Positive psychological functioning in breast cancer: An integrative review

Early postoperative core symptoms and their relationship with resilience in oesophageal cancer patients-A multicentre cross-sectional study

AIM

To assess early postoperative core symptoms in oesophageal cancer patients and their relationship with resilience.

BACKGROUND

Patients with oesophageal cancer face a high number of severe symptoms in the early post-operative period and require the development of an effective symptom management programme. Identifying core symptoms through network analysis helps in accurate patient care.

DESIGN

A multicentre cross-sectional study.

METHODS

A cross-sectional survey was conducted from August 2022 to August 2023 at three hospitals in Anhui Province, China. A total of 469 patients were recruited for this study and 418 (89.1%) patients completed this investigation. Using network analysis to find early post-operative core symptoms in oesophageal cancer patients. Multiple linear regression was used to analyse resilience factors affecting core symptoms.

RESULTS

Sadness was the most core symptom in oesophageal cancer patients in the early post-operative period (rs = 1.41), followed by incision pain and difficulty breathing while resting (rs = 1.20, rs = 1.08). Resilience was significantly associated with patients' feelings of sadness, with optimism having the greatest impact on sadness (p < .01).

CONCLUSION

Sadness is the most core symptom in patients in the early post-operative period and special attention should be paid to improving their level of resilience. Local symptoms and dysfunction in the early post-operative period should be treated in a synergistic manner.

IMPACT

This study identifies core symptoms and their relationship to resilience in patients with oesophageal cancer in the early post-operative period. Symptoms as the main core symptom in patients in the early post-operative period, which was sadness and was significantly associated with resilience. Precise interventions can be made to target patients' core post-operative symptoms, which can help improve the effectiveness of symptom management.

REPORTING METHOD

We have complied with the relevant EQUATOR research reporting checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution in the study.

Resilience and related factors in caregivers of adult cancer patients: a systematic review

Background

This systematic review aimed to investigate resilience and its related factors in caregivers of adult patients with cancer.

Materials and methods

A systematic search of online electronic databases including Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) was performed using keywords extracted from Medical Subject Headings such as "Psychological Resilience", "Caregiver", and "Cancer" from the earliest to 6 June 2023. The quality of the studies included in this review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool).

Results

A total of 2735 caregivers of cancer patients participated in 15 studies. The majority of the studies found that caregivers of cancer patients had high levels of resilience. Factors related to the resilience of cancer patients' caregivers included caregivers' social support, caregivers' quality of life, patients' resilience, caregivers' family function, patients' performance, caregivers' age, caregivers' health status, caregivers' self-esteem, caregivers post-traumatic growth, caregivers religious, caregivers hope, caregivers positive affect, patients age, patients social support, patients resilience support, patients quality of life, caregivers' anxiety, caregivers' depression, caregivers' burden, caregivers level of education, caregivers financial problem, caregivers memory, caregivers negative affect, caregivers post-traumatic stress disorder, maternal distress, and patients post-traumatic stress disorder.

Conclusion

Therefore, healthcare administrators and policymakers can enhance the resilience of caregivers and the quality of care they provide by instituting ongoing training initiatives focused on evaluating mental well-being and implementing coping strategies for managing stress and depression.

Scoping review protocol of post-traumatic growth (PTG) in Korean cancer survivors

INTRODUCTION

Cancer, a life-threatening chronic disease, is the leading cause of death in Korea, accounting for 27% of all deaths in 2020. Due to advancements in medical technology and early detection of cancer in Korea, the 5-year relative survival rate reached 70.7% (2015-2019), highlighting remarkable progress over the past decades. Although cancer has been seen as a traumatic event, cancer survivors also go through a subjective process of self-maturation, which is called post-traumatic growth (PTG). Because research on PTG among Korean cancer survivors has not been systematically synthesised, a scoping review on this topic will provide a better understanding of the positive psychological changes that occur as a patient moves through the illness trajectory of cancer from a Korean cultural perspective. The purpose of this study was to describe the protocol of a scoping review regarding PTG in Korean cancer survivors.

METHODS AND ANALYSIS

The scoping review framework suggested by Arksey and O'Malley and the manual refined by the Joanna Briggs Institute for scoping reviews will be used with the six framework guidelines developed by Levac et al. Searched databases will include Ovid-MEDLINE, PubMed, Embase, CINAHL, Cochrane Library and PsycInfo, as well as Korean databases, examining all articles published between 2012 and 2023 in Korean or English on PTG in Korean cancer survivors. Extracted data will be collated, charted and summarised.

ETHICS AND DISSEMINATION

Because the scoping review methodology undertakes a secondary analysis of collected data from previous research studies, this study does not require ethical approval. The results of this scoping review will be disseminated through presentations at conferences and publication in a scientific journal.

Roles of benefit finding in psychological and inflammatory adjustments in persons with colorectal cancer: a prospective analysis on the multidimensionality of benefit finding

OBJECTIVE

This study examined the unique associations of different dimensions of the resilience factor, benefit finding, on concurrent and prospective psychological and biological adjustment outcomes over the first year after a colorectal cancer diagnosis.

METHODS AND MEASURES

Individuals newly diagnosed with colorectal cancer (n = 133, mean age = 56 years old, 59% female, 46% Hispanic) completed questionnaires assessing the multidimensional aspects of benefit finding around 4 months post-diagnosis (T1). Psychological (depressive symptoms and life satisfaction) and biological [C-reactive protein (CRP) and interleukin-10 (IL-10)] adjustments were assessed at T1 and one-year post-diagnosis (T2).

RESULTS

Structural equation modeling revealed that at T1, greater reprioritization was concurrently related to higher depressive symptoms (p=.020). Lower acceptance, lower empathy, and greater positive self-view predicted higher life satisfaction at T2 (ps<.010). Additionally, lower empathy and greater family valuation predicted higher CRP at T2 (ps<.004), whereas greater positive self-view predicted higher IL-10 at T2 (p=.039). Greater overall benefit finding was associated with lower IL-10 at T1 (p=.013).

CONCLUSION

Various aspects of benefit finding differentially relate to psychological and inflammatory markers during the first year after diagnosis in persons with colorectal cancer. Interventions designed to specifically enhance positive self-view may promote both the psychological and biological health of individuals with cancer.

Reliability and Validity of the Japanese Version of the Short Form of the Expanded Version of the Posttraumatic Growth Inventory (PTGI-X-SF-J): A Cross-Sectional Study

A Japanese version of the short form of the expanded Posttraumatic Growth Inventory (PTGI-X-SF-J) was developed in this study, as the extended version captures broader, more diverse personal growth perspectives, such as existential spiritual growth. We collected cross-sectional data from 408 (first sample) and 284 (second sample) Japanese university students using the expanded version of the Posttraumatic Growth Inventory (PTGI-X-J). Exploratory factor analysis (EFA) was performed with the first sample and confirmatory factor analysis (CFA) with the second; reliability and validity were examined. The short-form version resulting from the EFA and CFA comprised 10 items and five factors. Cronbach's alpha for the PTGI-X-SF-J total and subscale scores ranged from 0.671 to 0.875. The intraclass correlation coefficient for the total and subscale scores between the PTGI-X-J and PTGI-X-SF-J ranged from 0.699 to 0.821. Regarding external validity, no significant correlation was found between posttraumatic growth and posttraumatic stress disorder checklists. Due to its brevity, the PTGI-X-SF-J can help assess diverse spiritual and existential personal growth experiences among clients, patients, and trauma survivors while reducing physical and psychological burdens.

Sense of coherence mediates perceived social support and depressive and anxiety symptoms in cervical cancer patients: a cross-sectional study

BACKGROUND

Depression and anxiety symptoms are two common psychological disturbances in cervical cancer patients. We tested whether sense of coherence (SOC) mediates the association of perceived social support (PSS) with depression and anxiety symptoms among cervical cancer patients in China.

METHODS

We conducted a survey involving 294 cervical cancer patients aged ≥ 18 years from July to December 2020 at three hospitals in Liaoning Province, China; 269 patients completed the survey. We included a demographic questionnaire, the Multidimensional Scale of Perceived Social Support (MSPSS), Antonovsky's Sense of Coherence Scale, the Hamilton Depression Rating Scale, and the Zung Self-Rating Anxiety Scale (SAS) in this study. We used hierarchical regression analysis to examine the relationship among PSS, SOC, and symptoms of depression and anxiety. We used asymptotic and resampling strategies to explore the mediating effect of SOC.

RESULTS

PSS was negatively associated with depressive symptoms (r = - 0.439, P < 0.01) and anxiety symptoms (r = - 0.325, P < 0.01). SOC was negatively related to depressive symptoms (r = - 0.627, P < 0.01) and anxiety symptoms (r = - 0.411, P < 0.01). SOC partially mediated the association between PSS and depressive symptoms (a*b = - 0.23, BCa95% CI: [- 0.31, - 0.14]) and anxiety symptoms (a*b = - 0.15, BCa95% CI: [- 0.23, - 0.08]). The proportions of the mediating effect accounting for SOC were 49.78% and 41.73% for depressive symptoms and anxiety symptoms, respectively.

CONCLUSION

The study showed that SOC could mediate the association between PSS and symptoms of depression and anxiety. This suggests that SOC might serve as a potential target for intervention in symptoms of depression and anxiety that accompany cervical cancer.

Relationships Between Colorectal Cancer Survivors' Positive Psychology, Symptoms, and Quality of Life

This cross-sectional study examined colorectal cancer (CRC) survivors' symptom and symptom cluster characteristics (occurrence, frequency, and severity), positive psychology (benefit-finding and post-traumatic growth), and quality of life (QoL), and determined whether positive psychology moderates symptoms and QoL relationship during acute cancer survivorship, time from diagnosis to treatment completion. A total of 117 CRC survivors completed demographics, symptoms, QoL, and positive psychology questionnaires. Descriptive statistics, multiple linear regression, and moderation analyses were performed. Participants reported high QoL (94%, M = 5.15) and moderate-high positive psychology (75%, M = 3.21). Nineteen symptoms and five symptom clusters were inversely related to QoL (p < .05). Positive psychology (M = ~≥3.24) moderated the relationship of QoL (p < .05) with symptoms occurrence (n = 10), symptom severity (n = 1), and with the generalized symptom cluster (weakness, fatigue, dizziness, drowsy, sleep disturbances, and pain). Positive psychology aids in symptom management and improves QoL. Nurses are poised to identify, prevent, promote, and advocate self-management skills to improve health-related outcomes.

The correlation between posttraumatic growth and social support in people with breast cancer: A meta-analysis

Posttraumatic growth (PTG) is consistently reported to be associated with social support among people with breast cancer. But so far there is no consensus on the size and direction to which social support are related to PTG in people with breast cancer. Thus, a meta-analysis was performed by us to quantitatively synthesize the previous results. This meta-analysis followed the PRISMA 2020 guidelines. We searched PubMed, PsycINFO, Web of Science, Embase, Chongqing VIP Information Co., Ltd. (VIP), China National Knowledge Infrastructure (CNKI), and WANFANG DATA databases prior to 1 June 2022. A random effects model of Stata software (version 17.0) was employed to compute the pooled association coefficient and examine a series of moderating factors: economic level, publication type, region, year of publication, participants' age, and social support measurement tools. Ultimately, 31 studies including 6,380 breast cancer patients were identified. This meta-analysis offers evidence of a highly positive correlation between PTG and social support among people with breast cancer (r = 0.425). Economic level, region, and social support measurement tools moderated the link between PTG and social support among people with breast cancer. Whether variables such as disease stage, time since diagnosis, and disease treatment moderate the link between PTG and social support among people with breast cancer can be further investigated in the future.

Cancer-related posttraumatic growth and posttraumatic stress: how are they connected and what are their correlates?

PURPOSE

Cancer is a stressful life event that can lead to specific posttraumatic reactions. Posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) are two main posttraumatic reactions that are related to each other, and both have different correlates.

METHODS

The linearity of the relationship between PTG and PTSS and the different socio-demographic, cancer-related, emotional, and psychological correlates were analyzed in patients with cancer (N = 126).

RESULTS

The relationship between PTG and PTSS was found to be more curvilinear than linear. PTSS was more strongly related to psychological factors (e.g., anxious preoccupation, hope-helplessness, and resilience) while PTG was strongly related to existential factors (e.g., self-transcendence and religiosity).

CONCLUSION

The results show that cancer-related PTSS and PTG are specifically related constructs which are related differently to particular correlates. Specifically, the greatest differences were observed in the psychological variables. In the early phases, therapeutic interventions focused on variables related to PTSS can lead to the reduction of PTSS. In follow-up phases, the therapeutic intervention focused on the increase of the level of variables related to PTG can help the development of PTG.

Cancer and Covid-19: a preliminary study on the trauma aspects of Coronavirus in cancer patients

Objective

Because of Covid 19, it has become necessary to revise the treatment of cancer patients (“how” and “when”). That has had important psychological repercussions. The purpose of this study is the evaluation of the impact of Covid19 in terms of Post‐Traumatic Stress Disorder and Depression and the potential association with coping strategies.

Methods

We conducted an exploratory study with 106 patients undergoing treatment, using following questionnaires: Screening Questionnaire for Disaster Mental Health and Mini‐Mental Adjustment to Cancer.

Results

Only 25.5% of our sample showed symptoms of posttraumatic stress disorder (PTSD) and 6.6% revealed a probable presence of depression. In addition, it came up a significant correlation between SQD_P and the coping styles “Hopelessness” (r = 0.41 p < 0.001) and “Anxious Preoccupation” (r = 0.45, p < 0.001).

A strong correlation also emerged between non‐Covid 19 patients and PTSD (r = 0.29, p = 0.002).

Conclusions

Our preliminary data did not reveal a prevalence of PTSD, but the persistence of the health emergency requires to focus future research on protective and risk factors related to PTSD and psychological distress in cancer patients, in order to reduce the mental health burden of Covid19.

Posttraumatic Growth and Psychological Distress among Female Breast Cancer Survivors in India: A Cross-Sectional Study

Introduction Breast cancer survivors (BCS) may experience a cascade of negative reactions during the entire treatment process in the form of psychiatric morbidity. However, exposure to a traumatic event also has the fertile ground for the potential to catalyze a host of positive changes, including development in personal, interpersonal, and spiritual levels, commonly referred to as posttraumatic growth (PTG). PTG is defined as “positive psychological change experienced due to a struggle with highly challenging life circumstances.”

Objective This study aims to measure the prevalence and correlates of PTG among BCS.

Materials and Methods It was a cross-sectional study carried in a tertiary care center of North India from January 2021 to April 2021. Total 700 BCS were approached and screened using the purposive sampling technique. Data were analyzed using the Statistical Package for Social Sciences, version 20.

Results The mean age (standard deviation [SD]) of the patients was 43.14 (8.53) years. The mean (SD) PTG score was 37 (13.66). Among the subdomain of PTG, most respondents showed growth in personal strength, relating to others, followed by an appreciation of life, spiritual change, and less growth in new possibilities. PTG was found to be significantly positively correlated with treatment completion time (r = 2.260, p = 0.02) and negatively correlated with depression, anxiety, and stress (r = –0.152, p = 0.04; r = –0.145, p = 0.05; r = –0.162, p = 0.02).

Conclusion Psychological morbidities must be addressed along with medical treatment of breast cancer so that growth post trauma can be further facilitated.

Perceived trajectory of psychological and physical states after breast cancer: An optimistic perception

BACKGROUND

In cancer research, studying the quality of life trajectory helps us understand the complaints but also the cognitive, physical, and emotional aspects that can evolve positively. Examining both the suffering and the improvements expressed by the patients facilitates their care and their recovery knowing that an optimistic perception of the future is important for adaptative functioning after cancer. Through retrospective, present and prospective measures, we sought to characterize the subjective trajectory perceived by women with breast cancer about their cognitive, emotional and physical states, as it relates to quality of life.

METHODS

Nine hundred ninety women survivors of breast cancer (after curative treatments) described, on the appropriate scales, their perceived cognitive, emotional and physical states over three periods of time: from past care (i.e., retrospective analysis) to the future (i.e., projective analysis), including the present period, as a function of their treatment (chemotherapy vs. no chemotherapy) and surgery (lumpectomy vs. mastectomy) using ANCOVA.

RESULTS

The 732 women who had received chemotherapy perceived the most significant consequences, regardless of the type of surgery (η²= .01). Moreover, all survivors expressed an optimistic perception of the change in their states in the anticipated future as a normative optimistic perception.

CONCLUSIONS

Results are discussed in terms of the benefits of specific and early interventions that enable patients to cope better with the disease and its treatments by taking into account their more or less optimistic perception of the future.

Barriers to seeking psychosocial support among adult patients with hematologic neoplasms: a qualitative study

PURPOSE

This study aims to explore the barriers that adult patients with hematologic neoplasms experience when seeking psychosocial support.

METHODS

A descriptive qualitative approach was used to investigate the experiences of patients with hematologic neoplasms. Face-to-face, semi-structured, in-depth individual interviews were conducted between June and October 2020 with 17 patients diagnosed with hematologic neoplasms. The interviews were audio-recorded and transcribed verbatim. A thematic analysis was performed to identify the essential themes.

RESULTS

Seventeen patients aged 28-67 years completed the interviews. Two themes and six subthemes were identified that describe barriers to seeking psychosocial support. Internal barriers included limited communication, negative emotions, social avoidance, and focusing on treatment rather than psychosocial needs; external barriers included traditional cultural influences and lack of professional support.

CONCLUSIONS

Significant others were the key source for psychosocial support for patients with hematologic neoplasms. Tackling diverse barriers to accessing psychosocial support remains a challenge for these patients. Healthcare providers should continually assess and provide effective support.

Automatic breast mass detection in mammograms using density of wavelet coefficients and a patch-based CNN

PURPOSE

For the purpose of accurate and efficient mass detection in full-field digital mammograms, we propose a method for automated mass detection that consists of two stages: suspicious region localization and false-positive (FP) reduction, by classifying these regions into mass and non-mass regions (normal tissues).

METHODS

In the first stage, the density of the wavelet coefficients based on Quincunx Lifting Scheme (DWC-QLS) is used to find suspicious regions (regions of interest, ROIs) in full mammograms. In the second stage, a patch-based CNN classifier is developed as an FP reduction to classify the suspicious regions. The main aim of this stage is to reduce the false-positive suspicious regions while keeping the true-positive suspicious regions. To further improve the performance of the FP reduction, the effectiveness of different transfer learning strategies is further explored and the best fine-tuning strategy in training InceptionV3 model is determined experimentally.

RESULTS

The experimental results show that the proposed method can achieve an overall performance of 0.98 TPR @1.43 FPI on the INbreast database. In addition, the suggested segmentation method detects the mass location with 100% sensitivity and average of 5.4 false positives per image.

CONCLUSIONS

Based on the obtained results, the introduced method was able to successfully detect and classify suspicious regions in digital mammograms and provide better TPR and FPI results in comparison with other state-of-the-art method.

Examining the role of pets in cancer survivors' physical and mental wellbeing

PURPOSE

Australian cancer survivors have multiple wellbeing support needs, and Australians frequently keep pets, a practice associated with physical and mental health benefits. This mixed-methods study explores the influence of relationships of PERMA (positive emotion, engagement, relationships, meaning, and accomplishment) wellbeing domains and pet ownership on cancer survivors' physical and mental wellbeing and quality of life.

METHODS

A convenience sample of Australian cancer survivors (N = 162) were surveyed, recording demographic, pet ownership, PERMA wellbeing, physical and mental health characteristics, and support needs. Quality of life and health scores were predicted from PERMA domains and pet ownership.

RESULTS

Pet ownership was highly prevalent in participating cancer survivors, predicting increased mental health scores. No associations were seen for physical health. Cancer survivors sought instrumental pet care support and pet-owner relationship maintenance during survivorship.Implications: Pet ownership may be leverageable in interventions for mental health and wellbeing improvement during cancer recovery. Research should next clarify pet ownership prevalence in this population.

Validation of the Brief Version of the Cancer Behavior Inventory in Breast Cancer Portuguese Patients

Self-efficacy is a coping resource with a positive impact on well-being, quality of life, anxiety, and depression in cancer patients, even after treatment. This study focused on the validation of the Cancer Behavior Inventory-Brief Version (CBI-B) in Portuguese patients with breast cancer. The study included 115 patients with breast cancer receiving outpatient chemotherapy in four hospitals located in Portugal. Participants (N = 115) completed the translated version of the CBI-B in Portuguese and measures of quality of life (QLQ- C30), psychological distress (HADS), and illness perceptions (IPQ-B). Confirmatory factor analysis supported the four-factor original structure of the CBI-B. The Portuguese version of the CBI-B showed good psychometric properties as shown by measures of internal consistency (Cronbach's alpha = .88), test-retest reliability (intraclass correlation coefficient = .59), convergent validity with the QLQ-C30 (r = .43, p < .001), and divergent validity with the HADS (r = -.60, p < .001) and the IPQ-B (r = -.51, p < .001). The Portuguese version of the CBI-B is a valid and reliable instrument to evaluate the self-efficacy for coping in Portuguese breast cancer patients. Future studies should validate the CBI-B in patients with other types of cancer.

Posttraumatic growth as a buffer and a vulnerability for psychological distress in mothers who are breast cancer survivors

BACKGROUND

This study investigated the role of posttraumatic growth (PTG) in moderating the associations between parenting efficacy and psychological distress, and between fear of cancer recurrence (FCR) and psychological distress, in mothers who are breast cancer survivors.

METHODS

In this cross-sectional study, mothers who were breast cancer survivors (N = 91) completed the Depression, Anxiety and Stress Scale (DASS-21), Cancer-Related Parenting Self-Efficacy (CaPSE), Concerns About Cancer Recurrence (CARS) and Posttraumatic Growth Inventory Short Form (PTGI-SF). Hierarchical multiple linear regressions and simple-slope tests were used to examine the main effects of the predictors (CaPSE and CARS) and moderator (PTGI-SF), and interaction effects of CaPSExPTGI-SF and CARSxPTGI-SF. The analyses were repeated for each outcome variable: Depression, Anxiety and Stress.

RESULTS

Higher CARS significantly predicted higher Depression, Anxiety and Stress, and lower CaPSE significantly predicted higher Depression and Stress. Significant CaPSExPTGI-SF and CARSxPTGI-SF interactions predicted Depression. Simple-slopes tests indicated a significant positive association between CARS and Depression for mothers with high levels of PTG, but not with low levels of PTG. A negative association was indicated between CaPSE and Depression for mothers with low levels of PTGI-SF, though neither slope was significant.

LIMITATIONS

Our results are only generalisable to mothers with similar socio-demographic backgrounds.

CONCLUSIONS

PTG may serve as both a protective and a risk factor for depression in mothers who are breast cancer survivors. Debate remains whether PTG is best conceptualised as a perceived positive outcome or an ongoing coping mechanism in the face of parenting challenges and cancer-related threats such as FCR.

Patients' communication preferences for receiving a cancer diagnosis: Differences depending on cancer stage

OBJECTIVE

This study aimed to identify communication preferences for receiving a cancer diagnosis in South Korean patients and explore differences depending on cancer stage-with or without recurrence/metastasis.

METHODS

A total of 312 patients from five cancer centers in South Korea completed the Korean version of the Measure of Patients' Preferences questionnaire, Mini-Mental Adjustment to Cancer scale, Insomnia Severity Index, and Hospital Anxiety and Depression Scale.

RESULTS

Among patients without recurrence/metastasis, four factors were indicated: "additional information," "medical information," "emotional support," and "supportive environment." Among patients with recurrence/metastasis, five factors were indicated: "medical information and explanation," "emotional support," "supportive environment," "additional information," and "informing family." In the group without recurrence/metastasis, a positive attitude was a significant predictor of the preference for all four factors and a lower anxiety level was a predictor of the preference for additional information. Patients who reported a high level of anxious preoccupation preferred supportive environments. In the group with recurrence/metastasis, patients who showed a high level of cognitive avoidance preferred to receive medical and additional information and emotional support.

CONCLUSIONS

Cancer patients' preferences for communication when receiving bad news differ whether recurrence/metastasis or not in South Korea. Especially, patients with recurrence/metastasis preferred a clear explanation of medical information, and physicians informing patients' families about their diagnosis and prognosis. Thus, physicians should take patients' medical and psychological characteristics into consideration when delivering the news regarding their condition.

Resilience process and its protective factors in long-term survivors after lung cancer surgery: a qualitative study

BACKGROUND

Resilience was correlated with psychological outcomes and quality of life in lung cancer patients. But the resilience process and its protective factors remained uncertain.

PURPOSE

To investigate and analyze resilience process and its protective factors in long-term survivors after lung cancer surgery.

METHODS

This qualitative study included 19 patients who had survived at least 5 years after lung cancer surgery. Colaizzi's method of phenomenology was used for data analysis.

RESULTS

Analysis of this study was divided into the resilience process and protective factors. The resilience process was summarized into three stages, including initial stress, adaptation to disease, and personal growth. Five themes were regarded contributing to their own resilience in this process, including excellent psychological qualities, good social support, regular lifestyle and exercise, participating in social activities, and Chinese medicine.

CONCLUSION

This study showed the dynamic process of resilience and its protective factors in long-term survivors after lung cancer surgery. Future studies could identify average length of time of each stage and how patients transfer between stages during resilience process. Besides, interventions could be carried out to educate patients diagnosed with cancer about normal stages of change in body and resilience through time and strategies on adaptation and adjustment of lung cancer.

Deep Learning Computer-Aided Diagnosis for Breast Lesion in Digital Mammogram

For computer-aided diagnosis (CAD), detection, segmentation, and classification from medical imagery are three key components to efficiently assist physicians for accurate diagnosis. In this chapter, a completely integrated CAD system based on deep learning is presented to diagnose breast lesions from digital X-ray mammograms involving detection, segmentation, and classification. To automatically detect breast lesions from mammograms, a regional deep learning approach called You-Only-Look-Once (YOLO) is used. To segment breast lesions, full resolution convolutional network (FrCN), a novel segmentation model of deep network, is implemented and used. Finally, three conventional deep learning models including regular feedforward CNN, ResNet-50, and InceptionResNet-V2 are separately adopted and used to classify or recognize the detected and segmented breast lesion as either benign or malignant. To evaluate the integrated CAD system for detection, segmentation, and classification, the publicly available and annotated INbreast database is used over fivefold cross-validation tests. The evaluation results of the YOLO-based detection achieved detection accuracy of 97.27%, Matthews's correlation coefficient (MCC) of 93.93%, and F1-score of 98.02%. Moreover, the results of the breast lesion segmentation via FrCN achieved an overall accuracy of 92.97%, MCC of 85.93%, Dice (F1-score) of 92.69%, and Jaccard similarity coefficient of 86.37%. The detected and segmented breast lesions are classified via CNN, ResNet-50, and InceptionResNet-V2 achieving an average overall accuracies of 88.74%, 92.56%, and 95.32%, respectively. The performance evaluation results through all stages of detection, segmentation, and classification show that the integrated CAD system outperforms the latest conventional deep learning methodologies. We conclude that our CAD system could be used to assist radiologists over all stages of detection, segmentation, and classification for diagnosis of breast lesions.

Gender Differences in Psycho-Social-Spiritual Healing

Background: Many individuals exhibit significant distress in response to serious and/or life-limiting illness. However, there are others who make life-transforming changes, which involve healing experiences in the psychological, social, and spiritual domains of life regardless of illness outcome. The aim of the present study is to determine if there are any differences in psycho-social-spiritual healing between genders.

Materials and Methods: The NIH Healing Experiences in All Life Stressors (NIH-HEALS), a 35-item measure of psycho-social-spiritual healing, is composed of three factors: Connection, Reflection & Introspection, and Trust & Acceptance. NIH-HEALS and a demographic questionnaire were administered to 193 patients with serious and/or life-limiting illness at the National Institutes of Health Clinical Center.

Results: In response to NIH-HEALS, men and women significantly differed on the Reflection & Introspection factor. Women reported increased enjoyment of mind–body practices (p < 0.001), compassion (p = 0.005), gratitude (p = 0.014), and a desire to be more positive (p = 0.044) compared to men. Men rated their pain levels (p = 0.035) and severity of illness (p = 0.016) higher and their overall level of health (p = 0.010) poorer compared to women. Women's responses to items regarding compassion (r_s = 0.37, p < 0.001) and gratitude (r_s = 0.24, p = 0.015) correlated positively with better overall health ratings.

Conclusion: Men and women show some differences in their self-reported psycho-social-spiritual healing, which may have implications when designing interventions aimed at promoting a healing experience in the context of serious and life-limiting illness.

Stress and Growth in Cancer: Mechanisms and Psychotherapeutic Interventions to Facilitate a Constructive Balance

Post-traumatic stress and growth are common responses to adverse life events such as cancer. In this article, we establish how cancer becomes a "fertile land" for the emergence of stress and growth responses and analyze the main mechanisms involved. Stress-growth responses on adjusting to cancer is potentially determined by factors like the phase of the illness (e.g., initial phases vs. period of survivorship), patient's coping strategies, meaning-making, and relationships with significant others. We also review the mechanisms of constructive and adaptative stress-growth balances in cancer to study the predictors, interrelated associations, triggering mechanisms, long-term results, and specific trajectories of these two responses to cancer. Finally, we update the evidence on the role of these stress-growth associations in psychologically adjusting to cancer. Together with this evidence, we summarize preliminary results regarding the efficacy of psychotherapeutic interventions that aim to facilitate a constructive psychological balance between stress and growth in cancer patients. Recommendations for future research and gaps in knowledge on stress-growth processes in this illness are also highlighted. Researchers are encouraged to design and use psychotherapeutic interventions according to the dynamic and changeable patients' sources of stress and growth along the illness. Relevant insights are proposed to understand the inconsistency of stress-growth literature and to promote psychotherapeutic interventions to facilitate a constructive balance between these key responses in cancer.

The long noncoding RNA HOTTIP promotes breast cancer cell migration, invasiveness, and epithelial-mesenchymal transition via the Wnt-β-catenin signaling pathway

Long noncoding RNA HOTTIP (HOXA transcript at the distal tip) has recently been reported to have a role in the proliferation of various cancer cells, yet its role in cell migration, invasiveness, and the EMT (epithelial-mesenchymal transition) in breast cancer and the potential mechanisms remain unknown. Breast cancer cell lines MDA-MB-231 and MDA-MB-468 were transfected with shRNA (short hairpin RNA) that specifically targeting HOTTIP. We observed a remarkable decrease in migration and invasiveness in these two breast cancer cell lines after knock-down of HOTTIP by shHOTTIP. We also demonstrated that the EMT of these two breast cell lines was suppressed after HOTTIP knock-down, as evidenced by increased E-cadherin levels, and decreased levels of N-cadherin, Snail, and Twist. Moreover, HOTTIP silencing also suppressed tumor metastasis in nude mice in vivo. In addition, we found that the expression of β-catenin was significantly decreased in breast cancer cells after knock-down of HOTTIP. In a further rescue experiment using overexpression of β-catenin, the rates of cell migration, invasiveness, and EMT of HOTTIP-silenced breast cancer cells were promoted, disclosing a potential role of the Wnt-β-catenin signaling pathway in this process. Overall, we discovered the positive regulatory function of HOTTIP in the migration, invasiveness, and EMT of breast cancer cells, via regulating the Wnt-β-catenin pathway.

Family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers

Walsh's family resilience theory indicated that families could foster resilient outcomes among their members when they are facing changes or crises. However, little is known about family resilience and psychological well-being among Chinese breast cancer survivors and their caregivers. Therefore, this study aimed to examine the direct and indirect relationships between family resilience, breast cancer survivors' post-traumatic growth (PTG), quality of life (QOL), and their principal caregivers' caregiver burden. A total of 108 breast cancer survivors/principal caregivers pairs completed a cross-sectional questionnaire survey in a comprehensive cancer of a public hospital in Shandong Province, China. The structural equation modelling (SEM) results showed that family resilience had direct and indirect effects on QOL and caregiver burden, and it was positively related to the PTG of the survivors. The survivors' PTG was positively related to their QOL, and their QOL was negatively associated with caregiver burden. Therefore, a better understanding of how family resilience contributes to PTG and QOL of the survivors and caregiver burden could help clinicians tailor interventions to enhance interventions aimed at improving both survivors' and caregivers' well-being.

Psychological distress, role, and identity changes in mothers following a diagnosis of cancer: A systematic review

OBJECTIVE

To systematically review findings of the impact of cancer diagnosis and treatment on mothers' psychological well-being, roles, and identity and to explore the psychosocial factors that contribute to mothers' psychological well-being.

METHODS

Six databases were searched for research articles and theses exploring the association between the impact of cancer diagnosis and treatment on mothers' psychological well-being, identity, and role, and the psychosocial factors contributing to mothers' psychological distress regardless of their cancer type and stage. The Mixed-Method Appraisal Bias Tool was used to assess the selected studies' methodological quality.

RESULTS

A total of 30 qualitative, quantitative, and mixed-method studies were deemed eligible for inclusion. Most studies reported that mothers experienced significant psychological distress, changes to or loss of parenting efficacy, maternal identity, and role. Psychosocial factors that contributed to mothers' distress included mothers' young age, presence of metastases, lower parenting efficacy, fear of cancer recurrence, higher illness intrusiveness, and lack of appropriate support. Four main themes emerged from the qualitative studies: psychological impact of cancer on mothers, changes in maternal identity and role, relationship changes and concerns for their children, and meaning-making in cancer experience.

CONCLUSIONS

Changes in mothers' psychological well-being, role, and identity occurred across cancer diagnoses, treatment, and recovery trajectories. The evidence suggests that mothers may benefit from continued and tailored psychosocial support to cope with these challenges, even after treatment is completed. Further studies with improved methodological quality are needed to explore these issues in depth.

The self-reported perceptions of the repercussions of the disease and its treatments on daily life for young women with breast cancer and their partners

PURPOSE

This study aimed to compare the self-reported perceptions of the repercussions of the disease and its treatments and emotional distress in young women with breast cancer and their partners.

DESIGN

Cross-sectional study using self-reported questionnaires.

SAMPLE

491 couples in which women were aged <45 years when diagnosed with non-metastatic breast cancer in four different groups of treatment: during chemotherapy with or without Trastuzumab; under Trastuzumab with or without hormone therapy; during hormone therapy; and during the follow-up period.

METHODS

Patients and partners completed a questionnaire assessing their self-reported perceptions of the disease and treatments (Patient YW-BCI and Partner YW-BCI for the partners) and their emotional distress (CESD; STAI).

FINDINGS

Patients reported more difficulties than partners in the management of child(ren) and everyday life, body image and sexuality, negative affectivity about the disease and apprehension about the future, career management, and finances. While the difficulties were generally more marked in the chemotherapy and Trastuzumab groups than in the hormone therapy and follow-up groups, the negative affectivity about the disease and apprehension about the future was high in all four groups, especially in patients. The partners reported more difficulties in sharing with close relatives, and even more in those groups reflecting the latest treatment phases. No difference appeared between patients and partners in couple cohesion and deterioration of relationships with relatives. Partners were less anxious than patients but as depressed as them.

CONCLUSIONS

Difficulties of patients and partners seem particularly severe in the early care pathway, maybe reflecting better adjustment in women under surveillance and their partners. A longitudinal study will substantiate this finding and enable a better identification of some explanatory processes of these differences and similarities in the daily self-reported repercussions of the disease throughout the cancer care pathway. Implications for psychosocial oncology: It seems important to support young women with breast cancer and their partners, as our results evidence distress in both and differences according to the type of treatment the woman is currently receiving. Healthcare providers need consistent methods to identify and respond to couples' distress and reduce significant disparities in support.

Predictors and interdependence of family support in a random sample of long-term young breast cancer survivors and their biological relatives

OBJECTIVE

Women diagnosed with breast cancer younger than 45 years (young breast cancer survivors-YBCS) and their biological relatives face significant stressors. Although family support is an important coping resource, little is known about YBCS' and relatives' support and whether it is interdependent. The study described family support in YBCS and their biological relatives; identified demographic, clinical, and psychosocial predictors of support; and determined the interdependence of support in YBCS-relatives family units.

METHODS

Data were collected from a random sample of YBCS and their first- or second-degree female relatives. Actor-partner interdependence models (APIM) explored predictors and interdependence of YBCS' and relatives' family support in dyads (YBCS and relative) and triads (YBCS and two relatives).

RESULTS

Among n = 310 YBCS and n = 431 first- or second-degree relatives, family support was higher in triads compared to dyads. APIMs identified actor effects in dyads, and actor and partner effects in triads. Across all family units, YBCS' higher self-efficacy was associated with higher YBCS support (actor effect) and relative support (partner effect); YBCS' prior diagnosis of depression was associated with lower YBCS and relative support (actor and partner effect); cost-related lack of access to care was associated with lower support among YBCS (actor effect) and relatives (actor and partner effect).

CONCLUSIONS

Family support was interdependent and was affected by self-efficacy, depression, and access to care. Interventions should include YBCS and relatives, enhance self-efficacy and access to care.

Positive mental health among cancer survivors: overlap in psychological well-being, personal meaning, and posttraumatic growth

Purpose

Positive mental health involves theoretical constructs like psychological well-being, personal meaning, and posttraumatic growth. This study aims to provide empirical insight into possible overlap between these constructs in cancer survivors.

Methods

Within the context of a randomized controlled trial, 170 cancer survivors completed the patient-reported outcome measures (PROMs) Ryff’s Scales of Psychological Well-Being (SPWB), Personal Meaning Profile (PMP), and Posttraumatic Growth Inventory (PTGI). Exploratory factor analysis (EFA) on the subscales of these PROMs, as well as structural equation modeling (SEM), was used to explore overlap in these three constructs.

Results

The EFA resulted in a three-factor solution with an insufficient model fit. SEM led to a model with a high estimated correlation (0.87) between SPWB and PMP and lower estimated correlations with PTGI (respectively 0.38 and 0.47). Furthermore, the estimated correlation between the subscales relation with God (PMP) and spiritual change (PTGI) was high (0.92). This model had adequate fit indices (χ²(93) = 144, p = .001, RMSEA = 0.059, CFI = 0.965, TLI = 0.955, SRMR = 0.061).

Conclusions

The constructs psychological well-being and personal meaning overlap to a large extent in cancer survivors. Posttraumatic growth can be seen as a separate construct, as well as religiosity. These findings facilitate researchers to select the appropriate PROM(s) when testing the effect of a psychosocial intervention on positive mental health in cancer survivors.

Relevance

An increasing number of psychosocial intervention trials for cancer survivors use positive mental health outcomes. These constructs are often multifaceted and overlapping. Knowledge of this overlap is important in designing trials, in order to avoid the pitfalls of multiple testing and finding artificially strengthened associations.

Netherlands Trial Register

NTR3571

Electronic supplementary material

The online version of this article (10.1007/s00520-018-4325-8) contains supplementary material, which is available to authorized users.

Staying the Course: Using Hypnosis to Help Cancer Patients Navigate Their Illness

Although sometimes maligned and often misunderstood, clinical hypnosis can be utilized as a powerful adjunct for the treatment of mind-body conditions, including cancer. Unlike customary medical regimens that treat diseases of the body and psychotherapies that address disorders of the psyche, hypnosis is a uniquely customizable multi-tool that can augment the treatment of both physical and emotional disorders as well as their complex interactions. This article presents a longitudinal, phase-oriented, clinical model that uses hypnosis in a series of sequential interventions that incorporate targeted suggestions to address the unfolding phases of the cancer continuum. Five such phases of the cancer patient's trajectory, along with their associated medical and psychological challenges, are conceptualized. Each phase is illustrated by case examples from the author's clinical practice and by a discussion of relevant hypnotic approaches. On the somatic level, the intrinsic capacities of hypnotic phenomena, paired with suggestions, can be harnessed to effect perceptual and functional changes to offer symptom relief, re-establishment of systemic homeostasis, amelioration of cellular chemistry, and the acceleration of tissue healing. In the psychological realm, hypnotic strategies can be used to provide a much needed continuity of emotional support, a sense of mastery and self-agency, emotional regulation, and behavioral change.

To be or not to be positive: Development of a tool to assess the relationship of negative, positive, and realistic thinking with psychological distress in breast cancer

There is a widespread belief that positive thinking is a key strategy to cope with cancer. While dispositional optimism is associated with lower psychological distress, the literature supporting the efficacy of cognitive-behavioral therapy indirectly suggests that realistic thinking is also effective. This article describes the development of the Thoughts and Anticipations about Cancer questionnaire designed to directly compare the effect of realistic thinking versus positive thinking on adjustment to cancer. Preliminary data on its relationships with psychological distress gathered in 10 breast cancer patients are promising. The validity of the Thoughts and Anticipations about Cancer questionnaire will need to be confirmed in larger studies.