mediating and moderating role of meaning‐based coping on that relationship. Methods Data came from patients with advanced cancers (breast, colorectal, lung, and prostate) and their family caregivers (N = 484 dyads). Study hypotheses were examined with structural equation modeling using the actor‐partner interdependence mediation model. Bootstrapping and model constraints were used to test indirect effects suggested by the mediation models. An interaction term was added to the standard actor‐partner interdependence model to test for moderation effects. Results More patient comorbidities were associated with lower patient QOL. More caregiver chronic conditions were associated with lower patient and caregiver QOL. Patient comorbidities and caregiver chronic conditions had a negative influence on caregiver meaning‐based coping but no significant influence on patient meaning based coping. Caregiver meaning‐based coping mediated relationships between patient comorbidities and caregiver health conditions and patient and caregiver QOL. No significant moderating effects were observed. Conclusions Despite the severity of advanced cancer for patients and caregivers, the co‐existing health problems of one member of the dyad have the potential to directly or indirectly affect the wellbeing of the other. Future research should consider how the number of patient comorbidities and caregiver chronic conditions, as well as the ability of patients and caregivers to manage those conditions, influences their meaning‐based coping and wellbeing. Copyright © 2016 John Wiley & Sons, Ltd.

  May 05, 2016   doi: 10.1002/pon.4146   open full text
• The effects of music therapy in patients with high‐dose chemotherapy and stem cell support: a randomized pilot study.
  Gert Tuinmann, Pia Preissler, Hauke Böhmer, Anna Suling, Carsten Bokemeyer.
  Psycho-Oncology. May 05, 2016
  Objective Patients with high dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) are highly distressed. Psycho‐oncological support might be beneficial but is not routinely provided. Our aim was to investigate whether music therapy (MT) in addition to standard supportive treatment had any effect on quality of life, depression, anxiety, side effects of therapy, medication, and immunological changes during and within three months after HDC plus ASCT. Methods Patients (n = 66) with HDC plus ASCT were randomly assigned to either MT (Intervention Group = IG) or standard supportive treatment (Control Group = CG). Quality of life was measured by EORTC QLQ‐C30. Depression and anxiety were measured by the HADS‐D before transplantation, during and after the inpatient stay. In addition, adverse events (AE), medication, and immunological parameters were observed. Results There was no improvement of global quality of life for patients receiving additional MT, but their perception of pain significantly changed (p = 0.027). Patients were neither depressed nor anxious on admission, therefore no improvements were found. IG patients had less 3–4° toxicities (e.g., mucositis). Aprepitant for antiemetic therapy was administered significantly more often in the CG (p = 0.040). The IgA decline and T4 count was less in IG, T8, and NK count decreased most in IG. These findings failed significance. Conclusions MT may improve pain perception in patients receiving HDC plus ASCT. Additionally positive effects on toxicities, use of antiemetic medication, and immunological changes were observed. As some of these findings failed significance, studies with larger sample sizes are needed. Copyright © 2016 John Wiley & Sons, Ltd.

  May 05, 2016   doi: 10.1002/pon.4142   open full text
• A systematic review of sleep in hospitalized pediatric cancer patients.
  Soeun Lee, Gaya Narendran, Lianne Tomfohr‐Madsen, Fiona Schulte.
  Psycho-Oncology. May 05, 2016
  Objective The purpose of this systematic review was to describe the occurrence of sleep disruptions in pediatric cancer patients and to identify and discuss the factors related to the hospital sleep environment that may be associated with disturbed sleep. Methods A total of 108 articles were located in five databases (PubMed, PsychINFO, Medline, CancerLit, and Google Scholar), and seven met our inclusion criteria and formed the basis of this review. Results Participants ranged from 1 to 18 years (n = 147). Data from objective and subjective assessments of sleep showed that child sleep was disrupted in the hospital when compared to previously established age‐related norms. Noise, light levels, and staff room interruptions were associated with decreased total sleep minutes and increased nighttime awakenings. Methodological limitations of the current research as well as potential directions for future research are discussed. Conclusions Investigations into the sources of increased sleep difficulties can be used to inform hospital procedures to create a more supportive sleep environment and more effective screening tools for patients who may be at greater risk for sleep difficulties. This may help to minimize the role that hospitalization plays in precipitating and perpetuating chronic sleep disturbances in pediatric cancer patients. Copyright © 2016 John Wiley & Sons, Ltd.

  May 05, 2016   doi: 10.1002/pon.4149   open full text
• The relationship between illness representations, risk perception and fear of cancer recurrence in breast cancer survivors.
  Laurie A. Freeman‐Gibb, Nancy K. Janz, Maria C. Katapodi, Brian J. Zikmund‐Fisher, Laurel Northouse.
  Psycho-Oncology. May 04, 2016
  Objective Fear of cancer recurrence, although distinct from distress continues to be under‐evaluated, captured, or treated when standard distress scales are used to assess concerns of cancer survivors. We tested a model assessing the association of demographic and clinical factors, illness representations, and perceived risk with fear of cancer recurrence in breast cancer survivors. Methods We recruited 117 breast cancer survivors at least one year after completing breast cancer treatment from Internet discussion boards for this cross‐sectional, descriptive, correlational study. Participants completed a survey that assessed their level of fear of cancer recurrence as well as their illness representations, perceived risk of recurrence, and demographic and medical characteristics. Results Our model explained 62% of the variance in fear of cancer recurrence. Emotional representations (β = .46, p < .01), symptom attribution (β = .21, p < .01), timeline (β = .23, p < .01), and consequences (β = .16, p < .03) were significantly related to fear of recurrence. By contrast, the majority of clinical and demographic variables were not significant contributors to fear of recurrence. Conclusions Upon completion of cancer treatment, survivors with more emotional representations of the experience and those who attribute unrelated symptoms to their breast cancer have a higher level of fear of recurrence. Evaluation of these factors during treatment may help mitigate fear of recurrence in the survivorship phase of the breast cancer trajectory. Copyright © 2016 John Wiley & Sons, Ltd.

  May 04, 2016   doi: 10.1002/pon.4143   open full text
• Feasibility, acceptability and preliminary psychological benefits of mindfulness meditation training in a sample of men diagnosed with prostate cancer on active surveillance: results from a randomized controlled pilot trial.
  David Victorson, Vered Hankin, James Burns, Rebecca Weiland, Carly Maletich, Nathaniel Sufrin, Stephanie Schuette, Bruriah Gutierrez, Charles Brendler.
  Psycho-Oncology. May 03, 2016
  Objective In a pilot randomized controlled trial, examine the feasibility and preliminary efficacy of an 8‐week, mindfulness training program (Mindfulness Based Stress Reduction) in a sample of men on active surveillance on important psychological outcomes including prostate cancer anxiety, uncertainty intolerance and posttraumatic growth. Methods Men were randomized to either mindfulness (n = 24) or an attention control arm (n = 19) and completed self‐reported measures of prostate cancer anxiety, uncertainty intolerance, global quality of life, mindfulness and posttraumatic growth at baseline, 8 weeks, 6 months and 12 months. Results Participants in the mindfulness arm demonstrated significant decreases in prostate cancer anxiety and uncertainty intolerance, and significant increases in mindfulness, global mental health and posttraumatic growth. Participants in the control condition also demonstrated significant increases in mindfulness over time. Longitudinal increases in posttraumatic growth were significantly larger in the mindfulness arm than they were in the control arm. Conclusions While mindfulness training was found to be generally feasible and acceptable among participants who enrolled in the 8‐week intervention as determined by completion rates and open‐ended survey responses, the response rate between initial enrollment and the total number of men approached was lower than desired (47%). While larger sample sizes are necessary to examine the efficacy of mindfulness training on important psychological outcomes, in this pilot study posttraumatic growth was shown to significantly increase over time for men in the treatment group. Mindfulness training has the potential to help men cope more effectively with some of the stressors and uncertainties associated with active surveillance. Copyright © 2016 John Wiley & Sons, Ltd.

  May 03, 2016   doi: 10.1002/pon.4135   open full text
• Examination of moderators of expressive writing in patients with renal cell carcinoma: the role of depression and social support.
  Kathrin Milbury, Gabriel Lopez, Amy Spelman, Christopher Wood, Surena F. Matin, Nizar M. Tannir, Eric Jonasch, Louis Pisters, Qi Wei, Lorenzo Cohen.
  Psycho-Oncology. May 03, 2016
  Objective To identify groups most likely to benefit from an Expressive Writing (EW) intervention, we examined psychosocial variables as intervention moderators. We hypothesized that EW would be particularly effective for participants with high levels of depressive symptoms and social support at study entry. Methods Patients (n = 277; 60.6% male) with kidney cancer were randomly assigned to either an expressive (EW) or neutral writing (NW) condition. Intervention outcomes included measures of depressive symptoms (CESD), cancer‐related symptoms (MDASI), fatigue (BFI), and sleep disturbances (PSQI) assessed at baseline, 1, 4, and 10 months later. Moderators were measured at baseline. Results As hypothesized, depressive symptoms and social support moderated intervention efficacy. When examining both moderators simultaneously, EW appeared to be most effective in terms of cancer‐related symptoms (p < 0.05) and depressive symptoms (p < 0.01) for participants with elevated depressive symptoms who received high levels of social support at baseline relative to their counterparts in the NW condition. Moreover, participants in EW with high levels of social support at baseline reported lower levels sleep disturbances (p = 0.005) than their counterparts in NW. Conclusions Recognition of baseline depressive symptoms and social support as intervention moderators may lead to improved patient selection for EW interventions, as EW may be particularly beneficial regarding QOL outcomes for patients that have social support available including participants with depressive symptoms. EW may not be beneficial, or potentially even contraindicated, for participants lacking social support. Copyright © 2016 John Wiley & Sons, Ltd.

  May 03, 2016   doi: 10.1002/pon.4148   open full text
• The intensity of caregiving is a more important predictor of adverse bereavement outcomes for adult–child than spousal caregivers of patients who die of cancer.
  Sarah McLean, Barbara Gomes, Irene J. Higginson.
  Psycho-Oncology. May 02, 2016
  Increasing attention is being paid to specific difficulties experienced by bereaved family caregivers (FCs). Limited capacity within health and social care structures results in high intensity of informal caregiving. The focus of recent research is the identification of specific predictors of adverse FC outcomes, in order to identify those FCs who will benefit most from intervention and support. Research is challenged by multiple influencing and confounding variables. This study aimed to evaluate factors of care associated with higher grief intensity in bereaved adult–child (AC‐FCs) and spousal FCs (S‐FCs). Data from the Qualycare study, a mortality follow‐back study of bereaved FCs of patients who died of cancer, was analyzed. Four hundred eighty‐four patient–FC dyads were included: 246 AC‐FCs and 238 S‐FCs. S‐FCs received more formal (SPC) (p = 0.026), and AC‐FCs more informal (p < 0.001), support. AC‐FCs were more likely to continue to work while caregiving (p < 0.001). Patients with AC‐FCs were more likely to spend time in and die in a nursing home (p < 0.001). Higher grief intensity was associated with higher caregiving intensity (p < 0.001), as well as other factors. AC‐FCs whose relative died in NH experienced significantly lower grief intensity (p < 0.001). Intensity of caregiving predicted 11.6% of variance in grief intensity for AC‐FCs compared to 0.5% for S‐FCs. The ‘relief model’ of bereavement is relevant for AC‐FCs. The support needs of AC‐FCs and S‐FCs differ. AC‐FCs should be targeted for practical supports and interventions, in order to support home‐death, if desired by patient and FC, and optimize bereavement outcomes.Copyright © 2016 John Wiley & Sons, Ltd.

  May 02, 2016   doi: 10.1002/pon.4132   open full text
• The experiences of caregivers of patients with delirium, and their role in its management in palliative care settings: an integrative literature review.
  Anne M. Finucane, Jean Lugton, Catriona Kennedy, Juliet A. Spiller.
  Psycho-Oncology. May 01, 2016
  Objectives To explore the experiences of caregivers of terminally ill patients with delirium, to determine the potential role of caregivers in the management of delirium at the end of life, to identify the support required to improve caregiver experience and to help the caregiver support the patient. Methods Four electronic databases were searched—PsychInfo, Medline, Cinahl and Scopus from January 2000 to July 2015 using the terms ‘delirium’, ‘terminal restlessness’ or ‘agitated restlessness’ combined with ‘carer’ or ‘caregiver’ or ‘family’ or ‘families’. Thirty‐three papers met the inclusion criteria and remained in the final review. Results Papers focused on (i) caregiver experience—distress, deteriorating relationships, balancing the need to relieve suffering with desire to communicate and helplessness versus control; (ii) the caregiver role—detection and prevention of delirium, symptom monitoring and acting as a patient advocate; and (iii) caregiver support—information needs, advice on how to respond to the patient, interventions to improve caregiver outcomes and interventions delivered by caregivers to improve patient outcomes. Conclusion High levels of distress are experienced by caregivers of patients with delirium. Distress is heightened because of the potential irreversibility of delirium in palliative care settings and uncertainty around whether the caregiver–patient relationship can be re‐established before death. Caregivers can contribute to the management of patient delirium. Additional intervention studies with informational, emotional and behavioural components are required to improve support for caregivers and to help the caregiver support the patient. Reducing caregiver distress should be a goal of any future intervention. © 2016 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.

  May 01, 2016   doi: 10.1002/pon.4140   open full text
• Depression and healthcare service utilization in patients with cancer.
  Brent T. Mausbach, Scott A. Irwin.
  Psycho-Oncology. April 21, 2016
  Objective It is estimated that as many as 38% of cancer patients suffer from depression, which may have distal impacts on cancer care, including clinical outcomes, health care utilization, and cost of care. The purpose of this study was to determine the impact of depression on overall healthcare utilization among patients with cancer. Methods A retrospective analysis of administrative data was conducted on 5055 patients with an ICD‐9 diagnosis of cancer from a single large healthcare system. Of these, 561 (11.1%) had ICD‐9 diagnoses consistent with a depressive disorder. Negative binomial regression modeling was used to test the association between depression status and total annual healthcare visits for the year 2011. Logistic regression was used to examine the association between depression and secondary outcomes of emergency department visit, overnight hospitalization, and 30‐day hospital readmission. Results After adjusting for age, gender, race/ethnicity, insurance type, medical comorbidities, length of time with cancer, and metastatic status, depressed patients had significantly more annual non‐mental health provider healthcare visits (aRR = 1.76, 95% CI = 1.61–1.93), and were significantly more likely to have an ED visit (OR = 2.45; 95% CI = 1.97–3.04), overnight hospitalization (OR = 1.81; 95% CI = 1.49–2.20), and 30‐day hospital readmission (OR = 2.03; 95% CI = 1.48–2.79) than non‐depressed patients with cancer. Conclusions Among patients with cancer, the presence of depression was associated with greater healthcare utilization. Effective screening for, and management of, depression may help reduce overall healthcare utilization and cost while improving care quality. Copyright © 2016 John Wiley & Sons, Ltd.

  April 21, 2016   doi: 10.1002/pon.4133   open full text
• Co‐worker perceptions of return‐to‐work opportunities for Japanese cancer survivors.
  Hisashi Eguchi, Koji Wada, Yoshiyuki Higuchi, Derek R. Smith.
  Psycho-Oncology. April 13, 2016
  Purpose This study examined workplace factors and perceptions of Return‐to‐Work (RTW) opportunities for colleagues with cancer‐related symptoms and/or treatment side effects in Japan. Methods We conducted an online, cross‐sectional survey of 3710 employed Japanese individuals of working age. Colleagues' perceptions of RTW opportunities for cancer survivors were examined (using a Japanese questionnaire), along with workplace factors such as job demand, job control and workplace social support (using the Brief Job Stress Questionnaire). Associations between workplace factors and RTW opportunities were evaluated using multiple logistic regression analysis, with participants stratified in tertiles (low, middle and high) according to their levels of workplace social support and job control. Results Colleagues' perceptions of inadequate RTW opportunities were associated with low workplace social support (middle tertile: Odds Ratio [OR] 1.22, 95% Confidence Interval [CI]: 1.08–1.36; low tertile: OR 1.43, 95%CI: 1.30–1.57; p for trend <0.01); low levels of job control (middle tertile: OR 1.27, 95%CI: 1.06–1.50; low tertile: OR 1.91, 95%CI: 1.64–2.21; p for trend <0.01); and no prior experience working with a cancer survivor (OR 2.08, 95%CI: 1.83–2.31). Conclusions This study suggests that workplace factors and prior experience of working with a cancer survivor may affect a colleagues' perception of RTW opportunities in Japanese workplaces. Consideration of workplace social factors (workplace support and job control), as well as increased openness and awareness of the particular needs of cancer survivors, is therefore essential to facilitate successful RTW in Japan, as elsewhere.Copyright © 2016 John Wiley & Sons, Ltd.

  April 13, 2016   doi: 10.1002/pon.4130   open full text
• Unmet needs of non‐Hodgkin lymphoma survivors in Korea: prevalence, correlates, and associations with health‐related quality of life.
  Soo Hyun Kim, Suyeon Lee, So Hee Kim, Oh Nam Ok, Im‐Ryung Kim, Eunju Choi, Yoon‐Koo Kang, Seok Jin Kim, Moon Hee Lee.
  Psycho-Oncology. April 13, 2016
  Objective We aimed to describe the prevalence and correlates of unmet needs among non‐Hodgkin lymphoma (NHL) survivors in Korea and to identify their association with health‐related quality of life (HRQOL). Methods Participants were 826 NHL survivors from three hospitals in South Korea diagnosed at least 24 months prior to participating (mean, 6.3 years; range, 2.1–20.9 years). We used self‐reported questionnaires, including the Need Scale for Cancer Patients Undergoing Follow‐up Care (NS‐C) developed in Korea and the EORTC QLQ‐C30. We defined an unmet need as a moderate to high level of unmet need in the NS‐C response scale. Results Among six domains, unmet need prevalence ranged from 1.7% to 38.3%. Most commonly reported domains with unmet needs were ‘treatment and prognosis’ (38.3%) and ‘keeping mind under control’ (30.5%). The three most frequently reported individual unmet needs were ‘being informed about prevention of recurrence’ (50.7%), ‘being informed about prevention of metastasis’ (49.7%), and ‘having self‐confidence of overcoming cancer’ (42.7%). Multivariate logistic analyses revealed that younger age, being unmarried, and low monthly income were associated with unmet needs of multiple domains. Participants with unmet needs demonstrated significantly poorer HRQOL, and the most clinically meaningful differences were found in social function and emotional function. Conclusions Korean NHL survivors have substantial unmet needs, especially those who are younger, unmarried, and have a lower income. Initiating supportive care programs for meeting unmet needs may enhance their HRQOL. Copyright © 2016 John Wiley & Sons, Ltd.

  April 13, 2016   doi: 10.1002/pon.4136   open full text
• Prevalence and associated positive psychological variables of anxiety and depression among patients with central nervous system tumors in China: a cross‐sectional study.
  Yijun Bao, Lizhuo Li, Yanlei Guan, Wei Wang, Yan Liu, Pengfei Wang, Xiaolong Huang, Shanwei Tao, Yunjie Wang.
  Psycho-Oncology. April 13, 2016
  Background Anxiety and depression have been identified as common psychological distresses faced by the majority of patients with cancer. However, no studies have investigated the relationship between positive psychological variables (hope, optimism and general self‐efficacy) and anxiety and depression among patients with central nervous system (CNS) tumors in China. Our hypothesis is that the patients with higher levels of hope, optimism or general self‐efficacy have lower levels of anxiety and depression when encountered by stressful life events such as CNS tumors. Methods Questionnaires, including the Hospital Anxiety and Depression Scale, the Herth Hope Index, the Life Orientation Scale‐Revised and the General Self‐Efficacy Scale, and demographic and clinical records were used to collect information about patients with CNS tumors in Liaoning Province, China. The study included 222 patients (effective response rate: 66.1%). Hierarchical linear regression analyses were performed to explore the associations among hope, optimism, general self‐efficacy and anxiety/depression. Results Prevalence of anxiety and depression were 42.8 and 32.4%, respectively, among patients with CNS tumors. Hope and optimism both were negatively associated with anxiety and together accounted for 21.4% of variance in anxiety. Similarly, hope and optimism both were negatively associated with depression and accounted for 32.4% of variance in depression. Conclusions The high prevalence of anxiety and depression among patients with CNS tumors should receive more attention in Chinese medical settings. To help reduce anxiety and depression, health care professionals should develop interventions to promote hope and optimism based on patients' specific needs. Copyright © 2016 John Wiley & Sons, Ltd.

  April 13, 2016   doi: 10.1002/pon.4128   open full text
• Experiences of cervical screening and barriers to participation in the context of an organised programme: a systematic review and thematic synthesis.
  Amanda J. Chorley, Laura A. V. Marlow, Alice S. Forster, Jessica B. Haddrell, Jo Waller.
  Psycho-Oncology. April 12, 2016
  Objective As uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on women's perceptions and experiences of cervical screening in the context of an organised call–recall programme, in order to understand the barriers to informed uptake. Methods We searched nine databases for English language peer‐reviewed publications reporting on qualitative data from screening‐eligible women, exploring barriers to cervical screening in countries that offer a nationally organised call–recall programme. Evidence was integrated using thematic synthesis. Results Thirty‐nine papers from the UK, Australia, Sweden and Korea were included. The majority of participants had attended screening at least once. Two broad themes were identified: (a) should I go for screening? and (b) screening is a big deal. In considering whether to attend, women discussed the personal relevance and value of screening. Women who had previously attended described how it was a big deal, physically and emotionally, and the varied threats that screening presents. Practical barriers affected whether women translated screening intentions into action. Conclusions The variation in women's understanding and perceptions of cervical screening suggests that interventions tailored to decisional stage may be of value in increasing engagement with the invitation and uptake of screening in those who wish to take part. There is also a need for further research with women who have never attended screening, especially those who remain unaware or unengaged, as their perspectives are lacking in the existing literature. © 2016 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.

  April 12, 2016   doi: 10.1002/pon.4126   open full text
• Comparing the meanings of living with advanced breast cancer between women resilient to distress and women with persistent distress: a qualitative study.
  W. W. T. Lam, S. W. Yoon, W. K. Sze, A. W. Y. Ng, I. Soong, A. Kwong, D. Suen, J. Tsang, W. Yeo, K. Y. Wong, R. Fielding.
  Psycho-Oncology. April 06, 2016
  Background Most women with advanced breast cancer (ABC) show little distress, but about one in ten show persistent distress over time. It remains unclear if meanings ascribed by patients to ABC differentiate these distress trajectories. Study aims This qualitative study (a) compared illness meanings of ABC between women with persistent psychological distress and those with low/transient distress, and (b) examined how illness meanings might influence coping strategies. Methods The sample was drawn from a prior quantitative study exploring psychological distress trajectories following ABC diagnosis. Overall, 42 Cantonese‐ or Mandarin‐speaking Chinese women diagnosed with locally advanced or metastatic ABC were recruited based on their distress trajectory status (low‐stable, transient, or persistent distress). Interviews were recorded, transcribed, and analyzed following grounded theory approach using simultaneous analysis. Results Women with persistent distress viewed their diagnosis as another blow in life, the illness was global, permeating every aspect of their life. Maladaptive rumination and thought suppression were common responses to illness demands. These women had poor social support. A sense of demoralization stood out in their narratives. In contrast, women with transient/low‐stable distress encapsulated the illness, with minimum impacts of their life. They did not evidence dysfunctional repetitive thoughts. Living in a supportive environment, they were able to accept and/or live in the present‐moment. Conclusions Rumination, thought suppression, social constraints, and pre‐existing exposure to life stress may be potential risks for chronic distress in response to advanced breast cancer. Persistent and transient distress responses to cancer may have different underpinnings. Copyright © 2016 John Wiley & Sons, Ltd.

  April 06, 2016   doi: 10.1002/pon.4116   open full text
• Inequalities in long term health‐related quality of life between partnered and not partnered breast cancer survivors through the mediation effect of social support.
  Janni Leung, Michelle D. Smith, Deirdre McLaughlin.
  Psycho-Oncology. April 06, 2016
  Objective To compare long‐term quality of life outcomes by marital status among women living with breast cancer, and to test the mediation effects of social support as an underlying factor. Methods Data are drawn from 1996 to 2010 of the Australian Longitudinal Study on Women's Health. The sample included 505 women with breast cancer with six years of follow‐up data. Social support was measured by the Medical Outcomes Study Social Support Survey (MOS‐SSS). Physical and mental health‐related quality of life (HRQOL) was measured using the Short‐Form Health Survey (SF‐36). Results Breast cancer survivors who did not have a partner, compared to those who had a partner, had significantly lower levels of social support, which was associated with poorer HRQOL. Social support mediated the relationship between not having a partner and poorer HRQOL. Results were consistent after taken into consideration socio‐demographic characteristics, which included age, highest level of education, country of birth, and area of residence. Conclusions Women recovering from breast cancer who do not have partners have poorer physical and mental HRQOL, than those with partners, with a lack of social support as an underlying inequality. Partners of breast cancer survivors are importance sources in the provision of social support to help them maintain well‐being and quality of life. Copyright © 2016 John Wiley & Sons, Ltd.

  April 06, 2016   doi: 10.1002/pon.4131   open full text
• Savoring moderates the association between cancer‐specific physical symptoms and depressive symptoms.
  Wai Kai Hou, Kam Man Lau, Sin Man Ng, Ashley Chi Kin Cheng, Tracy Chui Yu Shum, Sheung‐tak Cheng, Hester Yui Shan Cheung.
  Psycho-Oncology. March 16, 2016
  Background This study investigated the associations of savoring with cancer‐specific physical symptoms, psychological distress, and psychological well‐being and the moderating effect of savoring in the associations between physical symptoms and psychological outcomes among cancer patients. Methods A total of 263 Chinese adults recently diagnosed with cancer (mean time since diagnosis = 43.72 days, SD = 38.20) were recruited and administered a questionnaire assessing cancer‐specific physical symptoms, perceived capability of savoring the moment, psychological distress, and psychological well‐being within six months following diagnosis. Results Structural equation modeling revealed significant associations of savoring with physical symptoms and psychological distress and well‐being (β = −0.41–0.54, p < 0.0001). Savoring significantly moderated the association between physical symptoms and depressive symptoms. Simple slope tests revealed that the association was not significant at higher levels of savoring (estimate = 0.15, z = 0.49, p = 0.62) whereas it was stronger at lower (estimate = 1.11, z = 4.81, p < 0.001) and medium (estimate = 0.63, z = 3.04, p < 0.01) levels of savoring. The effects of demographic and medical covariates were controlled for in all models. Conclusions The findings suggest that savoring is positively associated with physical and psychological functioning among people with cancer. The link between physical symptoms and depressive symptoms could be exacerbated at lower levels of savoring. Fostering savoring beliefs and practices could be a significant psychological component of symptom management among cancer patients. Copyright © 2016 John Wiley & Sons, Ltd.

  March 16, 2016   doi: 10.1002/pon.4114   open full text
• Promoting improved family caregiver health literacy: evaluation of caregiver communication resources.
  Elaine Wittenberg, Joy Goldsmith, Betty Ferrell, Sandra L. Ragan.
  Psycho-Oncology. March 16, 2016
  Objectives Family caregivers of cancer patients have a vital role in facilitating and sharing information about cancer, revealing a need to develop caregiver health literacy skills to support caregiver communication. The goal of this study was to investigate caregiver print materials and develop and assess a new caregiver communication resource titled A Communication Guide for CaregiversTM. Methods Using a model of six domains of caregiver health literacy skills, print cancer education materials were collected and evaluated for caregiver communication support. A new caregiver communication resource was also developed and assessed by caregivers and healthcare providers. Caregivers reviewed content and assessed utility, relatability, and reading quality. Healthcare providers also assessed whether the material would be understandable and usable for cancer caregivers. Results Only three of the 28 print materials evaluated were written at the recommended sixth grade reading level and only five addressed all six caregiver health literacy skills. Readability scores for A Communication Guide for CaregiversTM were at the sixth grade level, and caregivers reported its contents were relatable, useful, and easy to read. Healthcare providers also rated the material as easy for patient/family members of diverse backgrounds and varying levels of literacy to understand and use. Conclusions Existing print‐based caregiver education materials do not address caregivers' health literacy skill needs and are aimed at a highly literate caregiving population. A Communication Guide for CaregiversTM meets health literacy standards and family caregiver and provider communication needs. The findings are relevant for healthcare professionals who provide cancer education. Copyright © 2016 John Wiley & Sons, Ltd.

  March 16, 2016   doi: 10.1002/pon.4117   open full text
• Grief symptoms and difficult patient loss for oncologists in response to patient death.
  Leeat Granek, Merav Ben‐David, Shahar Shapira, Gil Bar‐Sela, Samuel Ariad.
  Psycho-Oncology. March 14, 2016
  Objective The study aimed to explore oncologist's grief symptoms over patient death and to identify why and which losses are particularly challenging when patients die. Methods The grounded theory method was used to collect and analyze the data. Twenty‐two oncologists were interviewed between March 2013 and June 2014 from three adult oncology centers in the north, center, and south of Israel. Oncologists were at different stages of their careers and varied in their sub‐specialties, gender, and personal and professional backgrounds. Results Grief begun when the patient died, in anticipation of the patient's death, many days after the death, or when the patient received a poor prognosis. The phenomenological experience of grief for oncologists included behavioral, cognitive, physical, and emotional symptoms in response to patient death. Behavioral symptoms included crying and difficulties sleeping. Cognitive symptoms included self‐doubt and rumination about the patient and the care the patient had received before death. Physical symptoms included chest pain, fatigue, and general physical discomfort. Emotional symptoms included sadness, anxiety, helplessness, guilt, relief, irritability, and loss. Difficult patient loss was caused by patient‐related factors, family‐related factors, and disease‐related factors. Conclusions Patient deaths result in behavioral, cognitive, physical, and emotional symptoms of grief in oncologists. These symptoms become particularly intense in the context of patient, family, and disease‐related factors. Educational and supportive interventions for managing grief related to patient death are needed in order to support oncologists in their emotionally and mentally taxing work. Copyright © 2016 John Wiley & Sons, Ltd.

  March 14, 2016   doi: 10.1002/pon.4118   open full text
• A systematic review of inequalities in psychosocial outcomes for women with breast cancer according to residential location and Indigenous status in Australia.
  PH Youl, P Dasgupta, D Youlden, JF Aitken, G Garvey, H Zorbas, J Chynoweth, I Wallington, PD Baade.
  Psycho-Oncology. March 14, 2016
  Background The aim of this systematic review was to examine variations in psychosocial outcomes by residential location and Indigenous status in women diagnosed with breast cancer (BC) in Australia. Methods Systematic searches were undertaken using multiple databases covering articles between 1 January 1990 and 1 March 2015 focusing on adult women with BC in an Australian setting and measuring quality of life (QOL), psychological distress or psychosocial support. Results Thirteen quantitative and three qualitative articles were included. Two quantitative and one qualitative article were rated high quality, seven moderate and the remaining were low quality. No studies examining inequalities by Indigenous status were identified. Non‐metropolitan women were more likely to record lower QOL relating to breast cancer‐specific concerns and reported a lack of information and resources specific to their needs. Continuity of support, ongoing care and access to specialist and allied health professionals were major concerns for non‐metropolitan women. Non‐metropolitan women identified unmet needs in relation to travel, fear of cancer recurrence and lack of psychosocial support. Conclusions Overall, there was a lack of evidence relating to variations in psychosocial outcomes for women with BC according to residential status or Indigenous status. While the review identified some specific concerns for non‐metropolitan women with BC, it was limited by the lack of good quality studies using standardised measures. Copyright © 2016 John Wiley & Sons, Ltd.

  March 14, 2016   doi: 10.1002/pon.4124   open full text
• Short‐term effectiveness of a web‐based tailored intervention for cancer survivors on quality of life, anxiety, depression, and fatigue: randomized controlled trial.
  Roy A. Willems, Catherine A. W. Bolman, Ilse Mesters, Iris M. Kanera, Audrey A. J. M. Beaulen, Lilian Lechner.
  Psycho-Oncology. March 14, 2016
  Background The aim of this study was to evaluate the short‐term effectiveness of the web‐based computer‐tailored intervention Kanker Nazorg Wijzer (Cancer Aftercare Guide). The intervention aims to support cancer survivors with managing psychosocial and lifestyle‐related issues. In this study, the impact on quality of life, anxiety, depression, and fatigue were evaluated. Methods Cancer survivors were recruited through 21 Dutch hospitals (November 2013–June 2014). Outcome measures included quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐C30), anxiety and depression (Hospital Anxiety and Depression Scale), and fatigue (Checklist Individual Strength). In a randomized controlled trial with an intervention group (n = 231) and a waiting list control group (n = 231), the short‐term effectiveness was evaluated through multilevel linear regression analyses, controlling for selective dropout, baseline differences, and several demographic and disease‐related characteristics. Results In total, 188 participants of the intervention group and 221 of the control group completed the 6‐month measurement (dropout = 11.5%). The intervention was effective in reducing depression (B = −0.63, p = 0.007, f2 = 0.019, d = 0.21) and fatigue (B = −4.36, p = 0.020, f2 = 0.013, d = 0.21). In addition, effects were found for emotional (B = 3.47, p = 0.022, f2 = 0.013, d = 0.15) and social functioning (B = 3.95, p = 0.011, f2 = 0.017, d = 0.15), although this evidence was less strong. There were indications that the effects of fatigue and social functioning were influenced by module use. Conclusions While effect sizes were small, they can be considered as clinically relevant. With the Cancer Aftercare Guide being an effective, low‐intensive, and easy accessible intervention, it could serve as a first step in stepped care for needs assessment and initial support for psychosocial problems that are present after cancer treatment. Copyright © 2016 John Wiley & Sons, Ltd.

  March 14, 2016   doi: 10.1002/pon.4113   open full text
• Avoidant coping and self‐efficacy mediate relationships between perceived social constraints and symptoms among long‐term breast cancer survivors.
  Rebecca N. Adams, Catherine E. Mosher, Andrea A. Cohee, Timothy E. Stump, Patrick O. Monahan, George W. Sledge, David Cella, Victoria L. Champion.
  Psycho-Oncology. March 10, 2016
  Objective Many breast cancer survivors feel constrained in discussing their cancer experience with others. Limited evidence suggests that social constraints (e.g., avoidance and criticism) from loved ones may negatively impact breast cancer survivors' global health, but research has yet to examine relationships between social constraints and common physical symptoms. Informed by social cognitive processing theory, this study examined whether perceived social constraints from partners and healthcare providers (HCPs) were associated with fatigue, sleep disturbance, and attentional functioning among long‐term breast cancer survivors (N = 1052). In addition, avoidant coping and self‐efficacy for symptom management were examined as potential mediators of these relationships. Methods Long‐term breast cancer survivors (mean years since diagnosis = 6) completed questionnaires assessing social constraints from partners and HCPs, avoidant coping, self‐efficacy for symptom management, and symptoms (i.e., fatigue, sleep disturbance, and attentional functioning). Structural equation modeling was used to evaluate the hypothesized relationships among variables in two models: one focused on social constraints from partners and one focused on social constraints from HCPs. Results Both models demonstrated good fit. Consistent with theory and prior research, greater social constraints from both partners and HCPs were associated with greater symptom burden (i.e., greater fatigue and sleep disturbance, poorer attentional functioning). In addition, all relationships were mediated by avoidant coping and self‐efficacy for symptom management. Conclusions Findings are consistent with social cognitive processing theory and suggest that symptom management interventions may be enhanced by addressing the impact of social constraints from survivors' partners and HCPs on their coping and self‐efficacy. Copyright © 2016 John Wiley & Sons, Ltd.

  March 10, 2016   doi: 10.1002/pon.4119   open full text
• Wonders & Worries: evaluation of a child centered psychosocial intervention for families who have a parent/primary caregiver with cancer.
  Farya Phillips, Elizabeth A. Prezio.
  Psycho-Oncology. March 08, 2016
  Objective Scant evidence exists to guide interventions for children who have a parent with cancer. This study evaluated the outcomes of a community based psychosocial intervention targeted to children dealing with parental or primary caregiver cancer. This curriculum provided an age‐appropriate understanding of the illness, facilitated the expression of feelings, identified individual coping skills to help ease feelings related to parent's cancer, and enhanced the family's ability to communicate about the disease. Methods Families whose children participated in the six‐week curriculum‐based intervention completed a questionnaire that included demographic information, a five‐item assessment of changes in parenting abilities, and a nine‐item assessment of changes in children's behavioral issues. The prevalence of each reported item was determined through a secondary analyses of cross‐sectional data derived from a multi‐year sample of these survey results. Results A sample of 156 families responded to the survey between 2009 and 2014. A majority of families described improvement in all five areas of parenting abilities assessed including communication skills and confidence in parenting. Amelioration of multiple children's issues was reported including improved communication skills (87%), reduced anxiety (84%), increased feeling of security at home (90%), and improved school performance (73%). Conclusions The results reported here suggest that this child centered psychosocial intervention promoted positive adaptation by actively supporting families and children while a parent/primary caregiver coped with a cancer diagnosis. Future research is planned utilizing a randomized controlled study design to formally evaluate the effectiveness and preventative impact of this manualized six‐week curriculum. Copyright © 2016 John Wiley & Sons, Ltd.

  March 08, 2016   doi: 10.1002/pon.4120   open full text
• A randomized pilot trial of a videoconference couples communication intervention for advanced GI cancer.
  Laura S. Porter, Francis J. Keefe, Donald H. Baucom, Maren Olsen, S. Yousuf Zafar, Hope Uronis.
  Psycho-Oncology. March 08, 2016
  Objective This study aims to test the feasibility and preliminary efficacy of a couple‐based communication intervention for advanced GI cancer delivered via videoconference. Methods Thirty‐two couples were randomly assigned to either couples communication skills training (CCST) or an education comparison intervention, both delivered via videoconference. Participation was limited to couples who reported communication difficulties at screening. Patients and partners completed measures of relationship functioning and individual functioning at baseline and post‐intervention. Results Eighty‐eight percent of randomized dyads completed all six sessions and reported high levels of satisfaction with the intervention. Between‐group effect sizes suggested that the CCST intervention led to improvements in relationship satisfaction for patients and partners and to improvements in intimacy and communication for patients. Conclusions A couples‐based communication intervention delivered via videoconference is feasible and acceptable in the context of advanced cancer. Preliminary findings suggest that the intervention shows promise in contributing to enhanced relationship functioning. Copyright © 2016 John Wiley & Sons, Ltd.

  March 08, 2016   doi: 10.1002/pon.4121   open full text
• Impact of high self‐perceived burden to others with preferences for end‐of‐life care and its determinants for terminally ill cancer patients: a prospective cohort study.
  Siew Tzuh Tang, Chia‐Hsun Hsieh, Ming‐Chu Chiang, Jen‐Shi Chen, Wen‐Cheng Chang, Wen‐Chi Chou, Ming‐Mo Hou.
  Psycho-Oncology. March 07, 2016
  Background/Objective Self‐perceived burden to others (SPB) is a major concern of terminally ill cancer patients and is frequently factored into end‐of‐life (EOL) care decision‐making. However, changes in and determinants of SPB and its longitudinal impact on preferences for EOL care over the dying process have not been investigated. Our study was aimed at filling this gap in knowledge. Methods A convenience sample of 325 cancer patients was followed until death. High SPB was identified as scoring >20 on the Self‐perceived Burden Scale. Preferences for EOL care included EOL‐care goals, life‐sustaining treatments, and hospice care. Factors potentially precipitating/minimizing patients' high SPB included demographics, disease characteristics and burden, and social support and were examined by multivariate logistic regression modeling with the generalized estimating equation. Results Prevalence of high SPB increased as death approached (51.78%, 58.26%, 62.66%, and 65.38% for 181–365, 91–180, 31–90, and 1–30 days before death, respectively). High SPB was precipitated by women, younger age, having inadequate financial resources, without religious affiliation, and suffering from severe symptom distress and heavy functional dependence but was independent of time proximity to patient death, disease characteristics, and social support. Furthermore, high SPB was not associated with EOL‐care preferences, whether aggressive life‐sustaining treatments or hospice care. Conclusions High SPB was prevalent among terminally ill cancer patients but independent of preferences for EOL care. Cancer patients' SPB may be lessened by adequate symptom relief to facilitate functional independence. These strategies to ease SPB may improve the quality of death and dying. Copyright © 2016 John Wiley & Sons, Ltd.

  March 07, 2016   doi: 10.1002/pon.4107   open full text
• Factors associated with self‐perceived burden to the primary caregiver in older patients with hematologic malignancies: an exploratory 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. March 04, 2016
  Objective Although cancer patients frequently experience self‐perceived burden to others, this perception has not been enough studied. The aim of this study was to investigate the prevalence of self‐perceived burden to the primary caregiver (SPB‐PC) and associated factors in an older patient population with hematologic malignancies at the time of chemotherapy initiation. Methods In total, 166 consecutive patients with hematologic malignancies aged ≥65 years were recruited at the time of chemotherapy initiation. Patients' SPB‐PC was assessed using a 100‐mm visual analogue scale (VAS). Characteristics potentially associated with SPB‐PC, including sociodemographic and medical characteristics, physical functioning status (Karnofsky performance score, activities of daily living (ADL)/instrumental ADL), symptoms (fatigue, pain, nausea, quality of life), psychological distress (Hospital Anxiety and Depression Scale (HADS)), perceived cognitive function (Functional Assessment of Cancer Therapy Cognitive (FACT‐Cog) Scale), and patients'/primary caregivers' personal relationship characteristics (family tie, support), were assessed. Results Thirty‐five percent of patients reported moderate to severe SPB‐PC (VAS ≥ 50 mm). Patients' SPB‐PC was associated with lower Karnofsky performance (β = −0.135, p = 0.058) and ADL (β = −0.148, p = 0.037) scores, and higher HADS (β = 0.283, p < 0.001) and FACT‐Cog perceived cognitive impairments subscale (β = 0.211, p = 0.004) scores. The proportion of explained variance was 23.5%. Conclusions Health care professionals should be aware that about one third of older cancer patients experience moderate to severe SPB‐PC at the time of chemotherapy initiation. They should adapt their support of patients who report such a feeling. Copyright © 2016 John Wiley & Sons, Ltd.

  March 04, 2016   doi: 10.1002/pon.4108   open full text
• A qualitative study exploring health perceptions and factors influencing participation in health behaviors in colorectal cancer survivors.
  Sarah J. Hardcastle, Chloe Maxwell‐Smith, Nik Zeps, Cameron Platell, Moira O'Connor, Martin S. Hagger.
  Psycho-Oncology. March 03, 2016
  Purpose The purpose of the study was to explore colorectal cancer survivors' health perceptions following cessation of active treatment for cancer and to explore the factors influencing participation in health‐promoting behaviors that may help reduce cardiovascular disease risk. Methods Face‐to‐face interviews were conducted with participants that had completed active treatment for cancer within the previous 2 years. Participants were colorectal cancer survivors (N = 24, men = 11, women = 13, M age = 69.38 years, SD = 4.19) recruited from a private hospital in Perth, Australia on the basis that they had existing morbidities that put them at increased risk of cardiovascular disease. Interview transcripts were analyzed using thematic analysis. Results Five main themes emerged: back to normal; the pleasures in life: ‘is it worth it?’; beliefs about health behavior; skepticism of eating guidelines; and lack of motivation. The majority of participants felt they were in good health and had made a full recovery. Participants questioned whether it was worth changing their lifestyle given their life stage and referred to the desire to enjoy life. Lay health beliefs, skepticism of eating guidelines, and a lack of motivation were barriers to change. Conclusions Interventions should target lay beliefs and skepticism in relation to health behaviors in order to reinforce the importance and value of participating in health‐related behavior. Implications for Cancer Survivors Findings may inform the development of effective, patient‐centered interventions that target lay health beliefs and build motivation for health behavior change. Copyright © 2016 John Wiley & Sons, Ltd.

  March 03, 2016   doi: 10.1002/pon.4111   open full text
• Physical activity in Black breast cancer survivors: implications for quality of life and mood at baseline and 6‐month follow‐up.
  Allyson D. Diggins, Lauren E. Hearn, Suzanne C. Lechner, Debra Annane, Michael H. Antoni, Nicole Ennis Whitehead.
  Psycho-Oncology. February 28, 2016
  Background The present study sought to examine the influence of physical activity on quality of life and negative mood in a sample of Black breast cancer survivors to determine if physical activity (dichotomized) predicted mean differences in negative mood and quality of life in this population. Methods Study participants include 114 women diagnosed with breast cancer (any stage of disease, any type of breast cancer) recruited to participate in an adaptive cognitive–behavioral stress management intervention. The mean body mass index of the sample at baseline was 31.39 (standard deviation = 7.17). Results A multivariate analysis of covariance (MANCOVA) was conducted to determine if baseline physical activity predicted mean differences in negative mood and quality of life at baseline and at follow ups while controlling for relevant covariates. A one‐way MANCOVA revealed a significant multivariate effect by physical activity group for the combined dependent variables at Time 2 (post 10‐week intervention), p = .039. The second one‐way MANCOVA revealed a significant multivariate effect at Time 3 (6 months after Time 2), p = .034. Specifically, Black breast cancer survivors who engaged in physical activity experienced significantly lower negative mood and higher social/family well‐being at Time 2 and higher spiritual and functional well‐being at Times 2 and 3. Conclusions Results show that baseline physical activity served protective functions for breast cancer survivors over time. Developing culturally relevant physical activity interventions specifically for Black breast cancer survivors may prove vital to improving quality of life and mood in this population. Copyright © 2016 John Wiley & Sons, Ltd.

  February 28, 2016   doi: 10.1002/pon.4095   open full text
• Psychological variables associated with quality of life following primary treatment for head and neck cancer: a systematic review of the literature from 2004 to 2015.
  Simon Dunne, Orla Mooney, Laura Coffey, Linda Sharp, Deirdre Desmond, Conrad Timon, Eleanor O'Sullivan, Pamela Gallagher.
  Psycho-Oncology. February 26, 2016
  Objective There has been a recent proliferation of research on quality of life (QoL) in head and neck cancer (HNC). The objective of this review was to systematically examine the evidence on psychological factors associated with QoL outcomes for HNC survivors in the post‐treatment period published during 2004–2015. Methods Five databases were searched for studies investigating psychological factors associated with QoL in HNC survivors. Empirical studies published between January 2004 and June 2015 were included if they measured QoL as an outcome following treatment using a reliable and valid measure, examined its association with at least one psychological factor and included at least 50 HNC survivors. Results Twenty‐four publications describing 19 studies (9 cross‐sectional, 10 prospective) involving 2,263 HNC survivors were included. There was considerable heterogeneity in study design and diversity in measurement and analysis. Distress‐related variables (depression, anxiety, distress) were most frequently investigated, and mostly reported negative associations with QoL outcomes. Associations were also observed between other psychological factors (e.g., coping, neuroticism and fear of recurrence) and QoL. Conclusions Several psychological factors predict QoL among HNC survivors who have completed treatment. Routine screening and early interventions that target distress could improve HNC survivors' QoL following treatment. Longitudinal and population‐based studies incorporating more systematic and standardised measurement approaches are needed to better understand relationships between psychological factors and QoL and to inform the development of intervention and supportive care strategies. Copyright © 2016 John Wiley & Sons, Ltd.

  February 26, 2016   doi: 10.1002/pon.4109   open full text
• Posttraumatic growth among head and neck cancer survivors with psychological distress.
  K. Holtmaat, N. Spek, P. Cuijpers, C. R. Leemans, I. M. Verdonck‐de Leeuw.
  Psycho-Oncology. February 25, 2016
  Background Information on posttraumatic growth (PTG) among head and neck cancer (HNC) survivors with a high level of distress is limited. The aim of this cross‐sectional study was to investigate the occurrence of PTG among distressed HNC survivors and its association with anxiety, depressive, nicotine, and alcohol use disorders and health‐related quality of life. Methods Seventy‐four HNC survivors with psychological distress (Hospital Anxiety and Depression Scale (HADS) anxiety > 7 and/or HADS depression > 7) completed the Posttraumatic Growth Inventory, which comprises five subscales: relating to others, new possibilities, personal strength, spiritual change, and appreciation of life, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Anxiety, depressive, nicotine, and alcohol use disorders were measured using the Composite International Diagnostic Interview. Results Moderate to high Posttraumatic Growth Inventory (PTGI) scores occurred in 10% of the HNC survivors with distress. The mean total PTGI score was 30.8 (SD = 19.7), with the highest mean score on the subscale relating to others. A multivariate regression model consisting of tumor stage, anxiety disorder, alcohol use disorder, and social functioning predicted total PTGI score best (F(4, 64) = 7.565, p < .000, R2 = .321). Conclusions The presence of PTG in this population of distressed HNC survivors was low. PTG occurred most in the domain of relating to others. Among distressed HNC survivors, higher PTG was associated with lower tumor stage, absence of an anxiety disorder, absence of an alcohol use disorder, and better social functioning. Copyright © 2016 John Wiley & Sons, Ltd.

  February 25, 2016   doi: 10.1002/pon.4106   open full text
• Predictive factors of depressive symptoms of elderly patients with cancer receiving first‐line chemotherapy.
  S. Duc, M. Rainfray, P. Soubeyran, M. Fonck, J. F. Blanc, J. Ceccaldi, L. Cany, V. Brouste, S. Mathoulin‐Pélissier.
  Psycho-Oncology. February 23, 2016
  Background Depression is the most common psychiatric disorder in geriatrics and oncology. For elderly cancer patients, it has a significant impact on quality of life, morbidity, and mortality. Nevertheless, depression is under‐diagnosed and under‐treated. Cancer management is key in improving the quality of care in this population. We aim to identify sociodemographic, clinical, and treatment‐related factors of depression in elderly patients during chemotherapy, thus allowing early detection of patients in need of specific treatment. Further, we investigate whether chemotherapy efficacy and safety are associated with depression. Patients and methods A prospective multicenter cohort composed of incident cases of cancer diagnosed in patients 70 years and older, receiving first‐line chemotherapy. Depressive symptoms were measured by the Geriatric Depression Scale at baseline and after four chemotherapy cycles. Associations between depressive symptoms during chemotherapy and patients' clinical and treatment characteristics were identified by logistic regression. Results Among 344 patients measured for depression before chemotherapy, 260 had a second assessment at the fourth treatment cycle. At baseline, 45.4% were depressed, and 44.6% were depressed after the fourth cycle. Independent factors of depression were depressive symptoms at baseline (odds ratio (OR) = 6.7, p < 0.001), malnutrition (OR = 5.1, p = 0.014), and risk of malnutrition (OR = 1.6, p = 0.014). After controlling for missing data, effective chemotherapy was associated with a lower risk of depression (OR = 0.4, p = 0.018). Conclusion We highlight the role of depressive symptoms and nutritional status at baseline, on the occurrence of depressive symptoms during chemotherapy. These factors should be taken into account in any pre‐treatment consultation and appropriate nutritional and psychiatric preventative measures established. Copyright © 2016 John Wiley & Sons, Ltd.

  February 23, 2016   doi: 10.1002/pon.4090   open full text
• What do women with breast cancer expect from their treatment? Correlates of negative treatment expectations about endocrine therapy.
  Sarah R. Heisig, Meike C. Shedden‐Mora, Pia Blanckenburg, Winfried Rief, Isabell Witzel, Ute‐Susann Albert, Yvonne Nestoriuc.
  Psycho-Oncology. February 23, 2016
  Objectives Patients' negative treatment expectations can lead to nocebo‐related side effects and non‐initiation of treatment. This study aims to identify correlates of treatment expectations in patients with breast cancer before the start of endocrine therapy. Methods Expectations were assessed in a cross‐sectional sample of 166 patients with breast cancer after receiving treatment information. Side effect expectations (one item) and treatment necessity–concern balance (Beliefs about Medicines Questionnaire) were assessed. Correlates were analyzed using regression analyses. The structure of treatment expectations was investigated using a network analysis. Results About 25% of patients expressed negative expectations. Higher side effect expectations were associated with lower treatment efficacy expectations (ß = −0.20, p = 0.01), higher medication overuse beliefs (ß = 0.17, p = 0.01), and a negative treatment appraisal before study treatment information (ß = −0.17, p = 0.02). A negative necessity–concern balance was associated with lower treatment efficacy expectations (ß = 0.36, p < 0.001), lower adherence intention (ß = 0.21, p < 0.001), and no knowledge of tumor's receptor status (ß = 0.21, p < 0.001); furthermore, it was associated with higher medication harmfulness beliefs (ß = −0.16, p = 0.02), negative treatment pre‐appraisal (ß = 0.15, p = 0.01), higher somatosensory amplification (ß = −0.14, p = 0.02), and higher education (ß = −0.12, p = 0.02). The most important network node was the concern that endocrine therapy disrupts life. Conclusion Negative treatment expectations before treatment start are mainly associated with psychological variables. These results are relevant for patient education in clinical settings. To improve expectations, clinicians might emphasize treatment efficacy and discuss general and specific medication concerns. Improving treatment knowledge could also be beneficial. Copyright © 2016 John Wiley & Sons, Ltd.

  February 23, 2016   doi: 10.1002/pon.4089   open full text
• Clinically assessed posttraumatic stress in patients with breast cancer during the first year after diagnosis in the prospective, longitudinal, controlled COGNICARES study.
  Varinka Voigt, Franziska Neufeld, Judith Kaste, Markus Bühner, Philipp Sckopke, Rachel Wuerstlein, Karin Hellerhoff, Anikó Sztrókay‐Gaul, Michael Braun, Franz Edler Koch, Eliane Silva‐Zürcher, Stephan Hasmüller, Ingo Bauerfeind, Gerlinde Debus, Peter Herschbach, Sven Mahner, Nadia Harbeck, Kerstin Hermelink.
  Psycho-Oncology. February 22, 2016
  Objective There is ongoing debate whether cancer qualifies as traumatic stressor. We investigated prevalence and course of posttraumatic stress in patients with early breast cancer (BC) during their first year after diagnosis and determined effects of mastectomy and chemotherapy. Methods Patients with stage 0–III BC aged ≤65 years were evaluated with the Structured Clinical Interview for DSM‐IV modules for acute and posttraumatic stress disorder (ASD and PTSD, respectively) before treatment, after chemotherapy, and 1 year after diagnosis. Matched controls were assessed at matched intervals. Effects of time, mastectomy, and chemotherapy on BC‐related PTSD symptom severity were tested with linear mixed model analysis. Results Stress disorder (ASD or PTSD) related to BC was diagnosed in 6 (3.6%) of 166 patients before treatment and in 3 patients (2.0%) 1 year later. The rate of patients who experienced PTSD symptoms related to BC decreased from 82.5 to 57.3% (p < 0.001), and the mean of BC‐related PTSD symptoms diminished from 3.1 to 1.7 (p < 0.001). Only university education significantly predicted the course of BC‐related PTSD symptom severity (p = 0.009). In 60 controls, no diagnosis of stress disorder, a rate of 18% women experiencing PTSD symptoms, and a mean of 0.4 PTSD symptoms (p vs. patients <0.001) were found. Conclusions Most newly diagnosed patients with BC experience PTSD symptoms, whereas full diagnoses of DSM‐IV stress disorder are rare. Symptoms diminish somewhat within 1 year furthered by university education but independently from mastectomy and chemotherapy. Throughout the year after diagnosis, having BC entails markedly increased PTSD symptom burden. Copyright © 2016 John Wiley & Sons, Ltd.

  February 22, 2016   doi: 10.1002/pon.4102   open full text
• Factors influencing health‐related quality of life among Korean cancer survivors.
  KiSook Kim, Ji‐Su Kim.
  Psycho-Oncology. February 18, 2016
  Objective Early cancer detection and remarkable improvements in cancer treatment have seen the cancer survival rate grow steadily for the past 40 years. Despite expectations regarding treatment effectiveness, acceptable quality of life, and a comfortable death, patients with cancer generally have a decreased quality of life. The study aim was to examine the factors influencing health‐related quality of life among South Korean cancer survivors for future development of an intervention to enhance their survivorship. Methods Korea National Health and Nutrition Examination Survey 2008–2012 data regarding 1020 cancer survivors were used for analysis. Health‐related quality of life was measured using the EuroQol 5‐Dimension. Results The factors influencing health‐related quality of life were age, educational status, employment status, income, smoking, time since diagnosis, subjective health status, stress, depression, and suicidal ideation. Conclusions Individual‐centered clinical interventions that consider dimensional‐influencing factors, including subjective health status, are needed to improve cancer survivors' health‐related quality of life. Subsequent systematic studies are needed regarding dimension‐specific differences according to cancer types and time since diagnosis. Copyright © 2016 John Wiley & Sons, Ltd.

  February 18, 2016   doi: 10.1002/pon.4105   open full text
• The role of social–cognitive and emotional factors on testicular self‐examination.
  Lee Shepherd, Callum Watt, Brian Lovell.
  Psycho-Oncology. February 18, 2016
  Objective This study determined the role of social–cognitive and affective factors in promoting testicular self‐examination. Methods Male participants (N = 115) rated their perceptions of testicular cancer, social–cognitive variables (attitude, subjective norm, and perceived control), and their emotions towards testicular cancer (anxiety and shame) and testicular self‐examination (anticipated regret and relief). Participants also stated whether or not they had performed a testicular self‐examination within the last month. Results Perceived control and anticipated relief positively predicted testicular self‐examination within the last month. Both these factors also positively predicted the intention to self‐examine in the future. Intention was also positively predicted by attitude and negatively predicted by shame. Conclusions These results highlight the importance of social–cognitive and emotional factors in promoting health screening. Targeting these factors might improve the effectiveness of testicular self‐examination interventions. Copyright © 2016 John Wiley & Sons, Ltd.

  February 18, 2016   doi: 10.1002/pon.4097   open full text
• An evaluation of factors affecting preference for immediate, delayed or no breast reconstruction in women with high‐risk breast cancer.
  Kathy Flitcroft, Meagan Brennan, Daniel Costa, April Wong, Kylie Snook, Andrew Spillane.
  Psycho-Oncology. February 16, 2016
  Objective Women with locally advanced breast cancer face many conflicting issues affecting their choice of immediate versus delayed versus no breast reconstruction (BR). This single‐centre pilot study assessed high‐risk women's reasons and priorities in choosing the timing and type of BR in a setting where all clinically feasible options were discussed with all women. Methods Fifty‐one women from a metropolitan breast oncology practice, who were likely to require post‐mastectomy radiotherapy (PMRT), were recruited after making their decision about BR. Participants completed a questionnaire (69% preoperatively), adapted from Reaby (1998), evaluating the factors affecting their decision. Responses were subsequently classified into eight issue‐based domains (feeling normal, feeling good, being practical, influence of others, expectations, fear, timing and unnecessary). Demographic and clinical data were also collected. Results There were 32 immediate BR (IBR = 63%), seven delayed BR (DBR = 13%) and 12 no BR (NBR = 23%). Analysis using the chi square test showed women over 60 were more likely to choose NBR (p = 0.005), while women living with a partner were more likely to choose IBR (p = 0.032). The most relevant domains for both IBR and DBR were ‘feeling good’ and ‘feeling normal’; and for NBR were ‘unnecessary’ and ‘being practical’. Although all women understood pre‐operatively the potential aesthetic limitations of PMRT, 63% still chose IBR. Conclusions These data will enable clinicians, researchers and women with breast cancer to gain a clearer understanding of the factors that impact on the choice and timing of BR in women requiring PMRT, a major breast cancer survivorship decision. Copyright © 2016 John Wiley & Sons, Ltd.

  February 16, 2016   doi: 10.1002/pon.4087   open full text
• In sickness and in health: classmates are highly motivated to provide in‐hospital support during childhood cancer therapy.
  Lea H. Lindgren, Kjeld Schmiegelow, Anne Sofie Helms, Troels Thorsteinsson, Hanne B. Larsen.
  Psycho-Oncology. February 12, 2016
  Objectives Extended hospitalization for school‐aged cancer patients increases their risk of social marginalization. School‐aged children mature through peer‐interaction, but healthcare providers fail to incorporate this in rehabilitation efforts. The RESPECT study offers classmates to cancer patients to become ambassadors during hospital stays. This study explores classmate decision‐making patterns about ambassadorship. Methods An open‐ended question was prospectively and consecutively provided to classmates (N = 221) (and parents) of 10 children diagnosed with cancer in 2014 and enrolled in the RESPECT study. Statements were analysed using thematic content analysis. Results Of 221 classmates, 140 responded (63%). Of these, 81 applied for ambassadorship (median 8/patient), 58 declined, one was undecided. Nine forms were incomplete; leaving 131 in total that revealed 303 statements for analysis. Five major themes emerged: existing friendship (132/303 statements), personal resources (academic, emotional and social) (107/303), attitudes towards the ambassadorship (34/303), hospital environment (18/303) and logistics (12/303). Of the classmates with pre‐existing friendships, 77% applied for ambassadorship and 80% with a surplus of personal resources applied. These were predominant predictors for ambassadorship application. Classmate motives were condensed into four archetypes: pre‐existing friendship with a surplus of resources (100% applied), non‐friend classmates with a surplus of resources (63% applied), pre‐existing friendship with limited resources (22% applied) and non‐friend classmates with limited resources (0% applied). Conclusion Classmates are highly motivated to support patients during serious illness, irrespective of pre‐existing friendships. Ambassadors offer a novel in‐hospital approach to promote rehabilitation in children with severe/chronic diseases. Results need validation in other settings. Copyright © 2016 John Wiley & Sons, Ltd.

  February 12, 2016   doi: 10.1002/pon.4094   open full text
• Impact of gender on decisions to participate in faecal immunochemical test‐based colorectal cancer screening: a qualitative study.
  Nicholas Clarke, Pamela Gallagher, Patricia M. Kearney, Deirdre McNamara, Linda Sharp.
  Psycho-Oncology. February 11, 2016
  Objective Faecal immunochemical tests (FITs) are increasingly being used in population‐based colorectal cancer‐screening programmes. Uptake of FIT is lower in men than women; however, the reasons for this are not well understood. We aimed to explore gender differences in influences on decisions to participate in FIT screening. Methods This is a qualitative study using in‐depth face‐to‐face interviews of four groups of screening invitees (male and female screening users and male and female screening non‐users), purposively sampled from the database of a population‐based FIT screening programme. Recruitment continued until saturation was reached. Interviews were audio recorded and transcribed verbatim. Thematic analysis using the framework approach was employed with the theoretical domains framework guiding analysis. Results Forty‐seven screening invitees were interviewed. Six theoretical domains influenced screening uptake: ‘environmental context and resources’, ‘beliefs about capabilities’, ‘beliefs about consequences’, ‘emotions’, ‘social influences’ and ‘knowledge’. Male non‐users were often fatalistic, less knowledgeable and misinformed about cancer and FIT screening compared with other groups. Female non‐users expressed negative attitudes, beliefs and emotions towards FIT screening, cancer, social influences and the medical profession and were over‐confident about their health. Conclusions Negative attitudes and emotions to screening dominated non‐user decision‐making but differed by gender. Opportunities to improve uptake in men and women exist. Greater national discussions on the benefits of FIT screening, and development of screening materials tackling negative attitudes and beliefs while recognising male/female differences, may improve screening uptake. Copyright © 2016 John Wiley & Sons, Ltd.

  February 11, 2016   doi: 10.1002/pon.4085   open full text
• Health behaviours and fear of cancer recurrence in 10 969 colorectal cancer (CRC) patients.
  A. Fisher, R.J. Beeken, M. Heinrich, K. Williams, J. Wardle.
  Psycho-Oncology. February 11, 2016
  Background This study aimed to examine whether fear of cancer recurrence (FCR) was related to two important health behaviours (physical activity and smoking) in a large sample of colorectal cancer patients. Methods Ten thousand nine hundred sixty nine patients, diagnosed in 2010–11, and in remission in 2013, completed the ‘Living with and Beyond Colorectal Cancer’ survey. The survey included purpose‐designed questions on fear of recurrence (‘I have fear about my cancer coming back’), demographics, treatment and health variables. Physical activity (PA) was recorded as number of days per week doing at least 30 min of brisk activity, and smoking status was reported. Results Fifty per cent of respondents reported fear of their cancer returning. More women than men ((Odds Ratio; (OR) 1.58; 95% confidence interval (CI) 1.46, 1.71)) more younger than older patients (OR 2.53; CI 2.33, 2.74) and slightly more patients from deprived areas (OR 1.14, 1.05, 1.23) reported FCR. Independently of demographics and treatment, compared with those meeting the PA guidelines, those who were doing only ‘some’ (OR 1.22; CI 1.11, 1.35) or ‘no’ PA (OR 1.28; CI 1.15, 1.42) reported higher FCR. Compared with non‐smokers, more current smokers reported fear (OR 1.34, CI 1.10, 1.58) and slightly more ex‐smokers (OR 1.11; CI 1.04, 1.21). Conclusions This cross‐sectional study provided novel data showing that colorectal cancer survivors with poorer health behaviours (those with lower activity levels and those who smoked) were more likely to experience FCR. Future research should replicate findings using detailed measures of fear, objective measures of health behaviours and identify directions of associations. © 2016 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.

  February 11, 2016   doi: 10.1002/pon.4076   open full text
• Perceived diagnostic delay and cancer‐related distress: a cross‐sectional study of patients with colorectal cancer.
  Anne Miles, Paula L. McClements, Robert J.C. Steele, Claudia Redeker, Nick Sevdalis, Jane Wardle.
  Psycho-Oncology. February 11, 2016
  Objective This study aimed to examine the effect of perceived diagnostic delay on cancer‐related distress and determine whether fear of cancer‐recurrence and quality of life mediate this relationship. Methods Cross‐sectional study in which 311 colorectal cancer (CRC) survivors in Scotland completed a survey, which included questions on cancer‐related distress (IES‐R), perceived diagnostic delay, quality of life (trial outcome index of the FACT‐C: FACT‐C TOI) and fear of cancer recurrence. Fifteen patients withheld consent to data matching with medical records, leaving a sample size of 296. Participants were an average of 69 years old (range 56 to 81) and between 3.5 and 12 years post‐diagnosis. Multiple regressions were used to test predictors of distress and regression and bootstrapping to test for mediation. Results Perceived diagnostic delay was correlated with higher cancer‐related distress, while objective markers of diagnostic delay (disease stage at diagnosis and treatment received) were not. Some of the relationship between perceived diagnostic delay and cancer‐related distress was mediated by quality of life, but not by fear of cancer recurrence. Conclusions Perceived diagnostic delay was associated with higher cancer‐related distress among CRC survivors. While poorer quality of life partly explained such associations, fear of cancer recurrence, stage at diagnosis and treatment did not. The exact features of diagnostic delay that are associated with cancer‐related distress remain unclear. Future research should examine the experiences patients go through prior to diagnosis that may increase distress, in an effort to improve our understanding of the factors affecting emotional wellbeing among CRC survivors. Copyright © 2016 John Wiley & Sons, Ltd.

  February 11, 2016   doi: 10.1002/pon.4093   open full text
• Mental disorder diagnoses of offspring affected by parental cancer before early adulthood: the 1987 Finnish Birth Cohort study.
  Mika Niemelä, Reija Paananen, Helinä Hakko, Marko Merikukka, Mika Gissler, Sami Räsänen.
  Psycho-Oncology. February 09, 2016
  Objective The purpose of this study is to investigate psychiatric diagnoses given to children affected by parental cancer in psychiatric and somatic specialized health care settings. Methods The 1987 Finnish Birth Cohort data (n = 59 476) were followed up through national registers from birth of cohort members up to the end of 2008. The health‐related data of cohort members and their parents were obtained from the Care Register of Health Care provided by the National Institute of Health and Wellbeing. Results By the age of 21 years 7711 of the cohort members had used specialized psychiatric outpatient care and, of them, 549 (7.1%) were affected by parental cancer. Of affected offspring a mental disorder diagnosis was made in 424 (77.2%), while 125 (22.8%) children had not been given any specific mental disorder diagnosis. In females the likelihood for a mental disorder diagnosis assessed in outpatient care was significantly increased by up to 1.2 fold in cases of parental cancer. In males with a father having cancer, psychological development disorders were significantly increased whether assessed in outpatient (OR 1.5) or inpatient (OR1.9) settings. Conclusions The prevalence of psychiatric diagnoses in children with parental cancer does not seem to differ from those of children with parents without cancer. However, evidence was found that children affected by parental cancer are at increased risk for some specific psychiatric disorders. Quarter of affected offspring who were referred to specialized psychiatric outpatient care only received diagnoses related to use of health care services or crises or received no psychiatric diagnosis at all. Copyright © 2016 John Wiley & Sons, Ltd.

  February 09, 2016   doi: 10.1002/pon.4088   open full text
• Trajectories of total depression and depressive symptoms in prostate cancer patients receiving six months of hormone therapy.
  Christopher F. Sharpley, David R. H. Christie, Vicki Bitsika, Bradley J. Miller.
  Psycho-Oncology. February 09, 2016
  Objective The aim of this study was to investigate the effects of hormone therapy (HT) on depression and depressive symptoms in prostate cancer patients undergoing 6 months of HT. Methods One hundred two prostate cancer patients who had been prescribed HT completed the Zung Self‐rating Depression Scale (SDS) and two questions about their sexual enjoyment and performance, plus a background questionnaire before HT, after 8 to 10 weeks of HT and again after 16 to 20 weeks of HT. Results There was a significant increase in SDS scores from before to during HT. High depression score before HT was a significant predictor of later increases in depression during HT. Increases in depressive symptoms were restricted to 8 of the 20 SDS symptoms, the most powerful change being in sexual anhedonia, which was a result of decreased ability to perform during sexual activity. Conclusions The association between HT and elevated depression is confirmed, but the relative influence of sexual anhedonia over other depressive symptoms expands the understanding of this association. The effects of decreased ability to perform during sex appear to dominate the increase in depression during HT. Copyright © 2016 John Wiley & Sons, Ltd.

  February 09, 2016   doi: 10.1002/pon.4100   open full text
• Changes in social support predict emotional well‐being in breast cancer survivors.
  Angela J. Fong, Tanya M.F. Scarapicchia, Meghan H. McDonough, Carsten Wrosch, Catherine M. Sabiston.
  Psycho-Oncology. January 28, 2016
  Background Breast cancer survivors who have completed surgery and adjuvant treatment have distinct social support needs that may relate to emotional health. There is little research on both levels of social support following treatment and the association between social support and emotional well‐being over time following breast cancer diagnosis and treatment. The aims of this study were to assess (1) the direction and magnitude of change in social support quality and quantity and (2) the degree to which change in quality and quantity of social support predicted change in emotional well‐being over time following completion of breast cancer treatment. Methods A sample of 157 female breast cancer survivors (Mage = 55, SD = 11 years) completed a baseline and a 1‐year follow‐up questionnaire assessing sociodemographic information, quality and quantity of social support, and emotional well‐being including depression symptoms, stress, and positive and negative affect. Results Social support quantity significantly decreased over 1 year, while social support quality remained stable. Based on change score analyses, a decrease in social support quality was a significant predictor of increases in depression, stress, and negative affect, explaining an extra 4 to 6% of variance in the emotional well‐being outcomes compared with social support quantity. Conclusions This study highlights the decline in social support among recently treated female breast cancer survivors and the importance of maintaining high‐quality social support for emotional well‐being. Copyright © 2016 John Wiley & Sons, Ltd.

  January 28, 2016   doi: 10.1002/pon.4064   open full text
• The effect of marriage on stage at diagnosis and survival in women with cervical cancer.
  Sanae El Ibrahimi, Paulo S. Pinheiro.
  Psycho-Oncology. January 26, 2016
  Purpose This study assessed the effect of marital status on stage at diagnosis and survival in women with cervical cancer. Methods Cervical cancer cases diagnosed between 2000 and 2010 were identified from the Surveillance, Epidemiology and End Results (SEER) program. Patient demographic and clinical characteristics were compared by marital status. Multivariate logistic and Cox proportional hazard regression models were performed to calculate odds ratios of advanced stage at diagnosis and hazard ratios of death risk respectively. Results Among 31 425 women, 46% of cases were married at the time of diagnosis. Married women were more commonly diagnosed at a localized stage (55%) compared to other non‐marital groups (47% of singles, 42% of separated/divorced, and 28% of widowers, p < 0.001). After controlling for age, race/ethnicity, period of diagnosis, histology, and SEER area, single [adjusted odds ratio (aOR) 1.41; 95% Confidence Interval (CI) 1.33–1.49], separated/divorced [aOR 1.44; 95% CI 1.34–1.55], and widowed women [aOR 1.43; 95% CI 1.31–1.58] were all more likely to be diagnosed at an advanced stage compared to married women. In terms of prognosis, single (adjusted hazard ratio (aHR) 1.35; 95% CI 1.28–1.43), separated/divorced (aHR 1.22; 95% CI 1.15–1.29), and widowed women (aHR 1.28; 95% CI 1.19–1.36) had significant increased risk of death compared to married women. Adjusting for insurance status did not change the findings. Conclusion Being married is associated with earlier diagnosis and a more favorable prognosis for cervical cancer among US women. Interventions to improve prognosis for unmarried women, including increasing use of cervical cancer screenings, are warranted.

  January 26, 2016   doi: 10.1002/pon.4070   open full text
• The financial impact of head and neck cancer caregiving: a qualitative study.
  Myles Balfe, Phyllis Butow, Eleanor O'Sullivan, Rachael Gooberman‐Hill, Aileen Timmons, Linda Sharp.
  Psycho-Oncology. January 26, 2016
  Background There is a lack of research on the financial impacts that head and neck cancer has on caregivers. Objective To explore the overall financial impact of head and neck cancer on caregivers; to describe the factors that mitigate this impact. Methods Interviews with 31 caregivers (mean time caring: 5.7 years). Results Head and neck cancer had a considerable financial impact on caregivers. It resulted in out of pocket costs and caregivers and/or their relative/friend with cancer often became under‐ or un‐employed. Caregivers with large debts or ongoing expenses appeared to be particularly vulnerable to cancer‐related financial pressures. Finance related psychological stress was prevalent, although some caregivers hid their psychological difficulties from other people. Factors which help caregivers to mitigate financial distress included having private health insurance and being able to access to medical and/or social welfare benefits. Conclusions Head and neck cancer can cause caregivers substantial financial and psychological distress. Distress may be mitigated by providing caregivers and their households with access to welfare benefits. Implications for practice Health professionals should be aware that head and neck cancer can have short and long‐term financial consequences for caregivers and their families. Health professionals should refer patients and their caregivers to medical social workers who can help them with their financial issues. Copyright © 2016 John Wiley & Sons, Ltd.

  January 26, 2016   doi: 10.1002/pon.4079   open full text
• Does knowledge of diagnosis really affect rates of depression in cancer patients?
  Éva Kállay, Sebastian Pintea, Csaba L. Dégi.
  Psycho-Oncology. January 26, 2016
  Significant levels of distress usually accompany the entire cancer experience, affecting the patients' general functioning and adaptation to illness. Objective The major objective of the present study was to investigate potential demographic and intrapersonal moderators of the relationship between knowing the cancer diagnosis and the level of depression experienced. Method The present research has a transversal comparative repeated cross‐sectional design (2006–2014), sampling following the proportional quota method. Research was conducted in the four major oncological institutes in Romania, obtaining a national sample of cancer patients, maintaining gender and ethnic rates, and permitting the investigation of the stability of the results from one assessment to the other. Results Results indicate that in the Romanian context, knowing the diagnosis is associated with a lower level of depression than not knowing the diagnosis, the results being similar in both assessments (2006–2014). Furthermore, from the explored demographic factors (gender, residence, age, and education), only age has a main effect upon depression (depression increasing with age), while education is the only factor from those analyzed, which has a moderator effect. Regarding the analyzed intra‐individual variables, only dysfunctional attitudes, emotion‐focused coping, and lack of emotional support from the family (loneliness) have main effects upon the level of depression (i.e., higher levels of dysfunctional attitudes, emotion‐focused coping, and loneliness are associated with higher levels of depression), while neither of them has a moderator effect on the relationship between knowing the diagnosis and depression. Conclusion These results are important in the improvement of the doctor–patient relationship, the management of cancer‐related distress, and implicitly for the course of illness. Copyright © 2016 John Wiley & Sons, Ltd.

  January 26, 2016   doi: 10.1002/pon.4073   open full text
• Perceived social support and health‐related quality of life in AYA cancer survivors and controls.
  Marta Tremolada, Sabrina Bonichini, Giuseppe Basso, Marta Pillon.
  Psycho-Oncology. January 26, 2016
  Background This study compared education levels, health‐related quality of life (HRQoL) and perceived social support of adolescent and young adult (AYA) cancer survivors with those of a control group of peers with no history of serious illness. The links between socio‐demographic and medical factors and AYA cancer survivor outcomes were investigated. Methods The participants included AYA cancer survivors (n = 205) recruited during follow‐up visits, and AYA peers (n = 205) recruited from the secondary schools, youth groups and universities. All of the participants filled in self‐report questionnaires regarding HRQoL and perceived social support. In addition, medical and socio‐demographic information was collected. Results There were statistically significant differences between survivors and controls in terms of education level, HRQoL and perceived social support. Cancer survivors attended school for fewer years had a more positive perception of their health and a lower level of perceived social support provided by family, friends and significant others than controls. The results showed that female gender, the diagnosis of haematological disorder, haematopoietic stem cell transplantation and a shorter off‐treatment period are risk variables for poorer HRQoL and social functioning in AYA cancer survivors. Conclusions Adolescent and young adult cancer survivors perceived a better quality of life than controls, especially those treated for haematological disorders or with a shorter off‐treatment period. Future studies should aim to understand better this positive self‐reported phenomenon, as well as investigating post‐traumatic growth using qualitative narratives. Copyright © 2016 John Wiley & Sons, Ltd.

  January 26, 2016   doi: 10.1002/pon.4072   open full text
• Cancer patients' referral wish: effects of distress, problems, socio‐demographic and illness‐related variables and social support sufficiency.
  J. M. Admiraal, F. M. Nuenen, J. G. M. Burgerhof, A. K. L. Reyners, J. E. H. M. Hoekstra‐Weebers.
  Psycho-Oncology. January 25, 2016
  Background The present study's aim was to examine effects of cancer patients' perceived distress and problems, socio‐demographic and illness‐related variables and social support sufficiency on referral wish. Methods A cross‐sectional group of 1340 patients (response = 51%) completed a questionnaire consisting of the Dutch version of the Distress Thermometer and Problem List, including the referral wish question, and questions on socio‐demographic and illness‐related variables and perceived social support sufficiency. Univariate and multivariate analyses were performed to investigate the effects of these variables on patients' referral wish. Results Of the patients who completed the referral wish question (N = 1297), 13% wished and 21% considered a referral, while 66% did not want a referral. Univariate analyses showed that, in comparison with patients not having a referral wish, those having a (maybe) wish were more distressed, reporting more problems in all Problem List domains, younger, more likely not to have children or children living at home, higher educated, more likely to be employed, under active treatment or recently diagnosed, receiving more intensive treatment and more likely to perceive support received to be insufficient. A final ordinal logistic regression analysis showed independent effects of distress, practical and emotional problems, age and treatment phase on referral wish (χ2(6) = 205.9; p < 0.001; Nagelkerke's R2 = 0.24). Conclusions A third of the patients (maybe) wished a referral. Knowledge of risk variables (particularly increased distress, experience of more practical and emotional problems, younger age and receiving active treatment or recently diagnosed) may support the identification of patients at increased need of additional healthcare services. Copyright © 2016 John Wiley & Sons, Ltd.

  January 25, 2016   doi: 10.1002/pon.4067   open full text
• Linking dispositional mindfulness and positive psychological processes in cancer survivorship: a multivariate path analytic test of the mindfulness‐to‐meaning theory.
  Eric L. Garland, Paul Thielking, Elizabeth A. Thomas, Mary Coombs, Shelley White, Joy Lombardi, Anna Beck.
  Psycho-Oncology. January 22, 2016
  Background Research indicates that dispositional mindfulness is associated with positive psychological functioning. Although this disposition has been linked with beneficial outcomes in the broader mental health literature, less is known about dispositional mindfulness in cancer survivors and how it may be linked with indices of psychological and physical health relevant to cancer survivorship. Methods We conducted a multivariate path analysis of data from a heterogeneous sample of cancer patients (N = 97) to test the Mindfulness‐to‐Meaning Theory, an extended process model of emotion regulation linking dispositional mindfulness with cancer‐related quality of life via positive psychological processes. Results We found that patients endorsing higher levels of dispositional mindfulness were more likely to pay attention to positive experiences (β = .56), a tendency which was associated with positive reappraisal of stressful life events (β = .51). Patients who engaged in more frequent positive reappraisal had a greater sense of meaning in life (β = .43) and tended to savor rewarding or life affirming events (β = .50). In turn, those who engaged in high levels of savoring had better quality of life (β = .33) and suffered less from emotional distress (β = −.54). Conclusions Findings provide support for the Mindfulness‐to‐Meaning Theory and help explicate the processes by which mindfulness promotes psychological flourishing in the face of cancer. Implications for Cancer Survivorship Cancer survivors may benefit from enhancing mindfulness, reappraisal, and savoring. Copyright © 2016 John Wiley & Sons, Ltd.

  January 22, 2016   doi: 10.1002/pon.4065   open full text
• Treatment of depression in cancer and non‐cancer patients in German neuropsychiatric practices.
  Louis Jacob, Karel Kostev, Matthias Kalder.
  Psycho-Oncology. January 20, 2016
  Aims The aim of this study is to analyze the use of antidepressants in German patients with and without cancer. Methods This study included patients with cancer diagnosed with depression in German neuropsychiatric practices between 2004 and 2013. Each patient was matched for age, gender, health insurance, physician, and index year with a depressed, cancer‐free control. The share of patients and controls receiving medical therapy within 1 year after depression diagnosis and the proportion of subjects treated with tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, or benzodiazepines were analyzed. Results A total of 604 depressed cancer patients and 604 depressed controls were included. There are 27.6% of patients that had breast cancer, 13.3% malignant neoplasms of the lymphoid or hematopoietic tissue, 12.5% brain tumors, 8.3% prostate cancer, and 10.0% cancer of the digestive organs. After 1 year of follow up, 66.5% of patients and 72.8% of controls had received antidepressant drugs (p = 0.017). Tricyclic antidepressants was given less frequently to patients than to controls (31.2% vs 38.2%, p‐value = 0.011). By contrast, 7.0% of patients with cancer and 4.2% of controls received benzodiazepines (p‐value = 0.033). Conclusions The use of antidepressants in Germany is less common in patients with cancer and depression than in people with depression only. Copyright © 2016 John Wiley & Sons, Ltd.

  January 20, 2016   doi: 10.1002/pon.4066   open full text
• Acute empathy decline among resident physician trainees on a hematology–oncology ward: an exploratory analysis of house staff empathy, distress, and patient death exposure.
  Daniel C. McFarland, Adriana K. Malone, Andrew Roth.
  Psycho-Oncology. January 18, 2016
  Objective A reason for empathy decline during medical training has not been fully elucidated. Empathy may decrease acutely during an inpatient hematology–oncology rotation because of the acuity of death exposures. This study aimed to explore physician trainee empathy, distress, death exposures, and their attributed meaning for the trainee. Methods Internal medicine interns and residents at a single academic center were evaluated before and after hematology–oncology ward rotations using Interpersonal Reactivity Index for empathy, previously cited reasons for empathy decline, Impact of Event Scale‐Revised for distress, death exposures (no. of dying patients cared for) and attributed sense of meaning (yes/no) (post‐rotation). Results Fifty‐six trainees completed both pre‐rotation and post‐rotation questionnaires (58% response). Empathy averaged 58.9 (SD 12.0) before and 56.8 (SD 11.1) after the rotation (2.1 point decrease) (p = 0.018). Distress was elevated but did not change significantly during the rotation. Residents cared for 4.28 dying patients. Seventy‐three percent reported that death was the most stressful event during the rotation, yet 68% reported that they derived a sense of meaning from caring for dying patients. Empathy and distress scales were positively correlated before the rotation (r = 0.277, p = 0.041) but not after (r = .059, p = 0.69). Conclusion This study suggests that an acute drop in empathy can occur over several weeks in residents rotating through inpatient hematology–oncology, similar to empathy decline associated with years of training in other studies. Empathy decline may be associated with elevated distress and death exposures on the hematology–oncology ward and should be explored further in other medical training environments. Copyright © 2016 John Wiley & Sons, Ltd.

  January 18, 2016   doi: 10.1002/pon.4069   open full text
• How doctors communicate the initial diagnosis of cancer matters: cancer disclosure and its relationship with Patients' hope and trust.
  Weidan Cao, Xiaona Qi, Ting Yao, Xuanye Han, Xujing Feng.
  Psycho-Oncology. January 17, 2016
  Objective The study is to examine the relationships between perceived initial cancer disclosure communication with doctors, levels of hope, and levels of trust in doctors among cancer patients in China. Methods A total number of 192 cancer inpatients in a cancer hospital in China were surveyed. Perceived disclosure strategies, levels of hope, levels of trust in their doctors, as well as the demographic information were obtained from the participants. Results In addition to age, patients who had higher levels of perceived emotional support from doctors, or higher levels of perceived personalized disclosure from doctors, or higher levels of perceived discussion of multiple treatment plans with doctors were more likely to have higher levels of trust in doctors. In addition to perceived health status, perceived emotional support from doctors significantly predicted participants' levels of hope. That is, patients who had higher higher levels of perceived doctors' emotional support were more likely to have higher levels of hope. Key disclosure person was a marginally significant variable, that is, patients who were mainly disclosed by family members might have higher levels of hope compared with patients who were mainly disclosed by doctors. Conclusions When communicating with a cancer patient, doctors might not ignore the importance of emotional support during cancer diagnosis communication. Doctors might want to involve family and collaborate with family to find out ways of personalized disclosure. During the communication process, doctors could provide their patients with multiple treatment options and discuss the benefits and side effects of each treatment. Copyright © 2016 John Wiley & Sons, Ltd.

  January 17, 2016   doi: 10.1002/pon.4063   open full text
• Web‐based cognitive training for breast cancer survivors with cognitive complaints—a randomized controlled trial.
  MF Damholdt, M Mehlsen, MS O'Toole, RK Andreasen, AD Pedersen, R Zachariae.
  Psycho-Oncology. January 13, 2016
  Background Cognitive complaints are common amongst breast cancer survivors, and no standard treatment exists. The present study evaluates whether web‐based cognitive training can alleviate subjectively reported and objectively assessed cognitive complaints in a sample of breast cancer survivors. The primary and secondary outcomes were an objective measure of working memory and a measure of perceived cognitive functioning. Additional outcomes were neuropsychological tests of memory, executive function, working memory and questionnaire‐based assessment of anxiety, depression and somatization. Methods A total of 157 female breast cancer survivors were recruited from an existing cohort and through announcements in open access cancer‐related Internet fora and randomly allocated to either web‐based cognitive training (eCogT) with telephone support (n = 94) or a waitlist control (WLC) condition (n = 63). eCogT encompassed 30 training sessions over 6 weeks. Neuropsychological assessments were undertaken over the telephone, and questionnaire data was collected online. Data was collected at baseline, post‐intervention and at 5‐month follow‐up. Results Mixed linear models revealed no statistically significant change in primary or secondary outcome at follow‐up in either group. Statistically significant improvements (p 0.040–0.043) were found in the eCogT group for verbal learning and on a working memory test. Conclusions Web‐based cognitive training did not result in improvements of the primary or secondary outcome. Improved performance was observed on verbal learning and working memory. These effects were observed at 5‐month follow‐up, indicating long‐term effects of training. The intervention may be applied in a clinical setting at low cost and without risk of adverse effects.© 2016 The Authors Psycho‐Oncology Published by John Wiley & Sons Ltd.

  January 13, 2016   doi: 10.1002/pon.4058   open full text
• Avoidance of cancer communication, perceived social support, and anxiety and depression among patients with cancer.
  Ansuk Jeong, Dong Wook Shin, So Young Kim, Hyung Kook Yang, Jong‐Hyock Park.
  Psycho-Oncology. January 11, 2016
  Purpose Patients with cancer are reported to experience high anxiety and depression related to their medical status. The current study aimed to investigate the effects of avoidance of cancer communication and of social support from family and medical professionals on the patients' anxiety and depression. Methods A national survey was conducted through regional branches of the National Cancer Center of South Korea, which yielded 296 patient–caregiver dyads. Patients' medical records complemented their self‐report survey data. Results Patients' anxiety was predicted by the family's avoidance of cancer communication and the level of emotional support from family. Patients' depression was predicted by the stage of cancer (Surveillance, Epidemiology, and End Results), the family's avoidance of cancer communication, the emotional support from family, and the medical professionals' respect. Interaction effects were not statistically significant. Conclusion The implications of the findings are discussed in terms of the psycho‐oncological and psycho‐social interventions. Copyright © 2016 John Wiley & Sons, Ltd.

  January 11, 2016   doi: 10.1002/pon.4060   open full text
• How young people describe the impact of living with and beyond a cancer diagnosis: feasibility of using social media as a research method.
  F. Gibson, S. Hibbins, T. Grew, S. Morgan, S. Pearce, D. Stark, L. A. Fern.
  Psycho-Oncology. January 08, 2016
  Objective Young people with cancer exhibit unique needs. During a time of normal physical and psychological change, multiple disease and treatment‐related symptoms cause short and long‐term physical and psychosocial effects. Little is known about how young people cope with the impact of cancer and its treatment on daily routines and their strategies to manage the challenges of cancer and treatments. We aimed to determine how young people describe these challenges through a social media site. Methods Using the principles of virtual ethnography and watching videos on a social media site we gathered data from young people describing their cancer experience. Qualitative content analysis was employed to analyse and interpret the narrative from longitudinal ‘video diaries’ by 18 young people equating to 156 films and 27 h and 49 min of recording. Themes were described then organized and clustered into typologies grouping commonalities across themes. Results Four typologies emerged reflective of the cancer trajectory: treatment and relenting side effects, rehabilitation and getting on with life, relapse, facing more treatment and coming to terms with dying. Conclusions This study confirms the need for young people to strive towards normality and creating a new normal, even where uncertainty prevailed. Strategies young people used to gain mastery over their illness and the types of stories they choose to tell provide the focus of the main narrative. Social Media sites can be examined as a source of data, to supplement or instead of more traditional routes of data collection known to be practically challenging with this population. Copyright © 2016 John Wiley & Sons, Ltd.

  January 08, 2016   doi: 10.1002/pon.4061   open full text
• Post‐diagnosis social networks, and lifestyle and treatment factors in the After Breast Cancer Pooling Project.
  Candyce H Kroenke, Yvonne L. Michael, Xiao‐Ou Shu, Elizabeth M. Poole, Marilyn L. Kwan, Sarah Nechuta, Bette J. Caan, John P. Pierce, Wendy Y. Chen.
  Psycho-Oncology. January 08, 2016
  Objective Larger social networks have been associated with better breast cancer survival. To investigate potential mediators, we evaluated associations of social network size and diversity with lifestyle and treatment factors associated with prognosis. Methods We included 9331 women from the After Breast Cancer Pooling Project who provided data on social networks within approximately two years following diagnosis. A social network index was derived from information about the presence of a spouse or intimate partner, religious ties, community participation, friendship ties, and numbers of living relatives. Diversity was assessed as variety of ties, independent of size. We used logistic regression to evaluate associations with outcomes and evaluated whether effect estimates differed using meta‐analytic techniques. Results Associations were similar across cohorts though analyses of smoking and alcohol included US cohorts only because of low prevalence of these behaviors in the Shanghai cohort. Socially isolated women were more likely to be obese (OR = 1.21, 95% CI:1.03–1.42), have low physical activity (<10 MET‐hours/week, OR = 1.55, 95% CI:1.36–1.78), be current smokers (OR = 2.77, 95% CI:2.09‐3.68), and have high alcohol intake (≥15 g/d, OR = 1.23, 95% CI:1.00–1.51), compared with socially integrated women. Among node positive cases from three cohorts, socially isolated women were more likely not to receive chemotherapy (OR = 2.10, 95% CI:1.30–3.39); associations differed in a fourth cohort. Other associations (nonsignificant) were consistent with less intensive treatment in socially isolated women. Low social network diversity was independently associated with more adverse lifestyle, but not clinical, factors. Conclusions Small, less diverse social networks measured post‐diagnosis were associated with more adverse lifestyle factors and less intensive cancer treatment. Copyright © 2016 John Wiley & Sons, Ltd.

  January 08, 2016   doi: 10.1002/pon.4059   open full text
• Psychosocial oncology care resources in Europe: a study under the European Partnership for Action Against Cancer (EPAAC).
  Luzia Travado, Joaquim C. Reis, Maggie Watson, Josep Borràs.
  Psycho-Oncology. December 21, 2015
  Background Cancer is a complex health problem requiring multidisciplinary care. There are clinical guidelines available in order to improve the process and outcomes of cancer care within Europe. However, strategic action is still needed in many European Union (EU) Member States to develop or improve national cancer control plans (NCCPs), which play a key role in cancer control and care. The current study clarifies the extent of implementation of psychosocial oncology care (PSOC) in the EU. Method A survey methodology was used to cover four dimensions: (1) inclusion of PSOC in NCCPs; (2) structure and resources of PSOC delivery; (3) use of NCCP clinical guidelines; and (4) education and training resources available along with determination of training needs in PSOC. Results Twenty‐seven (90%) countries returned questionnaires of which 21 (78%) include PSOC in their NCCP. However, only 10 (37%) reported having specific budgets for PSOC, 8 (30%) having nationally recommended PSOC clinical guidelines, and 6 countries (22%) reported having an official certification for PSOC education. Conclusion Although many countries seem to have integrated PSOC into their NCCP, there is still much to do in terms of allocating resources and delivering psychosocial care equitably. Also, there is a need for improving training and certification in PSOC. The findings indicate the need to develop national policies concerning PSOC with clear targets for deliverables in an appropriate timetable in order that psychosocial services and existing clinical guidelines are implemented and fully integrated into EU NCCPs. Copyright © 2015 John Wiley & Sons, Ltd.

  December 21, 2015   doi: 10.1002/pon.4044   open full text
• Relationships between neurocognitive functioning, mood, and quality of life in patients with temporal lobe glioma.
  Kyle R. Noll, Mariana E. Bradshaw, Jeffrey S. Weinberg, Jeffrey S. Wefel.
  Psycho-Oncology. December 17, 2015
  Objective While neurocognitive functioning (NCF) and mood disturbance share a relationship with health‐related quality of life (HRQOL), few studies have examined relationships between these constructs in glioma patients prior to treatment. Methods Newly diagnosed patients with glioma in the left (N = 73; 49% glioblastoma) or right (N = 30; 57% glioblastoma) temporal lobe completed neuropsychological testing and self‐report measures of HRQOL (Functional Assessment of Cancer Therapy (FACT)‐General and Brain module) and mood (Beck Depression Inventory‐Second Edition and State‐Trait Anxiety Inventory). Results Verbal learning and memory, executive function, and language abilities were associated with various HRQOL scales. Stepwise linear regression showed that verbal learning predicted scores on the general well‐being scale and brain module, processing speed predicted social well‐being scores, and executive functioning predicted functional well‐being scores on the FACT. Upper extremity strength also predicted scores on the functional well‐being subscale and brain module. Mood was more strongly associated with HRQOL domains than NCF, with depressive symptoms accounting for a large proportion of variance across most subscales. Conclusions In patients with temporal lobe glioma, depressive symptoms are strongly related to most aspects of HRQOL but not with NCF. NCF, specifically verbal learning and memory, executive functioning, and processing speed, also show direct relationships with numerous aspects of HRQOL. These findings underscore the importance of multimodal assessment of NCF and mood in this population. Copyright © 2015 John Wiley & Sons, Ltd.

  December 17, 2015   doi: 10.1002/pon.4046   open full text
• Psychometric properties of the Parenting Concerns Questionnaire in cancer survivors with minor and young adult children.
  Laura Inhestern, Johanna C. Bultmann, Volker Beierlein, Birgit Möller, Georg Romer, Anna C. Muriel, Cynthia W. Moore, Uwe Koch, Corinna Bergelt.
  Psycho-Oncology. December 17, 2015
  Objective Although cancer patients with minor children have become more of a focus of psycho‐oncological research, little is known about specific parenting concerns. Instruments to assess the concerns and worries of parents with cancer are rare. The Parenting Concerns Questionnaire (PCQ) addresses this issue. We analyzed parenting concerns in cancer survivors and evaluated the German version of the PCQ. Methods A total of 1416 cancer survivors with minor and young adult children (≤21 years) were recruited in a register‐based study. Descriptive analyses as well as reliability and validity analyses were conducted. We performed a confirmatory factorial analysis of the factor structure proposed by the authors of the original version on the PCQ. Results Seventy‐three percent of the cancer survivors were women, average age was 47.5 years (SD 5.9). Mean time since diagnosis was 44 months (SD 23.4). Between 18 and 31% of survivors reported that they were concerned about their children. The PCQ proved to be a reliable and valid instrument showing medium correlations with standardized measures in expected directions and discriminating between survivors with and without use of psychosocial support services. The factor structure was supported by the confirmatory factorial analysis. Conclusions Assessing parenting concerns gives an additional insight into the situation of parents with cancer. In our sample of cancer survivors, we identified one out of three survivors being concerned regarding the impact of their illness on their children. The PCQ can be considered as a valid and reliable instrument with regard to identifying concerned parents with cancer. Copyright © 2015 John Wiley & Sons, Ltd.

  December 17, 2015   doi: 10.1002/pon.4049   open full text
• Participation in pediatric oncology: views of child and adolescent patients.
  Katharina M. Ruhe, Domnita O. Badarau, Pierluigi Brazzola, Heinz Hengartner, Bernice S. Elger, Tenzin Wangmo,.
  Psycho-Oncology. December 17, 2015
  Objective The aim of the present study is to explore patient's perspectives in pediatric oncology on participation in discussions and decision‐making surrounding their cancer diagnosis. Methods Seventeen patients between 9 and 17 years of age receiving treatment at centers of the Swiss Pediatric Oncology Group were interviewed for this study. Their interview data was analyzed qualitatively to identify themes with regard to participation in medical communication and/or decision‐making. Results Participants highlighted how their roles in health care discussions varied from direct participation to indirect involvement. Overall, there were fewer accounts of involvement in decision‐making than in overall health care discussions. Challenges with regard to completely understanding the information provided and making decisions were identified. Participants also discussed situations when they were not involved in medical communication or decision‐making. While they generally valued their participation, the preferred level of involvement oscillated between participants as well as within one and the same child across time. Conclusions The complex pattern of participation found in this study calls for a flexible model of involving children and adolescents in health care that accounts for the varying roles and preferences that they manifest. A patient may appreciate active involvement in some decisions while choosing to remain in the background for others. Copyright © 2015 John Wiley & Sons, Ltd.

  December 17, 2015   doi: 10.1002/pon.4053   open full text
• Role of family caregivers' self‐perceived preparedness for the death of the cancer patient in long‐term adjustment to bereavement.
  Youngmee Kim, Charles S. Carver, David Spiegel, Hannah‐Rose Mitchell, Rachel S. Cannady.
  Psycho-Oncology. December 10, 2015
  Background A substantial number of family caregivers go through bereavement because of cancer, but little is known about the bereaved caregivers' long‐term adjustment. This study aimed to document levels of bereavement outcomes (prolonged grief symptoms, intense emotional reaction to the loss, depressive symptoms, and life satisfaction) among family cancer caregivers 3–5 years post‐loss and to investigate how self‐rated preparedness for the patient's death predicted those bereavement outcomes. Methods Family members participated in a nationwide survey for cancer caregivers 2 years after the relative's diagnosis (T1). Of those, 109 were identified as bereaved by 5 years post‐diagnosis (T2). Of those, 88 continued to participate at 8‐year follow‐up (T3) and provided valid data for the study variables. Caregivers' distress risk factors were measured at T1, satisfaction with palliative care and preparedness for the death of the patient at T2, and time since death of the patient at T2 or T3. Results Substantial numbers of family members (18% to 48%) displayed heightened levels of bereavement‐related psychological distress years after the loss. Hierarchical general linear modeling revealed that perceived preparedness for the death of the patient concurrently and prospectively predicted better adjustment to bereavement, independent of contributions of other factors studied. Conclusions Findings underscore the high prevalence of long‐lasting bereavement‐related distress among family cancer caregivers and the role of preparedness for the relative's death in the level of that distress. Findings suggest that psychosocial programs among caregivers focus on not only caregiving skills per se but also preparedness for the death of the patient. Copyright © 2015 John Wiley & Sons, Ltd.

  December 10, 2015   doi: 10.1002/pon.4042   open full text
• The impact of a spiritual legacy intervention in patients with brain cancers and other neurologic illnesses and their support persons.
  Katherine M. Piderman, Carmen Radecki Breitkopf, Sarah M. Jenkins, Maria I. Lapid, Gracia M. Kwete, Terin T. Sytsma, Laura A. Lovejoy, Timothy J. Yoder, Aminah Jatoi.
  Psycho-Oncology. December 07, 2015
  Objective The objectives were to assess the feasibility of using a novel, comprehensive chaplain‐led spiritual life review interview to develop a personal Spiritual Legacy Document (SLD) for persons with brain tumors and other neurodegenerative diseases and to describe spiritual well‐being (SWB), spiritual coping, and quality of life (QOL) of patients and their support persons (SP) before and after receipt of the SLD. Methods Patient‐SP pairs were enrolled over a 2‐year period. Assessments included the Functional Assessment of Chronic Illness Therapy‐Spiritual Expanded Version, Brief Religious Coping Scale, Brief COPE Inventory, and QOL Linear Analog Scale. Baseline assessments were completed prior to an audio‐recorded spiritual life review interview with a chaplain. Results Thirty‐two patient/SP pairs were enrolled; 27 completed baseline assessments and the interview. Twenty‐four reviewed their SLD and were eligible for follow‐up. A total of 15 patients and 12 SPs completed the 1‐month follow‐up; 10 patients and seven SPs completed the 3‐month follow‐up. Patients endorsed high levels of SWB and spiritual coping at baseline. Both patients and SPs evidenced improvement on several aspects of SWB, spiritual coping, and QOL at 1 month, but patients' decreased financial well‐being was also observed. Patients and SPs demonstrated favorable changes in peacefulness and positive religious coping at both time points. Conclusions A chaplain‐led spiritual life review is a feasible intervention for patients with neurodegenerative disease and results in beneficial effects on patients and SPs. Copyright © 2015 John Wiley & Sons, Ltd.

  December 07, 2015   doi: 10.1002/pon.4031   open full text
• Poor‐prognosis disclosure preference in cancer patient–caregiver dyads and its association with their quality of life and perceived stress: a cross‐sectional survey in mainland China.
  Xin Nie, Dawei Ye, Qiming Wang, Anne Manyande, Lin Yang, Hong Qiu, Tengfei Chao, Peng Zhang, Chen Gong, Liang Zhuang, Shiying Yu, Huihua Xiong.
  Psycho-Oncology. December 07, 2015
  Background This study attempted to examine the discordance between family caregivers and cancer patients in their poor‐prognosis disclosure preferences in mainland China and then ascertained the associations between quality of life (QoL), perceived stress, and poor‐prognosis disclosure preferences. Methods Six hundred fifty‐one pairs of inpatients and their matched caregivers (participation rate = 92.2%) were recruited in this cross‐sectional survey. A set of paired self‐administered questionnaires were completed independently by patient–caregiver dyads. Results Fewer family caregivers than cancer patients felt that poor prognosis should be disclosed to patients (61.2% vs. 90.0%, p < 0.001). Patients' positive poor‐prognosis disclosure preference was associated with patients' better QoL (p < 0.05) and caregivers' reduced perceived stress levels (p = 0.013). However, caregivers' poor‐prognosis disclosure preference correlated only with their own physical state (p = 0.028). Moreover, the caregivers who concurred with patients in positive poor‐prognosis disclosure preference were more likely to experience a better QoL (p < 0.05) and lower perceived stress levels (p = 0.048) in the III–IV stage subgroup. Conclusions There was a significant discrepancy in poor‐prognosis disclosure preference between cancer patients and caregivers in China. The caregivers' preference of concealing poor prognosis from patients was not related to cancer patients' QoL or perceived stress. In addition, caregivers had better QoL and lower stress levels when they held the same positive poor‐prognosis disclosure preference as the patients. Copyright © 2015 John Wiley & Sons, Ltd.

  December 07, 2015   doi: 10.1002/pon.4055   open full text
• The relative contributions of function, perceived psychological burden and partner support to cognitive distress in bladder cancer.
  Susan M. Heyes, Malcolm J. Bond, Ann Harrington, Ingrid Belan.
  Psycho-Oncology. December 07, 2015
  Objective Bladder cancer is a genitourinary disease of increasing incidence. Despite improvements in treatment, outcomes remain equivocal with high recurrence rates. It is associated with poor psychosocial outcomes due to reduced functioning of the genitourinary system. The objective of these analyses was to query whether reported loss of function or the perception of psychological burden caused by this functional impedance was the key to understanding psychosocial outcomes. Methods The sample comprised 119 participants with a confirmed diagnosis of bladder cancer. They completed a self‐report questionnaire comprising the Bladder Cancer Index, Mini‐mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale and standard sociodemographic details. Simple mediation and serial mediation were used to explore the potential for psychological burden to mediate associations between loss of function and cognitive distress, and the potential additional contribution of positive partner support on these relationships. Age and duration of cancer were considered as covariates. Results Simple mediation demonstrated that the association between function and cognitive distress was fully mediated by perceived psychological burden. Serial mediation, which allowed for the addition of partner support, again demonstrated full mediation, with partner support being the key predictive variable. Conclusions These analyses emphasise the importance of an appreciation of individuals' interpretation of the burden occasioned by bladder cancer and the role of a supportive partner. The implications for management discussions and support services in alleviating negative psychological outcomes in bladder cancer are highlighted. Copyright © 2015 John Wiley & Sons, Ltd.

  December 07, 2015   doi: 10.1002/pon.4054   open full text
• Crossed views of burden and emotional distress of cancer patients and family caregivers during palliative care.
  Tanguy Leroy, Emmanuelle Fournier, Nicolas Penel, Véronique Christophe.
  Psycho-Oncology. December 03, 2015
  Objective Studies regarding natural caregivers' burden (CB) in palliative situations, as well as its determinants and consequences, have been numerous during the last 20 years. Yet, studies regarding how terminally ill cancer patients perceive their CB (self‐perceived burden, SPB) are less common. This study aims to assess the links between CB and SPB evaluated by means of the very same items. It also aims at identifying the determinants of potential differences between CB and SPB and their consequences on emotional distress among both members of the dyad. Methods Sixty cancer patients from a palliative care unit and their principal natural caregiver completed questionnaires concerning the subjective burden of the caregiver, their own personal emotional distress and that of the other member of the dyad. Results Globally, patients had a good perception of their CB, although a little overestimated, except for their difficulties in managing their time. Caregivers overestimated patients' distress. The minimisation by patients of CB was a source of emotional distress for the latter, and the perception of being a burden to others was a source of depression for patients. These results did not depend on the nature of the relationship between patients and their caregivers. Conclusions This data confirmed the need to study the experiences of the patient–caregiver dyad as well as their communication of their respective experiences, with a prospect to offer clinical interventions to optimise the quality of life and health of patients and their close relatives.Copyright © 2015 John Wiley & Sons, Ltd.

  December 03, 2015   doi: 10.1002/pon.4056   open full text
• Comparison of patient‐reported need of psycho‐oncologic support and the doctor's perspective: how do they relate to disease severity in melanoma patients?
  Sandra Nolte, Sicco H. Mei, Kerstin Strehl‐Schwarz, Johanna Köster, Armin Bender, Matthias Rose, Johannes Kruse, Eva M. J. Peters.
  Psycho-Oncology. December 03, 2015
  Objective Psycho‐neuro‐immune research suggests an association between cancer outcomes and psychosocial distress. Objective criteria to determine patients' levels of distress are important to establish potential links to disease outcomes. Methods We compared three patient‐reported with one doctor‐reported measures of psycho‐oncologic distress frequently used in routine cancer care and investigated associations with standard disease severity parameters in melanoma patients. We enrolled n = 361 patients, successively seen at two outpatient university clinics in Germany. In the naturalistic study, n = 222 patients had been diagnosed <180 days and were seen for the first time (Group I); n = 139 had been diagnosed >180 days and were in after‐care (Group II). Results Across groups, only moderate associations were seen between patient‐ reported and doctor‐reported measures. Regarding clinical variables, disease severity and perceived need of psycho‐oncologic support reported by patients or doctors showed hardly any association. After subgroup stratification, in patients of Group II, patient‐reported and doctor‐reported instruments showed some small associations with disease parameters commonly linked to more rapid cancer progression in patients who are in cancer after‐care. Conclusions Overall, the few and low associations suggest that need of psycho‐oncologic support and clinical variables were largely independent of each other and doctors' perception may not reflect the patient's view. Therefore, the assessment of the patient perspective is indispensable to ensure that melanoma patients receive appropriate support, as such need cannot be derived from other disease parameters or proxy report. More research is needed applying psychometrically robust instruments that are ideally combined with sensitive biomarkers to disentangle psycho‐neuro‐immune implications in melanoma patients. Copyright © 2015 John Wiley & Sons, Ltd.

  December 03, 2015   doi: 10.1002/pon.4050   open full text
• Repeated participation in pancreatic cancer surveillance by high‐risk individuals imposes low psychological burden.
  Ingrid C. A. W. Konings, Grace N. Sidharta, Femme Harinck, Cora M. Aalfs, Jan‐Werner Poley, Jacobien M. Kieffer, Marianne A. Kuenen, Ellen M. A. Smets, Anja Wagner, Jeanin E. Hooft, Anja Rens, Paul Fockens, Marco J. Bruno, Eveline M. A. Bleiker.
  Psycho-Oncology. December 03, 2015
  Background When assessing the feasibility of surveillance for pancreatic cancer (PC), it is important to address its psychological burden. The aim of this ongoing study is to evaluate the psychological burden of annual pancreatic surveillance for individuals at high risk to develop PC. Methods This is a multicenter prospective study. High‐risk individuals who undergo annual pancreatic surveillance with magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) were invited to complete questionnaires to assess motivations for participating in surveillance, experiences with participation, perceived PC risk, topics of concern, and psychological distress. Questionnaires were sent after intake for participation (T1), after the first MRI and EUS (T2), and after the MRI and EUS 1 (T3), 2 (T4), and 3 years (T5) after first surveillance. Results In total, 140 out of 152 individuals returned one or more of the questionnaires (response 92%); 477 questionnaires were analyzed. The most frequently reported motivation for participating in surveillance was the possible early detection of (a precursor stage of) cancer (95–100%). Only a minority of respondents experienced MRI and EUS as uncomfortable (10% and 11%, respectively), and respondents dreaded their next EUS investigation less as surveillance progressed. Respondents' cancer worries decreased significantly over time, and both their anxiety and depression scores remained stable and low over the 3‐year period of follow‐up. Conclusions The psychological burden of pancreatic surveillance is low at all assessments. Therefore, from a psychological point of view, participation of high‐risk individuals in an annual pancreatic surveillance program is feasible.Copyright © 2015 John Wiley & Sons, Ltd.

  December 03, 2015   doi: 10.1002/pon.4047   open full text
• Expecting the best and being prepared for the worst: structure, profiles, and 2‐year temporal stability of dispositional optimism in women with breast cancer.
  Fredrik Saboonchi, Lena‐Marie Petersson, Kristina Alexanderson, Richard Bränström, Agneta Wennman‐Larsen.
  Psycho-Oncology. December 03, 2015
  Objectives Dispositional optimism is viewed as a key personality resource for resiliency and has been linked to adjustment among women with breast cancer. The aim was to examine (a) the psychometric proprieties of Life Orientation Test‐Revised (LOT‐R), (b) the potential independence and co‐occurrence of positive and negative dimensions of future outcome expectancies, (c) the longitudinal invariance of LOT‐R and the temporal stability of dispositional optimism over 2 years following surgery, and (d) the predictive impact of optimism and pessimism on emotional distress among women with breast cancer. Methods Data from a prospective study (n = 750) of women with breast cancer were acquired shortly after surgery, and the women were followed up for 2 years. Assessments of LOT‐R, Hospital Anxiety and Depression Scale, treatment‐related, and demographic variables were subjected to structural equation modeling analysis. Results A bidimensional and temporarily invariant structure of LOT‐R displayed acceptable fit indices. Three profiles of future expectancies consisting of optimists, pessimists, and ambiguous were identified. Temporal stability in optimism and pessimism over 2 years was established. Women with higher education displayed higher degrees of pessimism. Baseline dispositional optimism inversely predicted emotional distress at 2 years. Conclusions The LOT‐R should be approached as a bidimensional measure. Co‐occurrence of optimism and pessimism may indicate a cautious defensive coping effort in women with breast cancer. The importance of systematic efforts to enhance optimism as well as the capacity to acknowledge both positive and negative future expectancies is emphasized.Copyright © 2015 John Wiley & Sons, Ltd.

  December 03, 2015   doi: 10.1002/pon.4045   open full text
• The complex interplay of physician, patient, and spouse in preoperative counseling for radical prostatectomy: a comparative mixed‐method analysis of 30 videotaped consultations.
  Johannes Huber, Jürg C. Streuli, Novica Lozankovski, Regina J. F. Stredele, Peter Moll, Markus Hohenfellner, Christian G. Huber, Andreas Ihrig, Tim Peters.
  Psycho-Oncology. December 03, 2015
  Objectives Spouses of cancer patients play a crucial role in deciding on therapeutic choices. The aim of our study was to assess their role in counseling for radical prostatectomy. Methods We analyzed 30 videotaped preoperative consultations prior to radical prostatectomy. Thereof, 14 included the patients' female partner and 16 took place without partner attendance. We performed quantitative and qualitative conversation analysis to compare both settings. Results Mean age of patients was 61 (47–73) years; 13% (4/30) did not have a partner. Duration of preoperative consultations was 20 (10–32) min. Physicians spoke most of the time (93%, range 71–99%), followed by patients (7%, range 1–20%) and spouses (2%, range 0–8%). Patients whose spouse was present at the consultation tended to have a more averted posture (50% vs. 25%, p = 0.04) and tended to speak less often (5% vs. 8%, p = 0.02). In 4 of 14 (29%) consultations, the spouses tended to be more dominant, speaking more frequently. Qualitative analysis showed several examples of emotional support and helpful contributions by spouses. Difference of opinion occurred when pros and cons of a nerve‐sparing approach were discussed. The spouses' impact appeared to influence the final decision of men contemplating a nerve‐sparing approach in 1 of 14 conversations. Conclusions Spouses appear to play a complex and sometimes ambivalent role in counseling for radical prostatectomy. Especially when discussing a nerve‐sparing approach, urologist should focus on the patients' true needs while interacting with both partners. Personalized decision aids might help to identify possible conflicts in advance.Copyright © 2015 John Wiley & Sons, Ltd.

  December 03, 2015   doi: 10.1002/pon.4041   open full text
• The effects of attachment and outness on illness adjustment among gay men with prostate cancer.
  Cassandra J. Crangle, David M. Latini, Tae L. Hart.
  Psycho-Oncology. December 02, 2015
  Objective Previous research has suggested that gay men facing prostate cancer may be particularly vulnerable to poor illness adjustment. Moreover, although attachment and greater disclosure of sexual orientation have been associated with health outcomes, their associations in this population have been largely unexamined. The purpose of the present study was to investigate whether greater outness about one's sexual orientation significantly mediated the associations between anxious and avoidant attachment and illness intrusiveness among gay men with prostate cancer. Methods Ninety‐two gay and bisexual men who had received a diagnosis of prostate cancer in the past 4 years were recruited for the present study. Self‐report questionnaires assessed demographic and medical variables, attachment, outness level and comfort, and illness intrusiveness. Bootstrapping procedures were used to assess for mediation. Results Results suggested significant associations between anxious attachment, outness comfort, and illness intrusiveness. Less comfort with outness significantly mediated the association between greater anxious attachment and more illness intrusiveness. Avoidant attachment was not significantly associated with illness intrusiveness. Conclusions Findings support the mediating role of the subjective experience of being an out gay man in the association between anxious attachment and illness intrusiveness. These results suggest that facilitating greater comfort with outness would be beneficial for illness adjustment among gay men with prostate cancer whom have more anxious attachment styles. Copyright © 2015 John Wiley & Sons, Ltd.

  December 02, 2015   doi: 10.1002/pon.4043   open full text
• Validity, specificity, feasibility and acceptability of a brief pediatric distress thermometer in outpatient clinics.
  Lori Wiener, Haven Battles, Sima Zadeh, Brigitte C. Widemann, Maryland Pao.
  Psycho-Oncology. November 30, 2015
  Objective Psychosocial distress is under‐recognized in children with cancer and other serious medical illnesses because of a focus on pressing medical concerns. Aims This study assessed the validity, inter‐rater reliability, sensitivity/specificity, acceptability, and feasibility of administration of a pediatric distress thermometer (DT) designed to screen for the presence of psychosocial distress in youth with serious medical illnesses. Materials & Methods Two hundred eighty‐one patient–caregiver–provider triads were enrolled from two hospital outpatient clinics. Patients diagnosed with cancer and other life‐threatening diseases, caregivers, and providers completed the DT and a DT acceptability rating. Patients and caregivers completed standardized measures of anxiety, depression, pain, and fatigue. Providers completed a measure of disease severity. Data collectors completed a feasibility rating. Results The DT was significantly correlated with both caregiver and patient reports of depression, anxiety, pain, and fatigue, exhibiting concurrent validity. Parent, child, and caregiver report demonstrated significant, moderate inter‐rater reliability, with lower concordance between raters in the youngest age group. The DT is a sensitive instrument for screening of psychosocial distress when compared with the selected gold standard (Brief Symptom Inventory 18 depression subscale and the Children's Depression Inventory). The DT is not highly specific but quickly identifies those in need of further psychosocial assessment. Discussion Screening, using an adapted pediatric DT, is valid, feasible, and acceptable to patients, caregivers, and medical providers across chronic medical illnesses. Conclusion As patient and caregiver reports are not always concordant, both patient and caregiver report of distress are important for the provider to obtain clinically meaningful information to guide interventions. Published 2015. This article is a U.S. Government work and is in the public domain in the USA

  November 30, 2015   doi: 10.1002/pon.4038   open full text
• Sharing bad news of a lung cancer diagnosis: understanding through communication privacy management theory.
  Nothando Ngwenya, Morag Farquhar, Gail Ewing.
  Psycho-Oncology. November 25, 2015
  Background The aim of this paper is to understand the process of information disclosure and privacy as patients share their news of lung cancer with significant others. Methods Twenty patients with lung cancer and 17 family members/friends accompanying them at diagnosis‐giving completed either individual or dyad semi‐structured interviews. Initial thematic analysis, then Petronio's Communication Privacy Management theory was used to inform interpretation. Results Patients described a sense of ownership of the news of their cancer and sought control of how, when and with whom it was shared. Family members expressed a need to follow the patients' rules in sharing this news, which limited their own support systems. Patients and family members had to live within the relational communication boundaries in order to maintain their trusting relationship and avoid potential disruptions. Conclusion Patients as individuals are strongly interlinked with significant others, which impacts on their experience of disclosing private information. This shapes their psychological processes and outcomes impacting on their illness experience. This should be considered when developing interventions to support patients with sharing bad news. Copyright © 2015 John Wiley & Sons, Ltd.

  November 25, 2015   doi: 10.1002/pon.4024   open full text
• Social outcomes in adult survivors of childhood cancer compared to the general population: linkage of a cohort with population registers.
  Anna Font‐Gonzalez, Elizabeth (Lieke) Feijen, Elske Sieswerda, Eline Dulmen‐den Broeder, Martha Grootenhuis, Helena Maurice‐Stam, Huib Caron, Marie‐Louise Essink‐Bot, Helena Pal, Ronald Geskus, Leontien Kremer.
  Psycho-Oncology. November 23, 2015
  Objective Self‐reported data show differences in social outcomes (not being married/having a registered partnership; not living independently; using social benefits) for childhood cancer survivors compared with their peers. We aimed to determine differences in these social outcomes between survivors and the general population using national register data and explored associated risk factors. Methods We performed medical record linkage between a single‐centre cohort of 1768 ≥ 5‐year survivors of childhood cancer (diagnosed 1966–2001) and two national registers (1999–2011) and obtained a random reference sample matched on gender and year of birth per survivor. We used multivariable logistic regression to calculate in adult survivors of childhood cancer (born before 1990) the odds of the specified social outcomes at the end of follow‐up in both groups. Within the survivors, we analysed risk factors for the social outcomes. Results We retrieved data from 1283 adult childhood cancer survivors and 25 082 reference persons. Survivors had higher odds (odds ratio; 95% confidence interval) of not being married (1.2; 1.07–1.42), not living independently (1.7; 1.41–2.00) and using social benefits (2.3; 1.98–2.69) compared with reference persons. Radiotherapy to head and/or neck, and an original central nervous system tumour diagnosis negatively influenced all social outcomes examined in childhood cancer survivors. Conclusions National register data show differences between social outcomes in childhood cancer survivors and the general population, especially for survivors treated with radiotherapy to head and/or neck and those originally diagnosed with central nervous system tumours. Development and implementation of effective targeted support strategies to improve social outcomes of childhood cancer survivors needs consideration. Copyright © 2015 John Wiley & Sons, Ltd.

  November 23, 2015   doi: 10.1002/pon.4040   open full text
• Experiences and desired nursing assistance of women on out‐patient breast cancer chemotherapy in Southeastern Nigeria.
  A. N. Anarado, E. R. Ezeome, O. B. Ofi, A. C. Nwaneri, Y. Ogbolu.
  Psycho-Oncology. November 20, 2015
  Objective This study explored the experiences and nursing support needs of women undergoing out‐patient breast cancer chemotherapy in two teaching hospitals in Southeastern Nigeria. Methods Using a qualitative descriptive design, based on grounded theory approach and focus group discussion (FGD) methodology, 20 histological confirmed breast cancer patients at different stages of combination chemotherapy (cyclophosphamide, doxorubicin, and fluorouracil ) were purposively selected and engaged in FGDs at two surgical oncology clinics. Data saturation was reached at the fourth FGD. The audio‐taped and transcribed data were content analyzed using thematic approach. Results Participants were all christians of the Igbo‐speaking ethnic group, and aged between 36 and 66 years. Most were married and had at least primary education. Five themes emerged from the FGDs: inadequate preparation for chemotherapy; chemotherapy scary, distressful, and financially demanding; hope, faith and courage sustained treatment; self‐care actions initiated to ‘weather the storm’; and nursing assistance desired to foster hope and enhance patients' acceptance of, adjustment and adherence to breast cancer chemotherapy in Nigeria. Culture influenced their chemotherapy perspectives and coping. Conclusion Women with breast cancer in southeastern Nigeria desired but were inadequately prepared to cope with chemotherapy distress they experienced. Nurses could help patients to accept and navigate through chemotherapy by initiating and supporting effective and efficient self‐care actions that are culturally congruent.Copyright © 2015 John Wiley & Sons, Ltd.

  November 20, 2015   doi: 10.1002/pon.4034   open full text
• Association of social support, functional status, and psychological variables with changes in health‐related quality of life outcomes in patients with colorectal cancer.
  M. Gonzalez‐Saenz de Tejada, A. Bilbao, M. Baré, E. Briones, C. Sarasqueta, J.M. Quintana, A. Escobar.
  Psycho-Oncology. November 18, 2015
  Background The aim of this study was to explore the association of social support received, and functional and psychological status of colorectal cancer patients before surgery with changes in health‐related quality of life (HRQoL) outcomes measured by EORTC QLQ‐C30 at 1‐year post‐intervention. Methods Consecutive patients that were because of undergo therapeutic surgery for the first time for colon or rectum cancer in nine hospitals in Spain were eligible for the study. Patients completed questionnaires before surgery and 12 months afterwards: one HRQoL instrument, the EORTC QLQ‐C30; a social network and social support questionnaire, the Duke‐UNC Functional Social Support Questionnaire; the Hospital Anxiety and Depression Scale, to assess anxiety and depression; and the Barthel Index, to assess functional status; as well as questions about sociodemographic information. General linear models were built to explore the association of social support, functional status, and psychological variables with changes in HRQoL 12 months after intervention. Results A total of 972 patients with colorectal cancer took part in the study. Patients' functional status, social support, and anxiety and depression were associated with changes in at least one HRQoL domain. The higher functional status, and the higher social support, the more they improved in HRQoL domains. Regarding anxiety and depression, the more anxiety and depression patients have at baseline, less they improve in HRQoL domains. Conclusions Patients with colorectal cancer who have more social support and no psychological distress may have better results in HRQoL domains at 1 year after surgery. Copyright © 2015 John Wiley & Sons, Ltd.

  November 18, 2015   doi: 10.1002/pon.4022   open full text
• A pilot study of cancer patients' use of traditional healers in the Radiotherapy Department, University College Hospital, Ibadan, Nigeria.
  C. C. Asuzu, T. Elumelu‐Kupoluyi, M. C. Asuzu, O. B. Campbell, E. O. Akin‐Odanye, D. Lounsbury.
  Psycho-Oncology. November 17, 2015
  Objective This descriptive cross‐sectional study assessed cancer patients' use of traditional healers, the association between delay in coming to this clinic and patients' use of traditional healers, reasons cancer patients use western medicine after trying traditional treatment and the cost of obtaining traditional treatment. Methods Participants were made of 400 consecutive and consenting new patients in the Department of Radiotherapy, University College Hospital (UCH), Ibadan. A validated interviewer‐administered semi‐structured questionnaire was used for data collection. Data was analyzed using descriptive and inferential statistics. Focus group discussions were held with some of the clients as well as the traditional healers. Results It showed that 34.5% of the patients patronized traditional healers, while 65.5% used only hospitals. The most common reason given among patients who patronized traditional healers for doing so was their desire to be healed and to be rid of pains (45.9%), while the most common reason they opt for western medicine afterwards was lack of improvement in their health condition (70.1%). The cost of traditional treatment for cancer ranged between no cost to N5,000 (that is approximately $31.25 @ $1 = N160) to be treated. The cost of orthodox care would range from a minimum of N40,000 to several millions of naira. Conclusions Patients patronize traditional healers to be rid of pains; hence physicians should endeavor to control cancer‐related symptoms, especially pains as the patients await diagnosis. Also, the low cost of obtaining traditional treatment, regular assurance of cure and other assistances given to them, could be an enticing factor in its use. Copyright © 2015 John Wiley & Sons, Ltd.

  November 17, 2015   doi: 10.1002/pon.4033   open full text
• Impact of disclosure of diagnosis and patient autonomy on quality of life and illness perceptions in Chinese patients with liver cancer.
  Bin Jie, Yan Qiu, Zheng‐Zhi Feng, Shai‐Nan Zhu.
  Psycho-Oncology. November 16, 2015
  Objective This prospective cohort study explored the impact of disclosure of diagnosis and patient autonomy on the health‐related quality of life (HRQOL) and illness perceptions in Chinese patients with hepatocellular carcinoma (HCC). Methods Patients with HCC who were admitted for potentially curative treatments in a teaching hospital were recruited from August 2013 to July 2014. Patients were interviewed at admission regarding their HRQOL and their attitude towards disclosure of diagnosis. They were interviewed again regarding HRQOL and illness perceptions at discharge. Results There were 218 patients recruited; 57.8% of them were aware of their cancer diagnosis (disclosed group). For 63.8% of the participants, their desire for disclosure or nondisclosure was satisfied (autonomy‐satisfied group). When comparing the patients in the disclosed group with the patients who were uninformed, the patients in the disclosed group had higher scores for global HRQOL at discharge (p = 0.013) and higher scores on understanding of their illness regarding illness perceptions (p = 0.022). When comparing the patients in the ‘autonomy‐satisfied’ group with the patients whose desire for disclosure was not satisfied, the patients in the autonomy‐satisfied group had better emotional functioning and better global HRQOL at discharge (p < 0.001 and p = 0.001, respectively). Additionally, the patients in the autonomy‐satisfied group had higher scores for personal control (p = 0.009) and lower scores for emotional reaction (p = 0.007) regarding illness perceptions, even after controlling for other confounding factors. Conclusions Our findings suggest that for patients with HCC who have undergone potentially curative treatment, physicians should satisfy patients' desires for autonomy regarding the disclosure of their diagnosis. Copyright © 2015 John Wiley & Sons, Ltd.

  November 16, 2015   doi: 10.1002/pon.4036   open full text
• Weight fluctuation during adulthood and weight gain since breast cancer diagnosis predict multiple dimensions of body image among rural breast cancer survivors.
  Tera L. Fazzino, Rebecca Clausius Hunter, Nora Sporn, Danielle N. Christifano, Christie A. Befort.
  Psycho-Oncology. November 12, 2015
  Objective Obesity and weight gain after breast cancer treatment are common among survivors, yet the relationship between weight and body image has received little attention. The purpose of the current study was to examine the relationship between current body mass index, weight gain since diagnosis, and largest weight fluctuation in adulthood with six dimensions of body image among overweight/obese breast cancer survivors. Methods The current study used data obtained from a weight control trial with 210 rural overweight/obese breast cancer survivors. Using data collected at baseline, multiple regression models were constructed to examine the relative association of the three weight variables with breast cancer‐specific dimensions of body image while controlling for demographic characteristics and cancer treatment‐related variables. Results Largest weight fluctuation in adulthood significantly predicted overall body image (p = 0.01) and was associated with the three socially oriented dimensions of body image: social activity restriction, embarrassment about appearance, and sexuality (all ps = 0.01). Weight gain since diagnosis approached statistical significance in predicting overall body image (p = 0.05) and was associated with embarrassment about appearance (p = 0.03). Current body mass index was not significantly associated with overall body image when controlling for the other weight variables (p = 0.07) and was negatively associated with social activity restriction (p = 0.01) and sexuality (p = 0.01). Conclusions Obese breast cancer survivors with a history of a large weight fluctuation in adulthood may be prone to poorer breast cancer‐specific body image several years after treatment. Copyright © 2015 John Wiley & Sons, Ltd.

  November 12, 2015   doi: 10.1002/pon.4035   open full text
• Fatalism, medical mistrust, and pretreatment health‐related quality of life in ethnically diverse prostate cancer patients.
  Natalie Escobio Bustillo, Heather L. McGinty, Jason R. Dahn, Betina Yanez, Michael H. Antoni, Bruce R. Kava, Frank J. Penedo.
  Psycho-Oncology. November 09, 2015
  Objective Few studies have examined the impact of cultural processes prevalent in minority ethnic groups such as cancer fatalism and medical mistrust on health‐related quality of life (HRQoL) following a cancer diagnosis. The present study examined relationships among ethnicity, HRQoL, and two possible cultural vulnerability factors—fatalistic attitudes and medical mistrust—among an ethnically diverse sample of men with prostate cancer (PC) prior to undergoing active treatment. Methods A total of 268 men with localized PC (30% African American, 29% Hispanic, and 41% non‐Hispanic White) were assessed cross‐sectionally prior to active treatment. Path analyses examined relationships among ethnicity, vulnerability factors, and HRQoL. Results Ethnicity was not related to HRQoL after controlling for relevant covariates. Hispanic men reported greater cancer fatalism compared with non‐Hispanic White men (β = 0.15, p = 0.03), and both Hispanics (β = 0.19, p < 0.01) and African Americans (β = 0.20, p < 0.01) reported greater medical mistrust than non‐Hispanic Whites. Fatalism demonstrated a trend toward negatively impacting physical well‐being (β = −0.12, p = 0.06), but was not significantly related to emotional well‐being (β = −0.10, p = 0.11). Greater medical mistrust was associated with poorer physical (β = −0.14, p = 0.03) and emotional well‐being (β = −0.13, p = 0.04). Conclusions Results indicate that fatalistic attitudes and medical system mistrust were more prevalent among minority men. Less trust in the medical system was associated with poorer physical and emotional well‐being. Attention to perceptions of the healthcare system and its relation to HRQoL may have implications for targeting culturally driven attitudes that may compromise adjustment to a PC diagnosis.Copyright © 2015 John Wiley & Sons, Ltd.

  November 09, 2015   doi: 10.1002/pon.4030   open full text
• Factors associated with psychological distress in women with breast cancer‐related lymphoedema.
  Jessica Alcorso, Kerry A. Sherman.
  Psycho-Oncology. November 03, 2015
  Background Previous research has shown that lymphoedema impacts negatively on an individual, including psychological distress and body image disturbance, particularly for younger women. This study identified psychological factors associated with distress in women with breast cancer‐related lymphoedema and determined whether age moderated the specific relationship between body image disturbance and distress. Methods Australian women (n = 166) diagnosed with breast cancer‐related lymphoedema were recruited through a community‐based breast cancer organisation and lymphoedema treatment clinics. Participants completed an online survey assessing lymphoedema‐related cognitions (personal control, perceived treatment effectiveness, and consequences of lymphoedema), perceived ability to self‐regulate lymphoedema‐related negative affect, body image disturbance, psychological distress (depression, anxiety and stress), and demographic/medical information. Results Beliefs about the consequences, perceived effectiveness of treatment and controllability of lymphoedema, perceived ability to self‐regulate negative affect, body image disturbance, and number of lymphoedema symptoms were correlated with depression, anxiety, and stress scores. Multivariate regression analyses indicated that body image disturbance was significantly associated with depression, anxiety, and stress, and perceived treatment effectiveness was associated with stress. Age was a significant moderator of the relationship between body image disturbance and depression and anxiety, with older women with greater body image disturbance more distressed. Conclusions Health professionals need to be aware that women diagnosed with lymphoedema are at risk of experiencing psychological distress, particularly arising from body image disturbance and beliefs that treatment cannot control lymphoedema. Furthermore, older women may be at an increased risk of anxiety and depression arising from body image disturbance. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  November 03, 2015   doi: 10.1002/pon.4021   open full text
• Economic evaluation of a psychological intervention for high distress cancer patients and carers: costs and quality‐adjusted life years.
  Mary Lou Chatterton, Suzanne Chambers, Stefano Occhipinti, Afaf Girgis, Jeffrey Dunn, Rob Carter, Sophy Shih, Cathrine Mihalopoulos.
  Psycho-Oncology. November 03, 2015
  Objective This study compared the cost‐effectiveness of a psychologist‐led, individualised cognitive behavioural intervention (PI) to a nurse‐led, minimal contact self‐management condition for highly distressed cancer patients and carers. Methods This was an economic evaluation conducted alongside a randomised trial of highly distressed adult cancer patients and carers calling cancer helplines. Services used by participants were measured using a resource use questionnaire, and quality‐adjusted life years were measured using the assessment of quality of life – eight‐dimension – instrument collected through a computer‐assisted telephone interview. The base case analysis stratified participants based on the baseline score on the Brief Symptom Inventory. Incremental cost‐effectiveness ratio confidence intervals were calculated with a nonparametric bootstrap to reflect sampling uncertainty. The results were subjected to sensitivity analysis by varying unit costs for resource use and the method for handling missing data. Results No significant differences were found in overall total costs or quality‐adjusted life years (QALYs) between intervention groups. Bootstrapped data suggest the PI had a higher probability of lower cost and greater QALYs for both carers and patients with high distress at baseline. For patients with low levels of distress at baseline, the PI had a higher probability of greater QALYs but at additional cost. Sensitivity analysis showed the results were robust. Conclusions The PI may be cost‐effective compared with the nurse‐led, minimal contact self‐management condition for highly distressed cancer patients and carers. More intensive psychological intervention for patients with greater levels of distress appears warranted. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  November 03, 2015   doi: 10.1002/pon.4020   open full text
• A qualitative exploration of the unmet psychosocial rehabilitation needs of cancer survivors in China.
  Ji‐Wei Wang, Qian Shen, Ning Ding, Tian‐Rui Zhang, Zhi‐Qi Yang, Cong Liu, Si‐Jia Chen, Helen Louise Berry, Zheng‐Ping Yuan, Jin‐Ming Yu.
  Psycho-Oncology. November 03, 2015
  Objective This study explores the unmet psychosocial rehabilitation needs of cancer survivors. Methods Sixty‐eight cancer survivors from the Shanghai Cancer Rehabilitation Club in China participated in one of the eight focus groups. These were transcribed verbatim, coded using thematic analysis and analysed using NVivo 10. Results Five main themes were identified: the need for (1) better information: Chinese cancer survivors find it difficult to sort and evaluate the overwhelming mass of information with which they are confronted; (2) psychological support: survivors fear cancer relapse and neighbours' discrimination against them; support from other cancer survivors can relieve the stress; (3) support for survivors' families: like the survivors, family members are under great but usually unacknowledged pressure; (4) improved health and medical services: community health service centres provide little medical, informational or psychological support for cancer survivors, who seek and expect more communication with doctors; and (5) assistance with the financial burden: costs of treatment and lack of adequate medical insurance cause substantial financial pressure for survivors. Conclusions This study shows that, in addition to their illness, Chinese cancer survivors experience a range of stresses related to their financial circumstances, lack of reliable and summarised information, poor access to support and services (including for their families) and discrimination. Support from families seems to improve survivors' ability to cope. Cancer survivors (and their families) need an integrated package of support from their families, doctors and other service providers, hospitals and communities. These findings can inform approaches to continuing care for cancer survivors. Copyright © 2015 John Wiley & Sons, Ltd.

  November 03, 2015   doi: 10.1002/pon.4023   open full text
• Psychological detachment and savoring in adaptation to cancer caregiving.
  Wai Kai Hou, Kam Man Lau, Sin Man Ng, Tatia Mei Chun Lee, Hester Yui Shan Cheung, Tracy Chui Yu Shum, Ashley Chi Kin Cheng.
  Psycho-Oncology. October 30, 2015
  Background Recovery experience including psychological detachment from caregiving and savoring positive moments in life could be complementary coping processes for cancer caregivers. This study aims to examine the nature of their associations with caregiving burden and anxiety and depressive symptoms among Chinese cancer caregivers in Hong Kong. Methods A total of 155 Chinese caregivers of recently diagnosed cancer patients (mean time since diagnosis = 42.57 days, SD = 39.25) were recruited from two major government‐funded hospitals and administered a questionnaire assessing psychological detachment, savoring, caregiving burden, anxiety and depressive symptoms, and demographics. Results Controlling for demographic and medical covariates, structural equation modeling revealed significant associations of detachment, savoring, and their interaction term with caregiving burden and anxiety and depressive symptoms. Detachment and savoring were inversely associated with caregiving burden only when the other was at lower/medium levels. Detachment was inversely associated with anxiety and depressive symptoms at lower/medium levels of savoring, but savoring was inversely associated with anxiety and depressive symptoms across all levels of detachment. Conclusions Detachment and savoring could overshadow the positive impact of the other on caregiving burden if either one is at higher levels, while they could demonstrate concurrent positive impact on burden when both are at lower/medium levels. Savoring could have a prioritized role in ameliorating caregivers' anxiety and depressive symptoms, supplemented by detachment. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  October 30, 2015   doi: 10.1002/pon.4019   open full text
• Exploring the communication of oncologists, patients and family members in cancer consultations: development and application of a coding system capturing family‐relevant behaviours (KINcode).
  Rebekah Laidsaar‐Powell, Phyllis Butow, Stella Bu, Rachel Dear, Alana Fisher, Joseph Coll, Ilona Juraskova.
  Psycho-Oncology. October 30, 2015
  Background Family members (FMs) regularly attend oncology consultations. However, limited studies have assessed actual behaviours of oncologists, patients and FMs – particularly during decision‐making. The current study aimed the following: (i) to rigorously develop a family (kin) interaction coding system (KINcode) capturing communication and decision‐making behaviours of FMs and family‐relevant behaviours of oncologists and patients and (ii) to apply KINcode to initial oncology consultations. Methods The 80‐item KINcode system was developed and applied to 72 transcripts of audiotaped medical/radiation oncology consultations including an FM, collected as part of two previous studies. Results The role of the FM varied considerably within the one encounter, with 33% of FMs assuming three or more roles across the four consultation stages. Whilst most FMs asked treatment decision questions (71%), a minority engaged in other behaviours such as prompting patient questions (4%) or providing information relevant to the decision to the oncologist (18%). Although oncologists rarely initiated interaction with FMs such as in rapport building (18%) or asking FMs questions (25%), they were typically fully responsive to FM questions (90%). Many patients asked their FM a question (42%), but few elicited the FM's decision preferences (4%). Conclusions This study provides novel insights into the complex nature of family involvement. The findings highlight potentially positive FM‐focused consultation behaviours such as oncologist responsiveness to family questions and potential areas for improvement such as rapport building, invitation of questions and validation of the family's role. Family‐specific communication skills training should be considered in medical student and professional education settings. Copyright © 2015 John Wiley & Sons, Ltd.

  October 30, 2015   doi: 10.1002/pon.4003   open full text
• Patient's lung cancer diagnosis as a cue for relatives' smoking cessation: evaluating the constructs of the teachable moment.
  Colleen M. McBride, Michelle Blocklin, Isaac M. Lipkus, William M. P. Klein, Thomas H. Brandon.
  Psycho-Oncology. October 30, 2015
  Background To understand whether patient‐reported experiences with lung cancer may create teachable moments (TM) for their relatives as evidenced by shifts in their risk perceptions, affective response, and self‐image and in turn, motivation to quit smoking. Methods Patients at a comprehensive cancer center (n = 152) completed a survey within 6 months of lung cancer diagnosis to assess their cancer‐related symptoms and openness and enumerated relatives who were smokers. Relative smokers (n = 218) then completed a survey assessing their risk perceptions, affective response, and self‐image as a smoker related to the patient's diagnosis (TM mechanisms), and their motivation to quit smoking. Cross‐sectional mediation and moderation analyses were conducted to explore the links between patient‐reported experiences, and relatives' TM mechanisms, and motivation to quit smoking. Results Relative‐reported affect was a significant mediator of the association between patient‐reported symptoms and relative smoker's desire to quit. Relatives' self‐image was a significant moderator of the association between patient‐reported symptoms and relative smoker's desire to quit, such that patients' reported symptoms were associated with relatives' desire to quit only when the relative smoker reported a generally positive self‐image as a smoker. No evidence was found for moderated mediation. However, the link between symptoms and negative affect was moderated by perceptions of risk. Conclusion Whether smokers experience a family member's lung cancer as a TM is influenced by multiple interrelated cognitive and affective factors that warrant further exploration. Clearer understanding of these factors could inform how to re‐invigorate and sustain this motivation to promote concrete actions toward smoking cessation. Copyright © 2015 John Wiley & Sons, Ltd.

  October 30, 2015   doi: 10.1002/pon.4011   open full text
• Metamemory function in chemotherapy‐treated patients with breast cancer: an explanation for the dissociation between subjective and objective memory measures?
  Barbara Collins, Lise Paquet, Rachelle Dominelli, Amanda White, Joyce MacKenzie.
  Psycho-Oncology. October 29, 2015
  Background The purpose of this study was to determine if a deficit in metamemory could account for the disparity between subjective and objective measures of memory function commonly observed in patients with breast cancer (BC). Metamemory refers to the awareness and management of one's own memory function. It is considered an aspect of executive functioning, one of the most common areas of cognitive compromise associated with BC and its treatment. Methods Fifty‐four women with early stage BC who had recently completed chemotherapy were compared with 54 healthy women matched on age and education. Cognitive function was objectively assessed with a neuropsychological test battery and subjectively assessed with the Functional Assessment of Cancer Therapy Cognitive Scale. Metamemory was assessed with a Feeling of Knowing (FOK) paradigm. Results The patients with BC scored significantly lower than the controls on both the objective and subjective cognitive measures, as well as on free recall and recognition conditions of the FOK, suggesting some decline in primary memory functions such as working memory, encoding, and retrieval. The discrepancy between the objective and subjective measures was larger in the patients with BC than in the controls, but there was no difference between the groups on the FOK metamemory index. Conclusions Discrepancy in objective and subjective measures of cognition in patients with BC cannot be accounted for in terms of a deficit in meta‐cognition. Objective and subjective measures are complementary, and a comprehensive cognitive assessment in patients with BC requires both. Copyright © 2015 John Wiley & Sons, Ltd.

  October 29, 2015   doi: 10.1002/pon.4012   open full text
• Effects of a combined physical and psychosocial intervention program for childhood cancer patients on quality of life and psychosocial functioning: results of the QLIM randomized clinical trial.
  Elisabeth M. Dijk‐Lokkart, Katja I. Braam, Eline Dulmen‐den Broeder, Gertjan J. L. Kaspers, Tim Takken, Martha A. Grootenhuis, Isabelle C. Streng, Marc Bierings, Johannes H. Merks, Marry M. den Heuvel‐Eibrink, Margreet A. Veening, Jaap Huisman.
  Psycho-Oncology. October 28, 2015
  Objective Although survival rates in childhood cancer have improved, prevention and reduction of late effects remain important. This study evaluates the effects of a combined physical exercise and psychosocial intervention on health‐related quality of life (HrQoL) and psychosocial functioning in childhood cancer patients. Methods In this multicenter randomized controlled trial, cancer patients (aged 8–18 years) and their parents filled in questionnaires on HrQoL, depressive symptoms, behavioral problems, and self‐esteem. Measurements were conducted at baseline, shortly after the 12‐week intervention period and 12 months after baseline. Generalized estimating equations analyses were performed to assess short‐term and long‐term psychosocial effects. Results Of the 174 eligible patients, 68 (39.1%) participated. The intervention group consisted of 30 participants at baseline [mean age 13.0 (SD 3.0) years; 53% male], 26 at short‐term and 22 at long‐term follow‐up. The ‘care as usual’ control group consisted of 38 participants at baseline [mean age 12.6 (SD 3.1) years; 53% male], 33 at short‐term and 31 at long‐term follow‐up. Overall, the intervention did not improve psychosocial functioning and HrQoL. According to parent‐proxy reports, the intervention leads to a greater improvement on pain‐related HrQoL on both the short (β = 13.4; 95% CI: 3.0; 23.8) and long term (β = 13.0; 95% CI: 1.6; 24.4) and to greater improvement on procedural anxiety immediately after the intervention (β = 12.6; 95% CI: 1.9; 23.3). Conclusion A combined physical and psychosocial training for children with cancer did not have effects on HrQoL or psychosocial functioning, with exception of modest positive effects on parent‐reported pain and procedural anxiety Copyright © 2015 John Wiley & Sons, Ltd.

  October 28, 2015   doi: 10.1002/pon.4016   open full text
• School‐based brief psycho‐educational intervention to raise adolescent cancer awareness and address barriers to medical help‐seeking about cancer: a cluster randomised controlled trial.
  Gill Hubbard, Iona Stoddart, Liz Forbat, Richard D. Neal, Ronan E. O'Carroll, Sally Haw, Petra Rauchhaus, Richard G. Kyle.
  Psycho-Oncology. October 27, 2015
  Objectives Raising cancer awareness and addressing barriers to help‐seeking may improve early diagnosis. The aim was to assess whether a psycho‐educational intervention increased adolescents' cancer awareness and addressed help‐seeking barriers. Methods This was a cluster randomised controlled trial involving 2173 adolescents in 20 schools. The intervention was a 50‐min presentation delivered by a member of Teenage Cancer Trust's (UK charity) education team. Schools were stratified by deprivation and roll size and randomly allocated to intervention/control conditions within these strata. Outcome measures were the number of cancer warning signs and cancer risk factors recognised, help‐seeking barriers endorsed and cancer communication. Communication self‐efficacy and intervention fidelity were also assessed. Results Regression models showed significant differences in the number of cancer warning signs and risk factors recognised between intervention and control groups. In intervention schools, the greatest increases in recognition of cancer warning signs at 6‐month follow‐up were for unexplained weight loss (from 44.2% to 62.0%) and change in the appearance of a mole (from 46.3% to 70.7%), up by 17.8% and 24.4%, respectively. Greatest increases in recognition of cancer risk factors were for getting sunburnt more than once as a child (from 41.0% to 57.6%) and being overweight (from 42.7% to 55.5%), up by 16.6% and 12.8%, respectively. Regression models showed that adolescents in intervention schools were 2.7 times more likely to discuss cancer at 2‐week follow‐up compared with the control group. No differences in endorsement of barriers to help‐seeking were observed. Conclusions School‐based brief psycho‐educational interventions are easy to deliver, require little resource and improve cancer awareness. © 2015 The Authors. Psycho‐Oncology published by John Wiley & Sons Ltd.

  October 27, 2015   doi: 10.1002/pon.4001   open full text
• Psychometric properties of the Fear of Cancer Recurrence Inventory: an item response theory approach.
  Daniel S. J. Costa, Mbathio Dieng, Anne E. Cust, Phyllis N. Butow, Nadine A. Kasparian.
  Psycho-Oncology. October 22, 2015
  Objective Classical psychometric methods have been used to demonstrate the validity and reliability of the 42‐item Fear of Cancer Recurrence Inventory (FCRI). Our aim was to expand on this evidence with information on the discriminative value of the individual items when administered to people with a personal history of melanoma, using an item response theory (IRT) approach. Methods We used a two‐parameter IRT model to examine all items of the FCRI, primarily regarding whether people with a personal history of melanoma use the response scale as expected (as indicated by item characteristic curves), and whether the items can discriminate between those low and high on the constructs assessed by the instrument. Results The sample was comprised of 286 adults with a personal history of melanoma (58% male, mean age: 59.1 years). The established factor structure of the FCRI was generally confirmed. IRT highlighted several items with problematic item characteristic curves, including most items in the Reassurance and Coping Strategies domains. Several other items exhibited poor discrimination. Conclusions Based on this IRT analysis, we outline suggestions for refinement of the FCRI and potential development of a short‐form, that could reduce respondent burden. Generalisability of these findings beyond melanoma warrants further examination. Copyright © 2015 John Wiley & Sons, Ltd.

  October 22, 2015   doi: 10.1002/pon.4018   open full text
• Demographic, medical, and psychosocial predictors of benefit finding among caregivers of childhood cancer survivors.
  Molly H. Gardner, Sylvie Mrug, David C. Schwebel, Sean Phipps, Kimberly Whelan, Avi Madan‐Swain.
  Psycho-Oncology. October 22, 2015
  Background There is a growing body of literature examining benefit finding, or finding positive outcomes in the face of adversity, among both adults and children with chronic conditions, and to some degree among caregivers. This study examined demographic, medical, and psychosocial predictors of greater benefit finding specifically among caregivers of childhood cancer survivors. Methods Caregivers of children who had completed treatment for cancer (n = 83) completed measures assessing child and caregiver demographic information and caregiver coping (active, acceptance, emotion‐focused, and avoidant), optimism, social support, caregiving burden, posttraumatic stress symptoms, illness impact (how much caregivers feel impacted by their child's illness in various domains), and benefit finding (positive outcomes). Result Regression analyses indicated that positive spiritual coping, optimism, and illness impact uniquely predicted overall benefit finding for caregivers of childhood cancer survivors. Conclusion Results point to adaptive tendencies that are associated with finding benefits when caring for a childhood cancer survivor and suggest potential avenues for intervention among this population. Copyright © 2015 John Wiley & Sons, Ltd.

  October 22, 2015   doi: 10.1002/pon.4014   open full text
• Advance care planning as a shared endeavor: completion of ACP documents in a multidisciplinary cancer program.
  Melissa A. Clark, Miles Ott, Michelle L. Rogers, Mary C. Politi, Susan C. Miller, Laura Moynihan, Katina Robison, Ashley Stuckey, Don Dizon.
  Psycho-Oncology. October 21, 2015
  Objective We examined the roles of oncology providers in advance care planning (ACP) delivery in the context of a multidisciplinary cancer program. Methods Semi‐structured interviews were conducted with 200 women with recurrent and/or metastatic breast or gynecologic cancer. Participants were asked to name providers they deemed important in their cancer care and whether they had discussed and/or completed ACP documentation. Evidence of ACP documentation was obtained from chart reviews. Results Fifty percent of participants self‐reported completing an advance directive (AD) and 48.5% had named a healthcare power of attorney (HPA), 38.5% had completed both, and 39.0% had completed neither document. Among women who self‐reported completion of the documents, only 24.0% and 14.4% of women respectively had documentation of an AD and HPA in their chart. Completion of an AD was associated with number (adjusted odds ratio [AOR] = 1.49) and percentage (AOR = 6.58) of providers with whom the participant had a conversation about end‐of‐life decisions. Participants who named a social worker or nurse practitioner were more likely to report having completed an AD. Participants who named at least one provider in common (e.g., named the same oncologist) were more likely to have comparable behaviors related to naming a HPA (AOR = 1.13, p = 0.011) and completion of an AD (AOR = 1.06, p = 0.114). Conclusions Despite the important role of physicians in facilitating ACP discussions, involvement of other staff was associated with a greater likelihood of completion of ACP documentation. Patients may benefit from opportunities to discuss ACP with multiple members of their cancer care team. Copyright © 2015 John Wiley & Sons, Ltd.

  October 21, 2015   doi: 10.1002/pon.4010   open full text
• Long‐term fear of recurrence in young breast cancer survivors and partners.
  Andrea A. Cohee, Rebecca N. Adams, Shelley A. Johns, Diane Von Ah, Kathleen Zoppi, Betsy Fife, Patrick O. Monahan, Timothy Stump, David Cella, Victoria L. Champion.
  Psycho-Oncology. October 21, 2015
  Background Fear of a breast cancer recurrence is the most prevalent and disruptive source of distress for long‐term survivors and their partners. However, few studies have focused on predictors of fear of recurrence. The aim of this study is to test the efficacy of the Social Cognitive Processing Theory (SCPT) in predicting fear of recurrence in long‐term breast cancer survivors diagnosed at age 45 years or younger and their partners. Methods In a large cross‐sectional study, breast cancer survivors (n = 222) 3–8 years from diagnosis and their partners completed a survey assessing demographic characteristics, fear of recurrence, social constraints, and cognitive processing (intrusive thoughts and cognitive avoidance). Mediation analyses were conducted for survivors and partners separately to determine if cognitive processing would mediate the relationship between social constraints and fear of recurrence. Results Cognitive processing mediated the relationship between social constraints and fear of recurrence both for survivors [F(3,213) = 47.541, R2 = 0.401, p < 0.001] and partners [F(3,215) = 27.917, R2 = 0.280, p < 0.001). Demographic variables were not significant predictors of fear of recurrence. Conclusions As predicted, cognitive processing mediated the relationship between social constraints and fear of recurrence. Results expand the utility of the SCPT in long‐term survivors and their partners by supporting its use in intervention design. Copyright © 2015 John Wiley & Sons, Ltd.

  October 21, 2015   doi: 10.1002/pon.4008   open full text
• Trajectories of self‐reported cognitive function in postmenopausal women during adjuvant systemic therapy for breast cancer.
  John D. Merriman, Susan M. Sereika, Adam M. Brufsky, Priscilla F. McAuliffe, Kandace P. McGuire, Jamie S. Myers, Mary L. Phillips, Christopher M. Ryan, Amanda L. Gentry, Lindsay D. Jones, Catherine M. Bender.
  Psycho-Oncology. October 20, 2015
  Objective In a sample of 368 postmenopausal women, we (1) determined within‐cohort and between‐cohort relationships between adjuvant systemic therapy for breast cancer and self‐reported cognitive function during the first 18 months of therapy and (2) evaluated the influence of co‐occurring symptoms, neuropsychological function, and other covariates on relationships. Methods We evaluated self‐reported cognitive function, using the Patient Assessment of Own Functioning Inventory (PAOFI), and potential covariates (e.g., co‐occurring symptom scores and neuropsychological function z‐scores) in 158 women receiving aromatase inhibitor (AI) therapy alone, 104 women receiving chemotherapy followed by AI therapy, and 106 non‐cancer controls. Patients were assessed before systemic therapy and then every 6 months, for a total of four assessments over 18 months. Controls were assessed at matched time points. Mixed‐effects modeling was used to determine longitudinal relationships. Results Controlling for covariates, patients enrolled before chemotherapy reported poorer global cognitive function (p < 0.001), memory (p < 0.001), language and communication (p < 0.001), and sensorimotor function (p = 0.002) after chemotherapy. These patients reported poorer higher‐level cognitive and intellectual functions from before chemotherapy to 12 months after initiation of AI therapy (p < 0.001). Higher levels of depressive symptoms (p < 0.001), anxiety (p < 0.001), and fatigue (p = 0.040) at enrollment were predictors of poorer cognitive function over time. PAOFI total score was a predictor of executive function (p = 0.048) and visual working memory (p = 0.005) z‐scores, controlling for covariates. Conclusions Findings provide further evidence of poorer self‐reported cognitive function after chemotherapy and of relationships between co‐occurring symptoms and cognitive changes. AI therapy alone does not have an impact on self‐reported cognitive function. Copyright © 2015 John Wiley & Sons, Ltd.

  October 20, 2015   doi: 10.1002/pon.4009   open full text
• Gender differences in caregiver burden and its determinants in family members of terminally ill cancer patients.
  Beate Schrank, Alexandra Ebert‐Vogel, Michaela Amering, Eva K. Masel, Marie Neubauer, Herbert Watzke, Sonja Zehetmayer, Sophie Schur.
  Psycho-Oncology. October 18, 2015
  Objective Female family caregivers consistently report higher levels of stress and burden compared to male caregivers. Explanations for the apparently higher psychological vulnerability of female caregivers are largely missing to date. This study assesses the correlates and determinants of caregiver burden in family caregivers of advanced cancer patients with a specific focus on gender differences. Methods Three hundred and eight self‐identified main informal caregivers of advanced cancer patients were cross‐sectionally assessed using structured questionnaires for caregiver burden and hypothesised determinants of burden, including sociodemographic characteristics, caring arrangements, support needs, hope and coping style. Gender differences and predictors of burden were assessed using t‐tests, chi‐squared tests and univariate linear regression. Significant univariate predictors were entered in an analysis of covariance separately for men and women. Results Burden was significantly higher in women. Hope was the most significant protective factor against burden in both genders, together with perceived fulfilment of support needs. Only in women emotion‐oriented coping and being in employment while caring were significantly predictive of higher burden in the multivariate analysis. The model explained 36% of the variance in burden in men and 29% in women. Conclusion Psychological support interventions for family caregivers should take gender‐specific risk factors into account. Interventions focusing on keeping up hope while caring for a terminally ill family member may be a valuable addition to palliative services to improve support for family carers. Women may benefit from interventions that address adaptive coping and strategies to deal with the dual demands of employment and caring. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  October 18, 2015   doi: 10.1002/pon.4005   open full text
• Does fear of cancer recurrence differ between cancer types? A study from the population‐based PROFILES registry.
  Marieke Wal, Lonneke Poll‐Franse, Judith Prins, Marieke Gielissen.
  Psycho-Oncology. October 14, 2015
  Objective Knowledge of factors associated with fear of cancer recurrence (FCR) may inform intervention development and improve patient care. The aims were (1) to compare FCR severity between cancer types and (2) to identify associations between FCR, demographics, medical characteristics, information provision and health‐related quality of life. Methods Cross‐sectional data were obtained from the Patient Reported Outcomes Following Initial Treatment and Long‐Term Evaluation of Survivorship registry. We included stage I and II survivors diagnosed with melanoma (n = 469), colorectal cancer (n = 861), endometrial cancer (n = 688), thyroid cancer (n = 218), Hodgkin (n = 103) and non‐Hodgkin lymphoma (n = 276). Cancer survivors completed questionnaires on FCR (Impact of Cancer scale – Health Worries subscale), satisfaction with information provision (European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire (EORTC‐QLQ) INFO25, satisfaction scale) and health‐related quality of life (EORTC‐QLQ C30, Short Form 36‐item). Results A total of 2615 survivors completed the Impact of Cancer scale – Health Worries subscale. No significant differences in FCR severity were found between any of the cancer types (p = 0.063). A younger age, female gender, stage II disease, a shorter time since diagnosis, scheduled follow‐up appointments and comorbidity were associated with higher FCR (p < 0.01). Satisfaction with information provision was negatively correlated with FCR severity (r = −0.16, p < 0.05). Demographic and medical factors accounted for 6% of explained variance in FCR. The full model, also including health‐related quality of life, explained 15% and 19%, respectively. Conclusion Fear of cancer recurrence seems to be a universal concern of cancer survivors rather than a cancer type‐specific problem. Gender, age and medical factors were identified as risk factors. Copyright © 2015 John Wiley & Sons, Ltd.

  October 14, 2015   doi: 10.1002/pon.4002   open full text
• Short‐term and long‐term effects of a psycho‐educational group intervention for family caregivers in palliative home care – results from a randomized control trial.
  Maja Holm, Kristofer Årestedt, Ida Carlander, Carl‐Johan Fürst, Yvonne Wengström, Joakim Öhlen, Anette Alvariza.
  Psycho-Oncology. October 09, 2015
  Background Family caregivers in cancer and palliative care often face heavy responsibilities and feel insufficiently prepared for the situation as caregivers. This study evaluates short‐term and long‐term effects of a psycho‐educational group intervention aiming to increase preparedness for family caregiving in specialized palliative home care. Methods The study design was a randomized control trial where family caregivers were allocated either to an intervention or control group. The intervention was delivered as a program including three sessions by health professionals (physician, nurse, and social worker/priest). Family caregivers from 10 specialized palliative home care settings were included. Questionnaires with validated instruments at baseline, upon completion, and 2 months following the intervention were used to measure effects of the intervention. The primary outcome was preparedness for caregiving in family caregivers. Results In total, 21 intervention programs were delivered, and 119 family caregivers completed all three measurements. The intervention group had significantly increased their preparedness for caregiving in both the short‐term and long‐term follow‐up compared with the control group. The intervention group also reported significantly increased competence for caregiving in short‐term but not long. No effects of the intervention were found on rewards for caregiving, caregiver burden, health, anxiety, or depression. Conclusions The psycho‐educational intervention has the potential to be used by health professionals to improve preparedness for caregiving among family caregivers in palliative care both in short and long terms. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  October 09, 2015   doi: 10.1002/pon.4004   open full text
• Effectiveness of a psycho‐oncology training program for oncology nurses: a randomized controlled trial.
  Yosuke Kubota, Toru Okuyama, Megumi Uchida, Shino Umezawa, Tomohiro Nakaguchi, Koji Sugano, Yoshinori Ito, Fujika Katsuki, Yumi Nakano, Takeshi Nishiyama, Yoshiko Katayama, Tatsuo Akechi.
  Psycho-Oncology. October 09, 2015
  Objective Oncology nurses are expected to play an important role in psychosocial care for cancer patients. The aim of this study was to examine whether a novel training program aimed at enhancing oncology nurses' ability to assess and manage common psychological problems in cancer patients would improve participants' self‐reported confidence, knowledge, and attitudes regarding care of patients with common psychological problems (trial register: UMIN000008559). Methods Oncology nurses were assigned randomly to either the intervention group (N = 50) or the waiting list control group (N = 46). The intervention group received a 16‐h program, the content of which focused on four psychological issues: normal reactions, clinically significant distress, suicidal thoughts, and delirium. Each session included a role‐play exercise, group work, and didactic lecture regarding assessment and management of each problem. Primary outcomes were changes in self‐reported confidence, knowledge, and attitudes toward the common psychological problems between pre‐intervention and 3 months post‐intervention. Secondary outcomes were job‐related stress and burnout. Intervention acceptability to participants was also assessed. Results In the intervention group, confidence and knowledge but not attitudes were significantly improved relative to the control group. No significant intervention effects were found for job‐ related stress and burnout. A high percentage (98%) of participants considered the program useful in clinical practice. Conclusions This psycho‐oncology training program improved oncology nurses' confidence and knowledge regarding care for patients with psychological problems. Copyright © 2015 John Wiley & Sons, Ltd.

  October 09, 2015   doi: 10.1002/pon.4000   open full text
• Rehabilitation of women with gynaecological cancer: the association between adult attachment, post‐traumatic stress disorder and depression.
  K. Adellund Holt, P. T. Jensen, D. Gilså Hansen, A. Elklit, O. Mogensen.
  Psycho-Oncology. October 09, 2015
  Objective We hypothesised that being diagnosed with gynaecological cancer influences adult attachment and occurrence of depression and post‐traumatic stress disorder (PTSD). The main aim of the study was to assess changes in the attachment dimensions, PTSD and depression from baseline to 5‐month post‐treatment. Further, we evaluated the association between attachment avoidance/anxiety dimensions and PTSD/depression among women newly diagnosed with ovarian, endometrial, or cervical cancer. Methods Consecutive Danish‐speaking women aged 20 to 75 years and treated surgically for primary gynaecological cancer were eligible. All patients were offered a rehabilitation programme consisting of two face‐to‐face sessions and two phone calls carried out by a nurse. Patients were asked to complete the Revised Adult Attachment Scale, the Harvard Trauma Questionnaire and the Major Depression Inventory at baseline and at 5‐month follow‐up. In all, 151 women consent to participate in the sessions where 51 fulfilled Revised Adult Attachment Scale questionnaire and contribute with socio‐demographic data. Results We found significant positive changes within the attachment anxiety dimension among women with ovarian cancer, a significant reduction of PTSD among endometrial cancer patients and insignificant changes in depression among all cancer types. The attachment anxiety dimension significantly increased the odds for PTSD and depression. Conclusions Depression and PTSD were prevalent among ovarian and cervical cancer patients. The adjustment of rehabilitation according to patients' attachment anxiety dimension contains possibilities for indirect impact on PTSD and depression symptoms. Copyright © 2015 John Wiley & Sons, Ltd.

  October 09, 2015   doi: 10.1002/pon.3996   open full text
• Quality of life and late‐effects among childhood brain tumor survivors: a mixed method analysis.
  Mirja Erika Gunn, Susanna Mört, Mikko Arola, Mervi Taskinen, Pekka Riikonen, Merja Möttönen, Päivi Maria Lähteenmäki.
  Psycho-Oncology. October 05, 2015
  Background Reports on the quality of life (QOL) of childhood brain tumor (BT) survivors have been inconsistent. As cognitive limitations may restrict their participation in questionnaire‐based studies, our aim was to evaluate in depth the QOL with a mixed‐method analysis. Methods The 5‐year survivors of childhood BTs born in 1975–2000 and alive in 2010 were identified via the Finnish Cancer Registry and treating clinics. Twenty‐one survivors (32%) participated in a mixed‐method analysis including 15D (a general health‐related QOL questionnaire), the Beck Depression Inventory, and a qualitative semi‐structured interview. Results Based on the 15D‐questionnaire, the BT survivors had an impaired health‐related QOL in several dimensions such as speech and usual activities. On the other hand, no difference was found in other dimensions such as distress or vitality. A majority (95%) of the survivors showed no increased risk for depression. The qualitative interview revealed that the most important aspects affecting the QOL of the survivors were positive mental growth, negative conceptions concerning illness, living one day at a time, age at diagnosis, time since diagnosis, social relationships, learning disabilities and limitations in vocational opportunities, limitations in independent life, and changed understanding of the term ‘health’. Conclusions Childhood BT survivors have heterogeneous attitudes on QOL. The survivors assess social aspects to be more important than functionality for their QOL. Social concerns should actively be brought up to offer support for those with significant social difficulties. Interventions for social difficulties should be more actively developed. Copyright © 2015 John Wiley & Sons, Ltd.

  October 05, 2015   doi: 10.1002/pon.3995   open full text
• The role of illness perceptions in adherence to surveillance in patients with familial adenomatous polyposis (FAP).
  Lars E. Eriksson, Kaisa Fritzell, Lorna Rixon, Jan Björk, Lena Wettergren.
  Psycho-Oncology. October 01, 2015
  Objective The aim of the study was to examine patients' beliefs about having familial adenomatous polyposis (FAP), a hereditary colorectal cancer syndrome, and how these beliefs are associated with adherence to endoscopic surveillance. Methods Adult patients diagnosed with FAP on the national Swedish polyposis register who had undergone prophylactic colorectal surgery (n 209, response rate 76%) completed the Illness Perception Questionnaire (IPQ). Logistic regression analysis was used to investigate the relationships between illness perceptions and adherence, when controlling for demographic and clinical factors. Results FAP was less distressing in men and those with fewer symptoms, reporting less serious consequences and more coherent understanding of FAP. Non‐adherence (14%) to surveillance was associated with being older, having undergone surgery less recently and no history of malignancy. Patients' beliefs about their FAP were able to explain unique variance in non‐adherence, in particular those who believed FAP was less distressing. Conclusions Patients who were non‐adherent to endoscopic surveillance had more positive perceptions about their FAP and, in particular, were less emotionally affected compared to those who adhered. As non‐adherence implies a greater risk of future malignancies, special efforts are required to effectively prevent cancer in all patients with FAP. Those who have lived with the condition for a long time, and are not troubled by gastrointestinal symptoms or worried about their FAP, may be in need of specific information and support. Further prospective research is required to examine emotional predictors and consequences of non‐adherence. Copyright © 2015 John Wiley & Sons, Ltd.

  October 01, 2015   doi: 10.1002/pon.3997   open full text
• The impact of a cancer diagnosis on health and well‐being: a prospective, population‐based study.
  Kate Williams, Sarah E. Jackson, Rebecca J. Beeken, Andrew Steptoe, Jane Wardle.
  Psycho-Oncology. October 01, 2015
  Objective Little is known about the trajectory of health and well‐being from before to after a cancer diagnosis. This study aimed to examine changes in health and well‐being across three time points (0–2 years before a cancer diagnosis, 0–2 years post‐diagnosis and 2–4 years post‐diagnosis) in individuals receiving a new cancer diagnosis, and at matched time points in a cancer‐free comparison group. Methods Data were from waves 1–6 of the English Longitudinal Study of Ageing. Repeated‐measures ANOVAs were used to examine differences in self‐rated health, mobility impairments, activities of daily living impairments, quality of life, depressive symptoms and life satisfaction by group and time, and group‐by‐time interactions. Results Of the 4565 participants with data from three time points, 444 (9.7%) reported a new cancer diagnosis. Those in the cancer group reported poorer self‐rated health (p < .001), quality of life (p < .001) and life satisfaction (p < .01) than participants in the comparison group, and a higher proportion reported depressive symptoms (p < .001) and impairments in mobility (p < .001) and activities of daily living (p < .001). All markers of health and well‐being worsened significantly over time. The group‐by‐time interaction was significant for self‐rated health (p < .001), with a greater decline in health over time in the cancer group. Conclusions Cancer survivors in this sample had poorer health and well‐being than those with no diagnosis, and self‐rated health deteriorated more rapidly following a cancer diagnosis. Screening for these factors around the time of a cancer diagnosis could allow for interventions to be targeted effectively and improve the health and well‐being of cancer survivors. © 2015 The Authors. Psycho‐Oncology published by John Wiley & Sons Ltd.

  October 01, 2015   doi: 10.1002/pon.3998   open full text
• Psychometric evaluation of novel measures of partner interfering and supportive behaviors among women with cancer.
  Diane R. Follingstad, Ann L. Coker, Lisandra S. Garcia, Heather M. Bush.
  Psycho-Oncology. October 01, 2015
  Purpose The aim of this study was to evaluate the psychometric properties of complementary and novel measures of partner interfering and partner supportive behaviors in cancer care (PIB‐C and PSB‐C). Methods Structured telephone interviews were conducted with 378 women (aged 18–79) in partnered relationships and recruited from the Kentucky Cancer Registry. Psychometric analyses of PIB‐C and PSB‐C were used to determine scale reliability, and scale construct and predictive validity (correlations with indicators of partner abuse, symptoms of depression, anxiety, and stress after cancer). Results Cronbach's alpha and split‐half calculations indicated excellent internal consistency of the 20‐item PIB‐C (0.936 and 0.87, respectively) and 12‐item PSB‐C (0.930 and 0.89). Three thematic clusters for the PIB‐C and two for the PSB‐C were identified through factor analyses. Regarding construct validity, higher PIB‐C and lower PSB‐C scores were associated with a measure of psychological impacts from abuse. Predictive validity was suggested through (1) lower PSB‐C associated with depression, (2) higher PIB‐C associated with anxiety, and (3) higher perceived stress associated with higher PIB‐C/lower PSB‐C scores. Conclusion Both PIB‐C and PSB‐C have strong psychometric properties and distinguish partner behaviors more likely to negatively impact women's depression, anxiety, and stress during cancer care/recovery. Use of these measures may assist clinical teams in comprehensively assessing women patients' home environment to best ensure cancer care/recovery. Copyright © 2015 John Wiley & Sons, Ltd.

  October 01, 2015   doi: 10.1002/pon.3990   open full text
• The perspective of prostate cancer patients and patients' partners on the psychological burden of androgen deprivation and the dyadic adjustment of prostate cancer couples.
  Lisa Dawn Hamilton, Dexter Van Dam, Richard J. Wassersug.
  Psycho-Oncology. September 28, 2015
  Objective Prostate cancer and its treatments, particularly androgen deprivation therapy (ADT), affect both patients and partners. This study assessed how prostate cancer treatment type, patient mood, and sexual function related to dyadic adjustment from patient and partner perspectives. Methods Men with prostate cancer (n = 206) and partners of men with prostate cancer (n = 66) completed an online survey assessing the patients' mood (profile of mood states short form), their dyadic adjustment (dyadic adjustment scale), and sexual function (expanded prostate cancer index composite). Results Analyses of covariance found that men on ADT reported better dyadic adjustment compared with men not on ADT. Erectile dysfunction was high for all patients, but a multivariate analysis of variance found that those on ADT experienced greater bother at loss of sexual function than patients not on ADT, suggesting that loss of libido when on ADT does not mitigate the psychological distress associated with loss of erections. In a multiple linear regression, patients' mood predicted their dyadic adjustment, such that worse mood was related to worse dyadic adjustment. However, more bother with patients' overall sexual function predicted lower relationship scores for the patients, while the patients' lack of sexual desire predicted lower dyadic adjustment for partners. Conclusions Both patients and partners are impacted by the prostate cancer treatment effects on patients' psychological and sexual function. Our data help clarify the way that prostate cancer treatments can affect relationships and that loss of libido on ADT does not attenuate distress about erectile dysfunction. Understanding these changes may help patients and partners maintain a co‐supportive relationship. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  September 28, 2015   doi: 10.1002/pon.3930   open full text
• A randomized controlled pilot trial of a Web‐based resource to improve cancer knowledge in adolescent and young adult survivors of childhood cancer.
  Alicia Kunin‐Batson, Jeanne Steele, Ann Mertens, Joseph P. Neglia.
  Psycho-Oncology. September 25, 2015
  Objective This study examined cancer knowledge in adolescent and young adult (AYA) survivors and pilot tested a Web‐based resource to provide individually tailored information regarding cancer treatment history, late effects risk, and resources. Methods Fifty‐two survivors (15–28 years old) who completed cancer treatment were recruited from the University of Minnesota oncology clinics. Participants were randomly assigned to receive access to personalized health history, late effects information, and resources via a password‐protected Web portal or to standard of care (physician counseling) only. Participants completed surveys measuring cancer knowledge, health locus of control, and psychosocial well‐being prior to randomization and approximately 1 year later. Results Overall, few participants accurately reported their chemotherapy history with detail (19% at baseline and 33% at follow‐up), and many did not recognize that previous cancer treatments could impact future health (60% at baseline and 54% at follow‐up). Among those randomized to the receive access to the website, utilization was very low, making it difficult to draw conclusions about efficacy. Nonetheless, these data suggest that offering tailored information through the Web was not more effective than standard of care at improving cancer knowledge. Anxiety and health beliefs were associated with cancer knowledge, including knowledge of steps survivors could take to mitigate late effects risks (p < 01). Conclusions Knowledge gaps exist among AYA survivors regarding important aspects of their treatment histories and ongoing health risks. Offering purely educational information (either in person by providers or via the Web) does not appear to be enough to close this gap. Copyright © 2015 John Wiley & Sons, Ltd.

  September 25, 2015   doi: 10.1002/pon.3956   open full text
• Let's talk about sex after cancer: exploring barriers and facilitators to sexual communication in male cancer survivors.
  Zac E. Seidler, Catalina R. Lawsin, Michael A. Hoyt, Katherine A. Dobinson.
  Psycho-Oncology. September 25, 2015
  Objective Changes to sexuality are a primary concern amongst cancer survivors, leading to psychological distress and impacting long‐term quality of life. Effective sexual communication has been found to be critical in improving sexual satisfaction post‐treatment. However, research suggests that many men struggle to disclose sexual concerns and preferences. This study aimed to qualitatively explore the common barriers and facilitators to sexual communication in male cancer survivors (MCSs). Methods Seventeen MCSs participated in semi‐structured telephone interviews, which were transcribed and coded using Grounded Theory methodology. Results The emergent theory described that those MCSs with lower quality sexual communication experienced diminished perceived masculinity following cancer‐related sexual dysfunction. These feelings of inadequacy were compounded by inadequate partner support. Contrastingly, participants reporting effective sexual communication expressed the importance of a stable self‐esteem and flexible partner support. Conclusions This study challenges the notion that men naturally struggle with intimate dyadic communication and suggests that adequate partner support and a stable sense of self can mitigate MCSs' communicative behaviour, subsequently bolstering self‐esteem. Future research should more broadly explore the diverse experiences of MCSs to enhance the efficacy of psychosexual interventions. Copyright © 2015 John Wiley & Sons, Ltd.

  September 25, 2015   doi: 10.1002/pon.3994   open full text
• The impact of surgery for vulval cancer upon health‐related quality of life and pelvic floor outcomes during the first year of treatment: a longitudinal, mixed methods study.
  Georgina L. Jones, Richard M. Jacques, Joanne Thompson, Hilary J. Wood, Jane Hughes, William Ledger, Mo'iad. Alazzam, Stephen C. Radley, John A. Tidy.
  Psycho-Oncology. September 25, 2015
  Objective To measure the long‐term impact of surgical treatment for vulval cancer upon health‐related quality of life and pelvic floor outcomes during the first year of therapy. Methods Prospective, longitudinal, mixed‐methods study. Twenty‐three women aged >18 years with a new diagnosis of vulval cancer were recruited. The EORTC QLQ C30, SF‐36 and an electronic pelvic floor assessment questionnaire (ePAQ‐PF) were administered at baseline (pre‐treatment) and 3, 6, 9 and 12 months post‐treatment. Mixed effects repeated measures models (all adjusted for age and BMI) were used to investigate changes over time and differences between cancer stage. Qualitative interviews were carried out with 11 of the women and analysed using a thematic approach. Results Mean age was 59.9 years (SD = 15.3; range = 23.8–86.6 yrs). Mean BMI was 30.0 (SD = 4.5; range = 24.4–38.2). Sixteen women had early (Stage 1 to 2B), and seven women had advanced stage disease (Stage 3 to 4B). Questionnaire scores revealed that physical and social functioning, fatigue, pain and general sex life were significantly worse at 12 months than pre‐treatment (p = < 0.05). Qualitative analysis revealed multiple treatment side effects which were perceived as severe and enduring. Women with advanced vulval cancer had significantly worse SF‐36 mental health scores at 12 months compared to women with early stage disease (p = 0.037). Conclusions Surgery for vulval cancer has long‐term implications which can be persistent 12 months post‐treatment. High rates of morbidity relating to lymphoedema and sexual function re‐enforce the need for specialist clinics to support women who suffer these complications. © 2015 The Authors. Psycho‐Oncology published by John Wiley & Sons Ltd.

  September 25, 2015   doi: 10.1002/pon.3992   open full text
• Patients are dissatisfied with information provision: perceived information provision and quality of life in prostate cancer patients.
  Romy E. D. Lamers, Maarten Cuypers, Olga Husson, Marieke Vries, Paul J. M. Kil, J. L. H. Ruud Bosch, Lonneke V. Poll‐Franse.
  Psycho-Oncology. September 25, 2015
  Objective To determine the satisfaction with information received by prostate cancer survivors and associations with health‐related quality of life (HRQoL) and illness perception. Methods A cross‐sectional study was performed among 999 patients diagnosed between 2006 and 2009. All patients received a questionnaire on HRQoL (EORTC QLQ‐C30), illness perception (B‐IPQ) and satisfaction with information provision (EORTC QLQ‐INFO‐25). Multivariate regression analyses were performed to assess the association between satisfaction with information provision and HRQoL as well as illness perception. Results Response rate was 70% (N = 697), 34% (N = 222) indicated to be dissatisfied with the information received. Multivariate linear regression analyses showed a significant positive association between satisfaction with information provision and global health (P = <0.001), emotional functioning (P = 0.004), social functioning (P = 0.027), physical functioning (P = 0.002) and role functioning (P = 0.001). Satisfaction was negatively associated with illness perception subscales on consequences (P = 0.020), timeline (P = 0.031), personal control (P = 0.013), treatment control (P < 0.001), illness concern (P < 0.001), coherence (P = 0.001) and emotional representation (P = 0.004). Hence, more satisfied patients reported fewer consequences of disease, illness concern and emotional representation, but higher personal and treatment control and coherence. Conclusions A third of all prostate cancer survivors reported to be dissatisfied with the information received and scored worse on HRQoL and illness perception. A prospective randomized study is needed to study the effect of an intervention that improves information provision on HRQoL and illness perception outcomes. Copyright © 2015 John Wiley & Sons, Ltd.

  September 25, 2015   doi: 10.1002/pon.3981   open full text
• Change in psychological distress in longer‐term oesophageal cancer carers: are clusters of illness perception change a useful determinant?
  Lisa Graham, Martin Dempster, Noleen K. McCorry, Michael Donnelly, Brian T. Johnston.
  Psycho-Oncology. September 20, 2015
  Objective This study provides a longitudinal assessment of distress in longer‐term oesophageal cancer carers, while examining illness perception schema as a possible determinant of change in distress over time. Methods Oesophageal cancer carers (n = 171), 48 months post‐diagnosis, were assessed at baseline and 12 months later with the Illness Perception Questionnaire‐Revised, Cancer Coping Questionnaire, Hospital Anxiety and Depression Scale and Concerns About Recurrence Scale. Results Findings report deterioration from normal to probable anxiety in 35.7% of carers and probable depression in 28.7% carers over time. Fear of recurrence remained stable. Changes in control, consequence and cause beliefs were identified as key determinants of a change in psychological morbidity. Conclusions Illness beliefs appear to be valuable targets for psychological intervention to improve wellbeing among carers of people with oesophageal cancer. Copyright © 2015 John Wiley & Sons, Ltd.

  September 20, 2015   doi: 10.1002/pon.3993   open full text
• A qualitative focus group study to identify the needs of survivors of stage II and III colorectal cancer.
  Maria Y. Ho, Mary L. McBride, Carolyn Gotay, Eva Grunfeld, Craig C. Earle, Sharon Relova, Miranda Tsonis, Jenny Y. Ruan, Jennifer T. Chang, Winson Y. Cheung.
  Psycho-Oncology. September 20, 2015
  Background Prior survivorship research has largely focused on issues faced by survivors of childhood tumors, breast cancers, or hematologic malignancies. Relatively little is known about the needs of other prevalent survivor groups. Our aim was to identify the specific concerns of colorectal cancer (CRC) survivors in the key domains of physical functioning, psychological wellbeing, and social relationships. Methods We conducted focus groups with stage II and III CRC survivors who had completed their primary active anti‐cancer treatments. Patients were asked to describe how their diagnosis and treatment impacted their lives, to outline deficiencies in the care that they received, and to suggest ways of addressing any unmet needs. A content analysis was subsequently conducted to identify major themes. Results Thirty CRC survivors participated in six focus groups. Individuals reported some degree of dissatisfaction with the amount and type of diagnostic and treatment information they received at their initial clinic visit. Distress from toxicities, such as peripheral neuropathy, was also common among the survivors. Similarly, the majority faced challenges adjusting to their lives and daily activities, especially in caring for their colostomy. Having survived CRC, many survivors expressed an interest in advocacy and health promotion of CRC. Conclusions CRC survivors face many barriers after their cancer treatment. Issues with colostomy are unique to this survivor group. Interventions to improve CRC survivorship care should also incorporate opportunities for patient advocacy. Copyright © 2015 John Wiley & Sons, Ltd.

  September 20, 2015   doi: 10.1002/pon.3988   open full text
• Depression and hopelessness in patients with acute leukemia: the psychological impact of an acute and life‐threatening disorder.
  Galina Gheihman, Camilla Zimmermann, Amy Deckert, Peter Fitzgerald, Ashley Mischitelle, Anne Rydall, Aaron Schimmer, Lucia Gagliese, Chris Lo, Gary Rodin.
  Psycho-Oncology. September 18, 2015
  Objective Acute leukemia (AL) is a life‐threatening cancer associated with substantial morbidity and mortality, particularly in older adults. Given that there has been little research on the psychological impact of such malignancies with acute onset, we assessed the prevalence and correlates of depression and hopelessness in patients with AL. Methods Three hundred forty‐one participants were recruited within 1 month of diagnosis or relapse and completed the Beck Depression Inventory‐II (BDI‐II), Beck Hopelessness Scale (BHS), Memorial Symptom Assessment Scale, and other psychosocial measures. Multivariate regression analyses identified correlates of depression and hopelessness. Results 17.8% reported clinically significant depressive symptoms (BDI‐II ≥ 15), 40.4% of which were in the moderate‐severe range (BDI‐II ≥ 20). 8.5% reported significant symptoms of hopelessness (BHS ≥ 8). Depression was associated with greater physical symptom burden (adjusted R2 = 48.4%), while hopelessness was associated with older age and lower self‐esteem (adjusted R2 = 45.4%). Both were associated with poorer spiritual well‐being. Conclusions Clinically significant depressive symptoms were common early in the course of AL and related to physical symptom burden. Hopelessness was less common and associated with older age and lower self‐esteem. The results suggest that whereas depression in AL may be related to disease burden, the preservation of hope may be linked to individual resilience, life stage, and realistic prognosis.Copyright © 2015 John Wiley & Sons, Ltd.

  September 18, 2015   doi: 10.1002/pon.3940   open full text
• Acceptability and pilot efficacy trial of a web‐based breast reconstruction decision support aid for women considering mastectomy.
  Sharon L. Manne, Neal Topham, Thomas A. D'Agostino, Shannon Myers Virtue, Laurie Kirstein, Kristin Brill, Cheryl Manning, Generosa Grana, Marc D. Schwartz, Pamela Ohman‐Strickland.
  Psycho-Oncology. September 18, 2015
  Objective The study aim was to test the acceptability and preliminary efficacy of a novel interactive web‐based breast reconstruction decision support aid (BRAID) for newly diagnosed breast cancer patients considering mastectomy. Methods Fifty‐five women considering mastectomy were randomly assigned to receive the BRAID versus the Cancer Support Community's Frankly Speaking About Cancer: Breast Reconstruction pamphlet. Participants completed measures of breast reconstruction (BR) knowledge, preparation to make a decision, decisional conflict, anxiety, and BR intentions before randomization and 2 weeks later. Results In terms of acceptability, enrollment into the study was satisfactory, but the rate of return for follow‐up surveys was lower among BRAID participants than pamphlet participants. Both interventions were evaluated favorably in terms of their value in facilitating the BR decision, and the majority of participants completing the follow‐up reported viewing the materials. In terms of preliminary efficacy, both interventions resulted in significant increases in BR knowledge and completeness and satisfaction with preparation to make a BR decision, and both interventions resulted in a significant reduction in decision conflict. However, there were no differences between interventions. Conclusion A widely available free pamphlet and a web‐based customized decision aid were highly utilized. The pamphlet was as effective in educating women about BR and prepared women equally as well to make the BR decision as compared with a more costly, customized web‐based decision support aid. Copyright © 2015 John Wiley & Sons, Ltd.

  September 18, 2015   doi: 10.1002/pon.3984   open full text
• Family involvement for breast cancer decision making among Chinese–American women.
  Shiuyu Katie C. Lee, M. Tish Knobf.
  Psycho-Oncology. September 16, 2015
  Background To describe family involvement in decision making for primary treatment in Chinese–American women with early‐stage breast cancer. Methods Qualitative data were collected in 2003 from semi‐structured questions in interviews with a sample of Chinese–American (ChA) women with breast cancer, who were recruited from the metropolitan New York area. Responses to the questions were written in Chinese immediately during the interview and read back to the subject for accuracy and validation. Content analysis was used to inductively code and analyze the data to generate themes. Results The participants consisted of 123 ChA women with early stage breast cancer with a mean age of 48.7 years (±9.3) and who had lived in the United States a median of 13.6 years. Support and Caring was the major theme that described family involvement in the breast cancer decision‐making process. Gathering Information, Being There, Navigating the Health Care System, Maintaining Family Life and Making the Decision described the aspects of family support in the process. The majority of women described the treatment decision making as a collaborative supportive process with the family, but limited English fluency, strong opinions, lack of a shared perspective, distant living proximity and competing work responsibilities of family members were stressful for the women and perceived as non‐supportive. Conclusions Family involvement in health care decision making is culturally embedded in Asian populations. Culturally sensitive patient and family consultation strategies are needed to assist informed treatment decision making in Chinese–American women diagnosed with breast cancer. Copyright © 2015 John Wiley & Sons, Ltd.

  September 16, 2015   doi: 10.1002/pon.3989   open full text
• Palliative care and spiritual well‐being in lung cancer patients and family caregivers.
  Virginia Sun, Jae Y. Kim, Terry L. Irish, Tami Borneman, Rupinder K. Sidhu, Linda Klein, Betty Ferrell.
  Psycho-Oncology. September 16, 2015
  Background Spiritual well‐being is an important dimension of quality of life (QOL) and is a core component of quality oncology and palliative care. In this analysis, we aimed to describe spiritual well‐being outcomes in a National Cancer Institute (NCI)‐supported Program Project that tested the effectiveness of an interdisciplinary palliative care intervention in lung cancer patients and their family caregivers (FCGs). Methods Patients undergoing treatments for NSCLC and their FCGs were enrolled in a prospective, quasi‐experimental study. Patients and FCGs in the intervention group were presented at interdisciplinary care meetings and received four educational sessions that included one session focused on spiritual well‐being. Spiritual well‐being for patients was measured using the FACIT‐Sp‐12, and FCG spiritual well‐being was measured using the COH‐QOL‐FCG spiritual well‐being subscale. Multivariate analysis of covariance was undertaken for subscale and item scores at 12 weeks, controlling for baseline, by religious affiliations (yes or no) and group assignment. Results Religiously affiliated patients reported better scores in the Faith subscale and items on finding strength and comfort in faith and spiritual beliefs compared to non‐affiliated patients. Non‐affiliated patients had better scores for feeling a sense of harmony within oneself. By group, patients who received the intervention had significantly better scores for the Meaning/Peace subscale. Conclusions Our findings support the multidimensionality of spiritual well‐being that includes constructs such as meaning and faith for lung cancer patients and FCGs with or without religious affiliations. Palliative care interventions should include content that targets the spiritual needs of both patients and FCGs. Copyright © 2015 John Wiley & Sons, Ltd.

  September 16, 2015   doi: 10.1002/pon.3987   open full text
• Self‐reported depression and perceived financial burden among long‐term rectal cancer survivors.
  Yuda Chongpison, Mark C. Hornbrook, Robin B. Harris, Lisa J. Herrinton, Joe K. Gerald, Marcia Grant, Joanna E. Bulkley, Christopher S. Wendel, Robert S. Krouse.
  Psycho-Oncology. September 14, 2015
  Objectives Types of surgery for rectal cancer (RC), including permanent ostomy (PO) or temporary ostomy followed by anastomosis (TO) or initial anastomosis (AN), can affect psychological and financial well‐being during active treatment. However, these relationships have not been well studied among long‐term survivors (≥5 years post‐diagnosis). Methods A mailed survey with 576 long‐term RC survivors who were members of Kaiser Permanente was conducted in 2010–2011. Prevalence of current depression was ascertained using a score of ≤45.6 on the Short Form‐12 version 2 mental component summary. Perceived financial burden was assessed using a Likert scale ranging from 0 (none) to 10 (severe). Regression analyses were used to measure associations after adjustment for covariates. Results The overall prevalence of depression was 24% among RC survivors with the highest prevalence among those with a history of PO (31%). The adjusted odds of depression among TO and AN survivors were lower than that among PO survivors, 0.42 (CI95% 0.20–0.89) and 0.59 (CI95% 0.37–0.93), respectively. Twenty‐two percent perceived moderate‐to‐high current financial burden (≥4 points). PO survivors also reported higher mean financial burden than AN survivors (2.6 vs. 1.6, respectively; p = 0.002), but perceived burden comparably to TO survivors (2.3). Self‐reported depression was associated with higher perceived financial burden (p < 0.001); surgical procedure history did not modify this relationship. Conclusions Depression was reported frequently among these long‐term RC survivors, particularly among PO survivors. Depression was associated with greater perception of financial burden. Screening for depression and assessing financial well‐being might improve care among long‐term RC survivors.Copyright © 2015 John Wiley & Sons, Ltd.

  September 14, 2015   doi: 10.1002/pon.3957   open full text
• Family caregivers require mental health specialists for end‐of‐life psychosocial problems at home: a nationwide survey in Japan.
  Makoto Kobayakawa, Hitoshi Okamura, Akemi Yamagishi, Tatsuya Morita, Shohei Kawagoe, Megumi Shimizu, Taketoshi Ozawa, Emi An, Satoru Tsuneto, Yasuo Shima, Mitsunori Miyashita.
  Psycho-Oncology. September 14, 2015
  Background Psychological distress is problematic for patients and their family caregivers in the oncological setting. The level of stress is influenced by the health status of the patient and their family members as well as the support system for home care. However, it remains unclear how best to support distressed caregivers providing end‐of‐life care at home. Methods The present study was performed as part of the Japan Hospice and Palliative Care Evaluation study among caregivers whose family members are provided home palliative care. The caregivers were asked whether they wished to receive psychological support from mental health specialists, and factors associated with the need for psychological support were analyzed. Results Of the 1052 caregivers, 628 completed the questionnaire. As a whole, 169 subjects [27%; 23–30% (95% confidence interval)] reported needing psychological support from a mental health specialist. According to a multiple regression analysis, factors associated with the need for psychological support included (1) emotional distress due to the need to adapt to rapid worsening of the patient's condition [adjusted odds ratio: 2.62 (95% CI 1.77–3.88), p < 0.001], (2) the poor health conditions of the caregivers [2.93 (1.61–5.36), p < 0.001], and (3) having someone else available to care for the patient in place of the caregiver [0.51 (0.34–0.78), p = 0.002]. Conclusions Psychological support is required for caregivers tending to patients at home. Further studies are needed to construct a system to provide continuous support to caregivers. Copyright © 2015 John Wiley & Sons, Ltd.

  September 14, 2015   doi: 10.1002/pon.3982   open full text
• Cancer caregiver quality of life: need for targeted intervention.
  Maria I. Lapid, Pamela J. Atherton, Simon Kung, Jeff A. Sloan, Varun Shahi, Matthew M. Clark, Teresa A. Rummans.
  Psycho-Oncology. September 11, 2015
  Objectives Caregiving can negatively impact well‐being. Cancer caregivers face unique challenges given the intense nature of cancer and treatment, which increases their risk for burden, poor quality of life (QOL), and burnout. Studies to reduce caregiver burden demonstrate QOL improvement and distress reduction in the short term. However, few studies exist to address long‐term benefits. We assessed changes in various QOL domains after participation in a QOL intervention for caregivers of patients having newly diagnosed advanced cancer. Methods Our institutional review board‐approved study randomized patient–caregiver dyads to either usual care or an in‐person group intervention composed of six 90‐min sessions of structured multidisciplinary QOL components delivered over 4 weeks, with 10 follow‐up phone calls within 20 weeks. Caregivers attended four of the six sessions attended by patients. Sessions included physical therapy, coping and communication strategies, mental health education, spirituality, and social needs. Caregiver QOL (Caregiver Quality of Life Index‐Cancer Scale [CQOLC] and Linear Analogue Self‐Assessment [LASA]) and mood (Profile of Mood States‐Brief [POMS‐B]) were measured at baseline and 4, 27, and 52 weeks. Wilcoxon tests and effect sizes were used to compare the caregiver groups. Results Of the 131 caregivers (65 intervention and 66 usual care), 116 completed the study. Caregivers post‐intervention (at 4 weeks) had improved scores on LASA Spiritual Well‐being; POMS‐B total score, Vigor/Activity, and Fatigue/Inertia; and CQOLC Adaptation. At long term (at 27 weeks), caregivers retained improvement in POMS‐B Fatigue/Inertia and gained improvements in CQOLC Disruptiveness and Financial Concerns. Conclusions Caregivers who received the intervention had higher QOL ratings for specific QOL domains but not for overall QOL. Although a comprehensive intervention was helpful, more specific, targeted interventions tailored for individual needs are recommended. Copyright © 2015 John Wiley & Sons, Ltd.

  September 11, 2015   doi: 10.1002/pon.3960   open full text
• Body image and quality of life of breast cancer patients: influence of timing and stage of breast reconstruction.
  Irene Teo, Gregory P. Reece, Israel C. Christie, Michele Guindani, Mia K. Markey, Leslie J. Heinberg, Melissa A. Crosby, Michelle Cororve Fingeret.
  Psycho-Oncology. September 10, 2015
  Objective The process of cancer‐related breast reconstruction is typically multi‐staged and can take months to years to complete, yet few studies have examined patient psychosocial well‐being during the reconstruction process. We investigated the effects of reconstruction timing and reconstruction stage on body image and quality of life at specific time points during the breast reconstruction process. Methods In this cross‐sectional study, 216 patients were grouped into four reconstructive stages: pre‐reconstruction, completed stage 1, completed stage 2, and final stages. Multiple regression analyses examined the roles of reconstruction timing (immediate vs delayed reconstruction) and reconstruction stage as well as their interaction in predicting body image and quality of life, controlling for patient age, BMI, type of reconstruction, chemotherapy, radiation therapy, and major complication(s). Results A difference in pattern of body image was observed across the reconstructive stages, with those receiving delayed reconstruction showing significant decrease in body image dissatisfaction compared with those with immediate reconstruction. At pre‐reconstruction, patients awaiting delayed reconstruction reported significantly lower social well‐being compared with those awaiting immediate reconstruction. Reconstruction stage predicted emotional well‐being, with higher emotional well‐being observed in those who had commenced reconstruction. Conclusions Timing and stage of reconstruction are important to consider when examining psychosocial outcomes of breast cancer patients undergoing reconstruction. Those waiting to initiate delayed reconstruction appear at particular risk for body image, emotional, and social distress. Our findings have implications for delivery of psychosocial treatment to maximize body image and quality of life of patients undergoing cancer‐related breast reconstruction.Copyright © 2015 John Wiley & Sons, Ltd.

  September 10, 2015   doi: 10.1002/pon.3952   open full text
• Do coping strategies mediate the effects of emotional support on emotional well‐being among Spanish‐speaking Latina breast cancer survivors?
  Felisa A. Gonzales, Alejandra Hurtado‐de‐Mendoza, Jasmine Santoyo‐Olsson, Anna María Nápoles.
  Psycho-Oncology. September 09, 2015
  Objective This study aimed to assess the relationship between emotional social support and emotional well‐being among Latina immigrants with breast cancer and test whether two culturally relevant coping strategies, fatalism and acceptance, mediate this relationship. Methods One hundred fifty Spanish‐speaking Latinas within 1 year of breast cancer diagnosis participating in a randomized trial of a stress management intervention were assessed in person at baseline and via telephone 6 months later. Survey measures included baseline emotional support, fatalism, and acceptance and emotional well‐being 6 months later. Generalized linear models estimated direct effects of emotional support on emotional well‐being and indirect effects through fatalism and acceptance. Results Mean age was 50.1 (SD = 10.9) years; most women had low education and acculturation levels. Emotional support was negatively associated with fatalism (r = −0.24, p < 0.01) and positively associated with acceptance (r = 0.30, p < 0.001). Emotional support (r = 0.23, p = 0.005) and acceptance (r = 0.28, p = 0.001) were positively associated with emotional well‐being, whereas fatalism (r = −0.36, p < 0.0001) was negatively associated with emotional well‐being. In multivariable models, emotional support was associated with emotional well‐being (b = 0.88, 95% CI: 0.24, 1.52). This direct effect remained significant when additionally controlling for fatalism (b = 0.66, 95% CI: 0.03, 1.30) and acceptance (b = 0.73, 95% CI: 0.09, 1.37) in separate models. There was a significant indirect effect of emotional support on emotional well‐being through fatalism (b = 0.21, 95% CI: 0.04, 0.51) as well as a marginally significant effect through acceptance (b = 0.15, 95% CI: 0.001, 0.43). Conclusions Emotional support may increase well‐being among Spanish‐speaking Latina cancer survivors by reducing cancer fatalism.Copyright © 2015 John Wiley & Sons, Ltd.

  September 09, 2015   doi: 10.1002/pon.3953   open full text
• Cancer treatment decision‐making among young adults with lung and colorectal cancer: a comparison with adults in middle age.
  Jennifer W. Mack, Angel Cronin, Karen Fasciano, Susan D. Block, Nancy L. Keating.
  Psycho-Oncology. September 02, 2015
  Objective Our aim is to understand experiences with treatment decision‐making among young adults with cancer. Methods We studied patients with lung cancer or colorectal cancer in the Cancer Care Outcomes Research and Surveillance Consortium, a prospective cohort study. We identified 148 young adult patients aged 21–40 years who completed baseline interview questions about cancer treatment decision‐making; each was propensity score matched to three middle adult patients aged 41–60 years, for a cohort of 592 patients. Patients were asked about decision‐making preferences, family involvement in decision‐making, and worries about treatment. An ordinal logistic regression model evaluated factors associated with more treatment worries. Results Young and middle‐aged adults reported similar decision‐making preferences (p = 0.80) and roles relative to physicians (p = 0.36). Although family involvement was similar in the age groups (p = 0.21), young adults were more likely to have dependent children in the home (60% younger versus 28% middle‐aged adults, p < 0.001). Young adults reported more worries about time away from family (p = 0.002), and, in unadjusted analyses, more cancer treatment‐related worries (mean number of responses of ‘somewhat’ or ‘very’ worried 2.5 for younger versus 2.2 for middle‐aged adults, p = 0.02.) However, in adjusted analyses, worries were associated with the presence of dependent children in the home (odds ratio [OR] 1.55, 95% CI = 1.07–2.24, p = 0.02), rather than age. Conclusions Young adults involve doctors and family members in decisions at rates similar to middle‐aged adults but experience more worries about time away from family. Patients with dependent children are especially likely to experience worries. Treatment decision‐making strategies should be based on individual preferences and needs rather than age alone. Copyright © 2015 John Wiley & Sons, Ltd.

  September 02, 2015   doi: 10.1002/pon.3949   open full text
• Androgen deprivation therapy's impact on the mood of prostate cancer patients as perceived by patients and the partners of patients.
  Dexter Van Dam, Richard J. Wassersug, Lisa Dawn Hamilton.
  Psycho-Oncology. August 31, 2015
  Objective To assess the relationship between of androgen deprivation therapy (ADT) and the mood of prostate cancer (PCa) patients and partners of PCa patients. Methods PCa patients (n = 295) and partners of patients (n = 84) completed an online survey assessing the patients' current mood and mood prior to treatment, relationship adjustment, and sexual function. We compared men on ADT to men who received non‐hormonal treatments for their PCa. Results Patients currently treated with ADT (n = 82) reported worsened mood as measured by the Profile of Mood States compared to those not on ADT (n = 213). The negative impact of ADT on mood, however, was reduced in older patients. Partners of patients on ADT (n = 42) reported similar declines in the patient's mood that patients reported, but to a greater degree than patient‐reported levels. Conclusions Our data support ADT's impact on PCa patients' mood and verify that partners concurrently see the effects. The psychological changes related to ADT can impact relationships and affect the quality of life of both PCa patients and partners. Patients and their partners are likely to benefit from being well informed about the psychological effects of androgen deprivation on men beginning ADT. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  August 31, 2015   doi: 10.1002/pon.3932   open full text
• Substance use among adolescent and young adult cancer survivors.
  Joel Milam, Rhona Slaughter, Kathleen Meeske, Anamara Ritt‐Olson, Sandra Sherman‐Bien, David R. Freyer, Aura Kuperberg, Ann S. Hamilton.
  Psycho-Oncology. August 27, 2015
  Objective Health‐promoting behaviors are recommended to childhood cancer survivors (CCS) to reduce late effects resulting from cancer treatment. Understanding factors associated with substance use is needed, especially among Hispanic CCS who are underrepresented in previous studies. The objective of this study is to examine substance use behaviors of recently treated Hispanic and non‐Hispanic CCS. Methods One hundred ninety‐three Los Angeles County CCS who were diagnosed between 2000 and 2007 (54% Hispanic; mean age 19.9 years, SD = 2.8; mean age at diagnosis = 12.1, SD = 3.0; mean years since diagnosis = 7.8, SD = 2.0) provided self‐reported information on substance use, demographics, clinical factors, religiosity, and depressive symptoms. Risk and protective factors for substance use were examined using multivariable logistic regression. Results Prevalence of 30‐day substance use was 11%, 25%, and 14% for tobacco, alcohol, and marijuana, respectively. In controlled regression models, age was positively associated with tobacco use, binge drinking, and polysubstance use (use of at least two of the three substances). Male gender, higher depressive symptoms, and higher socioeconomic status were associated with greater marijuana use. In addition, religiosity was negatively associated with the use of all substances. Conclusions The prevalence rates for substance use in this ethnically diverse representative sample of CCS are lower than those observed in the general population. Older CCS were at higher risk of substance use, and depression was associated with greater marijuana use. No differences by ethnicity were observed. Interventions for substance use prevention/cessation among CCS may be most effective if implemented before the age of 21 years and address mental health as part of survivorship care. Copyright © 2015 John Wiley & Sons, Ltd.

  August 27, 2015   doi: 10.1002/pon.3958   open full text
• Shared health characteristics in Hispanic colorectal cancer patients and their primary social support person following primary diagnosis.
  David S. Black, Michael J. Li, Ugonna Ihenacho, Nathalie T. Nguyen, Maria Fatima Reyes, Joel Milam, Mary Ann Pentz, Jane C. Figueiredo.
  Psycho-Oncology. August 20, 2015
  Purpose The aim of this paper was to determine individual and shared levels of psychosocial, behavioral, and symptomological health characteristics among Hispanics with recent history of cancer and their primary social support person (PSSP) in the years following diagnosis. Patients and Methods Recruited from a population‐based cohort study were 409 Hispanic patients with a previous diagnosis of colorectal cancer. Forty‐seven patients identified a PSSP, who assists with medical decision‐making and health‐related matters, who also participated in the study. Current behavioral (smoking, alcohol use, physical activity, and complementary and alternative medicine use), psychosocial (stress and mindfulness), and physical symptom (fatigue) data were obtained using validated instruments. Analyses tested the individual and shared (between patients and PSSPs) variance in these health measures. Results The sample was diagnosed on average 3.1 years (standard deviation = 1.7) prior to assessment. PSSPs were mainly spouses/partners (63%) or children (28%) of patients. Among patients, stress was positively associated with being a current smoker (p < 0.01) and with fatigue (r = 0.45, p < 0.001); stress was negatively correlated with mindfulness (r = −0.41, p < 0.001); mindfulness was negatively associated with smoking (odds ratio (OR) = 0.72, p < 0.01) and alcohol consumption (OR = 0.83, p < 0.05); the inverse relationship between mindfulness and fatigue was partially mediated through lower levels of stress (β = −0.17, p < 0.001). Similar patterns were observed among PSSPs. Patient mindfulness was negatively correlated with PSSP stress (r = −0.45, p < 0.01). Complementary and alternative medicine use showed interdependence between patients and PSSPs for use of herbal remedies (OR = 6.2; p < 0.01) and bodywork (OR = 8.3, p < 0.05). Conclusion Hispanic colorectal cancer patients and their PSSP share a common health milieu in the years following a cancer diagnosis, offering opportunities for advancing interpersonal intervention approaches in cancer care. Copyright © 2015 John Wiley & Sons, Ltd.

  August 20, 2015   doi: 10.1002/pon.3938   open full text
• Why do patients choose (not) to participate in an exercise trial during adjuvant chemotherapy for breast cancer?
  Hanna Waart, Wim H. Harten, Laurien M. Buffart, Gabe S. Sonke, Martijn M. Stuiver, Neil K. Aaronson.
  Psycho-Oncology. August 17, 2015
  Objective Only between 25% and 50% of patients invited to participate in clinical trial‐based physical exercise programs during cancer treatment agree to do so. The purpose of this study was to identify factors associated significantly with the decision (not) to participate in a randomized controlled trial of physical exercise during adjuvant chemotherapy for breast cancer. Methods Based on questionnaire data, we compared trial participants and non‐participants on a range of sociodemographic, clinical health‐related, practical, behavioral, and attitudinal variables. Results Two hundred thirty of 524 patients agreed to participate in the trial (44%). The 294 (56%) non‐participants indicated that they wanted to exercise on their own or that they did not wish to exercise in the context of a trial. Those who preferred to exercise on their own were relatively similar to trial participants but were more likely to be in the maintenance exercise stage. Those non‐participants who did not wish to exercise had a significantly lower level of education, were less likely to be working, reported more fatigue and lower health‐related quality of life, had lower sense of self‐efficacy, more negative attitudes towards exercise, less social support, and perceived fewer benefits and more barriers to exercising during treatment than trial participants. Conclusion Minimizing practical barriers to participation, providing educational materials on the potential benefits of exercise, and giving adequate professional and social network encouragement may increase the number of patients willing to exercise during treatment and to participate in such studies. Copyright © 2015 John Wiley & Sons, Ltd.

  August 17, 2015   doi: 10.1002/pon.3936   open full text
• Parenting concerns, quality of life, and psychological distress in patients with advanced cancer.
  Eliza M. Park, Allison M. Deal, Devon K. Check, Laura C. Hanson, Katherine E. Reeder‐Hayes, Deborah K. Mayer, Justin M. Yopp, Mi‐Kyung Song, Anna C. Muriel, Donald L. Rosenstein.
  Psycho-Oncology. August 17, 2015
  Objective Parents with life‐limiting illness anticipate the loss of their parental role and the long‐term consequences of their illness on their children. The purpose of this study was to examine relationships between parenting concerns, quality of life (QOL), and symptoms of depression and anxiety in parents with advanced cancer who have dependent children. Methods Sixty‐three parents diagnosed with a Stage IV solid malignancy completed the Hospital Anxiety Depression Scale (HADS), Parenting Concerns Questionnaire (PCQ), and Functional Assessment of Cancer Therapy—General (FACT‐G). The Medical Outcomes Study Social Support Survey (social support) and Eastern Cooperative Oncology Group (ECOG) performance status were assessed as potential covariates. We performed descriptive statistics and multivariable linear regression models for depression, anxiety, and QOL measures. Results Mean PCQ score was 2.3 (SD 0.9), reflecting mild to moderate parenting concerns. Average depression and anxiety scores were 6.0 (SD 4.2) and 8.2 (SD 3.9), respectively. PCQ scores were associated with depressive symptoms (r = 0.46, p < 0.001), anxiety symptoms (r = 0.52, p < 0.0001), and QOL scores (r = −0.60, p < 0.001). The relationship of PCQ scores to anxiety symptoms (B = 1.5 p = 0.016) and QOL (B = −5.7, p = 0.02) remained significant after controlling for ECOG status, social support, and treatment status. Conclusions Parenting concerns are associated with anxiety and depressive symptoms and worse QOL in parents diagnosed with advanced cancer. Further studies that evaluate how parental status affects coping and psychological distress in advanced cancer are needed.Copyright © 2015 John Wiley & Sons, Ltd.

  August 17, 2015   doi: 10.1002/pon.3935   open full text
• Financial burden among US households affected by cancer at the end of life.
  John G. Cagle, Dawn C. Carr, Seokho Hong, Sheryl Zimmerman.
  Psycho-Oncology. August 17, 2015
  Objective Economic burden on families coping with end‐stage cancer remains poorly understood. Advanced malignancy threatens financial stability of families, and interventions are needed to buffer them from impoverishment. This study examined the relationship between subjective and objective assessments of financial burden on families (financial strain and stress, respectively) and identified potentially modifiable factors to inform intervention efforts. Methods Using national survey data, we analyzed responses from households that had recently experienced a cancer death; 176 of households provided information on financial strain, and 158 provided data on financial stress. In addition to self‐reported appraisals of financial burden, measures assessed elements of the cancer care experience, treatment, symptom burden, work impact, insurance coverage, and demographics. Results Despite being well insured, approximately a quarter of respondents reported that the cost of care was a major financial burden, and a third used all or most of their savings. Financial strain and stress were moderately positively correlated (r = 0.46, p < 0.01). Higher financial stress scores were negatively correlated with decedent's age at death (r = −0.34, p < 0.01), and minority respondents (‘other’ race) reported much higher financial stress (M = 4.7; SD = 3.2) than White (M = 0.8; SD = 1.4) or Black (M = 1.6; SD = 2.2) respondents (p < 0.001). Financial burden was also associated with no or limited insurance coverage, changes in employment, severe pain and nausea, and provider interactions during the cancer care experience (e.g., whether the MD paid attention to non‐medical factors or having unanswered questions about medications) (p < 0.05 for all). Conclusions The cancer care experience, symptoms, and work impact were associated with financial burden and have important implications for research and practice. Copyright © 2015 John Wiley & Sons, Ltd.

  August 17, 2015   doi: 10.1002/pon.3933   open full text
• Relationship between antidepressant prescription and breast cancer: a population based study in Taiwan.
  Vincent Chin‐Hung Chen, Yin‐To Liao, Dah‐Cherng Yeh, Hsien‐Chun Tseng, Robert Stewart, Charles Tzu‐Chi Lee.
  Psycho-Oncology. August 14, 2015
  Objective To investigate the association between antidepressant prescription and breast cancer. Methods The National Health Research Institute in Taiwan provided a database of 1 000 000 random subjects for this study. We identified 14 737 new antidepressant female users who were more than 15 years old during 1999–2005 with at least 10 prescriptions and one year exposure to an antidepressant. These were matched 1:1 by age and residence to non‐antidepressant users from the same database to compare the risk of breast cancer. Results In a model adjusted by age, residence, insurance amount, and depressive disorder, antidepressant prescription was not associated with breast cancer risk. This held true for both selective serotonin re‐uptake inhibitors (SSRIs) and tricyclic antidepressants. Conclusions There was no evidence for an association between antidepressant prescription and the risk of breast cancer. Copyright © 2015 John Wiley & Sons, Ltd.

  August 14, 2015   doi: 10.1002/pon.3929   open full text
• Effects of physical and mental health on relationship satisfaction: a dyadic, longitudinal examination of couples facing prostate cancer.
  Kaile M. Ross, Krista W. Ranby, Jennalee S. Wooldridge, Cary Robertson, Isaac M. Lipkus.
  Psycho-Oncology. August 10, 2015
  Objectives Prostate cancer may affect quality of life in men diagnosed as well as their spouses. Changes in health may disrupt the couple's relationship functioning which disrupts recovery. This study examined how mental and physical health relates to relationship satisfaction for couples at diagnosis through the year following treatment. Methods Patients with stage I–II prostate cancer and their spouses (N = 159 couples) were recruited from a urology clinic and completed questionnaires at diagnosis, 1 month, 6 months, and 12 months post prostatectomy on demographics, mental and physical health quality of life, and relationship satisfaction. The Actor–Partner Interdependence Model was employed to examine effects of each partners' mental and physical health on their own and their partner's relationship satisfaction. Results Patients and spouses had declined mental and physical health at 1 month post‐surgery. Health improved at 6 and 12 months but did not fully return to pre‐surgery levels. Actor effects showed that patient's physical health consistently predicted own relationship satisfaction. Both patient's and spouse's mental health consistently related to their own relationship satisfaction. Partner effects showed that patient's and spouse's physical health had an effect on each other's relationship satisfaction at 1 month. Spouse's mental health predicted patient's relationship satisfaction throughout the year following treatment. Conclusion The effects of patient and spouse mental and physical health quality of life on their own as well as their partner's relationship satisfaction differed across time which will inform psychosocial interventions for couples with prostate cancer. Copyright © 2015 John Wiley & Sons, Ltd.

  August 10, 2015   doi: 10.1002/pon.3931   open full text
• Longitudinal associations among maternal communication and adolescent posttraumatic stress symptoms after cancer diagnosis.
  Lexa K. Murphy, Erin M. Rodriguez, Laura Schwartz, Heather Bemis, Leandra Desjardins, Cynthia A. Gerhardt, Kathryn Vannatta, Megan Saylor, Bruce E. Compas.
  Psycho-Oncology. July 27, 2015
  Objective The purpose of this study was to prospectively examine adolescent and maternal posttraumatic stress symptoms (PTSS) and maternal communication from time near cancer diagnosis to 12‐month follow‐up to identify potential risk factors for adolescent PTSS. Methods Forty‐one adolescents with cancer (10–17 years, 54% female) and their mothers self‐reported PTSS at T1 (two months after cancer diagnosis) and T3 (1‐year follow‐up). At T2 (3 months after T1), mother–adolescent dyads were videotaped discussing cancer, and maternal communication was coded with macro (harsh and withdrawn) and micro (solicits and validations) systems. Results Adolescent PTSS at T1 was associated with adolescent PTSS at T3. Greater maternal PTSS at T1 predicted greater harsh maternal communication at T2. There was an indirect effect of maternal PTSS at T1 on adolescent PTSS at T3 through maternal validations at T2. Conclusions Findings underscore the importance of maternal PTSS, maternal communication, and subsequent adolescent PTSS over the course of treatment of childhood cancer. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  July 27, 2015   doi: 10.1002/pon.3918   open full text
• Factitious disorder (Munchausen's syndrome) in oncology: case report and literature review.
  Muhammad R. Baig, Tomer T. Levin, Wendy G. Lichtenthal, Patrick J. Boland, William S. Breitbart.
  Psycho-Oncology. July 14, 2015
  Background Factitious disorder is where patients repeatedly seek medical care for feigned illnesses in the absence of obvious external rewards; ‘Munchausen's syndrome’ is the historical name for this disorder. Method We report on a case that was presented to a tertiary oncology center as a suspected rare bone cancer. Results and Conclusions Psychosocial clinicians working in oncology settings should be aware of the complexities of diagnosing factitious disorder in cancer settings where empathy is prominent and suspicion unusual. Moreover, comorbidity can cloud the diagnosis (in this case substance abuse), and, even when accurately diagnosed, there are no evidence‐based management approaches to offer to the patient. What seems to linger most after the patient is discharged, usually in a huff, are strong counter‐transference feelings and substantial medical bills. Copyright © 2015 John Wiley & Sons, Ltd.

  July 14, 2015   doi: 10.1002/pon.3906   open full text
• Identifying cancer patients who alter care or lifestyle due to treatment‐related financial distress.
  Ryan D. Nipp, Leah L. Zullig, Gregory Samsa, Jeffrey M. Peppercorn, Deborah Schrag, Donald H. Taylor, Amy P. Abernethy, S. Yousuf Zafar.
  Psycho-Oncology. July 07, 2015
  Background Cancer patients may experience financial distress as a side effect of their care. Little is known about which patients are at greatest risk for altering their care or lifestyle due to treatment‐related financial distress. Methods We conducted a cross‐sectional survey study to determine which patients are at greatest risk for altering their care or lifestyle due to treatment‐related financial distress. Eligible patients were adults receiving cancer treatment enrolled between June 2010 and May 2011. We grouped coping strategies as lifestyle altering or care altering. We assessed coping strategies and relationships between covariates using descriptive statistics and analysis of variance. Results Among 174 participants, 89% used at least one lifestyle‐altering coping strategy, while 39% used a care‐altering strategy. Care‐altering coping strategies adopted by patients included the following: not filling a prescription (28%) and taking less medication than prescribed (23%). Lifestyle‐altering strategies included the following: spending less on leisure activities (77%), spending less on basics like food and clothing (57%), borrowing money (54%), and spending savings (50%). Younger patients were more likely than older patients to use coping strategies (p < 0.001). Lower‐income patients adopted care‐altering strategies more than higher‐income patients (p = 0.03). Participants with more education and shorter duration of chemotherapy used lifestyle‐altering strategies more than their counterparts (both p < 0.05). Conclusions As a means of coping with treatment‐related financial distress, patients were more likely to use lifestyle‐altering approaches, but more than one‐third adopted potentially harmful care‐altering strategies. Younger age, lower income, higher education, and shorter duration of chemotherapy were characteristics associated with greater use of coping strategies. Copyright © 2015 John Wiley & Sons, Ltd.

  July 07, 2015   doi: 10.1002/pon.3911   open full text
• Matching of received social support with need for support in adjusting to cancer and cancer survivorship.
  Thomas V. Merluzzi, Errol J. Philip, Miao Yang, Carolyn A. Heitzmann.
  Psycho-Oncology. July 01, 2015
  Background Optimal matching theory posits that the effects of social support are enhanced when its provision is matched with need for support. We hypothesized that matching received social support with the needs of persons with cancer, and cancer survivors would be related to better psychosocial adjustment than a mismatched condition. Method In a cross‐sectional design, sample 1, consisting of 171 cancer patients, and sample 2, consisting of 118 cancer survivors, completed measures of emotional and instrumental received support, physical debilitation, and psychological distress. Results The optimal matching theory model was confirmed; those needing support (i.e., greater physical debilitation), who did not receive it, experienced more distress than those who needed support and received it. Patients in treatment benefited from the matching of need and provision for both emotional and instrumental support, whereas survivors only benefited from the matching of emotional support. Conclusions The results suggest that social support is contextualized by the degree of physical impairment and may be somewhat different for cancer patients in treatment compared with cancer survivors. The transition to cancer survivorship may involve a transformation in the need for as well as the type and amount of received social support. Copyright © 2015 John Wiley & Sons, Ltd.

  July 01, 2015   doi: 10.1002/pon.3896   open full text
• Randomized psychosocial interventions for breast cancer: impact on life purpose.
  Maria G. Mens, Vicki S. Helgeson, Barry C. Lembersky, Andrew Baum, Michael F. Scheier.
  Psycho-Oncology. June 28, 2015
  Objective The present study sought to identify mediators underlying the effects of an education and a peer support intervention for women with breast cancer and to determine if the efficacy of a peer support intervention is moderated by cancer severity. Methods Participants included 180 patients with early stage (I or II) and 65 patients with late stage (IV) breast cancer. The study was originally planned as a 2 (early stage, late stage) × 3 (education intervention, peer support intervention, control condition) design; however, the education condition for the late stage cancer group was dropped, because of slow recruitment. Participants completed measures of well‐being prior to being randomized (Time 1), then again 2 weeks after the group meetings ended (Time 2), and 6 months later (Time 3). Results Among the participants who had attended at least one group meeting, the education intervention predicted more life purpose and marginally predicted more perceived physical health at Time 2. The peer support intervention predicted more life purpose and less depressive symptoms at Time 2. Cancer severity did not moderate these effects. The effect of the peer support intervention on depressive symptoms was mediated by life purpose. None of the intervention effects were evident at Time 3. Conclusions Peer support interventions have positive short‐term effects on well‐being, among women with late and early stage breast cancer, and these effects are partially mediated by changes in life purpose. Education interventions have positive short‐term effects on well‐being among women with early stage breast cancer. Copyright © 2015 John Wiley & Sons, Ltd.

  June 28, 2015   doi: 10.1002/pon.3891   open full text
• The health action process approach applied to African American breast cancer survivors.
  Raheem J. Paxton.
  Psycho-Oncology. June 08, 2015
  Background The health action process approach (HAPA) is a relevant model for understanding physical activity (PA), yet it has not been examined in cancer survivors or minorities. In this study, we assessed the HAPA in African American breast cancer survivors using covariance modeling. Methods A total of 304 African American breast cancer survivors (mean age = 54 years) participated in a Web‐based survey assessing demographic and medical characteristics as well as constructs of the HAPA. A two‐step covariance modeling approach was used to assess the structural relationships among the constructs. Results The hypothesized measurement model fit the data; however, general severity was not significantly associated with the remaining constructs. General severity was removed, and the fit did not change significantly. The final adjusted model provided a reasonable fit to the data and accounted for significant variance in intentions (49%) and PA (42%). Action (β = 0.1, p < 0.01) and coping (β = 0.3, p < 0.01) planning mediated the relationship between intentions and behavior. Conclusions The HAPA appears to be a relevant model for understanding PA in African American breast cancer survivors. However, more work is needed to determine whether these relationships can be replicated in other breast cancer survivors. Copyright © 2015 John Wiley & Sons, Ltd.

  June 08, 2015   doi: 10.1002/pon.3866   open full text
• Neuropsychological functioning of children treated for acute lymphoblastic leukemia: impact of whole brain radiation therapy.
  Robert D. Annett, Sarah Hile, Edward Bedrick, Alicia S. Kunin‐Batson, Kevin R. Krull, Leanne Embry, Willliam E. MacLean, Robert B. Noll.
  Psycho-Oncology. June 02, 2014
  ObjectivesTo provide one of the first prospective reports examining neuropsychological outcomes for children treated with 1800 cGy whole brain radiotherapy (WBRT) and prophylactic chemotherapy versus prophylactic chemotherapy alone for acute lymphoblastic leukemia (ALL). Acute and long‐term neuropsychological toxicities associated with WBRT are compared. MethodsThis multisite study included 188 children, ages 4–21 years at enrollment, who were assessed with standardized neuropsychological tests at 9, 21, and 48 months after diagnosis with intermediate risk ALL. All participating children were receiving treatment on a parent study CCG105. ResultsVerbal intelligence (VIQ) scores for children receiving WBRT was significantly lower than VIQ for prophylactic chemotherapy at the 48‐month time point (p < 0.05). A significant cross‐level interaction between time since diagnosis and treatment condition was observed (p < 0.05). WBRT did not result in differences in PIQ; both groups of children demonstrated comparable increases in PIQ. Neuropsychological findings at 48 months after diagnosis indicated diminished performance in neuromotor, visual–motor coordination, and executive functioning for children receiving WBRT. Academic achievement was unaffected by WBRT at 4 years after diagnosis. ConclusionsThe measurement of verbal and performance IQ as a primary endpoint in ALL clinical trials is critical to characterizing neuropsychological late effects. A trajectory of decline in neuropsychological functioning, specifically verbal IQ, was observed. Missing data within the trial occurred at random and did not impact results observed. The impact of WBRT becomes evident at 48 months after diagnosis, suggesting the need for long‐term follow‐up beyond the time frame typically used in Phase III trials. Copyright © 2014 John Wiley & Sons, Ltd.

  June 02, 2014   doi: 10.1002/pon.3586   open full text
• Intolerance of uncertainty, cognitive complaints, and cancer‐related distress in prostate cancer survivors.
  Stacy A. Eisenberg, Keiko Kurita, Megan Taylor‐Ford, David B. Agus, Mitchell E. Gross, Beth E. Meyerowitz.
  Psycho-Oncology. June 01, 2014
  ObjectiveProstate cancer survivors have reported cognitive complaints following treatment, and these difficulties may be associated with survivors' ongoing cancer‐related distress. Intolerance of uncertainty may exacerbate this hypothesized relationship by predisposing individuals to approach uncertain situations such as cancer survivorship in an inflexible and negative manner.We investigated whether greater cognitive complaints and higher intolerance of uncertainty would interact in their relation to more cancer‐related distress symptoms. MethodsThis cross‐sectional, questionnaire‐based study included 67 prostate cancer survivors who were 3 to 5 years post treatment. Hierarchical multiple regression analyses tested the extent to which intolerance of uncertainty, cognitive complaints, and their interaction were associated with cancer‐related distress (measured with the Impact of Event Scale‐Revised; IES‐R) after adjusting for age, education, physical symptoms, and fear of cancer recurrence. ResultsIntolerance of uncertainty was positively associated with the IES‐R avoidance and hyperarousal subscales. More cognitive complaints were associated with higher scores on the IES‐R hyperarousal subscale. The interaction of intolerance of uncertainty and cognitive complaints was significantly associated with IES‐R intrusion, such that greater cognitive complaints were associated with greater intrusive thoughts in survivors high in intolerance of uncertainty but not those low in it. ConclusionsProstate cancer survivors who report cognitive difficulties or who find uncertainty uncomfortable and unacceptable may be at greater risk for cancer‐related distress, even 3 to 5 years after completing treatment. It may be beneficial to address both cognitive complaints and intolerance of uncertainty in psychosocial interventions. Copyright © 2014 John Wiley & Sons, Ltd.

  June 01, 2014   doi: 10.1002/pon.3590   open full text
• Exploring psychological responses to genetic testing for Lynch Syndrome within the family context.
  Dina Eliezer, Donald W. Hadley, Laura M. Koehly.
  Psycho-Oncology. May 28, 2014
  ObjectiveGenetic testing for hereditary cancer susceptibility syndromes is a family‐centered process. Nonetheless, little research has explored how the family context affects psychological responses to genetic testing. We examine how personal test results and the test results of immediate and extended family members shape responses to genetic testing. MethodsIndividuals at risk of carrying a mutation associated with an inherited cancer susceptibility syndrome (Lynch syndrome) received genetic testing. Six months after receiving their results, participants reported on cancer distress, cancer worry, and depressive symptoms. ResultsAmong mutation carriers for Lynch syndrome, the higher the proportion of carriers in their immediate family, the less cancer worry and distress they reported. In contrast, mutation carriers and non‐carriers with a high proportion of carriers in their immediate family and mutation carriers with a high proportion of carriers in their extended family were at elevated risk for clinically significant levels of depressive symptoms. ConclusionPersonal test results alone are not highly predictive of psychological outcomes. Instead, the interaction between personal and family test results, or in some cases, family test results alone, predict key psychological outcomes. The current research has important implications for genetic counseling and intervention efforts. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

  May 28, 2014   doi: 10.1002/pon.3551   open full text
• The association of self‐leadership, health behaviors, and posttraumatic growth with health‐related quality of life in patients with cancer.
  Young Ho Yun, Jin Ah Sim, Ju Youn Jung, Dong‐Young Noh, Eun Sook Lee, Young Woo Kim, Jae Hwan Oh, Jung Sil Ro, Sang Yoon Park, Sang Jae Park, Kwan Ho Cho, Yoon Jung Chang, Yeon Min Bae, Si Young Kim, Kyung Hae Jung, Zae Ill Zo, Jae‐Young Lim, Soon Nam Lee.
  Psycho-Oncology. May 21, 2014
  PurposeWe tried to evaluate the association of self‐leadership, effective health behaviors, and posttraumatic growth with health‐related quality of life (HRQOL). MethodsWe recruited survivors of cancer from seven hospitals in Korea between 2001 and 2006. The patients completed the Seven Habits Profile (7HP) to evaluate leadership competency, the 10 rules for highly effective health behavior to evaluate health behavior, the Posttraumatic Growth Inventory (PTGI) to evaluate posttraumatic growth, the Short Form 36 (SF‐36) to evaluate HRQOL, and the Hospital Anxiety and Depression Scale (HADS) to evaluate anxiety and depression. We performed multiple logistic regressions to identify significant associations. ResultsA total of 668 patients with cancer participated in the study. Patients who scored high on the leadership subscales of Be Proactive, Begin with the End in Mind, Put First Things First, Think Win‐Win, Synergize, and Sharpen the Saw in 7HP tried to practice and keep their health behaviors more. The Begin with the End in Mind, Put First Things First, Synergize, and Sharpen the Saw subscales of the 7HP were also significantly correlated with subscales on the PTGI. Patients who scored high on the leadership subscales of Life Balance, Be Proactive, Begin with the End in Mind, Think Win‐Win, and Sharpen the Saw had higher physical and mental component scale scores on the SF‐36 and lower anxiety and depression subscale scores on the HADS. ConclusionSelf‐leadership, health behaviors, and posttraumatic growth are associated with QOL in survivors of cancer. Copyright © 2014 John Wiley & Sons, Ltd.

  May 21, 2014   doi: 10.1002/pon.3582   open full text
• The prevalence of burnout among oncology professionals: oncologists are at risk of developing burnout.
  S. Eelen, S. Bauwens, C. Baillon, W. Distelmans, E. Jacobs, A. Verzelen.
  Psycho-Oncology. May 21, 2014
  ObjectiveInternational research shows that oncology staff suffers more from burnout than other healthcare professionals.Burnout is common among oncologists. The prevalence of emotional exhaustion, depersonalization, and low personal accomplishment appears to be significantly higher among physicians. Detecting burnout is highly relevant, because it affects the personal well‐being and quality of life of the healthcare professional.A national study on the prevalence of burnout in oncology was never conducted in Flanders (Dutch‐speaking part of Belgium). MethodsThe Cédric Hèle institute spread anonymous questionnaires among 923 healthcare workers in oncology (physicians, social workers, psychologists, nurses, and specialist‐nurses) in Flanders.The questionnaire consisted of two parts. The first part contained questions concerning demographic and job features.The second part included the Dutch version of the Maslach Burnout Inventory. ResultsFive hundred and fifty subjects participated in the survey (response rate of 59.5%).Of the medical oncologists, 51.2% suffered from emotional exhaustion, 31.8% from depersonalization, and 6.8% from a lack of personal accomplishment.Multivariate analysis of variance suggested a significantly elevated level of emotional exhaustion and depersonalization in oncologists compared with other professionals.Logistic regression indicated that the following variables have predictive value on risk of burnout: gender, profession, and combining work in a university hospital with work in a private hospital. ConclusionThe CHi research showed a significantly increased level of burnout‐components in professionals working in oncology, especially in medical oncologists. These results should have an impact on the daily clinic of oncology, and could be guidance for further research. Copyright © 2014 John Wiley & Sons, Ltd.

  May 21, 2014   doi: 10.1002/pon.3579   open full text
• Cross‐sectional study of patient‐reported neurobehavioral problems following hematopoietic stem cell transplant and health‐related quality of life.
  Lisa M. Wu, Jane Austin, Heiddis Valdimarsdottir, Luis Isola, Scott D. Rowley, Michael A. Diefenbach, Meredith Cammarata, William H. Redd, Christine Rini.
  Psycho-Oncology. May 21, 2014
  ObjectiveAlthough hematopoietic stem cell transplant (HSCT) patients may experience neurocognitive impairment, experiences of neurobehavioral problems (including apathy and disinhibition) are understudied. These experiences reflect behavioral signs and symptoms of neurological dysfunction that can potentially reduce health‐related quality of life (HRQOL). Understanding them is important because they may be confused with other diagnoses, including depression, potentially leading to inappropriate treatments. The objectives of this preliminary cross‐sectional study were to describe HSCT patients' neurobehavioral functioning pre‐HSCT and post‐HSCT and to examine relations with HRQOL. MethodsPatients (n = 42) 9 months to 3 years post‐HSCT completed measures of neurobehavioral functioning to report apathy and disinhibition pre‐HSCT (retrospectively) and post‐HSCT (currently). Paired t‐tests and McNemar tests were used to explore differences in the incidence of patient‐reported neurobehavioral problems within and across time points. Regression analyses were conducted to examine relations between neurobehavioral functioning and physical and mental HRQOL. ResultsElevated levels of apathy were reported by many patients post‐HSCT (36%) and increased significantly from pre‐HSCT to post‐HSCT (p = 0.001). Hierarchical regression analysis indicated that higher levels of apathy were associated with reduced mental HRQOL (p < 0.05) even after controlling for depressed mood and fatigue. ConclusionsFindings from this preliminary study highlight the importance of investigating neurobehavioral problems, particularly apathy, in HSCT patients. Because apathy is often confused with other diagnoses and may worsen HRQOL, understanding the nature of these symptoms has implications for interventions. Further research is needed in this important area. Copyright © 2014 John Wiley & Sons, Ltd.

  May 21, 2014   doi: 10.1002/pon.3554   open full text
• Intentions for risk‐reducing surgery among high‐risk women referred for BRCA1/BRCA2 genetic counseling.
  Angie Tong, Scott Kelly, Rachel Nusbaum, Kristi Graves, Beth N. Peshkin, Heiddis B. Valdimarsdottir, Marie Wood, Wendy McKinnon, Judy Garber, Shelley R. McCormick, Lina Jandorf, Marc D. Schwartz.
  Psycho-Oncology. May 17, 2014
  ObjectiveGenetic testing for breast and ovarian cancer susceptibility is now part of routine clinical practice. Although rates of risk‐reducing surgery following genetic testing have been increasing, little is known about attitudes toward risk‐reducing surgery in women prior to genetic counseling and testing. This study examines correlates of patient intentions to undergo risk‐reducing mastectomy (RRM) and risk‐reducing oophorectomy (RRO). MethodsParticipants were 696 women, ages 21–85, who sought breast cancer gene 1 and 2 (BRCA1/2) genetic counseling and had at least a 10% risk of carrying a mutation. The sample included women who were affected with breast or ovarian cancer and unaffected women with a known familial BRCA1/2 mutation. Participants completed a precounseling telephone questionnaire. ResultsPrior to receiving genetic counseling, 23.3% of participants were considering RRM and 42.5% were considering RRO. Variables that were independently associated with RRM intentions were cancer‐specific distress (OR = 1.14, 95% CI = 1.03–1.26), perceived risk of breast cancer (OR = 1.16, 95% CI = 1.05–1.28), education (OR = 1.76, 95% CI = 1.03–2.99), and age (OR = 0.96, 95% CI = 0.95–0.98). Predictors of RRO intentions were perceived risk for ovarian cancer (OR = 1.25, 95% CI = 1.14–1.37), perceived risk of carrying a BRCA1/2 mutation (OR = 1.74, 95% CI = 1.15–2.62), marital status (OR = 1.92, 95% CI = 1.34–2.76), and age (OR = 1.02, 95% CI = 1.00–1.03). ConclusionsBecause precounseling intentions predict subsequent risk‐reducing surgery decisions, this study identified patient factors associated with surgical intentions. These factors reinforce the critical role for pretest genetic counseling in communicating accurate risk estimates and management options, and addressing psychosocial concerns, to facilitate informed decision making regarding RRM and RRO. Copyright © 2014 John Wiley & Sons, Ltd.

  May 17, 2014   doi: 10.1002/pon.3560   open full text
• Caregiving experiences predict changes in spiritual well‐being among family caregivers of cancer patients.
  Rebecca N. Adams, Catherine E. Mosher, Rachel S. Cannady, Aurelie Lucette, Youngmee Kim.
  Psycho-Oncology. May 17, 2014
  ObjectiveAlthough enhanced spiritual well‐being has been linked to positive mental health outcomes among family caregivers of cancer patients, little is known regarding predictors of spiritual well‐being in this population. The current study aimed to examine caregiving experiences as predictors of change in family caregivers' spiritual well‐being during the initial months following the patient's cancer diagnosis. MethodsSeventy family caregivers of newly diagnosed cancer patients (74% female, mean age = 59 years) participated in this longitudinal survey. Caregivers completed baseline questionnaires shortly before staying with the patient at an American Cancer Society Hope Lodge. Baseline questionnaires assessed caregiving experiences (i.e., self‐esteem related to caregiving, family support for providing care, impact of caregiving on finances, and impact of caregiving on one's schedule). In addition, caregivers' spiritual well‐being (i.e., meaning in life, peace, and faith) was assessed at baseline and 4‐month follow‐up. ResultsIn univariate analyses, all caregiving experiences studied were associated with one or more aspects of spiritual well‐being at 4‐month follow‐up. However, in the multivariate analysis, the only caregiving experience associated with aspects of spiritual well‐being at 4‐month follow‐up was caregivers' perceptions of family support. Specifically, lack of family support was associated with lower levels of meaning and peace. ConclusionsFindings point to the importance of family support in facilitating the search for meaning and peace shortly after a loved one's cancer diagnosis and suggest that interventions targeting caregivers' support system may enhance their spiritual well‐being. Copyright © 2014 John Wiley & Sons, Ltd.

  May 17, 2014   doi: 10.1002/pon.3558   open full text
• Determinants of long‐term fatigue in breast cancer survivors: results of a prospective patient cohort study.
  Martina E. Schmidt, Jenny Chang‐Claude, Petra Seibold, Alina Vrieling, Judith Heinz, Dieter Flesch‐Janys, Karen Steindorf.
  Psycho-Oncology. May 17, 2014
  ObjectiveFatigue is among the most distressing symptoms across the breast cancer continuum. However, little is known about the factors contributing to long‐term persisting fatigue. Therefore, we explored determinants of long‐term physical, affective, and cognitive fatigue in a prospective cohort of breast cancer patients. MethodsBreast cancer patients recruited in a population‐based case–control study (MARIE study) provided comprehensive data on sociodemographics, lifestyle, and preexisting medical conditions. At follow‐up (median 6.3 years post‐diagnosis, MARIEplus), disease‐free cancer survivors (N = 1928) reported current fatigue using a validated multidimensional questionnaire. Additionally, survivors retrospectively rated their fatigue levels before diagnosis, during the treatment phase, and 1 year post‐surgery. Linear regression analyses were performed. ResultsAs major determinants of long‐term physical, affective, and cognitive fatigue, multiple regression analyses revealed preexisting psychological or depressive disorders, migraine, analgesic use, peripheral arterial obstructive disease (PAOD), and arthritis. A physically inactive lifestyle and obesity were associated with persisting physical fatigue. Aromatase inhibitors were also associated with long‐term fatigue, especially cognitive fatigue. Chemotherapy and, to a lower extent, radiotherapy were major contributors to the development of fatigue during the treatment phase, yet were not associated with long‐term fatigue. ConclusionsAlthough the development of fatigue in breast cancer patients seems largely impacted by cancer therapy, for the long‐term persistence of fatigue, preexisting medical or psychological conditions related to depression or pain and lifestyle factors appear to be more relevant. Physicians, psycho‐oncologists, and researchers may need to distinguish between acute fatigue during therapy and long‐term persisting fatigue with regard to its pathophysiology and treatment. Copyright © 2014 John Wiley & Sons, Ltd.

  May 17, 2014   doi: 10.1002/pon.3581   open full text
• Identification of posttraumatic growth trajectories in the first year after breast cancer surgery.
  Ashley Wei‐Ting Wang, Cheng‐Shyong Chang, Shou‐Tung Chen, Dar‐Ren Chen, Wen‐Yau Hsu.
  Psycho-Oncology. May 16, 2014
  BackgroundEmpirical studies of the relationship between posttraumatic growth (PTG) and adjustment outcomes reveal a fairly inconclusive picture. We argue that the inconsistent findings are likely due to the heterogeneity of the PTG experience over time. In this regard, we predicted that individuals with different PTG trajectories vary in the level of adjustment and the correlational patterns between PTG and adjustment. MethodsParticipants were 124 Taiwanese women who underwent surgery for breast cancer. Measures of PTG and adjustment variables, including positive affect, negative affect, mental and physical quality of life, anxiety, and depression, were assessed at 1 day and 3, 6, and 12 months after surgery. A group‐based trajectory model was used to identify subpopulations of individuals who shared homogenous growth patterns. Then, we determined whether the trajectory predicted adjustment at 12 months after surgery. The correlations between PTG and adjustment outcomes were computed in each subpopulation across every time point. ResultsThe patients were categorized into the following four groups, which showed very different patterns of PTG change over the first year after breast cancer surgery: stable high (27.4%), high decreasing (39.4%), low increasing (16.9%), and low decreasing (16.9%). Differences in the level of adjustment at 12 months and the patterns of the correlations across time were found among these latent subgroups ConclusionsThis study was the first longitudinal examination of PTG trajectories and their different levels of adjustment. The findings support our argument that identifying distinct PTG trajectories can better determine the nature of the relationship between PTG and adjustment. Copyright © 2014 John Wiley & Sons, Ltd.

  May 16, 2014   doi: 10.1002/pon.3577   open full text
• Patterns of psychological responses in parents of children that underwent stem cell transplantation.
  Roberto Riva, Ulla Forinder, Johan Arvidson, Karin Mellgren, Jacek Toporski, Jacek Winiarski, Annika Lindahl Norberg.
  Psycho-Oncology. May 16, 2014
  ObjectiveHematopoietic stem cell transplantation (HSCT) is curative in several life‐threatening pediatric diseases but may affect children and their families inducing depression, anxiety, burnout symptoms, and post‐traumatic stress symptoms, as well as post‐traumatic growth (PTG). The aim of this study was to investigate the co‐occurrence of different aspects of such responses in parents of children that had undergone HSCT. MethodsQuestionnaires were completed by 260 parents (146 mothers and 114 fathers) 11–198 months after HSCT: the Hospital Anxiety and Depression Scale, the Shirom–Melamed Burnout Questionnaire, the post‐traumatic stress disorders checklist, civilian version, and the PTG inventory. Additional variables were also investigated: perceived support, time elapsed since HSCT, job stress, partner‐relationship satisfaction, trauma appraisal, and the child's health problems. A hierarchical cluster analysis and a k‐means cluster analysis were used to identify patterns of psychological responses. ResultsFour clusters of parents with different psychological responses were identified. One cluster (n = 40) significantly differed from the other groups and reported levels of depression, anxiety, burnout symptoms, and post‐traumatic stress symptoms above the cut‐off. In contrast, another cluster (n = 66) reported higher levels of PTG than the other groups did. ConclusionsThis study shows a subgroup of parents maintaining high levels of several aspects of distress years after HSCT. Differences between clusters might be explained by differences in perceived support, the child's health problems, job stress, and partner‐relationship satisfaction. Copyright © 2014 John Wiley & Sons, Ltd.

  May 16, 2014   doi: 10.1002/pon.3567   open full text
• Experiences of paradox: a qualitative analysis of living with cancer using a framework approach.
  Isabel Leal, Joan Engebretson, Lorenzo Cohen, Alma Rodriguez, Tenzin Wangyal, Gabriel Lopez, Alejandro Chaoul.
  Psycho-Oncology. May 16, 2014
  ObjectivesLife‐threatening diseases such as cancer represent unique traumas—compared with singular, time‐limited traumatic events—given their multidimensional, uncertain, and continuing nature. However, few studies have examined the impact of cancer on patients as a persistent stressor. The aim of this qualitative study is to explore patients' ongoing experiences of living with cancer and the changes encountered in this experience over time. MethodsWritten reflections to three open‐ended questions collected from 28 patients on their experience of cancer at two time points were analyzed to explore participants' experiences and perspectives over time. Content analysis using a framework approach was employed to code, categorize, and summarize data into a thematic framework. ResultsData analysis yielded the thematic framework—living with paradox, consisting of four interrelated themes: sources, experiences, resolution of paradox, and challenges with medical culture/treatment. The primary theme concerned moving through a dualistic and complex cancer experience of concurrently negative and positive emotional states across the course of cancer. ConclusionsRespondents indicated that cycling through this contradictory trajectory was neither linear, nor singular, nor conclusive in nature, but reiterative across time. Recognition that patients' cancer experience may be paradoxical and tumultuous throughout the cancer trajectory can influence how practitioners provide patients with needed support during diagnosis, treatment, and recovery. This also has implications for interventions, treatment, and care plans, and adequately responding to the diversity of patient's psychosocial, physical, existential, and spiritual experience of illness. Copyright © 2014 John Wiley & Sons, Ltd.

  May 16, 2014   doi: 10.1002/pon.3578   open full text
• Effects of gender and depressive symptoms on quality of life among colorectal and lung cancer patients and their family caregivers.
  Youngmee Kim, Michelle Ryn, Roxanne E. Jensen, Joan M. Griffin, Arnold Potosky, Julia Rowland.
  Psycho-Oncology. May 16, 2014
  ObjectiveCancer patients and their family caregivers often report elevated levels of depressive symptoms, along with poorer mental and physical health (quality of life: QOL). Although the mutuality in distress between patients and their caregivers is relatively well known, unknown are the degree to which caregivers' depressive symptoms independently predict their patient's QOL and vice versa, and whether the relations vary by cancer type or gender. MethodsColorectal or lung cancer patients and their caregivers (398 dyads) provided complete data for study variables (212 colorectal cancer patient dyads, 186 lung cancer patient dyads; 257 male patient dyads, 141 female patient dyads). Patients' depressive symptoms and QOL were measured approximately 4 and 12 months post‐diagnosis; caregivers' depressive symptoms and QOL were measured approximately 5 months post‐diagnosis. ResultsThe actor–partner interdependence model confirmed that each person's depressive symptom level was uniquely associated with his/her own concurrent QOL. Female patients' depressive symptoms were also related to their caregivers' poorer physical and better mental health, particularly when the pair's depressive symptoms were at similarly elevated level. On the other hand, male patients' elevated depressive symptoms were related to their caregivers' poorer mental health. ConclusionsFindings suggest that QOL among patients and their family caregivers is interdependent. In light of this interdependency, psychosocial interventions for managing depressive symptoms should target both patients and their family caregivers, from which both may benefit by not only alleviating depressive symptoms but also improving QOL. Copyright © 2014 John Wiley & Sons, Ltd.

  May 16, 2014   doi: 10.1002/pon.3580   open full text
• ‘What is this active surveillance thing?’ Men's and partners' reactions to treatment decision making for prostate cancer when active surveillance is the recommended treatment option.
  Clare O'Callaghan, Tracey Dryden, Amelia Hyatt, Joanne Brooker, Sue Burney, Addie C. Wootten, Alan White, Mark Frydenberg, Declan Murphy, Scott Williams, Penelope Schofield.
  Psycho-Oncology. May 16, 2014
  ObjectiveIn the past decade, localised prostate cancer (LPC) management has been shifting from three radical treatment options (radical prostatectomy, external beam radiotherapy, or brachytherapy) to also include active surveillance (AS). This study examines men with LPC and partners' experiences of choosing between AS and radical treatments, and their experiences of AS when selected. MethodsA qualitative descriptive research design was used. Interviewed participants were men, and partners of men, who either had chosen radical treatment immediately following diagnosis or had been on AS for at least 3 months. AS was the recommended treatment. Transcribed interviews were thematically analysed and inter‐rater reliability integrated. ResultsTwenty‐one men and 14 partners participated. Treatment decisions reflected varied reactions to prostate cancer information, regularly described as contradictory, confusing, and stressful. Men and partners commonly misunderstood AS but could describe monitoring procedures. Partners often held the perception that they were also on AS. Men and partners usually coped with AS but were sometimes encumbered by treatment decision‐making memories, painful biopsies, ongoing conflicting information, and unanswered medical questions. Radical treatment was selected when cancer progression was feared or medically indicated. Some preferred doctors to select treatments. ConclusionsTo reduce distress frequently experienced by men diagnosed with LPC and their partners during treatment decision making and ongoing AS monitoring, the following are needed: improved community and medical awareness of AS; consistent information about when radical treatment is required; and consistent, unbiased information on treatment options, prognostic indicators, and side effects. Regularly updated decisional support information/aids incorporating men's values are imperative. Copyright © 2014 John Wiley & Sons, Ltd.

  May 16, 2014   doi: 10.1002/pon.3576   open full text
• Mental health needs and service use in a national sample of adult cancer survivors in the USA: has psychosocial care improved?
  Robin L. Whitney, Janice F. Bell, Richard J. Bold, Jill G. Joseph.
  Psycho-Oncology. May 13, 2014
  ObjectiveThis study aims to estimate and test temporal differences in mental health (MH) need and service use among adult cancer survivors nationally before and after important policy recommendations for psychosocial cancer care. MethodsAdults (n = 58,585) from the National Health Interview Survey, 2005 and 2010, were categorized as having (1) no chronic disease, (2) chronic disease other than cancer, (3) cancer without other chronic disease, and (4) cancer with other chronic disease. In these groups, we compared psychological distress, MH visits, and unmet need for MH services. Survey‐weighted logistic regression was used to model these variables as functions of disease status and sociodemographic covariates and the interactions of disease status and survey year. ResultsWhereas the proportion of individuals with psychological distress and MH visits was significantly higher in 2010 versus 2005 for the no chronic disease group, the only group with significantly lower unmet need in 2010 versus 2005 was the cancer with other chronic disease group (5.3% vs. 3.0%, p < 0.05). In adjusted models, cancer survivors with other chronic disease had significantly lower odds of unmet need in 2010 (odds ratio 1.38; 95% confidence interval 0.85, 2.25) than in 2005 (odds ratio 3.32; 95% confidence interval 2.28, 4.83). ConclusionsWe find evidence of MH care quality improvement among cancer survivors between 2005 and 2010, a period that coincides with policy and clinical attention to psychosocial cancer care. These efforts may have reduced, but not eliminated, unmet need for MH services among cancer survivors. Copyright © 2014 John Wiley & Sons, Ltd.

  May 13, 2014   doi: 10.1002/pon.3569   open full text
• Patients' sense of support within the family in the palliative care context: what are the influencing factors?
  Anna Milberg, Rakel Wåhlberg, Barbro Krevers.
  Psycho-Oncology. May 13, 2014
  ObjectiveMutual support within the family is of great importance to maintain its proper functioning. The study aim, which was based on a family system approach, was to evaluate which variables are associated with patients' sense of support within the family in the palliative care context. MethodsWe recruited 174 adult patients (65% of those eligible) from six palliative home care units, who had non‐curable disease with an expected short‐term survival, such as disseminated cancer or non‐malignant diagnosis. The relationship between the endpoint and individual factors were evaluated in a stepwise model‐building procedure using generalised linear model (ordinal multinomial distribution and logit link). ResultsThe respondents' ratings of their sense of support within the family ranged from 1 (never) to 6 (always), with a mean value of 5.2 (standard deviation 1.06). Patients who less frequently sensed family support experienced more often stress, worry about their private economy, lower self‐efficacy, lower sense of security with palliative care provided (lower ratings on subscales of care interaction, mastery and prevailed own identity), more often anxiety, less often perceived general well‐being for closest ones and less often sense of support from more distant family members. In the model building, three variables were selected to predict the patients' sense of support within the family. ConclusionsThe dying patients' sense of support within the family related to several factors, and these may help the palliative care teams to identify patients at risk and to alleviate suffering, for example, through supporting the closest family members. Copyright © 2014 John Wiley & Sons, Ltd.

  May 13, 2014   doi: 10.1002/pon.3564   open full text
• Family caregivers' awareness of illness and attitude toward disclosure during chemotherapy for advanced cancer.
  Soyeun Kim, Youngjin Ko, Sinyoung Kwon, Dong‐Yeop Shin, Cheol Hyeon Kim, Sung Hyun Yang, Seong‐Jin Cho, Im Il Na.
  Psycho-Oncology. May 12, 2014
  Objective We investigated family caregivers' awareness of disease status and attitude toward disclosure of disease progression compared with those of cancer patients and explored the potential association between family caregivers' attitudes and patients' quality of life (QOL). Methods We carried out a survey using self‐administered questionnaires answered by pairs of family caregivers and patients diagnosed with advanced cancer (n = 136 pairs). To assess patients' QOL, we used the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire. Results More than half of family caregivers (54%) did not have full knowledge of patients' advanced stage and goal of therapy. Positive attitudes toward disclosure were less common in family caregivers than in patients (59.4% and 85.4%, respectively; p < 0.01). The family caregivers' positive attitudes toward disclosure were inversely associated with patients' low functional scores (emotion [p = 0.04] and cognition [p = 0.02]) and high symptom scores (nausea and vomiting, pain, and insomnia; p < 0.05). However, in most QOL scales, patients' attitudes were not significantly associated with functioning and symptom scores. Conclusions A large portion of family caregivers may not know the patients' exact status. This study also suggests that the family caregivers' attitudes may differ from patients' and may be associated with patients' QOL. Copyright © 2014 John Wiley & Sons, Ltd.

  May 12, 2014   doi: 10.1002/pon.3565   open full text
• Information seeking and avoidance throughout the cancer patient journey: two sides of the same coin? A synthesis of qualitative studies.
  Evi Germeni, Peter J. Schulz.
  Psycho-Oncology. May 10, 2014
  Objective Understanding what motivates patients to seek or avoid information beyond the medical consultation is essential for effective information provision that will be relevant to patients' needs and preferences. We conducted a synthesis of published qualitative research to provide insight into patients' motivations for cancer information seeking and avoidance. Methods We searched five electronic databases: Medline, CINAHL, PsycINFO, Communication and Mass Media Complete, and Sociological Abstracts. We complemented this process by reviewing reference lists of relevant articles and searching in Google Scholar. We independently assessed the quality of selected studies and used the technique of meta‐ethnography to synthesize available findings. Results Eighteen articles that reported the information‐seeking experiences of 650 patients diagnosed with more than 20 different types of cancer were included. Key concepts were experience of diagnosis, sense of control, trust in medical expertise, hope and fear, and need to resume normality. The synthesis revealed the fluid boundaries existing between information seeking and avoidance throughout the cancer journey and pointed toward the exploration of factors that could influence patients' motivations to engage in information seeking. Patient characteristics, disease characteristics, characteristics of incoming information, and the context of cancer care were found to facilitate or hinder individuals' willingness and potential to assume the role of ‘informed patient’. Conclusions This meta‐ethnography suggests that information seeking and avoidance should not be necessarily considered as two distinct behaviors pertaining to different groups of patients; rather, a number of personal and contextual characteristics should be taken into account when evaluating patient desire for information. Copyright © 2014 John Wiley & Sons, Ltd.

  May 10, 2014   doi: 10.1002/pon.3575   open full text
• Parental stress predicts functional outcome in pediatric cancer survivors.
  Sarah Hile, Sarah J. Erickson, Brittany Agee, Robert D. Annett.
  Psycho-Oncology. May 10, 2014
  Background Childhood cancer survivors are at risk for long‐term neurocognitive and psychosocial morbidities. Research has seldom examined the relationship between these morbidities; thus, little empirical evidence exists concerning overall salience and how morbidities converge to impair day‐to‐day functioning. An increased understanding of functional impairment resulting from the pediatric cancer experience can inform early risk identification as well as sources for intervention. The purpose of this study was to characterize the frequency/severity of functional impairment and identify significant neurocognitive and psychosocial determinants of functional impairment. Methods Fifty child–parent dyads were enrolled. Children were aged 7–19 years who were at least 2 years postdiagnosis with leukemia/lymphoma and were recruited through a pediatric oncology late effects clinic. Parents completed questionnaires, rating their own adjustment to their child's illness as well as their child's level of functional impairment, while a brief neuropsychological exam was administered to children. Results Twenty‐six percent of the sample evidenced clinically significant functional impairment. Regression analyses indicated that neurocognitive deficits did not predict functional impairment, whereas parental stress was a significant predictor. Conclusions Although children demonstrated both neurocognitive deficits and functional impairments, results favor psychosocial factors, such as parental stress, as a predictor of overall functional impairment. The implications of this study suggest that late effects aggregate to impact day‐to‐day functioning in pediatric cancer survivor populations and parental stress may serve as a marker for heightened risk. The results suggest that broader functional domains, especially school and self‐care domains, should be evaluated and considered when identifying potential targets for psychosocial interventions. Copyright © 2014 John Wiley & Sons, Ltd.

  May 10, 2014   doi: 10.1002/pon.3543   open full text
• Psychological, demographic, illness and treatment risk factors for emotional distress amongst paediatric oncology patients prior to reaching 5‐year survivorship status.
  S. Canning, P. Bunton, L. Talbot Robinson.
  Psycho-Oncology. May 09, 2014
  Objectives Studies assessing emotional distress severity of paediatric oncology patients prior to reaching 5‐year survivorship status have produced inconsistent findings. This cross‐sectional multi‐centre study aimed to determine psychological, demographic, illness and treatment risk factors for emotional distress in this population. Methods Paediatric oncology patients (n = 74), aged 12–18 years, completed the Paediatric Index of Emotional Distress, Self‐Description Questionnaire and Paediatric Quality of Life Inventory. Seventy‐two parents provided background information regarding demographics, diagnoses and treatment protocols in addition to appropriate proxy ratings. Results Hierarchical multiple regression analyses demonstrated that demographic, illness and treatment factors explained little variance in emotional distress. Global self‐concept, global‐generic and cancer‐specific health‐related quality of life (HRQOL) were significant predictors. Provisional multiple regression analyses indicated that pain/hurt, illness‐related worries, communication difficulties and negative self‐views in relation to math abilities, parent relations and opposite‐sex peer relations were risk factors for emotional distress in this sample. Paired‐sample t‐tests and Pearson's moment‐correlation coefficients showed patient and parent reports of patients' self‐concepts and HRQOL were highly consistent. Conclusions This study empirically identified modifiable psychological risk factors for emotional distress prior to 5‐year survivorship status and provided guidance for future interventions. Furthermore, findings suggest that parent reports can provide reliable estimates of patients' self‐concepts and HRQOL. Generalizability of the findings was enhanced by the diversity of the sample studied, in terms of diagnosis and treatment exposure, and the multi‐centre recruitment strategy employed. Nevertheless, the findings should be corroborated by larger, longitudinal studies. Copyright © 2014 John Wiley & Sons, Ltd.

  May 09, 2014   doi: 10.1002/pon.3563   open full text
• Unmet supportive care needs and characteristics of family caregivers of patients with oral cancer after surgery.
  Shu‐Ching Chen, Yeur‐Hur Lai, Chun‐Ta Liao, Bing‐Shen Huang, Chien‐Yu Lin, Kang‐Hsing Fan, Joseph Tung‐Chien Chang.
  Psycho-Oncology. January 08, 2014
  Objective The aim of this study was to identify factors associated with unmet supportive care needs in family caregivers of patients with oral cancer after surgery. Methods In a cross‐sectional study, we recruited patient–family caregiver dyads from the otolaryngology head and neck surgery wards of a medical center in northern Taiwan. Patients were assessed using a set of structured questionnaires to measure symptom distress, sleep quality, and depression. Social support and supportive care needs of family caregivers were measured. Results Of the 102 dyads surveyed, needs for supportive care in information domain and healthcare professional/healthcare services domain were highest. Patients with more severe symptoms and family caregivers who received less social support from family were associated with greater overall unmet supportive care needs. Conclusions Family caregivers report the need for more information and healthcare services after a family member has had oral surgery. Caregiving training programs should be developed for caregivers on the basis of meeting reported needs. Copyright © 2014 John Wiley & Sons, Ltd.

  January 08, 2014   doi: 10.1002/pon.3458   open full text
• Guilt, censure, and concealment of active smoking status among cancer patients and family members after diagnosis: a nationwide study.
  Dong Wook Shin, Jong Hyock Park, So Young Kim, Eal Whan Park, Hyung Kook Yang, Eunmi Ahn, Seon Mee Park, Young Joon Lee, Myong Cheol Lim, Hong Gwan Seo.
  Psycho-Oncology. December 19, 2013
  Objectives We aimed to identify the prevalence of feelings of guilt, censure, and concealment of smoking status among cancer patients and their family members who continued to smoke after the patient's diagnosis. Methods Among 990 patient–family member dyads, 45 patients and 173 family members who continued to smoke for at least 1 month after the patients' diagnoses were administered questions examining feelings of guilt, censure, and smoking concealment. Results Most patients who continued to smoke reported experiencing feelings of guilt toward their families (75.6%) and censure from their family members (77.8%), and many concealed their smoking from their family members (44.4%) or healthcare professionals (46.7%). Family members who continued to smoke also reported feelings of guilt with respect to the patient (63.6%) and that the patient was critical of them (68.9%), and many concealed their smoking from the patient (28.5%) or healthcare professionals (9.3%). Patients' feeling of guilt was associated with concealment of smoking from family members (55.9% vs. 10.0%) or health care professionals (55.9% vs. 20.0%). Family members who reported feeling guilty (36.5% vs. 16.3%) or censured (34.5% vs. 16.7%) were more likely to conceal smoking from patients. Conclusion Many patients and family members continue to smoke following cancer diagnosis, and the majority of them experience feelings of guilt and censure, which can lead to the concealment of smoking status from families or health care professionals. Feelings of guilt, censure, and concealment of smoking should be considered in the development and implementation of smoking cessation programs for cancer patients and family members. Copyright © 2013 John Wiley & Sons, Ltd.

  December 19, 2013   doi: 10.1002/pon.3460   open full text
• Modeling intention to participate in face‐to‐face and online lung cancer support groups.
  Yangmu Xu, Laura S. Testerman, Jason E. Owen, Erin O. Bantum, Andrea A. Thornton, Annette L. Stanton.
  Psycho-Oncology. December 18, 2013
  Background Lung cancer patients and survivors are significantly less likely to use support groups than those with other cancers. In this study, we evaluated the utility and specificity of the Behavioral Model for Vulnerable Populations for modeling intention to participate in face‐to‐face (F2F) and online lung cancer support groups. Methods Adults diagnosed with lung cancer (n = 230) completed measures assessing predisposing, enabling, and need factors associated with intention to use support services. Results Intention to join a F2F support group (found among 36.4% of survivors) was associated with positive attitude about F2F support groups, fewer perceived time constraints, less travel time from the clinic, and not having enough social support. Intention to join an online support group (34% of survivors) was associated with having more positive attitudes about online support, greater use of avoidance coping strategies, more comfort using computers, and fewer perceived time constraints. Demographics, medical history, health status, and psychological status were not associated with intention to join either type of group. Conclusions Reducing barriers to participation and addressing attitudes about support services may be the most effective ways to increase utilization of lung cancer support services. Copyright © 2013 John Wiley & Sons, Ltd.

  December 18, 2013   doi: 10.1002/pon.3449   open full text
• Communication about existential issues with patients close to death—nurses' reflections on content, process and meaning.
  Susann Strang, Ingela Henoch, Ella Danielson, Maria Browall, Christina Melin‐Johansson.
  Psycho-Oncology. December 09, 2013
  Objective Encountering dying patients with implicit existential questions requires the nurses to have positive and comfortable attitude to talking about existential issues. This paper describes the nurses' reflections on existential issues in their communication with patients close to death. Methods Nurses (n = 98) were recruited from a hospital, hospices and homecare teams. Each nurse participated in five group reflection sessions that were recorded, transcribed and analysed using qualitative content analysis. Results Three domains and nine themes emerged. The content domain of the existential conversation covered living, dying and relationships. The process domain dealt with using conversation techniques to open up conversations, being present and confirming. The third domain was about the meaning of existential conversation for nurses. The group reflections revealed a distinct awareness of the value of sensitivity and supportive conversations. Conclusion This study supports the assertion that experience of talking about existential issues and supporting environment make nurses comfortable when counselling patients close to death. It was obvious from this study that having the courage to be present and confirming, having time and not trying to ‘solve’ every existential problem were the most important factors in conversations with the patients close to death. Copyright © 2013 John Wiley & Sons, Ltd.

  December 09, 2013   doi: 10.1002/pon.3456   open full text
• Physicians' experiences and perspectives regarding the use of continuous sedation until death for cancer patients in the context of psychological and existential suffering at the end of life.
  Livia Anquinet, J. Rietjens, A. Heide, Sophie Bruinsma, Rien Janssens, Luc Deliens, Julia Addington‐Hall, W. Henry Smithson, Jane Seymour.
  Psycho-Oncology. December 05, 2013
  Objective The use of continuous sedation until death for terminally ill cancer patients with unbearable and untreatable psychological and existential suffering remains controversial, and little in‐depth insight exists into the circumstances in which physicians resort to it. Methods Our study was conducted in Belgium, the Netherlands, and the UK in hospitals, PCUs/hospices, and at home. We held interviews with 35 physicians most involved in the care of cancer patients who had psychological and existential suffering and had been continuously sedated until death. Results In the studied countries, three groups of patients were distinguished regarding the origin of their psychological and existential suffering. The first group had preexisting psychological problems before they became ill, the second developed psychological and existential suffering during their disease trajectory, and the third presented psychological symptoms that were characteristic of their disease. Before they resorted to the use of sedation, physicians reported that they had considered an array of pharmacological and psychological interventions that were ineffective or inappropriate to relieve this suffering. Necessary conditions for using sedation in this context were for most physicians the presence of refractory symptoms, a short life expectancy, and an explicit patient request for sedation. Conclusions Physicians in our study used continuous sedation until death in the context of psychological and existential suffering after considering several pharmacological and psychological interventions. Further research and debate are needed on how and by whom this suffering at the end of life should be best treated, taking into account patients' individual preferences. © 2013 The Authors. Psycho‐Oncology published by John Wiley & Sons, Ltd.

  December 05, 2013   doi: 10.1002/pon.3450   open full text
• Fear of recurrence in long‐term breast cancer survivors—still an issue. Results on prevalence, determinants, and the association with quality of life and depression from the Cancer Survivorship—a multi‐regional population‐based study.
  Lena Koch, Heike Bertram, Andrea Eberle, Bernd Holleczek, Sieglinde Schmid‐Höpfner, Annika Waldmann, Sylke R. Zeissig, Hermann Brenner, Volker Arndt.
  Psycho-Oncology. November 30, 2013
  Background Fear of recurrence (FoR) is a widespread problem among breast cancer survivors. So far, little is known about prevalence, determinants, and consequences of FoR specifically in long‐term breast cancer survivors, even though it was found to be one of the most important concerns in this group. Methods Analyses are based on data of several population‐based cohorts of long‐term breast cancer survivors, recruited by six German cancer registries. Overall, 2671 women were included in the analyses. FoR was assessed using the short form of the Fear of Progression Questionnaire. Potential determinants of moderate/high FoR and the association with depression and quality of life (QoL) were explored via multiple logistic and linear regression. Results Even though the majority of women reported low levels of FoR (82%), a substantial percentage experienced moderate (11%) and high (6%) FoR. Younger age (odds ratio = 3.00, confidence intervals = 1.91–4.73 for women below age 55 years) and considering oneself as a tumor patient (odds ratio = 3.36, confidence intervals = 2.66–4.25) were found to exhibit the strongest associations with moderate/high FoR. Overall, psychosocial and sociodemographic factors played a far bigger role in FoR than clinical factors. Higher FoR was associated with higher depression and lower QoL. Conclusion Fear of recurrence (mostly low levels) is highly prevalent among long‐term breast cancer survivors and can negatively affect QoL and well‐being. Therefore, it should be given appropriate consideration in research and clinical practice. As specifically younger women tended to be impacted by FoR, it is crucial to be particularly attentive to specific needs of younger survivors. Copyright © 2013 John Wiley & Sons, Ltd.

  November 30, 2013   doi: 10.1002/pon.3452   open full text
• Support needs and resources of sexual minority women with breast cancer.
  Laurie B. Paul, Dulcinea Pitagora, Brienne Brown, Adrian Tworecke, Lisa Rubin.
  Psycho-Oncology. November 28, 2013
  Objective The current paper utilizes qualitative methods to better understand the support needs and resources of sexual minority women (SMW) breast cancer patients. Methods Thirteen semi‐structured interviews were conducted with SMW, who were recruited from community‐based organizations and had undergone mastectomy for treatment of breast cancer. Interviews explored support needs and resources. Data were analyzed using thematic analysis. Results Three key domains emerged: support groups, family of origin support, and partner support. Participants emphasized the value of cancer support groups and resources tailored to SMW while stating that other dimensions of identity or experience, particularly age and cancer stage, were also important. Participants noted the dearth of social support resources for same‐sex partners. Family of origin and partners were typically participants' primary sources of tangible and emotional support; participants often engaged in protective buffering to mitigate caregivers' distress. Single women faced the greatest challenges in terms of support needs and resources. Former partners were often key sources of support. Conclusions SMW and their partners have many shared and unique support resources and barriers. Heteronormativity that is implicit in the structure of support resources can serve as a barrier to support for SMW and their partners. Flexibility in relationship roles enabling some SMW to include former partners as significant means of support may be a source of resiliency, particularly for unpartnered SMW cancer patients. Support needs and resources of SMW are best understood through an intersectionality framework that considers sexual orientation, relationship status, cancer stage, age, healthcare access, and other important identities and experiences. Copyright © 2013 John Wiley & Sons, Ltd.

  November 28, 2013   doi: 10.1002/pon.3451   open full text
• Factors associated with feelings of loss of masculinity in men with prostate cancer in the RADAR trial.
  Christopher F. Sharpley, Vicki Bitsika, James W. Denham.
  Psycho-Oncology. November 28, 2013
  Objectives To identify the factors underlying prostate cancer (PCa) patients' depression–anxiety, sexual problems, urinary dysfunction and androgen deprivation therapy (ADT)‐linked breast changes and hot flushes, and test these as predictors of loss of masculinity (LoM) over 36 months following diagnosis. Methods One thousand seventy patients from the TROG 03.04 (RADAR) trial the EORTC QLQ C‐30 and PR 25 questionnaires, and the International Prostate Cancer Symptom Score of the American Urological Association at baseline, 3, 7, 12, 18, 24 and 36 months. Selected items from these scales were factor‐analysed to identify a four‐component solution for responses at 18 and 36 months, and these components were regressed against a single‐item measuring LoM. Results Depression–anxiety factor was the most powerful predictor of LoM at both time points, followed by sexual problems of ADT side effects (breast changes and hot flushes). Urinary dysfunction was not a consistent predictor of LoM. Depression–anxiety was also the most significant factor distinguishing between those men who reported LoM and those who did not. Conclusions Although LoM is often reported as arising from ADT, the relative power of depression–anxiety in predicting LoM, both at the selected time points and using a time‐lagged analysis, plus the finding that depression–anxiety was the most consistent difference between men who reported LoM and those who did not, argues for the presence of adverse mood states as being the key ingredient in deciding if PCa patients experience loss of their feelings of masculinity. Copyright © 2013 John Wiley & Sons, Ltd.

  November 28, 2013   doi: 10.1002/pon.3448   open full text
• Is implementing screening for distress an efficient means to recruit patients to a psychological intervention trial?
  Corinne Scheppingen, Maya J. Schroevers, Grieteke Pool, Ans Smink, Véronique E. Mul, James C. Coyne, Robbert Sanderman.
  Psycho-Oncology. November 28, 2013
  Objectives Psychological interventions show greater efficacy when evaluated with distressed patients. We report on the feasibility of implementing screening for recruiting distressed cancer patients to a randomized controlled trial of problem‐solving therapy (PST), characteristics associated with enrolment, and time investment and challenges of implementing screening. Methods Three medical settings implemented screening of patients, directly after cancer treatment (T1) and 2 months later (T2), using Hopkins Symptom Checklist‐25 and one question about need for services. Distressed patients indicating need for services were interviewed. Eligible patients were offered the possibility to participate in the trial. Consenting patients were randomized to PST or waitlist. Results At T1, 366 of 970 screened patients (37%) scored above the cutoff and at T2, 208 of 689 screened patients (30%). At either or both T1 and T2, 423 patients reported distress, of whom 215 indicated need for services. Only 36 (4% of 970) patients consented to trial participation. Twenty‐seven patients needed to be screened to recruit a single patient, with 17 h required for each patient recruited. Barriers to screening were time constraints and negative attitudes of oncology staff towards screening. Conclusions Implementing screening proved inefficient for recruiting distressed cancer patients post‐treatment to a randomized controlled trial on PST, with need for services being much less than anticipated. Consecutively screening patients did not result in a sample representative of the larger pool of distressed patients, which may lower generalizability. An adequately powered intervention trial using screening requires a feasibility study establishing recruitment rates and dedicated, funded staff assistance. Copyright © 2013 John Wiley & Sons, Ltd.

  November 28, 2013   doi: 10.1002/pon.3447   open full text
• Perceived communication between physicians and breast cancer patients as a predicting factor of patients' health‐related quality of life: a longitudinal analysis.
  Julie G. Trudel, Nicole Leduc, Serge Dumont.
  Psycho-Oncology. November 11, 2013
  Objective Communication between cancer patients and healthcare providers is recognized as an important aspect of these patients' health‐related quality of life (HRQOL). Nevertheless, no study has examined whether perceived communication between physicians and breast cancer patients is a determining factor in their HRQOL along the disease's trajectory. This longitudinal study aimed to ascertain whether such communication influenced the HRQOL of such women at three points in time. Methods The sample consisted of 120 French‐speaking women with stage I or II breast cancer aged 18 years or over (mean = 55 years) who underwent a lumpectomy with adjuvant treatment. The women filled out questionnaires at three different times: around the time of diagnosis, halfway through radiotherapy and at follow‐up. Either at the hospital or at home, they completed demographic and medical data questionnaires, the Medical Outcomes Study‐Social Support Survey, an HRQOL questionnaire (EORTC QLQ‐C30/BR23) and the Medical Communication Competence Scale. Results Generalized estimated equations analyses indicated that the women's perceptions of their own communication skills towards physicians had a greater impact on their HRQOL than the women's perception of physicians' communication skills. The women had better global health and better role, emotional, cognitive and sexual functioning as well as fewer side effects and symptoms during radiotherapy and at follow‐up when they perceived themselves as competent communicators at diagnosis and during radiotherapy. Conclusions The results underscore the importance for breast cancer patients of being proactive in information seeking and in the socio‐emotional aspect of their relationship with physicians to enhance their HRQOL. Copyright © 2013 John Wiley & Sons, Ltd.

  November 11, 2013   doi: 10.1002/pon.3442   open full text
• A telephonic‐based trial to reduce depressive symptoms among Latina breast cancer survivors.
  Kimlin Ashing, Monica Rosales.
  Psycho-Oncology. November 11, 2013
  Objective Greater mental health symptomatology of Latina breast cancer (LBC) patients along with the paucity of intervention trials to reduce distress underscores the scientific and practice gaps in comprehensive care. This trial investigated the effect of a paraprofessionally delivered, telephonic‐based psycho‐educational intervention on depressive symptoms among LBC patients. Methods Latina breast cancer patients were recruited from the California Cancer Registry, hospital registries, and support groups. Participants were randomly assigned to the intervention or control condition. The primary outcome was level of depressive symptoms as measured by the Center for Epidemiological Studies Depression scale. Results One hundred ninety‐nine LBC patients (84 English language preferred and 115 Spanish language preferred) participated. The overall trial outcomes demonstrated a statistically significant decrease in depressive symptoms among LBC patients in the intervention condition compared with LBC patients in the control condition, after controlling for depressive symptoms at T1 and language (p < 0.05). At follow‐up, 63% of intervention LBC patients reported at least a five‐point decrease in symptoms compared with 26% of control LBC patients (p < 0.05). English language‐preferred and Spanish language‐preferred LBC patients in the intervention condition showed approximately an eight‐point mean decrease in depressive symptoms from baseline (M = 23.5 and M = 26.6, respectively) to follow‐up (M = 15.7 and M = 18.4, respectively) (p < 0.001), whereas those in the control condition showed no significant change. Conclusions Results demonstrate the effectiveness of a culturally responsive, paraprofessionally delivered intervention to reduce depressive symptoms among LBC patients. Therefore, community oncology practices can affiliate with trained paraprofessionals to implement mental health services to address distress among our growing and increasingly ethnically, linguistically, and economically diverse oncology patient population. Copyright © 2013 John Wiley & Sons, Ltd.

  November 11, 2013   doi: 10.1002/pon.3441   open full text
• It is out of my hands: how deferring control to God can decrease quality of life for breast cancer patients.
  Bryan McLaughlin, Woohyun Yoo, Jonathan D'Angelo, Stephanie Tsang, Bret Shaw, Dhavan Shah, Timothy Baker, David Gustafson.
  Psycho-Oncology. August 04, 2013
  Objective This paper seeks to contribute to the understanding of how and why religion affects psychosocial health outcomes. We propose a theoretical model predicting that when women with breast cancer defer control to God they will experience fewer breast cancer related concerns. Deferring control to God, however, should also reduce the likelihood that they take a proactive coping approach, which will be exacerbated by lowered breast cancer concerns. We therefore predict that this passive coping style will ultimately result in lower levels of quality of life. Methods Data were collected as part of a randomized clinical trial funded by the National Cancer Institute. A total of 192 women with breast cancer participated in a computer‐mediated social support group. Deferring control to God statements were captured by using computer‐aided content analysis of discussion posts. Psychosocial outcomes were measured using longitudinal survey data. Analysis was performed using structural equation modeling. Results The results of our analysis largely confirm our mediation model for which we find significant model fit. As predicted, deferring control to God leads to lower levels of breast cancer concerns but also to more passive coping styles. Ultimately, deferring control to God can lead to lower levels of quality of life. Conclusions Our study demonstrates how and why religious coping can lead to both positive and negative psychosocial health outcomes. Health care practitioners should encourage patients who are relying on religion to keep their end of the bargain and maintain an active coping style. Copyright © 2013 John Wiley & Sons, Ltd.

  August 04, 2013   doi: 10.1002/pon.3356   open full text
• Determinants of suicidal ideation in patients with breast cancer.
  Jae‐Min Kim, Ji‐Eun Jang, Robert Stewart, Seon‐Young Kim, Sung‐Wan Kim, Hee‐Ju Kang, Il‐Seon Shin, Min‐Ho Park, Jung‐Han Yoon, Jin‐Sang Yoon.
  Psycho-Oncology. August 01, 2013
  Background Breast cancer survivors are at higher risk of psychological problems including suicidal ideation. However, studies on suicidal ideation in breast cancer survivors have been rare and have not been investigated prospectively. This study aimed to investigate the prevalence and independent risk factors for suicidal ideation within 1 week and at 1 year after breast surgery for breast cancer. Methods A total of 284 patients with breast cancer were evaluated within 1 week after breast surgery, and 244 (84%) were followed up 1 year later. Suicidal ideation was ascertained using the item ‘suicidal thoughts’ from the Beck Depression Inventory. Various factors potentially related to suicidal ideation were evaluated including sociodemographic and clinical characteristics, and genetic polymorphisms on serotonin and brain‐derived neurotrophic factor (BDNF) systems. Results Suicidal ideation was present in 10.9% of participants at 1 week and 11.4% at 1 year after breast surgery. Suicidal ideation was independently associated with depression and physical disability at 1 week and with living alone, anxiety, advanced cancer stage, and the BDNF met allele (but not with genetic polymorphisms on serotonergic system) at 1 year after breast surgery. Conclusions Suicidal ideation was common and had similar prevalences in both short‐term and longer‐term follow‐ups after breast cancer. However, associated factors were substantially different between the two evaluation points, which suggest that time‐specific programs may be needed for identifying and managing suicidal risk in patients with breast cancer. Copyright © 2013 John Wiley & Sons, Ltd.

  August 01, 2013   doi: 10.1002/pon.3367   open full text
• The ‘information spectrum’: a qualitative study of how breast cancer surgeons give information and of how their patients experience it.
  Nicola Mendick, Bridget Young, Christopher Holcombe, Peter Salmon.
  Psycho-Oncology. July 31, 2013
  Objective Cancer clinicians are routinely criticised for communicating information poorly to patients, but expert guidance is sometimes contradictory or impractical. We wanted to understand how, and how well, breast cancer surgeons in their normal practice balanced the competing tasks of informing patients while keeping them hopeful. Method In a post‐operative surgical outpatient clinic in a UK breast unit, we recruited 9 surgeons and 20 breast cancer patients with whom they consulted. We audio recorded and interviewed both patients and surgeons about their consultations, then analysed data qualitatively within and across cases taking a constant comparative approach. Results Every consultation contained biomedical factually explicit information, but the information that was most significant for patients was factually less explicit. Progressively less explicit forms, along a ‘spectrum’ of information, included: judgments about treatment implications; judgments about prognosis; evaluative comments; and clues about what information signified. Surgeons used the less explicit types of information to communicate hope. Where prognosis was poor, communication was confined to more explicit information. Surgeons' practice was closely aligned with what patients sought. Conclusion Common criticisms of cancer clinicians for giving ‘too little’ information belie the complexity of their task in simultaneously managing information needs and hope. The ‘information spectrum’ could help educators and clinicians to understand this task. Copyright © 2013 John Wiley & Sons, Ltd.

  July 31, 2013   doi: 10.1002/pon.3301   open full text
• Positive psychology interventions in breast cancer. A systematic review.
  Anna Casellas‐Grau, Antoni Font, Jaume Vives.
  Psycho-Oncology. July 29, 2013
  Objective Positive psychology is an emerging area of empirical study, not only in clinical, but also in health psychology. The present systematic review aims to synthesize the evidence about the positive psychology interventions utilized in breast cancer. Methods Relevant studies were identified via Pubmed, PsycINFO, Web of Science, Scopus, Cochrane, CINAHL, Wiley Online Library, TDX, and DIALNET databases (up to April 2013). Only those papers focused on interventions related to positive psychology and carried out on breast cancer patients were included. Results Of the 7266 articles found through databases, 16 studies were finally included in this review. Five groups of therapies were found: mindfulness‐based approaches, expression of positive emotions, spiritual interventions, hope therapy, and meaning‐making interventions. These specific interventions promoted positive changes in breast cancer participants, such as enhanced quality of life, well‐being, hope, benefit finding, or optimism. However, the disparity of the interventions and some methodological issues limit the outcomes. Conclusions Some studies provided relevant evidence about the clear development of positive aspects from the breast cancer experience. Positive interventions applied to patients and survivors of breast cancer were found to be able to promote positive aspects. A global consensus of a positive therapies classification is needed to take one more step in structuring positive psychology. Copyright © 2013 John Wiley & Sons, Ltd.

  July 29, 2013   doi: 10.1002/pon.3353   open full text
• Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis.
  Inge Renske Bruinessen, Evelyn M. Weel‐Baumgarten, Hans Gouw, Josée M. Zijlstra, Akke Albada, Sandra Dulmen.
  Psycho-Oncology. July 29, 2013
  Objective This study aims to gain insight into patient‐perceived communication barriers and facilitators at different stages after the diagnosis of malignant lymphoma. We have detected patterns to explain when these factors influence communication predominantly. Method A qualitative approach was applied, derived from the context mapping framework. A total of 28 patients completed a set of assignments about their experiences with provider‐patient communication during medical consultations. Subsequently, these patients and nine companions shared their experiences during a semistructured (group) interview, which was recorded on audiotape. The audiotapes and assignments were analysed with MAXQDA software. Results From the patients' viewpoint, communicating effectively appears to depend on their own attributes (e.g. emotions), the health care professionals' attributes (e.g. attitude) and external factors (e.g. time pressure). Three patient communication states were identified: (i) overwhelmed, passive; (ii) pro‐active, self‐motivated; and (iii) proficient, empowered. Patients seem to behave differently in the three communication states. Conclusions This study lists patient‐perceived communication barriers and facilitators and identifies three different communication states, which indicate when certain barriers and facilitators are encountered. Practical implications These findings may support health care professionals to tailor the provision of support and information and remove communication barriers accordingly. Additionally, they provide input for interventions to support patients in effective communication. Copyright © 2013 John Wiley & Sons, Ltd.

  July 29, 2013   doi: 10.1002/pon.3352   open full text
• Anxiety, depression and related factors in family caregivers of newly diagnosed lung cancer patients before first treatment.
  Yun‐Hsiang Lee, Yu‐Chien Liao, Wei‐Yu Liao, Shiow‐Ching Shun, Yu‐Chun Liu, Jui‐Chun Chan, Chong‐Jen Yu, Pan‐Chyr Yang, Yeur‐Hur Lai.
  Psycho-Oncology. July 28, 2013
  Objective This study aimed to (i) explore the prevalence and levels (severity) of anxiety and depression in family caregivers (FCs) of patients newly diagnosed with advanced lung cancer (stage IIIb or IV) before first treatment, and (ii) identify the factors related to FCs' anxiety and depression. Methods For this cross‐sectional study, 106 patient–FC dyads were recruited from a medical center in northern Taiwan. FCs' anxiety and depression were measured using the self‐report Hospital Anxiety and Depression Scale, and FCs' ability to manage patients' symptoms was assessed using the Self‐Efficacy in Symptom Management Scale. FCs' risks for anxiety and depression were separately identified using two multivariate logistic regression models. Results This study found two major results. First, before patients' first treatment, 50.9% and 32.1% of FCs were at risk for anxiety and depression, respectively. FCs' overall mean anxiety and depression scores were 7.7 (SD = 4.7) and 6.1 (SD = 4.5), respectively. Second, both FCs' anxiety and depression were significantly related to four factors: caring for another sick family member, younger age, having pain problems, and lower self‐efficacy in managing symptoms. Conclusion Family caregivers of patients newly diagnosed with advanced lung cancer had anxiety and depression before the patients' first treatment. We strongly suggest developing and testing interventions to reduce FCs' psychological distress and enhance their quality of life, thus ensuring better quality of patient care. Copyright © 2013 John Wiley & Sons, Ltd.

  July 28, 2013   doi: 10.1002/pon.3328   open full text
• ‘You know I've joined your club… I'm the hot flush boy’: a qualitative exploration of hot flushes and night sweats in men undergoing androgen deprivation therapy for prostate cancer.
  C. U. Eziefula, E. A. Grunfeld, M. S. Hunter.
  Psycho-Oncology. July 28, 2013
  Objective Hot flushes and night sweats are common amongst menopausal women, and psychological interventions for managing these symptoms have recently been developed for women. However, flushes in men with prostate cancer, which commonly occur following androgen deprivation therapy (ADT), remain under‐researched. This study is a qualitative exploration of flush‐related cognitive appraisals and behavioural reactions reported by a sample of these men. Methods Semi‐structured, in‐depth interviews were conducted with 19 men who were experiencing flushes after receiving ADT for prostate cancer. Framework analysis was used to generate and categorise emergent themes and explore associations between themes. Results Five main cognitive appraisals included the following: changes in oneself, impact on masculinity, embarrassment/social‐evaluative concerns, perceived control and acceptance/adjustment. There were men who held beliefs about the impact of flushes on their perceptions of traditional gender roles, who experienced shame and embarrassment due to concerns about the salience of flushes and perceptions by others and who experienced feelings of powerlessness over flushes. Powerlessness was associated with beliefs about the potentially fatal consequences of discontinuing treatment. Two other dominant themes included awareness/knowledge about flushes and management strategies. Experiences of flushes appeared to be influenced by upbringing and general experiences of prostate cancer and ADT. Conclusions The range of men's appraisals of, and reactions to, flushes generated from this qualitative exploration were broadly similar to those of menopausal women but differed in terms of the influence of masculinity beliefs. These findings could be used to inform future research and psychological interventions in this under‐researched field. Copyright © 2013 John Wiley & Sons, Ltd.

  July 28, 2013   doi: 10.1002/pon.3355   open full text
• Preferences for and experiences of family involvement in cancer treatment decision‐making: patient–caregiver dyads study.
  Dong Wook Shin, Juhee Cho, Debra L. Roter, So Young Kim, Sang Kyun Sohn, Man‐Soo Yoon, Young‐Woo Kim, BeLong Cho, Jong‐Hyock Park.
  Psycho-Oncology. July 24, 2013
  Background Despite the important role that family caregivers play in providing emotional and practical support to cancer patients, relatively little is known about the family caregiver's role in treatment decision‐making (TDM). We sought to investigate patients' and family caregivers' preferences for and experiences of family involvement in TDM and factors associated with preference concordance. Method A national survey was performed with 990 patient–caregiver dyads (participation rate:76.2%). Questions examining preferences for and experiences of family involvement in TDM were administered independently to patients and family caregivers. Concordance was calculated with weighted kappa. Logistic regression analyses were used to identify predictors of patients' and caregivers' preferences for family involvement in TDM and concordance between them. Results Few patients or family caregivers expressed a preference for unilateral decision‐making; however, there was considerable variation and poor agreement within dyads in regard to whether the patient or family caregivers should take the lead in decision‐making with input from the other (weighted kappa between respondents for TDM preferences and experiences = 0.10 and κ = 0.18, respectively). Greater TDM preference concordance was associated with higher patient education, whereas lower levels of concordance were evident for younger patients, less educated caregivers, adult child patient dyads (as opposed to a spouse–patient dyads) and problematic family communication about cancer. Conclusions Most patients and family caregivers valued and expected family involvement in TDM. However, there is little explicit agreement in regard to which party in the dyad should take decisional leadership and who should play a supporting role. Copyright © 2013 John Wiley & Sons, Ltd.

  July 24, 2013   doi: 10.1002/pon.3339   open full text
• Parental coping and posttraumatic stress symptoms among pediatric cancer populations: tests of competing models.
  Laura Stoppelbein, Leilani Greening, Hayley Wells.
  Psycho-Oncology. July 24, 2013
  Objective The objective of this study is to examine the relation between parental coping style and the risk of parental and child posttraumatic stress symptoms (PTSS) among pediatric cancer survivors. Methods Child survivors of cancer ranging from 6 to 16 years of age (N = 111) completed standardized measures of depression and PTSS, while their parents completed standardized measures of PTSS and coping styles. Results Correlational analyses revealed that active and passive coping strategies were positively related to parental PTSS. Although child and parental PTSS were significantly related to each other, only one parental coping strategy—using substances—was significantly related to child PTSS. Regression analyses revealed support for a mediation and not for a moderation model for this relation, thereby suggesting that the relation between parental and child PTSS is mediated by parental substance use. Conclusions Clinical implications including identifying risk factors for PTSS among pediatric cancer survivors are discussed. Copyright © 2013 John Wiley & Sons, Ltd.

  July 24, 2013   doi: 10.1002/pon.3358   open full text
• The effect of including a ‘psychooncological statement’ in the discharge summary on patient‐physician communication: a randomized controlled trial.
  Katrin Book, Andreas Dinkel, Gerhard Henrich, Claudia Stuhr, Mareike Peuker, Kristin Härtl, Elmar Brähler, Peter Herschbach.
  Psycho-Oncology. July 24, 2013
  Objective The objective of this study is to determine whether the inclusion of a ‘psychooncological statement’ (PO‐statement) in the discharge summary enhances patient‐physician communication about psychosocial issues across the inpatient and outpatient sector. Methods A total of 1416 cancer patients were randomly assigned to the intervention (with PO‐statement in the discharge summary) or control group (discharge summary without PO‐statement). Shortly before discharge from the hospital (T1), patients from the intervention group were screened for psychosocial distress. Based on the electronic clinical documentation system, screening results were subsequently integrated into the discharge summary, which automatically generated a PO‐statement. To determine the effect of the PO‐statement, patients as well as their primary care physicians (n = 596) were asked during follow‐up care (T2) whether psychosocial distress was discussed during the last consultation. Results Including a PO‐statement in the discharge summary did not result in more frequent discussions about psychosocial issues compared with the control group from the patients' and physicians' perspectives. Instead, discussions about psychosocial well‐being were significantly associated with women of the patient (p = <0.001) and the physician (p = 0.011), medical discipline (gynecologists; p = 0.002), cancer diagnosis (gynecological cancer; p = 0.002), metastases (p = <0.001), professional training of patients (none, p = 0.026), and psychosocial qualification of physicians (p = 0.018). Conclusion Written information on psychosocial distress in the discharge summary alone does not affect communication. Copyright © 2013 John Wiley & Sons, Ltd.

  July 24, 2013   doi: 10.1002/pon.3347   open full text
• Routine screening for suicidal intention in patients with cancer.
  Yvonne W. Leung, Madeline Li, Gerald Devins, Camilla Zimmermann, Anne Rydall, Chris Lo, Gary Rodin.
  Psycho-Oncology. July 22, 2013
  Objectives Suicide rates are elevated in individuals with cancer, although suicidal intention is not typically assessed in cancer centers. We evaluated in a large comprehensive cancer center the utility of an electronic Distress Assessment and Response Tool (DART), in which suicidal intention is assessed with a single item. Methods Patients attending cancer clinics completed DART as part of routine care. DART includes measures of physical symptoms, depression, anxiety, social difficulties, and practical concerns. Medical variables were obtained from the Princess Margaret Cancer Registry, the data warehouse of cancer patient statistics. A Generalized Estimating Equation (GEE) model was used to assess factors associated with suicidal intention. Results Between September 2009 and March 2012, 4822/5461 patients (88.3%) who completed DART consented to the use of their data for research. Amongst the latter, 280 (5.9%) of the 4775 patients who answered the question reported suicidal ideation, which was related to physical and psychological distress, and social difficulties (ps < 0.0001). Amongst those with ideation who responded to the intention question, 20/186 (10.8%) reported suicidal intention. Of respondents with more severe suicidal ideation, 12/49 (24.5%) reported suicidal intention. Using a GEE model, suicidal intention in those with ideation was significantly associated with male sex, difficulty making treatment decisions, and with everyday living concerns. Conclusions Suicidal ideation is reported on an electronic distress screening tool (DART) by almost 6% of cancer patients, of whom almost 11% report suicidal intention and 33% decline to indicate intention. DART demonstrated utility in identifying patients who may be at highest risk of completed suicide and who require urgent clinical assessment. Copyright © 2013 John Wiley & Sons, Ltd.

  July 22, 2013   doi: 10.1002/pon.3319   open full text
• Psychosocial benefits of a novel mindfulness intervention versus standard support in distressed women with breast cancer.
  Daniel A. Monti, Kathryn M. Kash, Elisabeth J. Kunkel, Aleeze Moss, Michael Mathews, George Brainard, Ranni Anne, Benjamin E. Leiby, Edward Pequinot, Andrew B. Newberg.
  Psycho-Oncology. July 21, 2013
  Objective It is well documented that stress is associated with negative health outcomes in cancer patients. The purpose of this study was to assess the effects of a novel mindfulness intervention called mindfulness‐based art therapy (MBAT) versus standard educational support, on indices of stress and quality of life in breast cancer patients with high stress levels. Methods A total of 191 women were enrolled, stratified by age and stress level, and randomized to receive either an 8‐week MBAT intervention or a breast cancer educational support program of equal time and duration. Psychosocial stress was measured using the Symptoms Checklist‐90‐Revised, and quality of life was measured using the Medical Outcomes Study Short‐Form Health Survey at baseline, immediately post‐intervention, and at 6 months. Results Results showed overall significant improvements in psychosocial stress and quality of life in both the MBAT and educational support groups immediately post‐intervention; however, participants with high stress levels at baseline had significantly improved overall outcomes only in the MBAT group, both immediately post‐intervention and at 6 months. In addition, at 6 months follow‐up, participants attending five or more sessions trended toward retaining treatment effects better in the MBAT than in the control group. Finally, black women and white women were similar in terms of how they benefited from the MBAT intervention, even though white participants tended to have higher educational level and marital status. Conclusions In conclusion, MBAT is associated with significant, sustained benefits across a diverse range of breast cancer patients, particularly those with high stress levels. Copyright © 2013 John Wiley & Sons, Ltd.

  July 21, 2013   doi: 10.1002/pon.3320   open full text
• Appearance concerns among women with neurofibromatosis: examining sexual/bodily and social self‐consciousness.
  Kelly B. Smith, Daphne L. Wang, Scott R. Plotkin, Elyse R. Park.
  Psycho-Oncology. July 19, 2013
  Objective Neurofibromatosis (NF) 1 and 2 have distinct appearance effects, yet little research has examined patients' appearance concerns. We assessed appearance concerns and self‐consciousness, self‐esteem, and loneliness among women with NF. Methods Women with NF1 (n = 79) and NF2 (n = 48) completed the Derriford Appearance Scale to assess appearance concerns and sexual/bodily and social self‐consciousness, Rosenberg Self‐Esteem Scale, and UCLA Loneliness Scale. Women's appearance concerns were coded to determine whether they were NF‐related and whether psychosocial factors contributed to the concerns. Results A total of 85% of women reported appearance concerns, many of which were NF‐related and attributed to psychosocial factors. Women with NF1 reported significantly more sexual/bodily self‐consciousness but similar levels of social self‐consciousness compared with women with NF2. Significantly higher sexual/bodily self‐consciousness was found among married/cohabiting women regardless of NF group. Compared with general population norms and breast cancer survivors (BCS), women with NF1 reported significantly greater sexual/bodily and social self‐consciousness. Women with NF2 reported less sexual/bodily self‐consciousness compared with population norms, yet tended to report greater sexual/bodily self‐consciousness than BCS. Women with NF2 reported significantly greater social self‐consciousness compared with population norms and BCS. For both NF1 and NF2, higher levels of sexual/bodily and social self‐consciousness were related to lower self‐esteem and higher levels of social self‐consciousness to more loneliness. Conclusions Appearance concerns are prevalent, and social self‐consciousness is high, among women with NF1 and NF2. Women with NF1 compared with NF2 experience more sexual/bodily self‐consciousness. Providers should assess the impact of NF on women's self‐perceptions and address sexual, body image, and social concerns. Copyright © 2013 John Wiley & Sons, Ltd.

  July 19, 2013   doi: 10.1002/pon.3350   open full text
• The impact of awareness of terminal illness on quality of death and care decision making: a prospective nationwide survey of bereaved family members of advanced cancer patients.
  Eunmi Ahn, Dong Wook Shin, Jin Young Choi, Jina Kang, Dae Kyun Kim, Hyesuk Kim, Eunil Lee, Kwan Ok Hwang, Bumjo Oh, BeLong Cho.
  Psycho-Oncology. July 10, 2013
  Objects We aimed to assess whether awareness of a terminal illness can affect care decision making processes and the achievement of a good death in advanced cancer patients receiving palliative care services. Methods Awareness of terminal illness at the time of palliative care service admission was assessed by the health care professionals during the routine initial comprehensive assessment process and was recorded in the national terminal cancer patient registry. A follow‐up nationwide bereavement survey was conducted, which contained questions regarding decision making processes and the Korean version of the Good Death Inventory. Results Among the 345 patients included in the final analysis, the majority (68.4%) of the patients were aware of the terminal illness. Awareness of the terminal illness tended to reduce discordances in care decision making (adjusted odds ratio = 0.55; 95% CI: 0.29–1.07), and increased the patients' own decision making when there were discordances between patients and their families (adjusted odds ratio = 3.79; 95% CI: 1.31–10.94). The Good Death Inventory score was significantly higher among patients who were aware of their terminal illnesses compared with those who were not (5.04 vs. 4.80; p = 0.013) and especially in the domains of ‘control over the future’ (5.18 vs. 4.04; p < 0.001), ‘maintaining hope and pleasure’ (4.55 vs. 3.92; p = 0.002), and ‘unawareness of death’ (4.41 vs. 4.26; p = 0.024). Conclusion Awareness of the terminal illness had beneficial effect on the harmonious decision making, patient autonomy, and patient's quality of death. Disclosure of terminal illness should be encouraged. Copyright © 2013 John Wiley & Sons, Ltd.

  July 10, 2013   doi: 10.1002/pon.3346   open full text
• Low preparedness before the loss of a wife to cancer and the widower's chronic pain 4–5 years later—a population‐based study.
  Hildur Guðný Ásgeirsdóttir, Unnur Valdimarsdóttir, Carl Johan Fürst, Gunnar Steineck, Arna Hauksdóttir.
  Psycho-Oncology. July 10, 2013
  Objective The focus of this study was on the impact of spousal loss on the development of chronic pain thereafter. More specifically, the aim was to investigate the effect of experiencing low preparedness before a wife's death and the widower's chronic pain 4–5 years after loss. Methods In a population‐based study in the years 2004‐2005, anonymous questionnaires were sent out to 907 men in Sweden who had lost a wife to cancer in 2000 and 2001. The questionnaires contained questions on the man's preparedness for his wife's death and his physical and psychological health at follow‐up. Results Altogether, 691 out of 907 questionnaires were retrieved (76%). Younger widowers (38‐61 years old) with a low degree of preparedness for their wife's death had an increased risk of experiencing symptoms of chronic pain (odds ratio 6.67; 2.49‐17.82) 4‐5 years after loss. The same results did not apply for older widowers (62‐80 years old) (odds ratio 0.81; 0.32‐2.05). Widowers who experienced chronic pain were at an increased risk for psychological morbidity, depression (relative risk [RR] 2.21; 1.31‐3.74), anxiety (RR 2.11; 1.33‐3.37), and sleep disorders (RR 2.19; 1.30‐3.69). Conclusion Our data suggest that low preparedness for a wife's death may increase risk of chronic pain among younger widowers 4‐5 years after loss. In addition, we found comorbidity between psychological symptoms and chronic pain among widowers. These findings call for studies on possible mechanisms in the association between low preparedness and morbidity and on how to increase preparedness for a wife's death to cancer. Copyright © 2013 John Wiley & Sons, Ltd.

  July 10, 2013   doi: 10.1002/pon.3345   open full text
• Quam bene vivas referre: curing and caring in psycho‐oncology.
  Luigi Grassi.
  Psycho-Oncology. July 03, 2013
  Background By examining the medical–philosophical Latin heritage, some psycho‐oncology principles may be traced in Claudius Galenus and Lucius Anneus Seneca. The former hypothesized a link between depression and cancer; the latter strongly underlined the need for not wasting time, living in the present by searching for meaning and reaching well‐being of the soul through virtues, even when dealing with misfortune and negative life events. Methods On these premises, what follows here is an analysis of the first steps in the science of psychosocial care in cancer starting with the work of Arthur M. Sutherland and moving on to more recent psycho‐oncology research, which has shown the centrality of a biopsychosocial approach in cancer integrating cure and care (within the double meaning of the old Latin noun cura). Results Studies of the biopsychosocial approach covering the psychological implications of cancer (e.g., prevalence of emotional distress, application of DSM/ICD classical, and more recent psychiatric classification systems), their psychobiological concomitants (e.g., inflammation and immune dysregulation mechanisms in depression and chronobiology of stress and cancer), and interpersonal issues (e.g., doctor–patient communication and role of neuron mirror system) are discussed. Conclusions Psychosocial oncology avoids the distinction between curing and caring and includes science and compassion in a whole approach to the multidimensionality of the human being in balancing evidence‐based with person‐centered/narrative‐based oncology (values‐based oncology). Copyright © 2013 John Wiley & Sons, Ltd.

  July 03, 2013   doi: 10.1002/pon.3333   open full text
• Adjustment and social support at work early after breast cancer surgery and its associations with sickness absence.
  Marie I. Nilsson, Lena‐Marie Petersson, Agneta Wennman‐Larsen, Mariann Olsson, Marjan Vaez, Kristina Alexanderson.
  Psycho-Oncology. July 03, 2013
  Introduction As half of the women with breast cancer are of working ages and usually survive, knowledge is needed on how to support them early regarding work‐related problems caused by treatments. Most previous studies have focused on individual and disease‐related factors, whereas few have focused on work‐related factors such as work adjustment and social support. The aim of this study was to investigate received and perceived social support from supervisor and colleagues as well as work adjustments, and their associations with sickness absence, among women who recently had had breast cancer surgery. Method Inclusion criteria were as follows: women aged 20–63 years, living in Stockholm County, treated surgically for a first diagnosis of breast cancer, literate in Swedish, without pre‐surgical chemotherapy or known distant metastases. Included in the study were 605 women who worked at diagnosis and that had answered a questionnaire within eight weeks of inclusion. Descriptive statistics, univariate, and multivariable logistic regression analyses were applied to estimate odds ratios (OR) with 95% confidence intervals (CI) for the likelihood of being sickness absent. Results Most women perceived and received social support and work adjustment after breast cancer surgery. Low adjustment (OR = 2.14; 95% CI, 1.45–3.18) and less social support (OR = 1.80; 95% CI, 1.16–2.78) were significantly associated with being sickness absent. Adjusting for sociodemographics, strenuous work posture, and treatment did not attenuate these associations. Conclusion Adjustment at work and social support from employer are associated with sickness absence and needs to be explored in discussions on return to work after breast cancer surgery. Copyright © 2013 John Wiley & Sons, Ltd.

  July 03, 2013   doi: 10.1002/pon.3341   open full text
• Higher emotional distress in female partners of cancer patients: prevalence and patient–partner interdependencies in a 3‐year cohort.
  Michael T. Moser, Alfred Künzler, Fridtjof Nussbeck, Mario Bargetzi, Hans J. Znoj.
  Psycho-Oncology. July 03, 2013
  Objective Assessment and treatment of psychological distress in cancer patients was recognized as a major challenge. The role of spouses, caregivers, and significant others became of salient importance not only because of their supportive functions but also in respect to their own burden. The purpose of this study was to assess the amount of distress in a mixed sample of cancer patients and their partners and to explore the dyadic interdependence. Methods An initial sample of 154 dyads was recruited, and distress questionnaires (Hospital Anxiety and Depression Scale, Symptom Checklist 9‐Item Short Version and 12‐Item Short Form Health Survey) were assessed over four time points. Linear mixed models and actor–partner interdependence models were applied. Results A significant proportion of patients and their partners (up to 40%) reported high levels of anxiety, depression, psychological distress, and low quality of life over the course of the investigation. Mixed model analyses revealed that higher risks for clinical relevant anxiety and depression in couples exist for female patients and especially for female partners. Although psychological strain decreased over time, the risk for elevated distress in female partners remained. Modeling patient–partner interdependence over time stratified by patients' gender revealed specific effects: a moderate correlation between distress in patients and partners, and a transmission of distress from male patients to their female partners. Conclusions Our findings provide empirical support for gender‐specific transmission of distress in dyads coping with cancer. This should be considered as an important starting point for planning systemic psycho‐oncological interventions and conceptualizing further research. Copyright © 2013 John Wiley & Sons, Ltd.

  July 03, 2013   doi: 10.1002/pon.3331   open full text
• Psychosocial screening effects on health‐related outcomes in patients receiving radiotherapy. A cluster randomised controlled trial.
  Anna P. B. M. Braeken, Gertrudis I. J. M. Kempen, Daniëlle B. P Eekers, Ruud M. A. Houben, Francis C. J. M. Gils, Ton Ambergen, Lilian Lechner.
  Psycho-Oncology. July 03, 2013
  Objective This study examined the short‐term and long‐term effects of using a screening instrument on psychological distress and health‐related quality of life (HRQoL) among cancer patients receiving radiotherapy. In addition, we investigated the effect of early psychosocial treatment on patients' overall health‐related outcomes as previous research showed that patients in the screening condition were referred to a psychosocial caregiver at an earlier stage. Methods A cluster randomised controlled trial with a randomisation at the levels of 14 radiotherapists, 568 patients was conducted. Patients were asked to complete questionnaires at 3 and 12 months follow‐up. Results Mixed models analyses showed no significant intervention effects on patients' overall extent of psychosocial distress and HRQoL, both on the short and long terms. Post‐hoc analyses revealed significant interactions of the intervention with early referral and improved HRQoL and anxiety, suggesting that earlier referral might influence short‐term HRQoL and experienced anxiety in patients. Conclusions Our results suggest that the use of a psychosocial screening instrument among patients receiving radiotherapy in itself does not sufficiently improve patients' health‐related outcome. The effective delivery of psychosocial care depends upon several components such as identification of distress and successful implementation of screening procedures. One of the challenges is to get insight in the effects of early referral of cancer patients for psychosocial support because early referral might have a favourable effect on some of the patients' health‐related outcomes. Copyright © 2013 John Wiley & Sons, Ltd.

  July 03, 2013   doi: 10.1002/pon.3340   open full text
• The prevalence and correlates of supportive care needs in testicular cancer survivors: a cross‐sectional study.
  Allan ‘Ben’ Smith, Madeleine King, Phyllis Butow, Tim Luckett, Peter Grimison, Guy C. Toner, Martin Stockler, Elizabeth Hovey, John Stubbs, George Hruby, Howard Gurney, Sandra Turner, Mahmood Alam, Keith Cox, Ian Olver.
  Psycho-Oncology. July 03, 2013
  Objective This cross‐sectional study aimed to identify the prevalence and correlates of supportive care needs in testicular cancer (TC) survivors. Methods Men who had completed active anti‐cancer treatment for TC between 6 months and 5 years previously showing no evidence of recurrence were recruited from 14 Australian cancer centers (September 2009–February 2011). Participants completed a self‐report questionnaire measuring sociodemographics, disease, and treatment information, supportive care needs (CaSUN), psychological distress (DASS21) and health‐related quality of life (HRQoL; SF36v2). Results Of the 486 eligible TC survivors invited to participate, 244 completed the questionnaire. Sixty‐six percent reported one or more unmet supportive care needs. The mean number of unmet needs was 4.73 (SD = 7.0, Range = 0–34). The most common unmet needs related primarily to existential survivorship issues (e.g., life stress) and relationships (e.g., sex life). Younger age and presence of chronic illness other than TC were significantly associated with higher number of unmet needs. The number of unmet needs was more highly correlated with psychological distress and HRQoL than unmet need strength. Conclusions The majority of TC survivors reported one or more unmet needs. Unmet needs regarding existential survivorship issues were frequently reported by TC survivors despite their favorable prognosis. Relationships unmet needs were less prevalent but still more common than in breast and gynecological cancer survivors. These findings appear to be related to the young age of TC survivors. As a higher number of unmet needs is significantly associated with psychological morbidity and impaired HRQoL, interventions addressing this constellation of issues are needed. Copyright © 2013 John Wiley & Sons, Ltd.

  July 03, 2013   doi: 10.1002/pon.3323   open full text
• ‘I know they are distressed. What do I do now?’.
  Stirling Moorey.
  Psycho-Oncology. July 01, 2013
  Significant advances have been made in our understanding of psychological adjustment to cancer over the last 40 years. Most clinicians now recognise the importance of psychosocial factors and the need for skills in emotional support. In the first phase of psycho‐oncology, pioneering work in the 1970s and 1980s mapped the extent of psychological morbidity in cancer. This has been followed by a second phase where clinical trials have demonstrated that psychological treatments are effective. But although clinicians may feel more confident in identifying distress and listening to the patient, they rarely feel confident that they possess the skills to help. This paper will review the progress through the first two phases and argue that we are now in the third phase where we can begin to examine methods for delivering cost‐effective psychological care. One of these methods is to equip staff with basic skills to understand and manage psychological distress. This paper will also describe a programme over the last 10 years to evaluate the effectiveness and clinical impact of such training for palliative care professionals. Copyright © 2013 John Wiley & Sons, Ltd.

  July 01, 2013   doi: 10.1002/pon.3297   open full text
• Adjuvant chemotherapy in elderly women with breast cancer: patients' perspectives on information giving and decision making.
  Helena Harder, Rachel Ballinger, Carolyn Langridge, Alistair Ring, Lesley J. Fallowfield.
  Psycho-Oncology. June 27, 2013
  Background Decisions about adjuvant chemotherapy in older women with early stage breast cancer (EBC) are often challenging. Uncertainty about benefits due to limited data about treatment efficacy and outcomes complicates decision making. This qualitative study explored older patients' experiences and preferences towards information giving and ultimate decisions about adjuvant chemotherapy. Methods Clinicians from 24 UK breast cancer teams reported on adjuvant chemotherapy decisions for women aged ≥70 years with EBC from April 2010 to December 2011. Women who were offered chemotherapy were invited to participate in structured interviews. Self‐reported quality of life (QoL) and functional ability were assessed. Qualitative methods were used to identify themes associated with information giving and decision making. Results A total of 58/95 eligible women (61%) participated. Median age was 73 years (range 70–83). Mean total scores for QoL and functional ability were average. The majority of women preferred to make their treatment decisions collaboratively with a clinician (59%) or on their own (19%). The main reasons influencing decisions to accept chemotherapy were categorised as prevention of recurrence and clinician recommendation. Side effects, length of treatment, impact on QoL, low survival benefits and clinician recommendation influenced decisions to decline chemotherapy. The majority (80%) were satisfied with information provision, the communication with their clinician and explanation of treatment. Conclusions Older women with EBC preferred to be involved in clinical decision making. Clinician recommendation plays a significant role in either accepting or declining chemotherapy. Well‐informed decision making and effective communication between clinicians, older women and their family members are therefore important. Copyright © 2013 John Wiley & Sons, Ltd.

  June 27, 2013   doi: 10.1002/pon.3338   open full text
• Do we get it right? Radiation oncology outpatients' perceptions of the patient centredness of life expectancy disclosure.
  Lisa J. Mackenzie, Mariko L. Carey, Chris L. Paul, Rob W. Sanson‐Fisher, Catherine A. D'Este.
  Psycho-Oncology. June 26, 2013
  Objective A patient‐centred approach to discussing life expectancy with cancer patients is recommended in Western countries. However, this approach to eliciting and meeting patient preferences can be challenging for clinicians. The aims of this study were the following: (i) to examine cancer patients' preferences for life expectancy disclosure; and (ii) to explore agreement between cancer patients’ preferences for, and perceived experiences of, life expectancy disclosure. Methods Cancer patients undergoing radiotherapy treatment in metropolitan Australia completed a cross‐sectional touchscreen computer survey including optional questions about their life expectancy disclosure preferences and experiences. Results Of the 208 respondents, 178 (86%) indicated that they would prefer their clinician to ask them before discussing life expectancy, and 30 (14%) indicated that they would prefer others (i.e. clinicians, family) to decide whether they were given life expectancy information. Of the 175 respondents who were classified as having a self‐ determined or other‐determined disclosure experience, 105 (60%) reported an experience of life expectancy disclosure that was in accordance with their preferences. Cohen's κ was −0.04 (95% CI, −0.17, 0.08), indicating very poor agreement between patients' preferences for and perceived experiences of life expectancy disclosure (p = 0.74). Conclusions In light of patient‐centred prognosis disclosure guidelines, our findings of a majority preference for, and experience of, a self‐determined approach to life expectancy disclosure amongst radiation oncology patients are encouraging. However, poor agreement between preferences and experiences highlights that additional effort from clinicians is required in order to achieve a truly patient‐centred approach to life expectancy disclosure. Copyright © 2013 John Wiley & Sons, Ltd.

  June 26, 2013   doi: 10.1002/pon.3337   open full text
• A qualitative study of women's experiences of familial ovarian cancer screening.
  Kate J. Lifford, Alison Clements, Lindsay Fraser, Deborah Lancastle, Kate Brain,.
  Psycho-Oncology. June 26, 2013
  Objective One risk management strategy that women at increased familial risk of ovarian cancer may use is screening. Until recently, this has been available as part of the UK Familial Ovarian Cancer Screening Study (UKFOCSS), using ultrasound scans of the ovaries and tumour marker blood tests. The present study aimed to gain an in‐depth understanding of women's experiences of participating in ovarian cancer screening. Methods Semi‐structured interviews were conducted with 48 UKFOCSS participants. Interviews were recorded, transcribed and relevant sections analysed using a framework approach. Results Screening provided women with reassurance which they found beneficial. A sense of privilege, as well as feeling proactive in potentially detecting ovarian cancer at an early stage was described. The wider benefit to research and the potential impact this could have on others was also important to women. Negative experiences of screening included worry about the screening tests and results, false reassurance by test results and disappointment with ineffective screening. Aspects of the screening study, such as the logistics, organisation and communication, were described as both good and problematic. When weighed up by the women, most described an overall positive experience of screening. Conclusions Women reported both positive and negative experiences of screening. Overall, screening seemed to be an acceptable risk management strategy to most women who participated in this interview study. Improvements could be made particularly in helping women to understand the limitations of familial ovarian cancer screening in order to avoid false reassurance. Copyright © 2013 John Wiley & Sons, Ltd.

  June 26, 2013   doi: 10.1002/pon.3324   open full text
• Young people describe their prediagnosis cancer experience.
  Faith Gibson, Susie Pearce, Tim Eden, Adam Glaser, Louise Hooker, Jeremy Whelan, Daniel Kelly.
  Psycho-Oncology. June 20, 2013
  Objective Young people often report a protracted journey to diagnosis and frequently report perceived delays. This study was undertaken to increase understanding of the self‐reported prediagnosis experiences in young people with a non‐haematological cancer, as close as possible to the time of diagnosis. Methods Narrative interviews were conducted with 24 young people aged 16–24, 2–4 months from the diagnosis of a solid tumour. Data were analysed to identify whether prediagnosis narratives could be classified according to shared characteristics (typologies) to identify broader contextual issues concerning cancer, and cancer risk perceptions, in this age group. Case notes were also accessed to contextualize and confirm accounts. Results The main themes, which included a group narrative concerning perspectives of delay, included the impact on an individual's everyday life by symptoms; the role that significant others in young peoples' lives played in the interpretation of symptom significance; the negotiation of entry into, and experiences of, generalist health care; entry into specialist care; and the threshold points that exemplified when events shifted and a diagnosis was eventually obtained. Conclusions The narratives reveal complex, and multidimensional explanations for delay with individual and contextual factors contributing. Insights were gained into preventable diagnostic delay; including investigations having been instigated, but not followed up. Each narrative also offered significant insights into how cancer symptoms should be considered within the context of young peoples' lives. This would help prevent signs and symptoms in this age group failing to trigger suspicion and not being treated seriously. Copyright © 2013 John Wiley & Sons, Ltd.

  June 20, 2013   doi: 10.1002/pon.3325   open full text
• Association between cancer stigma and depression among cancer survivors: a nationwide survey in Korea.
  Juhee Cho, Eun‐kyung Choi, So Young Kim, Dong Wook Shin, Be‐Long Cho, Chang‐hoon Kim, Dai Ha Koh, Eliseo Guallar, Wayne A. Bardwell, Jong Hyock Park.
  Psycho-Oncology. June 20, 2013
  Objective Cancer patients are more likely to experience depression than the general population. This study aims to evaluate the possible association between cancer stigma and depression among cancer patients. Methods As a part of the Korean government's program to develop comprehensive supportive care, we conducted a nationwide survey in 2010 at the National Cancer Center and in nine regional cancer centers across Korea. Cancer stigma was assessed by using a set of 12 questions grouped in three domains—impossibility of recovery, stereotypes of cancer patients, and experience of social discrimination. Depression was measured by using the Hospital Anxiety and Depression Scale. Results A total of 466 cancer patients were included in the study. Over 30% of the cancer survivors had negative attitudes toward cancer and held stereotypical views of themselves: about 10% of the participants experienced social discrimination due to cancer, and 24.5% reported clinically significant depressive symptoms. Patients who had or experienced cancer stigma were 2.5 times more likely to have depression than patients with positive attitudes. Conclusions Regardless of highly developed medical science and increased survivorship, cancer survivors had cancer stigmas, and it was significantly associated with depression. Impact Our findings emphasize the need for medical societies and health professionals to pay more attention to cancer stigma that patients are likely to experience during treatment. Copyright © 2013 John Wiley & Sons, Ltd.

  June 20, 2013   doi: 10.1002/pon.3302   open full text
• Risk behaviors and externalizing behaviors in adolescents dealing with parental cancer—a controlled longitudinal study.
  Vanessa Jantzer, Juliane Groß, Fridrike Stute, Peter Parzer, Romuald Brunner, Katrin Willig, Bärbel Schuller‐Roma, Monika Keller, Wolfgang Herzog, Georg Romer, Franz Resch.
  Psycho-Oncology. June 20, 2013
  Objective The results of studies concerning levels of internalizing and externalizing behaviors in adolescent children with a parent suffering from cancer as compared with control groups or normative data are contradictory so far. Longitudinal designs using control groups are rare. No study explicitly exploring a broad range of risk behaviors in adolescent children with a parent suffering from cancer exists to date. Methods Therefore, 74 adolescents who have a parent with cancer (index group) were compared with 75 adolescents with healthy parents (control group) concerning several juvenile risk behaviors and externalizing behaviors. Participants were examined three times over the course of 12 months. Results No significant main effects for group or interactional effects of group with time could be found for any of the measured variables. Conclusions Results suggest that the somatic illness of the parent is not a developmental risk that is expressed in increased levels of juvenile risk behavior. Adolescents with a parent suffering from cancer adjusted generally quite well to the parental illness, although some individuals did show signs of severe strain. Copyright © 2013 John Wiley & Sons, Ltd.

  June 20, 2013   doi: 10.1002/pon.3327   open full text
• Patients' and family members' views on patient‐centered communication during cancer care.
  Kathleen M. Mazor, Reneé L. Beard, Gwen L. Alexander, Neeraj K. Arora, Cassandra Firneno, Bridget Gaglio, Sarah M. Greene, Celeste A. Lemay, Brandi E. Robinson, Douglas W. Roblin, Kathleen Walsh, Richard L. Street, Thomas H. Gallagher.
  Psycho-Oncology. June 18, 2013
  Objectives To explore patients' and family members' views on communication during cancer care and to identify those aspects of clinician–patient communication which were most important to patients and family members. Methods We conducted a secondary data analysis of qualitative data from 137 patients with cancer and family members of patients with cancer. We used a modified version of the constant comparative method and coding paradigm of grounded theory. Results Patients want sensitive, caring clinicians who provide information that they need, when they need it, in a way that they can understand; who listen and respond to questions and concerns, and who attempt to understand the patient's experience. Effective information exchange and a positive interpersonal relationship with the clinician were of fundamental importance to patients and family members. These were interrelated; for instance, failure to provide information a patient needed could damage the relationship, whereas excellent listening could foster the relationship. Information exchange and relationship were also integral to decision‐making, managing uncertainty, responding to emotions, and self‐management. Clinicians who were responsive to patients' needs beyond the immediate medical encounter were valued. Conclusions The complexity of cancer care today suggests that efforts to improve communication must be multilevel, acknowledging and addressing patient, clinician, organizational and policy barriers, and facilitators. Measurement tools are needed to assess cancer patients' and family members' experiences with communication over the course of cancer care to provide meaningful, actionable feedback to those seeking to optimize their effectiveness in communicating with patients with cancer. Copyright © 2013 John Wiley & Sons, Ltd.

  June 18, 2013   doi: 10.1002/pon.3317   open full text
• Spiritual beliefs near the end of life: a prospective cohort study of people with cancer receiving palliative care.
  Michael King, Henry Llewellyn, Baptiste Leurent, Faye Owen, Gerard Leavey, Adrian Tookman, Louise Jones.
  Psycho-Oncology. June 17, 2013
  Objectives Despite growing research interest in spirituality and health, and recommendations on the importance of spiritual care in advanced cancer and palliative care, relationships between spiritual belief and psychological health near death remain unclear. We investigated (i) relationships between strength of spiritual beliefs and anxiety and depression, intake of psychotropic/analgesic medications and survival in patients with advanced disease; and (ii) whether the strength of spiritual belief changes as death approaches. Methods We conducted a prospective cohort study of 170 patients receiving palliative care at home, 97% of whom had a diagnosis of advanced cancer. Data on strength of spiritual beliefs (Beliefs and Values Scale [BVS]), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), psychotropic/analgesic medications, daily functioning, global health and social support were collected at recruitment then 3 and 10 weeks later. Mortality data were collected up to 34 months after the first patient was recruited. Results Regression analysis showed a slight increase in strength of spiritual belief over time approaching statistical significance (+0.16 BVS points per week, 95% CI [−0.01, 0.33], p = 0.073). Belief was unrelated to anxiety and depression (−0.15 points decrease in HADS for 10 points increased in BVS (95% CI [−0.57, 0.27], p = 0.49) or consumption of psychotropic medication). There was a non‐significant trend for decreasing analgesic prescription with increasing belief. Mortality was higher over 6 months in participants with lower belief at recruitment. Conclusion Results suggest that although religious and spiritual beliefs might increase marginally as death approaches, they do not affect levels of anxiety or depression in patients with advanced cancer. © 2013 The Authors. Psycho‐Oncology published by John Wiley & Sons, Ltd.

  June 17, 2013   doi: 10.1002/pon.3313   open full text
• Impact of family‐oriented rehabilitation and prevention: an inpatient program for mothers with breast cancer and their children.
  Katja John, Katja Becker, Fritz Mattejat.
  Psycho-Oncology. June 13, 2013
  Objective This pilot intervention study assessed the impact of a 3‐week inpatient program for mothers with primary breast cancer and their children. The program combined rehabilitative treatment and preventive, psychosocial, child‐centered interventions. Methods A total of 116 mothers (age 29–57 years, mean = 41.1) with primary, non‐metastasized breast cancer completed standardized questionnaires before (Pre1), at the beginning of (Pre2), and at the end of (Post) a 3‐week inpatient intervention. The standardized scales included mothers' and children's quality of life and children's psychological symptoms. Mothers' emotional functioning and their 116 children's (age 3–14 years, mean = 7.4; 47% female) psychological health and emotional symptoms were defined as primary outcome measures. A within‐subject‐control‐group design was used to compare changes before the intervention (measurements Pre1–Pre2) to changes during the intervention (measurements Pre2–Post) via dependent one‐sided t‐tests. Additional exploratory analyses for further outcome variables were performed. Results Changes during the intervention period were significantly greater than changes during the waiting period for all primary outcome measures (mothers' emotional functioning: p < 0.0001; children's psychological health: p = 0.0035; and children's emotional symptoms: p = 0.0005). Conclusions Data suggest that the family‐oriented intervention ‘getting well together’ seems to be beneficial to mothers' and children's quality of life and psychological well‐being. Combining oncological rehabilitation and preventive child‐centered interventions might be a feasible approach to supporting breast cancer patients and their children and improving their emotional state. Further research is warranted. Copyright © 2013 John Wiley & Sons, Ltd.

  June 13, 2013   doi: 10.1002/pon.3329   open full text
• Trajectories of caregiver depressive symptoms while providing end‐of‐life care.
  Siew Tzuh Tang, Guan‐Hua Huang, Yu‐Chung Wei, Wen‐Cheng Chang, Jen‐Shi Chen, Wen‐Chi Chou.
  Psycho-Oncology. June 13, 2013
  Objective The course of caregivers' depressive symptoms may not be homogenous. This study identified trajectories of depressive symptoms among caregivers providing end‐of‐life care to cancer patients and profiled the unique characteristics of caregivers within each trajectory. Methods Trajectories of depressive symptoms were explored in 447 caregivers who completed the Center for Epidemiological Studies Depression Scale over four periods close to the patient's death (1–30, 31–90, 91–180, and >180 days). Distinct trajectories were identified by latent class analysis. Results Four trajectories were identified as endurance, resilience, moderately symptomatic, and chronically distressed and contained 32.0%, 11.4%, 36.9%, and 19.7% of the sample, respectively. Caregivers in the endurance trajectory were relatively well‐adjusted individuals with less education, adequate financial support, and ample psychological resources but provided care to older patients with greater symptom distress. They perceived less subjective caregiving burden than caregivers with moderate or chronic depressive symptoms. Caregivers in the resilience trajectory were in a more vulnerable position than those in other trajectories when they first transitioned into the caregiving role because they were more likely to be the patient's spouse, have greater educational attainment and insufficient finances, provide higher intensity assistance to a younger relative, and have weaker psychological resources. However, they were older, reported greater confidence in caregiving, and perceived less caregiving burden than caregivers in other trajectories. The moderately symptomatic and chronically distressed trajectories were differentiated only by the strength of psychological resources. Conclusions Caregivers of terminally ill cancer patients follow distinct depressive‐symptom trajectories while providing end‐of‐life care. Copyright © 2013 John Wiley & Sons, Ltd.

  June 13, 2013   doi: 10.1002/pon.3334   open full text
• Young breast cancer patients' involvement in treatment decisions: the major role played by decision‐making about surgery.
  Valérie Seror, Sébastien Cortaredona, Anne‐Deborah Bouhnik, Mégane Meresse, Camille Cluze, Patrice Viens, Dominique Rey, Patrick Peretti‐Watel.
  Psycho-Oncology. June 07, 2013
  Objective The objective of this study is to investigate young breast cancer patients' preferred and actual involvement in decision‐making about surgery, chemotherapy, and adjuvant endocrine therapy (AET). Methods A total of 442 women aged 18–40 years at the time of the diagnosis participated in the region‐wide ELIPPSE40 cohort study (southeastern France). Logistic regression analyses were performed on various factors possibly affecting patients' preferred and perceived involvement in the decisions about their cancer treatment. Results The women's mean age was 36.8 years at enrolment. Preference for a fully passive role in decision‐making was stated by 20.7% of them. It was favored by regular breast surveillance (p = 0.04) and positive experience of being informed about cancer diagnosis (p = 0.02). Patients' preferences were independently associated with their reported involvement in decision‐making about surgery (p = 0.01). A fully passive role in decision‐making about chemotherapy and AET was more likely to be reported by patients who perceived their involvement in decision‐making about surgery as having been fully passive (adjusted odds ratio = 4.8, CI95% [2.7–8.7], and adjusted odds ratio = 9.8, CI95% [3.3–29.2], respectively). This study shows a significant relationship between the use of antidepressants and involvement in decision‐making about surgery, and confirms the relationship between impaired quality of life (in the psychological domain) and a fully passive role in decisions about cancer treatment. Conclusions Patients' involvement in decision‐making about chemotherapy and AET was strongly influenced by their experience of decision‐making about surgery, regardless of their tumor stage and history of breast or ovarian cancer. When decisions are being made about surgery, special attention should be paid to facilitating breast cancer patients' involvement in the decision‐making. Copyright © 2013 John Wiley & Sons, Ltd.

  June 07, 2013   doi: 10.1002/pon.3316   open full text
• Factors associated with adherence to physical activity guidelines in patients with prostate cancer.
  Kelly Chipperfield, Jane Fletcher, Jeremy Millar, Joanne Brooker, Robin Smith, Mark Frydenberg, Tracy Oh, Sue Burney.
  Psycho-Oncology. June 07, 2013
  Objective This study aimed to estimate the proportion of patients with prostate cancer (PCa) meeting the National Physical Activity Guidelines of Australia (NPAGA) and determine sociodemographic and medical factors associated with meeting these guidelines. Secondary aims included examining physical activity (PA) levels by treatment type and domain (leisure, work, transport and domestic) and establishing a predictive model of the likelihood that men with PCa would meet NPAGA. Methods A questionnaire was mailed to 638 men with PCa attending for treatment at the Alfred, Cabrini or Latrobe Regional Hospitals during 2010 and 2011, with a response rate of 59%. Measures included International Physical Activity Questionnaire, Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy – Prostate and sociodemographic items. Inclusion criteria were English speaking men aged 40 to 80 years, who had undergone radiotherapy (RT) between 9 and 30 months prior to the survey. Results Of 356 men with PCa, less than half were meeting NPAGA (41.9%). Lower education and quality of life (QoL), a higher number of comorbid conditions and symptoms of depression and anxiety were associated with decreased leisure‐time PA. Patients treated with androgen deprivation therapy were significantly less active than patients treated with RT only. Logistic regression analyses indicated that the likelihood of meeting NPAGA was significantly lower with higher levels of depressive symptoms and lower levels of education. Conclusions Meeting NPAGA is associated with higher QoL and psychosocial well‐being in men with PCa. These findings contribute important information for targeting PA interventions to PCa survivors. Copyright © 2013 John Wiley & Sons, Ltd.

  June 07, 2013   doi: 10.1002/pon.3310   open full text
• Spiritual well‐being in long‐term colorectal cancer survivors with ostomies.
  Joanna Bulkley, Carmit K. McMullen, Mark C. Hornbrook, Marcia Grant, Andrea Altschuler, Christopher S. Wendel, Robert S. Krouse.
  Psycho-Oncology. June 07, 2013
  Objective Spiritual well‐being (SpWB) is integral to health‐related quality of life. The challenges of colorectal cancer (CRC) and subsequent bodily changes can affect SpWB. We analyzed the SpWB of CRC survivors with ostomies. Methods Two‐hundred‐eighty‐three long‐term (≥5 years) CRC survivors with permanent ostomies completed the modified City of Hope Quality of Life‐Ostomy (mCOH‐QOL‐O) questionnaire. An open‐ended question elicited respondents' greatest challenge in living with an ostomy. We used content analysis to identify SpWB responses and develop themes. We analyzed responses on the three‐item SpWB sub‐scale. Results Open‐ended responses from 52% of participants contained SpWB content. Fifteen unique SpWB themes were identified. Sixty percent of individuals expressed positive themes such as “positive attitude”, “I am fortunate”, “appreciate life more”, and “strength through religious faith”. Negative themes, expressed by only 29% of respondents, included “struggling to cope”, “not feeling ‘normal’ ”, and “loss”. Fifty‐five percent of respondents expressed ambivalent themes including “learning acceptance”, “an ostomy is the price for survival”, “reason to be around despite suffering”, and “continuing to cope despite challenges”. The majority (64%) had a high SpWB sub‐scale score. Conclusions Although CRC survivors with ostomies infrequently mentioned negative SpWB themes as a major challenge, ambivalent themes were common. SpWB themes were often mentioned as a source of resilience or part of the struggle to adapt to an altered body after cancer surgery. Interventions to improve the quality of life of cancer survivors should contain program elements designed to address SpWB that support personal meaning, inner peace, inter connectedness, and belonging. Copyright © 2013 John Wiley & Sons, Ltd.

  June 07, 2013   doi: 10.1002/pon.3318   open full text
• Trajectory of parental hope when a child has difficult‐to‐treat cancer: a prospective qualitative study.
  L. Granek, M. Barrera, J. Shaheed, D. Nicholas, L. Beaune, N. D'Agostino, E. Bouffet, B. Antle.
  Psycho-Oncology. June 05, 2013
  Objective This prospective and longitudinal study was designed to further our understanding of parental hope when a child is being treated for a malignancy resistant to treatment over three time points during the first year after diagnosis using a qualitative approach to inquiry. Methods We prospectively recruited parents of pediatric cancer patients with a poor prognosis who were treated in the Hematology/Oncology Program at a large children's hospital for this longitudinal grounded theory study. Parents were interviewed at three time points: within 3 months of the initial diagnosis, at 6 months, and at 9 months. Data collection and analysis took place concurrently using line‐by‐line coding. Constant comparison was used to examine relationships within and across codes and categories. Results Two overarching categories defining hope as a positive inner source were found across time, but their frequency varied depending on how well the child was doing and disease progression: future‐oriented hope and present‐oriented hope. Under future‐oriented hope, we identified the following: hope for a cure and treatment success, hope for the child's future, hope for a miracle, and hope for more quality time with child. Under present‐oriented hope, we identified hope for day‐to‐day/moment‐to‐moment, hope for no pain and suffering, and hope for no complications. Conclusions For parents of children with a diagnosis of cancer with a poor prognosis, hope is an internal resource that can be present and future focused. These views fluctuated over time in response to changes in the child's well‐being and disease progression. Copyright © 2013 John Wiley & Sons, Ltd.

  June 05, 2013   doi: 10.1002/pon.3305   open full text
• A tailored, supportive care intervention using systematic assessment designed for people with inoperable lung cancer: a randomised controlled trial.
  Penelope Schofield, Anna Ugalde, Karla Gough, John Reece, Meinir Krishnasamy, Mariko Carey, David Ball, Sanchia Aranda.
  Psycho-Oncology. June 04, 2013
  Objective People with inoperable lung cancer experience higher levels of distress, more unmet needs and symptoms than other cancer patients. There is an urgent need to test innovative approaches to improve psychosocial and symptom outcomes in this group. This study tested the hypothesis that a tailored, multidisciplinary supportive care programme based on systematic needs assessment would reduce perceived unmet needs and distress and improve quality of life. Methods A randomised controlled trial design was used. The tailored intervention comprised two sessions at treatment commencement and completion. Sessions included a self‐completed needs assessment, active listening, self‐care education and communication of unmet psychosocial and symptom needs to the multidisciplinary team for management and referral. Outcomes were assessed with the Needs Assessment for Advanced Lung Cancer Patients, Hospital Anxiety and Depression Scale, Distress Thermometer and European Organization of Research and Treatment of Cancer Quality of Life Q‐C30 V2.0. Results One hundred and eight patients with a diagnosis of inoperable lung or pleural cancer (including mesothelioma) were recruited from a specialist facility before the trial closed prematurely (original target 200). None of the primary contrasts of interest were significant (all p > 0.10), although change score analysis indicated a relative benefit from the intervention for unmet symptom needs at 8 and 12 weeks post‐assessment (effect size = 0.55 and 0.40, respectively). Conclusion Although a novel approach, the hypothesis that the intervention would benefit perceived unmet needs, psychological morbidity, distress and health‐related quality of life was not supported overall. Copyright © 2013 John Wiley & Sons, Ltd.

  June 04, 2013   doi: 10.1002/pon.3306   open full text
• Effectiveness of an integrated adventure‐based training and health education program in promoting regular physical activity among childhood cancer survivors.
  H. C. William Li, Oi Kwan Joyce Chung, Ka Yan Ho, Sau Ying Chiu, Violeta Lopez.
  Psycho-Oncology. June 04, 2013
  Background There is growing concern about declining levels of physical activity in childhood cancer survivors. This study aimed to examine the effectiveness of an integrated adventure‐based training and health education program in promoting changes in exercise behavior and enhancing the physical activity levels, self‐efficacy, and quality of life of Hong Kong Chinese childhood cancer survivors. Methods A randomized controlled trial, two‐group pretest and repeated post‐test, between‐subjects design was conducted to 71 childhood cancer survivors (9‐ to 16‐year‐olds). Participants in the experimental group joined a 4‐day integrated adventure‐based training and health education program. Control group participants received the same amount of time and attention as the experimental group but not in such a way as to have any specific effect on the outcome measures. Participants' exercise behavior changes, levels of physical activity, self‐efficacy, and quality of life were assessed at the time of recruitment, 3, 6, and 9 months after starting the intervention. Results Participants in the experimental group reported statistically significant differences in physical activity stages of change (p < 0.001), higher levels of physical activity (p < 0.001) and self‐efficacy (p = 0.04) than those in the control group. Besides, there were statistically significant mean differences (p < 0.001) in physical activity levels (−2.6), self‐efficacy (−2.0), and quality of life (−4.3) of participants in the experimental group from baseline to 9 months after starting the intervention. Conclusions The integrated adventure‐based training and health education program was found to be effective in promoting regular physical activity among childhood cancer survivors. Copyright © 2013 John Wiley & Sons, Ltd.

  June 04, 2013   doi: 10.1002/pon.3326   open full text
• Determinants of patient satisfaction with care in a Spanish oncology Day Hospital and its relationship with quality of life.
  Juan Ignacio Arraras, Jose Juan Illarramendi, Antonio Viudez, Berta Ibáñez, Maria Jose Lecumberri, Susana Cruz, Berta Hernandez, Uxue Zarandona, Koldo Cambra, Maite Martinez, Esteban Salgado, Nuria Lainez, Ruth Vera.
  Psycho-Oncology. June 04, 2013
  Objective This study evaluates satisfaction with care (SC) in cancer patients treated at a Spanish day hospital to identify SC determinants and assess the relationship between SC and quality of life. Methods One hundred seventy‐six patients with different tumour sites and disease stages completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ‐C30), the Cancer Outpatient Satisfaction with Care questionnaire for chemotherapy (OUT‐PATSAT35 CT), the Oberst patients' perception of care quality and satisfaction scales, and an item on intention to recommend the hospital. Frequencies in the SC instruments, Spearman correlations between each scale of the OUT‐PATSAT35 CT and overall satisfaction and between the subscales of OUT‐PATSAT35 CT and of QLQ‐C30 were calculated, and the determinants of patients' SC were calculated through multivariate regression models. Results Satisfaction with care was high: mean scores were >70 in all OUT‐PATSAT35 CT areas except doctor availability and environment. These scores were in line with the other SC instruments. Correlation with overall satisfaction was high and statistically significant (p < 0.01) for all subscales, especially for the nurses domain, which also had higher SC scores. Correlations between the EORTC QLQ‐C30 and the OUT‐PATSAT35 CT were low (≤0.35). Younger patients and those with breast cancer showed significantly lower satisfaction in most subscales. Unmarried patients and patients that had undergone surgery reported lower satisfaction only in specific subscales. Conclusions Satisfaction with care among cancer patients treated at the day hospital is high. Nurses play a key and successful role. Age and tumour location revealed stronger relationships with SC. Correlations between SC and quality of life indicate that these concepts are complementary. Copyright © 2013 John Wiley & Sons, Ltd.

  June 04, 2013   doi: 10.1002/pon.3307   open full text
• Concordance of parent proxy report and child self‐report of posttraumatic stress in children with cancer and healthy children: influence of parental posttraumatic stress.
  Ashley H. Clawson, Niki Jurbergs, Jennifer Lindwall, Sean Phipps.
  Psycho-Oncology. May 31, 2013
  Objective This study examined the relationships between parental posttraumatic stress symptoms (PTSS), child PTSS, and parent–child concordance for child PTSS. Method Participants were children with cancer (n = 199), and healthy children (n = 108) and their parents. Children self‐reported on PTSS and parents completed measures of child and parent PTSS. Results In the cancer group, child and parent reports of child PTSS were significantly correlated with no mean differences between reporters. In contrast, correlations were non‐significant in the control group, and parents reported significantly lower levels of child PTSS than children. Increased parental PTSS was associated with better concordance in the cancer group but not in the control group. In fact, in the cancer group, parent–child concordance was strongest at the highest level of parental PTSS. Conclusions Parents of children with cancer were found to be accurate reporters of their children's distress, even with high levels of reported personal distress. In contrast, parents of healthy children appear primarily influenced by personal distress when reporting child PTSS. Although multiple informant assessments are always desirable, it appears that utilization of a single informant may be reasonable in the cancer setting when access to informants is limited. Copyright © 2013 John Wiley & Sons, Ltd.

  May 31, 2013   doi: 10.1002/pon.3321   open full text
• Low socioeconomic status and mental health outcomes in colorectal cancer survivors: disadvantage? advantage? … or both?
  Michael A. Andrykowski, Mieke J. Aarts, Lonneke V. Poll‐Franse, Floortje Mols, Gerrit D. Slooter, Melissa S.Y. Thong.
  Psycho-Oncology. May 28, 2013
  Objective The goal of this study is to examine the relationship between socioeconomic status (SES) and both positive and negative mental health (MH) outcomes in a population‐based sample of colorectal cancer survivors. On the basis of theoretical conceptualizations of trauma and posttraumatic growth, low SES was hypothesized to be positively associated with both greater negative MH outcomes (e.g., distress) and greater positive MH outcomes (e.g., growth). Methods Colorectal cancer survivors (n = 1300; 57% male; mean age 69.4 and 4.0 years post‐diagnosis) were recruited using a regional, population‐based cancer registry in the Netherlands and completed a questionnaire assessing current negative and positive MH outcomes. Low, medium, and high SES respondents were identified using an area‐level indicator of SES based on aggregated individual fiscal data on monetary home value and household income. Results Analysis of covariance and logistic regression analyses indicated that low SES was a risk factor for greater negative MH outcomes. Relative to high SES survivors, low SES survivors reported poorer status on nine indices of MH, and high SES survivors were about 50% less likely to report clinically important levels of anxiety and depression. Results provided partial support for the hypothesis low SES was a ‘risk’ factor for greater positive MH outcomes. Relative to high SES survivors, low SES survivors reported greater positive MH outcomes on 2 of 5 positive MH indices examined (Positive Self‐Evaluation, Meaning of Cancer). Conclusions Study findings are the first to suggest that low SES might increase the likelihood of both greater negative as well as positive MH outcomes in cancer survivors. Copyright © 2013 John Wiley & Sons, Ltd.

  May 28, 2013   doi: 10.1002/pon.3309   open full text
• Assessing cancer patients' quality of life and coping mechanisms in Radiotherapy Department of the University College Hospital, Ibadan.
  Chioma Christie Asuzu, Theresa Nchekube Elumelu.
  Psycho-Oncology. May 28, 2013
  Background Cancer is often associated with a lot of pain and suffering. These suggest that coping with the symptoms, diagnosis and treatment of cancer is a major life stressor that is capable of influencing patients' quality of life (QoL). Purpose The purpose of the study is to assess the relationship between cancer patients' QoL dimensions and coping strategies in the Radiotherapy Department of the University College Hospital Ibadan, Nigeria. Methods Data were collected on clinic days from all available and consenting cancer patients who were receiving treatment at the radiotherapy department. Participants were informed of their right to decline to fill the questionnaires. Result In this study, 237 cancer patients participated. They had an age range of 15 to 95 years with a mean age of 49.91 years. There was significant inverse relationship between physical well‐being with behavioural disengagement, venting, planning and self‐blame (p < 0.05); social/family well‐being has significant linear relationship with active coping, emotional support, positive reframing, instrumental support, acceptance and religion (p < 0.05); emotional well‐being has significant inverse relationship with behavioural disengagement and self‐blame (p < 0.05); functional well‐being has significant linear relationship with active coping, instrumental support and acceptance (p < 0.05). Conclusion It is important to assess cancer patients for the kind of coping strategies they are adopting to use in coping with their cancer burden, thereby guiding against lower QoL due to negative coping strategies. Intervention programmes could be developed to help cancer patients adopt more positive and effective coping strategies to improve patients' QoL. Copyright © 2013 John Wiley & Sons, Ltd.

  May 28, 2013   doi: 10.1002/pon.3290   open full text
• Diffusion of a Distress Management Guideline into practice.
  Susan S. Tavernier, Susan L. Beck, William N. Dudley.
  Psycho-Oncology. May 27, 2013
  Objective The purpose of this study was to explore system and clinician‐related barriers, and predictors for the adoption of the National Comprehensive Cancer Network Distress Management Guideline (DMG) into oncology outpatient practice. Methods This descriptive, correlational study surveyed a national sample of oncology nurses working in an outpatient setting who completed the survey electronically or by mail. Results Study respondents (n = 409) were predominantly certified nurses (84%) yet largely unfamiliar with the DMG; 17% of respondents were using the DMG. Time, staff uncertainties and ambiguous accountability were the largest barriers to not assessing distress. Compared with those not using any assessment tool, those using the DMG were more comfortable discussing distress, worked as an oncology nurse longer, scored colleagues higher on valuing distress screening and had more organizational processes in place to support evidence‐based practices. Significant predictors of DMG use included higher familiarity with the DMG (OR 3.81, p < .001), lower perceived barriers (OR 0.41, p = .001), non‐profit status (OR 3.93, p = .05) and urban or rural (versus suburban) work settings (OR 04.59, p = .04; overall model chi‐square 133.25, df 12, p < .001, Nagelkerke R2 .67). Conclusions This study identified barriers and predictors to using the DMG, which are amenable to interventions. DMG adoption may be augmented by interventions, which increase familiarity with the guideline. Additionally, adoption of the DMG may improve through explicit articulation of the responsibilities oncology team members have in cancer‐related distress screening and management. Further studies are needed to evaluate the efficacy of such interventions and their impact on patient care outcomes. Copyright © 2013 John Wiley & Sons, Ltd.

  May 27, 2013   doi: 10.1002/pon.3295   open full text
• Prevalence and predictors of cancer specific distress in men with a family history of prostate cancer.
  M. E. McDowell, S. Occhipinti, R. A. Gardiner, S. K. Chambers.
  Psycho-Oncology. May 27, 2013
  Objective To examine prevalence and predictors of cancer‐specific distress in undiagnosed men with and without a family history of prostate cancer, and to examine the contribution of perceptions of an affected relative's cancer experience on the distress of unaffected male relatives. Methods Men with a first degree relative with prostate cancer (n = 207) and men without a family history (n = 239) from Australia completed a Computer Assisted Telephone Interview. Participants completed the Prostate Cancer Anxiety Subscale of the Memorial Anxiety Scale for Prostate Cancer, measures of perceived risk, and socio‐demographic information. Men with a family history provided details about their family history (number of relatives diagnosed with and dead from prostate cancer, relationship to affected relative, months since diagnosis) and reported their perceptions of their affected relative's prostate cancer experience including perceptions of threat related to the relative's diagnosis and perceived treatment phase and prognosis. Results Cancer‐specific distress was low for all men and there was no significant difference in the distress experienced by men with and without a family history. Regression analyses showed that for all men, cancer‐specific distress increased with urinary symptoms and decreased in those with higher education and in older participants. For men with a family history, having a relative who died from prostate cancer and perceiving greater threat from a relative's diagnosis was associated with greater cancer‐specific distress. Conclusions Interventions would benefit from examining appraisals of familial risk and examining prospective assessments of distress in the unaffected male relatives of men with prostate cancer over the course of the cancer trajectory. Copyright © 2013 John Wiley & Sons, Ltd.

  May 27, 2013   doi: 10.1002/pon.3312   open full text
• Anxiety, depression and defense mechanisms associated with treatment decisional preferences and quality of life in non‐metastatic breast cancer: a 1‐year prospective study.
  Thomas Hyphantis, Augoustina Almyroudi, Vassiliki Paika, Lesley F. Degner, André F. Carvalho, Nicholas Pavlidis.
  Psycho-Oncology. May 27, 2013
  Objective Treatment decisional preferences impact breast cancer patients' health‐related quality of life (HRQoL) and may relate to psychological variables, although many aspects of this relationship remain unknown. This prospective study aimed to assess psychological correlates of treatment decisional preferences and predictors of HRQoL in women with early non‐metastatic breast cancer. Methods Of the 124 women initially assessed for anxiety (Spielberger's State–Trait Anxiety Inventory) and depressive (Center for Epidemiologic Studies‐Depression (CES‐D)) symptoms, HRQoL (WHOQOL‐BREF), and defense mechanisms (Life Style Index), 82 (66.1%) completed the 1‐year follow‐up. Mean age was 54.6 years (SD = 9.76), and mean disease duration was 19.4 months (SD = 25.55); 19.5% had stage I, 63.4% stage II and 17.1% stage III disease. The predictive power and moderator effects of psychological variables were tested using multiple and hierarchical regression models. Results Depressive symptoms and physical HRQoL improved significantly, state anxiety and mental and environment HRQoL remained stable, and social relations HRQoL deteriorated over the 1‐year period. Older age (p = 0.021) and higher scores in repression defense (p = 0.044) were independently associated with passive decisional preferences. Earlier stage of cancer (p = 0.043), lower state anxiety (p = 0.039), lower repression scores (p = 0.021) and improvement in depressive symptoms (p < 0.001) predicted physical HRQoL improvement. Moderation analysis showed that active decisional preferences predicted physical HRQoL improvement, but only in those women with lower repression levels. Conclusions Defense mechanisms are associated with treatment decisional preferences and interact with factors predicting HRQoL in women with breast cancer. Clinicians should address the patients' anxiety and depressive symptoms and refer patients with high repression tendencies for psychological evaluation and management. Copyright © 2013 John Wiley & Sons, Ltd.

  May 27, 2013   doi: 10.1002/pon.3308   open full text
• Determinants of hopelessness and depression among Chinese hospitalized esophageal cancer patients and their family caregivers.
  Yanhong Han, Jie Yuan, Zhiguo Luo, Jing Zhao, Junbo Wu, Rongying Liu, Violeta Lopez.
  Psycho-Oncology. May 23, 2013
  Background It has been well documented that the diagnosis of cancer is psychologically devastating to both the patients and caregivers. The incidence and mortality of esophageal cancer were 20.85 and 16.24 per 100,000 persons and the sixth most commonly diagnosed cancer and the fourth main cause of cancer death in China. We surveyed patients–caregivers dyad and examined the determinants of their depression and hopelessness. Results The prevalence of depression among patients and caregivers was 52.8% and 47.2%, and the prevalence for hopelessness was 64.4% and 53.9%, respectively Regression models indicate that the variables measured could explain 58.9% and 51.7% of the variance in depression and 66.8% and 45.7% of the variance in hopelessness among patients and caregivers, respectively. Overall, hopelessness was a determinant of depression and vice versa to both patients and caregivers. Conclusion Esophageal patients' depression and hopelessness could also affect caregivers' depression and hopelessness despite the social support that family caregivers have. Psychosocial interventions should be planned to both Chinese patients and caregivers considering the predictors found in this study. Copyright © 2013 John Wiley & Sons, Ltd.

  May 23, 2013   doi: 10.1002/pon.3315   open full text
• Health‐care providers' perspectives on childhood cancer treatment in Manado, Indonesia.
  S. Mostert, S. Gunawan, J. A. P. Dongen, P. M. Ven, M. N. Sitaresmi, E. E. Wolters, A. J. P. Veerman, M. Mantik, G. J. L. Kaspers.
  Psycho-Oncology. May 23, 2013
  Background Childhood cancer survival in low‐income countries is low. Objective Our study investigated health‐care providers' perspectives on childhood cancer treatment in Indonesia. Their health beliefs and attitudes toward parental financial difficulties, protocol adherence, parental education, and communication were explored. Methods A self‐administered questionnaire was filled in by 222 health‐care providers (156 doctors, 51 nurses, 6 social workers, 9 administrators) Results Health of children with cancer is beyond doctor's control and determined by luck, fate or God according to 35% of health‐care providers, 30% were uncertain about this statement, and 35% disagreed. Combination of chemotherapy and alternative treatment is best to achieve cure according to 15% of health‐care providers, 50% were uncertain, and 35% disagreed. Prosperous parents adhere better with treatment (67%). Doctors adhere better with cancer treatment for prosperous patients (55%). When dealing with poor families, less elaborate explanation is given (62%), more difficult vocabulary is used (49%), and less cooperation is offered (46%). Reasons for non‐adherence with treatment protocol were as follows: financial difficulties parents (82%), side‐effects (77%), lack of motivation parents (75%), and inadequate drugs supply at pharmacy (70%). Information about cancer and treatment makes parents more afraid or depressed about future, and parents prefer not to know according to 27% of health‐care providers, 20% were uncertain, and 53% disagreed. Communication with parents is hindered by differences in status and social hierarchical structures (83%). Conclusions Health‐care providers' beliefs about childhood cancer treatment are characterized by much uncertainty and contradiction. This likely affects adherence of health‐care providers, parents, and childhood cancer treatment outcome. Copyright © 2013 John Wiley & Sons, Ltd.

  May 23, 2013   doi: 10.1002/pon.3314   open full text
• When a mother has cancer: pathways to relational growth for mothers and daughters coping with cancer.
  Venera Bekteshi, Karen Kayser.
  Psycho-Oncology. May 19, 2013
  Background: Most research on daughters of women with cancer have focused on the daughters' adjustment to the cancer with little attention given to the impact of the cancer on the relationships between mothers and daughters. Methods: Guided by the feminist relational‐cultural theory, this study examines mothers' perceptions of their cancer experience on their relationships with daughters, focusing on their emotional connections, ruptures or disconnections in the relationships, and relational competencies. By using the grounded theory, 29 in‐depth interviews of mothers with cancer were analyzed. Results: Although most of the participants reported closer relationships with their daughters as a result of the cancer experience, emotions such as fear, anger, or guilt were frequently cited. Mothers were able to work through these emotions with their daughters through four relational competencies: (a) anticipatory empathy (sensitivity about the impact of cancer on each other); (b) authenticity (full presence without fear of abandonment); (c) mutual empathy (caring and emotional support); and (d)mutual empowerment (capacity to empower one another). Conclusion: The concept of post‐traumatic relational growth is introduced to describe how mothers transformed the stressful experience of cancer into an experience in which they grew emotionally in relationship with their daughters. Copyright © 2013 John Wiley & Sons, Ltd.

  May 19, 2013   doi: 10.1002/pon.3299   open full text
• Depressive symptoms after treatment in hepatocellular carcinoma survivors: prevalence, determinants, and impact on health‐related quality of life.
  Naoko Mikoshiba, Mitsunori Miyashita, Tomoko Sakai, Ryosuke Tateishi, Kazuhiko Koike.
  Psycho-Oncology. May 19, 2013
  Objective The purposes of this study were to investigate the prevalence and determinants of depressive symptoms among hepatocellular carcinoma (HCC) survivors and to evaluate the impact of depressive symptoms on health‐related quality of life (HRQOL). Methods A cross‐sectional study was conducted on 128 consecutive patients attending an outpatient clinic in Japan 1 year or more after curative treatment. To assess depressive symptoms and HRQOL, the participants were asked to complete the Center for Epidemiologic Studies Depressive Symptoms Scale, the European Organization for Research and Treatment of Cancer (EORTC) QLQ‐C30, and EORTC QLQ‐HCC18, respectively. Multiple logistic regression models were used to identify factors associated with depressive symptoms. EORTC QLQ‐C30 and EORTC QLQ‐HCC18 scores were compared between participants with and without depressive symptoms. Results The prevalence of depressive symptoms among the HCC survivors was 28.3%. The multiple logistic regression analysis revealed that the determinants of depressive symptoms included poor Karnofsky performance status (odds ratio [OR] = 4.59, 95% CI = 1.03–20.55, p = 0.04), poor liver function (OR = 3.22, 95% CI = 1.11–10.0, p = 0.03), living alone (OR = 6.87, 95% CI = 2.53–18.63, p = 0.0002), and unemployment (OR = 5.18, 95% CI = 1.73–15.54, p = 0.003). Survivors with depressive symptoms had poorer HRQOL in almost all domains compared with survivors with no depressive symptoms. Conclusions This study suggests that after treatment, many HCC survivors experience depressive symptoms that are strongly associated with poorer HRQOL. Copyright © 2013 John Wiley & Sons, Ltd.

  May 19, 2013   doi: 10.1002/pon.3300   open full text
• Cancer survivors with self‐reported late effects: their health status, care needs and service utilisation.
  Charlene Treanor, Olinda Santin, Moyra Mills, Michael Donnelly.
  Psycho-Oncology. May 16, 2013
  Objective Cancer survivors (CSs) are at risk of developing late effects (LEs) associated with the disease and its treatment. This paper compares the health status, care needs and use of health services by CSs with LEs and CSs without LEs. Methods Cancer survivors (n = 613) were identified via the Northern Ireland Cancer Registry and invited to participate in a postal survey that was administered by their general practitioner. The survey assessed self‐reported LEs, health status, health service use and unmet care needs. A total of 289 (47%) CSs responded to the survey, and 93% of respondents completed a LEs scale. Results Forty‐one per cent (111/269) of CSs reported LEs. Survivors without LEs and survivors with LEs were comparable in terms of age and gender. The LEs group reported a significantly greater number of co‐morbidities, lower physical health and mental health scores, greater overall health service use and more unmet needs. Unadjusted logistic regression analysis found that cancer site, time since diagnosis and treatment were significantly associated with reporting of LEs. CSs who received combination therapies compared with CSs who received single treatments were over two and a half times more likely to report LEs (OR = 2.63, 95% CI = 1.32–5.25) after controlling for all other variables. Conclusions The CS population with LEs comprises a particularly vulnerable group of survivors who have multiple health care problems and needs and who require tailored care plans that take account of LEs and their impact on health‐related quality of life. Copyright © 2013 John Wiley & Sons, Ltd.

  May 16, 2013   doi: 10.1002/pon.3304   open full text
• Relationship between cancer‐related fatigue and personality in patients with breast cancer after chemotherapy.
  Shu‐Hong Wang, Guo‐Ping He, Ping‐Lan Jiang, Li‐Li Tang, Xiao‐Min Feng, Cui Zeng, Guo‐Fei Wang.
  Psycho-Oncology. May 15, 2013
  Background This study aimed to explore the relationship between cancer‐related fatigue (CRF) and personality in patients with breast cancer after chemotherapy. Methods A cross‐sectional study was conducted to study the relationship between CRF and personality in breast cancer patients after chemotherapy. CRF and personality were measured by the cancer fatigue score and the Eysenck Personality Questionnaire, respectively. Results A total of 300 breast cancer patients who had received chemotherapy were recruited to this study. Eysenck Personality Questionnaire scores of psychoticism, introversion, and extroversion in the patients were lower than the norm level (p < 0.01), but those of neuroticism and lie were higher than the norm level (p < 0.01). Multivariate analyses showed positive correlation between psychoticism and affective fatigue, neuroticism and total fatigue, and physical fatigue and cognitive fatigue. Multivariate analyses also showed negative correlation between introversion or extroversion and total fatigue, physical fatigue or affective fatigue, and lie and total fatigue or cognitive fatigue. Conclusions There was CRF in patients with breast cancer after chemotherapy. Psychoticism, extroversion/introversion, neuroticism, and lie are correlated with CRF in breast cancer patients after chemotherapy. Copyright © 2013 John Wiley & Sons, Ltd.

  May 15, 2013   doi: 10.1002/pon.3303   open full text
• Structural equation modeling for implementation intentions, cancer worry, and stages of mammography adoption.
  Kei Hirai, Kazuhiro Harada, Aiko Seki, Miwa Nagatsuka, Hirokazu Arai, Ayako Hazama, Yoshiki Ishikawa, Chisato Hamashima, Hiroshi Saito, Daisuke Shibuya.
  Psycho-Oncology. May 10, 2013
  Objectives This study aimed to develop a structural model for mammography adoption in Japanese middle‐aged women by using constructs from the transtheoretical model (TTM), the theory of planned behavior (TPB), implementation intentions, and cancer worry. Methods Questionnaires based on items including TTM, TPB, implementation intentions, cancer worry‐related variables, and demographic variables were distributed to 1000 adult women aged 40 to 59 years, with 641 subjects being used in the final analysis (response rate = 64.1%). Results Regarding the stage of adoption, 79 participants (12.3%) were at the precontemplation stage, 30 (4.7%) were at the relapse stage, 142 (22.2%) were at the contemplation stage, 88 (13.7%) were at the action stage, and 302 (47.1%) were at the maintenance stage. Our model, derived from structural equation modeling, revealed that the stage of mammography adoption was significantly affected by goal intentions, implementation intentions, perceived barriers, history of breast cancer screening, and relative risk. A logistic regression analysis revealed that goal intentions and implementation intentions significantly predicted mammography uptake within 1 year. Conclusion This study developed an integrated model constructed from TTM, TPB, implementation intentions, and cancer worry to account for mammography adoption in Japan, and also confirmed the predictive validity of the model. Copyright © 2013 John Wiley & Sons, Ltd.

  May 10, 2013   doi: 10.1002/pon.3293   open full text
• Tibetan sound meditation for cognitive dysfunction: results of a randomized controlled pilot trial.
  K. Milbury, A. Chaoul, K. Biegler, T. Wangyal, A. Spelman, C. A. Meyers, B. Arun, J. L. Palmer, J. Taylor, L. Cohen.
  Psycho-Oncology. May 09, 2013
  Objective Although chemotherapy‐induced cognitive impairment is common among breast cancer patients, evidence for effective interventions addressing cognitive deficits is limited. This randomized controlled trial examined the feasibility and preliminary efficacy of a Tibetan Sound Meditation (TSM) program to improve cognitive function and quality of life in breast cancer patients. Methods Forty‐seven breast cancer patients (mean age 56.3 years), who were staged I–III at diagnosis, 6–60 months post‐chemotherapy, and reported cognitive impairment at study entry were recruited. Participants were randomized to either two weekly TSM sessions for 6 weeks or a wait list control group. Neuropsychological assessments were completed at baseline and 1 month post‐treatment. Self‐report measures of cognitive function (Functional Assessment of Cancer Therapy (FACT)‐Cog), quality of life (SF‐36), depressive symptoms (Center for Epidemiologic Studies Depression Scale), sleep disturbance (Pittsburgh Sleep Quality Index), fatigue (Brief Fatigue Inventory), and spirituality (FACT‐Sp) were completed at baseline, the end of treatment, and 1 month later. Results Relative to the control group, women in the TSM group performed better on the verbal memory test (Rey Auditory Verbal Learning Test trial 1) (p = 0.06) and the short‐term memory and processing speed task (Digit Symbol) (p = 0.09) and reported improved cognitive function (p = 0.06), cognitive abilities (p = 0.08), mental health (p = 0.04), and spirituality (p = 0.05) at the end of treatment but not 1 month later. Conclusions This randomized controlled trial revealed that TSM program appears to be a feasible and acceptable intervention and may be associated with short‐term improvements in objective and subjective cognitive function as well as mental health and spirituality in breast cancer patients. Copyright © 2013 John Wiley & Sons, Ltd.

  May 09, 2013   doi: 10.1002/pon.3296   open full text
• Couples facing advanced cancer: examination of an interdependent relational system.
  Chris Lo, Sarah Hales, Michal Braun, Anne C. Rydall, Camilla Zimmermann, Gary Rodin.
  Psycho-Oncology. April 29, 2013
  Background The relational impact of advanced cancer on both patients and spouse caregivers has rarely been examined simultaneously. This study describes a framework for understanding distress in each partner as a consequence of psychosocial characteristics, burden of disease or of caregiving, and the distress of the other person. A model focusing on the protective value of social relatedness was tested to illustrate the interdependence of patients and spouses in their mutual adaptation to disease. Methods A total of 278 advanced cancer patients and their spouse caregivers completed measures of psychological distress (e.g., depression), physical burden from cancer (e.g., symptom count), caregiving burden (i.e., time and task demand), and social relatedness (i.e., social support and attachment security). Structural equation modeling was used to extract latent factors associated with these constructs and to examine their interrelationships. Results The model fit was adequate. Patient distress was related to disease burden (standardized path coefficient = 0.52) and patient social relatedness (−0.32). Caregiver distress was related to caregiving burden (0.21) and caregiver social relatedness (−0.51). Caregiving burden was related to patient disease burden (0.43) and caregiver social relatedness (−0.37). Reciprocal pathways between patient and caregiver distress indicated that caregiver distress was influenced by patient distress (0.30) but not vice versa (0.12). Conclusions These findings support the view that patients and caregivers constitute an interdependent relational system and interventions in this setting should take into account both interactions between patients and caregivers and the nature of their social relatedness. Copyright © 2013 John Wiley & Sons, Ltd.

  April 29, 2013   doi: 10.1002/pon.3289   open full text
• The influence of dispositional optimism on post‐visit anxiety and risk perception accuracy among breast cancer genetic counselees.
  B. M. Wiering, A. Albada, J. M. Bensing, M. G. E. M. Ausems, A. M. Dulmen.
  Psycho-Oncology. April 29, 2013
  Objective Much is unknown about the influence of dispositional optimism and affective communication on genetic counselling outcomes. This study investigated the influence of counselees' optimism on the counselees' risk perception accuracy and anxiety, while taking into account the affective communication during the first consultation for breast cancer genetic counselling. Methods Counselees completed questionnaires measuring optimism, anxiety and the perceived risk that hereditary breast cancer runs in the family before, and anxiety and perceived risk after the first consultation. Consultations were videotaped. The duration of eye contact was measured, and verbal communication was rated using the Roter Interaction Analysis System. Results Less‐optimistic counselees were more anxious post‐visit (β = −.29; p = .00). Counsellors uttered fewer reassuring statements if counselees were more anxious (β = −.84; p = .00) but uttered more reassurance if counselees were less optimistic (β = −.76; p = .01). Counsellors expressed less empathy if counselees perceived their risk as high (β = −1.51; p = .04). An increase in the expression of reassurance was related to less post‐visit anxiety (β = −.35; p = .03). More empathy was related to a greater overestimation of risk (β = .92; p = .01). Conclusions Identification of a lack of optimism as a risk factor for high anxiety levels enables the adaptation of affective communication to improve genetic counselling outcomes. Because reassurance was related to less anxiety, beneficial adaptation is attainable by increasing counsellors' reassurance, if possible. Because of a lack of optimally adapted communication in this study, further research is needed to clarify how to increase counsellors' ability to adapt to counselees. Copyright © 2013 John Wiley & Sons, Ltd.

  April 29, 2013   doi: 10.1002/pon.3292   open full text
• Psychosocial predictors of four health‐promoting behaviors for cancer prevention using the stage of change of Transtheoretical Model.
  Jean H. Choi, Kyong‐Mee Chung, Keeho Park.
  Psycho-Oncology. April 29, 2013
  Objectives The present study aimed to examine whether demographic as well as psychosocial variables related to the five stages of change of the Transtheoretical Model can predict non‐clinical adults' cancer preventive and health‐promoting behaviors. This study specifically focused on cancer, one of the major chronic diseases, which is a serious threat of national health. Methods A total of 1530 adults participated in the study and completed questionnaires. Collected data were analyzed by using multinominal logistic regression. Results The significant predictors of later stages varied among the types of health‐promoting behaviors. Certain cancer preventive health‐promoting behaviors such as well‐balanced diet and exercise were significantly associated with psychosocial variables including cancer prevention‐related self‐efficacy, personality traits, psychosocial stress, and social support. On the other hand, smoking cessation and moderate or abstinence from drinking were more likely to be predicted by demographic variables including sex and age. Conclusions The present study found that in addition to self‐efficacy—a relatively well‐studied psychological variable—other personality traits and psychological factors including introversion, neuroticism, psychosocial stress, and social support also significantly predicted later stages of change with respect to cancer preventive health‐promoting behaviors. The implications of this study are also discussed. Copyright © 2013 John Wiley & Sons, Ltd.

  April 29, 2013   doi: 10.1002/pon.3278   open full text
• A population‐based study comparing HRQoL among breast, prostate, and colorectal cancer survivors to propensity score matched controls, by cancer type, and gender.
  Traci LeMasters, Suresh Madhavan, Usha Sambamoorthi, Sobha Kurian.
  Psycho-Oncology. April 19, 2013
  Background Objectives were to compare health‐related quality of life (HRQoL) between breast cancer survivors, prostate cancer survivors (PCS), and colorectal cancer survivors (CCS) to matched controls, stratified by short and long‐term survivors, by cancer type, and gender. Methods By using the 2009 Behavioral Risk Factor Surveillance System, propensity scores matched three controls to adult survivors >1 year past diagnosis (N = 11,964) on age, gender, race/ethnicity, income, insurance status, and region of the USA Chi‐square tests and logistic regression models compared HRQoL outcomes (life satisfaction, activity limitations, sleep quality, emotional support, general, physical, and mental health). Results Although all cancer survivors reported worse general health (p < 0.000) and more activity limitations (p < 0.004) than controls, these disparities decreased among long‐term survivors. Short‐term PCS and male CCS were more likely to report worse outcomes across additional domains of HRQoL than controls, but PCS were 0.61, 0.63, and 0.70 times less likely to report activity limitations, fair/poor general health, and 1–15 bad physical health days in the past month than male CCS. Breast cancer survivors and female CCS were 2.12 and 3.17, 1.58 and 1.86, and 1.49 and 153, respectively, times more likely to report rarely/never receiving needed emotional support, 1–15 bad mental health days in the past month, and not receiving enough sleep 1–15 days in the past month than PCS and male CCS. Conclusions Cancer survivors experience worse HRQoL than similar individuals without a history of cancer and the severity of affected HRQoL domains differ by time since diagnosis, cancer type, and gender. Copyright © 2013 John Wiley & Sons, Ltd.

  April 19, 2013   doi: 10.1002/pon.3288   open full text
• The benefits of being self‐determined in promoting physical activity and affective well‐being among women recently treated for breast cancer.
  Jennifer Brunet, Shaunna M. Burke, Catherine M. Sabiston.
  Psycho-Oncology. April 18, 2013
  Purpose In this study, changes in motivational regulations in women following treatment for breast cancer were described. Changes in motivational regulations as predictors of subsequent change in light and moderate‐to‐vigorous physical activity (PA) and affect were also examined. Methods Women [n = 150; Mage = 54.41 (SD = 10.87) years] completed self‐report questionnaires and wore an accelerometer for 7 days at Time 1 [M = 3.94 (SD = 3.08) months following primary treatment], as well as 3 (Time 2) and 6 (Time 3) months later. Data were analyzed using repeated‐measures analysis of variance and path analysis using residual change scores. Results Identified regulation and self‐determined motivation (i.e., combined intrinsic motivation and identified regulation) scores decreased over time (p < 0.05). In the path model [χ2(4) = 5.66, p = 0.22, root mean square error of approximation = 0.05 (90% CI: 0.0; 0.15), comparative fit index = 0.99, standardized root mean square of the residuals = 0.03], ΔTime1–2 in external regulation was associated with ΔTime2–3 in positive affect (β = −0.16), ΔTime1–2 in introjected (β = 0.25) and amotivation (β = 0.19) were related to ΔTime2–3 in negative affect, and ΔTime1–2 in self‐determined motivation was related to ΔTime2–3 in positive affect (β = 0.40) and moderate‐to‐vigorous PA (β = 0.21). Conclusions Changes in motivational regulations were related to changes in PA and affect in the aftermath of breast cancer. Given the benefits of self‐determined motivation, additional research is needed to develop and test interventions aimed at enhancing this type of motivation. Copyright © 2013 John Wiley & Sons, Ltd.

  April 18, 2013   doi: 10.1002/pon.3287   open full text
• Changes in health‐related quality of life by occupational status among women diagnosed with breast cancer—a population‐based cohort study.
  Marie Høyer Lundh, Claudia Lampic, Karin Nordin, Johan Ahlgren, Leif Bergkvist, Mats Lambe, Anders Berglund, Birgitta Johansson.
  Psycho-Oncology. April 14, 2013
  Objective To investigate whether longitudinal changes in health‐related quality of life (HRQoL) among breast cancer patients vary by prediagnosis occupational status or postdiagnosis changes in working time. Methods We identified 1573 patients in the Breast Cancer Quality Register of Central Sweden and asked them to participate in a longitudinal questionnaire study. A total of n = 841 women completed three questionnaires within a mean time of 4, 16, and 38 months postdiagnosis. Generalized estimating equation models were used to examine changes in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Breast Cancer‐Specific Quality of Life Questionnaire subscales stratified by prediagnosis occupational status and postdiagnosis changes in working time. Results Over time, the proportion of employed women reporting good functioning increased more, and the proportion reporting a high level of symptoms decreased more compared with women on sick leave/disability pension and retirement pensioners (p < 0.001). The latter two also showed a worsening in several subscales (p < 0.05). Among employed women, more consistent improvements in role and social functioning were observed among those with an increase/no change in working time than among those who had decreased it or stopped working (p < 0.05). A decrease in the proportion reporting pain was observed among women with an increase/no change in working time compared with women with decreased working time, among whom the proportion reporting pain increased (p = 0.008). Conclusions Being employed prediagnosis and resuming work to the same extent as prior to the breast cancer diagnosis are associated with consistent improvements in HRQoL. These results highlight the importance of interventions to improve HRQoL and policies to support return to work following diagnosis. Copyright © 2013 John Wiley & Sons, Ltd.

  April 14, 2013   doi: 10.1002/pon.3285   open full text
• Psychosocial support in patients with multiple myeloma at time of diagnosis: who wants what?
  Jette Lamers, Mechthild Hartmann, Hartmut Goldschmidt, Anette Brechtel, Jens Hillengass, Wolfgang Herzog.
  Psycho-Oncology. April 11, 2013
  Objective The aim of this study was to examine interest in psychosocial interventions among patients with multiple myeloma at time of diagnosis as well as associated factors. Methods Patients with newly diagnosed multiple myeloma were recruited from our outpatient myeloma unit at the Heidelberg University Hospital. Patients completed questionnaires that included a checklist on desired psychosocial interventions and the Patient Health Questionnaire 9‐item (PHQ‐9) depression and Generalized Anxiety Disorder 7‐item scale (GAD‐7) anxiety scales. Medical data were extracted from the patients' electronic records. Results The survey was completed by 114 out of the 130 myeloma patients. Half of the patients (51%) desired psychosocial interventions. The most common preferences were relaxation techniques (21%), psychological counseling (20%), and peer support groups (18%). Approximately 24% of the patients reported symptoms of depression, and 8% reported symptoms of anxiety. Patients with symptoms of depression had twice as many preferences for psychosocial interventions as nondepressed patients. They more frequently desired individual psychotherapy (p = 0.035) and peer support groups (p = 0.015). In general, lower age was associated with greater interest in psychosocial interventions. Medical status was not strongly associated with interest in psychosocial interventions. Conclusions A high percentage (51%) of patients with multiple myeloma has psychosocial intervention desires at the time of diagnosis. The greatest interest was found in depressed and younger patients. However, depressed patients do not prefer a single intervention form but rather show a broad variability of wishes, so ‘one size does not fit all’. Therefore, to reach all patients in need, a choice of psychosocial interventions should be offered. Copyright © 2013 John Wiley & Sons, Ltd.

  April 11, 2013   doi: 10.1002/pon.3284   open full text
• A randomised, wait‐list controlled trial: evaluation of a cognitive–behavioural group intervention on psycho‐sexual adjustment for men with localised prostate cancer.
  Heather M. Siddons, Addie C. Wootten, Anthony J. Costello.
  Psycho-Oncology. April 10, 2013
  Objective To examine the effectiveness of a cognitive–behavioural therapy (CBT) group intervention to facilitate improved psycho‐sexual adjustment to treatment side effects in prostate cancer survivors post‐radical prostatectomy. Methods A randomised, wait‐list controlled trial was conducted with a total of 60 men who participated in a manualised 8‐week cognitive–behavioural group intervention 6 months to 5 years post‐radical prostatectomy for localised prostate cancer. Participants completed standardised questionnaires pre‐intervention and post‐intervention, which assessed mood state, stress, general and prostate cancer anxiety, quality of life and areas of sexual functioning. Results Paired samples t‐tests identified a significant improvement in sexual confidence, masculine self‐esteem, sexual drive/relationship and a significant decline in sexual behaviour from pre‐intervention to post‐intervention. Hierarchical regression analyses revealed that after controlling for covariates, participation in the group intervention significantly improved sexual confidence, sexual intimacy, masculine self‐esteem and satisfaction with orgasm. Conclusions This group‐based CBT intervention for men post‐radical prostatectomy for localised prostate cancer shows promising results in terms of improving quality of life. Copyright © 2013 John Wiley & Sons, Ltd.

  April 10, 2013   doi: 10.1002/pon.3273   open full text
• Post‐traumatic growth among an ethnically diverse sample of adolescent and young adult cancer survivors.
  T. Em Arpawong, Alyssa Oland, Joel E. Milam, Kathleen Ruccione, Kathleen A. Meeske.
  Psycho-Oncology. April 01, 2013
  Objective Although some survivors of childhood cancer report significant psychosocial distress, many also report having derived benefits, or post‐traumatic growth (PTG), from their cancer experience. This study examines PTG and its correlates among an ethnically diverse sample of adolescent/young adult (AYA) cancer survivors who have recently completed treatment. Methods Survivors of childhood cancer (n = 94; 47% Hispanic), ages 11–21 and within 6 months of completing cancer therapy, were recruited from three pediatric cancer centers. Participants completed a structured interview that assessed demographics, PTG, post‐traumatic stress symptoms, health‐related quality of life, optimism, and depressive symptoms. Diagnosis/treatment information was collected from each patient's medical record. Multiple regression analyses were used to identify significant correlates of PTG. Results The majority of survivors reported positive growth. PTG was positively associated with psychosocial functioning and post‐traumatic stress symptoms and inversely associated with physical functioning and depressive symptoms. PTG was significantly lower among survivors of bone tumors (vs. survivors of other cancers) and Hispanic survivors who primarily spoke English at home (vs. Hispanics who primarily spoke Spanish at home and non‐Hispanics). PTG was not significantly related to age, sex, optimism, cancer treatment modality, duration of treatment, or treatment intensity. Conclusions The AYA survivors commonly reported PTG in the immediate aftermath of cancer treatment. Findings regarding PTG among more acculturated Hispanic and bone tumor AYA survivors may help to inform risk‐adapted clinical interventions, among those transitioning from active treatment to post‐treatment surveillance, to mitigate negative long‐term sequelae and enhance positive psychosocial adaptation from the cancer diagnosis and treatment. Copyright © 2013 John Wiley & Sons, Ltd.

  April 01, 2013   doi: 10.1002/pon.3286   open full text
• Existential behavioural therapy for informal caregivers of palliative patients: a randomised controlled trial.
  M. J. Fegg, M. Brandstätter, M. Kögler, G. Hauke, P. Rechenberg‐Winter, V. Fensterer, H. Küchenhoff, M. Hentrich, C. Belka, G. D. Borasio.
  Psycho-Oncology. March 27, 2013
  Background Existential behavioural therapy (EBT) was developed to support informal caregivers of palliative patients in the last stage of life and during bereavement as a manualised group psychotherapy comprising six sessions. We tested the effectiveness of EBT on mental stress and quality of life (QOL). Methods Informal caregivers were randomly assigned (1:1) to EBT or a treatment‐as‐usual control group using computer‐generated numbers in blocks of 10. Primary outcomes were assessed with the Brief Symptom Inventory (subscales somatisation, anxiety and depression), the Satisfaction with Life Scale (SWLS), the WHOQOL‐BREF and a numeric rating scale for QOL (QOL‐NRS, range 0–10). Data were collected at baseline, pre‐treatment, post‐treatment and follow‐ups after 3 and 12 months. Treatment effects were assessed with a multivariate analysis of covariance. Results Out of 160 relatives, 81 were assigned to EBT and 79 to the control group. Participants were 54.5 ± 13.2 years old; 69.9% were female. The multivariate model was significant for the pre‐/post‐comparison (p = 0.005) and the pre‐/12‐month comparison (p = 0.05) but not for the pre‐/3‐month comparison. Medium to large effects on anxiety and QOL (SWLS, WHOQOL‐BREF, QOL‐NRS) were found at post‐treatment; medium effects on depression and QOL (QOL‐NRS) emerged in the 12‐month follow‐up. No adverse effects of the intervention were observed. Conclusion Existential behavioural therapy appears to exert beneficial effects on distress and QOL of informal caregivers of palliative patients. Further longitudinal evidence is needed to confirm these findings. Copyright © 2013 John Wiley & Sons, Ltd.

  March 27, 2013   doi: 10.1002/pon.3260   open full text
• Assessment of family psychosocial functioning in survivors of pediatric cancer using the PAT2.0.
  Jordan Gilleland, Bonney Reed‐Knight, Sarah Brand, Anya Griffin, Karen Wasilewski‐Masker, Lillian Meacham, Ann Mertens.
  Psycho-Oncology. March 26, 2013
  Background This study aimed to examine clinical validity and utility of a screening measure for familial psychosocial risk, the Psychosocial Assessment Tool 2.0 (PAT2.0), among pediatric cancer survivors participating in long‐term survivorship care. Methods Caregivers (N = 79) completed the PAT2.0 during their child's survivorship appointment. Caregivers also reported on family engagement in outpatient mental health treatment. Medical records were reviewed for treatment history and oncology provider initiated psychology consults. Results The internal consistency of the PAT2.0 total score in this survivorship sample was strong. Psychology was consulted by the oncology provider to see 53% of participant families, and families seen by psychology had significantly higher PAT2.0 total scores than families without psychology consults. PAT2.0 total scores and corresponding subscales were higher for patients, parents, and siblings enrolled in outpatient mental health services since treatment completion. Results were consistent with psychosocial risk categories presented within the Pediatric Psychosocial Preventative Health Model. Fifty‐one percent of families presenting for survivorship care scored in the “universal” category, 34% scored in the “targeted” category, and 15% scored in the “clinical” category. Conclusions Data indicate that the overall proportions of families experiencing “universal”, “targeted”, and “clinical” levels of familial distress may be constant from the time of diagnosis into survivorship care. Overall, the PAT2.0 demonstrated strong psychometric properties among survivors of pediatric cancer and shows promise as a psychosocial screening measure to facilitate more effective family support in survivorship care. Copyright © 2013 John Wiley & Sons, Ltd.

  March 26, 2013   doi: 10.1002/pon.3265   open full text
• Age‐specific influences of emotional distress on performance status in cancer patients.
  Ji‐Hyun Kim, Sujung Yoon, Wang‐Youn Won, Chul Lee, Chang‐Uk Lee, Kyo Young Song, Jung‐Ah Min, In Kyoon Lyoo, Tae‐Suk Kim.
  Psycho-Oncology. March 24, 2013
  Objective Improving and maintaining performance status is an important part of cancer treatment because it may predict patients' survival. Several cancer‐related medical conditions have been known to influence the functional performance of cancer patients. We here examined whether emotional distress would also contribute to performance decline of cancer patients. Methods With consecutive sampling, a total of 880 patients diagnosed as having cancer were recruited and evaluated on cancer‐related variables, emotional distress, and performance status using the standardized instruments. Results Approximately 8.9% of participants showed compromised performance rated 2 or more on the Eastern Cooperative Oncology Group performance status scale. Emotional distress was strongly associated with compromised performance after controlling for demographic and cancer‐related external risk factors. The effects of emotional distress on performance decline were likely to be remarkably greater in the younger age group (<45 years) than in old‐aged cancer patients (≥65 years). Conclusions Our results provide support for the independent effects of emotional distress on having a higher risk for performance decline in cancer patients. These effects seem to be age‐dependent suggesting that special clinical attention to emotional distress may be required in younger patients with cancer. Copyright © 2013 John Wiley & Sons, Ltd.

  March 24, 2013   doi: 10.1002/pon.3276   open full text
• Worry about one's own children, psychological well‐being, and interest in psychosocial intervention.
  Karin Stinesen‐Kollberg, Thordis Thorsteinsdottir, Ulrica Wilderäng, Gunnar Steineck.
  Psycho-Oncology. March 20, 2013
  Background This study investigated the association between worrying about own children and low psychological well‐being during the year that follows breast cancer. Methods In an observational population‐based study, we collected data from 313 women operated for breast cancer at Sahlgrenska University Hospital in Gothenburg, Sweden. Results Worrying about one's own children (3–7 on a 1–7 visual digital scale) was, among other variables, significantly associated with low psychological well‐being 1 year after breast cancer surgery (relative risk 2.63; 95% CI 1.77–3.90; posterior probability value 98.8%). Conclusions In this group of women operated for breast cancer, we found an association between worrying about one's own children and low psychological well‐being. In a healthcare system where resources are scarce, it becomes imperative to identify to whom resources should be directed. Therefore, we may consider prioritizing psychological interventions for mothers with younger children and develop effective means to communicate about issues related to the children to increase chances of an effective, successful rehabilitation.Copyright © 2013 John Wiley & Sons, Ltd.

  March 20, 2013   doi: 10.1002/pon.3266   open full text
• Exploring the influence of gender‐role socialization and objectified body consciousness on body image disturbance in breast cancer survivors.
  Virginia M. Boquiren, Mary Jane Esplen, Jiahui Wong, Brenda Toner, Ellen Warner.
  Psycho-Oncology. March 20, 2013
  Objective This study aimed to explore the relationships between gender‐role socialization, objectified body consciousness and quality of life in breast cancer (BC) survivors with body image (BI) disturbance post‐treatment. Methods A total of 150 BC survivors participating in an ongoing randomized clinical trial of a group psychotherapy intervention for BI‐related concerns completed a baseline battery of standardized measures including the following: Body Image Scale (BIS), Body Image after Breast Cancer Questionnaire (BIBCQ), Objectified Body Consciousness Scale (OBCS) measuring Body Shame and Surveillance, Gender‐Role Socialization Scale (GRSS) measuring internalization of traditional gender roles and attitudes and the Functional Assessment of Cancer Therapy‐Breast Quality‐of‐Life Instrument (FACT‐B). Correlational analyses were conducted between the two BI questionnaires, the two primary psychosocial variables GRSS and OBCS, and FACT‐B. Path analysis was conducted on a proposed theoretical model delineating pathways between the two primary psychosocial variables and BI disturbance. Results Significant positive correlations were found between the two BI scales and (a) GRSS (average r = 0.53, p < 0.000), (b) Body Shame (average r = 0.53, p < 0.000) and Surveillance (average r = 0.48, p < 0.000). The BIS and BIBCQ were negatively associated with the FACT‐B (r = −0.62, −0.73, respectively; p < 0.000). Results from the path analysis demonstrated support for the proposed model. Conclusion Breast cancer survivors who endorsed greater internalization of traditional gender roles and attitudes, who engaged in greater self‐surveillance and experienced greater body shame, reported greater BI disturbance and poorer quality of life post‐treatment. Women with these predispositions are likely to be more vulnerable for psychological distress and may experience poorer adjustment after BC treatment. Copyright © 2013 John Wiley & Sons, Ltd.

  March 20, 2013   doi: 10.1002/pon.3271   open full text
• Awareness of psychological and relationship problems amongst brain tumour patients and its association with carer distress.
  Holly E. Andrewes, Katharine J. Drummond, Mark Rosenthal, Andrew Bucknill, David G. Andrewes.
  Psycho-Oncology. March 19, 2013
  Objective The aim of this research was to investigate if brain tumour patients underestimate the severity of their impairments and the impact of this behaviour on carer distress . This study also aimed to identify the support services that patients and carers experiencing distress would find most beneficial. Method A total of 32 post‐surgery brain tumour patients, their carers, and a control group of 29 patients following surgery to extra‐cerebral areas and their carers were recruited from outpatient clinics. Patients and carers rated the patient's psychological well‐being and the impact of a range of changes since diagnosis/surgery. Patients and carers also rated their own level of distress and the support services they would find most beneficial. Results When compared with the control group, brain tumour patients were more likely to underestimate their psychological problems (p < 0.005) and the negative impact of changes to their emotional function (p < 0.05), interpersonal relationships (p < 0.05), cognition (p < 0.05) and coping skills (p<0.05). A multiple regression analysis showed that underestimation of psychological and interpersonal problems by brain tumour patients explained 35% of the variance in their carer's anxiety. Conclusion The finding of reduced awareness or denial in brain tumour patients and its contribution to increased carer anxiety highlights the need for therapeutic interventions, which improve patient insight/denial and encourage patient and carer communication. Copyright © 2013 John Wiley & Sons, Ltd.

  March 19, 2013   doi: 10.1002/pon.3274   open full text
• If you had less than a year to live, would you want to know? A seven‐country European population survey of public preferences for disclosure of poor prognosis.
  R. Harding, V. Simms, N. Calanzani, I. J. Higginson, S. Hall, M. Gysels, A. Meñaca, C. Bausewein, L. Deliens, P. Ferreira, F. Toscani, B. A. Daveson, L. Ceulemans, B. Gomes,.
  Psycho-Oncology. March 18, 2013
  Objective With increasing European cancer deaths, clinicians must manage information regarding poor prognosis. This study aimed to determine European citizens' preferences, within a scenario of serious illness such as cancer with less than a year to live, for information disclosure regarding poor prognosis, the likely symptoms and problems, and the care options available, to measure variations between countries and to identify factors associated with preferences. Methods A population‐based cross‐national telephone survey using random digit dialling in seven countries was conducted. Results Among 9344 respondents, data revealed an international preference (73.9%) to always be informed in the scenario of having a serious illness such as cancer with less than a year to live. This varied from 67.6% in Italy to 80.7% in Flanders. A minority (21.1%) did not want such information unless they ask, or at all. People younger than 70 years (OR 0.72, 95% CI 0.62–0.83, p < 0.001), men (OR 1.23, 95% CI 1.10–1.37, p < 0.001), those with experience of illness (OR = 1.20. 95% CI 1.01–1.43, p < 0.05) and with more education (OR = 1.20, 95% CI 1.09–1.32, p < 0.001) were more likely to want to know of limited time left. Conclusions The models confirmed the influence of four factors in more than one country (age, gender, education and most concerning problem) and added 11 country‐specific factors to which national policies and clinical practice should respond. These findings confirm a majority public preference to be informed in a scenario of poor prognosis. Policy clinical practice should facilitate elucidation and delivery of preferences. Evidence for effective communication skills‐building interventions for clinicians is required. Copyright © 2013 John Wiley & Sons, Ltd.

  March 18, 2013   doi: 10.1002/pon.3283   open full text
• Reports of ‘growth’ in survivors of non‐small cell lung cancer and healthy controls: what is the value‐added by the cancer experience?
  Michael A. Andrykowski, Rachel F. Steffens, Heather M. Bush, Thomas C. Tucker.
  Psycho-Oncology. March 15, 2013
  Background Reports of ‘growth’ following cancer diagnosis and treatment are common and are considered evidence for the transformative potential of the cancer experience. However, reports of growth are also common in the general population. This study sought to identify the unique, ‘value‐added’ with regard to the nature and magnitude of growth represented by the cancer experience. Methods Lung cancer (LC) survivors (n = 190; mean 15 months post‐diagnosis) completed the Posttraumatic Growth Inventory (PTGI), reporting changes occurring ‘as a result of having cancer’. Community‐based, healthy controls (HC) (n = 152) completed the PTGI, reporting changes occurring ‘in the past year’. Results Reports of growth were common in both the LC and HC groups. However, the LC group reported greater total PTGI scores (effect size (ES) = 0.39 SD) and greater growth for 3 of 5 subscales (ESs 0.34–0.48 SD). The LC group was more likely to report any degree of change for 11 of 21 PTGI items (mean odds ratio (OR) across 21 items = 1.92) and were more likely to report ‘moderate’ to ‘very great’ change for eight of 21 items (mean OR = 1.75). The LC group was more likely to report growth in the areas of social relationships and appreciation for life. Conclusions In sum, the growth evidenced by LC survivors after diagnosis quantitatively and qualitatively differs from growth reported by the general population over a similar period. Estimates of the value‐added by the cancer experience suggest a magnitude representing at least the lower range of clinical significance. Copyright © 2013 John Wiley & Sons, Ltd.

  March 15, 2013   doi: 10.1002/pon.3281   open full text
• Physical activity and psychosocial benefits among breast cancer patients.
  Bernardine M. Pinto, Shira Dunsiger, Marissa Waldemore.
  Psycho-Oncology. March 15, 2013
  Objective Physical activity (PA) has been shown to provide health benefits for breast cancer patients. The effects of augmenting oncology healthcare provider (HCP) advice for PA with 3 months of telephone counseling versus contact control were evaluated in a randomized trial. Our goal in this secondary analysis was to examine the amount of PA (min/week) needed for psychosocial benefits among both groups. Methods After receiving brief HCP advice to become physically active, 192 women (age in years: mean = 60.0, SD = 9.9) who had completed treatment for Stage 0–IV breast cancer were randomized to telephone counseling to support PA (n = 106) or contact control (n = 86). Their PA, fatigue, physical functioning, and quality of life were assessed at baseline (before receiving HCP advice), 3, 6, and 12 months. A non‐randomized design was used to examine the dose–response relationship between PA and psychosocial outcomes. Results Exercising for at least 150 min/week at moderate intensity was associated with improved physical functioning (b = 5.9, SE = 2.9, p = 0.04) and quality of life (b = 3.6, SE = 1.9, p = 0.05) at 3 months. These relationships were not found at 6 and 12 months (p's > 0.05). However, women who reported at least 150 min/week of PA at both 3 and 6 months had significantly reduced fatigue (b = 1.3, SE = 0.7, p = 0.05) and improved physical functioning (b = 3.1, SE = 1.3, p = 0.02) and quality of life (b = 2.0, SE = 0.9, p = 0.02) compared with women who did not meet this criterion. Conclusion Women who exercised at recommended levels (at least 150 min/week) and sustained this level of activity for at least 6 months accrued psychosocial benefits. Copyright © 2013 John Wiley & Sons, Ltd.

  March 15, 2013   doi: 10.1002/pon.3272   open full text
• Written emotional disclosure for women with ovarian cancer and their partners: randomised controlled trial.
  Emily Arden‐Close, Yori Gidron, Louise Bayne, Rona Moss‐Morris.
  Psycho-Oncology. March 15, 2013
  Objective Written emotional disclosure for 15–20 min a day over 3 to 4 days improves physical and psychological health and may benefit cancer patients. However, no studies have tested the effectiveness of guided writing in cancer patients and their partners. A randomised controlled trial tested whether writing about the patient's diagnosis and treatment of ovarian cancer using the Guided Disclosure Protocol (GDP) is effective in reducing perceived stress and improving quality of life (QoL) in ovarian cancer couples. The study also tested two theories that may account for beneficial effects of written emotional disclosure, the cognitive processing hypothesis and the social interaction hypothesis. Methods Patients and their partners (N = 102 couples) were randomised to write at home for 15 min a day over 3 days about the patient's diagnosis and treatment using the GDP or what the patient did the previous day (control). Couples were assessed at baseline, 3‐ and 6‐month follow‐ups on the primary outcomes of perceived stress and QoL and secondary outcomes of intrusive thoughts (testing the cognitive processing hypothesis) and illness‐related couple communication (testing the social interaction hypothesis). Results There were no main effects for any outcomes. However, in patients, the GDP improved QoL if illness‐related couple communication improved and buffered the effect of intrusive thoughts on perceived stress. Conclusions The GDP might benefit patients in certain circumstances, through changes in communication (in line with the social interaction hypothesis). Further research is needed to determine whether patients benefit from interventions to improve illness‐related couple communication and under which conditions. Copyright © 2013 John Wiley & Sons, Ltd.

  March 15, 2013   doi: 10.1002/pon.3280   open full text
• Does awareness of terminal status influence survival and quality of life in terminally ill cancer patients?
  Seon‐Young Kim, Jae‐Min Kim, Sung‐Wan Kim, Il‐Seon Shin, Kyung‐Yeol Bae, Hyun‐Jeong Shim, Jun‐Eul Hwang, Woo‐Kyun Bae, Sang‐Hee Cho, Ik‐Joo Chung, Jin‐Sang Yoon.
  Psycho-Oncology. March 15, 2013
  Background Clinical studies, with a proper scientific design, on the impact of disclosing a prognosis on a patient's psychological or physical conditions are rare. We investigated the effect of patient awareness of terminal status on survival and quality of life (QoL) in a palliative care setting. Methods This is a prospective cohort study of patients with terminal cancer. Patients with cancer at a palliative care unit were enrolled consecutively. The patients' awareness of their terminal status was determined using a semistructured interview. Sociodemographic and clinical characteristics, including Eastern Cooperative Oncology Group performance status, depressed mood, and QoL, were investigated. To determine the independent effects of awareness of illness on survival and QoL, multivariate Cox proportional‐hazards regression and multivariate linear regression were used, respectively. Results For the 262 cases analyzed, the median survival time (interquartile range) was 28.5 (15.8–55.3) days, and 76 (29.0%) patients were unaware of their prognosis. Patients who were aware survived for a shorter period than did those who were unaware (HR, 1.44; 95% CI, 1.07–1.93, p = 0.015) after adjusting for clinical variables including physical status and depression. Also, patients who were aware reported lower subjective QoL compared with patients who were unaware in a multivariate linear regression analysis (B, −0.10; 95% CI, −0.17 to −0.03, p = 0.008). Conclusions Awareness of prognosis may negatively impact survival and QoL in terminally ill cancer patients. Therefore, the patient's preference for and individual susceptibility to receiving such information should be assessed carefully before disclosure. Copyright © 2013 John Wiley & Sons, Ltd.

  March 15, 2013   doi: 10.1002/pon.3275   open full text
• Helping Her Heal‐Group: a pilot study to evaluate a group delivered educational intervention for male spouses of women with breast cancer.
  Jennifer M. Jones, Frances Marcus Lewis, Kristin Griffith, Terry Cheng, Scott Secord, Tara Walton, Lori J. Bernstein, Christine Maheu, Pamela Catton.
  Psycho-Oncology. March 15, 2013
  Background Distress in husbands of women with early‐stage breast cancer may be equivalent to or even higher than their wives. Husbands often struggle to help and support their wives cope with the illness and its treatment. In response, we developed a five‐session group educational counselling intervention (Helping Her Heal‐Group (HHH‐G)) for husbands of women with early‐stage breast cancer. The primary aim of the current pilot study was to determine the acceptability and feasibility of HHH‐G and to obtain a preliminary estimate of its impact on participating men's skills, self‐confidence and self care. Secondary aims were to assess the impact of the intervention on both the participating spouses' and wives' ratings of marital quality and depressed mood. Methods The study employed a one‐arm, pre–post‐intervention design whereby participating men (n = 54) and their wives (n = 54) independently completed measures at baseline (T0), immediately following the last session (T1) and 3 months after the last session (T2). Results Overall, there was very high study retention (87%). On the basis of the questionnaire data, we found significant improvements in spouses' self‐efficacy (p < 0.001) and self‐reported skills including wife support (p = 0.003) and self‐care (p < 0.001). In addition, there was a significant improvement in wives' mood scores (p = 0.003). Post‐intervention interviews support acceptability and impact of the HHH‐G intervention, and provide support for the group format of the program. Conclusions The feasibility and acceptability of HHH‐G was supported, and treatment outcomes suggest the potential benefits of the intervention. Phase III evaluation of HHH‐G program is warranted. Copyright © 2013 John Wiley & Sons, Ltd.

  March 15, 2013   doi: 10.1002/pon.3263   open full text
• Co‐morbid mental health conditions in cancer patients at working age – prevalence, risk profiles, and care uptake.
  S. Singer, C. Szalai, S. Briest, A. Brown, A. Dietz, J. Einenkel, S. Jonas, A. Konnopka, K. Papsdorf, D. Langanke, M. Löbner, F. Schiefke, J.‐U. Stolzenburg, A. Weimann, H. Wirtz, H. H. König, S. Riedel‐Heller.
  Psycho-Oncology. March 14, 2013
  Objective This study examined the prevalence of mental health conditions in cancer patients, the role of socioeconomic position in relation to that, and the use of professional mental health care. Methods Prospective cohort with measurements at the beginning of inpatient treatment (baseline) and 3, 9, and 15 months after baseline using structured clinical interviews based on DSM‐IV, questionnaires, and medical records. Results At baseline, 149 out of 502 cancer patients (30%) were diagnosed with a mental health condition. Prevalence was associated with unemployment (odds ratio [OR] 2.0), fatigue (OR 1.9), and pain (OR 1.7). Of those with mental health conditions, 9% saw a psychotherapist within 3 months of the diagnosis, 19% after 9 months, and 11% after 15 months. Mental health care use was higher in patients with children ≤18 years (OR 3.3) and somatic co‐morbidity (OR 2.6). There was no evidence for an effect of sex on the use of mental health care. Conclusion Few cancer patients with psychiatric disorders receive professional mental health care early enough. If patients are unemployed or if they suffer from fatigue or pain, special attention should be paid because the risk of having a mental health condition is increased in these patients. Copyright © 2013 John Wiley & Sons, Ltd.

  March 14, 2013   doi: 10.1002/pon.3282   open full text
• Predictors of depression, anxiety and quality of life in patients with prostate cancer receiving androgen deprivation therapy.
  Kelly Chipperfield, Jane Fletcher, Jeremy Millar, Joanne Brooker, Robin Smith, Mark Frydenberg, Sue Burney.
  Psycho-Oncology. March 11, 2013
  Objectives To evaluate the effects of androgen deprivation therapy (ADT) on depression, anxiety and quality of life (QoL) in patients with prostate cancer (PCa) and to examine the relationship between meeting the National Physical Activity Guidelines of Australia (NPAGA) and the presence and severity of both psychological sequelae and physical side effects associated with ADT. A secondary purpose was to examine the predictors of depression, anxiety and QoL in patients with PCa. Methods A questionnaire was mailed to English‐speaking patients aged 40 to 80 years, who had received radiotherapy for PCa during 2010 and 2011, between 9 and 30 months prior to study initiation. Measures included the following: the International Physical Activity Questionnaire; the Hospital Anxiety and Depression Scale; the Functional Assessment of Cancer Therapy—Prostate; and sociodemographic items. Results Long‐term use of ADT was associated with poorer QoL and psychosocial well‐being. Those meeting NPAGA had significantly lower levels of depression and anxiety and improved QoL compared with those not meeting NPAGA. Logistic regression analyses showed the odds of clinically significant depression and anxiety scores, increased with younger age and comorbid conditions. Not meeting NPAGA increased the likelihood of caseness for depression. Multiple regression analyses revealed that comorbid conditions and treatment category predicted poorer QoL, whereas meeting NPAGA positively predicted QoL. Conclusions The use of ADT in the management of patients with PCa has a measurable effect on QoL. These findings support the utility of physical activity as an intervention for men undergoing ADT. Copyright © 2013 John Wiley & Sons, Ltd.

  March 11, 2013   doi: 10.1002/pon.3269   open full text
• Incidence and risk of mood disorders in patients with breast cancers in Taiwan: a nationwide population‐based study.
  Yi‐Ping Hung, Chia‐Jen Liu, Chia‐Fen Tsai, Man‐Hsin Hung, Cheng‐Hwai Tzeng, Chun‐Yu Liu, Tzeng‐Ji Chen.
  Psycho-Oncology. March 06, 2013
  Objective The objective of this study is to assess the incidence and risk of mood disorders, including major depression, anxiety, and bipolar disorders, in Taiwanese patients after the diagnosis of breast cancer compared with a matched cohort. Methods From January 2000 to December 2005, 26,629 newly diagnosed breast cancer patients were enrolled by the Taiwan National Health Insurance program database. The control cohort was selected randomly from 1,000,000 National Health Insurance beneficiaries from a population of 21,400,826 enrolled throughout Taiwan. Each patient was matched with one subject without breast cancer by age, sex, and presence of comorbidities with the same diagnosis index date. The diagnosis of mood disorders was defined by compatible International Classification of Diseases, 9th revision, clinical modification codes plus the prescription of antidepressants for at least 30 days. Results The overall incidence rate ratio of mood disorders was 1.33 (95% CI 1.28–1.39, p < 0.001) in the breast cancer cohort compared with the matched cohort. The incidence rate ratios for specific mood disorders were 2.06 for bipolar disorder (95% CI 1.37–3.15 p = 0.0003), 1.94 for major depressive disorder (95% CI 1.76–2.13 p < 0.001), and 1.22 for anxiety (95% CI 1.16–1.27 p < 0.001). Independent risk factors for developing mood disorders included breast cancer, as well as age, hypertension, chronic obstructive pulmonary disease, autoimmune disease, ischemic heart disease, and cerebrovascular disease. Conclusions Breast cancer is a prominent risk factor for mood disorders, including major depressive disorder, anxiety, and bipolar disorder. The impact is most potent in the first year after diagnosis. Psychological support is a critical issue in these patients. Copyright © 2013 John Wiley & Sons, Ltd.

  March 06, 2013   doi: 10.1002/pon.3277   open full text
• Cancer‐related self‐efficacy following a consultation with an oncologist.
  Berit Kjærside Nielsen, Mimi Mehlsen, Anders Bonde Jensen, Robert Zachariae.
  Psycho-Oncology. March 06, 2013
  Objective When receiving a cancer diagnosis, patients are often faced with psychological distress and loss of control. As a result, their psychological well‐being may be influenced by their perceived ability to cope with disease‐related and treatment‐related challenges. Research indicates that the patient–oncologist relationship may have an impact on patients' self‐efficacy. The aim was to examine predictors of self‐efficacy following a consultation in an oncology outpatient clinic and the predictors of change. Methods A total of 226 patients (mean age: 61 years, 40% male) attending an oncology outpatient clinic completed questionnaires before and after a consultation including the Hospital Anxiety and Depression Scale, two domain‐specific self‐efficacy scales measuring coping self‐efficacy and decision self‐efficacy, the Physician–Patient Relationship Inventory, and the Information Satisfaction Questionnaire. Results While most patients experienced an increase in self‐efficacy following the consultation, some patients experienced lower self‐efficacy post‐consultation. In the multivariate analysis, depressive symptoms emerged as a relatively strong predictor of both coping self‐efficacy and decision self‐efficacy, whereas marital status was a significant predictor of coping self‐efficacy, and satisfaction with information significantly predicted decision self‐efficacy. No significant associations were found between self‐efficacy and the patients' ratings of the physician–patient relationship. Conclusion Depression seems to be a potential risk factor for lower cancer‐related self‐efficacy, following an oncologist consultation. By identifying patients who exhibit symptoms of depression, health professionals can increase their attention on empowering these patients. Furthermore, our results suggest that patients' experience of self‐efficacy depends on what particular challenges they have to overcome. Copyright © 2013 John Wiley & Sons, Ltd.

  March 06, 2013   doi: 10.1002/pon.3261   open full text
• Do healthcare professionals discuss the emotional impact of cancer with patients?
  Allison Bonito, Nina Horowitz, Ruth McCorkle, Anees B. Chagpar.
  Psycho-Oncology. March 06, 2013
  Background It is known that cancer may affect patients' emotions and their relationships with other people and that those with strong emotional support may enjoy improved outcomes. We sought to determine the frequency with which healthcare professionals discuss the impact of cancer on patients' emotions and relationships with others. Methods Data regarding healthcare professionals' discussions of the emotional impact of cancer and relevant covariates were obtained from the 2010 National Health Interview Survey. Statistical analyses were performed using sudaan software (Research Triangle Institute, Raleigh, NC, USA). Results Of the 2074 people with a prior diagnosis of cancer surveyed, 701 (33.8%) claimed that a doctor, nurse, or other healthcare professional had discussed with them ‘how cancer could affect their emotions or relationships with others’. Of these, 586 (84.5%) reported that they were ‘very satisfied’ with how well their emotional and social needs were met; 73.4% of those who had not had this discussion reported being very satisfied. Patients with leukemia/lymphoma, younger patients, African Americans, and those with a lower degree of education were most likely to report having discussions about emotional issues. Gender was not correlated with these discussions (30.6% in men vs. 33.3% in women). On multivariate analysis, age, race, and cancer type remained independent significant predictors of having a discussion regarding the emotional impact of cancer. Conclusion Only a third of cancer patients discussed the emotional impact of a cancer diagnosis with their healthcare professional. Age, race, and type of malignancy affect the likelihood of having these discussions. Copyright © 2013 John Wiley & Sons, Ltd.

  March 06, 2013   doi: 10.1002/pon.3258   open full text
• Association of pre‐operative brain pathology with post‐operative delirium in a cohort of non‐small cell lung cancer patients undergoing surgical resection.
  James C. Root, Kane O. Pryor, Robert Downey, Yesne Alici, Marcus L. Davis, Andrei Holodny, Beatriz Korc‐Grodzicki, Tim Ahles.
  Psycho-Oncology. March 04, 2013
  Objective Post‐operative delirium is associated with pre‐operative cognitive difficulties and diminished functional independence, both of which suggest that brain pathology may be present in affected individuals prior to surgery. Currently, there are few studies that have examined imaging correlates of post‐operative delirium. To our knowledge, none have examined the association of delirium with existing structural pathology in pre‐operative cancer patients. Here, we present a novel, retrospective strategy to assess pre‐operative structural brain pathology and its association with post‐operative delirium. Standard of care structural magnetic resonance imaging (MRIs) from a cohort of surgical candidates prior to surgery were analyzed for white matter hyperintensities and cerebral atrophy. Methods We identified 23 non‐small cell lung cancer patients with no evidence of metastases in the brain pre‐operatively, through retrospective chart review, who met criteria for post‐operative delirium within 4 days of surgery. 24 age‐ and gender‐matched control subjects were identified for comparison to the delirium sample. T1 and fluid‐attenuated inversion recovery sequences were collected from standard of care pre‐operative MRI screening and assessed for white matter pathology and atrophy. Results We found significant differences in white matter pathology between groups with the delirium group exhibiting significantly greater white matter pathology than the non‐delirium group. Measure of cerebral atrophy demonstrated no significant difference between the delirium and non‐delirium group. Conclusions In this preliminary study utilizing standard of care pre‐operative brain MRIs for assessment of structural risk factors to delirium, we found white matter pathology to be a significant risk factor in post‐operative delirium. Limitations and implications for further investigation are discussed. Copyright © 2013 John Wiley & Sons, Ltd.

  March 04, 2013   doi: 10.1002/pon.3262   open full text
• Conveying genomic recurrence risk estimates to patients with early‐stage breast cancer: oncologist perspectives.
  Elizabeth Spellman, Nadiyah Sulayman, Susan Eggly, Beth N. Peshkin, Claudine Isaacs, Marc D. Schwartz, Suzanne C. O'Neill.
  Psycho-Oncology. February 28, 2013
  Objective The development and increased use of genomic profiling has led to refinement of breast cancer treatment. This study sought to examine medical and surgical oncologists' perceptions of factors related to the translation and integration of Oncotype DX® (Genomic Health, Inc., Redwood City, CA, USA) into routine clinical care. Methods Twenty oncologists (10 medical and 10 surgical oncologists) participated in qualitative interviews. Questions centered on the following themes: oncologists' perceptions about the clinical utility of testing, the impact of patient preferences on the decision to test and use results to inform treatment decisions, methods of communicating risk associated with test results to patients, and benefits of and barriers to incorporating testing into multidisciplinary care settings. Results Oncologists found Oncotype DX test results useful in their practice but had concerns as well. These included that some oncologists either used testing inappropriately or placed undue emphasis on the results at the expense of other clinical information. The use of intermediate test results, which have less clear clinical implications, incorporating results with patient treatment preferences, and the use of testing in multidisciplinary teams were noted as specific challenges. Conclusion Oncologists noted several benefits of testing and also many challenges, despite wide dissemination and common use. Education for health providers should include specific training in how to interpret and communicate the uncertainty inherent in genomic tests while integrating patient preferences to inform treatment decision making. Copyright © 2013 John Wiley & Sons, Ltd.

  February 28, 2013   doi: 10.1002/pon.3264   open full text
• Slower processing speed after treatment for pediatric brain tumor and acute lymphoblastic leukemia.
  Lisa S. Kahalley, Heather M. Conklin, Vida L. Tyc, Melissa M. Hudson, Stephanie J. Wilson, Shengjie Wu, Xiaoping Xiong, Pamela S. Hinds.
  Psycho-Oncology. February 28, 2013
  Background Acute lymphoblastic leukemia (ALL) and brain tumor (BT) survivors are at risk for post‐treatment IQ declines. The extent to which lower scores represent global cognitive decline versus domain‐specific impairment remains unclear. This study examined discrepancies between processing speed and estimated IQ (EIQ) scores and identified clinical characteristics associated with score discrepancies in a sample of pediatric cancer survivors. Procedure Survivors (50 ALL, 50 BT) ages 12–17 years completed cognitive testing. The Wechsler Abbreviated Scale of Intelligence provided an untimed measure of general reasoning ability (EIQ). The age‐appropriate Wechsler Intelligence Scale provided a Processing Speed Index (PSI) score. Scores were examined and compared. Results Survivors' PSI scores were lower than their EIQ scores (BT t(45) = 6.3, p < 0.001; ALL t(49) = 6.9, p < 0.001). For BT survivors, lower PSI scores were associated with history of craniospinal irradiation, t(44) = 3.3, p < 0.01. For ALL survivors, lower PSI scores were associated with male gender, grade retention, and time since diagnosis, F(3, 46) = 10.1, p < 0.001. Clinically significant EIQ‐PSI score discrepancies were identified in 41.3% of BT and 14.0% of ALL survivors. Conclusions Many pediatric BT and ALL survivors exhibit slower processing speed than expected for age, whereas general reasoning ability remains largely intact. Risk factors associated with larger EIQ‐PSI discrepancies include the following: BT diagnosis, craniospinal irradiation (BT only), male gender, and younger age at diagnosis (ALL only). Grade retention was frequent and associated with lower EIQ scores (both groups) and PSI scores (ALL only). Describing post‐treatment cognitive declines using global measures of intellectual ability may underestimate dysfunction or fail to isolate specific underlying deficits contributing to impairment. Copyright © 2013 John Wiley & Sons, Ltd.

  February 28, 2013   doi: 10.1002/pon.3255   open full text
• Quantitative assessment of appearance changes and related distress in cancer patients.
  Keiko Nozawa, Chikako Shimizu, Minako Kakimoto, Yuri Mizota, Seiichiro Yamamoto, Yumiko Takahashi, Atsuko Ito, Hideko Izumi, Yasuhiro Fujiwara.
  Psycho-Oncology. February 25, 2013
  Objectives This study examined both the frequency of appearance‐related symptoms and distress resulting from these symptoms in cancer patients receiving chemotherapy. Methods Self‐report questionnaires were distributed to 753 outpatients receiving ≧4 weeks of treatment at an outpatient chemotherapy center. Valid responses were returned by 638 patients (response rate, 84.7%). Participants were questioned about 57 appearance‐related symptoms (AS) and 23 non‐appearance‐related physical symptoms (non‐AS); psychological well‐being was assessed using a shortened version of the Derriford Appearance Scale 59. Results Questionnaire responses were obtained from 264 male and 374 female patients (mean age, 59.5 years; range, 18–85 years). Most respondents (80.3%) were concerned with changes in appearance resulting from treatment. By sex and disease type, women suffered more than men, and treatment for breast cancer created the greatest distress for women. Conclusion Cancer patients are concerned about a variety of AS, and these may result in greater distress than non‐AS. AS‐related information and care are increasingly being sought in advance of treatment. Copyright © 2013 John Wiley & Sons, Ltd.

  February 25, 2013   doi: 10.1002/pon.3268   open full text
• The James Supportive Care Screening: integrating science and practice to meet the NCCN guidelines for distress management at a Comprehensive Cancer Center.
  Sharla Wells‐Di Gregorio, Emily K. Porensky, Matthew Minotti, Susan Brown, Janet Snapp, Robert M. Taylor, Michael D. Adolph, Sherman Everett, Kenneth Lowther, Kelly Callahan, Devita Streva, Vicki Heinke, Debra Leno, Courtney Flower, Anne McVey, Barbara Lee Andersen.
  Psycho-Oncology. February 25, 2013
  Background Selecting a measure for oncology distress screening can be challenging. The measure must be brief, but comprehensive, capturing patients' most distressing concerns. The measure must provide meaningful coverage of multiple domains, assess symptom and problem‐related distress, and ideally be suited for both clinical and research purposes. Methods From March 2006 to August 2012, the James Supportive Care Screening (SCS) was developed and validated in three phases including content validation, factor analysis, and measure validation. Exploratory factor analyses were completed with 596 oncology patients followed by a confirmatory factor analysis with 477 patients. Results Six factors were identified and confirmed including (i) emotional concerns; (ii) physical symptoms; (iii) social/practical problems; (iv) spiritual problems; (v) cognitive concerns; and (vi) healthcare decision making/communication issues. Subscale evaluation reveals good to excellent internal consistency, test–retest reliability, and convergent, divergent, and predictive validity. Specificity of individual items was 0.90 and 0.87, respectively, for identifying patients with DSM‐IV‐TR diagnoses of major depression and generalized anxiety disorder. Conclusions Results support use of the James SCS to quickly detect the most frequent and distressing symptoms and concerns of cancer patients. The James SCS is an efficient, reliable, and valid clinical and research outcomes measure. Copyright © 2013 John Wiley & Sons, Ltd.

  February 25, 2013   doi: 10.1002/pon.3256   open full text
• The cancer psychosocial care matrix: a community‐derived evaluative tool for designing quality psychosocial cancer care delivery.
  Laura P. Forsythe, Julia H. Rowland, Lynne Padgett, Karyl Blaseg, Scott D. Siegel, Chad M. Dingman, Theresa A. Gillis.
  Psycho-Oncology. February 25, 2013
  Objective Although the Institute of Medicine provided a vision for effective psychosocial care for cancer survivors, limited guidance exists regarding the essential components of comprehensive care or progressive steps for implementing each component. This paper describes the development of a unique tool for assessing capacity to provide quality psychosocial care to cancer survivors and the results of the first implementation of this tool in community settings. Methods The psychosocial working group of the National Cancer Institute Community Cancer Centers Program (NCCCP) developed the Cancer Psychosocial Care Matrix assessment tool. All NCCCP sites (n = 30, enrolled in 2007 and 2010) completed the matrix indicating their capacity for providing psychosocial care at entry into NCCCP (‘baseline’) after 2 years of NCCCP participation (2007 sites only) and within the coming year (‘future aspirations’). Results At baseline, matrix responses reflected few or no systematic processes in place for most components of comprehensive psychosocial care. However, reported capacity to deliver specific components improved at 2 years post‐NCCCP entry for the 2007 sites and in all NCCCP sites' future aspirations. Conclusions With growing demand on cancer centers to meet new metrics of quality care, the psychosocial matrix can help centers systematically identify and develop steps to address gap areas in their capacity to meet these new standards. The Cancer Psychosocial Care Matrix appears to enable evaluation of psychosocial programs, may promote intentions to improve psychosocial services, and can facilitate communication of ‘best practices’ among cancer centers. Copyright © 2013 John Wiley & Sons, Ltd.

  February 25, 2013   doi: 10.1002/pon.3254   open full text
• Unmet needs of Australian and Canadian haematological cancer survivors: a cross‐sectional international comparative study.
  Alix Hall, H. Sharon Campbell, Rob Sanson‐Fisher, Marita Lynagh, Catherine D'Este, Robin Burkhalter, Mariko Carey.
  Psycho-Oncology. February 25, 2013
  Objective Few population‐based studies have assessed the needs of haematological cancer survivors or conducted international comparisons. We aimed to assess and compare the unmet needs of Australian and Canadian haematological cancer survivors. Methods Two cross‐sectional datasets were analysed. Survivors were recruited from population‐based cancer registries and sent a self‐report survey containing the Survivors Unmet Needs Survey. Australians were aged 18–80 years at the time of study and diagnosed in the last 3 years. Canadians were diagnosed 1–5 years prior and aged 19 years and over at diagnosis. Results A total of 268 Australian and 169 Canadian survivors returned a completed survey. ‘Dealing with feeling tired’ was identified as the highest concern by survivors. Country (LRχ2 = 4.0(1), p = 0.045) was associated with survivors reporting a ‘high/very high’ unmet need with ‘worry about earning money,’ with Australians reporting marginally nonsignificantly higher odds than Canadians (OR 2.1; 95% CI; 0.99, 4.3). Country was not significantly associated with any other outcome. Having a personal expense in the last month as a result of having cancer, younger age at diagnosis, female sex, vocational or other level education, and consulting a health care professional for cancer treatment or concerns about cancer in the last month were associated with multiple areas of need. Conclusions Australian and Canadian haematological cancer survivors were found to experience similar levels of unmet needs. Overall, haematological cancer survivors may require additional assistance in dealing with feeling tired. Copyright © 2013 John Wiley & Sons, Ltd.

  February 25, 2013   doi: 10.1002/pon.3247   open full text
• Elevated peri‐transplant distress in caregivers of allogeneic blood or marrow transplant patients.
  Teresa L. Simoneau, Susan K. Mikulich‐Gilbertson, Crystal Natvig, Kristin Kilbourn, Janet Spradley, Rachel Grzywa‐Cobb, Samuel Philips, Peter McSweeney, Mark L. Laudenslager.
  Psycho-Oncology. February 25, 2013
  Purpose A full‐time 24/7 caregiver is required for 100 days or longer following an allogeneic blood or marrow transplant during which time caregivers have multiple demands. Although distress in caregivers is documented, generalization is limited by small sample sizes, restricted range of assessments, and lack of information as to which caregivers may be more vulnerable to distress. The purpose of this study was to describe the peri‐transplant psychological status of a sample of caregivers of allogeneic transplant patients. Methods We assessed caregiver mood, stress, burden, and sleep using valid self‐report measures in 109 caregivers of allogeneic transplant patients prior to stem cell transplantation. Caregivers' scores were compared with norms or established cutoff scores for behavioral measures. Additionally, demographic characteristics such as age and sex were tested as predictors of distress. Results Caregivers showed significant levels of anxiety, stress, intrusion and avoidance behaviors, and poor sleep at the start of transplant compared with established norms. Younger caregivers were more distressed than older caregivers. There were no differences in levels of distress between male and female caregivers. Conclusion The peri‐transplant period is a time of heightened anxiety and distress for caregivers of allogeneic transplant patients. This study indicates that caregivers would benefit from support programs in the peri‐transplant period. Recommendations for types of support that may be helpful to caregivers are provided, but additional research is needed to validate that these programs would help caregivers providing care to patients receiving an allogeneic transplant in the peri‐transplant period. Copyright © 2013 John Wiley & Sons, Ltd.

  February 25, 2013   doi: 10.1002/pon.3259   open full text
• Satisfaction with information provision in cancer patients and the moderating effect of Type D personality.
  Olga Husson, Johan Denollet, Simone Oerlemans, Floortje Mols.
  Psycho-Oncology. February 19, 2013
  Objective Optimal information provision is important in cancer survivorship, but satisfaction with this provision may depend upon individual differences in personality. We examined the effect of the personality traits negative affectivity and social inhibition, and their combined effect (Type D personality) on satisfaction with received information. Methods Four population‐based, cross‐sectional surveys were conducted. All individuals diagnosed with lymphoma, multiple myeloma, endometrial cancer or colorectal cancer (1998–2008) as registered in the Eindhoven Cancer Registry were eligible for participation. In total, 4446 patients received questionnaires including the EORTC QLQ‐INFO25 and the Type D personality scale (DS14); 69% responded (n = 3080). Results Nineteen percent of patients (n = 572) had a Type D personality. The perceived receipt of disease‐specific (mean 46 vs. 51), medical test (56 vs. 63) and treatment information (37 vs. 42) was significantly lower for Type D patients compared with non‐Type Ds as assessed with the EORTC QLQ‐INFO25 (scales 0–100; all ps < 0.01). Cancer patients with a Type D personality were less satisfied with the received information (49 vs. 58; p < 0.01) and found the received information less useful (55 vs. 61; p < 0.01) compared with non‐Type Ds. Multivariate linear regression analyses showed that Type D personality was independently associated with information about the disease (Beta = −0.09), medical tests (Beta = −0.12) and treatment (Beta = −0.08), and with satisfaction with information received (OR = 0.54; 95%CI = 0.44–0.66;all ps < 0.01). Conclusions This study showed that patients with a Type D personality perceived that they received less information and reported less satisfaction with the amount of received information as compared with non‐Type D patients. Copyright © 2013 John Wiley & Sons, Ltd.

  February 19, 2013   doi: 10.1002/pon.3267   open full text
• Young adult daughters of BRCA1/2 positive mothers: What do they know about hereditary cancer and how much do they worry?
  Andrea F. Patenaude, Nadine Tung, Paula D. Ryan, Leif W. Ellisen, Larissa Hewitt, Katherine A. Schneider, Kenneth P. Tercyak, Julie Aldridge, Judy E. Garber.
  Psycho-Oncology. February 18, 2013
  Objective The objectives of this study are to determine (i) what daughters, ages 18–24 years, of BRCA1/2 mutation carriers understand about their 50% chance of carrying a BRCA1/2 mutation and about risk reduction or management options for mutation carriers, (ii) the extent and nature of daughters' cancer‐related distress, and (iii) the effects of knowing mother's mutation status on daughters' future plans. Methods A total of 40 daughters, currently aged 18–24 years, of mothers who tested positive for a mutation in BRCA1/2 were invited by mail to participate (with contact information supplied by their mothers). Daughters participated in a qualitative telephone interview about the impact of learning their mother's mutation status on their understanding of their own cancer risks and their cancer‐related distress, and their knowledge of screening strategies, risk‐reducing surgery, current health status, and future plans. Participants also completed study‐specific demographic and family history questionnaires, the Brief Symptom Inventory‐18, Impact of Event Scale (with hereditary predisposition to breast/ovarian cancer as the event), and the Breast Cancer Genetic Counseling Knowledge Questionnaire. Results Daughters' genetic knowledge is suboptimal; gaps and misconceptions were common. Over 1/3 of the daughters reported high cancer‐related distress, despite normal levels of general distress. Disclosed genetic information raised future concerns, especially regarding childbearing. Conclusion Targeted professional attention to this high‐risk cohort of young women is critical to inform the next generation of daughters of BRCA1/2 mutation carriers and encourage recommended screening by age 25 years. Improved uptake of screening and risk reduction options could improve survival, and psychoeducation could reduce cancer‐related distress. Copyright © 2013 John Wiley & Sons, Ltd.

  February 18, 2013   doi: 10.1002/pon.3257   open full text
• Breast cancer meanings: a cognitive‐developmental study.
  Luzia Travado, Joaquim C. Reis.
  Psycho-Oncology. February 18, 2013
  Objective This study addresses the meanings women with breast cancer attach to their illness within a cognitive‐developmental framework. The aim of the present study was twofold: (i) to identify the content of women's meanings in five domains of breast cancer representation (identity, causes, consequences, timeline and controllability), and (ii) to verify if those meanings can be classified developmentally and propose a developmental sequence of meanings for breast cancer. Methods Fifty women treated for breast cancer, as outpatients by the Breast Surgery Multidisciplinary Team at Hospital S. José, Lisbon, Portugal, were randomly selected and interviewed using a semi‐structured method, in order to obtain data on the significance they attached to their illness. Results A typical breast cancer representation profile was identified: 74% of women know their diagnosis, 70% conceive its causes as external factors, 50% refer to emotional and functional changes as main consequences, 62% are expectant towards the future and 36% considered themselves cured. It was possible to classify women's illness meanings into different developmental levels: the majority of women acceded only to lower (level 2 = 36%) and intermediate levels (level 3 = 50%). A developmental sequence of meanings for breast cancer is presented. Conclusions The identification of women's illness meanings enhances understanding of the emotional reactions and coping processes they use in this stressful situation. Also, it enables the clinician to match clinical methodologies with the patient's developmental level. Cognitive and developmental approaches offer a useful framework for making decisions about prevention and clinical procedures with breast cancer women, which may benefit clinical outcomes. Copyright © 2013 John Wiley & Sons, Ltd.

  February 18, 2013   doi: 10.1002/pon.3246   open full text
• Fear of cancer recurrence in young early‐stage breast cancer survivors: the role of metacognitive style and disease‐related factors.
  B. Thewes, M. L. Bell, P. Butow.
  Psycho-Oncology. February 13, 2013
  Objective Fear of cancer recurrence (FCR) is a common challenge of cancer survivorship, particularly in younger survivors. Maladaptive metacognitions have been shown to be important to the development of a range of emotional disorders but have not previously been explored in the context of FCR. Aims This study aimed to explore the relationship between FCR and a maladaptive metacognitions. Methods This cross‐sectional study included young women diagnosed with early‐stage breast cancer at least 1 year prior to study entry. Participants completed a web‐based questionnaire, which included the Fear of Cancer Recurrence Inventory (FCRI) and the brief Metacognitions Questionnaire‐30 (MCQ‐30). Linear regression was used to calculate unadjusted and adjusted slope estimates of the association of FCR with six metacognition variables, the total score of the MCQ‐30 and the five subscales. Results Two‐hundred and eighteen women with a mean age of 39 years at diagnosis participated. All measures of metacognitive style were moderately correlated with FCRI scores (r = 0.31–0.49) and significantly associated with FCRI in both unadjusted and adjusted models. Overall metacognitive style explained 36% of the variance in FCR scores in combination with disease and demographic factors. Negative metacognitions (R2 = 0.32) and need for control over cognition (R2 = 0.26) were the MCQ‐30 subscales most associated with higher FCR. Conclusions Unhelpful metacognitions appear to play an important role in FCR in young women with early‐stage breast cancer. Treatments that focus on changing unhelpful metacognitions may prove a useful approach for treating clinical FCR in cancer survivors in the future. Copyright © 2013 John Wiley & Sons, Ltd.

  February 13, 2013   doi: 10.1002/pon.3252   open full text
• The impact of a managed transition of care upon psychosocial characteristics and patient satisfaction in a cohort of adult survivors of childhood cancer.
  M. Laar, A. Glaser, R. S. Phillips, R. G. Feltbower, D. P. Stark.
  Psycho-Oncology. February 12, 2013
  Objective Many adult survivors of childhood cancer receive care in paediatric departments, despite national policy to transition their care to adult services. When long‐term follow‐up care for survivors of childhood cancer in our region moved from a paediatric to an adult environment in 2009, we prospectively assessed the impact of this change on patient satisfaction. Methods Questionnaire data were collected in paediatric and adult clinical environments regarding the level of satisfaction with care and potential mediators: quality of life, psychological health and social difficulties. Predictors of satisfaction and optimum longitudinal risk‐based care were described using path analysis and compared with previously described models. Results There was no significant difference in satisfaction between the paediatric and adult settings. Short waiting times and increased understanding of the purpose of follow‐up were significantly associated with increased satisfaction. Those with a higher perception of health problems and those that were older were more likely to not attend all of their clinic appointments. Conclusions Within our service, transition to adult care did not impact significantly upon patient satisfaction. Shorter waits and knowing why participants were attending the clinic increased satisfaction. Joint working between adult and paediatric cancer professionals enabled adult survivors of childhood cancer to receive highly satisfactory care in adult services. Copyright © 2013 John Wiley & Sons, Ltd.

  February 12, 2013   doi: 10.1002/pon.3248   open full text
• Screening for depression and anxiety in women with breast and gynaecologic cancer: course and prevalence of morbidity over 12 months.
  Stafford Lesley, Judd Fiona, Gibson Penny, Komiti Angela, Mann G. Bruce, Quinn Michael.
  Psycho-Oncology. February 12, 2013
  Objective This study aims to investigate the course and prevalence of anxiety and depression symptoms over 56 weeks in women with newly diagnosed breast and gynaecologic cancer and determine the acceptability and efficiency of incorporating routine screening into practice. Methods Participants completed the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS‐A) and Centre for Epidemiological Studies Depression Scale (CES‐D) at diagnosis and again every 8 weeks for 56 weeks. Changes over time were analysed with repeated measures ANOVA adjusted for post hoc comparisons. Thresholds for caseness/referral to mental health were ≥11 and ≥16 on the HADS‐A and CES‐D, respectively. Results Participants were 167 women (101 breast, 66 gynaecologic). Mean ± SD age was 57.63 ± 22.66 years. Rates of anxiety (17.7%), depression (32.5%) and combined anxiety and depression (35%) symptoms were highest at diagnosis. Mean ± SD scores of anxiety (6.43 ± 3.83) and depression symptoms (12.68 ± 9.47) were highest at diagnosis with significant improvements observed by 8 and 24 weeks, respectively, and maintained thereafter. Overall rates of anxiety, depression and combined symptoms were 7.5%, 23.4% and 24.1%, respectively. Patients with breast and gynaecologic cancer did not differ. Referral was offered at least once to 94 women (56.3%), of whom 45 (47.9%) declined, 23 (24.5%) accepted and 26 (27.7%) were already receiving treatment. Patient evaluation was favourable. Conclusions Women are most vulnerable to psychological morbidity at diagnosis. Symptoms improve significantly over time. Reported rates are lower than those in the literature. Regular screening by self‐report is acceptable to patients but may not be the most efficient method of improving patient outcomes. Copyright © 2013 John Wiley & Sons, Ltd.

  February 12, 2013   doi: 10.1002/pon.3253   open full text
• Adolescent survivors of childhood cancer: are they vulnerable for psychological distress?
  Micol E. Gianinazzi, Corina S. Rueegg, Laura Wengenroth, Eva Bergstraesser, Johannes Rischewski, Roland A. Ammann, Claudia E. Kuehni, Gisela Michel,.
  Psycho-Oncology. February 11, 2013
  Objectives We aimed to (i) evaluate psychological distress in adolescent survivors of childhood cancer and compare them to siblings and a norm population; (ii) compare the severity of distress of distressed survivors and siblings with that of psychotherapy patients; and (iii) determine risk factors for psychological distress in survivors. Methods We sent a questionnaire to all childhood cancer survivors aged <16 years when diagnosed, who had survived ≥5 years and were aged 16–19 years at the time of study. Our control groups were same‐aged siblings, a norm population, and psychotherapy patients. Psychological distress was measured with the Brief Symptom Inventory‐18 (BSI‐18) assessing somatization, depression, anxiety, and a global severity index (GSI). Participants with a T‐score ≥57 were defined as distressed. We used logistic regression to determine risk factors. Results We evaluated the BSI‐18 in 407 survivors and 102 siblings. Fifty‐two survivors (13%) and 11 siblings (11%) had scores above the distress threshold (T ≥ 57). Distressed survivors scored significantly higher in somatization (p = 0.027) and GSI (p = 0.016) than distressed siblings, and also scored higher in somatization (p ≤ 0.001) and anxiety (p = 0.002) than psychotherapy patients. In the multivariable regression, psychological distress was associated with female sex, self‐reported late effects, and low perceived parental support. Conclusions The majority of survivors did not report psychological distress. However, the severity of distress of distressed survivors exceeded that of distressed siblings and psychotherapy patients. Systematic psychological follow‐up can help to identify survivors at risk and support them during the challenging period of adolescence. Copyright © 2013 John Wiley & Sons, Ltd.

  February 11, 2013   doi: 10.1002/pon.3249   open full text
• Melanoma survivors at high risk of developing new primary disease: a qualitative examination of the factors that contribute to patient satisfaction with clinical care.
  J. K. McLoone, K. J. Watts, S. W. Menzies, K. Barlow‐Stewart, G. J. Mann, N. A. Kasparian.
  Psycho-Oncology. February 05, 2013
  Background Providing ongoing clinical care that adequately addresses patients' medical, psychosocial and information needs is challenging, particularly for patient groups at increased risk of developing life‐threatening disease such as malignant melanoma. This study examined a model of clinical care developed by the High Risk Clinic (HRC) of the Sydney Melanoma Diagnostic Centre in relation to patient satisfaction. Methods Semi‐structured telephone interviews were conducted and analyzed using the framework of Miles and Huberman, and themes were organized using the qualitative software package, QSR NVivo8. Results Twenty HRC patients participated in the study (nine men, 11 women; mean age 57.6 years, age range 34–74 years; response rate 91%). Satisfaction with clinical care at the HRC was high. Factors contributing to patient satisfaction included: rapid and regular access to physicians who were perceived by participants as experts, the development of confidence and trust in one's treating doctor, and a sense of being cared about and understood by one's healthcare team. Although one‐third of the participants reported some inconveniences in attending the clinic, these were viewed as minor difficulties and not significant barriers to care. Formal psychological support was not sought or expected by participants, although many expressed long‐standing melanoma‐related fears and concerns. Conclusions Accessible, expert medical attention, delivered in a patient‐centered manner was integral to melanoma survivors' satisfaction with clinical management. Appropriate referrals to psychological support may further increase satisfaction with clinical care. Copyright © 2013 John Wiley & Sons, Ltd.

  February 05, 2013   doi: 10.1002/pon.3243   open full text
• Psychiatric manifestations, personality traits and health‐related quality of life in cancer of unknown primary site.
  Thomas Hyphantis, Ilias Papadimitriou, Dimitrios Petrakis, George Fountzilas, Dimitra Repana, Konstantinos Assimakopoulos, André F. Carvalho, Nicholas Pavlidis.
  Psycho-Oncology. January 29, 2013
  Objective Psychiatric manifestations and personality traits are known to influence cancer patients. We aimed to assess psychological distress symptoms, psychosocial factors and health‐related quality of life (HRQoL) in cancer of unknown primary site (CUP) and to test whether these parameters differ between CUP and Metastatic (MKPC) or Non‐Metastatic Known Primary Cancers (N‐MKPC) after controlling for demographics and clinical variables. Methods In this cross‐sectional study, we recruited 50 CUP, 264 N‐MKPC and 52 MKPC participants. We assessed depressive symptoms (Center for Epidemiologic Studies‐Depression [CES‐D]), psychological distress symptoms (Symptom Distress Checklist‐90 Revised), sense of coherence (SOC), ego defense mechanisms (Life Style Index) and HRQoL (World Health Organization Quality of Life Instrument, Short Form). Results The prevalence of clinically significant depressive symptoms (CES‐D ≥ 23) was 40.0% in CUP, 28.8% in MKPC and 23.5% N‐MKPC (p = 0.037). Multivariate logistic regression analysis showed that N‐MKPC patients were 5 times less likely (p = 0.028) and MKPC patients 3.3 times less likely (p = 0.05) to be assessed with probable depression compared with CUP patients after controlling for the major demographic and clinical variables studied. CUP patients presented also higher levels of somatization, anxiety and depressive symptoms; they also had more impaired Physical (p = 0.005), Mental (p = 0.041) and Social Relations (p = 0.044) HRQoL, along with lower scores on SOC and intellectualization defense and higher scores on repression defense, compared with MKPC and N‐MKPC patients. Conclusions These findings suggest that psychiatric manifestations are frequent in CUP, and the patients' resources to cope with the burden of their illness are limited. Attention to CUP patients' psychological distress and coping resources and capacities may enable oncologists to identify and manage modifiable aspects of HRQoL. Copyright © 2013 John Wiley & Sons, Ltd.

  January 29, 2013   doi: 10.1002/pon.3244   open full text
• Predicting outcomes of vocational rehabilitation in patients with brain tumours.
  S. L. Rusbridge, N. C. Walmsley, S. B. Griffiths, P. A. Wilford, J. H. Rees.
  Psycho-Oncology. January 27, 2013
  Objective The aim of this study was to examine the outcome of a vocational rehabilitation programme for patients with brain tumours and to determine whether the outcome could be predicted at point of referral to the service. Methods Data was collected for 34 patients with brain tumours referred to the Macmillan vocational rehabilitation service. Work status at baseline (time of referral) and at discharge was compared. Logistic regression analyses were computed to identify which variables (demographic, tumour and treatment, functional and vocational) predicted work status at discharge from the service. Results Significantly, more patients were working at discharge from the service than at baseline. Having at least some physical disability decreased the likelihood of being in work at discharge from the service. Conclusions The vocational rehabilitation programme for brain tumour survivors showed significant improvement over time. Functional ability affected the likelihood of working to some extent. Vocational rehabilitation services should be available to patients with brain tumours and should focus on supporting patients wishing to return to or maintain their current work. However, more support for brain tumour patients with physical impairments is needed. Copyright © 2013 John Wiley & Sons, Ltd.

  January 27, 2013   doi: 10.1002/pon.3241   open full text
• Reducing the psychological distress of family caregivers of home‐based palliative care patients: short‐term effects from a randomised controlled trial.
  Peter Hudson, Tom Trauer, Brian Kelly, Moira O'Connor, Kristina Thomas, Michael Summers, Rachel Zordan, Vicki White.
  Psycho-Oncology. January 21, 2013
  Background Palliative care is expected to incorporate comprehensive support for family caregivers given that many caregivers suffer psychological morbidity. However, systematically implemented evidence‐based psychological support initiatives are lacking. Aim The objective of this study was to prepare caregivers for the role of supporting a patient with advanced cancer receiving home‐based palliative care by offering a one‐to‐one psycho‐educational intervention. We hypothesised that primary family caregivers who participated in the intervention would report decreased psychological distress (primary outcome), fewer unmet needs and increased levels of perceived preparedness, competence and positive emotions. Methods A three‐arm randomised controlled trial was conducted comparing two versions of the intervention (one face‐to‐face visit versus two visits) plus standard care to a control group (standard care) across four sites in Australia. Results A total of 298 participants were recruited; 148 were in the Control condition, 57 in Intervention 1 (one visit) and 93 in Intervention 2 (two visits). Relative to participants in the control group; the psychological well‐being of participants in the intervention condition was improved by a small amount but non‐significantly. No significant reduction in unmet needs or improvements in positive aspects of caregiving amongst the intervention group were identified. However, the intervention demonstrated significant improvements in participants' levels of preparedness and competence for Intervention 2. Conclusion/implications This research adds to accumulating body of evidence demonstrating that relatively short psycho‐educational interventions can enable family caregivers to feel more prepared and competent in the role of supporting a dying relative. Further investigation is required to determine the longer term outcomes of such interventions. Copyright © 2013 John Wiley & Sons, Ltd.

  January 21, 2013   doi: 10.1002/pon.3242   open full text
• Self‐efficacy for coping with cancer in melanoma patients: its association with physical fatigue and depression.
  Karoline Albrecht, Hannah Droll, Jürgen M. Giesler, Dorothee Nashan, Frank Meiss, Katrin Reuter.
  Psycho-Oncology. January 03, 2013
  Objective The purpose of this study was to explore the impact of self‐efficacy for coping with cancer (SECC) on physical fatigue and depressive symptoms in melanoma patients, in comparison with objective factors, such as treatment with interferon‐alpha (IFN‐α) and medical and sociodemographic variables. Current literature shows that psychological distress in melanoma patients is generally moderate, that they experience high quality of life, and that symptoms of depression and fatigue have been mostly associated with adjuvant IFN‐α treatment Methods A total of 175 melanoma patients, stages Ib–IIIc with and without low‐dose IFN‐α therapy, completed surveys on SECC, depression, and fatigue. Two hierarchical regression analyses were conducted to explore the predictive role of objective factors (first step: tumor stage, time since diagnosis, and current IFN‐α treatment; second step: age and gender) in conjunction with the subjective factor of SECC (third step) on physical fatigue and depression. Results Regression analysis revealed no significant effect of IFN‐α treatment upon depression. Current IFN‐α treatment was predictive of higher fatigue scores, however. The highest predictive effect by far was obtained for SECC, indicating higher fatigue and depression in patients with lower SECC. Conclusions The findings suggest that the treatment with IFN‐α is mainly accompanied by physical fatigue in melanoma patients rather than by mood changes. Most notably, the potential influence of increased SECC on reducing both physical fatigue and depression is suggested by the data, indicating the importance of self‐efficacy enhancing interventions in the psycho‐oncological support of melanoma patients. Copyright © 2013 John Wiley & Sons, Ltd.

  January 03, 2013   doi: 10.1002/pon.3238   open full text
• Beta‐blockers may reduce intrusive thoughts in newly diagnosed cancer patients.
  Monica E. Lindgren, Christopher P. Fagundes, Catherine M. Alfano, Stephen P. Povoski, Doreen M. Agnese, Mark W. Arnold, William B. Farrar, Lisa D. Yee, William E. Carson, Carl R. Schmidt, Janice K. Kiecolt‐Glaser.
  Psycho-Oncology. December 17, 2012
  Objective A cancer diagnosis provokes significant levels of emotional distress, with intrusive thoughts being the most common manifestation among breast cancer survivors. Cancer‐related intrusive thoughts can take the form of emotional memories, flashbacks, nightmares, and intrusive images. Emotional arousal after a severe life stressor prolongs adrenergic activation, which in turn may increase risk for post‐traumatic symptomatology. However, antihypertensive beta‐blockers block adrenergic activation and are known to reduce traumatic memories and related psychological distress. Thus, the current study examined the association between beta‐blocker use and the severity of cancer‐related intrusive thoughts and related symptoms following a cancer diagnosis. Methods The 174 breast and 36 female colorectal cancer patients who had recently undergone diagnostic screening or biopsy included 39 beta‐blocker users and 171 non‐users. Prior to any cancer treatment including surgery, participants completed questionnaires that included the Impact of Events Scale and the Center for Epidemiological Studies Depression Scale. Analyses controlled for age, education, cancer stage, cancer type, days since diagnosis, marital status, depression, and comorbidities. Results Although the high rates of cancer‐related distress in this sample were similar to those of other studies with recently diagnosed patients, beta‐blocker users endorsed 32% fewer cancer‐related intrusive thoughts than non‐users. Conclusions Recently diagnosed cancer patients using beta‐blockers reported less cancer‐related psychological distress. These results suggest that beta‐blocker use may benefit cancer patients' psychological adjustment following diagnosis, and provide a promising direction for future investigations on the pharmacological benefits of beta‐blockers for cancer‐related distress. Copyright © 2012 John Wiley & Sons, Ltd.

  December 17, 2012   doi: 10.1002/pon.3233   open full text
• A longitudinal study of distress (depression and anxiety) up to 18 months after radiotherapy for head and neck cancer.
  Kate Neilson, Annabel Pollard, Ann Boonzaier, June Corry, David Castle, David Smith, Tom Trauer, Jeremy Couper.
  Psycho-Oncology. December 13, 2012
  Objective The aim of the study was to assess symptoms of depression and anxiety in patients with head and neck cancer up to 18 months after radiotherapy. Methods Prospective observational study of consecutive head and neck outpatients was conducted at a tertiary cancer centre (n = 101). Eligibility included diagnosis of cancer in the head and neck region, where the patient agreed to radiotherapy with curative intent. Data were collected before commencement of radiotherapy and 3 weeks and 18 months after completion. Symptoms of depression and anxiety were assessed by the Hospital Anxiety and Depression Scale. Tumour/treatment‐related physical symptoms were assessed using the ‘Additional Concerns’ subscale of the Functional Assessment of Chronic Illness Therapy for Head and Neck Cancer. Results The prevalence of identified probable cases of depression was 15% at baseline, increasing to 29% 3 weeks post‐treatment, falling to 8% at 18‐month follow‐up. The number of probable cases of anxiety was 20% at baseline, 17% at 3 weeks post‐treatment and 22% at 18‐month follow‐up. Depression scores significantly increased from baseline to 3 weeks post‐treatment and decreased at 18‐month follow‐up. Variability in depression scores was accounted for by tumour/treatment‐related physical symptoms. Anxiety scores significantly decreased between baseline and 3‐week post‐treatment and increased at 18‐month follow‐up. Younger age and more tumour/treatment‐related physical symptoms predicted anxiety scores. Conclusions The rates of depression in head and neck cancer patients increase following cancer treatment and are related to tumour/treatment‐related physical symptoms. Anxiety levels are higher pre‐treatment, lower immediately following cancer treatment but rise to near pre‐treatment levels more than a year after completion of cancer treatment. Copyright © 2012 John Wiley & Sons, Ltd.

  December 13, 2012   doi: 10.1002/pon.3228   open full text
• Screening for psychological distress in neurosurgical brain tumor patients using the Patient Health Questionnaire‐2.
  Adomas Bunevicius, Vytenis Deltuva, Sarunas Tamasauskas, Arimantas Tamasauskas, Robertas Bunevicius.
  Psycho-Oncology. December 12, 2012
  Objective Psychological distress is highly prevalent but often undiagnosed in brain tumor patients. We evaluated the psychometric properties of the Patient Health Questionnaire‐2 (PHQ‐2) for screening of distressed neurosurgical brain tumor patients. Methods A total of 226 (69% women; mean age 55.6 ± 14.7 years) consecutive patients on admission for elective brain tumor surgery were evaluated for psychological distress using the PHQ‐2, the Hospital Anxiety and Depression Scale (HADS; n = 206), and the Beck Depression Inventory‐II (BDI‐II; n = 196). At discharge, the patients were reevaluated using the PHQ‐2 and HADS. Results On admission, 43% and 18% of patients had moderate‐severe psychological distress according to the HADS (HADS depression or anxiety score ≥11) and BDI‐II (score ≥20), respectively. At discharge, there was a significant decrease in psychological distress among patients according to the PHQ‐2 (p = 0.04) and HADS (p < 0.001) screening results. The PHQ‐2 had marginal internal consistency (Cronbach's coefficient alpha = 0.68) and suboptimal test–retest reliability (intraclass correlation coefficient = 0.51). The PHQ‐2 had acceptable psychometric properties for identifying patients with moderate‐severe psychological distress according to the HADS (sensitivity = 74%, specificity = 68%, and positive predictive value (PPV) = 40%) and BDI‐II (sensitivity = 71%, specificity = 65%, and PPV = 30%). Psychometric properties of the PHQ‐2 were inferior for mild‐severe psychological distress. Greater number of PHQ‐2 depressive symptoms was associated with greater scores on the HADS and BDI‐II (all ps < 0.001). Conclusions Psychological distress is prevalent in brain tumor patients and can be successfully identified using the PHQ‐2. The PHQ‐2 has moderate internal consistency. The PHQ‐2 should be considered for routine use in brain tumor patients for psychological distress screening purposes. Copyright © 2012 John Wiley & Sons, Ltd.

  December 12, 2012   doi: 10.1002/pon.3237   open full text
• Predicting positive and negative impacts of cancer among long‐term endometrial cancer survivors.
  Ingrid J. Rowlands, Christina Lee, Monika Janda, Christina M. Nagle, Andreas Obermair, Penelope M. Webb,.
  Psycho-Oncology. December 12, 2012
  Objective Although the survival outcomes among women diagnosed with endometrial cancer are very favorable, little is known about the long‐term impact of their cancer experience. This study identifies the extent of positive and negative impacts of cancer and factors associated with this, amongst long‐term survivors of endometrial cancer. Methods Australian women diagnosed with endometrial cancer (N = 632) were sent questionnaires at the time of diagnosis and 3–5 years later. Hierarchical multiple regression models were used to examine whether a range of variables at diagnosis/treatment predicted subsequent scores on the Impact of Cancer Scale, which examines positive (e.g. health awareness) and negative (e.g. appearance concerns) impacts amongst cancer survivors. Results Overall, women had a higher mean score for the positive than negative impact scales (M = 3.5 versus M = 2.5, respectively). An intermediate grade of endometrial cancer, a prior diagnosis of cancer and lower levels of education were significant, but weak, predictors of higher scores on the positive impact scale. Higher scores on the negative impact scale were predicted by a higher grade of cancer, poor physical and mental health, a younger age, being single or having lower levels of education. Conclusions The study demonstrates that factors that predict positive impact in cancer survivors differ to those that predict negative impact, suggesting that interventions to optimize cancer survivors' quality of life will need to be multi‐dimensional, and this supports the need for tailored intervention. Copyright © 2012 John Wiley & Sons, Ltd.

  December 12, 2012   doi: 10.1002/pon.3236   open full text
• Head and neck cancer and dysphagia; caring for carers.
  J. M. Patterson, T. Rapley, P. N. Carding, J. A. Wilson, E. McColl.
  Psycho-Oncology. December 04, 2012
  Objectives A diagnosis of head and neck cancer (HNC) is a profound event for patients and family members who play a crucial role in their care. Eating and drinking difficulties affect patients' quality of life (QOL), but the impact on the carers' QOL has not been explored. This preliminary mixed method study reports on carer QOL over time and investigates the relationship with dysphagia. Methods Two hundred and eight HNC patients referred for (chemo)radiotherapy were asked to identify a carer and complete a health‐related QOL and a swallowing QOL questionnaire at pre‐treatment, 3 and 12 months post‐treatment. Carers were given the Caregiver QOL‐Cancer (CQOL‐C) questionnaire at the same time points. A purposive sample of patient and carer dyads was observed over mealtimes and interviewed. Results Seventy per cent of carers returned a questionnaire at least once. There was no change in CQOL‐C scores between pre‐treatment and 3  months, but a significant improvement was found between 3 and 12 months post‐treatment (p = 0.012). Patient‐reported outcomes accounted for 52% of variance in carer QOL measurements (R2 = 0.52, p < 0.001). Four themes emerged from the qualitative data food provision, monitoring, motivation and changes to lifestyle. Conclusions Findings suggest a relationship between carer and patient QOL. Elsewhere, these two characteristics have been associated such that the greater the patients' physical care needs, the poorer the carers' and patients' QOL. Living with someone with dysphagia not only involves managing the physical swallowing difficulties but is also likely to impact on social activities such as participation in shared meals, leading to permanent lifestyle changes. Copyright © 2012 John Wiley & Sons, Ltd.

  December 04, 2012   doi: 10.1002/pon.3226   open full text
• My changed body: breast cancer, body image, distress and self‐compassion.
  Astrid Przezdziecki, Kerry A. Sherman, Andrew Baillie, Alan Taylor, Elizabeth Foley, Kellie Stalgis‐Bilinski.
  Psycho-Oncology. December 02, 2012
  Background Bodily changes after breast cancer treatment can lead to long‐term distress. Self‐compassion, the ability to be kind to oneself, is an internal resource that may enhance a woman's ability to adjust to cancer‐related bodily changes. The aim of the present study was to test the hypothesis that self‐compassion mediates the relationship between body image and distress, controlling for alternate plausible mediators. Methods Members of a nationwide breast cancer consumer network were invited to participate. A total of 279 women who had finished active cancer treatment completed the online survey. Assessments included the Body Image Scale; Self‐compassion Scale; Depression, Anxiety and Stress Scale and items measuring perceived normative pressure and comfort with one's weight. Possible mediating effects of proposed variables on the body image–distress relationship were assessed. Results Tests using a bootstrapping approach with multiple mediators were significant for self‐compassion on distress. Body image disturbance was indirectly associated with distress through low self‐compassion. Conclusions Body image disturbance and lower self‐compassion were associated with increased psychological distress among these breast cancer survivors. This study provides preliminary evidence for a mediating role of self‐compassion between body image disturbance and psychological distress, suggesting a potentially protective effect of higher levels of self‐compassion for women at risk of experiencing body image disturbance. Copyright © 2012 John Wiley & Sons, Ltd.

  December 02, 2012   doi: 10.1002/pon.3230   open full text
• Levels of distress in breast cancer survivors approaching discharge from routine hospital follow‐up.
  Joanne Thompson, Rob Coleman, Brigitte Colwell, Jenny Freeman, Diana Greenfield, Karen Holmes, Nigel Mathers, Malcolm Reed.
  Psycho-Oncology. December 02, 2012
  Background Hospital‐based breast cancer follow‐up provides reassurance to patients despite limited evidence for clinical efficacy. Although alternative models of hospital/community‐based follow‐up have yielded encouraging results, traditional hospital follow‐up continues to be offered to all patients. Survival rates continue to rise; consequently, more patients are likely to require support, as many have a limited understanding of the long‐term physical and emotional consequences of cancer and its treatment. We examine levels of psychological distress in breast cancer patients in follow‐up 2 years or more from diagnosis. Methods This prospective study measured psychological distress levels using standardized measures [Hospital Anxiety and Depression Scale (HADS), Clinical Outcomes for Routine Evaluation (CORE) and Measure Yourself Medical Outcomes Profile (MYMOP)]. Between January and September 2008, 323 consecutive patients were approached in outpatient clinics. Ninety‐six patients declined to participate. Results Two hundred twenty‐seven patients took home patient information sheets; 172 (75%) returned completed questionnaires to assess levels of distress (HADS, CORE). MYMOP provided self‐reported data on patient symptoms. Patients reported low levels of distress in hospital‐based follow‐up, which were comparable or better than general population norms, although there was a significant minority of patients reporting high scores (n = 27, 15.7%) on HADS or CORE. There was good agreement between these two measures. All sub‐scales of CORE (except risk) correlated well with HADS for anxiety/depression. No significant changes were detected in the standardized measures. MYMOP results showed that 23.8% of respondents reported both physical and emotional symptoms. Conclusions Breast cancer survivors reported good psychological outcomes 2 years on from diagnosis. Screening for psychological/emotional distress is a vital part of follow‐up care, which should be incorporated into UK policy. Copyright © 2012 John Wiley & Sons, Ltd.

  December 02, 2012   doi: 10.1002/pon.3229   open full text
• Working memory training in survivors of pediatric cancer: a randomized pilot study.
  Kristina K. Hardy, Victoria W. Willard, Taryn M. Allen, Melanie J. Bonner.
  Psycho-Oncology. December 02, 2012
  Objectives Survivors of pediatric brain tumors and acute lymphoblastic leukemia (ALL) are at increased risk for neurocognitive deficits, but few empirically supported treatment options exist. We examined the feasibility and preliminary efficacy of a home‐based, computerized working memory training program, CogmedRM, with survivors of childhood cancer. Methods Survivors of brain tumors or ALL (n = 20) with identified deficits in attention and/or working memory were randomized to either the success‐adapted computer intervention or a non‐adaptive, active control condition. Specifically, children in the adaptive condition completed exercises that became more challenging with each correct trial, whereas those in the non‐adaptive version trained with exercises that never increased in difficulty. All participants were asked to complete 25 training sessions at home, with weekly, phone‐based coaching support. Brief assessments were completed pre‐intervention and post‐intervention; outcome measures included both performance‐based and parent‐report measures of working memory and attention. Results Eighty‐five percent of survivors were compliant with the intervention, with no adverse events reported. After controlling for baseline intellectual functioning, survivors who completed the intervention program evidenced significant post‐training improvements in their visual working memory and in parent‐rated learning problems compared with those in the active control group. No differences in verbal working memory functioning were evident between groups, however. Conclusions Home‐based, computerized cognitive training demonstrates good feasibility and acceptability in our sample. Children with higher intellectual functioning at baseline appeared to benefit more from the training, although further study is needed to clarify the strength, scope, and particularly the generalizability of potential treatment effects. Copyright © 2012 John Wiley & Sons, Ltd.

  December 02, 2012   doi: 10.1002/pon.3222   open full text
• Multiple primary cancer survivors have poorer health status and well‐being than single primary cancer survivors: a study from the population‐based PROFILES registry.
  Melissa S. Y. Thong, Floortje Mols, Rob H. A. Verhoeven, Lifang Liu, Michael A. Andrykowski, Jan A. Roukema, Lonneke V. Poll‐Franse.
  Psycho-Oncology. December 02, 2012
  Objective The health status and psychosocial well‐being of multiple primary cancer (MPC) survivors are under‐researched. Methods In total, 3615 survivors identified from the Eindhoven Cancer Registry between 2008 and 2009 were assessed. About one in six survivors had survived MPC (n = 556). All survivors completed questionnaires on health status (SF‐36/European Organization of Research and Treatment of Cancer quality of life module), mental health (Hospital Anxiety and Depression Scale) and impact of cancer (Impact of Cancer). Results Compared with single primary cancer survivors, MPC survivors reported significantly poorer scores on general health and higher symptom scores on diarrhoea and fatigue. Significantly more MPC survivors met the subclinical cut‐off score of ≥8 points on the Hospital Anxiety and Depression Scale depression subscale (27% vs. 19%, p = 0.0001). MPC survivors also reported significantly greater negative impact of cancer (namely body changes and life interferences) and positive impact of health awareness on their lives. All results were adjusted for age at survey, time since last diagnosis, sex, comorbidity, body mass index and marital status. In secondary analyses, MPC survivors with different primary cancer combinations or time interval between primary cancer diagnoses had comparable health status and psychosocial well‐being. Conclusion Multiple primary cancer survivors reported a poorer health status and, in general, experienced a greater negative impact of cancer on their psychosocial well‐being than single primary cancer survivors. Copyright © 2012 John Wiley & Sons, Ltd.

  December 02, 2012   doi: 10.1002/pon.3227   open full text
• Screening for depression with Centre for Epidemiological Studies Depression Scale Revised and its implication for consultation–liaison psychiatry practice among cancer subjects: a perspective from a developing country.
  Andrew T. Olagunju, Olatunji F. Aina, Babatunde Fadipe.
  Psycho-Oncology. November 29, 2012
  Objective Co‐morbidity of depressive symptomatology is a common indication for use of mental health services in oncology. In this regard, screening instruments are useful for prompt identification of mental disorders in cancer. This study is set to evaluate the diagnostic validity of Centre for Epidemiological Studies Depression Scale Revised (CES‐DR) for depression screening in cancer. Methods The CES‐DR and the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) were administered by the researchers on 200 attendees of a Nigerian hospital with histological diagnoses of cancer. Subsequently, the diagnostic validity of CES‐DR was compared with SCAN. Results Ninety‐eight (49.0%) participants had significant depressive symptomatology (CES‐DR scores of ≥16) as against the diagnosis of depression in 55 (27.5%) participants following SCAN interview. Furthermore, of these 55 (27.5%) depressed participants, two (3.6%) participants had CES‐DR scores <16 (non‐cases). The Cronbach's alpha reliability of CES‐DR was 0.86, and sensitivity and specificity of CES‐DR were 96.4% and 68.7%, respectively, whereas positive and negative predictive values of CES‐DR were found to be 0.54 and 0.98, respectively, in this study. The average administration time of CES‐DR was 6 (±2) min, and an inter‐rater reliability of 93.7% was observed. Conclusions The CES‐DR was found in this study to be a useful tool for screening for depression in cancer but with diagnostic limitation when compared with SCAN. The development as well as popularization of screening instrument(s) with improved diagnostic and administration property for prompt identification of mental disorders to improve consultation–liaison psychiatry services in cancer care is recommended. Furthermore, replication of similar research is warranted. Copyright © 2012 John Wiley & Sons, Ltd.

  November 29, 2012   doi: 10.1002/pon.3234   open full text
• Web‐based self‐monitoring for weight loss among overweight/obese women at increased risk for breast cancer: the HELP pilot study.
  Lisa Cadmus‐Bertram, Julie B. Wang, Ruth E. Patterson, Vicky A. Newman, Barbara A. Parker, John P. Pierce.
  Psycho-Oncology. November 27, 2012
  Objective Excess weight and physical inactivity are modifiable risk factors for breast cancer. Training women to use self‐help resources over the internet has potential for reducing intervention costs and enhancing maintenance. Methods A total of 50 overweight/obese women at increased breast cancer risk were randomized to a 12‐week intervention or a comparison group. Telephone‐based sessions trained participants to use web‐based self‐monitoring tools to set goals and track diet and exercise. The comparison group received dietary information but no training. At baseline and 12 weeks, participants were weighed and wore an accelerometer. Results Participants were aged 60.9 ± 0.8 years with a BMI of 33.1 ± 0.6 kg/m2. The intervention group lost 3.3 ± 4.0 kg, whereas the comparison group gained 0.9 ± 3.4 kg (p < 0.0001). Intervention participants who found the website helpful lost 5.6 ± 0.7 kg; those who did not lost 0.8 ± 0.9 kg (p < 0.001). Change in physical activity was +70 ± 140 min/week among those who found the website helpful, −6 ± 75 min/week among those who did not, and −34 ± 207 min/week in the comparison group (p < 0.01). Conclusions A program to train women to use web‐based weight loss tools achieved a substantial short‐term weight loss among the majority of participants. Further follow‐up is needed to assess weight loss maintenance over time. Copyright © 2012 John Wiley & Sons, Ltd.

  November 27, 2012   doi: 10.1002/pon.3219   open full text
• Occupational stress and its association with early retirement and subjective need for occupational rehabilitation in cancer patients.
  Hilke M. Böttcher, Monika Steimann, Martin Rotsch, Karl‐Heinz Zurborn, Uwe Koch, Corinna Bergelt.
  Psycho-Oncology. November 23, 2012
  Objective Returning to work often plays an important role for cancer survivors. Occupational stress may hamper a successful return to work, so cancer survivors should be given the opportunity to address occupational stress issues before returning to work. We investigated the amount of occupational stress among cancer patients and whether it is associated with their well‐being, their subjective need for occupational rehabilitation and elevations in their risk of early retirement. Methods At the beginning of rehabilitation, we asked cancer patients to respond to occupation‐related and health‐related questionnaires. We used t‐tests, chi‐square tests, and logistic regression analyses to address our research questions. Results A total of 477 patients participated in the study. Of these, 19% were occupationally stressed, and 26% reported subjective need for occupational rehabilitation. Patients who reported work‐related stress had a diminished quality of life, were more likely to report subjective need for occupational rehabilitation (OR = 2.16), and had a higher risk of early retirement (OR = 5.44). Furthermore, cancer patients reported deficits in both active coping abilities and mental stability at work. Conclusions Because occupational stress is associated with a higher risk of early retirement, both patients and physicians should take work‐related problems seriously. Screening patients for occupational stress may help physicians identify patients who are at risk of experiencing problematic work re‐entries. Furthermore, the results of the study suggest that cancer patients might have problems maintaining confidence in their abilities to solve work‐related problems. Therefore, facilitating the development of a perception of self‐efficacy might be an important treatment goal. Copyright © 2012 John Wiley & Sons, Ltd.

  November 23, 2012   doi: 10.1002/pon.3224   open full text
• Screening for distress, the sixth vital sign, in lung cancer patients: effects on pain, fatigue, and common problems—secondary outcomes of a randomized controlled trial.
  Linda E. Carlson, Amy Waller, Shannon L. Groff, Barry D. Bultz.
  Psycho-Oncology. November 12, 2012
  Background This randomized controlled trial examined the impact of an online routine screening for distress program on physical symptoms and common psychosocial and practical problems in lung cancer outpatients. Method Patients were randomly assigned to either the minimal screening group (the Distress Thermometer plus usual care); full screening group (Distress Thermometer, Canadian Problem Checklist (CPC), Pain Thermometer, Fatigue Thermometer, and the Psychological Screen for Cancer Part C, with a personalized report summarizing concerns); or triage (full screening plus option of personalized phone triage). Outcomes included pain, fatigue and psychosocial, practical and physical problems. Patients were reassessed 3 months later. Results A total of 549 lung patients completed baseline measures (89% of eligible patients) and 65.9% were retained at 3 months. At 3 months follow‐up, significantly fewer patients in the triage group (32.1%) reported pain compared with the minimal screening group (49.6%), but the triage and full screening groups were not significantly different from one another. Patients in the triage group reported fewer problems with coping compared with the minimal and full screening groups and fewer problems with family conflict compared with the minimal screening group. Full screening patients reported fewer problems with breathlessness compared with the minimal screening group. No differences were found among groups in fatigue. Referrals were not associated with changes in outcomes over time. Conclusions Routine screening for distress followed by personalized triage resulted in the most benefit for lung patients, with fewer fully screened and triaged patients reporting physical symptoms and psychosocial problems than those only minimally screened. Copyright © 2012 John Wiley & Sons, Ltd.

  November 12, 2012   doi: 10.1002/pon.3223   open full text
• Prevalence and predictors of post‐traumatic stress symptoms in adolescent and young adult cancer survivors: a 1‐year follow‐up study.
  Minyoung Kwak, Brad J. Zebrack, Kathleen A. Meeske, Leanne Embry, Christine Aguilar, Rebecca Block, Brandon Hayes‐Lattin, Yun Li, Melissa Butler, Steven Cole.
  Psycho-Oncology. November 08, 2012
  Objectives Post‐traumatic stress symptoms (PTSS) have been identified as a meaningful indicator of distress in cancer survivors. Distinct from young adult survivors of childhood cancer, young people diagnosed with cancer as adolescents and young adults (AYAs) face unique psychosocial issues; however, there is little published research of PTSS in the AYA population. This study examines prevalence and predictors of PTSS among AYAs with cancer. Methods As part of a longitudinal study of AYAs with cancer, 151 patients aged 15–39 years completed mailed surveys at 6 and 12 months post‐diagnosis. Severity of PTSS was estimated at 6 and 12 months post‐diagnosis. Multiple regression analyses were conducted to investigate the predictive effects of socio‐demographic and clinical characteristics on changes in PTSS over time. Results At 6 and 12 months, respectively, 39% and 44% of participants reported moderate to severe levels of PTSS; 29% had PTSS levels suggestive of post‐traumatic stress disorder. No significant differences in severity of PTSS between 6 and 12 months were observed. Regression analyses suggested that a greater number of side effects were associated with higher levels of PTSS at 6 months. Currently receiving treatment, having surgical treatment, diagnosis of a cancer type with a 90–100% survival rate, remaining unemployed/not in school, and greater PTSS at 6 months were associated with higher levels of PTSS at 12 months. Conclusions Post‐traumatic stress symptoms were observed as early as 6 months following diagnosis and remained stable at 12‐month follow‐up. The development of early interventions for reducing distress among AYA patients in treatment is recommended. Copyright © 2012 John Wiley & Sons, Ltd.

  November 08, 2012   doi: 10.1002/pon.3217   open full text
• Body image in recently diagnosed young women with early breast cancer.
  Shoshana M. Rosenberg, Rulla M. Tamimi, Shari Gelber, Kathryn J. Ruddy, Sandra Kereakoglow, Virginia F. Borges, Steven E. Come, Lidia Schapira, Eric P. Winer, Ann H. Partridge.
  Psycho-Oncology. November 07, 2012
  Objective To assess body image concerns among young women following a breast cancer diagnosis. Methods A total of 419 women with recently diagnosed stage 0–III breast cancer were surveyed following enrollment as part of a prospective cohort study of women age 40 or younger at diagnosis. Body image was assessed using three items from the psycho‐social scale of the Cancer Rehabilitation Evaluation System (CARES). CARES scores range from 0 to 4, with higher scores indicative of greater image concerns. Mean CARES scores were calculated and compared between treatment groups using t‐tests and analysis of variance. Multiple linear regression models were fit to evaluate the relationship between physical and psychological factors and body image. Results Mean time from diagnosis to completion of the baseline survey was 5.2 months. The mean CARES score for all women was 1.28. Mean CARES scores in the mastectomy‐only group (1.87) and in the mastectomy with reconstruction group (1.52) were significantly higher (p < 0.0001) compared with the scores in the lumpectomy group (0.85), indicating that radical surgery was associated with more body image concerns. Radiation (p = 0.01), anxiety (p = 0.0001), depression (p < 0.0001), fatigue (p = 0.04), musculoskeletal pain symptoms (p < 0.0001), weight gain (p = 0.01), and weight loss (p = 0.02), in addition to surgery type (p < 0.0001), were all associated with more body image concerns in the multi‐variable analysis. Conclusion This analysis highlights the impact of treatment, along with physical and psychological factors, on body image early in the survivorship period. Our findings provide targets for potential future intervention and may aid young women in the surgical decision‐making process. Copyright © 2012 John Wiley & Sons, Ltd.

  November 07, 2012   doi: 10.1002/pon.3221   open full text
• Predictors of anxiety and depression in hematopoietic stem cell transplant patients during protective isolation.
  Cristina Tecchio, Chiara Bonetto, Mariaelena Bertani, Doriana Cristofalo, Antonio Lasalvia, Ilaria Nichele, Anna Bonani, Angelo Andreini, Fabio Benedetti, Mirella Ruggeri, Giovanni Pizzolo.
  Psycho-Oncology. November 07, 2012
  Objective To examine in a sample of hematopoietic stem cell transplant patients assessed throughout protective isolation (i) levels of anxiety and depression and (ii) pre‐isolation factors (socio‐demographics, biomedical variables and personality traits), which might predict higher levels of anxiety and depression during isolation. Methods The study used a longitudinal prospective design. Anxiety and depression were assessed in 107 participants by the State‐Trait Anxiety Inventory and Self‐rating Depression Scale at admission and weekly at fixed time points throughout isolation. Among pre‐isolation factors, patients' psychological status was evaluated by the Cognitive Behavioral Assessment (2.0). Predictors were explored by random‐effects models. Results One‐tenth of the patients suffered from clinically significant anxiety and depressive symptoms at admission. Although the percentage of depressed patients increased more than twofold after 2 weeks of isolation, that of anxious patients did not significantly change over time. Female gender, higher anxiety and obsessive–compulsive symptoms, intratensive personality traits and lower performance status predicted higher depression during isolation. Conclusions Anxiety and depression represent a relevant problem for hematopoietic stem cell transplant patients during isolation. Early detection of predictors, such as anxiety levels, obsessive–compulsive symptoms and performance status, could help prevent depression via targeted psychological intervention. Copyright © 2012 John Wiley & Sons, Ltd.

  November 07, 2012   doi: 10.1002/pon.3215   open full text
• Trajectories of psychological distress after colorectal cancer.
  Jeff Dunn, Shu Kay Ng, Jimmie Holland, Joanne Aitken, Pip Youl, Peter D. Baade, Suzanne K. Chambers.
  Psycho-Oncology. November 05, 2012
  Objective Heightened psychological distress after cancer is common but likely highly heterogeneous. This raises potential challenges in how and when to target services; however, data describing longitudinal patterns of distress are limited. This study describes the long term psychological outcomes for colorectal cancer (CRC) survivors and trajectories of adjustment over time. Methods A prospective survey of a population‐based sample of 1966 CRC survivors assessed sociodemographic variables, perceived social support and psychological distress, including distress subtypes of anxiety, depression and somatization, at six time points from 5 months to 5 years post‐diagnosis. Results Over the 5‐year trajectory, the prevalence of high overall distress ranged between 44% and 32% but was greater for men compared with women (p < 0.001). Four distress trajectory styles within clusters were identified for overall distress and for each distress subtype with a constant low distress group providing the basis for comparison. Higher distress trajectories varied for overall distress and distress subtypes but were generally differentiated by gender, younger age, lower education, poor socioeconomic advantage, late disease stage and poor social support. Conclusions For global distress, by comparison with women, men with CRC are vulnerable to distress, with men who are younger and with low education and poor social support being a priority for targeted intervention. While distress screening early in the cancer experience will identify those with a constant high distress trajectory, others with late emerging distress or caseness may be missed. On this basis, distress screening through the illness trajectory into long term survivorship seems warranted. Copyright © 2012 John Wiley & Sons, Ltd.

  November 05, 2012   doi: 10.1002/pon.3210   open full text
• Attitudes of cancer patients in a university teaching hospital in southeast Nigeria on disclosure of cancer information.
  K. C. Nwankwo, Agnes N. Anarado, E. R. Ezeome.
  Psycho-Oncology. October 29, 2012
  Objective The attitudes of cancer patients from southeast Nigeria on disclosure of cancer information were studied to ascertain their information needs and what information was disclosed to them by their physicians. Methods Structured questionnaires were administered on all consenting cancer patients that were managed at the University of Nigeria Teaching Hospital Enugu between July and October 2011. The data collected were analysed with Statistical Package for Social Sciences version 18. Results Two hundred and forty‐four patients participated in the study. Ninety‐five per cent of the participants wanted to know the nature of their diagnosis, but 76.7% admitted to being informed of the diagnosis by their doctors. Nearly 54% of participants will like to be informed of a bad prognosis, but only 1.8% was informed. The word cancer was used to disclose the diagnosis to 69.4% of the patients, but 108 (44.3%) patients did not have any idea what cancer meant, 39.8% knew it as an incurable disease whereas 8.6% described it as a tumour or abnormal growth. Patient factors that significantly improved the disclosure of diagnostic information were education (p = 0.044) and site of the cancer (p = 0.043). Conclusions Most of the surveyed cancer patients in University of Nigeria Teaching Hospital Enugu desire to know the truth about the diagnosis of their disease, and more than 50% of them desire to know when the disease becomes terminal and death is imminent. Physicians in southeast Nigeria should consider the information needs of the individual patients and tailor their disclosure practices to meet these individual needs. Copyright © 2012 John Wiley & Sons, Ltd.

  October 29, 2012   doi: 10.1002/pon.3220   open full text
• Chemotherapy and cognitive complaints in women with breast cancer.
  Marleen J. J. Pullens, Jolanda De Vries, Laurence J. C. Van Warmerdam, Marieke A. Van De Wal, Jan A. Roukema.
  Psycho-Oncology. October 29, 2012
  Background Results of existing studies are inconclusive concerning the relationship between chemotherapy and subjective cognitive functioning (SCF). The aim of this study was to evaluate SCF of breast cancer (BC) patients and to find predictors of impaired SCF. Both satisfaction and frequency of complaints about SCF were measured. Methods BC patients who were about to receive chemotherapy (N = 74) and patients with a benign breast disease (BBD) (N = 63) participated. Before chemotherapy started (Time 1) and 3 months after ending chemotherapy (and at comparable moments for the BBD group) (Time 2), women completed validated questionnaires concerning the frequency of complaints and satisfaction with SCF, fatigue, perceived stress, anxiety, and depressive symptoms. Results No differences were found between the BBD and BC patients concerning the frequency of complaints about SCF across time. Satisfaction with SCF decreased across time in BC patients but remained stable across time in BBD patients (p < 0.001; p = 0.003 after controlling for state anxiety and perceived stress). Correlation coefficients between the satisfaction and the frequency of complaints about SCF ranged between −0.26 and −0.49. Depressive symptoms and satisfaction with SCF (Time 1) predicted the frequency of complaints about SCF (Time 2). Diagnosis, frequency of complaints about SCF, and state anxiety (Time 1) predicted satisfaction with SCF (Time 2). Conclusions BC patients do not differ in the frequency of complaints about SCF compared with BBD patients, but their satisfaction with SCF decreased after treatment. Psychological factors predicted the frequency of complaints about SCF. Psychological factors and diagnosis predicted satisfaction with SCF. Copyright © 2012 John Wiley & Sons, Ltd.

  October 29, 2012   doi: 10.1002/pon.3214   open full text
• Do cancer and treatment type affect distress?
  J. M. Admiraal, A. K. L. Reyners, J. E. H. M. Hoekstra‐Weebers.
  Psycho-Oncology. October 29, 2012
  Objective We examined differences in distress levels and Distress Thermometer (DT) cutoff scores between different cancer types. The effect of socio‐demographic and illness‐related variables on distress was also examined. Methods One thousand three hundred fifty patients (response = 51%) completed questions on socio‐demographic and illness‐related variables, the Dutch version of the DT and Problem List, and the Hospital Anxiety and Depression Scale. Receiver operating characteristics analyses were performed to determine cancer specific cutoff scores. Univariate and multivariate effects of socio‐demographic and illness‐related variables (including cancer type) on distress were examined. Results Prostate cancer patients reported significantly lower DT scores (M = 2.5 ± 2.5) and the cutoff score was lower (≥4) than in patients with most other cancer types (M varied between 3.4 and 5.1; cutoff ≥ 5). Multivariate analyses (F = 10.86, p < .001, R2 = 0.08) showed an independent significant effect of four variables on distress: intensive treatment (β = .10, any (combination of) treatment but surgery only and ‘wait and see’); a non‐prostate cancer type (β = −.17); the interaction between gender and age (β = −.12, highest distress in younger women as compared with older women and younger and older men); and the interaction between cancer type and treatment intensity (β = .08, lowest scores in prostate cancer patients receiving non‐intensive treatment as compared with their counterparts). Conclusions Distress and cutoff score in prostate cancer patients were lower than in patients with other cancer types. Additionally, younger women and patients receiving treatment other than surgery only or ‘wait and see’ are at risk for higher distress. These results can help identify patients possibly in need of referral to professional psychosocial and/or allied health care. Copyright © 2012 John Wiley & Sons, Ltd.

  October 29, 2012   doi: 10.1002/pon.3211   open full text
• Parenting stress and neurocognitive late effects in childhood cancer survivors.
  Sunita K. Patel, Andrew L. Wong, Michelle Cuevas, Hillary Van Horn.
  Psycho-Oncology. October 25, 2012
  Background Surveillance of neurocognitive late effects has typically focused on the pediatric survivor alone and rarely has focused on the potential family burden. We investigated the impact of child neurocognitive effects on parenting stress and hypothesized that parents of childhood cancer survivors with greater executive difficulties experience higher stress relative to parents of children with less adverse impact. Methods Parents of 44 children who survived cancer involving central nervous system‐directed treatments and who had documented neurocognitive deficits completed standardized questionnaires assessing their perceived level of stress and perception of their child's executive functioning abilities in daily life. Data from performance‐based cognitive tests were obtained on the children. Multiple regression models examined socio‐demographic, clinical, and child's executive functioning as predictors of parent stress. Differences in parenting stress based on child's level of executive functioning were evaluated. Results Parent stress was significantly associated with both performance‐based and parent report measures of child executive functioning. Child executive functioning significantly predicted parent stress even after controlling for socio‐demographic and clinical factors, and the final model accounted for 42% of the variance in parent stress levels. Significant differences in parent stress were found when comparing higher versus lower levels of child executive functioning. The nature of the executive difficulties, however, appears important, as we found increased parenting stress among children with behavioral regulation problems rather than metacognitive difficulties. Conclusions The associations between parenting stress and neurocognitive problems found in this study suggest the need for further research, along with professional monitoring and appropriate intervention. Copyright © 2012 John Wiley & Sons, Ltd.

  October 25, 2012   doi: 10.1002/pon.3213   open full text
• The impact of intrapersonal, interpersonal, and community factors on the identity formation of young adults with cancer: a qualitative study.
  Anisha Rajeev Kumar, Lidia Schapira.
  Psycho-Oncology. October 19, 2012
  Background The purpose of this study was to examine how young adult cancer patients make sense of their experiences with cancer. Methods Semi‐structured interviews were conducted with patients at an urban tertiary care center Results The sample for this study included 15 young adult cancer survivors. The ages of the participants ranged from 18 to 30 years. The sample was 67% female (n = 10) and 33% male (n = 5). The sample was 87% Caucasian (n = 13) and 13% Hispanic (n = 2). Fifty‐three percent of the participants were between ages 18 and 23 years (n = 8), and 47% of the participants were between ages 24 and 30 years (n = 7). Three themes emerged from the data: intrapersonal change, interpersonal interactions, and role and identity in the hospital and the community. As they inevitably lose control in their lives, young adult patients seek to return to a familiar lifestyle that they consider as ‘normal’. The formation of a revised identity and redefined set of norms allows the patients to regain control and express their individualism. Conclusions This study contributes to our knowledge of the experiences of young adult cancer patients and survivors. The findings serve to inform young adults, caregivers, and health professionals on coping with illness and its aftermath. Copyright © 2012 John Wiley & Sons, Ltd.

  October 19, 2012   doi: 10.1002/pon.3207   open full text
• Designing psycho‐oncology randomised trials and cluster randomised trials: variance components and intra‐cluster correlation of commonly used psychosocial measures.
  Melanie L. Bell, Joanne E. McKenzie.
  Psycho-Oncology. October 18, 2012
  Objective The study aims to provide information about variance components of psychosocial outcomes: within and between‐participant variance, within‐participant correlation and for cluster randomised trials, the intra‐cluster correlation (ICC) and, also, to demonstrate how estimates of these variance components and ICCs can be used to design randomised trials and cluster randomised trials. Method Data from 15 longitudinal multi‐centre psycho‐oncology studies were analysed, and variance components including ICCs were estimated. Studies with psychosocial outcomes that had at least one measurement post‐baseline including individual randomised controlled trials, cluster randomised trials and observational studies were included. Results Variance components and ICCs from 87 outcome measures were estimated. The unadjusted, single timepoint (first post‐baseline) ICCs ranged from 0 to 0.16, with a median value of 0.022 and inter‐quartile range 0 to 0.0605. The longitudinal ICCs ranged from 0 to 0.09 with a median value of 0.0007 and inter‐quartile range 0 to 0.018. Conclusions Although the magnitude of variance components and ICCs used for sample–size calculation cannot be known in advance of the study, published estimates can help reduce the uncertainty in sample‐size calculations. Psycho‐oncology researchers should be conservative in their sample‐size calculations and use approaches that improve efficiency in their design and analysis. Copyright © 2012 John Wiley & Sons, Ltd.

  October 18, 2012   doi: 10.1002/pon.3205   open full text
• Family factors associated with academic achievement deficits in pediatric brain tumor survivors.
  Emily Ach, Cynthia A. Gerhardt, Maru Barrera, Mary Jo Kupst, Eugene A. Meyer, Andrea F. Patenaude, Kathryn Vannatta.
  Psycho-Oncology. October 12, 2012
  Purpose The purpose of this study is to examine whether parental education, socioeconomic status, or family environment moderate the extent of academic achievement deficits in pediatric brain tumor survivors (PBTS) relative to classmate case‐controls. PBTS are known to be at risk for cognitive and academic impairment; however, the degree of impairment varies. Prior research has focused on treatment risk, and efforts to examine the protective role of family resources and relationships have been lacking. Methods Pediatric brain tumor survivors (N = 164), ages 8–15 and 1–5 years posttreatment, were recruited at five treatment centers in the United States and Canada. A case‐control classmate, matched for age, gender, and race, was recruited for each survivor. The Wide Range Achievement Test, a demographic form, and the Family Environment Scale were administered in families' homes. Treatment data were abstracted from medical charts. Results Pediatric brain tumor survivors demonstrated lower achievement than classmate‐controls in reading, spelling, and arithmetic. Parental education and socioeconomic status were associated with levels of achievement demonstrated by PBTS but did not account for discrepancies between PBTS and classmate‐controls. Deficits in achievement relative to classmate‐controls, across all academic domains, were greater for survivors in families lower in support and higher in conflict. These associations remained after controlling for age at diagnosis, time since treatment, and whether treatment had involved chemotherapy, focal, or whole brain radiation. Conclusions These results support the development of interventions to enhance family functioning as well as educational resources as part of intervention and rehabilitation services to optimize academic progress in children who have been treated for brain tumors. Copyright © 2012 John Wiley & Sons, Ltd.

  October 12, 2012   doi: 10.1002/pon.3202   open full text
• Exploring the impact of dignity therapy on distressed patients with advanced cancer: three case studies.
  Sue Hall, Cassie Goddard, Pauline Martin, Diana Opio, Peter Speck.
  Psycho-Oncology. October 11, 2012
  Background Dignity therapy (DT) has been developed to help reduce distress experienced by people nearing the end of life; however, evaluations of this novel intervention have largely involved non‐distressed samples. Objective The objective of this study was to explore in detail the impact of DT on distressed patients with advanced cancer. Methods We used a case study approach. Three patients with the highest levels of dignity‐related distress who received DT were explored in depth. We collected quantitative and qualitative outcomes from patients in face‐to‐face interviews at baseline and at 1 and 4 weeks after completion of the intervention. We assessed dignity‐related distress using the Patient Dignity Inventory. Patients rated the benefits of DT at completion of the intervention and at both follow‐ups. We conducted qualitative interviews exploring experiences of DT with patients and with two recipients of generativity documents produced by patients. Results These patients were experiencing a wide range of major or overwhelming physical and psychosocial problems when they received the intervention, most of which would not be expected to be helped by DT. All felt that DT had helped them and had helped or would help their families; however, patients' concerns about their current situation made delivering the intervention challenging, and DT‐relevant problems returned when a patients' condition deteriorated. Conclusions The extent to which DT can help these patients and their families, either as a stand‐alone therapy or as an adjunct to other therapies, needs to be determined in studies focussing on distressed patients, particularly those with problems likely to be helped by the therapy.Copyright © 2012 John Wiley & Sons, Ltd.

  October 11, 2012   doi: 10.1002/pon.3206   open full text
• Do advanced cancer patients in Denmark receive the help they need? A nationally representative survey of the need related to 12 frequent symptoms/problems.
  Anna Thit Johnsen, Morten Aagaard Petersen, Lise Pedersen, Lise Jul Houmann, Mogens Groenvold.
  Psycho-Oncology. October 07, 2012
  Objectives The aim of the study was to investigate the adequacy of help delivered by the healthcare system for 12 symptoms/problems in a national, randomly selected sample of advanced cancer patients in Denmark. Methods Advanced cancer patients (n = 1630) from 54 hospital departments across Denmark received the 3‐Levels‐of‐Needs Questionnaire (3LNQ). The 3LNQ measures ‘problem burden’, the degree to which a symptom or problem is perceived as a problem, and ‘felt need’, whether the patient receives adequate help. Prevalences were calculated for ‘problems’ (at least ‘a little’ of a problem), ‘moderate/severe problems’ (at least ‘quite a bit’ of a problem) and ‘felt need’ (inadequate help or no help despite wanting it). Results In total, 977 (60%) patients participated. The most frequent ‘problems’ were fatigue (73%; ‘moderate/severe’ 36%) and limitations doing physical activities (65%; ‘moderate/severe’ 36%). For the 12 symptoms/problems assessed the prevalence of ‘felt need’ was 11–35%. Of the patients who had received help, 34–74% viewed the help as inadequate. Of those who had not received help, 48–78% wished for help. Conclusion Advanced cancer patients are not receiving the help they need. Large proportions of patients were burdened by symptoms/problems. Of those who had received help, many viewed it as inadequate. Better symptom/problem identification and management is warranted for advanced cancer patients. Copyright © 2012 John Wiley & Sons, Ltd.

  October 07, 2012   doi: 10.1002/pon.3204   open full text
• Do prostate cancer patients suffer more from depressed mood or anhedonia?
  Christopher F. Sharpley, Vicki Bitsika, David H. R. Christie.
  Psycho-Oncology. September 27, 2012
  Objective This study aimed to compare the prevalence of depressed mood and anhedonia in a sample of men with prostate cancer (PCa) and to determine which of these key symptoms contributed most to the overall depressive status of that sample. Method From Zung Self‐rating Depression Scale (SDS) responses collected on 526 PCa patients, direct comparisons were made between the prevalence of the first two DSM‐IV‐TR symptoms of Major Depressive Episode. These symptoms were then tested for their predictive power on depression total score and Zung's criteria for ‘clinically significant’ depression. Results Mean scores for anhedonia were significantly higher than for depressed mood, and nearly 25 times as many patients had a high score for anhedonia as for depressed mood. The same pattern of results was apparent for those patients who had clinically significant levels of depression. Anhedonia was a more powerful predictor of total SDS depression score for the entire sample as well as for those patients with more severe depression. Conclusion Because the biological basis for anhedonia is different to that for depressed mood, treatment options also differ for patients who show a preponderance of anhedonia in their depressive symptomatology. Suggestions are made for treatment choices for these PCa patients. Copyright © 2012 John Wiley & Sons, Ltd.

  September 27, 2012   doi: 10.1002/pon.3203   open full text