Social support moderates the relationship between emotion regulation and health-related quality of life in cancer patients

The relationship between emotion regulation (cognitive reappraisal and expressive suppression) and HRQoL in cancer patients is currently gaining momentum, yet, no research to date has investigated the nature of this relationship. The purpose of this study was to investigate the moderating role of social support in the relationship between ER and HRQoL in Nigerian cancer patients. Participants included 361 cancer patients (female = 56.79%, mean age = 41.61, SD 15.47) conveniently drawn from the oncology unit of the University Teaching Hospital, Nigeria. They completed the measures of Functional Assessment of Cancer Therapy-General (FACT-G), emotion regulation and Perceived Social Support. The moderated regression analysis via PROCESS procedures for SPSS Version 3 was used for data analysis. The results showed that cognitive reappraisal significantly predicted HRQoL (β = 2.12, t = 4.39, p = .000). Social support also significantly predicted HRQoL (β = .73, t = 4.57, p = .000). Most importantly, social support moderated the relationship between cognitive reappraisal and HRQoL (β = -.034, t= -4.23, p = .000), but not between expressive suppression and HRQoL (β = -.015, t= -1.61, p = .10). The moderation slope revealed that cognitive reappraisal significantly predicted HRQoL particularly at lower and moderate levels of social support. These findings reveal that the effect of emotion regulation on HRQoL depends much on an individual's level of perceived social support. It also means that social support boosted the positive impact of emotion regulation on HRQoL. The findings highlighted the importance of social-support and emotion regulation particularly, cognitive-reappraisal in improving health-related quality of life in cancer patients.

Correlation of death anxiety with coping strategies among Palestinian women with breast cancer: a cross-sectional study

Background

Death anxiety and maladaptive coping accompany breast cancer diagnoses. The coping mechanisms and death anxiety among Palestinian patients with breast cancer have not been studied.

Aim

To assess the prevalence of death anxiety and its relationship with coping strategies among Palestinian women with breast cancer who are treated in Beit Jala Governmental Hospital in Bethlehem.

Method

A cross-sectional design was used, and 214 breast cancer patients who visited the Beit Jala Governmental Hospital in Bethlehem were recruited. Templer's Death Anxiety Scale and the Brief COPE Scale were used. To investigate the relationship between coping strategies and death anxiety, frequency, percentages, chi-square tests, and Pearson's correlation tests were utilized.

Results

The results indicated that 58.40% of the patients experienced death anxiety. The participants who used positive reframing (adjusted odds ratio (AOR) = 1.487, p = < 0.026), self-blame (AOR = 1.309, p = < 0.023), and religion (AOR = 1.260, p = < 0.031) as coping mechanisms were more likely to experience death anxiety. Conversely, the participants who adopted substance use (AOR = 0.657, p < 0.005) and active coping (AOR = 0.629, p < 0.007) as coping strategies had a lower likelihood of experiencing death anxiety.

Conclusion

The study revealed that breast cancer patients tended to use a combination of functional and emotional coping strategies and that a significant proportion of these patients (58.4%) experienced symptoms of death anxiety. This study emphasizes the significance of screening for death anxiety and understanding the coping strategies utilized by the patients. Gaining this understanding will assist in identifying patients who need more guidance and support.

Comparative Study of the Quality of Life and Coping Strategies in Oncology Patients

BACKGROUND

Despite the current data on morbidity and mortality, a growing number of patients with a diagnosis of cancer survive due to an early diagnosis and advances in treatment modalities. This study aimed to compare the quality of life and coping strategies in three groups of patients with cancer and identify associated clinical and sociodemographic characteristics.

METHODS

A comparative study was conducted with outpatients at a public hospital in the state of São Paulo, Brazil. The 300 participants were assigned to three groups: patients in palliative care (Group A), patients in post-treatment follow-up with no evidence of disease (Group B), and patients undergoing treatment for cancer (Group C). Data collection involved the use of the McGill Quality of Life Questionnaire and the Ways of Coping Questionnaire. No generic quality-of-life assessment tool was utilized, as it would not be able to appropriately evaluate the impact of the disease on the specific group of patients receiving palliative care.

RESULTS

Coping strategies were underused. Participants in the palliative care group had poorer quality of life, particularly in the psychological well-being and physical symptom domains. Age, currently undergoing treatment, and level of education were significantly associated with coping scores. Age, gender, income, and the absence of pharmacological pain control were independently associated with quality-of-life scores. Moreover, a positive association was found between coping and quality of life.

CONCLUSION

Cancer patients in palliative care generally report a lower quality of life. However, male patients, those who did not rely on pharmacological pain control, and those with higher coping scores reported a better perception of their quality of life. This perception tended to decrease with age and income level. Patients currently undergoing treatment for the disease were more likely to use coping strategies. Patients with higher education and quality-of-life scores also had better coping scores. However, the use of coping strategies decreased with age.

Sleep quality and lymphedema in breast cancer survivors: a mixed method analysis

PURPOSE

The purpose of this convergent mixed methods study was to assess the perceptions and characteristics of sleep in breast cancer survivors (BCSs) and elucidate perceptions of sleep among BCS with lymphedema.

METHODS

Participants were BCS with and without lymphedema. Both groups completed the Pittsburgh Sleep Quality Index (PSQI), PROMIS® Sleep Disturbance (8a short form), and wore an actigraph on their wrist to capture sleep/wake cycles for 7 days/nights while logging their sleep using a sleep diary. The coefficient of variation of sleep efficiency was calculated from the sleep diary to assess intraindividual variability. In addition, a subsample of BCS with lymphedema participated in a semi-structured qualitative interview. The qualitative data was analyzed separately, and the themes were applied to provide a more nuanced explanation of the quantitative outcomes.

RESULTS

The BCS with lymphedema (n=23) had a significant difference in PSQI (p=0.002), PROMIS® Sleep Disturbance (p=0.084), and sleep efficiency coefficient of variation (p=0.014) compared to BCS without lymphedema (n=23). There were no statistically significant differences between groups in the actigraphy results. BCS with lymphedema perceived that lymphedema management contributed to their sleep disturbance, further exacerbating their mind/body fatigue.

CONCLUSION

This study provides the foundation for future research to investigate the integration of sleep interventions with lymphedema management for holistic survivorship care for BCS with lymphedema.

IMPLICATIONS FOR CANCER SURVIVORS

An innovative sleep health intervention designed to consider the unique factors contributing to sleep disturbance in BCS with lymphedema will fill a gap in their post-cancer treatment quality of life.

Outcomes for Physiologic Microsurgical Treatment of Secondary Lymphedema Involving the Extremity

OBJECTIVE

The aim of this study was to examine the long-term impact of physiologic surgical options, including VLNT and LVB, on patients with secondary lymphedema of the upper or lower extremity (UEL/LEL).

SUMMARY BACKGROUND DATA

VLNT and LVB have become increasingly popular in the treatment of lymphedema. However, there is a paucity of long-term data on patient outcomes after use of these techniques to treat lymphedema.

METHODS

An analysis of prospectively collected data on all patients who underwent physiologic surgical treatment of secondary lymphedema over a 5.5-year period was performed. Patient demographics, surgical details, subjective reported improvements, LLIS scores, and postoperative limb volume calculations were analyzed.

RESULTS

Two hundred seventy-four patients with secondary lymphedema (197 upper, 77 lower) were included in the study. More than 87% of UEL patients and 60% of LEL patients had reduction in excess limb volume postoperatively. At 3 months postoperatively, patients with UEL had a 31.1% reduction in volume difference between limbs, 33.9% at 6 months, 25.7% at 12 months, 47.4% at 24 months and 47.7% at 4 years. The reduction in limb volume difference followed a similar pattern but was overall lower for LEL patients. Greater than 86% of UEL and 75% of LEL patients also had improvement in LLIS scores postoperatively. Fifty-nine complications occurred (12.9%); flap survival was >99%.

CONCLUSIONS

Patients with secondary UEL/LEL who undergo VLNT/LVB demonstrate improved functional status and reduced affected limb volumes postoperatively. Patients with UEL seem to have a more substantial reduction in limb volume differential compared to LEL patients.

Physical and Functional Outcomes of Simultaneous Vascularized Lymph Node Transplant and Lymphovenous Bypass in the Treatment of Lymphedema

BACKGROUND

The authors analyze the outcomes of simultaneous vascularized lymph node transplant and lymphovenous bypass for treatment of primary and secondary lymphedema. To the best of their knowledge, this is the largest study to date with long-term outcome data of this novel approach.

METHODS

Three hundred twenty-eight patients who underwent physiologic surgical treatment over a 5.5-year period were evaluated using a prospective database and chart review. Preoperative characteristics, operative details, and postoperative outcomes (volume difference change, Lymphedema Life Impact Scale score) were assessed. Statistical analysis including multivariate regression was performed.

RESULTS

Two hundred twenty patients (67.1 percent) underwent simultaneous vascularized lymph node transplant and lymphovenous bypass. Mean body mass index was 26.9 ± 4.7 kg/m 2 . Ninety-two patients (41.8 percent) had lymphedema of the lower extremity, 121 (55.0 percent) had upper extremity involvement, and seven had lymphedema of upper and lower extremities (3.2 percent). Average duration of lymphedema was 95.4 ± 103.6 months. Thirty patients (13.6 percent) had primary lymphedema and 190 patients (86.4 percent) had secondary lymphedema. The majority improved and experienced volume reduction of an average 21.4 percent at 1 year ( p < 0.0001), 36.2 percent at 2 years ( p < 0.0001), 25.5 percent at 3 years ( p = 0.1), and 19.6 percent at 4 years. Median Lymphedema Life Impact Scale scores were 7.0 points lower ( p < 0.0001) at 3 months and improved progressively over time to 27.5 points lower at 3 years postoperatively ( p < 0.005).

CONCLUSIONS

Simultaneous vascularized lymph node transplant and lymphovenous bypass is an appropriate and effective approach for both early and advanced stages of primary and secondary lymphedema, with significant objective and subjective improvements. Volume reduction in the affected limb was observed at all time points postoperatively, with significant improvement in Lymphedema Life Impact Scale scores.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Acceptance of disability, coping style, perceived social support and quality of life among patients with chronic lymphedema: a cross-sectional study

OBJECTIVE

To examine acceptance of disability, coping style, perceived social support, and quality of life and to explore the relationships between acceptance of disability, coping style, perceived social support, and quality of life among Chinese patients with chronic lymphedema.

METHODS

Chronic lymphedema patients were recruited from five tertiary hospitals between May and July 2020 in China. Recruited patients were assessed for quality of life (QOL), acceptance of disability (AOD), coping styles, perceived social support (PSS), and sociodemographic and disease-related factors. Multivariate linear regression models were conducted to examine the multivariate effect of AOD, coping style, PSS, and sociodemographic and disease-related factors on QOL.

RESULTS

A total of 163 chronic lymphedema patients were recruited. The mean score of QOL was 2.23 (SD = 0.68). AOD, number of symptoms, acceptance-resignation, avoidance, degree of pain, PSS, and educational level were found to be significant predictors of QOL.

CONCLUSION

Chinese patients with chronic lymphedema had moderate levels of QOL. The QOL and specific domains of patients were affected by different factors. Special attention and targeted interventions should be given to improve patients' QOL.

Spirituality, Religiosity and Coping Strategies Among Spanish People Diagnosed with Cancer

The present study evaluates the influence of spirituality/religiosity (S/R) on the coping strategies used by people with cancer (breast and prostate) compared with those without cancer, in a sample of 445 Spanish participants (160 with cancer and 285 without). Significant interactions between the presence of cancer and S/R are observed in the use of coping strategies such as religion, humor and disconnection. Spirituality as a predictor variable through the use of religion as a strategy, increased the explanatory capacity of age by 58.9% (β = .794) while praying/talking to God predicts the use of this strategy with a β = .383. In people with cancer, active coping was predicted by spirituality (β = .327). However, spirituality was a negative predictor of maladaptive coping, with a beta coefficient equal to .383. The data suggest that patients' beliefs need to be considered by health care professionals when designing interventions.

Age differences in cancer-related stress, spontaneous emotion regulation, and emotional distress

OBJECTIVES

Cancer risk increases with age, cancer-related stress is common and devastating to mental health of patients, yet little work has explored age differences in cancer-related stress. This study investigated sources of stress related to cancer diagnosis and treatment and its association with age and emotional health. Though not an a priori aim of the study, adaptive strategies mentioned within discussions of stress-which we classify as spontaneous emotion regulation (ER) - were also investigated.

METHOD

Participants (N = 147, aged 27-88) recruited from the VA (98% male) with oral-digestive cancers participated in semi-structured interviews regarding sources of stress 6-months post-diagnosis (T1) and treatment-related stress at 12-months post-diagnosis (T2). Patients also reported their emotional distress at T2 via the PROMIS-29. Inductive content analysis was used to classify sources of stress and ER into semantic themes and relative frequencies.

RESULTS

The greatest source of stress at diagnosis was psychological; physical symptoms were the greatest source of stress at treatment. Older adults less frequently reported psychological uncertainty, social stress, and situational stress, whereas age groups reported similar rates of physical stress. When describing stress, older adults more often made spontaneous references to emotion regulation (ER). Across age groups, those who reported stress without ER in qualitative comments had higher emotional distress on the PROMIS-29 than those reporting stress with ER or no stress.

CONCLUSION

ER may be key to psychological adjustment to cancer, especially in later-life. implications for assessment of stress at pivotal visits and mental health referral are discussed.

Combined Approach to Surgical Treatment of Lymphedema

Physiologic surgical interventions, including lymphovenous bypass (LVB) and vascularized lymph node transplant (VLNT), are increasingly being used to treat lymphedema. LVB has been shown to be effective in improving the severity of lymphedema, particularly for patients with still-functional superficial lymphatic vessels that can be identified for bypass. However, in many patients, there is a paucity of functional lymphatic vessels for bypass and, thus, they are not ideal candidates for LVB alone. Unlike LVB, VLNT does not depend on the presence of functioning lymphatic vessels, but the effects of VLNT are delayed, as the proposed mechanisms of action require more time for optimal function. The author has offered a combined approach to microsurgical treatment of lymphedema for both the upper and lower extremities. Simultaneous VLNT and LVB are safe and effective for patients with both early and advanced stages of primary and secondary lymphedema. Our experience shows that a majority of patients can expect some long-term improvement, in both overall limb volume and quality of life, after surgical intervention with LVB and/or VLNT.

Psychosocial Issues Associated with Breast Cancer-Related Lymphedema: a Literature Review

PURPOSE OF REVIEW

Breast cancer-related lymphedema (BCRL) is a chronic disease affecting breast cancer survivors. The purpose of this article is to update the scientific literature regarding psychosocial issues associated with BCRL.

RECENT FINDINGS

Reports describe economic burdens, social support, sexuality, BCRL patient-education needs, and interventions to reduce BCRL symptoms and improve QOL among women with breast cancer. The psychosocial impact of BCRL may differ between younger and older women which has implications for age-related interventions to reduce the adverse psychosocial experiences of women with BCRL. We did not locate studies reporting the psychosocial impact of BCRL on male breast cancer survivors.

SUMMARY

More psychosocial-based interventions are needed that target the concerns of those with BCRL, including age-related needs, sexual concerns, body image, and social support. Future research is indicated to study the psychosocial impact of BCRL among men. Researchers may consider how pandemic-driven health care policies affect the psychosocial needs of those with BCRL.

Adjustment to hand injury: Cross-sectional survey exploring adjustment in relation to illness perceptions and coping strategies

STUDY DESIGN

Cross-sectional descriptive.

INTRODUCTION

Hand injuries are highly prevalent, and the impact they have on physical, emotional, and functional adjustment is well recognized. Increasingly, adjustment to health conditions including hand injuries is being understood in terms of psychological variables.

PURPOSE OF THE STUDY

To examine the role of illness beliefs and coping strategies in adjustment to hand injury. Adjustment was considered from a complete perspective including quality of life (QOL) and functional ability as well as mood and trauma symptoms.

METHODS

Cross-sectional survey whereby consecutive patients (n = 65) attending the regional plastic surgery service with hand injuries were invited to complete a questionnaire assessing illness perceptions, coping strategies, QOL, hand functioning, depression, and trauma symptoms. Data were analyzed in SPSS (IBM Corporation, Armonk, NY) by correlation and then hierarchical regression analysis.

RESULTS

Illness perceptions and coping strategies were significantly related to the adjustment outcomes (hand functioning, QOL, depression, and trauma symptoms). Specifically, poorer adjustment was associated with more negative illness beliefs (r = 0.31-0.47), greater use of denial (r = 0.24-0.53), and avoidance-based (r = 0.41-0.64) coping strategies.

DISCUSSION

Illness beliefs and coping play an important role in adjustment after hand injury. Adjustment is multifaceted with a need to consider physical and emotional functioning. More optimistic beliefs and adaptive coping styles are associated with improved adjustment.

CONCLUSION

The role of psychological variables in optimizing adjustment is an important consideration for the design of psychological interventions, but because this study was cross sectional and cannot assume directional effects, future longitudinal studies are needed.

LEVEL OF EVIDENCE

N/A.

An Important Tool in Lymphedema Management: Validation of Turkish Version of the Patient Benefit Index-Lymphedema

Background: The aim of this study was to investigate the Turkish adaptation, validity, and reliability of the Patient Benefit Index-Lymphedema (PBI-L) ensuring direct assessment of the benefit in patients with lymphedema (LE), lipedema, and lipolymphedema. Methods and Results: Eighty-one patients who were consulted for physiotherapy, whose diagnoses were LE, lipedema, and lipolymphedema, and who were treated or planned to be treated for these diagnoses, were included in this study. PBI-L was adapted to Turkish by considering the stages of the cultural adaptation process. Short Form-36 (SF-36) was applied for the validity of PBI-L. PBI-L was repeated after a 1-week interval for test-retest reliability. The mean age was 47.66 ± 14.23 years. The intraclass correlation coefficient (ICC) value was determined as 0.73 (p < 0.0001) for the total score. There was a moderate correlation between first (ICC = 0.63, p < 0.0001) and second subdimensions (ICC = 0.62, p < 0.0001). Cronbach's α values ranged between 0.83 and 0.89. Low correlations were found between total scores of PBI-L and mental health, physical function subdimensions of SF-36 (p < 0.05). The Kaiser Meyer Olkin value was 0.6, and it was found that the PBI-L was not consistent with factor analysis. Conclusion: The Turkish version of PBI-L is a valid and reliable tool in patients with LE, lipedema, and lipolymphedema. However, the reassessment validity of PBI-L would be suggested by using an LE-specific quality of life questionnaire.

Investigating the relationship between the quality of life and religious coping in mothers of children with recurrence leukemia

Background:

Leukemia is a life-threatening chronic disease for children. The recurrence of the disease causes tension and reduces the quality of life for the family, especially for mothers. Religion is an important humanitarian aspect of holistic care that can be very effective in determining the health level of the patient and the family members. The present study aims at investigating the role of religious coping (RCOPE) in the quality of life for mothers of children with recurrent leukemia.

Methods:

This is a cross-sectional study of the descriptive-correlational type. Two-hundred mothers with children aging 1–15 years suffering from leukemia were selected using a continuous sampling method. The data were collected using questionnaires eliciting information about personal information, Persian version of the Caregiver Quality of Life Index-Cancer, and RCOPE. The collected data were analyzed in SPSS using descriptive tests and independent samples t-test.

Results:

The result of examining the relation between life quality and demographic features of mothers showed that education level, income, and occupation had a significant statistical relationship with general quality of life mothers. The results of examining the relationship between quality of life and RCOPE of mothers showed that RCOPE was positively correlated only with the positive coping dimension quality of life (P < 0/001). Negative RCOPE had a significant reverse statistical correlation with general quality of life and all its aspects.

Conclusion:

The quality of life for the participants in this study was significantly related to RCOPE. Mothers with negative RCOPE faced low scores for quality of life, and religious support can improve their life quality. Further longitudinal studies are required to investigate the effects of establishing support communities.

Test of a social cognitive model of well-being among breast cancer survivors

Given the potentially long-standing emotional impact of breast cancer, theoretical models are needed to identify critical resources and coping strategies that optimize survivors' long-term adjustment. This study tested a model of well-being recovery with breast cancer survivors at 4 years post-treatment. Structural equation modeling was used to examine relationships between affect, loneliness, self-compassion, self-efficacy for coping with cancer, well-being, and life satisfaction. Two model variations offered good fit to the data, accounting for large portions of the variance in well-being and life satisfaction. Coping efficacy mediated paths from affect and loneliness to emotional well-being and life satisfaction.