The quality of life of male spouses of women with breast cancer: hope, self-efficacy, and perceptions of guilt

BACKGROUND

The quality of life of male spouses of partners with breast cancer may determine the support they are able to give their wives. Little is known about the factors associated with their quality of life.

OBJECTIVE

The purpose of this study was to examine the relationship of the quality of life of male spouses of partners with breast cancer with the following factors: (a) demographic variables of male spouses and their partners, (b) levels of hope of male spouses and their partners, (c) self-efficacy and loss and grief of male spouses, and (d) quality of life of partners with breast cancer.

METHODS

Six hundred surveys were mailed to women with breast cancer (stage 1-3) and their male spouses. A total of 110 surveys were completed.

RESULTS

With the use of generalized linear modeling, participating male spouses with higher quality of life scores: (a) were older (P = .01), (b) had higher hope scores (P = .01), (c) had lower feelings of guilt scores (P < .01) (subscale of loss and grief), (d) had higher general self-efficacy scores (P < .01), and (e) had partners with breast cancer with higher quality of life scores (P < .01).

CONCLUSIONS

Hope, self-efficacy, feelings of guilt, age, and their partners' quality of life were significantly related to quality of life of the male spouses of women with breast cancer.

IMPLICATIONS FOR PRACTICE

The findings underscore the importance of assessing for and fostering hope and self-efficacy as well as decreasing guilt in male spouses of women with breast cancer to improve their quality of life.

Psychosocial Distress Screening Implementation in Cancer Care: An Analysis of Adherence, Responsiveness, and Acceptability

Purpose

The American College of Surgeons Commission on Cancer has mandated implementation of a systematic protocol for psychosocial distress screening and referral as a condition for cancer center accreditation beginning in 2015. Compliance with standards requires evidence that distress screening protocols are carried out as intended and result in appropriate referral and follow-up when indicated. The purpose of this study was to examine the fidelity of distress screening protocols at two tertiary cancer treatment centers.

Methods

A retrospective review and analysis of electronic medical records over a 12-week period examined clinic adherence to a prescribed distress screening protocol and responsiveness to patients whose scores on the National Comprehensive Cancer Network Distress Thermometer (DT) indicated clinically significant levels of distress requiring subsequent psychosocial contact. A weekly online survey assessed clinician perspectives on the acceptability of the protocol.

Results

Across clinics, rates of adherence to the distress screening protocol ranged from 47% to 73% of eligible patients. For patients indicating clinically significant distress (DT score ≥ 4), documentation of psychosocial contact or referral occurred, on average, 50% to 63% of the time, and was more likely to occur at one of two participating institutions when DT scores were high (DT score of 8 to 10). Clinician assessments of the protocol's utility in addressing patient concerns and responding to patient needs were generally positive.

Conclusion

Systematic tracking of distress screening protocols is needed to demonstrate compliance with new standards of care and to demonstrate how well institutions are responding to their clinical obligation to address cancer patients' emotional and psychosocial needs.

Development and implementation of an online program to improve how patients communicate emotional concerns to their oncology providers

PURPOSE

Patients often struggle to express their emotional concerns to their oncology providers and may therefore experience unmet needs. This paper describes the development and implementation of an online program that teaches patients how to communicate their emotions to their oncology providers.

METHODS

The intervention was developed by a multidisciplinary team consisting of palliative care physicians, psychologists, and an intervention software developer and included input from patients. It incorporated elements of Social Cognitive Theory and validated cognitive behavioral strategies for communication skills training. Strategies to increase intervention adherence were implemented midway through the study.

RESULTS

The intervention consists of four interactive, online modules to teach patients strategies for expressing emotional concerns to their providers and asking for support. In addition to skill-building, the intervention was designed to raise patients' expectations that expressing emotional concerns to providers would be helpful, to enhance their self-efficacy for doing so, and to help them overcome barriers to having these conversations. After implementing strategies to improve adherence, usage rates increased from 47 to 64 %.

CONCLUSIONS

This intervention addresses an unmet educational need for patients with advanced cancer. Strategies to increase adherence led to improvements in usage rates in this population of older patients. We are currently evaluating the intervention in a randomized clinical trial to determine its efficacy in increasing patient expression of emotional concerns and requests for support. If successful, this intervention could serve as a model for future online patient education programs.

Moderators of the effects of group-based physical exercise on cancer survivors' quality of life

Purpose

This study explored demographic, clinical, and psychological moderators of the effect of a group-based physical exercise intervention on global quality of life (QoL) among cancer survivors who completed treatment.

Methods

Cancer survivors were assigned to a 12-week physical exercise (n = 147) or a wait-list control group (n = 62). The main outcome measure was global QoL, assessed with the EORTC QLQ-C30 at baseline and 12 weeks later. Potential moderators were age, gender, education level, marital status, employment status, type of treatment, time since treatment, the presence of comorbidities, fatigue, general self-efficacy, depression, and anxiety. Linear regression analyses were used to test effect modification of the intervention by each moderator variable using interaction tests (p ≤ 0.10).

Results

The physical exercise intervention effect on global QoL was larger for cancer survivors who received radiotherapy (β = 10.3, 95 % confidence interval (CI) = 4.4; 16.2) than for cancer survivors who did not receive radiotherapy (β = 1.8, 95 % CI = −5.9; 9.5, p_interaction = 0.10), larger for cancer survivors who received a combination of chemoradiotherapy (β = 13.0, 95 % CI = 6.0; 20.1) than for those who did not receive this combination of treatments (β = 2.5, 95 % CI = −3.7; 8.7, p_interaction = 0.02), and larger for cancer survivors with higher baseline levels of fatigue (β = 12.6, 95 % CI = 5.7; 19.6) than for those with lower levels (β = 2.4, 95 % CI = −3.9; 8.7, p_interaction = 0.03). No other moderating effects were found.

Conclusions

This study suggests that cancer treatment modality and baseline fatigue levels moderate the effect of a physical exercise program on cancer survivors’global QoL.

Medication adherence skills training for African-American breast cancer survivors: the effects on health literacy, medication adherence, and self-efficacy

There are gaps in research regarding medication adherence, self-efficacy in proper medication adherence, and health literacy among breast cancer survivors. This pilot randomized controlled study was conducted to provide information addressing health literacy with respect to medication adherence and self-efficacy in African American breast cancer survivors. The study sample consisted of an intervention group (n = 24) of medication adherence skills training (MST) and a control group (n = 24), with a total sample population of 48 participants. The MST workshop was a collaborative intervention between pharmacy and social work and was designed to address issues that may be encountered while taking multiple medications for various acute and chronic conditions, increase participant confidence in accessing necessary resources for improved medication usage, and enhance personal self-efficacy regarding health care. A statistically significant relationship was detected between initial health literacy and medication adherence, as well as initial health literacy and self-efficacy. These findings indicated that individuals with higher health literacy were more likely to have higher levels of self-efficacy and were more likely to adhere to medication instructions. Analysis of the intervention and treatment groups did not show a statistically significant effect on health literacy, medication adherence, or self-efficacy from pre-test to post-test.

A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors

Purpose

Little is known about how to improve and create sustainable lifestyle behaviors of cancer survivors. Interventions based on social cognitive theory (SCT) have shown promise. This review examined the effect of SCT-based physical activity and nutrition interventions that target cancer survivors and identified factors associated with their efficacy.

Methods

A systematic search of seven databases identified randomized controlled trials that (i) targeted adult cancer survivors (any point from diagnosis); (ii) reported a primary outcome of physical activity, diet, or weight management; and (iii) included an SCT-based intervention targeting physical activity or diet. Qualitative synthesis and meta-analysis were conducted. Theoretical constructs and intervention characteristics were examined to identify factors associated with intervention efficacy.

Results

Eighteen studies (reported in 33 publications) met review inclusion criteria. Meta-analysis (n = 12) revealed a significant intervention effect for physical activity (standardized mean difference (SMD) = 0.33; P < 0.01). Most studies (six out of eight) that targeted dietary change reported significant improvements in at least one aspect of diet quality. No SCT constructs were associated with intervention effects. There were no consistent trends relating to intervention delivery method or whether the intervention targeted single or multiple behaviors.

Conclusions

SCT-based interventions demonstrate promise in improving physical activity and diet behavior in cancer survivors, using a range of intervention delivery modes. Further work is required to understand how and why these interventions offer promise for improving behavior.

Implications for Cancer Survivors

SCT-based interventions targeting diet or physical activity are safe and result in meaningful changes to diet and physical activity behavior that can result in health improvements.

Overcoming psychosocial and developmental barriers to blood and marrow transplantation (BMT) in an adolescent/young adult (AYA) transgender patient with chronic myelogenous leukemia

Adolescents/young adults (AYAs) afflicted with cancer face unique barriers to potentially standard curative therapies, such as blood and marrow transplantation (BMT). Transgender AYAs face additional barriers and there is a dearth of published literature regarding their oncology-related experience. We present the case of an AYA male-to-female (MTF) transgender patient on cross-sex hormone therapy, with a history of Chronic Myelogenous Leukemia (CML) and significant psychosocial barriers, which initially served as a barrier to BMT at two different centers; we modified our standard consent and education process and was able to successfully proceed with BMT and subsequently cure her CML. Despite unique challenges, AYA and transgender patients with significant psychosocial barriers may achieve successful outcomes with BMT. Research is needed regarding guidelines for cross-sex hormone therapy administration for patients undergoing BMT and other issues, which may be unique to the transgender experience.

Clinical perspective: Linking psychosocial care to the disease continuum in patients with multiple myeloma

OBJECTIVE

A model of psychosocial care specific for patients with multiple myeloma and their caregivers has not yet been proposed. We sought to develop a model of care that considers the specific profile of this disease.

METHOD

The authors, representing a multidisciplinary care team, met in December of 2012 to identify a model of psychosocial care for patients with multiple myeloma and their caregivers. This model was determined by consensus during the meeting and via total agreement following the meeting. The meeting was sponsored by Onyx Pharmaceuticals.

RESULTS

The need for targeted psychosocial care for the multiple myeloma patient and caregiver throughout the disease process is essential to ensure quality of life and optimal treatment outcomes. We propose herein the first known model of care for the treatment of multiple myeloma that engages both the patient and their caregivers.

SIGNIFICANCE OF RESULTS

Innovative partnerships between psychosocial providers and other entities such as pharmaceutical companies can maximize resources for comprehensive program development. This manuscript proposes a model of care that promotes active engagement in therapies for multiple myeloma while engaging the individual patient and their family caregivers. This treatment approach must be evidence based in terms of distress screening tools, comprehensive psychosocial assessments, and, most importantly, in the interventions and measurements of response that clinicians apply to this population.

Self-efficacy for coping with symptoms moderates the relationship between physical symptoms and well-being in breast cancer survivors taking adjuvant endocrine therapy

PURPOSE

This study examined the relationships between physical symptoms, self-efficacy for coping with symptoms, and functional, emotional, and social well-being in women who were taking adjuvant endocrine therapy for breast cancer.

METHODS

One hundred and twelve women who were taking adjuvant endocrine therapy (tamoxifen or an aromatase inhibitor) for breast cancer completed measures of physical symptoms, self-efficacy for coping with symptoms, and functional, social, and emotional well-being at the time of routine medical follow-up (women were on average 3.4 years post-surgery; range 3 months to 11 years).

RESULTS

Multiple linear regression analyses showed that higher self-efficacy for coping with symptoms was associated with greater functional, emotional, and social well-being after controlling for physical symptoms (p < 0.05). Self-efficacy for coping with symptoms moderated the relationship between physical symptoms and functional (B = 0.05, SE = 0.02, t = 2.67, p = 0.009) and emotional well-being (B = 0.03, SE = 0.01, t = 2.45, p = 0.02). As self-efficacy increased, the relationship between greater physical symptoms and lower well-being became weaker. Among women with high levels of self-efficacy, physical symptoms were not related to functional and emotional well-being.

CONCLUSIONS

Self-efficacy for coping with symptoms may reduce the negative impact of physical symptoms and contribute to well-being in breast cancer survivors taking adjuvant endocrine therapy. Future studies could examine whether psychosocial interventions aimed at increasing self-efficacy for managing symptoms help women better cope with treatment side effects and improve quality of life.

Recommendations for the implementation of distress screening programs in cancer centers: report from the American Psychosocial Oncology Society (APOS), Association of Oncology Social Work (AOSW), and Oncology Nursing Society (ONS) joint task force

In 2015, the American College of Surgeons (ACoS) Commission on Cancer will require cancer centers to implement screening programs for psychosocial distress as a new criterion for accreditation. A joint task force from the American Psychosocial Oncology Society, the Association of Oncology Social Work, and the Oncology Nursing Society developed consensus-based recommendations to guide the implementation of this requirement. In this review, the authors provide recommendations regarding each of the 6 components necessary to meet the ACoS standard: 1) inclusion of psychosocial representation on the cancer committee, 2) timing of screening, 3) method/mode of screening, 4) tools for screening, 5) assessment and referral, and 6) documentation.

An investigation of the colorectal cancer experience and receptivity to family-based cancer prevention programs

PURPOSE

Cancer is a shared family experience and may provide a "teachable moment" to motivate at-risk family members to adopt cancer prevention and health promotion behaviors. This study explored how a diagnosis of colorectal cancer (CRC) is experienced by family members and may be used to develop a family-based CRC prevention program. Preferences regarding content, timing, and modes of program delivery were examined. Social cognitive theory provided the conceptual framework for the study.

METHODS

This study employed mixed methodology (semi-structured interviews and self-report questionnaires). Participants included 73 adults (21 patients, 52 family members) from 23 families (two patients were deceased prior to being interviewed). Most patients (n = 14; 67 %) were interviewed 1-5 years post-diagnosis. Individual interviews were audio-recorded, transcribed, and content analyzed.

RESULTS

For many, a CRC diagnosis was described as a shared family experience. Family members supported each other's efforts to prevent CRC through screening, exercising, and maintaining a healthy diet. Teachable moments for introducing a family-based program included the time of the patient's initial cancer surgery and post-chemotherapy. Reported willingness to participate in a family-based program was associated with risk perception, self-efficacy, outcome expectancies, and the social/community context in which the program would be embedded. Program preferences included cancer screening, diet/nutrition, weight management, stress reduction, and exercise. Challenges included geographic dispersion, variation in education levels, generational differences, and scheduling.

CONCLUSIONS

CRC patients and family members are receptive to family-based programs. Feasibility concerns, which may be mitigated but not eliminated with technological advances, must be addressed for successful family-based programs.

Self-efficacy difference among patients with cancer with different socioeconomic status: application of latent class analysis and standardization and decomposition analysis

INTRODUCTION

Although the relationship between partial socioeconomic status (SES) and self-efficacy has been studied in previous studies, few research have examined self-efficacy difference among patients with cancer with different SES.

METHODS

A cross-sectional survey involving 764 patients with cancer was completed. Latent class analysis (LCA) was applied to identify distinct groups of patients with cancer using four SES indicators (education, income, employment status and health insurance status). Standardization and decomposition analysis (SDA) was then used to examine differences in patients' self-efficacy among SES groups and the components of the differences attributed to confounding factors, such as gender, age, anxiety, depression and social support.

RESULTS

Participants were classified into four distinctive SES groups via using LCA method, and the observed self-efficacy level significantly varied by SES groups; as theorized, higher self-efficacy was associated with higher SES. The self-efficacy differences by SES groups were decomposed into "real" group differences and factor component effects that are attributed to group differences in confounding factor compositions.

CONCLUSION

Self-efficacy significantly varies by SES. Social support significantly confounded the observed differences in self-efficacy between different SES groups among Chinese patients with cancer.

Randomized controlled trial of Nuevo Amanecer: a peer-delivered stress management intervention for Spanish-speaking Latinas with breast cancer

BACKGROUND

Latinas with breast cancer suffer symptom and psychosocial health disparities. Effective interventions have not been developed for or tested in this population.

PURPOSE

We describe community-based participatory research methods used to develop and implement the Nuevo Amanecer program, a culturally tailored, peer-delivered cognitive-behavioral stress management intervention for low-income Spanish-speaking Latinas with breast cancer, and unique considerations in implementing a randomized controlled trial to test the program in community settings.

METHODS

We applied an implementation science framework to delineate the methodological phases used to develop and implement the Nuevo Amanecer program and trial, emphasizing community engagement processes.

RESULTS

In phase 1, we established project infrastructure: academic and community co-principal investigators, community partners, community advisory board, steering committee, and funding. In phase 2, we identified three program inputs: formative research, a community best-practices model, and an evidence-based intervention tested in non-Latinas. In phase 3, we created the new program by integrating and adapting intervention components from the three sources, making adaptations to accommodate low literacy, Spanish language, cultural factors, community context, and population needs. In phase 4, we built community capacity for the program and trial by training field staff (recruiters and interventionists embedded in community sites), compensating field staff, and creating a system for identifying potential participants. In phase 5, we implemented and monitored the program and trial. Engaging community partners in all phases has resulted in a new, culturally tailored program that is suitable for newly diagnosed Latinas with breast cancer and a trial that is acceptable and supported by community and clinical partners. Lessons learned Engagement of community-based organizations and cancer survivors as research partners and hiring recruiters and interventionists from the community were critical to successful implementation in community settings. Having culturally and linguistically competent research staff with excellent interpersonal skills facilitated implementation. Facilitating and maintaining excellent communication among community partners was imperative to troubleshoot implementation issues. Randomization was challenging due to community concerns about assigning women to a control group. Patient privacy regulations and the need for extensive outreach to establish relationships between community partners and clinical sites hampered initial recruitment.

LIMITATIONS

These were resource-intensive processes to develop and implement the program that need to be compared to less-intensive alternatives.

CONCLUSION

Engaging community members in design and implementation of community-based programs and trials enhances cultural appropriateness and congruence with the community context. If the randomized trial demonstrates that the intervention is effective, it will fill a gap in evidence-based programs to address ethnic disparities in quality of life among Spanish-speaking Latinas with breast cancer.

A pilot randomized study of skills training for African American cancer survivors

This study tested the efficacy of a psychosocial group intervention for African American breast cancer survivors based on the Cancer Survival Toolbox with the specific aim of decreasing distress and improving aspects of psychosocial functioning and quality of life. This pilot study utilized a randomized, repeated measures, experimental design. The study sample (N = 71) consisted of an intervention group (n = 23) of cancer survival skills training for 6 weeks and a control group (n = 48). The study could not confirm that cancer skills training in a psychoeducational group setting had a positive effect on decreasing stress or improving aspects of psychosocial functioning and quality of life.

The effectiveness of a self-efficacy-enhancing intervention for Chinese patients with colorectal cancer: a randomized controlled trial with 6-month follow up

BACKGROUND

Colorectal cancer is a major public health problem. There is growing support for colorectal cancer survivors who are experiencing problems after cancer treatment to engage in self-management programs to reduce symptom distress. However, there is inconclusive evidence as to the effectiveness of such program especially in Asian region.

OBJECTIVES

This study tested the effects of a six-month nurse-led self-efficacy-enhancing intervention for patients with colorectal cancer, compared with routine care over a six-month follow up.

DESIGN

A randomized controlled trial with repeated measures, two-group design.

SETTING

Three teaching hospitals in Guangzhou, China.

PARTICIPANTS

One hundred and fifty-two Chinese adult patients with a diagnosis of colorectal cancer were recruited. The intervention group (n=76) received self-efficacy-enhancing intervention and the control group (n=76) received standard care.

METHOD

The participants were randomized into either intervention or control group after baseline measures. The outcomes of the study (self-efficacy, symptom distress, anxiety, depression and quality of life) were compared at baseline, three and six months after the intervention.

RESULTS

Sixty-eight participants in the intervention group and 53 in the control group completed the study. Their mean age was 53 (SD=11.3). Repeated measure MANOVA found that the patients in the intervention group had significant improvement in their self-efficacy (F=7.26, p=0.003) and a reduction of symptom severity (F=5.30, p=0.01), symptom interference (F=4.06, p=0.025), anxiety (F=6.04, p=0.006) and depression (F=6.96, p=0.003) at three and six months, compared with the control group. However, no statistically significant main effect was observed in quality of life perception between the two groups.

CONCLUSIONS

The nurse-led self-efficacy enhancing intervention was effective in promoting self-efficacy and psychological well-being in patients with colorectal cancer, compared with standard care. The intervention can be incorporated into routine care. Future empirical work is required to determine the longer term effects of the intervention.

Evaluation of the living with hope program for rural women caregivers of persons with advanced cancer

BACKGROUND

Hope has been identified as a key psychosocial resource among family caregivers to manage and deal with the caregiver experience. The Living with Hope Program is a self-administered intervention that consists of watching an international award winning Living with Hope film and participating in a two week hope activity ("Stories of the Present"). The purpose of this study was to examine the effects of the Living with Hope Program on self-efficacy [General Self-Efficacy Scale], loss and grief [Non-Death Revised Grief Experience Inventory], hope [Herth Hope Index] and quality of life [Short-Form 12 version 2 (SF-12v2)] in rural women caring for persons with advanced cancer and to model potential mechanisms through which changes occurred.

METHODS

A time-series embedded mixed method design was used, with quantitative baseline outcome measures repeated at day 7, day 14, and 3, 6 and 12 months. Qualitative data from the hope activity informed the quantitative data. Thirty-six participants agreed to participate with 22 completing all data collection. General estimating equations were used to analyze the data.

RESULTS

Herth Hope Index scores (p=0.05) had increased significantly from baseline at day 7. General Self Efficacy Scale scores were significantly higher than baseline at all data time points. To determine the mechanisms of the Living with Hope Program through which changes occurred, results of the data analysis suggested that as General Self Efficacy Scale scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01) Herth Hope Index scores increased. In addition as Herth Hope Index scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01), SF-12v2 mental health summary scores increased. Qualitative data suggested that through the hope activity (Stories of the Present) the participants were able to find positives and hope in their experience.

CONCLUSIONS

The Living with Hope Program has potential to increase hope and improve quality of life for rural women caregivers of persons with advanced cancer. The possible mechanisms by which changes in hope and quality of life occur are by decreasing loss and grief and increasing self-efficacy.

TRIAL REGISTRATIONS

Registration ClinicalTrials.gov, NCT01081301.

A systematic review of physical impairments following radical prostatectomy: effect of psychoeducational interventions

AIMS

To determine the effect of psychoeducational interventions on urinary and faecal incontinence and erectile dysfunction in men 50 years and older after prostatectomy for prostate cancer in comparison to usual care.

BACKGROUND

Prostate cancer is the second most frequently diagnosed cancer in men worldwide. The major complications of radical prostatectomy are urinary and faecal incontinence as well as sexual dysfunction, associated with significantly reduced quality of life.

DESIGN

A systematic review of randomized controlled trials was undertaken to provide a narrative synthesis and critical appraisal of included studies.

DATA SOURCES

The electronic databases MEDLINE and CINAHL were searched using a systematic search strategy for studies published between January 2001-December 2012. In addition, reference lists of included papers were checked. The Cochrane Database was screened for whether a review on this topic already exists.

REVIEW METHODS

The systematic review included randomized controlled trials in men after prostate cancer treatment and psychoeducational interventions to influence urinary or faecal incontinence and erectile dysfunction. The quality of studies was assessed by the reviewers using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method.

RESULTS

Eight trials met the inclusion criteria. Although these studies are heterogeneous and of varied quality, a descriptive synthesis of results suggests that psychoeducational interventions may improve urinary incontinence, bowel bother, sexual function and sexual bother to some extent.

CONCLUSION

The results of this systematic review indicate that it would be worthwhile to implement postprostatectomy psychoeducational interventions into nursing discharge planning. Future research is necessary to corroborate these results and define the most favourable time to implement psychoeducational interventions.

Development and qualitative evaluation of a self-management workshop for testicular cancer survivor-initiated follow-up

PURPOSE/OBJECTIVES

To describe the needs of testicular cancer survivors, develop a nurse-led workshop, and explore the experience of participation.

RESEARCH APPROACH

A systematic intervention development process was used to design a self-management workshop for cancer survivors, which then was evaluated qualitatively.

SETTING

Outpatient clinic in England.

PARTICIPANTS

26 healthcare professionals, charity workers, family members, and testicular cancer survivors participated in the intervention development process. Six testicular cancer survivors attended the workshop and participated in the postintervention focus group discussion.

METHODOLOGIC APPROACH

Ten participants, including four survivors, completed the initial needs assessment interviews. Twenty-six participants then rated the identified needs on two dimensions: importance to self-management and changeability via a self-management intervention. Literature review and expert consultation were used to identify potential workshop components. To explore the experience of attending the intervention, six testicular cancer survivors who participated in the nurse-led workshop were interviewed six weeks later.

FINDINGS

The workshop was well received by participants, who appreciated the goal-setting and information provision activities. The men also felt that they had benefited from the experience of being in the group.

CONCLUSIONS

Testicular cancer survivors had unmet post-treatment needs. The systematic intervention development method led to an evidence-based workshop to address those needs. Men reported benefits from attending the workshop, which may help maintain and improve health.

INTERPRETATION

Nurse-led workshops can address the current unmet needs of testicular cancer survivors.

KNOWLEDGE TRANSLATION

Testicular cancer survivors may require support with health information, maintaining psychological health, and monitoring cancer symptoms. Survivors also need help planning and maintaining an active lifestyle. In addition, a brief workshop approach to intervention delivery is acceptable to testicular cancer survivors.

Trajectories of Psychological Distress in Adolescent and Young Adult Patients With Cancer: A 1-Year Longitudinal Study

Purpose

To examine prevalence and changes in symptoms of psychological distress over 1 year after initial cancer diagnosis in adolescent and young adult (AYA) patients with cancer. Sociodemographic and clinical predictors of changes in distress were examined.

Patients and Methods

In this multisite, longitudinal, prospective study of an ethnically diverse sample, 215 patients age 14 to 39 years were assessed for psychological distress within the first 4 months of diagnosis and again 6 and 12 months later. Linear mixed models with random intercept and slope estimated changes in distress, as measured by the Brief Symptom Inventory-18 (BSI-18).

Results

Within the first 4 months of diagnosis, 60 respondents (28%) had BSI-18 scores suggesting caseness for distress. On average, distress symptoms exceeded population norms at the time of diagnosis, dipped at the 6-month follow-up, but increased to a level exceeding population norms at the 12-month follow-up. A statistically significant decline in distress over 1 year was observed; however, the gradient of change was not clinically significant. Multivariate analyses revealed that the reduction in distress over time was primarily a function of being off treatment and involved in school or work. Notably, cancer type or severity was not associated with distress.

Conclusion

Findings emphasize the importance of early psychosocial intervention for distress in AYAs as well as the need to manage treatment-related symptoms and facilitate AYAs' involvement in work or school to the extent possible. Continued research is needed to understand how distress relates to quality of life, functional outcomes, treatment, and symptom burden throughout the continuum of care.

Mindfulness-based narrative therapy for depression in cancer patients

Mindfulness-based narrative therapy (MBNT) is a therapeutic intervention for the treatment of depression in cancer patients. In a previous randomized controlled trial, MBNT was found to ameliorate anxiety and depression, improve functional dimensions of quality of life, and enhance treatment adherence. In this review, we describe MBNT and its technical characteristics in the context of other psychotherapeutic interventions for depression in cancer patients. We highlight needed adjustments to other narrative approaches and recommend clinical modifications tailored to the needs of cancer patients that are intended to encompass the client's initial depressive narrative. The narrative construction is supported by emotional regulation and attachment relationships on the one hand and by individual and social linguistic capabilities on the other. Through destabilization of the depressive narrative, MBNT facilitates the emergence of new meanings using both verbal and non-verbal techniques based on mindfulness. The attitude and practice of mindfulness are integrated throughout the therapeutic process. In summary, MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients.

KEY PRACTITIONER MESSAGE

In this review, we describe mindfulness-based narrative therapy (MBNT) for the treatment of depression in cancer patients. In a previous controlled trial, we found significant benefits of MBNT in terms of reducing depressive symptoms and improving treatment adherence and quality of life in depressed, non-metastatic cancer patients. Narrative construction is socially and neurobiologically derived. MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients. MBNT is proposed as an interesting and promising intervention, particularly for patients with somatic pathologies.

A breast reconstruction needs assessment: How does self-efficacy affect information access and preferences?

BACKGROUND

Breast cancer patients requiring mastectomy do not consistently receive information about post-mastectomy breast reconstruction (PMBR) surgery from the treatment team. Patients have varying levels of self-efficacy, defined as one's confidence in their ability to gather information and make health-related decisions. The present preliminary study was designed to evaluate the relationship between self-efficacy and access to PMBR information.

METHODS

A qualitative interview study was conducted on a convenience sample of 10 breast cancer patients considering or having already undergone PMBR and six key health care provider informants. The modified six-item Stanford Self-Efficacy Scale for managing chronic disease was administered.

RESULTS

Patient self-efficacy scores ranged from 5 to 9.3 (out of 10). Two main access to information themes were identified from the patient qualitative data: theme A - difficulty initiating the PMBR discussion; and theme B - perceived lack of access to PMBR information with the sub-themes of timing, modality, quantity and content of resources. All respondents expressed their concern over the absence of a standardized process for initiating the dialogue of PMBR. Patients also reported that credible and easily accessible information was not routinely available and expressed a desire to hear about their PMBR options early in the decision-making process.

CONCLUSIONS

Health care providers may need to assume more responsibility in standardizing information dissemination on PMBR. This information should be distributed early in the consultation process, the content should be complete, and there may be a role for individualizing the delivery of information based on a patient's level of self-efficacy.

Health-related quality of life and life satisfaction in colorectal cancer survivors: trajectories of adjustment

Background

This longitudinal study describes the five year trajectories of health-related quality of life (HR-QOL) and life satisfaction in long term colorectal cancer survivors.

Patients and methods

A population-based sample of 1966 colorectal cancer survivors were surveyed at six time points from five months to five years post-diagnosis. Predictor variables were: socio-demographic variables, optimism; cancer threat appraisal; perceived social support. Quality of life was assessed with the Functional Assessment of Cancer Therapy-Colorectal (HR-QOL); and the Satisfaction with Life Scale. Growth mixture models were applied to identify trajectory classes and their predictors.

Results

Distinct adjustment trajectories were identified for HR-QOL and life satisfaction. Lower optimism, poorer social support, a more negative cognitive appraisal, and younger age were associated with poorer life satisfaction, while survivors with less than 8 years of education had higher life satisfaction. This pattern was similar for overall HR-QOL except that educational level was not a significant predictor and later stage disease and female gender emerged as related to poorer outcomes. One in five survivors reported poorer constant HR-QOL (19.2%) and a small group had poor life satisfaction (7.2%); 26.2% reported constant high HR-QOL and 48.8% had high constant life satisfaction. Socioeconomic disadvantage and remoteness of residence uniquely predicted poorer outcomes in the colorectal cancer specific HR-QOL sub domain.

Conclusion

Although HR-QOL and subjective cognitive QOL share similar antecedents their trajectory patterns suggested they are distinct adjustment outcomes; with life satisfaction emerging as temporally stable phenomenon. Unique patterns of risk support suggest the need to account for heterogeneity in adjustment in longitudinal QOL studies with cancer survivors.

Effects of Psycho-Oncologic Interventions on Emotional Distress and Quality of Life in Adult Patients With Cancer: Systematic Review and Meta-Analysis

Purpose

This study aimed to evaluate the effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer.

Methods

Literature databases were searched to identify randomized controlled trials that compared a psycho-oncologic intervention delivered face-to face with a control condition. The main outcome measures were emotional distress, anxiety, depression, and quality of life. Outcomes were evaluated for three time periods: post-treatment, ≤ 6 months, and more than 6 months. We applied standard meta-analytic techniques to analyze both published and unpublished data from the retrieved studies. Sensitivity analyses and meta-regression were used to explore reasons for heterogeneity.

Results

We retrieved 198 studies (covering 22,238 patients) that report 218 treatment-control comparisons. Significant small-to-medium effects were observed for individual and group psychotherapy and psychoeducation. These effects were sustained, in part, in the medium term (≤ 6 months) and long term (> 6 months). Short-term effects were evident for relaxation training. Studies that preselected participants according to increased distress produced large effects at post-treatment. A moderator effect was found for the moderator variable “duration of the intervention,” with longer interventions producing more sustained effects. Indicators of study quality were often not reported. Small-sample bias indicative of possible publication bias was found for some effects, particularly with individual psychotherapy and relaxation training.

Conclusion

Various types of psycho-oncologic interventions are associated with significant, small-to-medium effects on emotional distress and quality of life. These results should be interpreted with caution, however, because of the low quality of reporting in many of the trials.

Distress screening: an opportunity for enhancing quality cancer care and promoting the oncology social work profession

Throughout its history, social work has played a critical role in major client/patient care initiatives because of its unique perspective, wisdom, and skills. The new screening standards set forth by the American College of Surgeons' Commission on Cancer place oncology social workers at the forefront of developing and implementing procedures for distress screening. Our profession is again challenged to work across disciplines and change systems of care to improve the health and welfare of patients with cancer and their families. Indeed, emerging research suggests that the use of psychosocial screening instruments results in reductions in emotional distress, better quality of life, and improved patient-provider communication. As an introduction to this special issue on distress screening, this article offers a brief overview of issues related to distress screening that are covered by papers authored in this special issue by Association of Oncology Social Work members. Topics addressed include a review of the historical context driving distress screening implementation, barriers and challenges to oncology social workers trying to implement distress screening, statistical and cultural considerations for selecting screening tools, best practice models, and future considerations. This special issue is intended to be a primer and serves to promote oncology social workers' involvement and leadership in the development and implementation of distress screening.

Coping skills among African-American breast cancer survivors

Women with a diagnosis of breast cancer, particularly African-American women, face multiple barriers to survival. Although research exists regarding the unique barriers faced by African-American breast cancer survivors, there has been little research into the various coping needs or coping strategies used among African-American women. The purpose of this article is to provide information from an exploratory study of data investigating the coping skills of 30 African-American women diagnosed and treated for breast cancer. Quantitative data was collected via a self-report questionnaire based on the pretest of the Breast Cancer Survivors Toolbox. The study sample was evaluated to determine overall coping skills followed by an analysis of individual categories of coping skills (e.g., communication, information seeking, negotiating, social support systems, cultural norms). Although limited by the non-random sampling technique and self-report, the results of the study support the need for further research regarding the use of interventions and strategies tailored to improve coping skills used by this population.

Rationale of the BREAst cancer e-healTH [BREATH] multicentre randomised controlled trial: an internet-based self-management intervention to foster adjustment after curative breast cancer by decreasing distress and increasing empowerment

BACKGROUND

After completion of curative breast cancer treatment, patients go through a transition from patient to survivor. During this re-entry phase, patients are faced with a broad range of re-entry topics, concerning physical and emotional recovery, returning to work and fear of recurrence. Standard and easy-accessible care to facilitate this transition is lacking. In order to facilitate adjustment for all breast cancer patients after primary treatment, the BREATH intervention is aimed at 1) decreasing psychological distress, and 2) increasing empowerment, defined as patients' intra- and interpersonal strengths.

METHODS/DESIGN

The non-guided Internet-based self-management intervention is based on cognitive behavioural therapy techniques and covers four phases of recovery after breast cancer (Looking back; Emotional processing; Strengthening; Looking ahead). Each phase of the fully automated intervention has a fixed structure that targets consecutively psychoeducation, problems in everyday life, social environment, and empowerment. Working ingredients include Information (25 scripts), Assignment (48 tasks), Assessment (10 tests) and Video (39 clips extracted from recorded interviews). A non-blinded, multicentre randomised controlled, parallel-group, superiority trial will be conducted to evaluate the effectiveness of the BREATH intervention. In six hospitals in the Netherlands, a consecutive sample of 170 will be recruited of women who completed primary curative treatment for breast cancer within 4 months. Participants will be randomly allocated to receive either usual care or usual care plus access to the online BREATH intervention (1:1). Changes in self-report questionnaires from baseline to 4 (post-intervention), 6 and 10 months will be measured.

DISCUSSION

The BREATH intervention provides a psychological self-management approach to the disease management of breast cancer survivors. Innovative is the use of patients' own strengths as an explicit intervention target, which is hypothesized to serve as a buffer to prevent psychological distress in long-term survivorship. In case of proven (cost) effectiveness, the BREATH intervention can serve as a low-cost and easy-accessible intervention to facilitate emotional, physical and social recovery of all breast cancer survivors.

TRIAL REGISTRATION

This study is registered at the Netherlands Trial Register (NTR2935).

Efficacy of interventions to improve adherence to inhaled corticosteroids in adult asthmatics: impact of using components of the chronic care model

BACKGROUND

Adherence to inhaled corticosteroids (ICS) remains poor among asthmatics, yet little is known about the efficacy of interventions to improve adherence. Implementing the Chronic Care Model (CCM) components among patients with respiratory disorders has been associated with an improvement in outcomes, yet little is known about its effects on ICS adherence in asthmatics.

OBJECTIVE

We conducted a systematic review to assess the efficacy of interventions to improve ICS adherence among adult-asthmatics, and whether the use of CCM components (i.e., teaching self-management skills, providing decision support, delivery system design, and clinical information systems) resulted in greater ICS adherence.

METHODS

All English language articles testing the efficacy of an intervention including ICS medication on outcome from MEDLINE and PsychINFO databases through Aug-2010 were reviewed. Interventions were categorized based on the inclusion of CCM components. We standardized treatment effects to obtain effect-size's (ES's) and we combined the ES's of studies according to the number of CCM components included in their interventions.

RESULTS

Eighteen studies met inclusion criteria. Inclusion of a greater number of CCM components within interventions was associated with stronger effects on ICS adherence outcomes, with interventions featuring one, two, and four CCM components having medium (ES = 0.29; 95%CI, 0.16-0.42), large (0.53; 0.40-0.66), and very-large (0.83; 0.69-0.98) effects respectively.

CONCLUSIONS

Findings provide support for using the CCM as a framework for the design and implementation of interventions to improve adherence among adult-asthmatics.

Relationship of general self-efficacy with anxiety, symptom severity and quality of life in cancer patients before and after radiotherapy treatment

PURPOSE

Treatment-related symptoms can increase psychological and physical distress and alter the patient's quality of life. The present study evaluates prospectively treatment-related symptoms, general self-efficacy, anxiety and quality of life (QoL) in patients with different types of cancer undergoing external beam radiotherapy (RT) and the relationship of patients' general self-efficacy with the assessed measures, at the baseline and their absolute change 1 month after the end of the treatment.

METHODS

The sample consisted of 90 cancer patients. General self-efficacy was assessed using the General Perceived Self-efficacy (GSE). QoL was evaluated using the Linear Analogue Scale Assessment (LASA), anxiety with the Anxiety subscale of the Hospital Anxiety and Depression (HAD) scale, whereas symptom severity and interference were assessed using the MD Anderson Symptom Inventory (MDASI). The instruments were administered first at the beginning of the RT and then 1 month after the completion of the RT.

RESULTS

At post-treatment, general self-efficacy was reduced (28.86 ± 6.42), anxiety scores were elevated (9.56 ± 4.42), QoL scores were reduced (6.74 ± 1.81) and symptoms severity were deteriorated (3.24 ± 2.62). Pre-treatment and post-treatment absolute change scores revealed statistically significant negative correlations between general self-efficacy absolute scores and anxiety (p < 0.0005). Moderate negative correlations between general self-efficacy absolute scores and symptoms (MDASI symptom severity: p = 0.003, symptom interference: p = 0.002), whereas a low positive correlation was found between general self-efficacy absolute scores and LASA energy scale (p = 0.048).

CONCLUSIONS

A sense of self-efficacy and its relationship with anxiety, symptom distress and quality of life are important factors for patients receiving radiotherapy. Health care professionals need to be aware of anxiety, symptom severity and patient's quality of life prior to treatment initiation.

Evaluation of a social cognitive theory-based email intervention designed to influence the physical activity of survivors of breast cancer

OBJECTIVE

The aim of this study is to evaluate a 12-week social cognitive theory (SCT)-based email intervention designed to influence the physical activity of survivors of breast cancer.

METHODS

Seventy-four volunteers (intervention group, n = 36; control group, n = 38) were recruited by mass email and written letter solicitation. Participants completed a series of online questionnaires measuring demographic characteristics, physical activity readiness, level of physical activity and selected SCT variables at baseline, 6 and 12 weeks. The intervention group received email messages based on SCT designed specifically for breast cancer survivors and targeting physical activity. For the first 6 weeks of the intervention, participants assigned to the intervention group received messages weekly, from weeks 7 to 12, participants received messages every other week and had access to an e-counselor. The control group did not receive email messages, nor did they have access to an e-counselor.

RESULTS

Significant differences in levels of self-reported vigorous physical activity were found between groups at 6 and 12 weeks. Significant differences were also found for self-reported moderate physical activity at 12 weeks.

CONCLUSION

Email-based interventions based on SCT can significantly influence levels of self-reported physical activity of breast cancer survivors.

What happens now? Psychosocial care for cancer survivors after medical treatment completion

The growing population of adults living with a history of cancer in the United States mandates attention to quality of life and health in this group, as well as to the implementation of evidence-based interventions to address psychosocial and physical concerns at completion of medical treatments and beyond. The goals of this article are to document the need for attention to psychosocial domains during the re-entry and later phases of the cancer survivor trajectory, offer an overview of current evidence on efficacy of psychosocial interventions during those phases, and offer suggestions for application and research regarding post-treatment psychosocial care.

Are psychosocial factors associated with quality of life in patients with haematological cancer? A critical review of the literature

BACKGROUND

Haematological cancers differ from other cancers mainly with regard to treatment strategies: surgery is used for diagnostic purposes but rarely for treatment, whereas chemotherapy is of central importance and, in some cases, cures patients. This article reviews studies that examine the relationships between psychosocial factors and quality of life (QoL) in haematological cancer patients.

METHODS

A review of the literature was conducted from the databases 'PsycInfo', 'Medline' and 'Science Direct' using the keywords 'lymphoma', 'leukaemia', 'myeloma', 'quality of life', 'psychosocial factors', 'coping', 'social support', 'personality', 'anxiety,' 'depression', 'locus of control' and 'alexithymia'.

RESULTS

Fourteen studies were analysed. One study found positive relationships between sense of coherence and health-related QoL, whereas another showed a positive link between self-esteem and QoL. Another study suggested that a high external health locus of control was related to a better QoL. Fighting spirit had a positive impact on QoL for two studies, and helplessness-hopelessness was positively related to emotional distress in one study. Two studies indicated the relationships between emotional distress and QoL. Satisfaction with information about disease determined emotional distress in another study. Social support, general health perceptions, global meaning or spirituality were found to improve QoL in four other reports.

CONCLUSION

Literature about the relationships between psychosocial factors and QoL is lacking. Sense of coherence, self-esteem and health locus of control, coping strategies, social support, global meaning or emotional distress are associated with QoL. Results concerning coping and social support should be interpreted with caution because of level II evidence in studies.

Self-efficacy and fear of cancer progression during the year following diagnosis of breast cancer

OBJECTIVE

The aim of this study was to investigate fear of disease progression (FoP) during the year following diagnosis of breast cancer and its association with general self-efficacy (SE).

METHODS

In a prospective study, 118 breast cancer patients were recruited shortly after diagnosis disclosure (response rate: 54%) and at 1-year follow-up (follow-up rate: 90%). Participants completed self-report measures of general self-efficacy (General Self-Efficacy Scale) and fear of progression (short form of the Fear of Progression Questionnaire).

RESULTS

Cross-sectional regression analysis revealed that high FoP is significantly associated with low SE, even when controlling for demographic and medical characteristics (total R² = 0.17). Having children and a relatively short time since diagnosis also significantly predicted higher FoP. Longitudinal analyses showed that FoP decreased significantly over time (p = 0.001; d = 0.25), but a significant decrease was only observed for patients with high initial FoP (p < 0.001; d = 0.74) and not for those with low initial FoP (p = 0.688; d = 0.08). SE was not a significant predictor of FoP at follow-up when controlling for initial FoP and other patient characteristics (incremental R² = 0.001; p = 0.674; total R² = 0.47). Overall, only initial FoP significantly predicted FoP at follow-up (p < 0.001; β = 0.671).

CONCLUSION

Findings that low SE is associated with high FoP can help to improve the treatment of dysfunctional fears in breast cancer patients. As FoP changes only slightly over time, treatment to enhance SE and reduce FoP should be initiated soon after disease disclosure.

Psychological treatment outcomes for cancer patients: what do meta-analyses tell us about distress reduction?

OBJECTIVE

The effectiveness of psychological treatment for distress reduction in cancer patients has been frequently studied and reviewed in systematic reviews but reviewer conclusions vary considerably. Clear and consistent evidence is needed to assist clinicians and administrators with their decision-making. We hypothesized that uneven handling of confounding methodological features are at least partly the reason for disagreements and reviewed the literature in this light.

METHOD

A systematic review of 14 published meta-analyses was conducted to determine whether due consideration of moderating variables in psycho-oncological treatments permits clearer recommendations. Quality of the reviews, treatment type, dosage, therapist qualities, outcomes at follow-up, and screening versus not screening for elevated distress were examined as moderator variables.

RESULTS

Treatment effects are consistently positive but also vary greatly in magnitude. There is lacking evidence for many important questions, in particular, differential treatment effects for different cancer types and stages. Regarding moderators of outcome, quality of review had no impact on results for depression but including lower quality reviews actually lead to underestimation of treatment effects for anxiety. The most potent negative moderator variable, however, is a floor effect that arises when patients are recruited for treatment studies without being selected for high levels of distress. Such indiscriminate recruitment is very frequent in psycho-oncology and leads to small reported treatment effects; when, however, patients are first screened for elevated distress, the ratio of observed treatment effects sizes is roughly three times greater.

CONCLUSION

Sweeping judgments about the effectiveness of psycho-oncological treatments for distress reduction are somewhat misleading and counter-productive. Among moderator variables, floor effects are particularly pervasive and have a large suppressor effect on observed outcomes.

[Psycho-oncology - psychosocial oncology: integration in a concept of oncological treatment]

Psycho-oncology is defined by psychosocial aspects of prevention, etiology, diagnostics, treatment, and rehabilitation of cancer. It is characterized by interdisciplinary medicine, as well as cooperation between medical and nonmedical professionals. Psychosocial distress and/or psychiatric disorders are manifested in 30-60% of cancer patients. The primary target of psycho-oncological management is to retain and ideally optimize the subjective quality of life of cancer patients. It is important to understand that psycho-oncological care is part of an integrative oncological patient management. Basic psycho-oncological management is usually provided by the primary oncologist, whereas more specific psycho-oncological measures call for specially trained psychiatric/psychotherapeutic staff. Psycho-oncological interventions include psychological/psychotherapeutic, as well as psychopharmacologic interventions.

Patient education integrated with acupuncture for relief of cancer-related fatigue randomized controlled feasibility study

Background

Cancer-related fatigue (CRF) is a prominent clinical problem. There are calls for multi-modal interventions.

Methods

We assessed the feasibility of delivering patient education integrated with acupuncture for relief of CRF in a pilot randomized controlled trial (RCT) with breast cancer survivors using usual care as control. Social cognitive and integrative medicine theories guided integration of patient education with acupuncture into a coherent treatment protocol. The intervention consisted of two parts. First, patients were taught to improve self-care by optimizing exercise routines, improving nutrition, implementing some additional evidence-based cognitive behavioral techniques such as stress management in four weekly 50-minute sessions. Second, patients received eight weekly 50-minute acupuncture sessions. The pre-specified primary outcome, CRF, was assessed with the Brief Fatigue Inventory (BFI). Secondary outcomes included three dimensions of cognitive impairment assessed with the FACT-COGv2.

Results

Due to difficulties in recruitment, we tried several methods that led to the development of a tailored recruitment strategy: we enlisted oncologists into the core research team and recruited patients completing treatment from oncology waiting rooms. Compared to usual care control, the intervention was associated with a 2.38-point decline in fatigue as measured by the BFI (90% Confidence Interval from 0.586 to 5.014; p <0.10). Outcomes associated with cognitive dysfunction were not statistically significant.

Conclusions

Patient education integrated with acupuncture had a very promising effect that warrants conducting a larger RCT to confirm findings. An effective recruitment strategy will be essential for the successful execution of a larger-scale trial.

Trial registration

NCT00646633

Analyzing differences between psychotherapy groups and social support groups for breast cancer patients: development of an assessment method using video recordings

OBJECTIVE

When comparing the efficacy of different interventions for cancer patients, there should be certainty that these types are sufficiently different in the way they are actually presented. The aim of the present study is to develop a method for assessing differences between the content of social support groups and experiential-existential therapy groups.

METHODS

Independent and blind raters assessed video fragments of both intervention types, using a self-developed checklist of five questions. This checklist was first evaluated by a group of experts for appropriateness, importance, and rateability.

RESULTS

Three out of the five questions were selected on the basis of these experts' evaluation and on inter-rater reliability. The scores on these questions were used to evaluate five social support groups and six experiential-existential therapy groups for breast cancer patients. According to the independent and blind raters the content of the two intervention forms appeared to be significantly different.

CONCLUSION

The assessment method we developed appeared reliable and valid.

PRACTICE IMPLICATIONS

Our assessment method is feasible as a check to compare the content of psycho-oncological interventions and can be easily adjusted into a test for other intervention types.

Effectiveness of small-group interactive education vs. lecture-based information-only programs on motivation to change and lifestyle behaviours. A prospective controlled trial of rehabilitation inpatients

OBJECTIVE

Although patient education may promote motivation to change health behaviours, the most effective method has not yet been determined.

METHODS

This prospective, controlled trial compared an interactive, patient-oriented group program with lectures providing only information. We evaluated motivational stages of change and self-reported behaviours in three domains (sports, diet, relaxation) at four times up to one year (60% complete data) among 753 German rehabilitation inpatients (mean age 50 years, 52% male) with orthopaedic (59%) or cardiologic disorders (10%) or diabetes mellitus (31%).

RESULTS

We found improvements between baseline and follow up regarding each outcome (p<.001) in both groups. At the end of rehabilitation, participants of the interactive group, as compared to the lectures, showed more advanced motivation regarding diet (p<.10) and sports (p=.006). Interactive group patients reported healthier diets both after 3 months (p=0.013) and 12 months (p=0.047), more relaxation behaviours (p=.029) after 3 months and higher motivation for sports after 12 months (p=.08).

CONCLUSIONS

The superior effectiveness of the interactive group was only partly confirmed.

PRACTICE IMPLICATIONS

This short, 5-session interactive program may not be superior to lectures to induce major sustainable changes in motivation.

Caregiver-assisted coping skills training for lung cancer: results of a randomized clinical trial

CONTEXT

Lung cancer is one of the most common cancers in the United States and is associated with high levels of symptoms, including pain, fatigue, shortness of breath, and psychological distress. Caregivers and patients are adversely affected. However, previous studies of coping skills training (CST) interventions have not been tested in patients with lung cancer nor have systematically included caregivers.

OBJECTIVES

This study tested the efficacy of a caregiver-assisted CST protocol in a sample of patients with lung cancer.

METHODS

Two hundred thirty-three lung cancer patients and their caregivers were randomly assigned to receive 14 telephone-based sessions of either caregiver-assisted CST or education/support involving the caregiver. Patients completed measures assessing pain, psychological distress, quality of life (QOL), and self-efficacy for symptom management; caregivers completed measures assessing psychological distress, caregiver strain, and self-efficacy for helping the patient manage symptoms.

RESULTS

Patients in both treatment conditions showed improvements in pain, depression, QOL, and self-efficacy, and caregivers in both conditions showed improvements in anxiety and self-efficacy from baseline to four-month follow-up. Results of exploratory analyses suggested that the CST intervention was more beneficial to patients/caregivers with Stage II and III cancers, whereas the education/support intervention was more beneficial to patients/caregivers with Stage I cancer.

CONCLUSION

Taken together with the broader literature in this area, results from this study suggest that psychosocial interventions can lead to improvements in a range of outcomes for cancer patients. Suggestions for future studies include the use of three-group designs (e.g., comparing two active interventions with a standard-care control) and examining mechanisms of change.

Cancer-related fatigue and rehabilitation: a randomized controlled multicenter trial comparing physical training combined with cognitive-behavioral therapy with physical training only and with no intervention

BACKGROUND

Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer. To date, it is unclear what type of rehabilitation is most beneficial.

OBJECTIVE

This randomized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention.

DESIGN

In this multicenter randomized controlled trial, 147 survivors of cancer were randomly assigned to a group that received physical training combined with cognitive-behavioral therapy (PT+CBT group, n=76) or to a group that received physical training alone (PT group, n=71). In addition, a nonintervention control group (WLC group) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included.

SETTING

The study was conducted at 4 rehabilitation centers in the Netherlands.

PATIENTS

All patients were survivors of cancer.

INTERVENTION

Physical training consisting of 2 hours of individual training and group sports took place twice weekly, and cognitive-behavioral therapy took place once weekly for 2 hours.

MEASUREMENTS

Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention (12 weeks after enrollment). The WLC group completed questionnaires at the same time points.

RESULTS

Baseline fatigue did not differ significantly among the 3 groups. Over time, levels of fatigue significantly decreased in all domains in all groups, except in mental fatigue in the WLC group. Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue, on physical and mental fatigue, and on reduced activation but not on reduced motivation. Compared with the WLC group, the PT group reported significantly greater decline in 4 domains of fatigue, whereas the PT+CBT group reported significantly greater decline in physical fatigue only. No significant differences in decline in fatigue were found between the PT+CBT and PT groups.

CONCLUSIONS

Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention. Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue, suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training.

Living with hope: developing a psychosocial supportive program for rural women caregivers of persons with advanced cancer

Background

Hope is defined by caregivers as the inner strength to achieve future good and to continue care giving. Pilot test findings of a Living with Hope Program (LWHP) suggested it is an acceptable and feasible intervention for use by family caregivers. Although it shows promise in potentially increasing hope and quality of life, further testing and development is needed. Questions remain as to: a) what are the mechanisms through which the LWHP affects outcomes and b) how long it is effective? The overall purpose of this time series mixed method study is the further development and testing of the LWHP by:

a. Determining the mechanisms of the LWHP by testing a LWHP conceptual model in which self-efficacy, and loss/grief are hypothesized intermediary variables for changes in hope, and subsequently quality of life among rural women caring for persons with advanced cancer, and;

b. Exploring the longitudinal effects of the LWHP on hope, quality of life and health services utilization among rural women caring for persons with advanced cancer.

Methods/Design

Using a time-series embedded mixed method design, data will be collected from 200 rural women caregivers. Following the collection of baseline and outcome variables, the intervention (LWHP) is applied to all subjects. Subjects are followed over time with repeated measures of outcome variables (1 wk, 2 wk, 3, 6 and 12 months). The journals that are completed as part of the LWHP comprise the qualitative data. Health services utilization data will be collected from the Saskatchewan Health Administrative Database for all subjects one year prior and one year after study enrolment.

Path analysis will be used to test the model post LWHP, at 1 and 2 weeks. Two-factor ANCOVA will determine patterns over time and Cortazzi's narrative analysis will be used to analyze subjects journals completed as part of the LWHP.

Discussion

Data Collection began January 2009 and is expected to be completed within 2 years time. Monthly meetings with data collectors and site collaborators have been instrumental in revisions to the original study protocol such as identifying and adding additional study sites.

Trial Registration

Trial Registration; Clinical Trials.Gov. NCT01081301