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Wen A, Metts AV, Zinbarg RE, Mineka S, Craske MG. Tri-level anxiety and depression symptom trajectory in adolescents: The role of emotion regulation diversity. J Anxiety Disord 2025; 109:102941. [PMID: 39700826 DOI: 10.1016/j.janxdis.2024.102941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/21/2024] [Accepted: 11/10/2024] [Indexed: 12/21/2024]
Abstract
Anxiety and depression are associated with impaired emotion regulation (ER). Recently, a novel construct named ER diversity has been proposed to assess the diversity in ER strategy use. Low ER diversity, particularly under stressful circumstances, may be a transdiagnostic vulnerability factor for anxiety and depression. This study utilized a longitudinal design to examine the association between ER diversity and transdiagnostic anxiety and depressive symptom trajectory in adolescents (N = 627 at baseline), while accounting for life stress. Measures of ER strategy use, chronic interpersonal life stress, neuroticism, and transdiagnostic dimensional symptoms of anxiety and depression were assessed. The ER diversity index and the traditional ER sum score were computed. Higher ER diversity index was associated with steeper decline in the Fears symptom factor over time, above and beyond the ER sum score and neuroticism. Moreover, chronic interpersonal life stress influenced these associations. When chronic interpersonal life stress was low, Fears declined over time regardless of the ER diversity level; when chronic interpersonal life stress was high, Fears only declined when ER diversity was high. Thus, low diversity in ER strategy use, particularly under stressful circumstances, may be a vulnerability factor for fear symptom development.
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Affiliation(s)
- Alainna Wen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - Allison V Metts
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095, USA
| | - Richard E Zinbarg
- Department of Psychology, Northwestern University, Swift Hall 102, 2029 Sheridan Road, Evanston, IL 60208, USA; The Family Institute, Northwestern University, 618 Library Place, Evanston, IL 60201, USA
| | - Susan Mineka
- Department of Psychology, Northwestern University, Swift Hall 102, 2029 Sheridan Road, Evanston, IL 60208, USA
| | - Michelle G Craske
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA; Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095, USA
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2
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Goldman CM, Chuning AE, Lane RD, Smith R, Weihs KL. Emotional awareness amplifies affective sensitivity to social support for women with breast cancer. J Health Psychol 2024:13591053241291018. [PMID: 39449575 DOI: 10.1177/13591053241291018] [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: 10/26/2024] Open
Abstract
Emotional awareness (EA) is thought to facilitate psychological health by aiding emotion regulation in oneself and garnering social support from others. This study tested these potential relationships within a one-year longitudinal study of 460 women (age 23-91 years, mean 56.4 years) recently diagnosed with breast cancer (i.e., within four months). The women completed measures of emotional awareness, social support, social stress, affective symptoms, and well-being. Linear models tested EA as a moderator of social support and stress on affective symptoms and well-being. In those with higher EA, low social support was associated with greater depression and lower optimism. There was some evidence that higher EA predicted greater depression at baseline but lower depression at nine-month follow-up. These results support the idea that EA increases sensitivity to available social support and facilitates emotional adjustment over time, suggesting that assessment of EA could help guide clinicians in identifying those at greatest risk of adverse mental health outcomes in this population.
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Affiliation(s)
| | - Anne E Chuning
- University of Kansas Medical Center, USA
- Center for Children's Healthy Lifestyles & Nutrition, USA
| | | | - Ryan Smith
- Laureate Institute for Brain Research, USA
- University of Tulsa, USA
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Gomes M, Silva ER, Salgado J. Focusing with colorectal cancer patients: a pilot study of a brief online group intervention. Front Psychol 2024; 15:1339823. [PMID: 39176044 PMCID: PMC11339957 DOI: 10.3389/fpsyg.2024.1339823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 07/22/2024] [Indexed: 08/24/2024] Open
Abstract
Introduction Focusing-Oriented Psychotherapy has had a long history and influence on the field of psychotherapy. By "clearing a space" and "focusing," individuals can enhance their emotional awareness and improve their ability to self-regulate. These tasks are particularly relevant in the context of Psycho-Oncology, although the research on their potential benefits for cancer patients is limited. Furthermore, the application of these tasks in a group or online setting has not been thoroughly explored. Methods This study aimed to examine the effectiveness of a two-session online intervention based on Focusing for cancer-diagnosed participants and its impact on their mental health and wellbeing. The study involved three participants with a diagnosis of colorectal cancer who were undergoing palliative treatment. We used both qualitative and quantitative methods. PFC-2 was used to assess participants' accomplishment of the task; FMS was used to assess the change in the focusing attitude, while CORE-OM, and PWBS-RV were used as mental health distress and psychological wellbeing measures; participant feedback was collected through questionnaires and a semi-structured interview. Results The results suggest that the tasks led to greater self-awareness, heightened self-reflection, and a sense of relief for the participants. Discussion These findings suggest that the group intervention protocol based on online Focusing sessions is potentially useful for broader applications.
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Affiliation(s)
- Marta Gomes
- Department of Social and Behavioural Sciences, University of Maia, Maia, Portugal
- Center for Psychology, University of Porto, Porto, Portugal
| | - Eunice R. Silva
- Portuguese Institute of Oncology of Porto Francisco Gentil, EPE, Porto, Portugal
| | - João Salgado
- Department of Social and Behavioural Sciences, University of Maia, Maia, Portugal
- Center for Psychology, University of Porto, Porto, Portugal
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Suskin JA, Paul SM, Stuckey AR, Conley YP, Levine JD, Hammer MJ, Miaskowski C, Dunn LB. Trajectories of Depressive Symptoms Among Patients Undergoing Chemotherapy for Breast, Gastrointestinal, Gynecological, or Lung Cancer. Cancer Nurs 2024:00002820-990000000-00278. [PMID: 39106444 DOI: 10.1097/ncc.0000000000001380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
BACKGROUND Individuals who undergo chemotherapy for cancer are at elevated risk of developing depressive symptoms, yet substantial interindividual variation exists in trajectories of these symptoms. OBJECTIVE To examine interindividual variations in trajectories of depressive symptoms during 2 cycles of chemotherapy and to evaluate associations between demographic and clinical characteristics, symptom severity scores, psychological adjustment characteristics (eg, stress and coping), and initial levels and trajectories of depressive symptoms. METHODS Patients (n = 1323) diagnosed with breast, gynecologic, lung, or gastrointestinal cancer completed the Center for Epidemiological Studies-Depression Scale 6 times, over 2 cycles of chemotherapy. At enrollment, patients provided demographic information and completed a broad range of symptom, stress, and coping measures. Hierarchical linear modeling was used to identify characteristics associated with initial levels and trajectories of depressive symptoms. RESULTS Interindividual differences in initial levels of depressive symptoms were associated with marital status, functional status, level of comorbidity, chemotherapy toxicity, sleep disturbance, morning fatigue, cognitive function, global and cancer-related stress, and coping characteristics (ie, sense of coherence, venting, behavioral disengagement, and self-blame). Interindividual differences in depression trajectories were associated with education, cancer type, chemotherapy toxicity, sleep disturbance, evening energy, evening fatigue, cognitive function, global and cancer-related stress, and self-blame. CONCLUSIONS We present new findings concerning the trajectories and predictors of depressive symptoms during chemotherapy. IMPLICATIONS FOR PRACTICE Modifiable risk factors (eg, stress and coping) are important targets for intervening to address depressive symptoms in oncology patients.
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Affiliation(s)
- Johanna A Suskin
- Author Affiliations: Mount Sinai-West, Icahn School of Medicine at Mount Sinai, New York (Dr Suskin); University of California, San Francisco (Drs Paul, Levine, and Miaskowski); Brown University, The Warren Alpert Medical School, Providence, Rhode Island (Dr Stuckey); University of Pittsburgh, School of Nursing, Pennsylvania (Dr Conley); Dana-Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); University of Arkansas for Medical Sciences, Little Rock (Dr Dunn)
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Pfeifer VA, Weihs KL, Lai VT. Narratives about Cancer: What Metaphors can tell us about Depressive Symptoms in Breast Cancer Patients. HEALTH COMMUNICATION 2024; 39:1888-1898. [PMID: 37559183 PMCID: PMC10853478 DOI: 10.1080/10410236.2023.2245989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Metaphors are pervasive in cancer discourse. However, little is known about how metaphor use develops over time within the same patient, and how metaphor use and its content relate to the mental health of the patient. Here, we analyzed metaphor use in personal essays written by breast cancer patients shortly after the time of diagnosis and nine months later, in relation to their depressive symptoms at both time points. Results show that metaphor use can provide important insight into a patient's current mental state. Specifically, patients who had no change in their depressive symptom levels used metaphors more densely after nine months. In addition, metaphor valence in the later essay was associated with depressive symptoms at study entry and nine months after. Lastly, we observed a shift in metaphor reference pattern for different symptom trajectories, such that those who recovered from initially elevated depressive symptoms used fewer self-referencing metaphors and more cancer-referencing metaphors in their later essay. Our work suggests that metaphor use reflects how a patient is coping with their diagnosis.
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Affiliation(s)
| | - Karen L. Weihs
- Psychiatry, University of Arizona Cancer Center, Tucson, AZ
| | - Vicky T. Lai
- Psychology Department, University of Arizona, Tucson, AZ
- Cognitive Science Program, University of Arizona, Tucson, AZ
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Senger AR, G Ratcliff C, K Semelsberger R, Chaoul A, Cohen L. The Role of Coping and Posttraumatic Stress in Fostering Posttraumatic Growth and Quality of Life Among Women with Breast Cancer. J Clin Psychol Med Settings 2024; 31:368-378. [PMID: 37803095 DOI: 10.1007/s10880-023-09977-x] [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] [Accepted: 09/07/2023] [Indexed: 10/08/2023]
Abstract
Tedeschi & Calhoun's model of posttraumatic growth (PTG) suggests that intrusive thoughts about a traumatic event, in combination with helpful coping strategies, facilitates PTG. This manuscript applies this model to a sample of breast cancer survivors, augments it to conceptualize coping strategies as "active" or "avoidant," and extends it to include health-related quality of life (HRQOL). This is a secondary analysis of a subset of breast cancer patients (N = 123) in a randomized clinical trial of Tibetan yoga, which examines the associations of coping at study entry with PTG, PTSS (i.e., intrusive thoughts and avoidance), and HRQOL (physical (PCS) and mental (MCS) component scales) reported 9 and 15 months later. Mediation analyses revealed that higher baseline active coping predicted higher 9-month PTG, which in turn predicted higher 15-month PCS [effect = .46, 95% CI (.06, 1.07)]. Exploratory moderated mediation analyses revealed that higher baseline intrusive thoughts about cancer predicted lower 9-month PTG, which in turn predicted lower 15-month PCS, but only for those reporting low active coping [effect = - .06, 95% CI (- .16, - .003)]. Active coping may play a critical role of fostering PTG and improving subsequent HRQOL in the presence of rumination about cancer.
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Affiliation(s)
| | - Chelsea G Ratcliff
- Department of Psychology and Philosophy, Sam Houston State University, 1901 Avenue I, Suite 390, Huntsville, TX, 77341, USA.
- Baylor College of Medicine, Houston, TX, USA.
| | - Robin K Semelsberger
- Department of Psychology and Philosophy, Sam Houston State University, 1901 Avenue I, Suite 390, Huntsville, TX, 77341, USA
| | | | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Heidkamp P, Hiltrop K, Breidenbach C, Kowalski C, Pfaff H, Geiser F, Ernstmann N. Coping with breast cancer during medical and occupational rehabilitation: a qualitative study of strategies and contextual factors. BMC Womens Health 2024; 24:183. [PMID: 38504261 PMCID: PMC10949761 DOI: 10.1186/s12905-024-03012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
PURPOSE This study aimed to gain a deeper understanding of the coping processes of breast cancer survivors (BCSs) during medical and occupational rehabilitation after acute treatment. METHODS This study is part of the mixed-methods Breast Cancer Patients' Return to Work study conducted in Germany. Data were collected through semistructured interviews with 26 female BCSs 5-6 years after their diagnosis. A qualitative content analysis was conducted to investigate the coping strategies and contextual factors of coping of BCSs. RESULTS The participants used different strategies for coping with their breast cancer, namely, approach- versus avoidance-oriented coping and emotion- versus problem-focused coping. During the medical rehabilitation process, coping behavior was used mainly to address disease management and its consequences. During the occupational rehabilitation process, most coping strategies were used to overcome discrepancies between the patient's current work capacity and the job requirements. The contextual factors of coping were in the health, healthcare, work-related, and personal domains. CONCLUSION The study findings provide in-depth insights into the coping processes for BCSs during the rehabilitation phase and highlight the importance of survivorship care after acute cancer treatment. IMPLICATIONS FOR CANCER SURVIVORS The results indicate that BCSs employ approach- and avoidance-oriented strategies to cope with their cancer during rehabilitation. As both attempts are helpful in the short term to cope with physical and emotional consequences of the cancer, healthcare and psychosocial personnel should respect the coping strategies of BCSs while also being aware of the potential long-term negative impact of avoidance-oriented coping on the rehabilitation process.
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Affiliation(s)
- Paula Heidkamp
- University Hospital Bonn, Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, Bonn, Germany.
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany.
- University Hospital Bonn, Center for Integrated Oncology, Bonn, Germany.
| | - Kati Hiltrop
- University Hospital Bonn, Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, Bonn, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany
- University Hospital Bonn, Center for Integrated Oncology, Bonn, Germany
| | - Clara Breidenbach
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany
- German Cancer Society, Berlin, Germany
| | | | - Holger Pfaff
- University of Cologne, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, Cologne, Germany
| | - Franziska Geiser
- University Hospital Bonn, Department of Psychosomatic Medicine and Psychotherapy, Bonn, Germany
| | - Nicole Ernstmann
- University Hospital Bonn, Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, Bonn, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany
- University Hospital Bonn, Center for Integrated Oncology, Bonn, Germany
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8
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Hebi M, Czamanski-Cohen J, Azaiza F, Weihs KL. Values and their relationship with emotion processing and physical and psychological symptoms among Jewish and Arab breast cancer survivors. Front Psychol 2024; 14:1297377. [PMID: 38239457 PMCID: PMC10794551 DOI: 10.3389/fpsyg.2023.1297377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/23/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Individuals from different cultures differ in their values, which encompass belief systems that individuals develop based on their culture, and play a pivotal role in shaping their perspectives. These values may affect emotion processing (EP): the recognition, interpretation, expression and response to bodily sensations, translated as emotions. These varying values may contribute to distinct emotional experiences, impacting physical and psychological symptoms in breast cancer (BC) survivors. Methods This cross-sectional study investigated how EP including acceptance, expression (avoidance and approach coping), and awareness, may mediate the relationship between conservation values and symptoms of pain, fatigue, and depression among Arab (n = 62) and Jewish (n = 179) women BC survivors in Israel. Conservation values include tradition, conformity, and security. Results Depression and fatigue were negatively correlated with acceptance of emotions, and positively correlated with avoidance and conservation levels. Emotion processing mediated the relationship between conservation and fatigue and depression. Arab women reported higher levels of various values, emotional acceptance, pain, fatigue, and depression symptoms compared to Jewish women. Conservation was higher in Arab women and correlated with both approach and avoidance coping which was not the case in Jewish women. Avoidance coping had a positive relationship with fatigue in the Jewish, but not the Arab women. Similarly, approach coping was negatively related to depression in Jewish, but not in Arab women. Discussion Cultural differences are important for understanding the experience of cancer in individuals from different cultures. Future interventions for more conservative BC survivors should take culture into account.
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Affiliation(s)
- Maimounah Hebi
- The School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Johanna Czamanski-Cohen
- The School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Emili Sagol Creative Arts Therapies Research Center, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Faisal Azaiza
- The College of Sakhnin for Teacher Education, Sakhnin, Israel
| | - Karen L. Weihs
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
- Cancer Prevention and Control Program, University of Arizona Comprehensive Cancer Center, Tucson, AZ, United States
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Hoch MM, MacDonald JJ, Jorge-Miller A, McCannel TA, Beran TM, Stanton AL. Depression in Uveal Melanoma Survivorship: Examining Psychological Predictors of Adjustment in the First Year Following Diagnosis. Ann Behav Med 2023; 57:1081-1096. [PMID: 37874742 DOI: 10.1093/abm/kaad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND A rare cancer, uveal melanoma (UM) affects 5 in 1 million adults annually. Research on predictors of mental health in UM survivors is scarce. PURPOSE In this prospective study, we tested models that postulate interactions between illness perceptions and coping processes in predicting depressive symptoms 1 year following UM diagnosis. METHODS Participants' approach- and avoidance-oriented coping processes and illness perceptions specific to control and chronicity were assessed. Participants (N = 107) completed assessments prior to diagnosis (T0), and 1 week (T1), 3 months (T2), and 12 months after UM diagnosis (T3). RESULTS At T1, a significant avoidance coping × chronicity perception interaction (b = 1.84, p = .03) indicated that the link between higher avoidance coping and greater T3 depressive symptoms was stronger for participants with prolonged chronicity perceptions (b = 17.13, p < .001). Chronicity perceptions at T2 interacted significantly with approach-oriented coping at all time points; the link between higher approach coping and lower T3 depressive symptoms was stronger for participants with prolonged chronicity perceptions at T2. Interactions between control perceptions and coping did not significantly predict T3 depressive symptoms. CONCLUSIONS Findings lend partial support to predictive models that consider the combined, interacting influence of chronicity perceptions and coping processes on depressive symptoms in survivors of eye cancer.
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Affiliation(s)
- Megan M Hoch
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - James J MacDonald
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Tara A McCannel
- Department of Ophthalmology, Retina Division and Ocular Oncology Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tammy M Beran
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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Hecht K, Günther MP, Kirchebner J, Götz A, von Känel R, Schulze JB, Euler S. Predictive Factors Associated with Declining Psycho-Oncological Support in Patients with Cancer. Curr Oncol 2023; 30:9746-9759. [PMID: 37999127 PMCID: PMC10670809 DOI: 10.3390/curroncol30110707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023] Open
Abstract
(1) Background: International cancer treatment guidelines recommend low-threshold psycho-oncological support based on nurses' routine distress screening (e.g., via the distress thermometer and problem list). This study aims to explore factors which are associated with declining psycho-oncological support in order to increase nurses' efficiency in screening patients for psycho-oncological support needs. (2) Methods: Using machine learning, routinely recorded clinical data from 4064 patients was analyzed for predictors of patients declining psycho-oncological support. Cross validation and nested resampling were used to guard against model overfitting. (3) Results: The developed model detects patients who decline psycho-oncological support with a sensitivity of 89% (area under the cure of 79%, accuracy of 68.5%). Overall, older patients, patients with a lower score on the distress thermometer, fewer comorbidities, few physical problems, and those who do not feel sad, afraid, or worried refused psycho-oncological support. (4) Conclusions: Thus, current screening procedures seem worthy to be part of daily nursing routines in oncology, but nurses may need more time and training to rule out misconceptions of patients on psycho-oncological support.
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Affiliation(s)
- Karoline Hecht
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091 Zürich, Switzerland; (M.P.G.); (J.B.S.); (S.E.)
| | - Moritz Philipp Günther
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091 Zürich, Switzerland; (M.P.G.); (J.B.S.); (S.E.)
| | - Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland;
| | - Anna Götz
- Department of Hemato-Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland;
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091 Zürich, Switzerland; (M.P.G.); (J.B.S.); (S.E.)
| | - Jan Ben Schulze
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091 Zürich, Switzerland; (M.P.G.); (J.B.S.); (S.E.)
| | - Sebastian Euler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091 Zürich, Switzerland; (M.P.G.); (J.B.S.); (S.E.)
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11
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Karademas EC, Mylona E, Mazzocco K, Pat-Horenczyk R, Sousa B, Oliveira-Maia AJ, Oliveira J, Roziner I, Stamatakos G, Cardoso F, Kondylakis H, Kolokotroni E, Kourou K, Lemos R, Manica I, Manikis G, Marzorati C, Mattson J, Travado L, Tziraki-Segal C, Fotiadis D, Poikonen-Saksela P, Simos P. Well-being trajectories in breast cancer and their predictors: A machine-learning approach. Psychooncology 2023; 32:1762-1770. [PMID: 37830776 DOI: 10.1002/pon.6230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE This study aimed to describe distinct trajectories of anxiety/depression symptoms and overall health status/quality of life over a period of 18 months following a breast cancer diagnosis, and identify the medical, socio-demographic, lifestyle, and psychological factors that predict these trajectories. METHODS 474 females (mean age = 55.79 years) were enrolled in the first weeks after surgery or biopsy. Data from seven assessment points over 18 months, at 3-month intervals, were used. The two outcomes were assessed at all points. Potential predictors were assessed at baseline and the first follow-up. Machine-Learning techniques were used to detect latent patterns of change and identify the most important predictors. RESULTS Five trajectories were identified for each outcome: stably high, high with fluctuations, recovery, deteriorating/delayed response, and stably poor well-being (chronic distress). Psychological factors (i.e., negative affect, coping, sense of control, social support), age, and a few medical variables (e.g., symptoms, immune-related inflammation) predicted patients' participation in the delayed response and the chronic distress trajectories versus all other trajectories. CONCLUSIONS There is a strong possibility that resilience does not always reflect a stable response pattern, as there might be some interim fluctuations. The use of machine-learning techniques provides a unique opportunity for the identification of illness trajectories and a shortlist of major bio/behavioral predictors. This will facilitate the development of early interventions to prevent a significant deterioration in patient well-being.
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Affiliation(s)
- Evangelos C Karademas
- Department of Psychology, University of Crete, Rethymnon, Greece
- Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - Eugenia Mylona
- Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - Ketti Mazzocco
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Ruth Pat-Horenczyk
- School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Berta Sousa
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Jose Oliveira
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Ilan Roziner
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Georgios Stamatakos
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
| | | | - Eleni Kolokotroni
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | | | - Raquel Lemos
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
- ISPA-Instituto Universitário de Ciências Psicológicas, Sociais e da Vida, Lisboa, Portugal
| | - Isabel Manica
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
| | - George Manikis
- Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Johanna Mattson
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Luzia Travado
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
| | | | - Dimitris Fotiadis
- Foundation for Research and Technology-Hellas, Heraklion, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Paula Poikonen-Saksela
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Panagiotis Simos
- Foundation for Research and Technology-Hellas, Heraklion, Greece
- Medical School, University of Crete, Rethymnon, Greece
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12
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Simnacher F, Götz A, Kling S, Schulze JB, von Känel R, Euler S, Günther MP. A short screening tool identifying systemic barriers to distress screening in cancer care. Cancer Med 2023; 12:17313-17321. [PMID: 37439075 PMCID: PMC10501250 DOI: 10.1002/cam4.6331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 06/09/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION International guidelines on cancer treatment recommend screening for early detection and treatment of distress. However, screening rates are insufficient. In the present study, a survey was developed to assess perceived systemic barriers to distress screening. METHODS A three-step approach was used for the study. Based on qualitative content analysis of interviews and an expert panel, an initial survey with 53 questions on barriers to screening was designed. It was completed by 98 nurses in a large comprehensive cancer center in Switzerland. From this, a short version of the survey with 24 questions was derived using exploratory principal component analysis. This survey was completed by 150 nurses in four cancer centers in Switzerland. A confirmatory factor analysis was then performed on the shortened version, yielding a final set of 14 questions. RESULTS The initial set of 53 questions was reduced to a set of 14 validated questions retaining 53% of the original variance. These 14 questions allow for an assessment within 2-3 min that identifies relevant barriers to distress screening from the perspective of those responsible for implementation of distress screening. Across several hospitals in Switzerland, the timing of the first distress screening, lack of capacity, patient and staff overload, and refusal of distressed patients to be referred to support services emerged as major problems. CONCLUSION The validated 14 questions on barriers to screening cancer patients for distress enable clinicians and hospital administrators to quickly identify relevant issues and take action to improve screening programs.
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Affiliation(s)
- Felice Simnacher
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Anna Götz
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Sabine Kling
- Computer Vision Laboratory, Department of Information Technology and Electrical EngineeringSwiss Federal Institute of Technology (ETH) ZurichZurichSwitzerland
| | - Jan Ben Schulze
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Roland von Känel
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Sebastian Euler
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Moritz Philipp Günther
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
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Harel K, Czamanski-Cohen J, Cohen M, Weihs KL. Emotional Processing, Coping, and Cancer-Related Sickness Symptoms in Breast Cancer Survivors: Cross- Sectional Secondary Analysis of the REPAT Study. RESEARCH SQUARE 2023:rs.3.rs-3164706. [PMID: 37503214 PMCID: PMC10371152 DOI: 10.21203/rs.3.rs-3164706/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Purpose The study aims to provide a better understanding of the relationship between emotional processing, coping, and cancer-related sickness symptoms. Methods The study used a cross-sectional, secondary analysis of data from 179 Israeli Jewish women who were breast cancer survivors (BCS) 3 to 18 months after completing primary treatment and who participated in a larger randomized controlled trial (REPAT study). Data were collected at baseline. Participants completed questionnaires measuring emotion acceptance, situational approach, avoidance coping, and cancer-related sickness symptoms (depression, fatigue, and pain) and a performance measure of emotional awareness. Hierarchical linear regressions were performed, controlling for background variables. Results Participants experienced significant clinical depression (51.7%), cancer-related fatigue (CRF, 78.8%), pain interference (78%), and pain intensity (66%) levels. There were strong correlations between cancer-related symptoms. After controlling for confounders, emotional processing (acceptance) was negatively associated with depression, and avoidance coping was positively associated with depression, CRF, and pain interference (i.e., higher use of avoidance related to higher cancer-related symptoms; higher acceptance was associated with lower depression). Emotional awareness and coping by approaching emotions were not related to cancer-related symptoms. Conclusions The BCS posttreatment period presents the challenge of dealing with elevated cancer-related symptoms. Regardless, BCS who used high emotional processing levels-especially acceptance of emotion and lower reliance on avoidance to cope-experienced fewer cancer-related symptoms. Implications for Cancer Survivors Professionals should recognize the potential role of emotional processing and avoidant coping relative to cancer-related symptoms and recognize their patterns in posttreatment patients.
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14
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Change Trajectory of Symptom Distress, Coping Strategies, and Spiritual Wellbeing in Colorectal Cancer Patients Undergoing Chemotherapy. Healthcare (Basel) 2023; 11:healthcare11060857. [PMID: 36981514 PMCID: PMC10047921 DOI: 10.3390/healthcare11060857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Impacts caused by cancer and associated treatment may change with time. The objective of this study is to examine the change trajectory of symptom distress, coping strategies, and spiritual wellbeing in colorectal cancer patients during chemotherapy and to further examine the predictors of spiritual wellbeing. A prospective longitudinal repeated measures study design was employed. A total of 97 patients undergoing chemotherapy for the first time were enrolled. A structured questionnaire was used to collect data at three timepoints, which were before chemotherapy (T0), during chemotherapy (T1: 3 months after T0), and after chemotherapy (T2: 6 months after T0). The results of this study show that patients have significantly lower spiritual wellbeing and significantly higher symptom distress during chemotherapy treatment (T1). Family support (B = 0.39, p = 0.007) and problem-focused coping strategies (B = 0.47, p = 0.001) are significant predictors of spiritual wellbeing before chemotherapy (T0). Symptom distress (B = −0.18, p = 0.048) and problem-focused coping strategies (B = 0.26, p = 0.028) are significant predictors of spiritual wellbeing during chemotherapy (T1). The results provide care recommendations for different stages of chemotherapy to help to achieve more precise patient care and improve care quality.
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15
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Enhanced supportive care for advanced cancer patients: study protocol for a randomized controlled trial. BMC Nurs 2022; 21:338. [PMID: 36461000 PMCID: PMC9716697 DOI: 10.1186/s12912-022-01097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/04/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Early palliative care along with standard cancer treatments is recommended in current clinical guidelines to improve the quality of life and survival of cancer patients. This study protocol aims to evaluate the effect of "Enhanced Supportive Care", an early primary palliative care provided by nurses. METHODS A randomized controlled trial (RCT) will be conducted including advanced cancer patients scheduled for first-line palliative chemotherapy (N=360) and their caregivers in South Korea. Participants will be randomly assigned to the intervention or control group in a 1:1 ratio. Participants in the intervention group will receive the "Enhanced Supportive Care", which provides five sessions of symptom management and coping enhancement counseling by nurses. The control group will receive symptom monitoring five times. The primary endpoints are symptoms, coping, and quality of life (QoL) at 3 months. Secondary endpoints are symptoms, coping, and QoL at 6 months, depression and self-efficacy for coping with cancer at 3 and 6 months, symptom and depression change from baseline to 3 months, survival at 6 and 12 months among patients, and depression among caregivers at 3 and 6 months. DISCUSSION This RCT will evaluate the effects of "Enhanced Supportive Care" on symptoms, depression, coping, self-efficacy for coping with cancer, QoL and survival of patients, as well as depression of caregivers. It will provide evidence of a strategy to implement early primary palliative care provided by nurses, which may consequently improve cancer care for newly diagnosed patients with advanced stage cancer. TRIAL REGISTRATION ClinicalTrials.gov, NCT04407013. Registered on May 29, 2020, https://www. CLINICALTRIALS gov/ct2/show/study/NCT04407013 . The protocol version is ESC 1.0.
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16
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Henry M, Albert JG, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Black M, MacDonald C, Richardson K, Mascarella M, Morand GB, Chartier G, Sadeghi N, Lo C, Rosberger Z. Body Image Concerns in Patients With Head and Neck Cancer: A Longitudinal Study. Front Psychol 2022; 13:816587. [PMID: 35401366 PMCID: PMC8988682 DOI: 10.3389/fpsyg.2022.816587] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/08/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Head and neck cancer (HNC) treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: (1) the prevalence, level, and course of body image concerns; (2) correlates of upon cancer diagnosis (pre-treatment) body image concerns; (3) predictors of immediate post-treatment body image concerns; and (4) association between body image concerns and levels of anxiety, depression, suicidal ideation, support (i.e., satisfaction with support from physician, social/family wellbeing, and unmet support needs), and alcohol and drug misuse. Methods Two hundred and twenty-three (participation rate = 72%), newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model. Results Sixty-eight percent of patients with HNC (n = 148 of 218) presented some level of body image concerns. Body image concerns at baseline (i.e., upon cancer diagnosis, pre-treatment) and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment (i.e., at 3 month follow-up), 89% (n = 132 of 148) presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism. Conclusion This longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions.
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Affiliation(s)
- Melissa Henry
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Oncology, Jewish General Hospital, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Justine G. Albert
- Department of Oncology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Saul Frenkiel
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Michael Hier
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Karen Kost
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Martin Black
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Christina MacDonald
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Nursing, Jewish General Hospital, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Marco Mascarella
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Gregoire B. Morand
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Gabrielle Chartier
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Nursing, Jewish General Hospital, Montreal, QC, Canada
| | - Nader Sadeghi
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Christopher Lo
- Department of Psychology, College of Healthcare Sciences, James Cook University, Singapore, Singapore
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Zeev Rosberger
- Department of Oncology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
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17
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James C, Brunckhorst O, Eymech O, Stewart R, Dasgupta P, Ahmed K. Fear of cancer recurrence and PSA anxiety in patients with prostate cancer: a systematic review. Support Care Cancer 2022; 30:5577-5589. [PMID: 35106656 PMCID: PMC9135793 DOI: 10.1007/s00520-022-06876-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/27/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE The impact of prostate cancer on the mental wellbeing of patients is increasingly being appreciated. Two important aspects of this include fear of cancer recurrence (FCR) and prostate-specific antigen (PSA) anxiety. However, their prevalence, severity and associating factors remain poorly understood. Therefore, this review aims to evaluate the current evidence for the prevalence, severity and associating features of PSA anxiety and FCR. METHODS A systematic search of MEDLINE, EMBASE and PsycINFO databases was conducted by two independent reviewers. Observational studies measuring FCR and PSA anxiety in prostate cancer using validated measures were included. Outcome measures were prevalence of significant levels, mean scores and significant correlations of FCR and PSA anxiety scores with patient, disease, treatment or other mental health and quality of life outcomes. RESULTS One thousand one hundred forty-eight individual records underwent screening with 32 studies included. Median prevalence of significant FCR and PSA anxiety was 16% and 22% respectively across all studies. Longitudinal studies demonstrated severity of both symptoms peaks at diagnosis, with little variability, even several years following this. Evaluating associating factors revealed younger age, generalised quality of life and mental health symptoms to be important factors for both outcomes. Few studies evaluated associations and differences between other patient, disease and treatment characteristics. CONCLUSION FCR and PSA anxiety are prominent symptoms for prostate cancer patients and importantly when present, are associated with poorer quality of life and mental health symptoms. Screening for these constructs and referral to appropriate services should form part of routine follow-up care.
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Affiliation(s)
- Callum James
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK.
| | - Omar Eymech
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK
| | - Robert Stewart
- King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK.,Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital Campus, 5th Floor Southwark Wing, London, SE1 9RT, UK.,Department of Urology, King's College Hospital, London, UK
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18
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Shahar G, Bauminger R, Zwerenz R, Brähler E, Beutel M. Centrality of Self-Criticism in Depression and Anxiety Experienced by Breast Cancer Patients Undergoing Short-Term Psychodynamic Psychotherapy. Psychiatry 2022; 85:215-227. [PMID: 35138986 DOI: 10.1080/00332747.2021.2004786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Depression and anxiety are prevalent in women suffering from breast cancer. However, the determinants of depression and anxiety in this population are not well known, particularly in the context of psychotherapy. Drawing from Blatt's theory, we examined the role of Depressive Personality Vulnerability (DPV) in depression and anxiety experienced in female sufferers of breast cancer treated for depression as part of a Randomized Clinical Trial. METHODS Seventy-eight patients were treated by Short-Term Psychodynamic Psychotherapy and 79 patients by Treatment as Usual. Assessments were conducted pre-treatment, at termination, and at six-month follow-up. Main outcomes were the depression and anxiety subscales of the Hospital Depression and Anxiety Scale. Predictors were pre-treatment dependency, self-criticism, and self-efficacy, assessed via the Depressive Experiences Questionnaire. Analyses targeted associations of these dimensions with baseline levels, main effects on pretreatment-termination and pretreatment-follow-up changes in depression and anxiety, and DPV by treatment interactions. RESULTS Consistent with our hypotheses, self-criticism - implicated in previous research as a serious dimension of vulnerability to psychopathology - predicted elevated levels, as well as pretreatment-follow-up changes, in both depression and anxiety. However, self-criticism also augmented the effect of STPP (compared with TAU) on depression in the pretreatment-termination period. CONCLUSIONS These findings highlight the centrality of self-criticism for both risk and resilience processes in breast cancer.
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Bean HR, Diggens J, Ftanou M, Weihs KL, Stanton AL, Wiley JF. Insomnia and Fatigue Symptom Trajectories in Breast Cancer: A Longitudinal Cohort Study. Behav Sleep Med 2021; 19:814-827. [PMID: 33470847 DOI: 10.1080/15402002.2020.1869005] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: Insomnia and fatigue are common, although not inevitable, during breast cancer. This study is one of the first aiming to describe distinct trajectory classes of insomnia and fatigue symptoms, and their correlates, from diagnosis through treatment.Methods: This longitudinal cohort study was conducted at a comprehensive cancer center and community oncology practices. Participants (N = 460) were women diagnosed with any stage of breast cancer in the previous 4 months. Primary outcomes for this ancillary study of the existing cohort were self-reported insomnia and fatigue symptoms assessed repeatedly across 12 months.Results: Four distinct classes of insomnia symptoms emerged: persistently very high, clinically elevated symptoms (13.7%); high, clinically elevated symptoms (65.9%); stable low (17.2%) or very low (2.6%) symptoms. Five fatigue symptom classes included high, increasing fatigue (9.6%), two recovery classes starting at high (26.3%), or moderate (18.0%) severity at diagnosis, stable low (33.3%) or very low (12.2%) classes. In multivariate analyses, higher depressive symptoms, anxiety, and chronic life stress were associated with being in the very high insomnia class versus the low symptom class. Oncologic factors were not associated with insomnia class membership. Receiving chemotherapy was linked significantly to high and recovery fatigue symptom classes versus the low class. Higher chronic life stress was associated with more persistent fatigue symptoms.Conclusions: Distinct classes of insomnia and fatigue symptoms were evident; 79.6% of the women had clinically elevated, persistent insomnia symptoms, 53.9% had elevated fatigue. A substantial minority evidenced low symptoms, suggesting targeted or stepped-care approaches to symptom management.
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Affiliation(s)
- Helena R Bean
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University
| | - Justine Diggens
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne
| | - Maria Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne
| | - Karen L Weihs
- Department of Psychiatry, University of Arizona.,University of Arizona Cancer Center
| | - Annette L Stanton
- Department of Psychology, University of California Los Angeles.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University
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20
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Fisher HM, Taub CJ, Lechner SC, Antoni MH. Greater Post-Surgical Pain Predicts Long-Term Depressed Affect in Breast Cancer Patients. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2021; 28:171-182. [DOI: 10.1027/2512-8442/a000084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: Depressed affect is observed during primary treatment for early-stage breast cancer and often persists into survivorship. Pain can influence the long-term emotions of women with breast cancer. Behavioral mechanisms explaining this relationship are less clear. Coping during primary treatment may play a role in the association between pain and depressed affect. Aims: Our observational study examined a longitudinal mediation model testing whether post-surgical pain intensity predicted depressed affect 5 years later via disengagement and/or engagement coping at the end of treatment. Method: Women ( N = 240) with stage 0–III breast cancer completed measures of pain, coping, and depressed affect 4–10 weeks post-surgery, and 12 months and 5 years later. Results: Structural modeling yielded measurement models of 12-month disengagement and engagement coping. Direct effects emerged between post-surgical pain intensity and 12-month disengagement (β = .37, p < .001) and engagement coping (β = .16, p < .05). Post-surgical pain intensity was also related to 5-year depressed affect (β = .25, p < .05). Disengagement and engagement coping were not associated with depressed affect at 5-year follow-up, and there was no evidence of mediation. Limitations: This is a secondary analysis of data from a trial conducted several years ago, and may not generalize due to a homogenous sample with attrition at long-term follow-up. Conclusions: Greater post-surgical pain intensity predicts more disengagement and engagement coping at the end of primary treatment, as well as depressed affect during survivorship. Managing post-surgical pain may influence the emotions of survivors of breast cancer up to 5 years later, possibly through coping or non-coping processes.
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Affiliation(s)
- Hannah M. Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Chloe J. Taub
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Michael H. Antoni
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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21
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Smith IS, Wellecke C, Weihs KL, Bei B, Wiley JF. Piloting CanCope: An internet-delivered transdiagnostic intervention to improve mental health in cancer survivors. Psychooncology 2021; 31:107-115. [PMID: 34425036 DOI: 10.1002/pon.5787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE CanCope is an internet-delivered, cognitive-behavioural intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors. Four separate pilot studies evaluated each of CanCope's modules for (1) feasibility and participant satisfaction, and changes in (2) module-specific outcomes, and (3) global measures of emotion dysregulation and anxiety and depressive symptoms, from pre-to-post module delivery. METHODS Eligible cancer survivors self-selected into one two-week online module designed to improve a specific aspect of emotion regulation ([1] understanding emotions, [2] mindfulness of emotions, [3] cognitive reappraisals, [4] challenging emotion-driven behaviours). RESULTS Across modules, post-intervention surveys were completed by 17-19 participants, (58.1%-90.5% completion rate for participants who received the intervention). Each module was feasible and participants reported high satisfaction. Moderate-to-large pre-to-post effect sizes in mean differences were observed in module-specific target outcomes (p's < 0.05). Emotion dysregulation significantly decreased across modules 1 to 3 (p's < 0.05) with a non-significant decrease for module 4 (p = 0.13). Anxiety symptoms significantly decreased across all modules (p's < 0.05). Depressive symptoms significantly decreased across modules 1 and 3 (p's < 0.05), with non-significant decreases across modules 2 (p = 0.08) and 4 (p = 0.06). CONCLUSIONS Each CanCope module demonstrated promise in targeting emotion regulation skills and supporting the mental health of cancer survivors. Randomised controlled trials are required to test the efficacy of CanCope as an intervention in its entirety.
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Affiliation(s)
- Isabelle S Smith
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Cornelia Wellecke
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Karen L Weihs
- The Department of Psychiatry, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
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22
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Radin A, Ganz PA, Van Dyk K, Stanton AL, Bower JE. Executive Functioning and Depressive Symptoms After Cancer: The Mediating Role of Coping. Psychosom Med 2021; 83:291-299. [PMID: 33657085 PMCID: PMC8691137 DOI: 10.1097/psy.0000000000000926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cognitive difficulties are a common complaint among patients with breast cancer and may adversely affect psychological well-being. In particular, problems with executive functioning (EF) may interfere with coping, which is known to influence depressive symptoms. The current study was designed to examine correlations between EF, coping, and depressive symptoms in breast cancer survivors and to longitudinally test the hypothesis that coping mediates the relationship between EF and depressive symptoms. METHODS Participants included 171 women with early-stage breast cancer assessed at the end of primary treatment with surgery, radiation, and/or chemotherapy and at 6 months, 1 year, and 2 years after treatment follow-ups as part of the Mind-Body Study. Participants completed questionnaires to assess subjective EF, approach and avoidant coping, and depressive symptoms, and neuropsychological testing was conducted to assess objective EF. Bivariate correlations were used to examine associations between EF, coping, and depressive symptoms. Mediation analyses were conducted using a bootstrapping approach (PROCESS). RESULTS At 1 year after treatment, objective and subjective EFs were correlated with avoidant coping (r = -0.172 [p = .024] and r = 0.297 [p < .001], respectively). In longitudinal analyses, use of the avoidant strategy behavioral disengagement at 1 year mediated the association between objective (95% bootstrap confidence interval = -0.282 to -0.042) and subjective (95% bootstrap confidence interval = 0.020 to 0.254) EFs at 6 months and depressive symptoms at 2 years. CONCLUSIONS This study highlights how problems with EF during survivorship are associated with avoidant coping and depressive symptoms. Thus, these findings identify potential cognitive and affective targets for depression intervention in this population.
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Affiliation(s)
- Arielle Radin
- From the Department of Psychology (Radin, Stanton, Bower), Schools of Medicine and Public Health (Ganz), Jonsson Comprehensive Cancer Center (Ganz, Van Dyk, Stanton, Bower), Department of Psychiatry and Biobehavioral Sciences (Van Dyk, Stanton, Bower), and Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior (Stanton, Bower), University of California, Los Angeles, Los Angeles, California
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Kim JHJ, Bright EE, Williamson TJ, Krull JL, Weihs KL, Stanton AL. Transitions in coping profiles after breast cancer diagnosis: implications for depressive and physical symptoms. J Behav Med 2021; 44:1-17. [PMID: 32535673 PMCID: PMC7736058 DOI: 10.1007/s10865-020-00159-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/14/2020] [Indexed: 12/17/2022]
Abstract
The objective of this study was to determine whether: (a) cancer-related coping profiles change across time; (b) coping profile transition types predict changes in depressive and physical symptoms. Latent transition analysis was conducted with repeated measures of seven cancer-related coping processes from 460 women recently diagnosed with breast cancer. In multilevel models, coping profile transition groups were entered as predictors of symptoms across 12 months. Three coping profiles emerged at study entry, with two profiles at later assessments. Forty-eight percent of women maintained high-moderate approach-oriented coping over time. Specific factors (e.g., age, acceptance of emotions) differentiated the transition groups. Women who increased and then maintained high-moderate approach-oriented coping had relatively high initial depressive symptoms that declined steeply. When cancer-related acceptance predominated, women experienced increasing physical symptoms. Distinct cancer-related coping patterns are related to the level of and change in depressive and physical symptoms longitudinally. Early intervention to increase approach-oriented coping strategies could yield favorable outcomes.
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Affiliation(s)
- Jacqueline H J Kim
- Department of Psychology, University of California (UCLA), Los Angeles, CA, USA.
| | - Emma E Bright
- Department of Psychology, University of California (UCLA), Los Angeles, CA, USA
| | | | - Jennifer L Krull
- Department of Psychology, University of California (UCLA), Los Angeles, CA, USA
| | - Karen L Weihs
- Department of Psychiatry, University of Arizona Cancer Center, The University of Arizona, Tucson, AZ, USA
| | - Annette L Stanton
- Department of Psychology, University of California (UCLA), Los Angeles, CA, USA
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California (UCLA), Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, Los Angeles, CA, USA
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Kim JHJ, Drake BL, Accortt EE, Pollin IS, Bairey Merz CN, Stanton AL. Younger Women Living with Chronic Disease: Comparative Challenges, Resiliencies, and Needs in Heart Disease and Breast Cancer. J Womens Health (Larchmt) 2021; 30:1288-1302. [PMID: 33428530 DOI: 10.1089/jwh.2020.8506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Younger women with chronic disease (<60 years of age), especially women with stereotypically "men's" heart disease (HD), are understudied. Unique difficulties may occur with HD, which is less commonly associated with women, compared with breast cancer (BC). Similarities may also exist across younger women, as chronic disease is less normative in younger people. Intersections of gender, age, and the specific disease experience require greater attention for improving women's health. This exploratory qualitative study compared younger women's experiences of HD or BC. Methods: Semistructured interviews with 20 women (n = 10 per disease) were analyzed using applied thematic analysis. Results: Amidst building careers, intimate relationships, and families, women felt thwarted by disease-related functional problems. Cognitive-behavioral coping strategies spurred resilience, including integrating the illness experience with self-identity. Barriers arose when medical professionals used representativeness heuristics (e.g., chronic disease occurs in older age). Important experiences in HD included worsened self-image from disability, negative impact of illness invisibility, and persisting isolation from lacking peer availability. Initial medical care reported by women with HD may reflect gender biases (e.g., HD missed in emergency settings and initial diagnostics). New information provided by the younger women includes limited illness-related optimism in women with HD facing age and gender stereotypes, as well as the advantages and disadvantages of peer availability in BC. Conclusions: Greater public awareness of younger women with chronic disease, alongside structural support and connection with similarly challenged peers, is suggested. As advocacy for BC awareness and action has strengthened over past decades, similar efforts are needed for younger women with HD.
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Affiliation(s)
- Jacqueline H J Kim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Brittany L Drake
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Eynav E Accortt
- Department of Obstetrics and Gynecology and Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Irene S Pollin
- Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences and University of California, Los Angeles, Los Angeles, California, USA.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California, USA
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Chung BPM, Olofsson J, Wong FKY, Rämgård M. Overcoming existential loneliness: a cross-cultural study. BMC Geriatr 2020; 20:347. [PMID: 32928151 PMCID: PMC7491097 DOI: 10.1186/s12877-020-01753-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Moving into a long-term care facility (LTCF) can reduce the ability for older adults to engage in meaningful roles and activities and the size of their social network. These changes and losses can lead them to experience existential loneliness (EL)-the intolerable emptiness and lack of meaningful existence resulted from the losses they have experienced. While EL has often been understood as a universal human experience, it has primarily been studied in people from Western cultures; little is known about how EL may be experienced by and manifested in people from Eastern cultures. Hence, this qualitative study aimed to describe the experience and coping of EL in Hong Kong Chinese and Swedish older adults living in LTCFs. METHODS A qualitative study using Thorne's (2004) interpretive description was conducted. Thirteen Chinese and 9 Swedes living in LTCFs in Hong Kong, China and Malmo, Sweden, respectively were interviewed about their experience of EL in two series of semi-structured interviews. Data were analyzed using thematic analysis. RESULTS The core theme of "overcoming EL" described the participants' experience of EL, which came about through the combined process of "Feeling EL" and "Self-Regulating". Both Chinese and Swedish participants had similar experience with EL. Realizing that they did not want to living with EL anymore, they coped by reframing their experience and identifying new meaning in their life. CONCLUSIONS The study findings suggested that early and clear counselling support that help older adults to define new meaning in life may help them cope. In addition, more opportunities should be available at the LTCFs to promote quality relationships, enable older adults to reflect on their lives with pride, and support their ability to do the things they enjoy.
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Affiliation(s)
- B P M Chung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China
| | - J Olofsson
- Faculty of Health and Society, Institute of Care Science, Malmo University, 25, Hus F, Malmo, Malmo, Sweden
| | - F K Y Wong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, SAR, China.
| | - M Rämgård
- Faculty of Health and Society, Institute of Care Science, Malmo University, 25, Hus F, Malmo, Malmo, Sweden
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Manne SL, Kashy DA, Kissane DW, Ozga M, Virtue SM, Heckman CJ. Longitudinal course and predictors of communication and affect management self-efficacy among women newly diagnosed with gynecological cancers. Support Care Cancer 2020; 28:1929-1939. [PMID: 31367918 PMCID: PMC6994366 DOI: 10.1007/s00520-019-04989-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/09/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Self-efficacy is an important psychological resource to assist people in managing chronic illness and has been associated with psychological outcomes among patients coping with cancer. Little is known about the course of self-efficacy among gynecological cancer patients coping with cancer and the sociodemographic, medical, and psychological factors that are associated with the course of self-efficacy among these patients. METHODS One hundred twenty-five women recently diagnosed with gynecological cancer completed a measure of communication and affective management self-efficacy at baseline, 5 weeks, 9 weeks, 6 months, 1 year, and 18 months post-baseline. Participants also completed measures of functional impairment, holding back, perceived unsupportive behaviors of family and friends, emotional expressivity, cancer concerns, depressive symptoms, cancer-specific intrusions and avoidance, problem-solving, and positive reappraisal coping. RESULTS Growth curve modeling suggested that women varied considerably in their average reports of self-efficacy and varied with regard to their linear trajectories of self-efficacy over time. Average affect management self-efficacy increased significantly over time. Greater functional impairment, more holding back, more unsupportive responses from friends and family, less emotional expressivity, more cancer concerns, depression, intrusions, or avoidance predicted lower average self-efficacy over time. Women who were less emotionally expressive or held back sharing concerns less reported lower self-efficacy which increased over time. CONCLUSIONS It will be important for providers to identify gynecological cancer patients who report low ability to communicate feelings and needs and manage emotional reactions to cancer and offer them interventions which bolster self-efficacy.
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Affiliation(s)
- Sharon L Manne
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA.
| | | | - David W Kissane
- University of Notre Dame Australia, Fremantle, WA, 6160, Australia
| | - Melissa Ozga
- Memorial Sloan Kettering Cancer Center, New York City, USA
| | | | - Carolyn J Heckman
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
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Weihs KL, McConnell MH, Wiley JF, Crespi CM, Sauer-Zavala S, Stanton AL. A preventive intervention to modify depression risk targets after breast cancer diagnosis: Design and single-arm pilot study. Psychooncology 2019; 28:880-887. [PMID: 30803095 DOI: 10.1002/pon.5037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/25/2019] [Accepted: 02/21/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Apply the National Institutes of Health (NIH) Stage Model to design and test an intervention to prevent depression in breast cancer patients at risk for depression. METHODS We identified mindful emotion awareness, along with approach and avoidance strategies for cancer-related coping and emotion regulation, as targets for a preventive intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Patients' preferences for individual, in-person, and time-efficient sessions informed the design. Patients at risk for depression received a 6-week, 5-hour intervention with daily exercises. Intervention targets were assessed at baseline, before each session, and 4-weeks post intervention. Mixed effects analysis of variance (ANOVA) assessed change over the follow-up period, controlling for age, partnered status, and disease stage. RESULTS Fifty-five percent (40/72) of women screened within 6 months of diagnosis had elevated depression risk. Of these, 24 (60%) signed consent. Sixteen received intervention after five were excluded for current depressive disorder, cognitive impairment, or death. Three dropped out. Ninety-eight percent attendance and 77% practice days indicated feasibility. Effect sizes (Cohen's d) corrected for regression to the mean (RTM) were 0.82 for cancer-related acceptance coping, 0.65 for cancer-related emotional expression, and 0.32 and 0.42 for decreased cancer-related avoidance coping and depressive symptoms, respectively. Effect sizes for variables lacking data to correct for RTM were 1.0, 0.7, and 0.5 for decreased rumination, experiential avoidance, and fear of depression, respectively, and 1.3, 0.6, and 0.4 for increased cognitive flexibility, distress tolerance, and describing/not judging emotions, respectively. CONCLUSIONS The feasibility of this intervention and malleability of its targets support its further investigation.
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Affiliation(s)
- Karen L Weihs
- Department of Psychiatry, University of Arizona, Tucson, Arizona
| | | | - Joshua F Wiley
- School of Psychological Sciences, Monash University, Melbourne, Victoria
| | - Catherine M Crespi
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California
| | - Shannon Sauer-Zavala
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
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