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Javadizadeh B, Ross J, Valenzuela MA, Adler TR, Wu B. What's the point in even trying? Women's perception of glass ceiling drains hope. THE JOURNAL OF SOCIAL PSYCHOLOGY 2024; 164:488-510. [PMID: 36062539 DOI: 10.1080/00224545.2022.2119121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
Abstract
In this study, we focus on glass ceiling perceptions, characterized by women's subjective feelings about their ability to move upward in their organization. Drawing on social information processing and hope theory, we propose that glass ceiling perceptions decrease women's citizenship behaviors and increase their turnover intentions by draining their hope in the workplace. Moreover, we suggest that the strength of the association between glass ceiling perceptions, drained hope in the workplace, and these two outcomes is conditional upon women's perceptions of their work-family conflict. Using a two-study design, we tested our hypothesized relationships. We found a mediating effect of drained hope in the workplace between glass ceiling perceptions and (a) turnover intention and (b) organizational citizenship behaviors. This effect is significant when work-family conflict is high. Finally, we discuss the implications of our findings regarding the tensions that women experience with simultaneously managing their careers and conflict in the family.
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Matbouei M, Samsami M, Soleimani M. Breast Cancer Survivors' Experiences of Acceptance Following Recurrence: A Qualitative Content Analysis. Cancer Nurs 2024; 47:E226-E235. [PMID: 36867010 DOI: 10.1097/ncc.0000000000001217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Breast cancer recurrence is a traumatic event for patients, and its treatment depends on the patient's ability to accept the circumstances. OBJECTIVE The aim of this study was to explore how patients experience breast cancer recurrence and go through a process of negotiating acceptance. METHODS This study explored the experiences of 16 patients with breast cancer recurrence regarding the acceptance of recurrence in a hospital in Tehran, Iran. Purposive sampling with maximum diversity was used. Data were collected through semistructured telephone interviews from November 2020 to November 2021 and analyzed using the qualitative content analysis. RESULTS Four themes emerged that described the process of accepting cancer recurrence: (1) response to recurrence (emotional reactions and loss of trust); (2) psychological preparedness (confirmation of medical diagnosis and acceptance of fate); (3) mobilizing supports (using spiritual capacities, utilizing supportive resources, and seeking relationships to promote knowledge); and (4) return to the path of treatment (rebuilding trust and continuation of treatment). CONCLUSIONS The acceptance of breast cancer recurrence is a process that begins with emotional reactions and ends with returning to the treatment path. The patient's psychological preparation, support systems, behavior of healthcare providers, and rebuilding trust are the determining factors in acceptance of recurrence. IMPLICATIONS FOR PRACTICE Nurses can compensate for the failures created in the primary treatment of breast cancer by spending time with patients and paying attention to their concerns, providing effective education, strengthening communication between patients with similar conditions and using the spiritual capacities of patients, and mobilizing the support of family and relatives.
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Affiliation(s)
- Mahsa Matbouei
- Author Affiliations: Student Research Committee, School of Nursing and Midwifery (Ms Matbouei), and Nursing Care Research Center (Dr Soleimani), Semnan University of Medical Sciences, Semnan; and Cancer Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran (Dr Samsami)
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Walsh LE, Rosenfeld B, Feuerstahler L, Pessin H, Breitbart W. Measuring hopelessness in advanced cancer: a secondary analysis of the Hopelessness Assessment in Illness questionnaire (HAI). Psychol Health 2023; 38:847-861. [PMID: 34678104 PMCID: PMC9023589 DOI: 10.1080/08870446.2021.1989430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/23/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Hopelessness, or a sense of despair about the future, has been a growing focus of psychological research among patients with serious medical illnesses. This study evaluated the psychometric properties of the Hopelessness Assessment in Illness (HAI) questionnaire, developed specifically for those facing a life-threatening illness. Participants were 344 advanced cancer patients (e.g. lung, breast, gastrointestinal, etc.) participating in two psychotherapy research trials. DESIGN Descriptive statistics characterised participants in regard to both demographic (age, gender, race, ethnicity, religiosity) and clinical characteristics (cancer type). Scale properties were assessed for internal consistency using Cronbach's coefficient alpha, item-total correlations, Principle Axis factor analysis, and its correlation to relevant psychological constructs. Nonlinear confirmatory factor analysis (CFA) assessed for latent construct variance by gender. MAIN OUTCOME MEASURES Psychometric properties of the Hopelessness Assessment in Illness questionnaire. RESULTS Results indicated strong internal consistency and temporal stability of the HAI, with significant correlations between the HAI and several theoretically related psychological constructs. CFA suggested the same single underlying factor for males and females. CONCLUSIONS The HAI demonstrated strong psychometric properties in the context of advanced cancer. Future research is needed to assess the utility of the HAI in more medically and geographically diverse populations.
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Affiliation(s)
- Leah E. Walsh
- Fordham University, Department of Psychology, 441 East Fordham Road, 226 Dealy Hall, Bronx, NY 10458
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 640 Lexington Ave., 7 Fl. New York, NY 10022
| | - Barry Rosenfeld
- Fordham University, Department of Psychology, 441 East Fordham Road, 226 Dealy Hall, Bronx, NY 10458
| | - Leah Feuerstahler
- Fordham University, Department of Psychology, 441 East Fordham Road, 226 Dealy Hall, Bronx, NY 10458
| | - Hayley Pessin
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 640 Lexington Ave., 7 Fl. New York, NY 10022
| | - William Breitbart
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 640 Lexington Ave., 7 Fl. New York, NY 10022
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Zhu S, Lei C. Association between marital status and all-cause mortality of patients with metastatic breast cancer: a population-based study. Sci Rep 2023; 13:9067. [PMID: 37277464 DOI: 10.1038/s41598-023-36139-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023] Open
Abstract
This study aimed to investigate the association between marital status and the prognosis of patients with metastatic breast cancer (MBC). Data of patients with MBC were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were classified into married and unmarried groups. Kaplan-Meier analysis with the log-rank test was conducted to compare breast cancer-specific survival (BCSS) and overall survival (OS) between the groups. Univariable and multivariable Cox proportional models were used to determine whether marital status was independently associated with OS, and the Fine-Gray subdistribution hazard method was performed to determine whether marital status was independently associated with BCSS. In total, 16,513 patients with MBC were identified, including 8949 married (54.19%) and 7564 unmarried (45.81%) patients. The married patients were significantly younger [median age (interquartile range), 59.0 (50.0-68.0) vs. 63.0 (53.0-75.0); p < 0.001] and received more aggressive treatments, such as chemotherapy (p < 0.001) and surgery (p < 0.001), than the unmarried patients. Moreover, married patients had higher 5-year BCSS (42.64% vs. 33.17%, p < 0.0001) and OS (32.22% vs. 21.44%, p < 0.0001) rates. Multivariable analysis revealed that marital status was an independent prognostic factor, and married status was associated with a significant reduction in the risk of breast cancer-specific (sub-hazard ratio, 0.845; 95% confidence interval, 0.804-0.888; p < 0.001) and all-cause (hazard ratio, 0.810; 95% confidence interval, 0.777-0.844; p < 0.001) mortality. Unmarried patients had a 15.5% increased risk of breast cancer-specific mortality and a 19.0% increased risk of overall mortality compared with married patients with MBC. BCSS and OS were superior in married populations compared with unmarried populations in most subgroups. Marital status was an independent prognostic indicator for survival in patients with MBC and was associated with significant survival benefits.
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Affiliation(s)
- Shouqiang Zhu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Chong Lei
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China.
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Social functioning, depression, and quality of life among breast cancer patients: A path analysis. Eur J Oncol Nurs 2023; 62:102237. [PMID: 36455513 DOI: 10.1016/j.ejon.2022.102237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/22/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To identify associations among social functioning, depression, and quality of life in breast cancer patients. METHOD A cross-sectional study was conducted. A total of 180 breast cancer patients were recruited from the surgical units in southern Taiwan hospital in 2021. Path analysis was employed to analyze the relationships between background information and social functioning, depression, and quality of life. Structural equation modeling (SEM) was used for examining the path analysis in this study. RESULTS The path model showed that respondents with a religious belief (ß = 0.18, p < .000) and less severe disease (ß = -0.29, p < .01) showed better social functioning. Income did not affect social functioning directly but was directly related to the social interaction dimension (ß = 0.30, p < .000). Moreover, younger age (ß = -0.29, p < .000, lower income (ß = -0.10, p < .05) and more severe disease (ß = 0.35, p < .000) increased the level of depression. Less severe disease would also result in a better quality of life (ß = -0.45, p < .000). Breast cancer patients with better social function levels have low levels of depression (ß = -0.82, p < .000) and better quality of life (ß = 0.76, p < .000). CONCLUSION Age, religion, income, and severity are crucial predictors of social functioning, depression, and quality of life. Furthermore, severity variables which combined clinical variables to make this variable a stronger predictor for SF, depression, and QOL.
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Bottaro R, Craparo G, Faraci P. What is the direction of the association between social support and coping in cancer patients? A systematic review. J Health Psychol 2022; 28:524-540. [PMID: 36314888 DOI: 10.1177/13591053221131180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aims of this systematic review were (a) to analyze recent studies about the association between social support and coping strategies in cancer patients after an established diagnosis; (b) to evaluate the direction of this association; and (c) to highlight any differences among different cancer types. Seven databases were searched for studies reporting the association between coping and social support for cancer patients in the last 51 years. Most of the 52 included studies highlighted the association between coping and social support, regardless of the source. Our findings supported a bidirectional association. No significant differences were found among the different types of cancer. In conclusion, our results sustain the importance of knowledge in studying this association to identify social limits and resources for the well-being of oncological patients. This knowledge could lead to the creation of holistic protocols to prevent poor adjustment to cancer.
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Yang Y, Lin Y, Sikapokoo GO, Min SH, Caviness-Ashe N, Zhang J, Ledbetter L, Nolan TS. Social relationships and their associations with affective symptoms of women with breast cancer: A scoping review. PLoS One 2022; 17:e0272649. [PMID: 35939490 PMCID: PMC9359609 DOI: 10.1371/journal.pone.0272649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/22/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Problems in affective and cognitive functioning are among the most common concurrent symptoms that breast cancer patients report. Social relationships may provide some explanations of the clinical variability in affective-cognitive symptoms. Evidence suggests that social relationships (functional and structural aspects) can be associated with patients' affective-cognitive symptoms; however, such an association has not been well studied in the context of breast cancer. PURPOSE The purpose of this scoping review was to address the following question: What social relationships are associated with affective-cognitive symptoms of women with breast cancer? METHODS This scoping review used the framework proposed by Arksey and O'Malley and PRISMA-Sc. Studies published by February 2022 were searched using four databases: MEDLINE (PubMed), Embase (Elsevier), PsycINFO (EBSCOhost), and Web of Science (Clarivate). All retrieved citations were independently screened and eligibility for inclusion was determined by study team members. Extracted data included research aims, design, sample, type and measures of social relationships (functional and structural), and the association between social relationships and affective-cognitive symptoms. RESULTS A total of 70 studies were included. Affective symptoms were positively associated with social support, family functioning, quality of relationships, social networks, and social integration, whereas the negative association was found with social constraints. CONCLUSION Our findings suggest positive social relationships may mitigate affective symptoms of women with breast cancer. Thus, health care providers need to educate patients about the importance of building solid social relationships and encourage them to participate in a supportive network of friends and family members.
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Affiliation(s)
- Yesol Yang
- Ohio State University Comprehensive Cancer Center-James, Columbus, Ohio, United States of America
| | - Yufen Lin
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | | | - Se Hee Min
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Nicole Caviness-Ashe
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Jing Zhang
- College of Nursing, Ohio State University, Columbus, Ohio, United States of America
| | - Leila Ledbetter
- Duke University Medical Center Library, Durham, North Carolina, United States of America
| | - Timiya S. Nolan
- College of Nursing, Ohio State University, Columbus, Ohio, United States of America
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Clinical and sociodemographic determinants of disease-specific health-related quality of life in long-term breast cancer survivors. J Cancer Res Clin Oncol 2022; 148:3461-3473. [PMID: 35879433 DOI: 10.1007/s00432-022-04204-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/09/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE It is important to monitor disease-specific health-related quality of life (HRQoL) in breast cancer (BC) survivors to identify potential unmet supportive care needs. However, previous studies were characterized by small samples of mostly short-term survivors and were limited to certain age ranges, stages and/or treatments. METHODS We used data from 3045 long-term BC survivors (5-15 years post-diagnosis) recruited in a German multi-regional population-based study. We assessed disease-specific HRQoL with the EORTC QLQ-BR23, scoring from 0 to 100. Differences in functioning and symptoms according to age at survey, self-reported treatments, stage, and disease status (disease-free vs. active disease) were assessed with multiple regression. Active disease was defined as any self-report of recurrence, metastasis or second primary cancer after the index cancer. RESULTS Older BC survivors reported a higher body image and a better future perspective, but lower sexual functioning. Survivors aged 30-49 years who had breast-conserving therapy or mastectomy with breast reconstruction reported a better body image compared to those who had mastectomy only. We also found differences in symptoms according to treatments in some age groups. Stage at diagnosis was not associated with HRQoL overall and in most age subgroups. Disease-free BC survivors aged 30-79 years reported a better future perspective and less systemic therapy side effects than those with active disease. CONCLUSION Several treatment-associated symptoms and functioning detriments were found 5-15 years after diagnosis. The results emphasize the need of a comprehensive, individualized survivorship care, recognizing differential needs of long-term BC survivors according to age, treatment modalities, and disease status.
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Towards a Better Understanding of the Factors Associated with Distress in Elderly Cancer Patients: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063424. [PMID: 35329112 PMCID: PMC8949443 DOI: 10.3390/ijerph19063424] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/21/2022]
Abstract
This study presents a systematic review of the sociodemographic, clinical, and psychosocial factors associated with distress in elderly cancer patients. Relevant studies were identified using four electronic databases: PubMed, Scopus, Web of Science and ProQuest. Cross-sectional and longitudinal studies exploring factors associated with distress in people over 60 years of age were included and independently assessed using the Joanna Briggs Institute Critical Assessment Checklists. A total of 20 studies met the inclusion criteria. Research showed that being a woman, being single, divorced or widowed, having low income, having an advanced diagnosis, having functional limitations, having comorbidities, and having little social support were factors consistently associated with emotional distress. Data further showed that the impact of age, cancer type, and cancer treatment on symptoms of anxiety and/or depression in elderly patients is not yet well established. The findings of this review suggest that the emotional distress of elderly cancer patients depends on a myriad of factors that are not exclusive, but coexisting determinants of health. Future research is still needed to better understand risk factors for distress in this patient population, providing the resources for healthcare providers to better meet their needs.
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Effects of Psychotherapy on Hope/Hopelessness in Adults with Cancer: a Systematic Review and Meta-analysis. Int J Behav Med 2022; 29:691-704. [PMID: 35137362 DOI: 10.1007/s12529-021-10051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although psychotherapy is a common treatment for hopelessness and hope, the effectiveness remains controversial. The purpose of this study was to quantitatively synthesize available evidence related to the effect of a broad range of psychotherapy interventions on hope/hopelessness in cancer patients. METHOD Eight electronic databases were searched for studies with adult cancer patients (mean age ≥ 18 years) receiving psychotherapy interventions with hope/hopelessness measured as outcomes and written in English. We used the random-effects model to compute effect size using Hedges' g and conducted moderator analyses. RESULTS We found 27 primary studies which included 1,998 participants who were 57.6 ± 8.0 years old across studies. The psychotherapy effect size ranged from - 0.86 to 2.92. Researchers who conducted psychotherapy at hospital/health centers showed higher effects, that is, improved hope scores (g = 0.63), than those who conducted psychotherapy in the community (g = 0.05). When researchers enrolled participants alone, psychotherapy resulted in higher effects (g = 0.62) than when partners/caregivers were involved (g = - 0.04). Researchers who included group discussion showed lower effects (g = 0.36) than without group discussion (g = 1.10). Researchers who examined fidelity found lower effects (g = 0.16) than researchers who did not examine fidelity (g = 0.66). Interestingly, researchers who studied people with breast cancer showed higher effects (g = 0.96) than those who studied people with other types of cancer (g = 0.26). Researchers who included higher percentages of women showed greater effects (slope = 0.008, Qmodel = 3.99, p = 0.046). Finally, the greater the time span between psychotherapy and the measurement of hope, the lower the psychotherapy effects (slope = - 0.002, Qmodel = 4.25, p = 0.039). CONCLUSION Psychotherapy had a solid moderate effect on reducing hopelessness and improving hope in cancer patients compared to controls.
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PSYChosomatic Medicine in ONcologIc and Cardiac Disease (PSYCHONIC) Study-A Retrospective and Prospective Observational Research Protocol. J Clin Med 2021; 10:jcm10245786. [PMID: 34945081 PMCID: PMC8709231 DOI: 10.3390/jcm10245786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
Psychosocial factors play an important role in non-communicable diseases (NCDs). This observational study is primarily aimed at assessing the relationship of psychological characteristics of patients with the outcomes of different NCDs, and to assess short-term psychotherapy (STP) efficacy in the real world. Methods: One hundred and forty patients with recent acute myocardial infarction, Takotsubo syndrome, or non-metastatic breast cancer and a control group of 140 age and sex-matched healthy subjects, will be enrolled. All subjects will be administered psychometric tests, quality of life tests, a specific body perception questionnaire, a dream questionnaire, and a projective test, the Six Drawing test at baseline and follow-up. All subjects with medical conditions will be asked to freely choose between an ontopsychological STP along with standard medical therapy and, whenever indicated, rehabilitation therapy or medical therapy plus rehabilitation alone. The study endpoints will be to evaluate: the relationship of the psychological characteristics of enrolled subjects with the outcomes of different NCDs, predictors of the choice of psychotherapy, and the efficacy of ontopsychological intervention on psychological and medical outcomes. Conclusion: This study will generate data on distinctive psychological characteristics of patients suffering from different CDs and their relationship with medical outcomes, as well as explore the efficacy of ontopsychological STP in these patients in the real world. (Number of registration: NCT03437642).
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Fekih-Romdhane F, Saadallah F, Mbarek M, Bouzaiene H, Cheour M. Prevalence and correlates of hopelessness in Tunisian women with benign breast disease and breast cancer. J Psychosoc Oncol 2021; 40:677-694. [PMID: 34328072 DOI: 10.1080/07347332.2021.1943103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is limited research suggesting that women with Benign Breast Disease (BBD) experience psychological distress similar to breast cancer (BC) women. We aimed to examine hopelessness and its related factors in BC and BBD women. METHOD This was a cross-sectional study. The Beck Hopelessness Scale and the Beck Depression Inventory were administered to 51 BBD and 52 BC women. RESULTS BC women had higher hopelessness scores as compared to those with BBD (6.9 ± 4.8 vs. 4.9 ± 3.6; p = .018). After controlling for confounding variables, depression and suicidal ideation/behavior were significantly associated with hopelessness in the BBD group, while only a lower socioeconomic status was associated with higher hopelessness scores in the BC group. CONCLUSION We found that not only BC but also BBD lead to a psychological burden. Early detection and handling of hopeless feelings and thoughts that may arise in this population are recommended.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Razi Hospital, Manouba, Tunisia
| | - Fatma Saadallah
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Salah Azaiez Institute, Tunis, Tunisia
| | - Mahdi Mbarek
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Salah Azaiez Institute, Tunis, Tunisia
| | - Hatem Bouzaiene
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Salah Azaiez Institute, Tunis, Tunisia
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Razi Hospital, Manouba, Tunisia
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Hagiwara G, Tsunokawa T, Iwatsuki T, Shimozono H, Kawazura T. Relationships among Student-Athletes' Identity, Mental Health, and Social Support in Japanese Student-Athletes during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7032. [PMID: 34209463 PMCID: PMC8297159 DOI: 10.3390/ijerph18137032] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/16/2021] [Accepted: 06/25/2021] [Indexed: 11/20/2022]
Abstract
The purpose of the two studies was to investigate the relationships among student athletes' identity and mental health during the COVID-19 pandemic. In addition, this study aimed to clarify the relationship between perceived social support from teammates and mental health in student-athletes. Two studies were conducted to investigate and clarify the mental health states of student-athletes in Japan during the COVID-19 pandemic. In Study 1, conducted in April 2020, the participants were 402 male student-athletes and we examined the relationships among student-athletes' identity and mental health. The results of correlational analyses indicated significant negative correlations between the degree of student-athletes' identity and depression and sports helplessness. In Study 2, conducted in March 2021, the participants were 135 male student-athletes and examined the relationship between perceived social support from teammates, student-athletes' identity, and mental health. The results indicated a significant correlation between social support, student athletes' identity, and mental health.
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Affiliation(s)
- Goichi Hagiwara
- Department of Human Science, Kyushu Sangyo University, 2-3-1 Matsukadai, Higasgi-ku, Fukuoka-shi, Fukuoka 813-8503, Japan
- Department of Human & Engineered Environmental Studies, Graduate School of Frontier Science, The University of Tokyo 5-1-5 Kashiwanoha, Kashiwa, Chiba 277-8561, Japan
| | - Takaaki Tsunokawa
- Department of Health and Sport Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba-shi, Ibaraki 305-8574, Japan;
| | - Takehiro Iwatsuki
- Department of Kinesiology, The Pennsylvania State University, Altoona College, 3000 Ivyside Park, Altoona, PA 16601, USA;
| | - Hironobu Shimozono
- Department of Sports and Health Science, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka-shi, Fukuoka 814-0180, Japan;
| | - Tsuyoshi Kawazura
- Department of Sports Science, Kyushu Kyoritsu University, 1-8, Jiyugaoka, Yahatanishi-ku, Kitakyushu-shi, Fukuoka 807-8585, Japan;
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Rossi AA, Marconi M, Taccini F, Verusio C, Mannarini S. From Fear to Hopelessness: The Buffering Effect of Patient-Centered Communication in a Sample of Oncological Patients during COVID-19. Behav Sci (Basel) 2021; 11:bs11060087. [PMID: 34198572 PMCID: PMC8231896 DOI: 10.3390/bs11060087] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background: COVID-19 represents a threat both for the physical and psychological health of oncological patients experiencing heightened distress levels to which the fear of the virus is also added. Moreover, fear of COVID-19 could lead oncological patients to experience feelings of hopelessness related to their medical care. Patient-centered communication may act as a buffer against the aforementioned variables. This study aimed to test the role of doctor–patient communication in the relationship between fear of COVID-19 and hopelessness. Methods: During the COVID-19 pandemic, a sample of 90 oncological outpatients was recruited (40 males (44.4%) and 50 females (55.6%), mean age = 66.08 (SD = 12.12)). A structured interview was developed and used during the pandemic to measure the patients’ perceived (A) fear of COVID-19, and (B) feelings of hopelessness, and (C) physicians’ use of empathetic and (D) clear language during the consultation. A multiple mediation model was tested, and the effects between males and females were also compared. Results: Empathetic and clear doctor–patient communication buffered the adverse effect of the fear of COVID-19 on hopelessness through a full-mediation model. The effects did not differ between males and females in the overall model but its indirect effects. Discussions: Patient-centered communication using empathy and clear language can buffer the adverse effect of the fear of COVID-19 and protect oncological patients from hopelessness during the pandemic. These findings might help to improve clinical oncological practice.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
- Correspondence:
| | - Maria Marconi
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, 21047 Saronno, Italy; (M.M.); (C.V.)
| | - Federica Taccini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
| | - Claudio Verusio
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, 21047 Saronno, Italy; (M.M.); (C.V.)
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
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15
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Dobretsova A, Derakshan N. Cognitive function and emotional vulnerability in metastatic breast cancer: Moderating effects of age and social support. Psychooncology 2021; 30:1563-1571. [PMID: 33991121 DOI: 10.1002/pon.5732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/01/2021] [Accepted: 04/24/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Previous literature has established a relationship between cognitive function and symptoms of anxiety, depression, and post-traumatic stress in primary breast cancer, but not in metastatic breast cancer (MBC). The current study examined the relationship between cognitive function and symptoms of anxiety, depression, and post-traumatic stress as well as the moderating effects of age, time since MBC diagnosis, and social support. METHODS Subjective and objective measures of cognitive function as well as self-reports of emotional vulnerability were completed by 59 women diagnosed with MBC who were recruited through social media and support groups. RESULTS Emotional vulnerability scores were associated with perceived measures of cognitive function. Additionally, low levels of perceived cognitive function were met with increased levels of depression with social support moderating this relationship buffering against depression. Age was found to moderate the relationship between cognitive function and post-traumatic stress with younger women at a greater risk of vulnerability. Out of all the emotional vulnerability measures, only anxiety negatively correlated with objective task performance. CONCLUSIONS This study established a relationship between cognitive function and emotional vulnerability in MBC patients. It emphasised how vulnerable younger MBC women are to post-traumatic stress, and the importance of the combined effects of cognitive function and social support in buffering against depression. Our results have important implications for developing new interventions and treatment plans that consider the roles of these factors in ensuring a better quality of life in MBC.
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Affiliation(s)
- Anna Dobretsova
- Department of Psychological Sciences, Birkbeck, University of London, London, UK.,Birkbeck Centre for Building Resilience in Breast Cancer (BRiC), London, UK
| | - Nazanin Derakshan
- Department of Psychological Sciences, Birkbeck, University of London, London, UK.,Birkbeck Centre for Building Resilience in Breast Cancer (BRiC), London, UK
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16
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Doege D, Thong MSY, Koch-Gallenkamp L, Jansen L, Bertram H, Eberle A, Holleczek B, Pritzkuleit R, Waldmann A, Zeissig SR, Brenner H, Arndt V. Age-specific prevalence and determinants of depression in long-term breast cancer survivors compared to female population controls. Cancer Med 2020; 9:8713-8721. [PMID: 33022889 PMCID: PMC7666751 DOI: 10.1002/cam4.3476] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/18/2020] [Accepted: 09/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background Depression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long‐term survivors. Study objectives were: (1) to compare the age‐specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease‐free BC survivors vs BC survivors with self‐reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors. Methods About 3010 BC survivors (stage I‐III, 5‐16 years post‐diagnosis), and 1005 population controls were recruited in German multi‐regional population‐based studies. Depression was assessed by the Geriatric Depression Scale‐15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression. Results Compared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups <80 years, prevalence of both mild/severe and severe depression only was significantly higher in BC survivors, while BC survivors ≥80 years reported severe depression less frequently than controls. BC survivors with recurrence reported significantly higher prevalence of mild/severe depression than disease‐free survivors and controls, but prevalence in disease‐free survivors and controls was comparable. Age, income, living independently, recurrence, and BMI were significant determinants of mild depression in BC survivors. Age, education, employment, income, recurrence, and BMI were significant determinants of severe depression. Conclusions Long‐term BC survivors <80 years report significantly higher prevalence of depressive symptoms than controls, which might be explained by recurrence and individual factors. The findings suggest that depression in BC survivors is common, and even more after BC recurrence. Clinicians should routinize screening and normalize referral to psychological care.
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Affiliation(s)
- Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | | | - Annika Waldmann
- Hamburg Cancer Registry, Hamburg, Germany.,Institute of Social Medicine and Epidemiology, University Lübeck, Lübeck, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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17
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Kupczyk D, Studzińska R, Bilski R, Baumgart S, Kołodziejska R, Woźniak A. Synthesis of Novel 2-(Isopropylamino)thiazol-4(5 H)-one Derivatives and Their Inhibitory Activity of 11β-HSD1 and 11β-HSD2 in Aspect of Carcinogenesis Prevention. Molecules 2020; 25:E4233. [PMID: 32942682 PMCID: PMC7570983 DOI: 10.3390/molecules25184233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/24/2023] Open
Abstract
Glucocorticoid metabolism at the tissue level is regulated by two isoenzymes 11β-hydroxysteroid dehydrogenase (11β-HSD), which mutually convert biologically active cortisol and inactive cortisone. Recent research is focused on the role of 11β-HSD1 and 11β-HSD2 as autocrine factors of tumor cell proliferation and differentiation. Herein, we report the synthesis of novel 2-(isopropylamino)thiazol-4(5H)-one derivatives and their inhibitory activity for 11β-HSD1 and 11β-HSD2. The derivative containing the spiro system of thiazole and cyclohexane rings shows the highest degree of 11β-HSD1 inhibition (54.53% at 10 µM) and is the most selective inhibitor of this enzyme among the tested compounds. In turn, derivatives containing ethyl and n-propyl group at C-5 of thiazole ring inhibit the activity of 11β-HSD2 to a high degree (47.08 and 54.59% at 10 µM respectively) and are completely selective. Inhibition of the activity of these enzymes may have a significant impact on the process of formation and course of tumors. Therefore, these compounds can be considered as potential pharmaceuticals supporting anti-cancer therapy.
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Affiliation(s)
- Daria Kupczyk
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-092 Bydgoszcz, Poland; (R.B.); (R.K.); (A.W.)
| | - Renata Studzińska
- Department of Organic Chemistry, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-089 Bydgoszcz, Poland;
| | - Rafał Bilski
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-092 Bydgoszcz, Poland; (R.B.); (R.K.); (A.W.)
| | - Szymon Baumgart
- Department of Organic Chemistry, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-089 Bydgoszcz, Poland;
| | - Renata Kołodziejska
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-092 Bydgoszcz, Poland; (R.B.); (R.K.); (A.W.)
| | - Alina Woźniak
- Department of Medical Biology and Biochemistry, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-092 Bydgoszcz, Poland; (R.B.); (R.K.); (A.W.)
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18
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Ishimwe AB, Kaufman J, Uwamahoro D, Wall JT, Herth K, Chang E, Ngirabega JDD, Leonard W. Cross-cultural adaptation and psychometric properties of the Herth Hope Index in Kinyarwanda: adapting a positive psychosocial tool for healthcare recipients and providers in the Rwandan setting. Health Qual Life Outcomes 2020; 18:286. [PMID: 32831084 PMCID: PMC7444040 DOI: 10.1186/s12955-020-01537-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background The lack of culturally appropriate instruments to measure hope across cultural settings is a barrier to assessing and addressing the relationship between hope and health outcomes. The study aim was to adapt and evaluate the psychometric properties of the Herth Hope Index (HHI) in Kinyarwanda in a population of healthcare recipients and healthcare workers in Rwanda. Methods A transcultural translation and adaptation of the HHI was conducted using qualitative methods (n = 43) to achieve semantic, content, and technical equivalence. The adapted instrument was administered to a purposive sample (n = 206) of Rwandan healthcare patients and providers. Temporal reliability, internal reliability using Cronbach’s alpha, and construct validity using confirmatory factor analysis (CFA) were assessed. Results The Herth Hope Index-Kinyarwanda (HHI-K) was found to have strong internal consistency (α = 0.85) and test-retest reliability (r = 0.85). The original HHI three-factor structure fit the data well in CFA (normed chi-square = 1.53; root mean square error of approximation = 0.05; standardized root mean square residual = 0.05; comparative fit index = 0.96; Tucker-Lewis Index = 0.95). Conclusion This article presents the first rigorous cultural adaptation of the HHI in a low-income country. The HHI-K has acceptable psychometric properties, resulting in a new useful tool for research, program development, and evaluation in Rwandan healthcare settings. The HHI-K instrument can be used to assess the effectiveness of programs that aim to promote hope and health outcomes across health system- and individual-levels. The process also provides a feasible model for adaptation of a positive psychosocial tool for both patients and providers in low-resource settings.
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Affiliation(s)
| | - Julia Kaufman
- TIP Global Health, PO Box 1285, KN 4 St, Kigali, Rwanda
| | | | - Jonathan Taylor Wall
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC, 27710, USA
| | - Kaye Herth
- Minnesota State University, Mankato, 228 Wiecking Center, Mankato, MN, 56001, USA
| | - Emery Chang
- UCLA Health, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Jean de Dieu Ngirabega
- East African Health Research Commission, Quartier Kigobe, Avenue des Etats Unis, no. 71, B.P, 350, Bujumbura, Burundi
| | - Wendy Leonard
- TIP Global Health, PO Box 1285, KN 4 St, Kigali, Rwanda
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19
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Chan K, Wong FKY, Lee PH. A Brief Hope Intervention to Increase Hope Level and Improve Well-Being in Rehabilitating Cancer Patients: A Feasibility Test. SAGE Open Nurs 2019; 5:2377960819844381. [PMID: 33415238 PMCID: PMC7774404 DOI: 10.1177/2377960819844381] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/23/2019] [Indexed: 12/22/2022] Open
Abstract
This article reports on the feasibility and effect of the brief hope intervention (BHI) in terms of increasing the hope level and psychological and physical health outcomes of rehabilitating cancer patients (RCP). Chinese RCP living in the community were invited to join the study. The BHI consisted of four one-on-one sessions: two (1-hour) face-to-face sessions and two (30-minute) telephone follow-up sessions in between. There were three core features in the hope therapy: (a) goal thoughts: finding workable goals, (b) pathway thoughts: finding ways to reach the targets, and (c) agency thoughts: positive self-talk to optimize their motivation to accomplish the set goals. A one-group pre- and postintervention design was used. Outcome measures included the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression Scale (CES-D), and the State Hope Scale. Recruitment, attrition, and qualitative feedback were collected to understand their comments on BHI. A total of 40 participants were recruited (female 92.3%). The mean age was 57.2 years (SD = 6.7). The participants had significant improvement in all aspects of the Memorial Symptom Assessment Scale, with moderate-to-large effect sizes (d = 0.49-0.74). The changes in present hope and depression scores were insignificant, with small effect sizes (d = 0.17-0.34). The BHI seemed to be promising in producing both physical and psychological benefits in RCP.
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Affiliation(s)
- Kitty Chan
- School of Nursing, The Hong Kong Polytechnic University, People's Republic of China
| | - Frances K Y Wong
- School of Nursing, The Hong Kong Polytechnic University, People's Republic of China
| | - Paul H Lee
- School of Nursing, The Hong Kong Polytechnic University, People's Republic of China
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20
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Romeo A, Di Tella M, Ghiggia A, Tesio V, Gasparetto E, Stanizzo MR, Torta R, Castelli L. The Traumatic Experience of Breast Cancer: Which Factors Can Relate to the Post-traumatic Outcomes? Front Psychol 2019; 10:891. [PMID: 31105621 PMCID: PMC6491882 DOI: 10.3389/fpsyg.2019.00891] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/03/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Post-traumatic growth (PTG) is considered a positive outcome of struggling with a traumatic event, distinct, and opposite from negative outcomes, i.e., psychological distress. The present study aimed to shed light on the relationship between potentially relating factors (i.e., coping strategies, perceived social support, and attachment style) and both positive and negative psychological outcomes. Methods: A total of 123 breast cancer survivors were recruited, who completed a battery of self-report questionnaires, assessing PTG, psychological distress, coping strategies, perceived social support, and attachment style. Three regression analyses were run to evaluate whether relating factors were significant predictors of the positive and negative psychological outcomes. Results: The regression analyses showed that the "Fatalism" coping strategy and perceived social support were two significant predictors of PTG. Instead, the "Helpless-Hopeless" and "Anxious Preoccupation" coping strategies, as well as an insecure attachment style, were significant predictors of depression, while the "Anxious Preoccupation" coping strategy and an insecure attachment style were significant predictors of anxiety. Conclusions: The present findings showed that the factors underlying a positive or negative outcome are different and specific. While perceived social support and a fatalistic attitude seem to play a key role in the positive outcome, dysfunctional coping strategies, together with an insecure attachment style, appear to be related with negative psychological outcome. Considering these factors in clinical practice would help patients to give meaning to their traumatic experience, enhancing psychological growth.
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Affiliation(s)
| | | | - Ada Ghiggia
- Department of Psychology, University of Turin, Turin, Italy
- Clinical Psychology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | | | - Eleonora Gasparetto
- Clinical Psychology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Maria Rosa Stanizzo
- Clinical Psychology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Riccardo Torta
- Clinical Psychology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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21
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Schneiderman N, McIntosh RC, Antoni MH. Psychosocial risk and management of physical diseases. J Behav Med 2019; 42:16-33. [PMID: 30632000 PMCID: PMC6941845 DOI: 10.1007/s10865-018-00007-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/18/2018] [Indexed: 12/24/2022]
Abstract
During the 40 years since the Yale conference on Behavioral Medicine and the founding of the Journal of Behavioral Medicine considerable progress has been made in understanding the role of psychosocial risk and management of physical diseases. We here describe the development of these fundamental concepts from early research on stress through studies of the Type A behavior pattern to more contemporary approaches to the relationship between psychosocial risks and benefits in relation to disease processes. This includes the relationship of psychosocial risk to cancers, cardiovascular diseases (CVD), cardiometabolic disorders, Human Immunodeficiency Virus (HIV)/Acquired Human Immune Deficiency Syndrome. During the past 40 years the effects of prolonged distress responses in the pathogenesis of some cancers and CVD have been well-established and modifiable behavioral, cognitive and social factors have been shown to produce favorable outcome components in the management of such diseases as breast cancer, coronary heart disease and HIV.
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Affiliation(s)
- Neil Schneiderman
- Health Division, Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, 33124, USA.
| | - Roger C McIntosh
- Health Division, Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, 33124, USA
| | - Michael H Antoni
- Health Division, Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, 33124, USA
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22
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Exposure to stress across the life course and its association with anxiety and depressive symptoms: Results from the Australian Women's Wellness After Cancer Program (WWACP). Maturitas 2017; 105:107-112. [PMID: 28551081 DOI: 10.1016/j.maturitas.2017.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Earlier life stressors can increase the risk of persistent anxiety and depressive symptoms in women after cancer, though our understanding of the underlying mechanisms is limited. In this study, we tested alternative life course models to determine which best described associations between exposure to stressors in childhood, adolescence, and adulthood, and self-reported health in women previously treated for breast, gynaecological, and blood cancer. STUDY DESIGN Data were drawn from 351 Australian women within 2 years of completing active cancer treatment who were participating in the Women's Wellness After Cancer Program (WWACP) randomised controlled trial. A model-building framework compared "accumulative risk" and "sensitive period" stress exposure hypotheses with the saturated model to determine best fit. MAIN OUTCOME MEASURES Symptoms of anxiety and depression were measured using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Zung Self-rating Anxiety Scale (SAS). RESULTS Participants with the greatest number of stressful life events (SLEs) reported higher anxiety scores and more depressive symptoms. Alternative life course models for psychological distress (measured through the CES-D and SAS) and stress were compared with the saturated model (i.e., the accumulative risk). The more restrictive "sensitive period" models were the best fit for depressive symptoms though none was significantly better than another. In contrast, an "early sensitive" model provided the best fit for anxiety data. CONCLUSIONS Anxiety scores were higher in women with early life stressors. This study highlights the need for whole-of-life supportive care approaches for women previously treated for cancer, which should include targeted strategies for effective management of stress, anxiety and depression.
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Eslami B, Kovacs AH, Moons P, Abbasi K, Jackson JL. Hopelessness among adults with congenital heart disease: Cause for despair or hope? Int J Cardiol 2017; 230:64-69. [DOI: 10.1016/j.ijcard.2016.12.090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/18/2016] [Accepted: 12/16/2016] [Indexed: 11/25/2022]
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24
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Liao KYH, Yeung NC, Wong CCY, Warmoth K, Lu Q. Fear of cancer recurrence and physical well-being among Chinese cancer survivors: the role of conscientiousness, positive reappraisal and hopelessness. Support Care Cancer 2016; 25:1141-1149. [DOI: 10.1007/s00520-016-3504-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
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25
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Archer S, Holland FG, Montague J. 'Do you mean I'm not whole?': Exploring the role of support in women's experiences of mastectomy without reconstruction. J Health Psychol 2016; 23:1598-1609. [PMID: 27596275 DOI: 10.1177/1359105316664135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study explores the role of others in supporting younger women who opt not to reconstruct their breast post-mastectomy. Semi-structured interviews were conducted with six women diagnosed with breast cancer in their 30s/40s. The women lived in England, had been diagnosed a minimum of 5 years previously and had undergone unilateral mastectomy. An interpretative phenomenological analysis revealed three themes: Assuring the self: 'I'll love you whatever', Challenging the self: 'Do you mean I'm not whole?' and Accepting the self: 'I've come out the other side'. The women's experiences of positive support and challenges to their sense of self are discussed.
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Lewis S, Willis K, Yee J, Kilbreath S. Living Well? Strategies Used by Women Living With Metastatic Breast Cancer. QUALITATIVE HEALTH RESEARCH 2016; 26:1167-1179. [PMID: 26130655 DOI: 10.1177/1049732315591787] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Metastatic breast cancer is a disease of changing status-once an imminent death sentence, now a chronic (albeit incurable) disease. Medical intervention advances mean women with metastatic breast cancer now have symptoms alleviated and, potentially, life extended. Living with this disease, however, requires more than a medical approach to symptoms. We were interested to know whether women manage, and if so, how, to "live well" with metastatic cancer. We conducted interviews with 18 women. Women differed in the approaches they used. Most common was the attempt to reestablish a sense of normality in their lives. However, a second group reevaluated and reprioritized their lives; and a third group was restricted in their capacity to live well because of symptoms. The findings provide the foundation for future research exploring normalization of experiences of metastatic cancer, and other chronic illnesses, where people are living with knowledge that they have contracted time.
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Affiliation(s)
| | - Karen Willis
- Australian Catholic University, Melbourne, Australia
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27
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Santos FRM, Sigulem D, Areco KCN, Gabbay MAL, Dib SA, Bernardo V. Hope matters to the glycemic control of adolescents and young adults with type 1 diabetes. J Health Psychol 2016; 20:681-9. [PMID: 25903254 DOI: 10.1177/1359105315573429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This study investigated the association of hope and its factors with depression and glycemic control in adolescents and young adults with type 1 diabetes. A total of 113 patients were invited to participate. Significant negative correlations were found between hope and HbA1c and also between hope and depression. Hope showed a significant association with HbA1c and depression in the stepwise regression model. Among the hope factors, "inner positive expectancy" was significantly associated with HbA1c and depression. This study supports that hope matters to glycemic control and depression. Intervention strategies focusing on hope should be further explored.
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Somasundaram RO, Devamani KA. A Comparative Study on Resilience, Perceived Social Support and Hopelessness Among Cancer Patients Treated with Curative and Palliative Care. Indian J Palliat Care 2016; 22:135-40. [PMID: 27162423 PMCID: PMC4843551 DOI: 10.4103/0973-1075.179606] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM Psychological distress is common among patients affected by cancer. In this study, we examined the relationship between resilience, social support, and hopelessness among cancer patients treated with curative and palliative care. PATIENTS AND METHODS Sixty cancer patients in the age range of 18-65 years were randomly selected and divided into two groups based on their treatment intent namely, curative care (n = 30) and palliative care (n = 30). Both groups were assessed by the following instruments: Bharathiar University Resilience Scale, Multidimensional Scale of Perceived Social Support and Beck Hopelessness Scale. RESULTS Resilience was significantly associated with less hopelessness and higher levels of perceived social support. CONCLUSION Cancer patients are found to be resilient, and the role of social support and hopelessness on promoting resilience cannot be ignored.
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Affiliation(s)
| | - Kiran A Devamani
- Department of Clinical Psychology, Sri Ramachandra University, Chennai, Tamil Nadu, India
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29
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Spangenberg L, Zenger M, Garcia-Torres F, Mueller V, Reck M, Mehnert A, Vehling S. Dimensionality, Stability, and Validity of the Beck Hopelessness Scale in Cancer Patients Receiving Curative and Palliative Treatment. J Pain Symptom Manage 2016; 51:615-22. [PMID: 26654946 DOI: 10.1016/j.jpainsymman.2015.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Hopelessness is a clinically important construct in patients with advanced illness. OBJECTIVES To evaluate the dimensionality, stability, and validity of the Beck Hopelessness Scale (BHS) in cancer patients receiving either curative or palliative treatment. METHODS Following a longitudinal design, we assessed a sample of cancer patients receiving either curative or palliative treatment (N = 315) at baseline and at follow-up after 12 months (N = 158). In addition to hopelessness, we measured depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), and health-related quality of life (Short-Form Health Survey-8). We analyzed dimensionality, stability, and construct validity of the BHS using confirmatory factor analysis, exploratory factor analysis and correlational analysis. RESULTS Independent of treatment intention, confirmatory factor analyses resulted in unsatisfactory model fits. Exploratory factor analysis yielded a two-factor solution in both groups receiving curative or palliative treatment. Factor 1 reflected pessimistic/resigned beliefs (Cronbach alpha ≥ 0.85), Factor 2 reflected positive beliefs toward the future (Cronbach alpha = 0.73). Both subscales showed significant associations with anxiety, depression, and decreased health-related quality of life. The factorial structure was partially replicated in patients being reexamined after 12 months (CMIN/DF = 2.130, Standardized Root Mean Square Residual = 0.0716, Comparative Fit Index = 0.904, Tucker-Lewis-Index = 0.883, Root Mean Square Error of Approximation = 0.085). Hopelessness scores were significantly higher in patients reporting suicidal ideation according to the Patient Health Questionnaire-9. CONCLUSION Our study demonstrates psychometric limitations of the BHS in patients receiving both curative and palliative treatment, suggesting reduced utility in cancer populations. Given the clinical importance of the construct, a cancer-specific approach to capture the unique meaning of hopelessness in patients with severe medical illness is recommended.
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Affiliation(s)
- Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany.
| | - Markus Zenger
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany; Faculty of Applied Human Studies, University of Applied Sciences Magdeburg and Stendal, Stendal, Germany
| | - Francisco Garcia-Torres
- Department of Psychology, Córdoba University/IMIBIC/Reina Sofía University Hospital, Córdoba, Spain
| | - Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Reck
- Department of Thoracic Oncology, LungenClinic Großhansdorf, Großhansdorf, Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Gheihman G, Zimmermann C, Deckert A, Fitzgerald P, Mischitelle A, Rydall A, Schimmer A, Gagliese L, Lo C, Rodin G. Depression and hopelessness in patients with acute leukemia: the psychological impact of an acute and life-threatening disorder. Psychooncology 2015; 25:979-89. [PMID: 26383625 DOI: 10.1002/pon.3940] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/01/2015] [Accepted: 07/15/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Acute leukemia (AL) is a life-threatening cancer associated with substantial morbidity and mortality, particularly in older adults. Given that there has been little research on the psychological impact of such malignancies with acute onset, we assessed the prevalence and correlates of depression and hopelessness in patients with AL. METHODS Three hundred forty-one participants were recruited within 1 month of diagnosis or relapse and completed the Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), Memorial Symptom Assessment Scale, and other psychosocial measures. Multivariate regression analyses identified correlates of depression and hopelessness. RESULTS 17.8% reported clinically significant depressive symptoms (BDI-II ≥ 15), 40.4% of which were in the moderate-severe range (BDI-II ≥ 20). 8.5% reported significant symptoms of hopelessness (BHS ≥ 8). Depression was associated with greater physical symptom burden (adjusted R(2) = 48.4%), while hopelessness was associated with older age and lower self-esteem (adjusted R(2) = 45.4%). Both were associated with poorer spiritual well-being. CONCLUSIONS Clinically significant depressive symptoms were common early in the course of AL and related to physical symptom burden. Hopelessness was less common and associated with older age and lower self-esteem. The results suggest that whereas depression in AL may be related to disease burden, the preservation of hope may be linked to individual resilience, life stage, and realistic prognosis.Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Galina Gheihman
- Faculty of Arts & Science, University of Toronto, Toronto, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Campbell Family Cancer Research Institute, Ontario Cancer Institute, University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Amy Deckert
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Peter Fitzgerald
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ashley Mischitelle
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Anne Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Aaron Schimmer
- Campbell Family Cancer Research Institute, Ontario Cancer Institute, University Health Network, Toronto, Canada.,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Lucia Gagliese
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Campbell Family Cancer Research Institute, Ontario Cancer Institute, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,School of Kinesiology and Health Science, York University, Toronto, Canada.,Department of Anesthesia, University of Toronto, Toronto, Canada.,Department of Anesthesia, University Health Network, Toronto, Canada
| | - Chris Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Campbell Family Cancer Research Institute, Ontario Cancer Institute, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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Geiser F, Zajackowski K, Conrad R, Imbierowicz K, Wegener I, Herth KA, Urbach AS. The German Version of the Herth Hope Index (HHI-D): Development and Psychometric Properties. Oncol Res Treat 2015; 38:356-60. [PMID: 26278579 DOI: 10.1159/000435900] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/19/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The importance of hope is evident in clinical oncological care. Hope is associated with psychological and also physical functioning. However, there is still a dearth of empirical research on hope as a multidimensional concept. The Herth Hope Index is a reliable and valid instrument for the measurement of hope and is available in many languages. Until now no authorized German translation has been published and validated. METHODS After translation, the questionnaire was completed by 192 patients with different tumor entities in radiation therapy. Reliability, concurrent validity, and factor structure of the questionnaire were determined. RESULTS Correlations were high with depression and anxiety as well as optimism and pessimism. As expected, correlations with coping styles were moderate. Internal consistency and test-retest reliability were satisfactory. We could not replicate the original 3-factor model. Application of the scree plot criterion in an exploratory factor analysis resulted in a single-factor structure. CONCLUSIONS The Herth Hope Index - German Version (HHI-D) is a short, reliable, and valid instrument for the assessment of hope in patient populations. We recommend using only the HHI-D total score until further research gives more insights into possible factorial solutions and subscales.
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Affiliation(s)
- Franziska Geiser
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Bonn, Germany
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Thornton LM, Cheavens JS, Heitzmann CA, Dorfman CS, Wu SM, Andersen BL. Test of mindfulness and hope components in a psychological intervention for women with cancer recurrence. J Consult Clin Psychol 2014; 82:1087-100. [PMID: 24884347 DOI: 10.1037/a0036959] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Psychological interventions can attenuate distress and enhance coping for those with an initial diagnosis of cancer, but there are few intervention options for individuals with cancer recurrence. To address this gap, we developed and tested a novel treatment combining Mindfulness, Hope Therapy, and biobehavioral components. METHOD An uncontrolled, repeated measures design was used. Women (N = 32) with recurrent breast or gynecologic cancers were provided 20 treatment sessions in individual (n = 12) or group (n = 20) formats. On average, participants were middle aged (M = 58) and Caucasian (81%). Independent variables (i.e., hope and mindfulness) and psychological outcomes (i.e., depression, negative mood, worry, and symptoms of generalized anxiety disorder) were assessed pre-treatment and 2, 4, and 7 months later. Session-by-session therapy process (positive and negative affect, quality-of-life) and mechanism (use of intervention-specific skills) measures were also included. RESULTS Distress, anxiety, and negative affect decreased, whereas positive affect and mental-health-related quality-of-life increased over the course of treatment, as demonstrated in mixed-effects models with the intent-to-treat sample. Both hope and mindfulness increased, and use of mindfulness skills was related to decreased anxiety. CONCLUSIONS This treatment was feasible to deliver and was acceptable to patients. The trial serves as preliminary evidence for a multi-component intervention tailored to treat difficulties specific to recurrent cancer. The blending of the components was novel as well as theoretically and practically consistent. A gap in the literature is addressed, providing directions for testing interventions designed for patients coping with the continuing stressors and challenges of cancer recurrence.
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Abstract
BACKGROUND Hopelessness negatively affects ovarian cancer patients' quality of life (QOL). Research validating the effects of complementary and alternative medicine (CAM) use on QOL and hope is scarce, even though QOL and hope are reasons that patients cite for using CAM therapy. Clinicians need effective, evidence-based interventions to improve QOL and reduce hopelessness. OBJECTIVE The objectives of this study were to examine factors influencing hopelessness in patients with newly diagnosed disease, long-term survivors, and patients experiencing ovarian cancer recurrence and to examine the effects of CAM on hopelessness in the same population. METHODS Surveys of ovarian cancer patients (N = 219) undergoing treatment at a comprehensive cancer center in the United States were analyzed. Descriptive, correlation, and multivariate analyses described variables and demonstrated the effects of sociodemographics, disease state, psychological distress, QOL, CAM use, and faith on hopelessness. RESULTS Patients ages 65 years or older (-0.95, P = .03), with strong faith (-0.28, P = .00), and good QOL (0.11, P = .00) directly reduced hopelessness scores (mean, 3.37). Massage therapy substantially reduced hopelessness scores (-1.07, P = .02); holding age constant, employed patients were twice as likely to use massage (odds ratio, 2.09; P = .04). Patients who had newly diagnosed and recurrent ovarian cancer were more hopeless because of greater distress from symptoms and adverse effects of treatment. CONCLUSION Patients who used massage therapy were significantly less hopeless, as were those with strong faith and well-controlled disease symptoms and treatment for adverse effects. IMPLICATIONS FOR PRACTICE Support of spiritual needs and symptom management are important interventions to prevent and/or reduce hopelessness, especially for patients with newly diagnosed and recurrent ovarian cancer. Further research testing the positive effect of massage interventions on hopelessness is needed.
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Willis K, Lewis S, Ng F, Wilson L. The experience of living with metastatic breast cancer--a review of the literature. Health Care Women Int 2014; 36:514-42. [PMID: 24579717 DOI: 10.1080/07399332.2014.896364] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Women's experiences with metastatic breast cancer have received little research attention. We reviewed published articles (1984-2013) reporting research examining women's experiences of metastatic breast cancer (n = 33). Findings from quantitative studies were categorized into three broad areas: adverse consequences, satisfaction with health care providers, and strategies for living. Themes identified from qualitative findings include living as a social outsider; importance of hope; health and quality of life; positive experiences; experiences at end of life; and strategies for living. More research is needed to explore experiences of subgroups to appropriately respond to women's diverse care needs.
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Affiliation(s)
- Karen Willis
- a Faculty of Health Sciences , University of Sydney , Sydney , New South Wales , Australia
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Thornton LM, Levin AO, Dorfman CS, Godiwala N, Heitzmann C, Andersen BL. Emotions and social relationships for breast and gynecologic patients: a qualitative study of coping with recurrence. Psychooncology 2013; 23:382-9. [PMID: 24123502 DOI: 10.1002/pon.3429] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 09/05/2013] [Accepted: 09/16/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND In contrast to the large literature on patients' coping with an initial diagnosis of cancer, there have been few quantitative or qualitative studies of patients coping with recurrence. A qualitative study was undertaken to aid in the development of a tailored intervention for these patients. METHODS Individuals (N=35) receiving follow-up care for recurrent breast or gynecologic cancer at a university-affiliated cancer center participated in an individual or a group interview. Transcripts of interviews were analyzed using a coding format with two areas of emphasis. First, we focused on patients' emotions, as there is specificity between emotions and the corresponding ways in which individuals choose to manage them. Secondly, we considered the patients' social environments and relationships, as they too appear key in the adjustment to, and survival from, cancer. RESULTS Patients identified notable differences in their responses to an initial diagnosis of cancer and their current ones to recurrence, including the following: (i) depressive symptoms being problematic; (ii) with the passing years and the women's own aging, there is shrinkage in the size of social networks; and (iii) additional losses come from social support erosion, arising from a) intentional distancing by social contacts, b) friends and family not understanding that cancer recurrence is a chronic illness, and/or c) patients stemming their support requests across time. CONCLUSION The contribution of these findings to the selection of intervention strategies is discussed.
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Affiliation(s)
- Lisa M Thornton
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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Lord K, Ibrahim K, Kumar S, Mitchell AJ, Rudd N, Symonds RP. Are depressive symptoms more common among British South Asian patients compared with British White patients with cancer? A cross-sectional survey. BMJ Open 2013; 3:bmjopen-2013-002650. [PMID: 23794580 PMCID: PMC3686160 DOI: 10.1136/bmjopen-2013-002650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES This cross-sectional survey investigated whether there were ethnic differences in depressive symptoms among British South Asian (BSA) patients with cancer compared with British White (BW) patients during 9 months following presentation at a UK Cancer Centre. We examined associations between depressed mood, coping strategies and the burden of symptoms. DESIGN Questionnaires were administered to 94 BSA and 185 BW recently diagnosed patients with cancer at baseline and at 3 and 9 months. In total, 53.8% of the BSA samples were born in the Indian subcontinent, 33% in Africa and 12.9% in the UK. Three screening tools for depression were used to counter concerns about ethnic bias and validity in linguistic translation. The Hospital Anxiety and Depression Scale (HADS-D), Patient Health Questionnaire-9 (both validated in Gujarati), Emotion Thermometers (including the Distress Thermometer (DT), Mini-MAC and the newly developed Cancer Insight and Denial questionnaire (CIDQ) were completed. SETTING Leicestershire Cancer Centre, UK. PARTICIPANTS 94 BSA and 185 BW recently diagnosed patients with cancer. RESULTS BSA self-reported significantly higher rates of depressive symptoms compared with BW patients longitudinally (HADS-D ≥8: baseline: BSA 35.1% vs BW 16.8%, p=0.001; 3 months BSA 45.6% vs BW 20.8%, p=0.001; 9 months BSA 40.6% vs BW 15.3%, p=0.004). BSA patients used potentially maladaptive coping strategies more frequently than BW patients at baseline (hopelessness/helplessness p=0.005, fatalism p=0.0005, avoidance p=0.005; the CIDQ denial statement 'I do not really believe I have cancer' p=0.0005). BSA patients experienced more physical symptoms (DT checklist), which correlated with ethnic differences in depressive symptoms especially at 3 months. CONCLUSIONS Health professionals need to be aware of a greater probability of depressive symptomatology (including somatic symptoms) and how this may present clinically in the first 9 months after diagnosis if this ethnic disparity in mental well-being is to be addressed.
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Affiliation(s)
- Karen Lord
- Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kausher Ibrahim
- Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sawan Kumar
- Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alex J Mitchell
- Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, Leicestershire, UK
| | - Nicky Rudd
- Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - R Paul Symonds
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, Leicestershire, UK
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Han Y, Yuan J, Luo Z, Zhao J, Wu J, Liu R, Lopez V. Determinants of hopelessness and depression among Chinese hospitalized esophageal cancer patients and their family caregivers. Psychooncology 2013; 22:2529-36. [PMID: 23703786 DOI: 10.1002/pon.3315] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 04/01/2013] [Accepted: 04/29/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND It has been well documented that the diagnosis of cancer is psychologically devastating to both the patients and caregivers. The incidence and mortality of esophageal cancer were 20.85 and 16.24 per 100,000 persons and the sixth most commonly diagnosed cancer and the fourth main cause of cancer death in China. We surveyed patients-caregivers dyad and examined the determinants of their depression and hopelessness. RESULTS The prevalence of depression among patients and caregivers was 52.8% and 47.2%, and the prevalence for hopelessness was 64.4% and 53.9%, respectively Regression models indicate that the variables measured could explain 58.9% and 51.7% of the variance in depression and 66.8% and 45.7% of the variance in hopelessness among patients and caregivers, respectively. Overall, hopelessness was a determinant of depression and vice versa to both patients and caregivers. CONCLUSION Esophageal patients' depression and hopelessness could also affect caregivers' depression and hopelessness despite the social support that family caregivers have. Psychosocial interventions should be planned to both Chinese patients and caregivers considering the predictors found in this study.
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Affiliation(s)
- Yanhong Han
- Department of Clinical Oncology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China; School of Nursing, Hubei University of Medicine, Shiyan, Hubei, China
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Vehling S, Oechsle K, Koch U, Mehnert A. Receiving palliative treatment moderates the effect of age and gender on demoralization in patients with cancer. PLoS One 2013; 8:e59417. [PMID: 23555030 PMCID: PMC3598752 DOI: 10.1371/journal.pone.0059417] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 02/14/2013] [Indexed: 11/30/2022] Open
Abstract
Background Existential distress is an important factor affecting psychological well-being in cancer patients. We studied occurrence and predictors of demoralization, a syndrome of existential distress, in particular the interaction of age, gender, and curative vs. palliative treatment phase. Methods A cross-sectional sample of N = 750 patients with different tumor sites was recruited from in- and outpatient treatment facilities. Patients completed the following self-report questionnaires: Demoralization Scale, Patient Health Questionnaire-9, Illness-Specific Social Support Scale Short Version-8, and physical problems list of the NCCN Distress Thermometer. Moderated multiple regression analyses were conducted. Results We found high demoralization in 15% and moderate demoralization in 8% of the sample. Curative vs. palliative treatment phase moderated the impact of age and gender on demoralization (three-way interaction: b = 1.30, P = .02): the effect of age on demoralization was negative for women receiving palliative treatment (b = −.26, P = .02) and positive for men receiving palliative treatment (b = .25, P = .03). Effects of age and gender were not significant among patients receiving curative treatment. Female gender was associated with higher demoralization among younger patients receiving palliative treatment only. Analyses were controlled for significant effects of the number of physical problems (b = 6.10, P<.001) and social support (b = −3.17, P<.001). Conclusions Existential distress in terms of demoralization is a relevant problem within the spectrum of cancer-related distress. It is associated with a complex interaction of demographic and medical patient characteristics; existential challenges related to palliative treatment may exacerbate the impact of age- and gender-related vulnerability factors on demoralization. Psychosocial interventions should acknowledge this interaction in order to address the individual nature of existential distress in subgroups of cancer patients.
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Affiliation(s)
- Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Psychosocial intervention effects on adaptation, disease course and biobehavioral processes in cancer. Brain Behav Immun 2013; 30 Suppl:S88-98. [PMID: 22627072 PMCID: PMC3444659 DOI: 10.1016/j.bbi.2012.05.009] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/09/2012] [Accepted: 05/11/2012] [Indexed: 02/06/2023] Open
Abstract
A diagnosis of cancer and subsequent treatments place demands on psychological adaptation. Behavioral research suggests the importance of cognitive, behavioral, and social factors in facilitating adaptation during active treatment and throughout cancer survivorship, which forms the rationale for the use of many psychosocial interventions in cancer patients. This cancer experience may also affect physiological adaptation systems (e.g., neuroendocrine) in parallel with psychological adaptation changes (negative affect). Changes in adaptation may alter tumor growth-promoting processes (increased angiogenesis, migration and invasion, and inflammation) and tumor defense processes (decreased cellular immunity) relevant for cancer progression and the quality of life of cancer patients. Some evidence suggests that psychosocial intervention can improve psychological and physiological adaptation indicators in cancer patients. However, less is known about whether these interventions can influence tumor activity and tumor growth-promoting processes and whether changes in these processes could explain the psychosocial intervention effects on recurrence and survival documented to date. Documenting that psychosocial interventions can modulate molecular activities (e.g., transcriptional indicators of cell signaling) that govern tumor promoting and tumor defense processes on the one hand, and clinical disease course on the other is a key challenge for biobehavioral oncology research. This mini-review will summarize current knowledge on psychological and physiological adaptation processes affected throughout the stress of the cancer experience, and the effects of psychosocial interventions on psychological adaptation, cancer disease progression, and changes in stress-related biobehavioral processes that may mediate intervention effects on clinical cancer outcomes. Very recent intervention work in breast cancer will be used to illuminate emerging trends in molecular probes of interest in the hope of highlighting future paths that could move the field of biobehavioral oncology intervention research forward.
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Alcalar N, Ozkan S, Kucucuk S, Aslay I, Ozkan M. Association of Coping Style, Cognitive Errors and Cancer-related Variables with Depression in Women Treated for Breast Cancer. Jpn J Clin Oncol 2012; 42:940-7. [DOI: 10.1093/jjco/hys119] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tae YS, Heitkemper M, Kim MY. A Path Analysis: A Model of Depression in Korean Women With Breast Cancer-Mediating Effects of Self-Esteem and Hope. Oncol Nurs Forum 2011; 39:E49-57. [DOI: 10.1188/12.onf.e49-e57] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kinsinger SW, Laurenceau JP, Carver CS, Antoni MH. Perceived partner support and psychosexual adjustment to breast cancer. Psychol Health 2011; 26:1571-88. [PMID: 21598184 DOI: 10.1080/08870446.2010.533771] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Support from a partner can play a key role in a woman's emotional adjustment to breast cancer. However, little is known about the influence of partner behaviours on a woman's sexual adjustment. This study examined the prospective relationship between baseline levels of several types of perceived partner support (instrumental, informational, emotional and negative) and psychosexual adjustment (sexual functioning and relationship satisfaction) over the course of 12 months post-surgery in a sample of 130 women with breast cancer. Results indicated that perceptions of greater emotional and informational support from the partner at baseline were associated with less sexual difficulties among breast cancer patients concurrently and 6 months post-surgery. Baseline perceptions of greater emotional and instrumental support from a partner were associated with greater relationship satisfaction at all time points. Perceptions of informational support at baseline were related to greater concurrent relationship satisfaction. Baseline perceptions of negative partner support were related to less relationship satisfaction, but only concurrently. These findings suggest that the perception of a partner's provision of emotional, instrumental and informational support may each play a role in facilitating sexual adjustment and relationship satisfaction.
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Price MA, Butow PN, Costa DSJ, King MT, Aldridge LJ, Fardell JE, DeFazio A, Webb PM. Prevalence and predictors of anxiety and depression in women with invasive ovarian cancer and their caregivers. Med J Aust 2011; 193:S52-7. [PMID: 21542447 DOI: 10.5694/j.1326-5377.2010.tb03929.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the prevalence and predictors of depression and anxiety in women with ovarian cancer and their caregivers, to compare levels of depression and anxiety with community norms, and to explore the relationship between patients and their nominated caregivers. DESIGN, SETTING AND PARTICIPANTS Prospective cohort study of 798 women with invasive ovarian cancer recruited between 1 January 2002 and 30 June 2006 through the nationwide Australian Ovarian Cancer Study, and 373 of their caregivers. MAIN OUTCOME MEASURES Depression and anxiety as assessed with the Hospital Anxiety and Depression Scale, and the role of demographic variables, disease and treatment variables, psychosocial variables, and use of mental health and support services as potential predictors. RESULTS Rates of anxiety and depression among patients were significantly lower than in previous reports, although clinical depression rates (5.9%) were significantly higher than community norms (3.0%; chi2 = 24.0; P < 0.001). Caregivers also reported higher levels of depression (chi2 = 21.1; P < 0.001) and anxiety (chi2 = 17.6; P < 0.001) compared with norms. There was no difference within patient-caregiver pairs for depression (P = 0.1), while caregivers reported significantly higher anxiety than patients (P < 0.01). In patients, higher symptom burden, lower optimism and current specialist mental health treatment all significantly predicted both depression and anxiety, while lower social support was a significant predictor of patient anxiety only. In caregivers, lower social support and lower optimism were significant predictors of depression and anxiety. Patients being treated for mental health was also a predictor of their caregiver's depression. CONCLUSIONS While depression is significantly more common in women with ovarian cancer than in the general population, it is caregivers of such patients who report much higher levels of both subclinical and clinical depression and anxiety.
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Affiliation(s)
- Melanie A Price
- Centre for Medical Psychology and Evidence-based Decision-Making, School of Psychology, University of Sydney, NSW.
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Mitchell AJ. Detecting and managing psychological distress in women with cancer: an update of recent evidence. ACTA ACUST UNITED AC 2011. [DOI: 10.1576/toag.13.1.22.27637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
BACKGROUND There are few studies of QoL among long-term gynecologic cancer survivors; available data suggest significant sequelae of disease and treatment. Research clarifying circumstances that improve difficult survivorship trajectories is lacking. PURPOSE The present study examines whether social support moderates the relationship between physical functioning and psychological outcomes by testing the stress-buffering hypothesis. METHODS Participants (N = 260) were gynecologic cancer survivors (cervical, n = 47; endometrial, n = 133; ovarian, n = 69; vulvar, n = 11). Compromised physical health was conceptualized as multidimensional. Social support (SNI, PSS-Fa, PSS-Fr, ISEL) was tested as a buffer of adverse psychological outcomes (IES-R, CES-D). RESULTS Results for traumatic stress provided evidence for buffering; whereas social support was of general benefit for depressive symptoms. Effects varied by source and type of support. CONCLUSIONS These results suggest that circumstances for gynecologic cancer survivors burdened with physical symptoms may be worse for those with fewer support resources, providing needed insight into a common target of psychosocial interventions for cancer survivors.
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48
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Thornton LM, Andersen BL, Blakely WP. The pain, depression, and fatigue symptom cluster in advanced breast cancer: covariation with the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Health Psychol 2010; 29:333-7. [PMID: 20496988 DOI: 10.1037/a0018836] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Neuroendocrine-immune models have been proposed to account for the frequent co-occurrence of pain, depression, and fatigue (PDF) among cancer patients. DESIGN In a cross-sectional observational study of advanced cancer patients (N = 104), we tested the hypothesis that the PDF cluster covaries with proposed biological mediators: hormones of the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. MAIN OUTCOME MEASURES PDF symptoms were measured using the Brief Pain Inventory, Fatigue Symptom Inventory, and the Center for Epidemiological Studies Depression scales. HPA activation was indicated by plasma levels of cortisol and adrenocorticotropic hormone, and SNS activation was indicated by plasma epinephrine and norepinephrine. RESULTS Preliminary analyses supported the use of covariance structure modeling to test whether shared variance among hormone levels predicted shared variance among PDF symptoms. Latent variable analysis indicated that neuroendocrine levels predicted PDF (standardized beta = .23, p = .039), while controlling for important disease and demographic variables. CONCLUSION Previous studies have linked individual symptoms to individual biomarkers. The observed significant paring of the 4 hormones to the PDF cluster provides the first evidence suggestive of stress hormones as a common mechanism for the co-occurrence of pain, depression, and fatigue symptoms.
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Affiliation(s)
- Lisa M Thornton
- Department of Psychology & Comprehensive Cancer Center, Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA.
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49
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DuHamel KN, Mosher CE, Winkel G, Labay LE, Rini C, Meschian YM, Austin J, Greene PB, Lawsin CR, Rusiewicz A, Grosskreutz CL, Isola L, Moskowitz CH, Papadopoulos EB, Rowley S, Scigliano E, Burkhalter JE, Hurley KE, Bollinger AR, Redd WH. Randomized clinical trial of telephone-administered cognitive-behavioral therapy to reduce post-traumatic stress disorder and distress symptoms after hematopoietic stem-cell transplantation. J Clin Oncol 2010; 28:3754-61. [PMID: 20625129 DOI: 10.1200/jco.2009.26.8722] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE A significant number of survivors of hematopoietic stem-cell transplantation (HSCT) report enduring adverse effects of treatment, including illness-related post-traumatic stress disorder (PTSD) symptoms and general distress. We report results of a randomized clinical trial that tested the effects of a 10-session, telephone-administered cognitive-behavioral therapy (CBT) intervention on PTSD, depression, and distress symptoms. METHODS Survivors who had undergone HSCT 1 to 3 years earlier (N = 408) were assessed for study eligibility. Those who met study eligibility criteria (n = 89) completed a baseline assessment that included a clinical interview and self-report measures of PTSD symptoms (the primary outcome) and depression and general distress (the secondary outcomes). Next, they were randomly assigned to CBT or an assessment-only condition. Survivors in the CBT group completed 10 individual telephone-based CBT sessions (T-CBT) that included strategies to reduce PTSD symptoms, depression, and general distress. Follow-up assessments occurred at 6, 9, and 12 months after the baseline assessment. RESULTS Linear mixed-model analyses revealed that, compared with HSCT survivors in the assessment-only condition, survivors who completed T-CBT reported fewer illness-related PTSD symptoms, including less avoidance (P < .001) and fewer intrusive thoughts (P < .05) as well as less general distress and fewer depressive symptoms (P < .05) even after controlling for potential demographic and medical covariates. These results were consistent across the three follow-up assessments. CONCLUSION A brief, telephone-administered CBT intervention developed for HSCT survivors is an efficacious treatment for reducing illness-related PTSD symptoms and general distress.
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Lo C, Zimmermann C, Rydall A, Walsh A, Jones JM, Moore MJ, Shepherd FA, Gagliese L, Rodin G. Longitudinal Study of Depressive Symptoms in Patients With Metastatic Gastrointestinal and Lung Cancer. J Clin Oncol 2010; 28:3084-9. [DOI: 10.1200/jco.2009.26.9712] [Citation(s) in RCA: 169] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Although early intervention is increasingly advocated to prevent and relieve distress in patients with metastatic cancer, the risk factors for such symptoms and their trajectory are not well established. We therefore conducted a longitudinal study to determine the course and predictors of depressive symptoms. Patients and Methods Patients (N = 365) with metastatic gastrointestinal or lung cancer completed measures of physical distress, self-esteem, attachment security, spiritual well-being, social support, hopelessness, and depression at baseline; physical distress, social support, hopelessness, and depression were subsequently assessed at 2-month intervals. Results Of the sample, 35% reported at least mild depressive symptoms, with 16% reporting moderate to severe depressive symptoms that persisted in at least one third of such individuals. Moderate to severe depressive symptoms were almost three times more common in the final 3 months of life than ≥ 1 year before death. Predictors of depressive symptoms included younger age, antidepressant use at baseline, lower self-esteem and spiritual well-being, and greater attachment anxiety, hopelessness, physical burden of illness, and proximity to death. The combination of greater physical suffering and psychosocial vulnerability put individuals at greatest risk for depression. Conclusion Depressive symptoms in advanced cancer patients are relatively common and may arise as a final common pathway of distress in response to psychosocial vulnerabilities, physical suffering, and proximity to death. These findings support the need for an integrated approach to address emotional and physical distress in this population and to determine whether early intervention may prevent depression at the end of life.
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Affiliation(s)
- Christopher Lo
- From Princess Margaret Hospital, Campbell Family Cancer Research Institute and Ontario Cancer Institute, and Toronto General Research Institute, University Health Network; University of Toronto; and York University, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- From Princess Margaret Hospital, Campbell Family Cancer Research Institute and Ontario Cancer Institute, and Toronto General Research Institute, University Health Network; University of Toronto; and York University, Toronto, Ontario, Canada
| | - Anne Rydall
- From Princess Margaret Hospital, Campbell Family Cancer Research Institute and Ontario Cancer Institute, and Toronto General Research Institute, University Health Network; University of Toronto; and York University, Toronto, Ontario, Canada
| | - Andrew Walsh
- From Princess Margaret Hospital, Campbell Family Cancer Research Institute and Ontario Cancer Institute, and Toronto General Research Institute, University Health Network; University of Toronto; and York University, Toronto, Ontario, Canada
| | - Jennifer M. Jones
- From Princess Margaret Hospital, Campbell Family Cancer Research Institute and Ontario Cancer Institute, and Toronto General Research Institute, University Health Network; University of Toronto; and York University, Toronto, Ontario, Canada
| | - Malcolm J. Moore
- From Princess Margaret Hospital, Campbell Family Cancer Research Institute and Ontario Cancer Institute, and Toronto General Research Institute, University Health Network; University of Toronto; and York University, Toronto, Ontario, Canada
| | - Frances A. Shepherd
- From Princess Margaret Hospital, Campbell Family Cancer Research Institute and Ontario Cancer Institute, and Toronto General Research Institute, University Health Network; University of Toronto; and York University, Toronto, Ontario, Canada
| | - Lucia Gagliese
- From Princess Margaret Hospital, Campbell Family Cancer Research Institute and Ontario Cancer Institute, and Toronto General Research Institute, University Health Network; University of Toronto; and York University, Toronto, Ontario, Canada
| | - Gary Rodin
- From Princess Margaret Hospital, Campbell Family Cancer Research Institute and Ontario Cancer Institute, and Toronto General Research Institute, University Health Network; University of Toronto; and York University, Toronto, Ontario, Canada
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