Sources of anticipatory distress among breast surgery patients

Assessment of psycho-oncology in the Middle East and North Africa region: a systematic review and meta-analysis

BACKGROUND

The Middle East and North Africa (MENA) region is expected to witness a significant increase in the burden of cancer. Contrary to Western literature, the burden of psycho-oncology is yet to be established within the MENA region. This study reviews all available evidence characterizing the psychological burden among patients with cancer across the MENA region.

METHODS

We systematically explored the PubMed/MEDLINE, Cochrane/CENTRAL, and Web of Science (WoS) databases for reports on the psychiatric burden among patients with cancer residing within the MENA region from January 2000 until January 2023. Raw proportion were extracted and analyzed using a random-effects model.

FINDINGS

Eighty-three studies comprised of 16 810 participants, representing 14 countries, met our inclusion criteria. Across the MENA region, the prevalence of depression, anxiety, and distress were 44% (95% CI, 39%-50%), 47% (95% CI, 40%-54%), and 43% (95% CI, 30%-56%), respectively. Prevalence of depression was significantly different across countries, with Palestine (73%; 95% CI, 42%-91%) reporting the highest rate while Morocco (23%; 95% CI, 7%-56%) reported the lowest. Similarly, anxiety significantly differed across MENA nations ranging from 64% (95% CI, 3%-99%) in Morocco to 28% (95% CI, 18%-42%) in Tunisia. Rates of depression and anxiety were significantly different across measurement tools but not between Arabic-speaking versus Persian/Farsi-speaking countries. Meta-regression models showed that neither publication year nor age affected the prevalence of both anxiety and depression (P = .374 and .091 for depression and P = .627, and .546 for anxiety, respectively).

INTERPRETATION

We report an abnormally high rate of psychiatric burden among patients with cancer in the MENA region. Thus, establishing appropriate psycho-oncologic interventions within the MENA region is of utmost importance.

An Immersive Virtual Reality Intervention for Preoperative Anxiety and Distress Among Adults Undergoing Oncological Surgery: Protocol for a 3-Phase Development and Feasibility Trial

BACKGROUND

Preoperative state anxiety (PSA) is distress and anxiety directly associated with perioperative events. PSA is associated with negative postoperative outcomes such as longer hospital length of stay, increased pain and opioid use, and higher rates of rehospitalization. Psychological prehabilitation, such as education, exposure to hospital environments, and relaxation strategies, has been shown to mitigate PSA; however, there are limited skilled personnel to deliver such interventions in clinical practice. Immersive virtual reality (VR) has the potential for greater accessibility and enhanced integration into an immersive and interactive experience. VR is rarely used in the preoperative setting, but similar forms of stress inoculation training involving exposure to stressful events have improved psychological preparation in contexts such as military deployment.

OBJECTIVE

This study seeks to develop and investigate a targeted PSA intervention in patients undergoing oncological surgery using a single preoperative VR exposure. The primary objectives are to (1) develop a novel VR program for patients undergoing oncological surgery with general anesthesia; (2) assess the feasibility, including acceptability, of a single exposure to this intervention; (3) assess the feasibility, including acceptability, of outcome measures of PSA; and (4) use these results to refine the VR content and outcome measures for a larger trial. A secondary objective is to preliminarily assess the clinical utility of the intervention for PSA.

METHODS

This study comprises 3 phases. Phase 1 (completed) involved the development of a VR prototype targeting PSA, using multidisciplinary iterative input. Phase 2 (data collection completed) involves examining the feasibility aspects of the VR intervention. This randomized feasibility trial involves assessing the novel VR preoperative intervention compared to a VR control (ie, nature trek) condition and a treatment-as-usual group among patients undergoing breast cancer surgery. Phase 3 will involve refining the prototype based on feasibility findings and input from people with lived experience for a future clinical trial, using focus groups with participants from phase 2.

RESULTS

This study was funded in March 2019. Phase 1 was completed in April 2020. Phase 2 data collection was completed in January 2024 and data analysis is ongoing. Focus groups were completed in February 2024. Both the feasibility study and focus groups will contribute to further refinement of the initial VR prototype (phase 3), with the final simulation to be completed by mid-2024.

CONCLUSIONS

The findings from this work will contribute to the limited body of research examining feasible and broadly accessible interventions for PSA. Knowledge gained from this research will contribute to the final development of a novel VR intervention to be tested in a large population of patients with cancer before surgery in a randomized clinical trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04544618; https://www.clinicaltrials.gov/study/NCT04544618.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55692.

Breast cancer patient experiences of perioperative distress and anxiety: A qualitative study

PURPOSE

Distress, often manifesting as anxiety, is common in breast cancer patients and becomes particularly elevated before surgery. This study investigated perspectives of those undergoing breast cancer surgery concerning what enhances and reduces distress and anxiety across the perioperative period (i.e., from diagnostic evaluation to recovery).

METHODS

The present study conducted qualitative semi-structured individual interviews with 15 adult breast cancer surgery patients within three months post-operation. Quantitative surveys provided background information (e.g., sociodemographics). Individual interviews were analyzed using thematic analysis. Quantitative data were analyzed descriptively.

RESULTS

Four main themes emerged from qualitative interviews: 1) "fighting an unknown" (sub-themes: uncertainty, health-related knowledge and experience); 2) "the cancer takes away the control" (sub-themes: "living at the whim of others", trusting care providers); 3) person at the centre of the patient (sub-themes: "managing life:" caregiving and work-related stressors, "everybody jumped in to help:" emotional and instrumental support); and 4) physical and emotional impacts of treatment (sub-themes: pain and impacted mobility, "losing a part of yourself"). Breast cancer patients' experiences of surgery-related distress and anxiety were contextualized by broader experiences of care.

CONCLUSIONS

Our findings illustrate the illness-specific experience of perioperative anxiety and distress in breast cancer patients and inform patient-centered care and intervention.

Gendered trajectories of depressive symptoms and social interactions among cancer patients

PURPOSE

This study examines whether and how depressive symptoms and social interactions change before and after cancer diagnosis, and whether this pattern varies by gender.

METHODS

This study used data about 722 middle- and older-aged adults from seven waves (3,963 person-observations) of the Korean Longitudinal Study of Ageing spanning 12 years between 2006 and 2018. Gender-stratified fixed effects regression models were used to investigate the effect of cancer diagnosis on changes in depressive symptoms and the frequency of social interactions (with friends, relatives, acquaintances, and neighbors) before and after cancer diagnosis.

RESULTS

For both men and women, an increase in depressive symptoms was found in the first and second year after cancer diagnosis, though the increase in the second year was significantly greater for men than women. Only men continued to suffer higher depressive symptoms after the third year and subsequent years. This study also found a decrease in the frequency of social interactions only among men in the second year and subsequent years after cancer diagnosis.

CONCLUSION

Trajectories of psychosocial adjustment to cancer are gendered. The psychosocial consequences of cancer are greater and last longer for men than women.

Psychological Aspects to Consider in Breast Cancer Diagnosis and Treatment

PURPOSE OF REVIEW

Breast cancer (BC) is the most common cancer diagnosed in women in the West World. Coping with cancer is cause of extreme stress for patients and their family. The purpose of this review is to evaluate possible approaches to follow to control those situations that can impact on quality of life (QoL) and compliance to treatments.

RECENT FINDINGS

Anxiety, distress, depression, and posttraumatic stress disorder are the most frequent psychological disorders in BC patients. Cognitive disorders and sexual dysfunction can also be important in affecting QoL both in younger and older patients. Younger and older patients show different characteristics of these disorders and different strategies of managing them. Several psychotherapeutic and supportive approaches have proven effective in managing psychological disorders in BC patients. Every BC patient should be supported with these techniques during her entire oncological history, in order to increase QoL and compliance to treatments.

Quality of life of older adults with cancer in Korea

This study examines the quality of life (QoL) of older adults with cancer (N = 176), by comparing them with age- and gender-matched groups without cancer (N = 176), and investigates factors associated with their QoL. The results of Medical Outcome Study Short Form-36 (MOS SF-36) showed that the study group had significantly lower scores than the noncancer group on all eight scales and on the Physical Component Summary and the Mental Component Summary. Comparison with gender and age groups revealed some differences. Optimism and social support were positively related to QoL while comorbidity, cancer-related concerns, and financial worries were inversely related.

Perceived distress and its association with depression and anxiety in breast cancer patients

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.

The level of emotion control, anxiety, and self-efficacy in the elderly in Bialystok, Poland

PURPOSE

The aim of the study was to assess the level of emotion control, anxiety, and self-efficacy in the inhabitants of Bialystok (Poland) aged above 60.

PATIENTS AND METHODS

The study included 300 people above the age of 60, inhabitants of Bialystok and its neighborhoods: 100 residents of public nursing home, 100 participants of the University of the Third Age in Bialystok, and 100 students of the University of Healthy Senior. The three standardized psychometric scales were used in the study: Courtauld Emotional Control Scale (CECS), State-Trait Anxiety Inventory (STAI), and General Self-Efficacy Scale (GSES).

RESULTS

The median of the overall score of CECS equaled 54 points, which is considered average in terms of negative emotions acceptance. The mean score of perceiving anxiety as the condition of STAI (X1) was 48 points, while anxiety as a trait of STAI (X2) was 49 points. The overall score for GSES proved that respondents had a subjective feeling of self-efficacy at the level of 29 points out of 40 points possible, which means that their self-efficacy was rather at the high level in their self-assessment. In women, a negative correlation was revealed between the sense of self-efficacy and age (r=-0.320, P<0.001). Analyzing the study group affiliation of respondents, a negative correlation was reported between the sense of self-efficacy and age among the elderly residents of public nursing home (r=-0.408, P<0.001). Taking into consideration the study group affiliation of respondents, a positive correlation between anger control (CECS) and the sense of anxiety as a trait of STAI (X2) was found among participants of the University of Healthy Senior (r=0.307, P=0.002).

CONCLUSION

The social and demographic features (gender, group affiliation, age) analyzed in the study were found to be correlated significantly with the control of negative emotions, the level of anxiety, and self-efficacy. The study group affiliation was a key variable conditioning the relations between the analyzed features. The elderly residents of public nursing home belonged to the group distinguishing negatively compared to other two study groups. The study respondents were characterized by the relatively high perception of anxiety, which may be as a result of the health and social problem present in this age group. In order to improve the quality of life, the study population should reduce level of perceived anxiety and increase the control of negative emotions and self-efficacy by social integration of seniors. The study scores in the scale of CECS, STAI, and GSES do not deviate from the world norms obtained by other researchers in the rest of the world.

Breast Biopsy: The Effects of Hypnosis and Music

The authors evaluated the efficacies of audio-recorded hypnosis with background music and music without hypnosis in the reduction of emotional and physical disturbances in patients scheduled for breast biopsy in comparison with a control group. A total of 75 patients were randomly assigned to 3 different groups and evaluated at baseline and before and after breast biopsy using visual analog scales of stress, pain, depression, anxiety, fatigue, optimism, and general well-being. The results showed that, before breast biopsy, the music group presented less stress and anxiety, whereas the hypnosis with music group presented reduced stress, anxiety, and depression and increased optimism and general well-being. After the biopsy, the music group presented less anxiety and pain, whereas the hypnosis group showed less anxiety and increased optimism.

A feasibility study exploring the role of pre-operative assessment when examining the mechanism of 'chemo-brain' in breast cancer patients

Background

Women receiving chemotherapy treatment for breast cancer may experience problems with their memory and attention (cognition), which is distressing and interferes with quality of life. It is unclear what causes or contributes to the problems they report: psychological distress, fatigue, coping style, or specific biological changes for example to pro inflammatory cytokines. Research shows however, that approximately a third of women with breast cancer perform poorly on tests of cognition before commencing chemotherapy. We aimed to examine the acceptability and relevance of pre-surgical assessments (bloods, brain imaging, cognitive tests and self-report questionnaires) when investigating the phenomenon of ‘chemo-brain’ and investigate whether inflammatory markers mediate chemotherapy-induced neuropsychological impairments in women treated for breast cancer.

Methods

Women with early stage breast cancer completed neuropsychological and quality of life assessments at T1 (pre-surgery), T2 (post-surgery before chemotherapy) and T3 (6 months later). Blood cytokine levels were measured at the same time points and brain imaging was performed at T1 and T3.

Results

In total, 14/58 women participated (8 chemotherapy, 6 non-chemotherapy). Prior to the start of chemotherapy a decline in cognitive performance compared to baseline was observed in one participant. At T3 women who received chemotherapy reported poorer quality of life and greater fatigue. Increases in soluble tumour necrosis factor receptor II (sTNFRII), interleukin-6, interleukin-10 and vascular endothelial growth factor occurred post chemotherapy only. Levels of sTNFRII were inversely correlated with grey matter volume (GMV) of the right posterior insula in both groups. At T3, the chemotherapy group displayed a greater reduction in GMV in the subgenual and dorsal anterior cingulate, and the inferior temporal gyrus.

Conclusions

Pre-operative recruitment to the study was challenging; however, the lack of significant changes in blood cytokine levels and neuropsychological tests at T2 implies that post surgery may be a valid baseline assessment, but this needs further investigation in a larger study. The preliminary results support the hypothesis that chemotherapy induced fatigue is mediated by a change in peripheral cytokine levels which could explain some symptoms of ‘chemo brain’ experienced by patients.

Anxiety prior to breast biopsy: Relationships with length of time from breast biopsy recommendation to biopsy procedure and psychosocial factors

This study investigated how time from breast biopsy recommendation to biopsy procedure affected pre-biopsy anxiety ( N = 140 women), and whether the relationship between wait time and anxiety was affected by psychosocial factors (chronic life stress, traumatic events, social support). Analyses showed a significant interaction between wait time and chronic life stress. Increased time from biopsy recommendation was associated with greater anxiety in women with low levels of life stress. Women with high levels of life stress experienced increased anxiety regardless of wait time. These results suggest that women may benefit from shorter wait times and receiving strategies for managing anxiety.

Pre-biopsy psychological factors predict patient biopsy experience

BACKGROUND

Excisional/surgical breast biopsy has been related to anticipatory emotional distress, and anticipatory distress has been associated with worse biopsy-related outcomes (e.g., pain, physical discomfort).

PURPOSE

The present study was designed to investigate (a) whether anticipatory distress before an image-guided breast biopsy would correlate with biopsy-related outcomes (pain and physical discomfort during the biopsy) and (b) whether type of distress (i.e., general anxiety, worry about the procedure, worry about biopsy results) would differentially relate to biopsy-related outcomes.

METHODS

Fifty image-guided breast biopsy patients (mean age = 44.4 years) were administered questionnaires pre- and post-biopsy. Pre-biopsy, patients completed the Profile of Mood States-tension/anxiety subscale and two visual analog scale items (worry about the biopsy procedure, worry about the biopsy results). Post-biopsy, patients completed two visual analog scale items (pain and physical discomfort at their worst during the procedure).

RESULTS

The following results were gathered: (1) Pre-biopsy worry about the procedure was significantly related to both pain (r = 0.38, p = 0.006) and physical discomfort (r = 0.31, p = 0.026); (2) pre-biopsy general anxiety was significantly related to pain (r = 0.36, p = 0.009), but not to physical discomfort; and (3) Pre-biopsy worry about the biopsy results did not significantly relate to pain or physical discomfort.

CONCLUSIONS

Worry about the procedure was the only variable found to be significantly correlated with both biopsy-related outcomes (pain and physical discomfort). From a clinical perspective, this item could be used as a brief screening tool to identify patients who might be at risk for poorer biopsy experiences and who might benefit from brief interventions to reduce pre-biopsy worry.

Development of a short version of the Dutch version of the Spielberger STAI trait anxiety scale in women suspected of breast cancer and breast cancer survivors

The objective of the current study was to develop a short form of the Dutch version of the State-Trait Anxiety Inventory (STAI) Trait scale and to provide initial validation data in a sample of breast cancer patients and survivors. This short trait anxiety (A-Trait) scale was designed to reduce time and effort required of severely ill or handicapped patients involved in extensive assessment procedures. Another goal was to assess A-Trait with minimal overlap with content that reflects Quality of Life (QoL) and fatigue. Three groups of women either completed the original Trait scale (Groups 1 and 2) or the 10-item trait version (Group 3). In Group 1, exploratory factor analysis with the Scree test, Velicer's MAP criteria and parallel analysis as tests for factor retention, indicated a 10-item Trait version reflecting two factors: Anxiety Present and Anxiety Absent. In the other groups, confirmatory factor analysis showed that the two-factor short form provided the best fit. In all three groups Trait Anxiety was highly related to Neuroticism. The correlation between Overall QoL and General Health and the Anxiety Present short scale was lower than the correlation between Overall QoL and General Health and the full form (Z = 2.20, p = .03). With this short A-Trait scale it becomes possible to study the relationship between dispositional anxiety and clinically important outcome variables without inflating estimates of these relations through psychometric contamination.

The preoperative sexual functioning and quality of sexual life in colorectal cancer: a study among patients and their partners

INTRODUCTION

Even though the body of literature on sexual functioning is growing, information on the preoperative sexual functioning and the quality of sexual life after colorectal cancer is lacking. Research focusing on female patients and on partners is also rather scarce.

AIM

This cross-sectional study aimed to describe the preoperative sexual functioning, quality of sexual life, and relationship functioning for male and female colorectal cancer patients and their partners. In addition, the mean scores of the patients and partners were compared with mean norm scores.

METHODS

Patients diagnosed with colorectal cancer (N = 136) and their partners (N = 106) were recruited before surgical treatment in six Dutch hospitals.

MAIN OUTCOME MEASURES

Men completed the International Index of Erectile Functioning, while women completed the Female Sexual Function Index. All partnered participants completed the Golombok-Rust Inventory of Sexual Satisfaction and the Maudsley Marital Questionnaire. The mean scores were compared with mean norm scores derived from the manuals of the questionnaires.

RESULTS

All participants were in a heterosexual relationship. Female patients reported a lower quality of sexual life compared with male patients. Male partners reported a lower sexual functioning and a lower quality of sexual life compared with male patients. Colorectal cancer patients and partners (both sexes) reported a lower sexual functioning and a lower quality of sexual life compared with norm populations but scored similar on relationship functioning.

CONCLUSION

A lower sexual functioning and a lower quality of sexual life are already reported preoperatively; however, relationship functioning was comparable with a norm population. Therefore, all the impairment seen after treatment should not be solely attributed to the effects of treatment.

Influence of yoga on mood states, distress, quality of life and immune outcomes in early stage breast cancer patients undergoing surgery

Context:

Breast cancer patients awaiting surgery experience heightened distress that could affect postoperative outcomes.

Aims:

The aim of our study was to evaluate the effects of yoga intervention on mood states, treatment-related symptoms, quality of life and immune outcomes in breast cancer patients undergoing surgery.

Settings and Design:

Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited for a randomized controlled trial comparing the effects of a yoga program with supportive therapy plus exercise rehabilitation on postoperative outcomes following surgery.

Materials and Methods:

Subjects were assessed prior to surgery and four weeks thereafter. Psychometric instruments were used to assess self-reported anxiety, depression, treatment-related distress and quality of life. Blood samples were collected for enumeration of T lymphocyte subsets (CD4 %, CD8 % and natural killer (NK) cell % counts) and serum immunoglobulins (IgG, IgA and IgM).

Statistical Analysis Used:

We used analysis of covariance to compare interventions postoperatively.

Results:

Sixty-nine patients contributed data to the current analysis (yoga n = 33, control n = 36). The results suggest a significant decrease in the state (P = 0.04) and trait (P = 0.004) of anxiety, depression (P = 0.01), symptom severity (P = 0.01), distress (P < 0.01) and improvement in quality of life (P = 0.01) in the yoga group as compared to the controls. There was also a significantly lesser decrease in CD 56% (P = 0.02) and lower levels of serum IgA (P = 0.001) in the yoga group as compared to controls following surgery.

Conclusions:

The results suggest possible benefits for yoga in reducing postoperative distress and preventing immune suppression following surgery.

Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery

CONTEXT

Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery.

OBJECTIVE

The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery.

METHODS

Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines-soluble Interleukin (IL)-2 receptor (IL-2R), tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes.

RESULTS

Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36). The results suggest a significant decrease in the duration of hospital stay (P = 0.003), days of drain retention (P = 0.001) and days for suture removal (P = 0.03) in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group (P < 0.001), as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels.

CONCLUSION

The results suggest possible benefits of yoga in reducing postoperative complications in breast cancer patients.

Distress and emotional well-being in breast cancer patients prior to radiotherapy: an expectancy-based model

Understanding precursors to distress and emotional well-being (EWB) experienced in anticipation of radiotherapy would facilitate the ability to intervene with this emotional upset (i.e. higher distress, lower EWB). Thus, this study tested an expectancy-based model for explaining emotional upset in breast cancer patients prior to radiotherapy. Women affected by breast cancer (N = 106) were recruited and participants completed questionnaires prior to commencing radiotherapy. Structural equation modelling was used to test a cross-sectional model, which assessed the ability of dispositional optimism (Life Orientation Test-Revised - two factors), response expectancies (Visual Analog Scale items), medical (type of surgery, cancer stage and chemotherapy history) and demographic (age, race, ethnicity, education and marital status) variables to predict both EWB (Functional Assessment of Chronic Illness Therapy - Emotional Well-being Subscale) and distress (Profile of Mood States - short version). The model represented a good fit to the data accounting for 65% of the variance in EWB and 69% in distress. Significant predictors of emotional upset were pessimism, response expectancies, Latina ethnicity, cancer stage and having had a mastectomy. These variables explained a large portion of emotional upset experienced prior to radiotherapy for breast cancer and are important to consider when aiming to reduce distress and improve EWB in this context.

Being in suspense: women's experiences awaiting breast cancer surgery

AIM

This article is a report of a qualitative study of women's experiences after having received a breast cancer diagnosis and awaiting primary surgery.

BACKGROUND

Breast cancer is experienced as an important stressor and a major challenge. How women appraise the diagnosis affects their postsurgery adaptation. Although studies have documented the presurgery period as stressful, in-depth understanding of women's experiences while awaiting surgery studied during this stressful period is still needed.

METHOD

Twenty-one women with newly diagnosed breast cancer were interviewed individually the day before surgery at a Norwegian university hospital, between February 2006 and February 2007. Interviews were analysed using the qualitative meaning condensation method.

FINDINGS

Feeling healthy, but having to adapt to disease, waiting, uncertainty, having to tell and existential awareness were themes identified. Having to wait was experienced as frightening, painful, long and difficult - but also necessary. Some expressed apprehension because they could not do anything about their situation. Others emphasized that it was good to have some time between diagnosis and surgery to become personally prepared and spend time with loved ones. Informing others about the diagnosis was a great burden for most of them. Social networks could both give and crave support.

CONCLUSION

Healthcare professionals need to be sensitive to the individual experiences of women awaiting breast cancer surgery to give support to ease their situation. Setting the date for surgery will alleviate anxiety. Follow-up studies about the potential impact of presurgery experiences on later experiences of living with breast cancer and intervention studies are needed.

The impact of optimism on anxiety, depression and quality of life in urogenital cancer patients

OBJECTIVE

The purpose of the present study was to examine the relationship between optimism and anxiety, depression and health-related quality of life (HRQOL). A further aim was to investigate the predictive value of optimism for anxiety, depression and HRQOL, quantified with and without controlling the corresponding base level.

METHODS

A total of 427 urogenital cancer patients were asked to complete the Life Orientation Test (LOT), the Hospital Anxiety and Depression Scale (HADS) and the health survey SF-8 during their stay in the hospital (T1), two weeks later (T2) and three months later.

RESULTS

Finally, 275 patients (64.4%) completed all questionnaires. Optimism at T1 was significantly associated with anxiety (r=-0.35), depression (r=-0.41) and HRQOL (physical: r=0.29; mental: r=0.27) and can predict outcome variables three months later. After controlling for the base levels of anxiety, depression and HRQOL, the predictive value of optimism remained significant but small. The incrementally variance explained by the LOT varied between 2.1% in anxiety and 8.2% in physical HRQOL.

CONCLUSION

Especially patients with a low level of optimism and a high level of pessimism are at risk for higher levels of anxiety and depression in addition to lowered HRQOL.

Pessimism predicts anxiety, depression and quality of life in female cancer patients

OBJECTIVE

The aim of this study was to investigate the predictive value of optimism/pessimism for anxiety, depression and health-related quality of life in female cancer patients, quantified with and without controlling the corresponding base level.

METHODS

A total of 97 women with breast cancer and other gynaecological cancer completed the Life Orientation Test, the Hospital Anxiety and Depression Scale and the Health Survey SF-8 at three time points: during their stay in the hospital (T1), 2 weeks later (T2) and 3 months later (T3).

RESULTS

The degree of self-assessed pessimism at T1 was significantly associated with anxiety, depression and health-related quality of life at T3. After controlling for the base levels of anxiety, depression and health-related quality of life, only the predictive value of pessimism remained significant and substantial.

CONCLUSIONS

Especially, women with a high level of pessimism are at risk for higher levels of anxiety and depression in addition to lowered health-related quality of life in the course of the disease. The results indicate that it seems to be more important not to be pessimistic than to be optimistic.

Psychological factors associated with poor sleep prior to breast surgery: an exploratory study

This study explored the relationship between psychological factors (including intrusive thoughts, anxiety, well-being, depressed mood) and poor sleep the night before surgery. Patients (N = 39) scheduled for breast surgery (mean age = 47 years) wore an actiwatch at home the night before surgery to provide an objective indication of sleep duration and sleep efficiency. Participants also completed 3 measures of their psychological experience during the week prior to surgery. In separate regression analyses, intrusive thoughts, anxiety, and emotional well-being were each related to sleep duration the night before surgery, when controlling for age, body mass index, ethnicity, and marital status. No relationships were found between depressed mood, physical or social well-being, and sleep duration. In a multiple regression model that included all significant variables, intrusive thoughts were most strongly associated with sleep duration. Intrusive thoughts were also significantly related to sleep efficiency. Results suggest that patients' intrusions about impending surgery are associated with lower sleep duration and sleep efficiency the night before surgery. Additional research is warranted to explore the implications of these associations for patients, as well as possible interventions to improve sleep in this clinical setting.

Presurgery psychological factors predict pain, nausea, and fatigue one week after breast cancer surgery

Before scheduled surgery, breast cancer surgical patients frequently experience high levels of distress and expect a variety of postsurgery symptoms. Previous literature has supported the view that presurgery distress and response expectancies are predictive of postsurgery outcomes. However, the contributions of distress and response expectancies to postsurgical side effect outcomes have rarely been examined together within the same study. Furthermore, studies on the effects of response expectancies in the surgical setting have typically focused on the immediate postsurgical setting rather than the longer-term setting. The purpose of the present study was to test the contribution of presurgery distress and response expectancies to common postsurgery side effects (pain, nausea, and fatigue). Female patients (n=101) undergoing breast cancer surgery were recruited to a prospective study. Results indicated that presurgery distress uniquely contributed to patients' postsurgery pain severity (P<0.05) and fatigue (P<0.003) one week after surgery. Response expectancies uniquely contributed to pain severity (P<0.001), nausea (P<0.012), and fatigue (P<0.010) one week after surgery. Sobel tests indicated that response expectancies partially mediated the effects of distress on pain severity (P<0.03) and fatigue (P<0.03). Response expectancies also mediated the effects of age on pain severity, nausea, and fatigue. Results highlight the contribution of presurgery psychological factors to postsurgery side effects, the importance of including both emotional and cognitive factors within studies as predictors of postsurgery side effects, and suggest presurgical clinical targets for improving patients' postoperative experiences of side effects.

Anxiety in patients with breast cancer undergoing treatment: a systematic review

BACKGROUND

Breast cancer is one of the most common cancers worldwide, and anxiety is a psychological morbidity that is inevitable. Many researchers have investigated its prevalence and detrimental effects, yet little is known when comparing the different breast cancer treatments. A systematic review of all available literature was indicated to encourage better understanding of anxiety in patients undergoing treatment for breast cancer.

OBJECTIVES

This review aimed to determine the best available evidence on the level of anxiety among women with breast cancer undergoing/had undergone cancer treatment(s), and factor(s) contributing to anxiety in these treatment modalities.

INCLUSION CRITERIA

Types of participants Women with breast cancer of stage 0 to stage IIIA breast cancer, over and equal to 21 and below the age of 65 years of age.Types of intervention Women who were undergoing/had undergone cancer treatment restricted to chemotherapy, radiotherapy, surgery or combined treatments, and were without other medical co morbidities.Types of outcomes A variety of outcome measures were used to assess anxiety in the included papers. Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory were mostly used.Types of studies This review considered quantitative papers (randomized control trials, descriptive studies and systematic review) that fulfilled both requirements: SEARCH STRATEGY: The search sought to gather data from published and unpublished studies conducted between 1990 and 2010. An initial search on CINAHL and Medline was done to identify relevant search terms. A search strategy was then developed, using MeSH headings and keywords. Following databases were searched: CINAHL; PubMed; ScienceDirect; PsycINFO; Cochrane Database of Systematic Review; Scopus; Wiley Interscience and PsycARTICLES.

DATA COLLECTION/EXTRACTION

Two reviewers independently assessed the eligibility of the papers for inclusion. Eighteen papers were selected based on relevance, and underwent assessment for methodological quality using MAStARI. Eleven research papers that met the level of methodological standard were included into the review. Both reviewers came to the same consensus on the included and excluded papers.

DATA ANALYSIS

Due to the methodological heterogeneity of the included papers, a meta-analysis was not possible. The studies were hence presented in narrative summary.

RESULTS

Anxiety seems to be ubiquitous, presenting itself in all treatment types for breast cancer. Anxiety level in breast cancer women who underwent chemotherapy was highest before the first chemotherapy infusion, mediated by age and trait anxiety. Radiotherapy regimes did not affect anxiety level in radiotherapy-treated patients, and most research concluded that anxiety level was higher among women who underwent mastectomy than breast conservation therapy. When compared, patients who underwent chemotherapy were more anxious.

CONCLUSIONS

The prevalence and intensity of anxiety has been shown to be pronounced among the three treatments. Chemotherapy, as compared to other treatments, has shown to be associated with a higher anxiety level.

IMPLICATIONS FOR RESEARCH

With the prevalence, intensity and correlated factors of anxiety identified through this review, future research may investigate the interventions that could help alleviate anxiety among these patients.

IMPLICATIONS FOR PRACTICE

Anxiety is prevalent in women with breast cancer undergoing treatment, especially those undergoing chemotherapy. Healthcare professionals should pay greater attention to identify cues of anxiety in patients and prevent/alleviate it.

A randomized trial of a cognitive-behavioral therapy and hypnosis intervention on positive and negative affect during breast cancer radiotherapy

Breast cancer radiotherapy can be an emotionally difficult experience. Despite this, few studies have examined the effectiveness of psychological interventions to reduce negative affect, and none to date have explicitly examined interventions to improve positive affect among breast cancer radiotherapy patients. The present study examined the effectiveness of a multimodal psychotherapeutic approach, combining cognitive-behavioral therapy and hypnosis (CBTH), to reduce negative affect and increase positive affect in 40 women undergoing breast cancer radiotherapy. Participants were randomly assigned to receive either CBTH or standard care. Participants completed weekly self-report measures of positive and negative affect. Repeated and univariate analyses of variance revealed that the CBTH approach reduced levels of negative affect [F(1, 38)=13.49; p=.0007, omega(2)=.56], and increased levels of positive affect [F(1, 38)=9.67; p=.0035, omega(2)=.48], during the course of radiotherapy. Additionally, relative to the control group, the CBTH group demonstrated significantly more intense positive affect [F(1, 38)=7.09; p=.0113, d=.71] and significantly less intense negative affect [F(1, 38)=10.30; p=.0027, d=.90] during radiotherapy. The CBTH group also had a significantly higher frequency of days where positive affect was greater than negative affect (85% of days assessed for the CBTH group versus 43% of the Control group) [F(1, 38)=18.16; p=.0001, d=1.16]. Therefore, the CBTH intervention has the potential to improve the affective experience of women undergoing breast cancer radiotherapy.

Determinants of fatigue 6 and 12 months after surgery in women with early-stage breast cancer: a comparison with women with benign breast problems

OBJECTIVE

The objective of this study was to examine the predictors of fatigue 6 and 12 months after surgical treatment in women with early-stage breast cancer (BC group) and in women with benign breast problems (BBP group) in a prospective follow-up study.

METHODS

Women entered the study prior to diagnosis and completed questionnaires on personality factors, psychological factors, and social support. Fatigue was assessed 6 and 12 months after diagnosis (BBP group) or surgical treatment (BC group). Clinical data were taken from medical records.

RESULTS

In the BC group (n=117), fatigue at 6 months was predicted by trait anxiety (P<.001) and extraversion (P<.05). Trait anxiety (P<.05), extraversion (P<.05), and depressive symptoms (P<.05) predicted fatigue at 12 months. In the BBP group (n=190), the predictors were trait anxiety (P<.001) for fatigue at 6 months, and trait anxiety (P<.001) and neuroticism (P<.01) for fatigue at 12 months.

CONCLUSION

Many patients who are already fatigued before diagnosis remain tired regardless of diagnosis. Trait anxiety is strongly related to fatigue in both groups.

Anticipatory psychological distress in women scheduled for diagnostic and curative breast cancer surgery

BACKGROUND

Psychological distress is a central experience for women facing diagnostic and curative breast cancer surgery.

PURPOSE

The present study was designed to predict anticipatory distress in 187 women scheduled to undergo excisional breast biopsy or lumpectomy.

METHOD

Participants completed questionnaires assessing emotional distress and predictors of this distress (surgery type, worry about the surgical procedure, and worry about what the surgeon will find).

RESULTS

The study found that lumpectomy patients experienced greater anticipatory distress than excisional breast biopsy patients on three of the four distress measures (all ps < 0.05) and that worry about what the surgeon might find partially mediated these effects.

CONCLUSION

The results suggest that although women awaiting lumpectomy are more distressed than women awaiting biopsy, both groups report substantial distress, and, consequently, psychosocial interventions are recommended for both groups.

The Predictive Validity of Optimism and Affectivity in a Longitudinal Study of Older Adults

The current study tested the independence of dispositional optimism and pessimism from negative and positive affectivity in the prediction of older adults' well-being, concurrently and five years later, using structural equation modeling. As hypothesized, in a community sample, both optimism/pessimism and affectivity were correlated cross-sectionally and prospectively with outcomes representing general health and well-being (self-rated health, somatic depression and life satisfaction). However, with both sets of predictors in the model, affectivity eliminated the relationships of optimism/pessimism with the outcomes. Our proposed explanation for these findings, derived from the theoretical self-regulation model, also explains the seemingly contradictory previous findings of an independent contribution of dispositional optimism in patient samples coping with specific stressors.

Hypnosis decreases presurgical distress in excisional breast biopsy patients

BACKGROUND

Excisional breast biopsy is associated with presurgical psychological distress. Such distress is emotionally taxing, and may have negative implications for postsurgical side effects and satisfaction with anesthesia. We investigated the ability of a brief hypnosis session to reduce presurgical psychological distress in excisional breast biopsy patients.

METHODS

Ninety patients presenting for excisional breast biopsy were randomly assigned to receive either a 15-minute presurgery hypnosis session (n = 49, mean age: 46.4 (95% CI: 42.3-50.4)) or a 15-minute presurgery attention control session (n = 41, mean age: 45.0 (95% CI: 40.8-49.2)). The hypnosis session involved suggestions for increased relaxation and decreased distress. The attention control session involved nondirective empathic listening. Presurgery distress was measured using visual analog scales (VAS) and the short version of the Profile of Mood States (SV-POMS). Data were analyzed using analysis of variance and chi2 procedures.

RESULTS

Groups did not differ in terms of the following: demographics (age, education, ethnicity, marital status, all P's > 0.28); medical variables (presurgery diagnosis, previous excisional biopsy, previous breast cancer, all P's > 0.11); or preintervention distress (SV-POMS P > 0.74) assessed on the day of surgery. Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS emotional upset (16.5 vs 38.2, P < 0.0001, d = .85), VAS depressed mood (6.6 vs 19.9, P < 0.02, d = .67), and SV-POMS anxiety (10.0 vs 5.0, P < 0.0001, d = 0.85); and significantly higher levels for VAS relaxation (75.7 vs 54.2, P < 0.001, d = -0.76) than attention controls.

CONCLUSIONS

The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical distress in women awaiting diagnostic breast cancer surgery.

Social Support, Optimism, and Self-Efficacy Predict Physical and Emotional Well-Being After Bone Marrow Transplantation

This study examined whether three psychosocial variables (social support, self-efficacy, and optimism) assessed prior to bone marrow transplantation (BMT) predicted physical and emotional wellbeing one year post-BMT. Data were gathered on 87 participants enrolled in a multicenter, randomized trial examining the impact of ex-vivo T-cell depletion on disease-free survival in leukemia patients receiving allogeneic BMT. Social support, optimism, and self-efficacy significantly predicted emotional and physical well-being one year post-BMT, controlling for age, gender, maximum grade of acute GVHD, and treatment arm. Attention to psychosocial factors prior to BMT and during recovery appears critical for physical and mental well-being, especially considering the influence of psychosocial variables independent of medical risk factors.

Impaired natural killer cell lysis in breast cancer patients with high levels of psychological stress is associated with altered expression of killer immunoglobin-like receptors

BACKGROUND

We previously reported that cancer-related psychological stress is associated with reduced natural killer (NK) cell lysis. We hypothesized that reduced NK cell cytotoxicity in patients with increased levels of stress would correlate with alterations in the expression of inhibitory NK cell receptors (killer immunoglobulin-like receptors, or KIRs). The specific aim of this study was to examine KIR expression in patients with high or low levels of psychologic stress and correlate alterations in KIR expression with NK cell function.

MATERIALS AND METHODS

Two hundred twenty-seven patients underwent baseline evaluation of cancer-related psychological stress and were randomized to psychosocial intervention versus observation. From this population, two groups were defined based on pretreatment measurements of NK lytic activity, stress levels, and the availability of cryopreserved peripheral blood mononuclear cells (PBMC). Group I (n=9) had low stress by the Impact of Events Scale (IES), and high NK cell lysis at the 50:1 effector: target ratio (NK(50)=52-89%). Group II (n=8) had high stress and low NK(50) (27-52%). Lymphokine activated killer (LAK) activity, antibody dependent cellular cytotoxicity (ADCC), and expression of cytokine receptors, adhesion molecules, and killer immunoglobulin-like receptors (KIRs) were assessed in PBMC.

RESULTS

Incubation of PBMC with NK-stimulatory cytokines (IL-2, IL-12, or IL-15) led to significant increases in cytotoxic activity regardless of IES/NK(50) scores. There were no significant group differences in NK cell surface expression of the IL-2 receptor components CD25 and CD122, antibody-dependent lysis of HER2/neu-positive SKBr3 cells treated with an anti-HER2/neu monoclonal antibody, expression of adhesion molecules (CD2, CD11a, CD18) and markers of activation (CD69), or expression of the KIRs CD158a, NKG2a, NKB1, and CD161. However, levels of CD158b were significantly higher in Group I after incubation in media alone or with IL-2, and CD94 expression was significantly lower in Group I after incubation with IL-2.

CONCLUSIONS

In this study of a small subset of breast cancer patients chosen from a previous clinical trial of psychosocial intervention for breast cancer, impaired NK lysis in breast cancer patients with high levels of psychological stress was associated with alterations in surface expression of killer immunoglobulin-like receptors. However, immune effectors retained the ability to lyse antibody-coated targets and to initiate lymphokine-activated killer activity, irrespective of stress levels or baseline NK(50).

Predictors of expectancies for post-surgical pain and fatigue in breast cancer surgical patients

Expectancies for post-surgical pain and fatigue have previously been found to predict pain and fatigue among breast cancer surgery patients. However, the study of predictors of these expectancies has been neglected. The present study was designed to investigate predictors of expectancies for post-surgical pain and fatigue among breast cancer surgery patients.Four hundred and eighteen women (M = 48.3 years, SD = 13.66 years) scheduled to undergo excisional breast biopsy or lumpectomy completed questionnaires assessing demographics/medical history, pre-surgical distress, stable personality characteristics, pre-surgical pain and fatigue, and expectancies for post-surgical pain and fatigue.Path analysis revealed: expectancies for post-surgical pain were significantly predicted by trait anxiety, acute pre-surgical distress, and age; and expectancies for post-surgical fatigue were significantly predicted by acute pre-surgical distress, acute pre-surgical fatigue, previous experience with the same surgical procedure, and education (all ps < .05). Examination of an alternative model revealed that the effects of the aforementioned predictors on expectancies were not mediated by acute pre-surgical distress, clarifying the directionality of the distress-expectancy relationship.Expectancies for post-surgical pain and fatigue are influenced by distress, treatment history, stable personality characteristics, extant symptoms, and demographic factors. These variables should be considered in designing clinical interventions to manipulate expectancies for patient benefit.

Interdependent anxiety and psychological distress in women with breast cancer and their partners

The purpose of this study was to determine the extent of interdependence on anxiety within dyads where one person was undergoing treatment for breast cancer. Perceptions of relationship quality were expected to mitigate the anxiety experienced by both members of the dyad. 96 dyads participated in a 3-wave longitudinal study that took place over 10 weeks. Dyads were composed of a woman with stage I-III breast cancer who was currently undergoing treatment, and a partner who she nominated to participate in the study along with her. Results indicated that anxiety felt by women with breast cancer was consistently associated with that of her partner. Structural equation analyses suggest that the within-dyad influence runs mostly from partners' anxiety to the anxiety of women with breast cancer. Partners' anxiety was also associated with other indicators of the women's well being including depression, fatigue, and symptom management. Perceptions of relationship quality from women with breast cancer and their partners were negatively associated with partners' anxiety. However, women's anxiety was only correlated with their partners', but not their own, perceptions of relationship quality. These findings underscore the benefit of having partners who are able to cope with or get help for their own personal distress as women cope with the stress of breast cancer and its treatment.

Psychologic stress, reduced NK cell activity, and cytokine dysregulation in women experiencing diagnostic breast biopsy

The purpose of this study was to evaluate a woman's psychological and immunological response to breast biopsy before and after the procedure. Women were enrolled into the study when notified of the need for breast biopsy. Psychological and immunological assessments were made at enrollment, on the day of breast biopsy, as well as 1 month and 4 months after notification of biopsy results. Psychological assessments demonstrated that perceived stress, anxiety, and mood disturbance were heightened before biopsy and remained elevated after biopsy regardless of the diagnosis. Immunologically, the women exhibited reduced natural killer cell activity and INF gamma production before biopsy with reductions significant 1 month after the procedure. In contrast, IL-4, IL-6, and IL-10 production were increased before and after the procedure with most significant increases prior to the procedure and continuing 1 month after the procedure. These results demonstrate that undergoing biopsy of the breast for cancer diagnosis is an emotional experience, characterized by increased perceived stress, anxiety, and mood disturbance. This emotional distress is accompanied by reduced NK cell activity and cytokine dysregulation. The psychological and immunological impact of breast biopsy is not transient, but persists well beyond the actual experience of the biopsy procedure. Noteworthy is the observation that women with benign or malignant biopsy results experienced similar psycho-immune consequences. Hence, these observations are of relevance not only to women diagnosed with malignancy, who face the challenges of cancer treatment and adaptation to illness, but also to women with benign biopsy findings.

Factors that influence cancer patients' anxiety following a medical consultation: impact of a communication skills training programme for physicians

BACKGROUND

No study has yet assessed the impact of physicians' skills acquisition after a communication skills training programme on the evolution of patients' anxiety following a medical consultation. This study aimed to compare the impact, on patients' anxiety, of a basic communication skills training programme (BT) and the same programme consolidated by consolidation workshops (CW), and to investigate physicians' communication variables associated with patients' anxiety.

PATIENTS AND METHODS

Physicians, after attending the BT, were randomly assigned to CW or to a waiting list. The control group was not a non-intervention group. Consultations with a cancer patient were recorded. Patients' anxiety was assessed with the State Trait Anxiety Inventory before and after a consultation. Communication skills were analysed according to the Cancer Research Campaign Workshop Evaluation Manual.

RESULTS

No statistically significant change over time and between groups was observed. Mixed-effects modelling showed that a decrease in patients' anxiety was linked with screening questions (P = 0.045), physicians' satisfaction about support given (P = 0.004) and with patients' distress (P < 0.001). An increase in anxiety was linked with breaking bad news (P = 0.050) and with supportive skills (P = 0.013). No impact of the training programme was observed.

CONCLUSIONS

This study shows the influence of some communication skills on the evolution of patients' anxiety. Physicians should be aware of these influences.

Optimism, distress, health-related quality of life, and change in cancer antigen 125 among patients with ovarian cancer undergoing chemotherapy

OBJECTIVE

This study investigated whether situational and dispositional optimism were protective against dimensions of distress and aspects of health-related quality of life (HQoL) in patients with ovarian cancer undergoing chemotherapy. This study also evaluated whether optimism predicted a decrease in cancer antigen (CA) 125 levels during treatment.

METHODS

Ninety women with epithelial ovarian cancer were assessed at the start and end of chemotherapy. Optimism, distress, and HQoL were measured by self-report; CA 125 levels were gathered from patients' medical charts.

RESULTS

Both measures of optimism were inversely associated with baseline anxiety, perceived stress, and depression. In addition, situational optimism was positively associated with baseline social and physical well-being, and dispositional optimism was positively associated with baseline social and functional well-being. However, neither measure of optimism predicted domains of distress or HQoL at the follow-up assessment after controlling for baseline levels. Dispositional optimism predicted CA 125 at the end of treatment after controlling for baseline levels. However, neither situational nor dispositional optimism predicted CA 125 falling to normal levels (< or =35 U/mL).

CONCLUSION

Consistent with prior research, optimism was inversely associated with distress and positively associated with HQoL in patients with ovarian cancer undergoing chemotherapy. Higher levels of dispositional optimism at the start of chemotherapy were associated with a greater decline in patients' CA 125 during treatment.

Cognitive Behavioral Therapy Techniques for Distress and Pain in Breast Cancer Patients: A Meta-Analysis

This meta-analysis is the first to examine cognitive behavioral therapy (CBT) techniques for distress and pain specifically in breast cancer patients. Twenty studies that used CBT techniques with breast cancer patients were identified and effect sizes were calculated to determine (1) whether CBT techniques have a significant impact on distress and pain, (2) if individual or group treatments are more effective, (3) whether severity of cancer diagnosis influences distress and pain outcomes, and, (4) if there is a relationship between CBT technique efficacy for distress and pain. Results revealed effect sizes of d = 0.31 for distress (p < 0.05) and .49 for pain (p < 0.05), indicating that 62 and 69% of breast cancer patients in the CBT techniques treatment groups had less distress and less pain (respectively) relative to the control groups. Studies with individual treatment approaches had significantly larger effects compared to studies that employed group approaches for distress (p = 0.04), but not for pain (p > 0.05). There were no significant differences in effects between those with or without metastases (p > 0.05). The correlation between effect sizes for distress and pain was not significant (p = 0.07). Overall, the results support the use of CBT techniques administered individually to manage distress and pain in breast cancer patients. However, more well-designed studies are needed.

Relations between coping responses and optimism-pessimism in predicting anticipatory psychological distress in surgical breast cancer patients

Individual differences in characteristics such as optimism, pessimism, and coping responses have been shown to contribute to variability in distress during stressful situations. However, the interrelationships among these characteristics are not well established. The purpose of this study was to investigate the interrelations among optimism, pessimism, and coping in predicting distress levels among patients scheduled for surgery related to breast cancer. Sixty surgical patients (mean age = 52; SD = 12.21) completed the Brief Cope and the Life Orientation Test as a part of a presurgery take-home packet. Distress was measured with the Profile of Mood States in the waiting area, just prior to surgery. Results revealed that optimism and pessimism were directly related to distress levels prior to surgery (p < 0.05). Coping responses also were related to distress (p < 0.05); however, these effects appeared to be largely mediated by optimism and pessimism.

Presurgery distress and specific response expectancies predict postsurgery outcomes in surgery patients confronting breast cancer

Prior to scheduled surgery, patients frequently experience particularly high levels of distress and expect a variety of postsurgery symptoms. Surgery patients who confront breast cancer are no exception. It has been suggested that such presurgery distress and response expectancies are predictive of postsurgery outcomes. To test the contribution of presurgery distress and expectancies to common postsurgery symptom outcomes (pain, nausea, fatigue, and discomfort), 63 female patients undergoing breast cancer surgery were recruited to a prospective study. Results indicated that presurgery distress uniquely contributed to patients' postsurgery nausea, fatigue, and discomfort; specific expectancies uniquely contributed to pain intensity, pain unpleasantness, and fatigue (ps < .05). Consistent with expectancy theory, associations between response expectancies and postsurgery outcomes were not due to presurgery distress.