Adjustment to cancer - coping or personal transition?

I am proud and hopeful: age-based comparisons in positive coping affect among women who use online peer-support

How do women who seek psychosocial support on the Internet by participating in cancer peer support groups respond to the process of coping with cancer? The current study examines whether older women with cancer have different perceptions about and are influenced to a different extent by online peer support than younger women. The study also explores age-based variations in outlook on coping with cancer as a result of using online support. Separate multivariate regression models estimated the effects of covariates on (1) positive coping affect (PCA) (2) positive coping affect-hopeful (PCA-H), and (3) positive coping affect-proud (PCA-P). A stratified analysis examined variations within age-based subsamples (≥51 and ≤50). Positive coping affect includes feeling proud about coping with cancer from a position of strength and empowerment rather than being a victim and being hopeful for a healthier future postdiagnosis. Online support was found to increase PCA significantly. This finding is consistent across age groups but was more pronounced for older patients. The only exception is that younger women perceive more benefit from using online support in terms of feeling proud. As severity of the symptoms increased, though the younger women increased the amount of time they were online, the older women increased the number of groups they participated in. The study concludes that the Internet might be particularly helpful for older adults who feel helpless to cope with cancer in old age. Online peer support services may help improve the patients' outlook on fighting with cancer and help them to feel more in control of their health.

Investigating the therapeutic potential of a heritage-object focused intervention: a qualitative study

This study explores the therapeutic potential of heritage-object handling in nurse-patient encounters with women facing cancer. Ten women participated in an object-focused conversation with a nurse specialist. Sessions were audio-tape recorded and transcribed. Kleinian theory framed the analysis to reveal the individual ways women 'used' the object in the session. Professionally observed heritage-object handling provides an aid to discussion with patients and has potential as an assessment platform for therapeutic work or as an intervention approach in its own right. Further longitudinal controlled trials are needed to evaluate such benefits, particularly given the depth of the talk revealed in this study.

Men's experiences of rheumatoid arthritis: an inductive thematic analysis

OBJECTIVES

There is a lack of evidence for understanding the clinical needs of men with rheumatoid arthritis (RA). This study investigated the psychosocial experience of this group, to inform clinical practice and generate further research.

METHODS

Twelve adult male patients with RA were interviewed once. Interview data were analysed using an inductive thematic analysis procedure. Categories and themes were validated by a second researcher and a male RA patient research partner.

RESULTS

Four themes were generated: loss of power and control; use of power and control; adjustment; influencing factors (age, pain, medication, relationships and health staff communication). Loss of power and control left participants vulnerable to low mood. Participants asserted power and control over RA by adopting a problem-solving stance in order to continue with ordinary life. An accepting attitude characterized the adjustment theme where men respected their bodies' limits. The final theme consisted of factors which influenced these three themes.

DISCUSSION

These data suggest that when RA results in loss of personal power and control, patients experience distress, which they may not express to their clinicians. Findings indicate directions for further research investigating the possibility that men and women may have differing clinical needs.

Coping resources and self-rated health among Latina breast cancer survivors

PURPOSE/OBJECTIVES

To examine relationships between coping resources and self-rated health among Latina breast cancer survivors.

DESIGN

Cross-sectional telephone survey.

SETTING

Four northern California counties.

SAMPLE

330 Latina breast cancer survivors within one to five years of diagnosis.

METHODS

Telephone survey conducted by bilingual and bicultural interviewers.

MAIN RESEARCH VARIABLES

Predictors were sociodemographic and clinical factors, cancer self-efficacy, spirituality, and social support from family, friends, and oncologists. Outcomes were functional limitations and self-rated health.

FINDINGS

Twenty-two percent of women reported functional limitations (n = 73) and 27% reported poor or fair self-rated health (n = 89). Unemployment (adjusted odds ratio [AOR] = 7.06; 95% confidence interval [CI] [2.04, 24.46]), mastectomy (AOR = 2.67; 95% CI [1.06, 6.77]), and comorbidity (AOR = 4.09; 95% CI [1.69, 9.89]) were associated with higher risk of functional limitations; cancer self-efficacy had a protective effect (AOR = 0.4, 95% CI [0.18, 0.9]). Comorbidity was associated with higher risk of poor or fair self-rated health (AOR = 4.95; 95% CI [2.13, 11.47]); cancer self-efficacy had a protective effect (AOR = 0.3; 95% CI [0.13, 0.66]).

CONCLUSIONS

Comorbidities place Latina breast cancer survivors at increased risk for poor health. Cancer self-efficacy deserves more attention as a potentially modifiable protective factor.

IMPLICATIONS FOR NURSING

Nurses need to assess the impact of comorbidity on functioning and can reinforce patients' sense of control over cancer and clinician support.

A longitudinal study on emotional adjustment of sarcoma patients: the determinant role of demographic, clinical and coping variables

The present study examined change on emotional distress of sarcoma patients from the diagnostic to treatment phases, the distinct trajectories of adjustment and the influence of demographic, clinical and coping variables on anxiety and depression. Thirty-six sarcoma patients completed questionnaires on emotional distress (Hospital Anxiety and Depression Scale) and coping strategies (Brief Cope) at time of diagnosis, and again during treatment. No significant change in emotional distress levels was found from diagnostic to treatment phase, with mean anxiety and depression scores remaining below the clinical range. Over time, 52.8% and 66.7% of patients maintained non-clinical anxious and depressive symptoms respectively, and 25% and 11.1% remained with clinical anxiety and depression. Living with partner, less use of humour and more denial were associated with high emotional distress at time of diagnosis and during treatments, and high levels of distress at baseline were predictive of poorer emotional adjustment during treatments. Although sarcoma patients, in general, seem to exhibit good psychological adjustment, there is a significant minority that requires mental health services in order to help decrease their emotional distress following the diagnosis, and prevent psychological difficulties during treatments. Our findings are an important contribution to understanding the psychological adjustment of patients with a specific and rare type of cancer.

Anxiety, depression and quality of life after cancer diagnosis: what psychosocial variables best predict how patients adjust?

OBJECTIVE

Significant numbers of cancer patients suffer distress, reduced quality of life and various other psychological problems. Evidence regarding psychological predictors of these outcomes is inconsistent. This study explored a range of predictors using an established psychological framework to identify the most important predictors of cancer adjustment, and when these are best assessed for optimal outcome prediction.

METHODS

One hundred sixty newly diagnosed breast, colorectal, lung and prostate cancer patients completed questionnaires after diagnosis and at 3- and 6-month follow-up. Measures included personality, illness cognitions, emotion, coping and outcome (anxiety, depression and quality of life).

RESULTS

Between 47-74% of variance in psychosocial outcome was explained although large proportions were accounted for by clinical factors, demographics and earlier levels of anxiety, depression and quality of life. Of the psychological variables, cognitive appraisals featured more consistently then either emotions or coping.

CONCLUSIONS

There are clear and consistent predictors of negative psychosocial outcome that could be used in clinical practice to risk-assess and monitor patients for adjustment difficulties. The finding that appraisals were more predictive of outcome than emotions and coping may inform the development of psychological interventions for cancer patients.

"I'm still who I was" creating meaning through engagement in art: The experiences of two breast cancer survivors

PURPOSE

The aim of this feasibility study was two-fold: i) develop lifelike torsos of two breast cancer survivors using innovative sculpting material and; ii) shed light on the meaning women give to the experience of breast cancer after viewing their sculpted torsos.

METHODS

This collaborative initiative between nurse researchers and artists was situated within phenomenological inquiry. Two breast cancer survivors shared their bodies, as models, and stories of their cancer journey and the experience of modeling to create life-sized torsos of their bodies.

KEY RESULTS

The participants articulated embodied knowing as each shared experiences of connectedness and relationship which culminated in the emergence of four core themes: The Landscape of Breast in Cancer; Red Shoes: The Re-claiming of Self; Liberation: towards an embodied self; and, Scars: Re-authoring Life.

CONCLUSIONS

Active engagement in art through the use of one's body has the potential to open the door to healing, the generation of meaning and a reaffirmation of self.

Survivor centrality among breast cancer survivors: implications for well-being

OBJECTIVE

The goal of this research was to examine the extent to which 10-year breast cancer survivors integrated cancer into their self-concept (i.e. survivor centrality), identify predictors of survivor centrality, and determine the relation of survivor centrality to well-being.

METHODS

Breast cancer survivors (n=240) were interviewed 10 years following the initial diagnosis. They completed measures of survivor centrality, illness valence (i.e. positive or negative views of illness), and well-being (positive and negative affect, mental and physical functioning, psychological distress, benefit finding).

RESULTS

There were few predictors of the kinds of women who were more likely to integrate breast cancer into their self-concepts, but survivor centrality was related to engaging in behaviors that suggested survivorship was relevant to women's daily lives, such as becoming involved in breast cancer activities. Survivor centrality was related to three markers of negative psychological well-being: more negative affect, poorer mental functioning, and greater psychological distress. However, in the case of negative affect and psychological distress, this relation was moderated by illness valence, such that survivor centrality was only related to negative psychological well-being when the illness was viewed in less positive terms.

CONCLUSIONS

Women vary in the extent to which they define themselves in terms of the breast cancer experience. Survivor centrality in and of itself is not always indicative of adjustment to disease. When women have a more negative view of being a breast cancer survivor, survivor centrality is more likely to signify potential problems.

Posttraumatic growth after cancer: the importance of health-related benefits and newfound compassion for others

PURPOSE

There is growing evidence in psycho-oncology that people can experience posttraumatic growth (PTG), or positive life change, in addition to the distress that may occur after a cancer diagnosis. Many studies utilise existing PTG measures that were designed for general trauma experiences, such as the Posttraumatic Growth Inventory. However, such inventories may not take into account life changes associated with a crisis specifically in a health-related context.

METHOD

The current study presents a mixed method exploration of the post-diagnosis experience of cancer survivors (N = 209) approximately 3 years after diagnosis.

RESULTS

Quantitative and qualitative assessment of PTG showed that appreciating life was the most salient area of positive life change for cancer survivors. The results also revealed that in addition to several PTG domains captured by existing quantitative PTG measures, further positive life changes were reported, including compassion for others and health-related life changes.

CONCLUSIONS

These domains of PTG highlight the unique context of a cancer diagnosis and the potential underestimation of positive life change by existing inventories. Further research is warranted that is directed towards designing a context-specific PTG measure for cancer survivors.

The impact of breast cancer on living an everyday life 4.5-5 years post-diagnosis - a qualitative prospective study of 39 women

BACKGROUND

The survival of women with breast cancer has improved. There are many studies available describing different aspects of how the illness and its treatment affect the women. Usually these studies are cross-sectional and focus on assessments of a sample of women at a single point in time during post-treatment. These studies are important but of limited value if we are interested in understanding more about breast cancer in a life context. The present study is a contribution.

METHODS

A consecutive sample of 39 women was followed up by means of repeated thematic interviews about how they lived their lives, from the end of radiation therapy to a point four years later, i.e. 4.5-5 years post diagnosis.

RESULTS

Four different groups of women emerged. Largely, the first group evaluated the cancer initiated transformation of their lives in a positive way. The breast cancer helped them depart from a career treadmill or to positive interpersonal experiences. In the second group the cancer and its treatment seemed to pass without marked traces. The cancer made a difference for the third group, but both in positive and negative ways. A different life perspective or improved relationships were weighted against troublesome side effects from treatment. Finally, in the fourth group a bodily decline due to side effects and other health problems was predominant and this obstructed their chances of living a good life.

DISCUSSION

The narratives showed that being diseased by breast cancer has different impacts depending on how the woman lives her life - it is very much a matter of transition in a life context. The results are furthermore discussed in relation to adaptation and coping theory.

Psychosocial group intervention for patients with primary breast cancer: a randomised trial

PURPOSE

To test the effectiveness of a psycho-educational group intervention to improve psychological distress measured by POMS TMD, Quality of Life measured by European Organisation for Research and Treatment of Cancer (EORTC), the core and breast cancer module, Mental Adjustment measured by MAC and marital relationship measured by BLRI in women with primary breast cancer conducted 10 weeks after surgery. A secondary outcome was 4-year survival.

PATIENTS AND METHODS

We randomly assigned 210 patients with primary breast cancer to a control or an intervention group. Patients in the intervention group were offered two weekly 6-h sessions of psycho-education and eight weekly 2-h sessions of group psychotherapy. All participants were followed up for Quality of Life, coping ability and social relations 1, 6 and 12 months after the intervention and on survival 4 years after surgical treatment.

RESULTS

No statistically significant effects of the intervention were found on any of the psychosocial questionnaire outcomes. There were not enough cases of death to analyse overall survival. The only statistically significant result was for patients who used anti depressive medication, for whom almost all measures improved over time, in both the control and intervention groups.

CONCLUSION

Psycho-education and group psychotherapy did not decrease psychological distress or increase Quality of Life, Mental Adjustment or improve marital relationship among patients with primary breast cancer.

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

OBJECTIVE

We examined whether post-traumatic growth would moderate the impact of intrusive thoughts on a range of dimensions of well-being in a sample of younger adult survivors of various types of cancer.

METHODS

167 participants completed questionnaires regarding intrusive thoughts, post-traumatic growth, mental and physical health-related quality of life, positive and negative affect, life satisfaction, and spiritual well-being. Multiple regression analyses controlling for relevant background and cancer-related variables tested the interaction effects of post-traumatic growth and intrusive thoughts.

RESULTS

Intrusive thoughts were related to poorer adjustment on all indices except physical health-related quality of life. However, post-traumatic growth moderated the effects of intrusive thoughts on positive and negative affect, life satisfaction, and spiritual well-being in a protective fashion. That is, for those higher in post-traumatic growth, higher levels of intrusive thoughts were related to better adjustment.

CONCLUSIONS

The positive meaning that individuals assign to their cancer experience as reflected in their reports of post-traumatic growth appears to be important in determining the impact of intrusive thoughts on post-cancer adjustment.

Experiences of adjusting to early stage Multiple Sclerosis

Multiple Sclerosis (MS) is a progressive, unpredictable neurological disease. Little research has examined adjustment to living with MS, especially within early disease stages. We interviewed 30 people with early stage MS and analysed transcripts using thematic analysis. Early stage MS was typically considered difficult but manageable and was dealt with through positivity and practical strategies to preserve normal life. However, adjustment seemed precariously contingent on reasonable current and future health status. Participants described disinclination towards involvement in the stigmatized world of MS. Findings have implications for sensitive services for people with MS and question acceptance as a marker of appropriate adaptation.

Survivor identity and post-traumatic growth after participating in challenge-based peer-support programmes

OBJECTIVES

The social construction of breast cancer (BC) survivor identity has produced a powerful image of woman as survivor. Group membership through peer-support programmes can provide positive role models, shape survivor identity and promote post-traumatic growth (PTG). The main objective of this study was to conduct a qualitative investigation based on a phenomenological framework in order to understand the lived experience of BC survivors participating in a peer-support programme based on a challenge event.

DESIGN

This is a qualitative semi-structured and written narrative study. Interviews were subjected to interpretative phenomenological analysis and the written narratives via thematic analysis.

METHOD

Interviews were conducted with 27 participants who were new to the peer-support event for women diagnosed with BC, and 10 participants who had taken part in multiple events provided written narratives of their experience. Interviews and surveys were completed pre- and post-event.

RESULTS

Important elements of the peer-support environment included a safe network of other survivors, which provided understanding and acceptance. Overcoming challenges during the event and the opportunity to bond with positive role models affirmed a strong survivor identity and promoted PTG. For some participants, a shift in identity was evident with a newfound positive identification with the term BC survivor.

CONCLUSIONS

Peer-support programmes based on challenge events have the potential to extend the type of supportive care that is available for women diagnosed with BC by providing an alternative to the traditional support group format.

Predictors of psychosocial adjustment during the postradiation treatment transition

The aim of this study was to examine the role of cognitive appraisal in predicting psychosocial adjustment during the postradiation treatment transition. A predictive correlational design was used in a convenience sample of 80 patients with breast, lung, and prostate cancer who were receiving radiation therapy. Two weeks prior to completion of treatment, participants completed instruments to measure symptom distress, uncertainty, cognitive appraisal, social support, and self-efficacy for coping. The Psychosocial Adjustment to Illness Scale was administered 1 month after therapy. Adjustment was significantly correlated with all independent variables, age, and comorbidity. Young age and high amounts of threat appraisal, harm/loss appraisal, uncertainty, and symptom distress were significantly associated with poor adjustment. The model predicted 52% of the variability in adjustment. Cognitive appraisal was not a significant explanatory variable for adjustment when controlling for uncertainty, cancer stage, age, and symptom distress. Symptom distress was the only significant predictor of adjustment.

Evaluation of the SCA instrument for measuring patient satisfaction with cancer care administered via paper or via the Internet

Background: Patients’ perspectives provide valuable information on quality of care. This study evaluates the feasibility and validity of Internet administration of Service Satisfaction Scale for Cancer Care (SCA) to assess patient satisfaction with outcome, practitioner manner/skill, information, and waiting/access.

Patients and methods: Primary data collected from November 2007 to April 2008. Patients receiving cancer care within 1 year were recruited from oncology, surgery, and radiation clinics at a tertiary care hospital. An Internet-based version of the 16-item SCA was developed. Participants were randomised to Internet SCA followed by paper SCA 2 weeks later or vice versa. Seven-point Likert scale responses were converted to a 0–100 scale (minimum–maximum satisfaction). Response distribution, Cronbach’s alpha, and test–retest correlations were calculated.

Results: Among 122 consenting participants, 78 responded to initial SCA. Mean satisfaction scores for paper/Internet were 91/90 (outcome), 95/94 (practitioner manner/skill), 89/90 (information), and 86/86 (waiting/access). Response rate and item missingness were similar for Internet and paper. Except for practitioner manner/skill, test–retest correlations were robust r = 0.77 (outcome), 0.74 (information), and 0.75 (waiting/access) (all P < 0.001).

Conclusions: Internet SCA administration is a feasible and a valid measurement of cancer care satisfaction for a wide range of cancer diagnoses, treatment modalities, and clinic settings.

Space, Place, and Psychosocial Well-Being: Women's Experience of Breast Cancer at an Environmental Retreat

Psychosocial oncology research has highlighted the complex experience of living with cancer, encompassing personal and emotional, as well as family, social and community experiences. This article seeks to extend the concept of “psychosocial” to include therapeutic landscapes, and to understand in what ways space and place shape the experience of living with cancer. These ideas are explored with reference to a qualitative study that explored women's experience of breast cancer at an environmental retreat in Victoria, Australia.

The structure of adversarial growth in a sample of cancer patients 8 years post-diagnosis: a revision of the SLQ-38

Stressful and traumatic events may trigger positive life changes, so-called adversarial growth. Despite growing interest in this topic, the structure and dimensionality of this concept has not been established. Recently, empirical reviews have suggested that the factors underlying this construct are highly related. Currently, the use of confirmatory factor analysis to test this hypothesis is advocated. Using data from cancer patients (n = 206), this study investigated the dimensionality of a Dutch translated version of the Silver Lining Questionnaire (SLQ-38). A 16-item SLQ (SLQ-16), with three subscales or first-order factors (enhanced personal relationships, changes in life philosophy and changes within the self) loading on a second-order general adversarial growth factor, was a good fitting model. In conclusion, the SLQ-16 may prove useful in the assessment of adversarial growth following illness.

The effects of religiosity, spirituality, and social support on quality of life: a comparison between Korean American and Korean breast and gynecologic cancer survivors

PURPOSE/OBJECTIVES

To examine the differences in religiosity, spirituality, and quality of life (QOL) between Korean American and Korean breast and gynecologic cancer survivors and investigate the effect of religiosity, spirituality, and social support on QOL.

DESIGN

Cross-sectional design.

SETTING

Participants were recruited from hospitals and community-based support groups in the areas of Southern California and Seoul, Korea.

SAMPLE

161 women diagnosed with breast and gynecologic cancer (110 Koreans and 51 Korean Americans).

METHODS

Participants completed a mailed questionnaire. To identify the QOL outcomes, religiosity, spirituality, and social support, four standardized measures were used.

MAIN RESEARCH VARIABLES

QOL outcomes, religiosity, spirituality, religious involvement, and social support.

FINDINGS

Religiosity and spirituality were related to some QOL outcomes in different patterns in Korean American and Korean breast and gynecologic cancer survivors. The effect on QOL, however, was not strong after controlling for covariates. Social support partially mediated the effect of spirituality on QOL but only among the Korean American cancer survivors.

CONCLUSIONS

The findings provide evidence that the effect of religiosity and spirituality on QOL varied between Korean American and Korean survivors. The mediating effect of social support between spirituality and QOL for Korean Americans also was demonstrated.

IMPLICATIONS FOR NURSING

The results present nursing practice and research implications that religiosity, spirituality, and social support need to be considered in developing services for enhancing QOL of immigrant cancer survivors.

Self-identity after cancer: "survivor", "victim", "patient", and "person with cancer"

BACKGROUND

Living through cancer often involves developing new identities which may strongly influence well-being and relationships with care providers, yet little is currently known about these post-cancer identities.

OBJECTIVES

To examine (1) the extent to which four post-cancer identities (patient, person who has had cancer, victim, and survivor) are adopted, (2) relations between each identity and involvement in cancer-related activities and mental and physical well-being, and (3) correlates of these identities.

DESIGN

Cross-sectional questionnaire-based study.

PARTICIPANTS

168 young to middle-aged adults who had previously experienced cancer.

MEASUREMENTS

Cancer identifications, background variables, psychological functioning, cancer risk appraisals and coping, cancer-related activities, and mental and physical well-being.

RESULTS

At least somewhat, 83% endorsed survivor identity, 81% identity of "person who has had cancer", 58% "patient", and 18% "victim". Identities were minimally correlated with one another and differentially associated with involvement in cancer-related activities. Survivor and person who has had cancer identities correlated with involvement in most cancer-related activities such as wearing cancer-related items and talking about prevention (ps < 0.5). Survivor identity correlated with better psychological well-being and post-traumatic growth, victim identity with poorer well-being (ps < 0.5); neither identifying as a patient nor a person with cancer was related to well-being. Through regression analyses, identities were shown to be explained by unique combination of background, functioning, appraisal and coping variables.

CONCLUSIONS

Survivor identity appears most common and most associated with active involvement and better psychological well-being, but other identifications are also common and simultaneously held. Adoption of specific cancer identities is likely to impact interactions with health care providers, including those in general internal medicine, and health behavior changes.

Making sense of living under the shadow of death: adjusting to a recurrent breast cancer illness

Women with recurrent breast cancer face many difficulties and challenges, from clinical symptoms of disease progression and treatment to a range of emotional responses. Guided by grounded theory methodology, we explored the main concerns of women with recurrent breast cancer, and how they were dealing with their situations. Data were collected from 40 in-depth interviews with 20 women diagnosed with recurrent breast cancer. The core category illustrated the process of "making sense of living under the shadow of death," and was based on the women's experiences of adjusting to living with a persistent life-threatening illness. Confronting a recurrence of breast cancer was a life-altering event. Moving through a difficult and challenging time, women eased their distress by letting go of losses and reassessing important values. Through a personal transition women transcended living with a life-threatening illness. These findings emphasize the importance of recognizing existential distress in clinical practice.

Patients' constructions of disability in metastatic spinal cord compression

Metastatic spinal cord compression (MSCC) is characterised by poor prognosis and serious physical disability. Patients have complex rehabilitation needs, but the evidence on rehabilitation is sparse. This study aimed to ascertain the constructions placed upon disability by patients with MSCC. The method consisted of a series of nine process-tracing, longitudinal case studies, involving 58 interviews with 9 patients, 6 carers and 29 staff in one National Health Service region. A context-mechanism-outcome configuration was adopted as a conceptual basis for data collection, together with a constant comparative method of data analysis. Patients' orientation to disability incorporated two apparently inconsistent attitudes. Patients acknowledged that their situation had changed and that their future plans would need to accommodate altered circumstances. However, they also resisted the idea of themselves as disabled, wanting to retain an image of themselves as resourceful and resilient. Patients used a number of strategies to reconcile the tension between these two positions. The illusions incorporated into the 'failure to acknowledge' pole of this orientation are self-protective and, like other positive illusions, have psychological benefits. Providing effective and acceptable support to patients living with disability relies on professional responses that are able to sustain patients' sense of their own competence.

Being in the script of menopause: mapping the complexities of coping strategies

In this article we explore the discourses of menopause, aging, and the complexities of coping with both menopause and aging among 30 women between the ages of 43 and 61 years living in Melbourne, Australia. Employing a qualitative design with thematic analysis, we uncover the complexity and heterogeneity of coping styles. Three major coping strategies are identified: inventive, troubled, and reactive. Recognition of the variety of coping strategies creatively negotiated within the dynamic, complex processes of aging and menopause might assist women in developing effective responses to these sometimes challenging life experiences.

Patterns of objective physical functioning and perception of mood and fatigue in posttreatment breast cancer patients and healthy controls: an ambulatory psychophysiological investigation

OBJECTIVE

To monitor objective physiological and self-report measures among apparently disease-free breast cancer patients (n = 33) in the first 2 years of posttreatment recovery, using a cross-sectional design, and compare findings with women without histories of cancer or other serious disorders (n =33). Time-since-treatment also served as an independent variable. Few studies have examined adjustment of breast cancer patients after primary treatment or objectively characterized posttreatment, everyday patterns of functioning.

METHODS

A 24-hour ambulatory minute-by-minute cardiorespiratory functioning and accelerometry activity were measured during one day, together with multiple repeated assessments of mood and fatigue. Traditional retrospective measures of well-being were also evaluated. Our ambulatory methodology permitted estimation of physiological rhythms of cardiorespiratory and accelerometry activity.

RESULTS

Patients reported lower ambulatory levels of energy and poorer mood during the daytime than controls. Time-since-treatment was related directly to both momentary mood and energy as well as to objective measures of activity and respiratory parameters. Retrospective self-reports of impaired mood and symptoms persisted in patients, independently of time-since-treatment and of ambulatory physical or physiological activity. Ambulatory self-report data were associated with concurrent respiratory measures. Chemotherapy-related elevation of heart rate was found but was unrelated to self-report measures.

CONCLUSIONS

Impaired sense of well being based on retrospective measures is not associated with pattern of physical or physiological functioning after treatment for breast cancer. However, ambulatory, momentary levels of mood and fatigue seem to be related to concurrent ventilatory activity and time-since-treatment. This is the first investigation that relates ambulatory and retrospective measures of affect and fatigue to concurrent, real-life physical functioning.

Women's Experiences of an Altered Appearance during Chemotherapy

This study explores breast cancer patients' experiences of chemotherapy treatment, with a focus on the impact of an altered appearance during this time. We present two key themes from the thematic analysis of interviews with 19 women: anxiety that chemotherapy will render them identifiable as a `person-with-cancer'; and problematic interactions with others. We discuss how changes in appearance can reveal disease status to others, demonstrate the personal impact of temporary changes to appearance, relate these findings to literature on psychosocial aspects of disfigurement and consider the provision of psychosocial care for women experiencing an altered appearance during chemotherapy.

Coping simultaneously with 2 stressors: immigrants with ovarian cancer

The dual adjustment to being a cancer patient and an immigrant involves major changes in life and might be a severe experience. This study set out to describe the experience of women who have come to Israel from the former Soviet Union and are coping with ovarian cancer. It focused on illness narratives as presented by 8 patients with cancer at stage III. Our findings indicated that the dual process might have different implications according to the meaning attributed by the patient to the illness situation. Viewing the illness as one more burden among other difficulties, such as language barrier, was a prism through which patients experienced their vulnerability in coping with the illness. Alongside a helplessness pattern, we found indications of interviewees' perceiving advantages in their status as immigrant cancer patients, by dealing with that problem alongside other difficulties. They showed a "fighting spirit" in coping with the illness. Immigration can have a moderating effect on patients' experiences, and the 2 stressors do not necessarily accumulate. Our findings indicate that patients' meaning to the illness experience was a "litmus test," which indicated the way patients would describe their coping stages. This may have potential as a clinical marker of psychological vulnerability.

Psychological distress in long-term survivors of hematopoietic stem cell transplantation

The prevalence of psychological distress is higher in cancers with poorer prognoses and speculated as higher in those receiving more aversive treatments. Since hematopoietic stem cell transplant (HSCT) is one of the most taxing cancer treatments to endure and is therefore likely to have more long-term sequelae, this study examined psychological distress symptoms in long-term HSCT survivors who were at least 1 year post-transplant. Participants in this cross-sectional study were recruited from urban medical centers as part of a larger study of HSCT survivors. The sample comprised 236 adults who were on average 3.4 years since transplant. Psychological distress was measured by a commonly used self-report questionnaire, the Brief Symptom Inventory. Clinically elevated psychological distress caseness was present in 43% of long-term HSCT survivors. Elevations were highest on clinical subscales of obsessive-compulsiveness, somatization, and psychoticism. However, item-level analyses revealed that the content of the most frequently reported symptoms included trouble with memory and feelings of loneliness. Results of this study suggest that HSCT survivors may experience memory and existential concerns and that such symptoms may not represent psychiatric sequelae.

Cancer families with children: factors associated with family functioning—a comparative study in Finland

OBJECTIVE

The objective is to examine the factors associated with family functioning in families with children where a parent has cancer in comparison to families without cancer.

SAMPLE AND METHODS

Eighty-five families including 85 cancer patients, 61 healthy spouses and 68 children between 11 and 17 years of age, and a control group of 59 families including 105 adults and 65 children were given a set of questionnaires including a background variable questionnaire, the Family Assessment Device, the Beck Depression Inventory and the Sense of Coherence (SOC). A statistical multilevel model allowing the use of data from several informants belonging to the same family was constructed for the analysis of associations between variables.

RESULTS

Maternal depression and SOC of family members were associated with family functioning; maternal depression impaired family functioning and family members' SOC improved it. No difference was found between the clinical group and the control group.

CONCLUSION

In clinical work with cancer families with children, maternal depression and SOC should be focused on.

Anticipating an altered appearance: Women undergoing chemotherapy treatment for breast cancer

Chemotherapy treatment for cancer can have a profound impact on appearance, and is often experienced as distressing. Few qualitative studies explore experiences of chemotherapy, and seldom focus on the process of anticipation and preparation for an altered appearance. We report findings from an interview study of 19 women which explored their expectations of chemotherapy-induced hair loss, their anticipated reactions to hair loss and how women intend to prepare for an altered appearance. The results demonstrate that women are active in anticipating hair loss and adopt a range of different strategies to manage their alopecia--even before it has occurred. Four key themes were identified: (a) anticipating hair loss, (b) coming to terms with the inevitability of hair loss, (c) becoming ready, and (d) taking control. We argue that this can be seen as a form of anticipatory coping, which involves affective and behavioural rehearsal so that women can feel more in control of their experience of the side effects of chemotherapy treatment for cancer. We suggest seeing these activities as a form of anticipatory coping, and understanding the psychological reasons why women engage in these activities, may help nursing professionals to better support women through this often traumatic time.

Gender and ethnic differences in cancer patients' needs for help: an Internet survey

BACKGROUND

Although a number of studies have reported different domains of cancer patients' needs for help, very little is known about gender and ethnic differences in those needs. Gender differences have been implicitly assumed in most studies, and specific ethnic groups have been focused on rather than comparing several ethnic groups.

OBJECTIVES

The purpose of this pilot study was to explore cancer patients' needs for help among four major ethnic groups in the US, to determine gender and ethnic differences in needs, and to provide direction for future studies.

DESIGN

This was a descriptive and comparative pilot study using a feminist perspective.

SETTINGS AND PARTICIPANTS

A total of 110 self-identified cancer patients were recruited through both Internet and community settings using a convenience sampling method.

METHODS

The instruments included sociodemographic questions, the Cancer Needs Questionnaire-Short Form, and the Supportive Care Needs Survey. The data were analyzed using descriptive statistics and inferential statistics including the Mann-Whitney U tests and Kruskal-Wallis tests.

RESULTS

The findings indicated that there was no significant gender difference in all domains of needs for help. There were significant ethnic differences in all domains of needs except communication and sexual needs. Asians reported the lowest scores in most domains of needs for help while Hispanics reported the highest scores in most domains of needs for help.

CONCLUSIONS

The findings indicated certain ethnic differences in cancer patients' needs for help and suggest further in-depth qualitative investigations on cultural beliefs and attitudes that may influence needs, with a careful examination of gender sensitivity and cultural competence of the instruments measuring cancer patients' needs for help.

Liminality as a Descriptor for the Cancer Experience

Liminality has been used in medical anthropology to conceptualize the cancer experience (Little, Jordens, & Paul, 1998). This article discusses the results of a recent study that support this, that indeed having ovarian cancer can instill a sense of alienation from life as a person has known it. However, it is also suggested here that the term needs to be amended to include the social surround of a liminal experience, as well as the generative potential inherent in such an experience. The study is qualitative in nature and explores the subjectivity of nine women living with stage-three ovarian cancer. The recurrent nature of the disease with its poor survival rate was found to instill a kind of sustained trauma that is accentuated by experiences of suffering in connection to loss. Finally, a pressing need to speak with and find recognition from other women who shared the same site of cancer was found.