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Langford L, Latchford G, Mulvey M. Can illness representations be used to understand pain experienced in breast cancer survivorship-a cross-sectional study. J Cancer Surviv 2024:10.1007/s11764-024-01533-2. [PMID: 38285112 DOI: 10.1007/s11764-024-01533-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Chronic pain is a recognised long-term consequence associated with breast cancer and its treatment; however, it is often underdiagnosed and undertreated. This study aims to explore the associations between illness representations, chronic cancer pain, and HRQoL in women who have survived breast cancer. DESIGN AND METHODS A cross-sectional online survey design was used. Data from 182 women who participated in the survey were analysed. RESULTS Chronic cancer pain was reported by 66% of respondents. Using the BPI-SF (score 0-10), participants were categorised into one of four pain categories: no chronic pain (BPI score 0; 34.1%), mild pain (BPI score 1-3; 35.7%), moderate pain (BPI score 4-6; 25.3%), and severe pain (BPI score 7 + ; 4.9%). The main findings were that having a strong illness identity (IPQ-R subscale which assesses the number of symptoms an individual attributes to their illness) was found to be a significant predictor of pain severity (OR 1.21 (95% CI 1.07-1.37), p = 0.003). Furthermore, HRQoL was significantly associated and predictive of pain severity (OR 0.97 (95% CI 0.95-0.99), p < 0.001). An additional finding was that not being in paid work was strongly associated with being in a higher pain category (OR 5.92 (95% CI 1.84-19.05), p = 0.003). CONCLUSIONS The findings of this study highlight the high prevalence of chronic cancer pain experienced by this population. Results show that dimensions of illness representations are associated with chronic cancer pain experienced by breast cancer survivors. Furthermore, having a strong illness identity and HRQoL were found to be independent, significant predictors of pain severity. IMPLICATIONS FOR CANCER SURVIVORS These findings demonstrate that chronic pain is an unmet clinical need experienced by breast cancer survivors, which is associated with reduced overall HRQoL. Therefore, consideration is needed regarding the assessment and management of chronic pain experienced by this population.
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Affiliation(s)
- Lewis Langford
- Clinical Neuropsychology, Salford Royal Hospital, Salford, M6 8HD, UK.
- Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Gary Latchford
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matt Mulvey
- Institute of Health Sciences, University of Leeds, Leeds, UK
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2
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Song W, Mansor NS, Shari NI, Zhang R, Abdullah MFILB. Psychometric properties of the Malay version of the Illness Cognition Questionnaire among cancer patients in Malaysia. BMC Public Health 2024; 24:173. [PMID: 38218795 PMCID: PMC10787442 DOI: 10.1186/s12889-023-17060-1] [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: 07/10/2023] [Accepted: 10/24/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE The Illness Cognition Questionnaire (ICQ) was translated from its original English version to the Malay version for this research, adapted the Malay language version of the ICQ (ICQ-M) for use in cancer patients, and assessed the internal consistency, content, face, construct, convergent, discriminant and concurrent validity of the ICQ-M among a cohort of cancer patients with mixed cancer types in Malaysia. METHOD Initially, the ICQ was translated into Malay and back-translated, and its content and face validity were evaluated. Then, 346 cancer patients with various cancer types received the ICQ-M, and its internal consistency, convergent, discriminant, construct, and concurrent validity were evaluated. RESULTS The ICQ-M and its domains had acceptable internal consistency with Cronbach's α ranging from 0.742 to 0.927. Construct validity assessment demonstrated that the ICQ-M consists of 17 items designated in two domains with good convergent and discriminant validity. The ICQ-M and its domains also had moderate correlations with the Acceptance and Action Questionnaire II, which denotes that the ICQ-M had acceptable concurrent validity. CONCLUSION The ICQ-M had good psychometric properties and is now available to measure the illness cognition of cancer patients in Malaysia.
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Affiliation(s)
- Wenjun Song
- The Second Affiliated Hospital of Xinxiang Medical University, Henan, People's Republic of China
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, 13200, Malaysia
| | - Nor Shuhada Mansor
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, 13200, Malaysia
| | - Nurul Izzah Shari
- School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities (FSSH), Universiti Teknologi Malaysia, Skudai, Johor, 81310, Malaysia
| | - Ruiling Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Henan, People's Republic of China.
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3
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Miller EM, Porter JE, Barbagallo MS. Patient and family members' experiences with language and environment when receiving bad news: A qualitative exploratory study. Palliat Support Care 2023:1-7. [PMID: 36718557 DOI: 10.1017/s1478951522001845] [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: 02/01/2023]
Abstract
OBJECTIVES Receiving bad news about one's health can be devastating, yet little is known about how the therapeutic nature of the environment where bad news is delivered affects the experience. The current study aimed to explore how patients and their families were affected by the language and the built, natural, social, and symbolic environments when receiving bad news, through the Therapeutic Landscapes theoretical framework. METHODS Patients diagnosed with a life-limiting illness living in regional Victoria who had a hospital admission within 24 months and a diagnostic/prognostic conversation were invited to participate, as well as a family member who witnessed the conversation. Participants were recruited through social media and snowballing, resulting in 14 online semi-structured interviews being conducted between November 2021 and March 2022, audio-recorded, and transcribed verbatim. Reflexive thematic analysis was used to develop the themes. RESULTS Fourteen semi-structured interviews were conducted with women aged between 30 and 77 years. Interviews lasted between 45 and 120 minutes, with an average of 69 minutes, and were conducted online or via mobile phone. Four central themes were developed: "Hearing bad news for the first time," "Preferences for having hard conversations," "Creating a sense of safety for ongoing care," and "The therapeutic nature of the ward." SIGNIFICANCE OF RESULTS This body of work will help inform practice and future policy regarding bad news delivery and the design and aesthetics of environments where bad news is delivered. It is essential that bad news is delivered within a quiet, calm, and emotionally safe environment within a supportive therapeutic relationship.
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Affiliation(s)
- Elizabeth M Miller
- Collaborative Evaluation & Research Group (CERG), Federation University Australia, Churchill, VIC, Australia
| | - Joanne E Porter
- Collaborative Evaluation & Research Group (CERG), Federation University Australia, Churchill, VIC, Australia
| | - Michael S Barbagallo
- Collaborative Evaluation & Research Group (CERG), Federation University Australia, Churchill, VIC, Australia
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4
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Jassim GA, Doherty S, Whitford DL, Khashan AS. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2023; 1:CD008729. [PMID: 36628983 PMCID: PMC9832339 DOI: 10.1002/14651858.cd008729.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015. OBJECTIVES To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer. SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes. MAIN RESULTS We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months. Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.
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Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | - Sally Doherty
- Psychiatry, Royal College of Surgeons in Ireland- Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | | | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
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The Relationship Between Neuropsychiatric Diagnoses and Revision Surgery After Breast Reconstruction. Ann Plast Surg 2022; 89:615-621. [DOI: 10.1097/sap.0000000000003268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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6
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Wieder-Huszla S, Owsianowska J, Chudecka-Głaz A, Branecka-Woźniak D, Jurczak A. The Significance of Adaptation and Coping with Disease among Patients with Diagnosed Gynaecological Cancer in the Context of Disease Acceptance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127218. [PMID: 35742468 PMCID: PMC9223192 DOI: 10.3390/ijerph19127218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 12/10/2022]
Abstract
Uterine/endometrial and ovarian tumours are among the most common gynaecological cancers. Adaptation to cancer encompasses a variety of complex behavioural, cognitive, and emotional processes. The purpose of mental adaptation is to alleviate emotional discomfort and regain mental stability. The aim of the study was to assess the influence of adaptation and coping with gynaecological cancer on the level of disease acceptance among the studied women. The study included 81 patients diagnosed with gynaecological cancer. Mental adaptation to cancer was measured using the Min-Mac scale, disease acceptance was measured using the AIS and the level of adaptation was measured using the CAPS. The average AIS score was 26.65 ± 8.85 points. Adaptation and coping methods did not vary significantly depending on the diagnosed type of cancer. The constructive style of fighting the disease prevailed (45.11 ± 6.01). The AIS scores correlated significantly and positively with the intensity of the constructive style of mental adaptation, and negatively with the intensity of the destructive style. The studied group of patients with gynaecological cancer displayed a moderate level of disease acceptance, the constructive style of adaptation was the most prevalent, and the location of the cancer did not have an effect on coping mechanisms.
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Affiliation(s)
- Sylwia Wieder-Huszla
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (J.O.); (A.J.)
- Correspondence: ; Tel.: +48-914-800-910
| | - Joanna Owsianowska
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (J.O.); (A.J.)
| | - Anita Chudecka-Głaz
- Department of Gynaecological Surgery and Gynaecological Oncology of Adults and Adolescents, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Dorota Branecka-Woźniak
- Department of Gynaecology and Reproductive Health, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland;
| | - Anna Jurczak
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (J.O.); (A.J.)
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Hillebrand LE, Söling U, Marschner N. The Significance of Patient-Reported Outcomes for Metastatic Breast Cancer Patients. Oncol Res Treat 2022; 45:423-429. [PMID: 34999590 DOI: 10.1159/000521826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Breast cancer is still the most common malignancy in women worldwide. Once metastasized, breast cancer treatment primarily aims at reducing symptom burden, thereby trying to maintain and improve a patient´s quality of life (QoL), delaying disease progression, and prolonging survival. Curing the disease is not possible in the palliative setting. To better understand metastatic breast cancer patients, their symptoms and wishes, which are important for treatment-decision making and outcome, patient-reported outcomes (PROs) are of great importance, giving an impression of what really matters to and concerns a patient. SUMMARY Many advances have been made to implicate PROs in clinical trials, non-interventional studies, registries, and clinical routine care of metastatic breast cancer. For example, large phase III trials like PALOMA-3 (NCT01942135), MONALEESA-7 (NCT02278120), HER2CLIMB (NCT02614794), and KEYNOTE-119 (NCT02555657) trials implemented PROs in their trial design to assess the QoL of their trial patients. Also, non-interventional studies on metastatic breast cancer, like e.g., the NABUCCO study (IOM-02240), and prospective non-interventional, multicenter registries e.g., the tumor registry breast cancer (NCT01351584) or the breast cancer registry platform OPAL (NCT03417115), have implemented PROs to assess QoL during the anti-cancer treatment periods of the patients. Key Message: Using PROs in metastatic breast cancer can support shared treatment-decision making and management of symptoms, eventually leading to an improvement in QoL. Progressively, regulatory authorities take PROs into consideration for the approval of new drugs. Hence, the implication of PROs in cancer treatment, and especially in MBC, is of significant value.
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Affiliation(s)
| | | | - Norbert Marschner
- Praxis für Interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany
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8
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The indirect effect of body image on distress in women with breast cancer undergoing chemotherapy. HEALTH PSYCHOLOGY REPORT 2022. [DOI: 10.5114/hpr.2022.113381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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9
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Restivo L, Apostolidis T, Julian-Reynier C. Les représentations de la maladie : choix des outils de mesure et applications dans le champ du cancer. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : Dresser un bilan des outils quantitatifs disponibles pour mesurer les représentations de la maladie et analyser leur utilisation empirique auprès de patients atteints de cancer.
Matériel et méthodes : Revue de la littérature.
Résultats : Sept outils de mesure des représentations de la maladie existent dont un spécifique au cancer. L’Illness Perception Questionnaire est utilisé dans 29 des 33 études retenues.
Conclusion : Associer ces échelles avec des méthodes reposant sur des approches davantage centrées sur le contexte socioculturel semble à privilégier.
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10
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Park SK, Min YH, Lee SB. Longitudinal Trends in Illness Perception and Depression during Adjuvant Breast Cancer Endocrine Therapy: A Prospective Observational Study. Healthcare (Basel) 2021; 9:healthcare9091223. [PMID: 34574995 PMCID: PMC8471043 DOI: 10.3390/healthcare9091223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 12/09/2022] Open
Abstract
This study aimed to identify the changes in the illness perceptions and depression of women with breast cancer, undergoing AET, at three time points (i.e., before initiating AET, 3 months follow-up, and 12 months follow-up). We investigated the interaction effects of their demographic and clinical characteristics on illness perception changes over time. Furthermore, factors including the patient’s characteristics and illness perceptions associated with depressive symptoms 1 year after starting AET were explored. Illness perception and depressive symptoms were assessed with the brief illness perception questionnaire and the Center for Epidemiologic Studies Depression Scale, in a prospective study of 150 women. The changes in illness perceptions and depression between the three time points were analyzed using repeated measures ANOVA. The factors associated with depressive symptoms were identified using regression analysis. Illness perception improved overall over the 12 months. However, more patients perceived their illness as chronic, experienced more symptoms, and developed negative beliefs that treatment could not control their disease. Patients’ depressive symptoms decreased significantly. Depression at the baseline, cancer stage, and the perception of personal control were highly associated with depression after 12 months. These findings suggest that healthcare providers should offer appropriate interventions to patients, for managing symptoms, having a positive belief that treatment can control their disease, and preventing long-term depressive symptoms.
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Affiliation(s)
- Seul Ki Park
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea;
| | - Yul Ha Min
- College of Nursing, Kangwon National University, Chuncheon-si 24341, Korea
- Correspondence: ; Tel.: +82-33-250-8876
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea;
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Personality Traits and Health-Related Quality of Life in Irritable Bowel Syndrome (IBS) Patients: The Mediating Role of Illness Perceptions. PSYCHOLOGICAL STUDIES 2021. [DOI: 10.1007/s12646-021-00618-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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12
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Rattel JA, Miedl SF, Liedlgruber M, Blechert J, Seidl E, Wilhelm FH. Sensation seeking and neuroticism in fear conditioning and extinction: The role of avoidance behaviour. Behav Res Ther 2020; 135:103761. [PMID: 33186828 DOI: 10.1016/j.brat.2020.103761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 09/15/2020] [Accepted: 10/23/2020] [Indexed: 12/26/2022]
Abstract
Maladaptive avoidance behaviour, a key symptom of anxiety-related disorders, prevents extinction learning and maintains anxiety. Individual personality traits likely influence avoidance propensity: high sensation-seeking may decrease avoidance, thereby increasing extinction, and neuroticism may have the reverse effect. However, research on this is scarce. Using a naturalistic conditioned avoidance paradigm, 163 women underwent differential fear acquisition to a conditioned stimulus (CSplus). Next, during extinction, participants could either choose a risky shortcut, anticipating shock signalled by CSplus, or a time-consuming avoidance option (lengthy detour). Across participants, increased skin conductance (SCR) acquisition learning predicted subsequent instrumental avoidance. Avoidance, in turn, predicted elevated post-extinction SCR and shock-expectancy, i.e., 'protection-from-extinction'. Mediation analyses revealed that sensation seeking decreased protection-from-extinction-both for shock-expectancy and SCR-via attenuating avoidance. Neither sensation seeking nor neuroticism were related to acquisition learning and neuroticism was neither related to avoidance nor extinction. Transcranial direct currentstimulation administered before extinction did not influence present results. Results highlight the important role of elevated avoidance propensity in fear maintenance. Results moreover provide evidence for reduced sensation-seeking and increased acquisition learning to be avoidance-driving mechanisms. Since approach-avoidance conflicts are faced by anxiety patients on a daily basis, strengthening sensation-seeking-congruent attitudes and approach behaviours may optimize individualized treatment.
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Affiliation(s)
- Julina A Rattel
- Division of Clinical Psychology and Psychopathology, University of Salzburg, Salzburg, Austria.
| | - Stephan F Miedl
- Division of Clinical Psychology and Psychopathology, University of Salzburg, Salzburg, Austria
| | - Michael Liedlgruber
- Division of Clinical Psychology and Psychopathology, University of Salzburg, Salzburg, Austria
| | - Jens Blechert
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria; Division of Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Esther Seidl
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Frank H Wilhelm
- Division of Clinical Psychology and Psychopathology, University of Salzburg, Salzburg, Austria
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Voute M, Morel V, Joly D, Villatte C, Martin E, Durando X, Pereira B, Pickering G. Predicting Pain Trajectories in the One Year Following Breast Cancer Diagnosis-An Observational Study. J Clin Med 2020; 9:E1907. [PMID: 32570868 PMCID: PMC7356308 DOI: 10.3390/jcm9061907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
The impact of psychosocial vulnerability on pain in the year following breast cancer diagnosis has been little studied. To identify a score of psychosocial vulnerability (cognitive, emotional, quality of life and precariousness parameters) as a predictor of a pain trajectory, we conducted an observational prospective study and included women with newly diagnosed breast cancer. One year follow-up with 3 visits (day of breast cancer diagnosis; 6 and 12 months) aimed to identify distinct pain-time trajectories. Baseline psychosocial vulnerability was characterized by z-score transformation, a higher score representing a more vulnerable patient. A total of 89 patients were included (59.3 ± 10.7 years). Two trajectories of pain were identified-"Transient Pain trajectory" (TP) (39/89 patients) and "Persistent Pain trajectory" (PP) (50/89). A significant difference of pain over time between trajectories (PP vs. TP at 6 months: 2.23 ± 0.23 vs. 0.27 ± 0.09, p < 0.001) was observed. Psychosocial vulnerability showed a large effect size (d, -0.82; 95% CI, -1.25 to -0.38; p < 0.001) and a higher score in "Persistent pain trajectory" (PP vs. TP: 0.12 ± 0.36 vs. -0.14 ± 0.26, p < 0.001). A predictive vulnerability marker of pain development is proposed and could be used at cancer diagnosis to orientate the care pathway of patients experiencing breast cancer.
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Affiliation(s)
- Marion Voute
- CHU Clermont-Ferrand, Inserm, Centre d’Investigation Clinique, CIC Inserm 1405, F-63000 Clermont–Ferrand, France; (M.V.); (V.M.); (E.M.)
| | - Véronique Morel
- CHU Clermont-Ferrand, Inserm, Centre d’Investigation Clinique, CIC Inserm 1405, F-63000 Clermont–Ferrand, France; (M.V.); (V.M.); (E.M.)
| | - Dominique Joly
- CHU Clermont-Ferrand, Centre Jean Perrin, Centre de Lutte contre le Cancer, F-63003 Clermont-Ferrand, France; (D.J.); (C.V.)
| | - Christine Villatte
- CHU Clermont-Ferrand, Centre Jean Perrin, Centre de Lutte contre le Cancer, F-63003 Clermont-Ferrand, France; (D.J.); (C.V.)
| | - Elodie Martin
- CHU Clermont-Ferrand, Inserm, Centre d’Investigation Clinique, CIC Inserm 1405, F-63000 Clermont–Ferrand, France; (M.V.); (V.M.); (E.M.)
| | - Xavier Durando
- Division de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre de Lutte contre le Cancer, Centre Jean Perrin, F-63003 Clermont-Ferrand, France;
| | - Bruno Pereira
- CHU de Clermont-Ferrand, Délégation Recherche Clinique & Innovation, 58 Rue Montalembert, F-63003 Clermont-Ferrand, France;
| | - Gisèle Pickering
- CHU Clermont-Ferrand, Inserm, Centre d’Investigation Clinique, CIC Inserm 1405, F-63000 Clermont–Ferrand, France; (M.V.); (V.M.); (E.M.)
- Université Clermont Auvergne, Inserm, Neuro-Dol, F-63000 Clermont-Ferrand, France
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14
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Fernández de Larrea-Baz N, Pérez-Gómez B, Guerrero-Zotano Á, Casas AM, Bermejo B, Baena-Cañada JM, Antolin S, Sánchez-Rovira P, Ramos Vázquez M, Garcia-Sáenz JÁ, Antón A, Muñoz M, de Juan A, Jara C, Chacón JI, Arcusa A, Gil-Gil M, Adrover E, Oltra A, Brunet J, González S, Bezares S, Lope V, Martín M, Pollán M. Primary breast cancer and health related quality of life in Spanish women: The EpiGEICAM case-control study. Sci Rep 2020; 10:7741. [PMID: 32385335 PMCID: PMC7211017 DOI: 10.1038/s41598-020-63637-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/02/2020] [Indexed: 01/06/2023] Open
Abstract
This study evaluates the impact of breast cancer (BC) in health related quality of life (HRQL) and in psychological distress (PD) during the initial phases of the disease and looks for contributing factors. A multicentric case-control study, EpiGEICAM, was carried out. Incident BC cases and age- and residence- matched controls were included. Clinical, epidemiological, HRQL (SF-36) and PD information (GHQ-28) was collected. We used multivariable logistic regression models to estimate OR of low HRQL and of PD in cases compared to controls, and to identify factors associated with low HRQL and with PD. Among 896 BC cases and 890 control women, cases had poorer scores than both, the reference population and the control group, in all SF-36 scales. BC women with lower education, younger, active workers, never smokers, those with comorbidities, in stage IV and with surgical treatment had lower physical HRQL; factors associated with low mental HRQL were dissatisfaction with social support, being current smoker and having children. Cases had a fivefold increased odds of PD compared to controls. Managing comorbidities and trying to promote social support, especially in younger and less educated women, could improve well-being of BC patients.
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Affiliation(s)
- Nerea Fernández de Larrea-Baz
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), C/Monforte de Lemos, 5, 28029, Madrid, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), C/Monforte de Lemos, 5, 28029, Madrid, Spain.
| | - Beatriz Pérez-Gómez
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), C/Monforte de Lemos, 5, 28029, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), C/Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Ángel Guerrero-Zotano
- Medical Oncology Unit, Instituto Valenciano de Oncología, C/Beltrán Báguena, 8, 46009, Valencia, Spain
| | - Ana María Casas
- Medical Oncology Unit, Hospital Virgen del Rocío, Avenida de Manuel Siurot s/n, 41013, Sevilla, Spain
| | - Begoña Bermejo
- Medical Oncology Unit, Hospital Clínico / INCLIVA, Avenida Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - José Manuel Baena-Cañada
- Medical Oncology Unit, Hospital Universitario Puerta del Mar, Avenida Ana de Viya, 21, 11009, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz/Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Silvia Antolin
- Medical Oncology Unit, Complejo Hospitalario Universitario A Coruña, Jubias de Arriba, 84, 15006, A Coruña, Spain
| | - Pedro Sánchez-Rovira
- Medical Oncology Unit, Complejo Hospitalario de Jaén, Avenida del Ejército Español, 10, 23007, Jaén, Spain
| | - Manuel Ramos Vázquez
- Medical Oncology Unit, Centro Oncológico de Galicia, Doctor Camilo Veiras, 1, 15009, A Coruña, Spain
| | - José Ángel Garcia-Sáenz
- Medical Oncology Unit, Hospital Clínico Universitario San Carlos, Profesor Martín Lagos, S/N, 28040, Madrid, Spain
| | - Antonio Antón
- Medical Oncology Unit, Hospital Universitario Miguel Servet, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain
| | - Montserrat Muñoz
- Medical Oncology Unit, Hospital Clinic i Provincial, C/Villarroel, 170, 08036, Barcelona, Spain
- Translational Genomics and Targeted Therapeutics, Institut d'Investigacions Biomèdiques Pi i Sunyer-IDIBAPS, Barcelona, Spain
| | - Ana de Juan
- Medical Oncology Unit, Hospital Marqués de Valdecilla, Avenida Valdecilla, 25, 39008, Santander, Spain
| | - Carlos Jara
- Medical Oncology Unit, Hospital Universitario Fundación Alcorcón-Universidad Rey Juan Carlos, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain
| | - José Ignacio Chacón
- Medical Oncology Unit, Hospital Virgen de la Salud, Avenida Barber, 30, 45004, Toledo, Spain
| | - Angels Arcusa
- Medical Oncology Unit, Consorci Sanitari de Terrassa, Carretera Torrebonica, S/N, 08227, Terrassa, Spain
| | - Miguel Gil-Gil
- Medical Oncology Unit, Instituto Catalán de Oncología, Avenida Granvia de l'Hospitalet, 199-203, 08908, L'Hospitalet de Llobregat, Spain
| | - Encarna Adrover
- Medical Oncology Unit, Hospital General de Alicante/Complejo Hospitalario Universitario de Albacete, C/Pintor Baeza, 12, 03010, Alicante, Spain
| | - Amparo Oltra
- Medical Oncology Unit, Hospital Virgen de los Lirios, Polígono de Caramanchel, S/N, 03804, Alcoy, Alicante, Spain
| | - Joan Brunet
- Medical Oncology Unit, Instituto Catalán de Oncología, Avenida de França, S/N, 17007, Girona, Spain
| | - Sonia González
- Medical Oncology Unit, Hospital Mutua Terrassa, Plaça Dr. Robert, 5, 08221, Terrassa, Spain
| | - Susana Bezares
- GEICAM Spanish Breast Cancer Group, Avenida de los Pirineos, 7, 28703, San Sebastián de los Reyes, Madrid, Spain
| | - Virginia Lope
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), C/Monforte de Lemos, 5, 28029, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), C/Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Miguel Martín
- Medical Oncology Unit, Instituto de Investigación Sanitaria Gregorio Marañón, C/Doctor Esquerdo, 46, 28007, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
- Consortium for Biomedical Research in Oncology (CIBERONC-ISCIII), Madrid, Spain
| | - Marina Pollán
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), C/Monforte de Lemos, 5, 28029, Madrid, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), C/Monforte de Lemos, 5, 28029, Madrid, Spain.
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Predictors of Returning to Work after Receiving Specialized Psycho-Oncological Care. HEALTH PSYCHOLOGY BULLETIN 2020. [DOI: 10.5334/hpb.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Faye-Schjøll HH, Schou-Bredal I. Pessimism predicts anxiety and depression in breast cancer survivors: A 5-year follow-up study. Psychooncology 2019; 28:1314-1320. [PMID: 30950120 DOI: 10.1002/pon.5084] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/27/2019] [Accepted: 03/28/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We investigated the prevalence of anxiety and depression at diagnosis and at 1, 3, and 5 years after breast cancer diagnosis. We hypothesized that a low level of optimism (pessimism) at diagnosis could predict change in anxiety and depression 5 years later. METHODS Three hundred sixty-seven women with operable breast cancer were included, and data were collected at all five-time points for 293 of these. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Dispositional optimism/pessimism was measured using the Life Orientation Test-Revised (LOT-R). Frequency analysis was used to determine the prevalence of anxiety and depression. Logistic regression was used to examine dispositional optimism/pessimism as a predictor of change in anxiety and depression 5 years after diagnosis. RESULTS The prevalence rates of anxiety and depression 5 years after diagnosis were 26.3% and 9.6%, respectively. Predictors of change in anxiety 5 years after diagnosis were pessimism (odds ratio [OR] = 0.82; 95% confidence interval [CI]: 0.76-0.89, P < .001); younger age (OR = 0.96; 95% CI: 0.93-0.99, P = .005); and anxiety at diagnosis (OR = 2.41; 95% CI: 1.33-4.37, P = .004). Predictors of change in depression 5 years after diagnosis were pessimism (OR = 0.84; 95% CI: 0.77-0.94, P < .001) and comorbidity (OR = 1.51, 95% CI: 1.10-2.06, P = 0.01). CONCLUSION Anxiety and depression did not decrease after the first postoperative year. Pessimism was a predictor of change in both anxiety and depression 5 years after breast cancer diagnosis.
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Affiliation(s)
| | - Inger Schou-Bredal
- Department of Cancer, Oslo University Hospital, Oslo, Norway.,Institute for Health and Science, University of Oslo, Oslo, Norway
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17
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Optimism outweighs neuroticism and anxiety sensitivity to predict insomnia symptoms in women after surgery for breast cancer. Support Care Cancer 2018; 27:2903-2909. [PMID: 30560420 DOI: 10.1007/s00520-018-4610-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/11/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Insomnia symptoms are common among women who have undergone surgery for breast cancer. Personality traits are also believed to have an impact on sleep. However, there are no reports to address the effects of personality traits on sleep in women with breast cancer. This study examined the separate and competing roles of neuroticism, anxiety sensitivity, and optimism in predicting post-surgery insomnia symptoms. METHODS Women with breast cancer (n = 749) were enrolled the week prior to surgery and required to complete a demographic questionnaire, the Chinese version of Neuroticism subscale of NEO-Five Factor Inventory (CV-N-NEO-FFI), Anxiety Sensitivity Index-3 (CV-ASI-3), and Life Orientation Test-Revised (CV-LOT-R). Four weeks post-surgery, the Chinese version of Insomnia Severity Index (CV-ISI) was administered to evaluate insomnia symptoms. RESULTS Neuroticism (β = 0.317, p < 0.001), anxiety sensitivity (β = 0.220, p < 0.001), and optimism (β = - 0.332, p < 0.001) could predict post-surgery insomnia symptoms. When putting them together into one stepwise regression, optimism (β = - 0.215, p < 0.001) became the statistically most important predictor for insomnia symptoms. Optimism suppressed the predictions of insomnia symptoms provided by neuroticism (β = 0.114, p < 0.001) and anxiety sensitivity (β = 0.079, p < 0.001). CONCLUSION Neuroticism and anxiety sensitivity positively predicted insomnia, but optimism negatively predicted insomnia. In particular, optimism plays a more important role in post-surgery insomnia symptoms in women with breast cancer compared to neuroticism and anxiety sensitivity. Sleep intervention in women with breast cancer should focus on enhancing their optimism level.
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18
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Kant J, Czisch A, Schott S, Siewerdt-Werner D, Birkenfeld F, Keller M. Identifying and predicting distinct distress trajectories following a breast cancer diagnosis - from treatment into early survival. J Psychosom Res 2018; 115:6-13. [PMID: 30470319 DOI: 10.1016/j.jpsychores.2018.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/29/2018] [Accepted: 09/29/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Most longitudinal studies on distress in breast cancer (BC) patients reported a continuous decrease after diagnosis, however masking individual variations in patterns of adjustment. We sought to identify distinct trajectories of distress during primary treatment into survivorship and to identify variables that are determinants of which patient follows which type of adjustment trajectory. METHODS Psychological distress was measured at four significant time points (after surgery/biopsy, at treatment completion, two and six months thereafter) among 181 newly diagnosed BC patients. A latent growth mixture modeling approach was used to identify distinct distress trajectories. RESULTS Four distress trajectories were identified: a 'resilient' pattern (73.1%), a 'high-remitting' (7.7%) trajectory, a 'delayed' increase in distress (7.9%), and a constantly high 'chronic' distress (11.3%) pattern. High perceived burden from physical symptoms at treatment completion encompassed a higher chance for the 'high-remitting' and 'chronic' distress trajectory. High self-efficacy at baseline increased chances for the 'high-remitting' pattern. Neither type of treatment, demographic or medical characteristics, nor baseline distress reliably predicted distress trajectories. CONCLUSION The majority of BC patients adjust well through a demanding treatment period. High patient-perceived burden from physical symptoms, and high coping self-efficacy is suggesting a transient, self-limiting distress trajectory, while patients experiencing constant 'chronic' distress, and those developing distress following treatment completion only cannot be identified by a single, initial assessment. Only systematic tracking with repeated measurement extending into survivorship can eliminate this problem. Interventions should aim at reducing the impact of symptom burden on women's every-day life and on strengthening coping-self efficacy.
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Affiliation(s)
- Janina Kant
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Hospital Ludwigsburg, Germany.
| | - Agnieszka Czisch
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany.
| | - Sarah Schott
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Germany.
| | - Daniela Siewerdt-Werner
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Hospital Ludwigsburg, Germany.
| | - Frauke Birkenfeld
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Hospital Ludwigsburg, Germany.
| | - Monika Keller
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany.
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19
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Villani D, Cognetta C, Repetto C, Serino S, Toniolo D, Scanzi F, Riva G. Promoting Emotional Well-Being in Older Breast Cancer Patients: Results From an eHealth Intervention. Front Psychol 2018; 9:2279. [PMID: 30538650 PMCID: PMC6277478 DOI: 10.3389/fpsyg.2018.02279] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/01/2018] [Indexed: 12/21/2022] Open
Abstract
Breast cancer is the most common cancer in women worldwide, with increases in diagnoses at all ages. Due to several age-related factors, older breast cancer patients show particular difficulties in adjusting to breast cancer and its related treatments. One consistent indicator of vulnerability to long-term complications is emotional distress occurring within 3 months of diagnosis. Thus, it is critical to develop early interventions specifically aimed at mitigating distress and promoting emotional wellbeing in older breast cancer patients. By taking advantage of the opportunities of online interventions, the present study aimed to test the efficacy of a 2 weeks e-health stress inoculation training (SIT) intervention on emotion regulation and cancer-related well-being, compared with a control group without such intervention. Twenty-nine women with a diagnosis of breast cancer, who had received radical surgery and who were suitable candidates for adjuvant chemotherapy with anthracyclines and taxanes (mean age = 62.76; SD = 6.19) voluntarily took part in the current study after giving written informed consent. To test intervention efficacy, self-report questionnaires were administered to all participants at baseline, at the end of the 2 weeks intervention, and 3 months after the end of the intervention. Results showed that after 2 weeks of ehealth intervention, patients did not achieve significant change, however, they significantly reduced emotional suppression and increased cancer-related emotional well-being 3 months after the end of the intervention. Furthermore, by monitoring at a distance the emotional experience during the online intervention, we found an increase in relaxation and a reduction of anxiety. Finally, patients in the experimental group reported a good level of acceptance of the ehealth intervention. To conclude, designing and developing eHealth interventions as part of the regular care path for breast cancer patients of all ages represents both a challenge and an opportunity; in particular, online interventions can be an important step in universal psychosocial care within a tiered model of care.
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Affiliation(s)
- Daniela Villani
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Chiara Cognetta
- Department of Medical Oncology, G.Salvini ASST Rhodense, Milan, Italy
| | - Claudia Repetto
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Silvia Serino
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
| | - Davide Toniolo
- Department of Medical Oncology, G.Salvini ASST Rhodense, Milan, Italy
| | - Francesco Scanzi
- U.O. Oncologia Medica, Ospedale S. Giuseppe-Multimedica, Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
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20
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de Rooij BH, Thong MS, van Roij J, Bonhof CS, Husson O, Ezendam NPM. Optimistic, realistic, and pessimistic illness perceptions; quality of life; and survival among 2457 cancer survivors: the population-based PROFILES registry. Cancer 2018; 124:3609-3617. [DOI: 10.1002/cncr.31634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Belle H. de Rooij
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology; Tilburg University; Tilburg the Netherlands
- The Netherlands Comprehensive Cancer Organisation; Utrecht the Netherlands
| | - Melissa S.Y. Thong
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam, Amsterdam Public Health Research Institute; Amsterdam the Netherlands
| | - Janneke van Roij
- The Netherlands Comprehensive Cancer Organisation; Utrecht the Netherlands
| | - Cynthia S. Bonhof
- The Netherlands Comprehensive Cancer Organisation; Utrecht the Netherlands
| | - Olga Husson
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust; London United Kingdom
| | - Nicole P. M. Ezendam
- Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology; Tilburg University; Tilburg the Netherlands
- The Netherlands Comprehensive Cancer Organisation; Utrecht the Netherlands
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21
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Norris CJ, Leaf PT, Fenn KM. Negativity bias in false memory: moderation by neuroticism after a delay. Cogn Emot 2018; 33:737-753. [PMID: 29986626 DOI: 10.1080/02699931.2018.1496068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The negativity bias is the tendency for individuals to give greater weight, and often exhibit more rapid and extreme responses, to negative than positive information. Using the Deese-Roediger-McDermott illusory memory paradigm, the current study sought to examine how the negativity bias might affect both correct recognition for negative and positive words and false recognition for associated critical lures, as well as how trait neuroticism might moderate these effects. In two experiments, participants studied lists of words composed of semantic associates of an unpresented word (the critical lure). Half of the lists were comprised of positive words and half were comprised of negative words. As expected, individuals remembered negative list words better than positive list words, consistent with a negativity bias in correct recognition. When tested immediately (Experiment 1), individuals also exhibited greater false memory for negative versus positive critical lures. When tested after a 24-hr delay (Experiment 2), individuals higher in neuroticism maintained greater false memory for negative versus positive critical lures, but those lower in neuroticism showed no difference in false memory between negative and positive critical lures. Possible mechanisms and implications for mental health disorders are discussed.
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Affiliation(s)
| | - Paula T Leaf
- b Department of Psychology , Michigan State University , East Lansing , MI , USA
| | - Kimberly M Fenn
- b Department of Psychology , Michigan State University , East Lansing , MI , USA
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22
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Survivorship care plans have a negative impact on long-term quality of life and anxiety through more threatening illness perceptions in gynecological cancer patients: the ROGY care trial. Qual Life Res 2018; 27:1533-1544. [PMID: 29511906 PMCID: PMC5951872 DOI: 10.1007/s11136-018-1825-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 11/29/2022]
Abstract
Purpose Prior results from the registration system oncological gynecology (ROGY) care trial showed that survivorship care plans (SCPs) increased threatening illness perceptions in gynecological cancer survivors, but it remained unclear whether this would result in poorer physical and psychosocial outcomes. The aim of the current study is to assess the direct and indirect effects of SCPs on health-related quality of life (HRQoL) and anxiety and depression, through illness perceptions. Methods Twelve hospitals in the South of the Netherlands were randomized to providing ‘SCP care’ or ‘usual care.’ Newly diagnosed endometrial and ovarian cancer patients completed questionnaires after initial treatment (endometrial, 221 [75%]; ovarian, 174 [71%]) and after 6, 12, and 24 months. SCPs were automatically generated after initial treatment by the oncology providers through the web-based ROGY. Illness perceptions were measured after initial treatment and HRQoL and anxiety and depression after 6, 12, and 24 months. Results Structural equation models showed that endometrial cancer patients who experienced more symptoms or concern due to the SCP reported worse social functioning (β = − 0.82; p = 0.01) and more fatigue, insomnia, pain, and anxiety (β = 0.58–0.86, p < 0.05) within 12 months after treatment. Ovarian cancer patients who had lower trust that the treatment would cure their disease due to the SCP reported worse emotional functioning 6 months after treatment (β = 0.27, p = 0.02). Conclusions Current results show that SCPs may have negative effects on HRQoL and anxiety in patients who experience more threatening illness perceptions due to the SCP. We should be aware of the potential negative consequences of SCPs. Trial Registration clinicaltrials.gov Identifier: NCT01185626.
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23
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Cook SA, Salmon P, Hayes G, Byrne A, Fisher PL. Predictors of emotional distress a year or more after diagnosis of cancer: A systematic review of the literature. Psychooncology 2018; 27:791-801. [PMID: 29318702 PMCID: PMC5873392 DOI: 10.1002/pon.4601] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 10/27/2017] [Accepted: 11/23/2017] [Indexed: 11/12/2022]
Abstract
Objective Why some people recover emotionally after diagnosis and treatment of cancer and others do not is poorly understood. To identify factors around the time of diagnosis that predict longer‐term distress is a necessary step in developing interventions to reduce patients' vulnerability. This review identified the demographic, clinical, social, and psychological factors available at or within 3 months of diagnosis that are reliable predictors of emotional distress at least 12 months later. Methods A systematic search of literature for prospective studies addressing our research question and predicting a range of distress outcomes was conducted. Thirty‐nine papers (reporting 36 studies) were subjected to narrative synthesis of the evidence. Results There was no consistent evidence that demographic, clinical, or social factors reliably predicted longer‐term distress. Of the psychological factors examined, only baseline distress (significant in 26 of 30 relevant papers; 24 of 28 studies) and neuroticism (significant in all 5 papers/studies that examined it) consistently predicted longer‐term distress. The heterogeneity of included studies, particularly in populations studied and methodology, precluded meta‐analytic techniques. Conclusions This review supports current clinical guidance advising early assessment of distress as a marker of vulnerability to persistent problems. Additionally, neuroticism is also indicated as a useful marker of vulnerability. However, the review also highlights that more sophisticated research designs, capable of identifying the psychological processes that underlie the association between these marker variables and persistent distress, are needed before more effective early interventions can be developed.
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Affiliation(s)
- Sharon A Cook
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Peter Salmon
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Gemma Hayes
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Angela Byrne
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Peter L Fisher
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.,Nidaros DPS, Østmarka University Hospital, Trondheim, Norway
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24
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Shim EJ, Lee JW, Min YH. Does depression decrease the moderating effect of self-efficacy in the relationship between illness perception and fear of progression in breast cancer? Psychooncology 2017; 27:539-547. [DOI: 10.1002/pon.4532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Eun-Jung Shim
- Department of Psychology; Pusan National University; Busan Korea
| | - Jong Won Lee
- Department of Surgery; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Yul Ha Min
- College of Nursing; University of Gachon; Incheon Korea
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25
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Kang KD, Bae S, Kim HJ, Hwang IG, Kim SM, Han DH. The Relationship between Physical Activity Intensity and Mental Health Status in Patients with Breast Cancer. J Korean Med Sci 2017; 32:1345-1350. [PMID: 28665072 PMCID: PMC5494335 DOI: 10.3346/jkms.2017.32.8.1345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 05/13/2017] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to investigate the correlation between physical activity (PA) level and mental health status in a population-based sample of Korean female patients with breast cancer. Our analysis included 76 patients with breast cancer and 44 healthy controls. The Korean versions of the International Physical Activity Questionnaire (IPAQ), Beck Depressive Inventory (BDI), State-Trait Anxiety Inventory-KY (STAI-KY), and Somatosensory Amplification Scale (SSAS), and Quality of Life (QOL) scale were assessed. The frequency of moderate PA level in breast cancer patients was significantly lower than that of healthy control subjects (t = -2.6; P = 0.011). In turn, the incidence of low PA level in breast cancer patients was significantly higher than that observed in healthy controls (t = 2.85; P = 0.005). A moderate PA level was inversely correlated with BDI score (r = -0.35; P = 0.008) and was positively correlated with QOL score (r = 0.38; P = 0.011). A low level of PA was inversely correlated with SSAS score (r = -0.39; P < 0.001). In healthy controls, a high level of PA was positively correlated with QOL score (r = 0.50; P = 0.043). Moderate PA level was inversely correlated with SSAS score (r = -0.59; P < 0.001). A low level of PA was also positively correlated with BDI score (r = 0.35; P = 0.008). A moderate or low intensity of PA was inversely correlated with depression and somatosensory amplification and was positively correlated with QOL in breast cancer patients. Finally, we suggest that progressively low-to-moderate levels of PA can be well adapted to positively impact several measures of mental health.
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Affiliation(s)
- Kyoung Doo Kang
- Department of Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sujin Bae
- Department of Industry Academic Cooperation Foundation, Chung-Ang University, Seoul, Korea
| | - Hee Jun Kim
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Korea
| | - In Gyu Hwang
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Korea
| | - Sun Mi Kim
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, Seoul, Korea.
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26
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Fischer MJ, Inoue K, Matsuda A, Kroep JR, Nagai S, Tozuka K, Momiyama M, Weijl NI, Langemeijer-Bosman D, Ramai SRS, Nortier JWR, Putter H, Yamaoka K, Kubota K, Kobayashi K, Kaptein AA. Cross-cultural comparison of breast cancer patients' Quality of Life in the Netherlands and Japan. Breast Cancer Res Treat 2017; 166:459-471. [PMID: 28762012 PMCID: PMC5668344 DOI: 10.1007/s10549-017-4417-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022]
Abstract
Purpose Cultural differences are hypothesized to influence patients’ Quality of Life (QoL) reports. However, there is a lack of empirical cross-cultural studies comparing QoL of patients with cancer. This study aims to compare QoL of women with breast cancer in the Netherlands and Japan, and to investigate the association of QoL with sociodemographic, clinical, and psychological variables (illness perceptions). Methods Dutch (n = 116) and Japanese (n = 148) women with early breast cancer undergoing chemotherapy completed the EORTC QLQ-C30 and Brief Illness Perception Questionnaire immediately before their second cycle of chemotherapy. Results Dutch women reported poorer Physical, Role, Emotional, and Cognitive functioning than Japanese women. Additionally, illness perceptions were significantly different in Japan and the Netherlands, but these did not vary across treatment type. In Japan, QoL of women receiving AC-chemotherapy was better than that of women receiving FEC-chemotherapy, whereas in the Netherlands, QoL did not vary as a function of chemotherapy. Illness perceptions about symptom severity, adverse consequences, and emotional representations were negatively related to most domains of patients’ QoL in both countries. Adding illness perceptions as covariates to the ANOVA analyses rendered the effects of country and treatment type on QoL non-significant. Conclusions Comparing Dutch and Japanese women with early breast cancer revealed important differences in treatment modalities and illness perceptions which both appear to influence QoL. Perceptions about cancer have been found to vary across cultures, and our study suggests that these perceptions should be considered when performing cross-cultural studies focusing on patient-reported outcomes.
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Affiliation(s)
- M J Fischer
- Department of Medical Oncology, Leiden University Medical Center, 2300 RC Leiden, P.O. Box 9600, Leiden, The Netherlands.
| | - K Inoue
- Division of Breast Oncology, Saitama Cancer Center, Saitama, Japan
| | - A Matsuda
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, 2300 RC Leiden, P.O. Box 9600, Leiden, The Netherlands
| | - S Nagai
- Division of Breast Oncology, Saitama Cancer Center, Saitama, Japan
| | - K Tozuka
- Division of Breast Oncology, Saitama Cancer Center, Saitama, Japan
| | - M Momiyama
- Division of Breast Oncology, Saitama Cancer Center, Saitama, Japan
| | - N I Weijl
- Department of Medical Oncology, Medical Center Haaglanden, The Hague, The Netherlands
| | - D Langemeijer-Bosman
- Department of Medical Oncology, Medical Center Haaglanden, The Hague, The Netherlands
| | - S R S Ramai
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - J W R Nortier
- Department of Medical Oncology, Leiden University Medical Center, 2300 RC Leiden, P.O. Box 9600, Leiden, The Netherlands
| | - H Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - K Yamaoka
- Graduate School of Public Health, Teikyo University, Saitama, Japan
| | - K Kubota
- Department of Pulmonary Medicine and Oncology, Nippon Medical School, Saitama, Japan
| | - K Kobayashi
- Department of Respiratory Medicine, Saitama International Medical Center, Saitama, Japan
| | - A A Kaptein
- Unit of Psychology, Leiden University Medical Center, Leiden, The Netherlands
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Do Cancer-Related Beliefs Influence the Severity, Incidence, and Persistence of Psychological Symptoms? Cancer Nurs 2017; 40:E50-E58. [DOI: 10.1097/ncc.0000000000000412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ng CG, Mohamed S, Kaur K, Sulaiman AH, Zainal NZ, Taib NA. Perceived distress and its association with depression and anxiety in breast cancer patients. PLoS One 2017; 12:e0172975. [PMID: 28296921 PMCID: PMC5351853 DOI: 10.1371/journal.pone.0172975] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/12/2017] [Indexed: 01/06/2023] Open
Abstract
Background Breast cancer patients often experience a high level of distress. Psychological distress is a broad construct encompass both depression and anxiety. Previous studies in examining which of these psychological symptoms (either anxiety or depression) were more significantly associated with the distress level in breast cancer patients is lacking. This study aims to compare the level of depression and anxiety between patients with different level of distress. The correlation between the changes in distress level with depression or anxiety over 12 months was also examined. Methods This study is from the MyBCC cohort study. Two hundred and twenty one female breast cancer patients were included into the study. They were assessed at the time of diagnosis, 6 months and 12 month using Hospital Anxiety and Depression Scale (HADS) and distress thermometer. The information on age, ethnicity, treatment types and staging of cancer were collected. Results 50.2%, 51.6% and 40.3% of patients had perceived high level of distress at baseline, 6 months and 1 year after diagnosis. Those with high perceived level of distress had significant higher anxiety scores even after adjusted for the underlying depressive scores (Adjusted OR at baseline = 1.28, 95% CI = 1.13–1.44; adjusted OR at 6 months = 1.27, 95% CI = 1.11–1.45; adjusted OR at 12 months = 1.51, 95% CI = 1.29–1.76). There were no significant differences in the depressive scores between the subjects with either low or high distress level. There was reduction in perceived level of distress, anxiety and depression scores at 12 months after the diagnosis. The decrease of distress was positively correlated with the reduction of anxiety scores but not the changes of depressive scores (r’ = 0.25). Conclusion Anxiety is a more significant psychological state that contributed to the feeling of distress in breast cancer as compared with depression. Levels of anxiety at diagnosis in this study would justify screening for anxiety, early identification and therapy for maintaining the psychological well-being of breast cancer patients. Further studies will be needed to measure the effectiveness of therapeutic interventions.
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Affiliation(s)
- Chong Guan Ng
- Department of Psychological Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- * E-mail:
| | - Salina Mohamed
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Kuala Lumpur, Malaysia
| | - Kiran Kaur
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Nor Zuraida Zainal
- Department of Psychological Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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A prospective study of changes in anxiety, depression, and problems in living during chemotherapy treatments: effects of age and gender. Support Care Cancer 2017; 25:1897-1904. [PMID: 28150043 DOI: 10.1007/s00520-017-3596-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Monitoring distress assessment in cancer patients during the treatment phase is a component of good quality care practice. Yet, there is a dearth of prospective studies examining distress. In an attempt to begin filling this gap and inform clinical practice, we conducted a prospective, longitudinal study examining changes in distress (anxiety, depression, and problems in living) by age and gender and the roles of age and gender in predicting distress. METHODS Newly diagnosed Brazilian cancer patients (N = 548) were assessed at three time points during chemotherapy. Age and gender were identified on the first day of chemotherapy (T1); anxiety, depression, and problems in living were self-reported at T1, the planned midway point (T2), and the last day of chemotherapy (T3). RESULTS At T1, 37 and 17% of patients reported clinically significant levels of anxiety and depression, respectively. At T3, the prevalence was reduced to 4.6% for anxiety and 5.1% for depression (p < .001). Patients 40-55 years, across all time points, reported greater anxiety and practical problems than patients >70 years (p < .03). Female patients reported greater emotional, physical, and family problems than their male counterparts (p < .04). CONCLUSIONS For most patients, elevated levels of distress noted in the beginning of treatment subsided by the time of treatment completion. However, middle-aged and female patients continued to report heightened distress. Evidence-based psychosocial intervention offered to at risk patients during early phases of the treatment may provide distress relief and improve outcomes over the illness trajectory while preventing psychosocial and physical morbidity due to untreated chronic distress.
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Carnelli L, Di Mattei VE, Mazzetti M, Bernardi M, Di Pierro R, Bergamini A, Pella F, Mangili G, Sarno L, Candiani M. Illness Perception in Gestational Trophoblastic Disease Patients: How Mental Representations Affect Anxiety, Depression, and Infertility-Related Stress. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojmp.2017.61001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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31
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Gibbons A, Groarke A, Sweeney K. Predicting general and cancer-related distress in women with newly diagnosed breast cancer. BMC Cancer 2016; 16:935. [PMID: 27914469 PMCID: PMC5135827 DOI: 10.1186/s12885-016-2964-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychological distress can impact medical outcomes such as recovery from surgery and experience of side effects during treatment. Identifying the factors that explain variability in distress would guide future interventions aimed at decreasing distress. Two factors that have been implicated in distress are illness perceptions and coping, and are part of the Self-Regulatory Model of Illness Behaviour (SRM). The model suggests that coping mediates the relationship between illness perceptions and distress. Despite this; very little research has assessed this relationship with cancer-related distress, and none have examined women with screen-detected breast cancer. This study is the first to examine the relative contribution of illness perceptions and coping on general and cancer-related distress in women with screen-detected breast cancer. METHODS Women recently diagnosed with breast cancer (N = 94) who had yet to receive treatment completed measures of illness perceptions (Revised Illness Perception Questionnaire), cancer-specific coping (Mental Adjustment to Cancer Scale), general anxiety and depression (Hospital Anxiety and Depression scale), and cancer-related distress. RESULTS Hierarchical regression analyses revealed that medical variables, illness perceptions and coping predicted 50% of the variance in depression, 42% in general anxiety, and 40% in cancer-related distress. Believing in more emotional causes to breast cancer (β = .22, p = .021), more illness identity (β = .25, p = .004), greater anxious preoccupation (β = .23, p = .030), and less fighting spirit (β = -.31, p = .001) predicted greater depression. Greater illness coherence predicted less cancer-related distress (β = -.20, p = .043). Greater anxious preoccupation also led to greater general anxiety (β = .44, p < .001) and cancer-related distress (β = .37, p = .001). Mediation analyses revealed that holding greater beliefs in a chronic timeline, more severe consequences, greater illness identity and less illness coherence increases cancer-specific distress (ps < .001) only if women were also more anxiously preoccupied with their diagnosis. CONCLUSIONS Screening women for anxious preoccupation may help identify women with screen-detected breast cancer at risk of experiencing high levels of cancer-related distress; whilst illness perceptions and coping could be targeted for use in future interventions to reduce distress.
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Affiliation(s)
- Andrea Gibbons
- Health Psychology Research Unit, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK. .,School of Psychology, National University of Ireland, Galway, Ireland.
| | - AnnMarie Groarke
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Karl Sweeney
- BreastCheck, the National Screening Programme, Western Unit, Galway, Ireland
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Richardson EM, Schüz N, Sanderson K, Scott JL, Schüz B. Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta-analysis. Psychooncology 2016; 26:724-737. [PMID: 27412423 DOI: 10.1002/pon.4213] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 06/27/2016] [Accepted: 07/07/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Cancer is associated with negative health and emotional outcomes in those affected by it, suggesting the need to better understand the psychosocial determinants of illness outcomes and coping. The common sense model is the leading psychological model of self-regulation in the face of illness and assumes that subjective illness representations explain how people attempt to cope with illness. This systematic review and meta-analysis examines the associations of the common sense model's illness representation dimensions with health and coping outcomes in people with cancer. METHODS A systematic literature search located 54 studies fulfilling the inclusion criteria, with 38 providing sufficient data for meta-analysis. A narrative review of the remaining studies was also conducted. RESULTS Random-effects models revealed small to moderate effect sizes (Fisher Z) for the relations between illness representations and coping behaviors (in particular between control perceptions, problem-focused coping, and cognitive reappraisal) and moderate to large effect sizes between illness representations and illness outcomes (in particular between identity, consequences, emotional representations, and psychological distress). The narrative review of studies with insufficient data provided similar results. CONCLUSIONS The results indicate how illness representations relate to illness outcomes in people with cancer. However, more high-quality studies are needed to examine causal effects of illness representations on coping and outcomes. High heterogeneity indicates potential moderators of the relationships between illness representations and health and coping outcomes, including diagnostic, prognostic, and treatment-related variables. This review can inform the design of interventions to improve coping strategies and mental health outcomes in people with cancer.
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Affiliation(s)
- Emma M Richardson
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Natalie Schüz
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jennifer L Scott
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Benjamin Schüz
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Brandão T, Schulz MS, Matos PM. Psychological adjustment after breast cancer: a systematic review of longitudinal studies. Psychooncology 2016; 26:917-926. [PMID: 27440317 DOI: 10.1002/pon.4230] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 05/24/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Breast cancer (BC) can be a traumatic and stressful experience for women, but there are wide-ranging differences in the ways in which women respond and adapt to BC. This systematic review examines which sociodemographic, disease-related, and psychosocial factors near diagnosis predict later psychological adjustment to BC. METHODS Database searches were conducted in 9 different health-related databases from 2000 to December 2015 using relevant search terms. Full-text, peer-reviewed articles in English that analyzed potential predictors of psychological adjustment in longitudinal studies were considered for inclusion. RESULTS Of 1780 abstracts, 41 studies fulfilled inclusion criteria. Consistent sociodemographic and disease-related variable predictors of adjustment were income, fatigue, cancer stage, and physical functioning. Psychosocial factors, particularly optimism and trait anxiety, as well as perceived social support, coping strategies, and initial levels of psychological functioning, were found to be predictive of later depressive and anxiety symptoms, psychological distress, and quality of life for women with BC, in predictable ways. Other psychosocial variables, such as cognitive and body image factors, predicted psychological adjustment but were explored only by a few studies. CONCLUSIONS The majority of studies showed a significant relationship between psychosocial factors and psychological adjustment. These results point to specific sociodemographic, disease-related, and psychosocial factors that can help to identify women at the time of diagnosis who are at risk for long-term psychological challenges so they can be referred for psychological support that targets their specific needs and can improve their quality of life and mood and decrease indicators of anxiety, depression, and psychological distress.
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Affiliation(s)
- Tânia Brandão
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.,Center for Psychology, University of Porto, Porto, Portugal
| | - Marc S Schulz
- Department of Psychology, Bryn Mawr College, Bryn Mawr, PA, USA
| | - Paula Mena Matos
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.,Center for Psychology, University of Porto, Porto, Portugal
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Freeman-Gibb LA, Janz NK, Katapodi MC, Zikmund-Fisher BJ, Northouse L. The relationship between illness representations, risk perception and fear of cancer recurrence in breast cancer survivors. Psychooncology 2016; 26:1270-1277. [PMID: 27146965 DOI: 10.1002/pon.4143] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 01/18/2016] [Accepted: 03/20/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Fear of cancer recurrence, although distinct from distress continues to be under-evaluated, captured, or treated when standard distress scales are used to assess concerns of cancer survivors. We tested a model assessing the association of demographic and clinical factors, illness representations, and perceived risk with fear of cancer recurrence in breast cancer survivors. METHODS We recruited 117 breast cancer survivors at least one year after completing breast cancer treatment from Internet discussion boards for this cross-sectional, descriptive, correlational study. Participants completed a survey that assessed their level of fear of cancer recurrence as well as their illness representations, perceived risk of recurrence, and demographic and medical characteristics. RESULTS Our model explained 62% of the variance in fear of cancer recurrence. Emotional representations (β = .46, p < .01), symptom attribution (β = .21, p < .01), timeline (β = .23, p < .01), and consequences (β = .16, p < .03) were significantly related to fear of recurrence. By contrast, the majority of clinical and demographic variables were not significant contributors to fear of recurrence. CONCLUSIONS Upon completion of cancer treatment, survivors with more emotional representations of the experience and those who attribute unrelated symptoms to their breast cancer have a higher level of fear of recurrence. Evaluation of these factors during treatment may help mitigate fear of recurrence in the survivorship phase of the breast cancer trajectory. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Nancy K Janz
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Maria C Katapodi
- Institute of Nursing Science/Faculty of Medicine, University of Basel, Basel, Switzerland
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Depressive symptom trajectories in women affected by breast cancer and their male partners: a nationwide prospective cohort study. J Cancer Surviv 2016; 10:915-26. [PMID: 27084710 DOI: 10.1007/s11764-016-0538-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/21/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to identify subgroups of breast cancer patients and their partners based on distinct trajectories of depressive symptoms, to examine how relationship quality and medical and sociodemographic factors were associated with these trajectories, and to explore whether patients and partners had similar trajectories. METHODS A nationwide, population-based cohort of couples dealing with breast cancer was established in Denmark. Participants completed the Center for Epidemiologic Studies-Depression Scale at baseline and 5 and 12 months later. Sociodemographic and medical characteristics were retrieved from registers. A trajectory finite mixture model was used to identify trajectories. RESULTS The trajectories of depressive symptoms over time were analyzed in 546 patients and 508 partners. Among patients, 13 % had a high stable trajectory, 38 % an intermediate decreasing trajectory, and 49 % a low trajectory. Similar trajectories were found for partners (11, 22, and 67 %, respectively). Compared to the low trajectory, trajectories with higher depressive symptoms were associated with poorer relationship quality and previous use of antidepressants for patients and partners and with younger age, comorbidity, basic education, and chemotherapy for patients. The trajectories of patients and their partners were weakly correlated. CONCLUSIONS A considerable minority of patients and partners had a persistently high level of depressive symptoms. Poorer relationship quality and previous antidepressant use most consistently characterized patients and partners with higher depressive symptom trajectories. IMPLICATIONS FOR CANCER SURVIVORS In clinical practice, attention to differences in depressive symptom trajectories is important to identify and target patients and partners who might need support.
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36
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Predictors of initial levels and trajectories of anxiety in women before and for 6 months after breast cancer surgery. Cancer Nurs 2016; 37:406-17. [PMID: 24633334 DOI: 10.1097/ncc.0000000000000131] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The diagnosis of breast cancer, in combination with the anticipation of surgery, evokes fear, uncertainty, and anxiety in most women. OBJECTIVE Study purposes were to examine in patients who underwent breast cancer surgery how ratings of state anxiety changed from the time of the preoperative assessment to 6 months after surgery and to investigate whether specific demographic, clinical, symptom, and psychosocial adjustment characteristics predicted the preoperative levels of state anxiety and/or characteristics of the trajectories of state anxiety. INTERVENTIONS/METHODS Patients (n = 396) were enrolled preoperatively and completed the Spielberger State Anxiety inventory monthly for 6 months. Using hierarchical linear modeling, demographic, clinical, symptom, and psychosocial adjustment characteristics were evaluated as predictors of initial levels and trajectories of state anxiety. RESULTS Patients experienced moderate levels of anxiety before surgery. Higher levels of depressive symptoms and uncertainty about the future, as well as lower levels of life satisfaction, less sense of control, and greater difficulty coping, predicted higher preoperative levels of state anxiety. Higher preoperative state anxiety, poorer physical health, decreased sense of control, and more feelings of isolation predicted higher state anxiety scores over time. CONCLUSIONS Moderate levels of anxiety persist in women for 6 months after breast cancer surgery. IMPLICATIONS FOR PRACTICE Clinicians need to implement systematic assessments of anxiety to identify high-risk women who warrant more targeted interventions. In addition, ongoing follow-up is needed to prevent adverse postoperative outcomes and to support women to return to their preoperative levels of function.
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Saboonchi F, Petersson LM, Wennman-Larsen A, Alexanderson K, Vaez M. Trajectories of Anxiety Among Women with Breast Cancer: A Proxy for Adjustment from Acute to Transitional Survivorship. J Psychosoc Oncol 2016; 33:603-19. [PMID: 26315500 DOI: 10.1080/07347332.2015.1082165] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination. To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within 2 years following BC surgery, survey data from a 2-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and Analysis of Variance. A piece-wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified: High Stable, High Decrease, Mild Decrease, and Low Decrease. Of these, High Stable anxiety showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties. Our results support an emphasis on the transitional nature of the stage that follows the end of primary active treatment and imply a need for supportive follow up care for those who display lack of adjustment at this stage.
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Affiliation(s)
- Fredrik Saboonchi
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,b Department of Medicine and Public Health , Red Cross University College , Stockholm , Sweden
| | - Lena-Marie Petersson
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Agneta Wennman-Larsen
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,c Sophiahemmet University, Stockholm , Sweden
| | - Kristina Alexanderson
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Marjan Vaez
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,d Centre for Occupational and Environmental Medicine , Stockholm County Council , Stockholm , Sweden
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38
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Les représentations de la maladie : choix des outils de mesure et applications dans le champ du cancer. PSYCHO-ONCOLOGIE 2016. [DOI: 10.1007/s11839-015-0544-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gold M, Dunn LB, Phoenix B, Paul SM, Hamolsky D, Levine JD, Miaskowski C. Co-occurrence of anxiety and depressive symptoms following breast cancer surgery and its impact on quality of life. Eur J Oncol Nurs 2016; 20:97-105. [PMID: 26187660 PMCID: PMC4706814 DOI: 10.1016/j.ejon.2015.06.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE Little is known about the prevalence of combined anxiety and depressive symptoms (CADS) in breast cancer patients. Purpose was to evaluate for differences in demographic and clinical characteristics and quality of life (QOL) prior to breast cancer surgery among women classified into one of four distinct anxiety and/or depressive symptom groups. METHODS A total of 335 patients completed measures of anxiety and depressive symptoms and QOL prior to and for 6 months following breast cancer surgery. Growth Mixture Modelling (GMM) was used to identify subgroups of women with distinct trajectories of anxiety and depressive symptoms. These results were used to create four distinct anxiety and/or depressive symptom groups. Differences in demographic, clinical, and symptom characteristics, among these groups were evaluated using analyses of variance and Chi square analyses. RESULTS A total of 44.5% of patients were categorized with CADS. Women with CADS were younger, non-white, had lower performance status, received neoadjuvant or adjuvant chemotherapy, had greater difficulty dealing with their disease and treatment, and reported less support from others to meet their needs. These women had lower physical, psychological, social well-being, and total QOL scores. Higher levels of anxiety with or without subsyndromal depressive symptoms were associated with increased fears of recurrence, hopelessness, uncertainty, loss of control, and a decrease in life satisfaction. CONCLUSIONS Findings suggest that CADS occurs in a high percentage of women following breast cancer surgery and results in a poorer QOL. Assessments of anxiety and depressive symptoms are warranted prior to surgery for breast cancer.
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Affiliation(s)
- Marshall Gold
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Laura B Dunn
- Schools of Medicine, University of California, San Francisco, CA, USA
| | - Bethany Phoenix
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Steven M Paul
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Deborah Hamolsky
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Jon D Levine
- Schools of Medicine, University of California, San Francisco, CA, USA
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Canavarro MC, Silva S, Moreira H. Is the link between posttraumatic growth and anxious symptoms mediated by marital intimacy in breast cancer patients? Eur J Oncol Nurs 2015; 19:673-9. [DOI: 10.1016/j.ejon.2015.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/24/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
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41
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Lo Sterzo E, Orgeta V. Illness representation and sense of coherence in dementia caregiving. J Health Psychol 2015; 22:722-732. [DOI: 10.1177/1359105315613132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objectives of this study were to describe illness representations in dementia caregiving and examine the relationship between illness perceptions and carers’ sense of coherence. Illness perceptions were assessed by the Brief Illness Perception Questionnaire. We measured sense of coherence, symptoms of anxiety and depression and carer burden. Regression analyses indicated that after controlling for demographic factors, burden and psychological distress in carers, illness coherence and emotional responses to the disease independently contributed towards explaining variance in carers’ sense of coherence. Results provide support for the usefulness of the self-regulation model in understanding dementia caregiving.
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Affiliation(s)
- Elena Lo Sterzo
- Studi Cognitivi, Cognitive Psychotherapy School, Modena, Italy
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Avis NE, Levine BJ, Case LD, Naftalis EZ, Van Zee KJ. Trajectories of depressive symptoms following breast cancer diagnosis. Cancer Epidemiol Biomarkers Prev 2015; 24:1789-95. [PMID: 26377192 PMCID: PMC4634642 DOI: 10.1158/1055-9965.epi-15-0327] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/31/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This longitudinal study sought to identify groups of breast cancer survivors exhibiting distinct trajectories of depressive symptoms up to 24 months following diagnosis, and to describe characteristics associated with these trajectories. METHODS A total of 653 women completed baseline questionnaires within 8 months of breast cancer diagnosis on patient characteristics, symptoms, and psychosocial variables. Depressive symptoms were assessed at baseline and 6, 12, and 18 months after baseline. Chart reviews provided cancer and treatment-related data. Finite mixture modeling identified trajectories of depressive symptoms measured with the Beck Depression Inventory (BDI). RESULTS Six distinct trajectories were identified. Just over half of the sample had consistently very low (3.8%) or low (47.3%) BDI scores well below the traditional BDI cutoff point of 10 thought to be indicative of clinically significant depression; 29.2% had consistently borderline scores; 11.3% had initially high scores that declined over time, but remained above the cutoff point; 7.2% showed increased BDI over time; and a small but unique group (1.1%) reported chronically high scores above 25. Women in groups with lower depressive symptom levels were older, had less rigorous chemotherapy, fewer physical symptoms (fatigue and pain), and lower levels of illness intrusiveness. CONCLUSIONS Approximately 20% of women had levels of depressive symptoms indicative of clinical depression that were maintained 2 years postdiagnosis. Factors related to trajectory membership such as illness intrusiveness, social support, fatigue, pain, and vasomotor symptoms suggest targets for possible intervention. IMPACT Results demonstrate the heterogeneity of depressive symptoms following breast cancer and the need for continued screening posttreatment.
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Affiliation(s)
- Nancy E Avis
- Department of Social Science and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Beverly J Levine
- Department of Social Science and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - L Douglas Case
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Giannousi Z, Karademas EC, Dimitraki G. Illness representations and psychological adjustment of Greek couples dealing with a recently-diagnosed cancer: dyadic, interaction and perception-dissimilarity effects. J Behav Med 2015; 39:85-93. [PMID: 26260786 DOI: 10.1007/s10865-015-9664-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 07/30/2015] [Indexed: 01/06/2023]
Abstract
The aim was to examine the impact of the dyadic, interaction and dissimilarity effects of the illness representations on the psychological health of recently diagnosed cancer patients and spouses in Greece. The sample consisted of 298 individuals nested in 149 couples. Effects were examined with the Actor-Partner Interdependence Model. Both actor (i.e., within person) and partner (i.e., between partners) effects were detected for both patients' and spouses' psychological symptoms. The negative association of patients' psychological symptoms with their representations of illness coherence was weak at the higher and medium levels, and stronger at the lower levels of spouse corresponding representations. Patient-partner discrepancy in perceived illness consequences was associated with more psychological symptoms in patients. Adaptation to cancer is a dyadic process within the context of which patient and partner psychological well-being is affected by each other's understanding of illness. Thus, the parallel examination of the illness representations of both partners is needed from the early phases of the illness trajectory.
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Affiliation(s)
- Zoe Giannousi
- Bank of Cyprus Oncology Centre, 32, Akropoleos Av., 2006, Nicosia, Cyprus.
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Chirico A, Lucidi F, Mallia L, D'Aiuto M, Merluzzi TV. Indicators of distress in newly diagnosed breast cancer patients. PeerJ 2015; 3:e1107. [PMID: 26244115 PMCID: PMC4517964 DOI: 10.7717/peerj.1107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 06/26/2015] [Indexed: 11/20/2022] Open
Abstract
Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life. Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment. Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress. Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient’s knowledge (β = − 0.22), which, in turn, was positively associated with both attitudes toward breast cancer (β = 0.39) and coping self-efficacy (β = 0.36). Self-efficacy was then directly related to psychological distress (β = − 0.68). Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress.
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Affiliation(s)
- Andrea Chirico
- Breast Cancer Department, National Cancer Institute Fondazione "G.Pascale," Naples , Italy ; Department of Psychology of Developmental and Socialisation Processes, "Sapienza" University of Rome , Rome , Italy
| | - Fabio Lucidi
- Department of Psychology of Developmental and Socialisation Processes, "Sapienza" University of Rome , Rome , Italy
| | - Luca Mallia
- Department of Psychology of Developmental and Socialisation Processes, "Sapienza" University of Rome , Rome , Italy
| | - Massimiliano D'Aiuto
- Breast Cancer Department, National Cancer Institute Fondazione "G.Pascale," Naples , Italy
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De Feudis R, Lanciano T, Rinaldi S. Coping Strategies of Southern Italian Women Predict Distress Following Breast Cancer Surgery. EUROPES JOURNAL OF PSYCHOLOGY 2015; 11:280-94. [PMID: 27247657 PMCID: PMC4873111 DOI: 10.5964/ejop.v11i2.908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/07/2015] [Indexed: 11/20/2022]
Abstract
The present study was aimed at investigating the role of coping strategies in predicting emotional distress following breast cancer, over and above the illness severity, operationalized in terms of the type of surgery performed. In order to achieve this goal, two groups of newly diagnosed breast cancer women were selected and compared on the basis of the type of surgical treatment received. A subsample of 30 women with quadrantectomy and sentinel lymph-node biopsy (SLNB) and a subsample of 31 patients with mastectomy and axillary dissection (MAD) filled in the Brief Cope scale and Hospital Anxiety and Depression Scale. Summarizing, results showed that emotional support, venting, and humor explained a statistically significant increment of variance in psychological distress indices. Implication for clinical practice and future research were discussed.
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Affiliation(s)
- Rossana De Feudis
- Psycho-Oncology, Breast Unit, "San Paolo" Hospital ASL BA, Bari, Italy
| | - Tiziana Lanciano
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy
| | - Stefano Rinaldi
- General Surgery Unit, Breast Unit, "San Paolo" Hospital of ASL BA, Bari, Italy
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Jassim GA, Whitford DL, Hickey A, Carter B. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2015:CD008729. [PMID: 26017383 DOI: 10.1002/14651858.cd008729.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. OBJECTIVES To assess the effects of psychological interventions on psychological morbidities, quality of life and survival among women with non-metastatic breast cancer. SEARCH METHODS We searched the following databases up to 16 May 2013: the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO; and reference lists of articles. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) search portal and ClinicalTrials.gov for ongoing trials in addition to handsearching. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for non-metastatic breast cancer in women. DATA COLLECTION AND ANALYSIS Two review authors independently appraised and extracted data from eligible trials. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcome. MAIN RESULTS Twenty-eight randomised controlled trials comprising 3940 participants were included. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. A wide range of interventions were evaluated, with 24 trials investigating a cognitive behavioural therapy and four trials investigating psychotherapy compared to control. Pooled standardised mean differences (SMD) from baseline indicated less depression (SMD -1.01, 95% confidence interval (CI) -1.83 to -0.18; P = 0.02; 7 studies, 637 participants, I(2) = 95%, low quality evidence), anxiety (SMD -0.48, 95% CI -0.76 to -0.21; P = 0.0006; 8 studies, 776 participants, I(2) = 64%, low quality evidence) and mood disturbance (SMD -0.28, 95% CI -0.43 to -0.13; P = 0.0003; 8 studies, 1536 participants, I(2) = 47%, moderate quality evidence) for the cognitive behavioural therapy group than the control group. For quality of life, only an individually-delivered cognitive behavioural intervention showed significantly better quality of life than the control with an SMD of 0.65 (95% CI 0.07 to 1.23; P = 0.03; 3 studies, 141 participants, I(2) = 41%, very low quality evidence). Pooled data from two group-delivered studies showed a non-significant overall survival benefit favouring cognitive behavioural therapy compared to control (pooled hazard ratio (HR) 0.76, 95% CI 0.25 to 2.32; P = 0.63; 530 participants, I(2) = 84%, low quality evidence). Four studies compared psychotherapy to control with one to two studies reporting on each outcome. The four studies were assessed as high risk of bias and provided limited evidence of the efficacy of psychotherapy. Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS A psychological intervention, namely cognitive behavioural therapy, produced favourable effects on some psychological outcomes, in particular anxiety, depression and mood disturbance. However, the evidence for survival improvement is still lacking. These findings are open to criticism because of the notable heterogeneity across the included studies and the shortcomings of the included studies.
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Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Adliya, Bahrain
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Chittem M, Norman P, Harris PR. Illness representations and psychological distress in Indian patients with cancer: does being aware of one's cancer diagnosis make a difference? Psychooncology 2015; 24:1694-700. [DOI: 10.1002/pon.3837] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 03/31/2015] [Accepted: 04/07/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Mahati Chittem
- Department of Liberal Arts; Indian Institute of Technology Hyderabad; Medak India
| | - Paul Norman
- Department of Psychology; University of Sheffield; Sheffield UK
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Ashley L, Marti J, Jones H, Velikova G, Wright P. Illness perceptions within 6 months of cancer diagnosis are an independent prospective predictor of health-related quality of life 15 months post-diagnosis. Psychooncology 2015; 24:1463-70. [PMID: 25946704 DOI: 10.1002/pon.3812] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 03/06/2015] [Accepted: 03/07/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Studies have found that illness perceptions explain significant variance in health outcomes in numerous diseases. However, most of the research is cross-sectional and non-oncological. We examined, for the first time in breast, colorectal and prostate cancer patients, if cognitive and emotional illness perceptions near diagnosis predict future multidimensional health-related quality of life (HRQoL). METHODS UK-based patients (N = 334) completed the illness perception questionnaire-revised within 6 months post-diagnosis and the quality of life in adult cancer survivors scale 15 months post-diagnosis. Sociodemographic and clinical data were obtained from medical records. Hierarchical multiple regression analyses were conducted. RESULTS The sociodemographic and clinical factors collectively significantly predicted 8/12 HRQoL domains, although for 5/8 accounted for <10% of the variance. For all 12 HRQoL domains, illness perceptions collectively explained significant substantial additional variance (∆R(2) range: 5.6-27.9%), and a single illness perception questionnaire-revised dimension was the best individual predictor of 9/12 HRQoL domains. The consequences dimension independently predicted 7/12 HRQoL domains; patients who believed their cancer would have a more serious negative impact on their life reported poorer future HRQoL. The emotional representations and identity dimensions also predicted multiple HRQoL domains. CONCLUSIONS Future research should focus on realising the potential of illness perceptions as a modifiable target for and mediating mechanism of interventions to improve patients' HRQoL.
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Affiliation(s)
- Laura Ashley
- Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Joachim Marti
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Helen Jones
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
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Bidstrup PE, Christensen J, Mertz BG, Rottmann N, Dalton SO, Johansen C. Trajectories of distress, anxiety, and depression among women with breast cancer: Looking beyond the mean. Acta Oncol 2015; 54:789-96. [PMID: 25761086 DOI: 10.3109/0284186x.2014.1002571] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Little is known about the development of psychological wellbeing over time among women who have been treated for breast cancer. The aim of this study was to identify distinct patterns of distress, anxiety, and depression in such women. METHODS We invited 426 consecutive women with newly diagnosed primary breast cancer to participate in this study, and 323 (76%) provided information on distress ('distress thermometer') and on symptoms of anxiety and depression ('hospital anxiety and depression scale'). Semiparametric group-based mixture modeling was used to identify distinct trajectories of distress, anxiety, and depressive symptoms assessed the week before surgery and four and eight months later. Logistic regression analysis was used to evaluate the characteristics of women in the distinct groups. RESULTS Although no sub-group of women with chronic severe anxiety or depressive symptoms was found, we did identify a sub-group of 8% of the women who experienced continuously severe distress. Young age, having a partner, shorter education, and receiving chemotherapy but not radiotherapy might characterize women whose psychological symptoms remain strong eight months after diagnosis. CONCLUSION By looking beyond the mean, we found that 8% of the women experienced chronic severe distress; no sub-groups with chronic severe anxiety or depression were identified. Several socio-demographic and treatment factors characterized the women whose distress level remained severe eight months after diagnosis. The results suggest that support could be focused on relatively small groups of patients most in need.
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Cook SA, Salmon P, Dunn G, Holcombe C, Cornford P, Fisher P. The association of metacognitive beliefs with emotional distress after diagnosis of cancer. Health Psychol 2015; 34:207-15. [PMID: 25133826 PMCID: PMC4321533 DOI: 10.1037/hea0000096] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 01/27/2014] [Accepted: 03/03/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Emotional distress after a diagnosis of cancer is normal and, for most people, will diminish over time. However, a significant minority of patients with cancer experience persistent or recurrent symptoms of emotional distress for which they need help. A model developed in mental health, the self-regulatory executive function model (S-REF), specifies that maladaptive metacognitive beliefs and processes, including persistent worry, are key to understanding why such emotional problems persist. This cross-sectional study explored, for the first, time whether metacognitive beliefs were associated with emotional distress in a cancer population, and whether this relationship was mediated by worry, as predicted by the S-REF model. METHOD Two hundred twenty-nine participants within 3 months of diagnosis of, and before treatment for, primary breast or prostate cancer completed self-report questionnaires measuring anxiety, depression, posttraumatic stress disorder (PTSD) symptoms, metacognitive beliefs, worry, and illness perceptions. RESULTS Regression analysis showed that metacognitive beliefs were associated with symptoms of anxiety, depression, and PTSD, and explained additional variance in these outcomes after controlling for age, gender, and illness perceptions. Structural equation modeling was consistent with cross-sectional hypotheses derived from the theory that metacognitive beliefs cause and maintain distress both directly and indirectly by driving worry. CONCLUSIONS The findings provide promising first evidence that the S-REF model may be usefully applied in cancer. Further study is required to establish the predictive and clinical utility of these findings.
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Affiliation(s)
| | | | - Graham Dunn
- Centre for Biostatistics, The University of Manchester
| | - Chris Holcombe
- Royal Liverpool and Broadgreen University Hospitals NHS Trust
| | - Philip Cornford
- Royal Liverpool and Broadgreen University Hospitals NHS Trust
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