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Sowan W, Baziliansky S. Acute Stress Symptoms, Intolerance of Uncertainty and Coping Strategies in Reaction to the October 7 War. Clin Psychol Psychother 2024; 31:e3021. [PMID: 38894501 DOI: 10.1002/cpp.3021] [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: 02/17/2024] [Revised: 05/01/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND On 7 October 2023, hundreds of armed Hamas fighters breached the security border fence and entered Israel from the Gaza Strip. More than 1400 Israeli citizens were murdered, and 239 individuals were kidnapped. Many Israeli citizens experienced these occurrences as psychologically traumatic events that caused stress and uncertainty. OBJECTIVES The present study aimed to examine the relationship between exposure to war (in more distant circles), intolerance of uncertainty (IU) and disengaged coping on acute stress symptoms (ASS). First, we examined whether exposure to war and IU were directly associated with ASS. Second, we tested the mediating role of disengaged coping in the relationship among war exposure, IU and ASS. METHODS This cross-sectional study involved 393 Israeli citizens. Participants answered questionnaires on exposure to war, IU, coping strategies and ASS. RESULTS The study results indicate that higher exposure and higher levels of IU were directly associated with more intensive ASS, and this association was partially mediated by higher use of disengaged coping strategies. CONCLUSIONS Individuals during wartime are at risk of experiencing high levels of ASS and developing ASD. However, degree of exposure to war alone was not associated with ASS, but it was related to personal resources and coping strategies.
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Affiliation(s)
- Wafaa Sowan
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Svetlana Baziliansky
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Asif M, Asad S, Ahmed Z, Emmanuel S. Spirituality, Intolerance and Fear of COVID-19: Psychological Distress Among Older Adults in Pakistan. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02015-6. [PMID: 38528274 DOI: 10.1007/s10943-024-02015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/27/2024]
Abstract
The present study aimed to investigate the role of spirituality, intolerance of uncertainty (IU), and fear of COVID-19 as correlates and predictors of psychological distress among older adults in Pakistan and also assess the gender differences among research variables. Using a quantitative correlational survey research design, a sample of 150 (75 = Men, 75 = Women) older adults aged 55 years and above from different cities of Pakistan were approached through a non-probability purposive sampling strategy. Participants completed the Daily Spiritual Experience Scale, Intolerance of Uncertainty Scale IUS-12, Fear of COVID-19, and Kessler Psychological Distress Scale-K10. Spirituality has a significant negative relationship with psychological distress. Whereas, IU (Inhibitory anxiety and prospective anxiety) and fear of COVID-19 have a significant positive relationship with psychological distress. Results also showed that spirituality, IU dimensions, and fear of COVID-19 emerged as significant predictors of psychological distress among older adults after controlling for the effect of covariates. In addition, elderly females significantly showed more spirituality, less IU, and fear of COVID-19 as compared to elderly males. It is proposed that mental health care plays an important role in treating the psychological needs of older adults in pandemic situations and that further study is needed to develop effective solutions for older persons in stressful situations such as pandemics.
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Affiliation(s)
- Maheen Asif
- Department of Lahore School of Behavioural Sciences (LSBS), The University of Lahore, Lahore, Pakistan.
| | - Sara Asad
- Department of Applied Psychology, Kinnaird College for Women University, Lahore, Pakistan
| | - Zohaib Ahmed
- Department of Lahore School of Behavioural Sciences (LSBS), The University of Lahore, Lahore, Pakistan
| | - Shalmee Emmanuel
- Department of Humanities, The COMSATS University Islamabad, Abbottabad Campus, Pakistan
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Lee HJ, Sin C, Kim H, Im HS, Jo JC, Lee YJ, Kim Y, Ahn J, Yoo S, Koh SJ, Chung S. Catastrophizing Maladaptive Coping Affects the Association Between Viral Anxiety and Fear of Progression in Cancer Patients During COVID-19 Pandemic. Psychiatry Investig 2023; 20:1204-1210. [PMID: 38011847 PMCID: PMC10758328 DOI: 10.30773/pi.2023.0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE The aim of the present study was to explore whether or not cancer patients' viral anxiety and depression during the coronavirus-2019 (COVID-19) pandemic were associated with a fear of cancer progression. We also assessed whether coping strategies affected the relationship. METHODS The present cross-sectional survey included cancer patients who visited Ulsan University Hospital in Ulsan, Korea. The participants' demographic information and responses to the following symptoms rating scales were collected: Stress and Anxiety to Viral Epidemic-6; Patient Health Questionnaire-9; Cognitive Emotion Regulation Questionnaire-short version; or Fear of Progression Questionnaire-short version. RESULTS Of the 558 cancer patients surveyed, 25 (4.5%) reported that their treatment schedule was delayed during the COVID-19 pandemic. The patients' fear of progression was found to be related to age (β=-0.08; p=0.011), viral anxiety (β=0.40; p<0.001), depression (β=0.26; p<0.001), and catastrophizing coping strategies (β=0.15; p=0.004), for an overall adjusted R2 of 0.46 (F=66.8; p<0.001). Mediation analysis showed that viral anxiety and depression were directly associated with fear of progression, while catastrophizing mediated this relationship. CONCLUSION Fear of progression in cancer patients was associated with viral anxiety, depression, and maladaptive coping techniques, such as catastrophizing, during the COVID-19 pandemic.
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Affiliation(s)
- Hyuk Joo Lee
- Seoul Dream Psychiatric Clinic, Hanam, Republic of Korea
| | - Cheolkyung Sin
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyeyeong Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyeon-Su Im
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Yoo Jin Lee
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Youjin Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Junseok Ahn
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Soyoung Yoo
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hammoudi SF, Ahmed O, An H, Hong Y, Ahn MH, Chung S. Adherence to Physical Distancing and Health Beliefs About COVID-19 Among Patients With Cancer. J Korean Med Sci 2023; 38:e336. [PMID: 37935163 PMCID: PMC10627725 DOI: 10.3346/jkms.2023.38.e336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/21/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND This study aimed to validate questionnaires on adherence to physical distancing and health beliefs about coronavirus disease 2019 (COVID-19) among patients with cancer and explore their interaction with depression or viral anxiety among them. METHODS Through an online survey, data from 154 cancer patients (female: 82.5%, breast cancer: 66.2%, current cancer treatment, presence: 65.6%) were collected from March to June 2022. The survey gathered responses to questionnaires on adherence to physical distancing, health beliefs about COVID-19, perceived social norms, Stress and Anxiety to Viral Epidemics-6 items, and Patient Health Questionnaire-2. Confirmatory factor analysis (CFA) for construct validity and structural equation model (SEM) were performed. RESULTS The CFA showed a good model fit for adherence to physical distancing (comparative fit index [CFI] = 1.000, Tucker-Lewis index [TLI] = 0.930, root-mean-square-error of approximation [RMSEA] = 0.000, and standardized root-mean-square residual [SRMR] = 0.050) and a satisfactory model fit for health beliefs about COVID-19 (CFI = 0.978, TLI = 0.971, RMSEA = 0.061, and SRMR = 0.089). Through SEM, we found that personal injunctive norms were the main mediators linking health beliefs with physical distancing in patients with cancer. Depression also mediated the effects of viral anxiety and perceived severity on physical distancing (χ² = 20.073, df = 15, P = 0.169; CFI = 0.984; RMSEA = 0.047). CONCLUSION The questionnaires are reliable and valid. Patients with cancer may be able to adhere to physical distancing by addressing perceived severity, viral anxiety, perceived benefits, self-efficacy, perceived barriers, as well as personal injunctive norms.
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Affiliation(s)
| | - Oli Ahmed
- Department of Psychology, University of Chittagong, Chattogram, Bangladesh
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Hoyoung An
- Department of Psychiatry, Keyo Hospital, Uiwang, Korea
| | - Youjin Hong
- Department of Psychiatry, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Myung Hee Ahn
- Division of Psychiatry, Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Harel K, Czamanski-Cohen J, Cohen M, Weihs KL. Emotional Processing, Coping, and Cancer-Related Sickness Symptoms in Breast Cancer Survivors: Cross- Sectional Secondary Analysis of the REPAT Study. RESEARCH SQUARE 2023:rs.3.rs-3164706. [PMID: 37503214 PMCID: PMC10371152 DOI: 10.21203/rs.3.rs-3164706/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Purpose The study aims to provide a better understanding of the relationship between emotional processing, coping, and cancer-related sickness symptoms. Methods The study used a cross-sectional, secondary analysis of data from 179 Israeli Jewish women who were breast cancer survivors (BCS) 3 to 18 months after completing primary treatment and who participated in a larger randomized controlled trial (REPAT study). Data were collected at baseline. Participants completed questionnaires measuring emotion acceptance, situational approach, avoidance coping, and cancer-related sickness symptoms (depression, fatigue, and pain) and a performance measure of emotional awareness. Hierarchical linear regressions were performed, controlling for background variables. Results Participants experienced significant clinical depression (51.7%), cancer-related fatigue (CRF, 78.8%), pain interference (78%), and pain intensity (66%) levels. There were strong correlations between cancer-related symptoms. After controlling for confounders, emotional processing (acceptance) was negatively associated with depression, and avoidance coping was positively associated with depression, CRF, and pain interference (i.e., higher use of avoidance related to higher cancer-related symptoms; higher acceptance was associated with lower depression). Emotional awareness and coping by approaching emotions were not related to cancer-related symptoms. Conclusions The BCS posttreatment period presents the challenge of dealing with elevated cancer-related symptoms. Regardless, BCS who used high emotional processing levels-especially acceptance of emotion and lower reliance on avoidance to cope-experienced fewer cancer-related symptoms. Implications for Cancer Survivors Professionals should recognize the potential role of emotional processing and avoidant coping relative to cancer-related symptoms and recognize their patterns in posttreatment patients.
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Shen H, Masingboon K, Samartkit N. Factors related to preoperative uncertainty among patients with breast cancer in Wenzhou, China: A cross-sectional study. BELITUNG NURSING JOURNAL 2023; 9:236-243. [PMID: 37492757 PMCID: PMC10363974 DOI: 10.33546/bnj.2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/30/2023] [Accepted: 06/02/2023] [Indexed: 07/27/2023] Open
Abstract
Background One of the most prevalent psychological signs of breast cancer is uncertainty, which is more prevalent in Chinese patients during the preoperative period. Despite the numerous factors contributing to preoperative uncertainty, there is limited relevant research conducted in China. Objective This study aimed to describe the current state of preoperative uncertainty and to investigate the relationship between anxiety, illness perception, social support, and preoperative uncertainty in patients with breast cancer in Wenzhou, China. Methods This cross-sectional research used a simple random sampling technique to select 122 participants from a university hospital in Wenzhou, China, from July 2022 to December 2022, employing validated instruments. Descriptive statistics and Pearson's correlation coefficient were utilized to analyze the data. Results The average preoperative uncertainty scores of the patients fell within a moderate range (M = 61.92, SD = 7.51). Significant correlations were found between anxiety (r = 0.638, p <0.01), illness perception (r = 0.704, p <0.01), social support (r = -0.481, p <0.01), and preoperative uncertainty. Conclusions The results can assist healthcare professionals, especially nurses, in recognizing the factors contributing to uncertainty before surgery in patients with breast cancer. This knowledge enables them to promptly address and minimize this issue, leading to improved outcomes.
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Affiliation(s)
- Huaiyu Shen
- Faculty of Nursing, Burapha University, Chon Buri, Thailand
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Taylor S, Stanworth M, Eastwood C, Gomes F, Khatoon B, Yorke J. Understanding the experiences of lung cancer patients during the COVID-19 pandemic: a qualitative interview study. Qual Life Res 2023; 32:701-711. [PMID: 36342627 PMCID: PMC9638463 DOI: 10.1007/s11136-022-03283-z] [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] [Accepted: 10/15/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The study explores experiences of lung cancer patients during COVID-19 and considers how changes to care delivery and personal lives affected patient needs. METHODS Semi-structured telephone interviews were conducted to explore experiences of lung cancer patients during COVID-19. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Interview participants were purposively selected based on age, gender, treatment status, timing of diagnosis (pre/post first COVID-19 lockdown) from a sample of lung cancer patients (any histological subtype/any cancer stage/any point in treatment) who had completed a questionnaire exploring how participants' lives were impacted by the pandemic and their thoughts on clinical care and remote communication. RESULTS Thirty lung cancer patients who participated in the questionnaire study were approached and participated in an interview. Three themes were identified: (1) Adapting to new modes of communication (focusing on experiences of remote communication); (2) Experience of care delivery during the pandemic (describing how all aspects of care delivery had been affected); (3) Impact of the COVID-19 pandemic on quality of life (QOL) (focus on the psychological impact and feeling of reduced support). Themes 1 and 2 are heavily interlinked and both had bearing on patients' QOL experience. CONCLUSION Lung cancer patients were impacted psychologically by changes to care delivery and changes in their personal life. The findings highlight some benefits to remote consultations but the stage of the treatment pathway and illness trajectory should be considered when determining if this is appropriate. Participants felt support from peers, family and friends was limited during the pandemic.
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Affiliation(s)
- Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK. .,School of Nursing and Midwifery, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Melissa Stanworth
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Charlotte Eastwood
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Fabio Gomes
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK.,Medical Oncology Department, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Binish Khatoon
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK.,School of Nursing and Midwifery, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Janelle Yorke
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK.,School of Nursing and Midwifery, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Perego G, Di Mattei VE, Mazzetti M, Milano F, Gatti C, Rancoita PMV, Taranto P, Rabaiotti E, Cioffi R, Candiani M. The Experience of COVID-19 in a Sample of Gynecological Cancer Patients Undergoing Chemotherapy: A Focus on the Psychological Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3851. [PMID: 36900862 PMCID: PMC10002022 DOI: 10.3390/ijerph20053851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Cancer patients are at an increased risk of developing severe consequences due to the COVID-19 infection. However, psychological outcomes in this population have been overlooked in the literature. The present study aims to identify significant psychological differences between gynecological cancer patients undergoing chemotherapy before and during the pandemic. Additionally, we explore the correlations between COVID-19-related concerns and anxiety, depression, distress, and quality of life levels. Forty-two patients completed the STAI-Y, the EORTC QLQ-C30, the BDI II, the DT, and an ad-hoc questionnaire that investigated COVID-19-related concerns. The analyses did not show significant differences in the psychometric scales between the two groups, highlighting a considerable resilience against mental health and quality of life deterioration during the COVID-19 pandemic in gynecologic cancer patients. However, COVID-19-related concerns were positively associated with anxiety and inversely related to emotional functioning levels. These results emphasize the importance of a comprehensive patient care and the need to implement a multidisciplinary approach that includes psychological support in the treatment plan. Moreover, it is essential to encourage clear communication to convey comprehensive information about the impact of the pandemic on physical and psychological levels, as well as to offer psychoeducational tools to face the pandemic.
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Affiliation(s)
- Gaia Perego
- School of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Valentina Elisabetta Di Mattei
- School of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Martina Mazzetti
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Francesca Milano
- Department of Psychology, University of Milano-Bicocca, 20132 Milan, Italy
| | - Carola Gatti
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Paola Maria Vittoria Rancoita
- University Centre for Statistics in Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, 20132 Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Paola Taranto
- Clinical and Health Psychology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Emanuela Rabaiotti
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Raffaella Cioffi
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Massimo Candiani
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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Cohen M, Yagil D. Posttraumatic stress and COVID-19-related stressors: a prospective observational study. ANXIETY, STRESS, AND COPING 2022; 35:533-546. [PMID: 35446738 DOI: 10.1080/10615806.2022.2067983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic may trigger posttraumatic stress symptoms (PTSS) due to its threat to health, well-being, and survival. OBJECTIVES We sought to assess levels of change in PTSS at three waves during the COVID-19 pandemic. Our second objective was to examine the role of four objective and subjective predictors salient to COVID-19-loss of resources, sense of loneliness, perceived COVID-19 threat, and uncertainty stress-on the trajectory of PTSS. METHODS The study consisted of three waves, a month apart, between June and August 2020, with 903, 718, and 684 participants in each wave, respectively. RESULTS At T0, participants had a medium level of PTSS (M = 2.07, SD = 0.89), which increased at T1 (M = 2.46, SD = 0.97) and decreased at T2 (M = 2.24, SD = 0.93). Linear mixed-effects modeling showed that loss of resources, sense of loneliness, perceived COVID-19 threat, and uncertainty stress were significant predictors of PTSS over the three time-points. Significant interactions between these predictors (except sense of loneliness) and time were found: At higher levels of resource loss, uncertainty stress, and COVID-19 threat, there was a steeper increase in PTSS from baseline to 1 month. CONCLUSIONS The four predictors of PTSS should be addressed via strengthening resilience of individuals and communities.
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Affiliation(s)
- Miri Cohen
- School of Social Work, University of Haifa, Haifa, Israel
| | - Dana Yagil
- Department of Human Services, University of Haifa, Haifa, Israel
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Decat Bergerot C, Costas-Muñiz R, Lee D, Philip EJ. Social support as a protective factor for patients with cancer during the pandemic. Cancer Invest 2022; 40:473-474. [PMID: 35510567 DOI: 10.1080/07357907.2022.2074410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Cristiane Decat Bergerot
- Instituto Unity de Ensino e Pesquisa. Centro de Câncer de Brasília (CETTRO), Brasília, DF, Brazil
| | | | - David Lee
- University of New Mexico, Albuquerque, NM, USA
| | - Errol J Philip
- University of California San Francisco, San Francisco, CA, USA
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