Quality of Life in Hematologic Malignancy in the Eastern Mediterranean Region: A Systematic Review

Health-related quality of life (HRQoL) indicates patients' overall health and is an essential aspect of cancer care. Although multiple studies have addressed the various aspects of HRQoL in cancer patients, few studies have investigated HRQoL in hematologic malignancy patients in the Eastern Mediterranean region (EMR). This review conducted an electronic search using OVID-Medline to identify HRQoL-related articles involving hematologic malignancy patients in the EMR. Eight studies met the inclusion criteria. Two studies validated translated QoL psychometric instruments, three were observational studies, and three were interventional studies. Except for the validation studies, all studies discussed HRQoL in leukemia patients. Our review highlighted a scarcity in the number of studies focusing on patients with hematological malignancies in this region. The included studies demonstrated the negative impact of hematological malignancies and therapies on patients' HRQoL. In addition, the studies displayed the association between physical symptoms and QoL of cancer patients, necessitating the importance of addressing these symptoms. The studies were limited by publication year, the number of patients, geographical locations, and disease entities. Future studies in this area are encouraged to help understand factors affecting HRQoL in the EMR region and ways to improve it. Consequently, further research is needed to establish translated and validated QoL assessment instruments that target patients in the EMR using the most common tools including the Short-Form 36-item Health Survey and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire.

The impact of employment on quality of life for adults with brain injury

BACKGROUND: Employment is associated with greater quality of life (QOL) for people with disabilities. Yet, for individuals with traumatic brain injury (TBI), the benefits of work are not often realized given high rates of unemployment. OBJECTIVE: This study examined the unique impact of psychosocial variables and employment status (working vs. not working) on self-reported QOL among adults with TBI. METHODS: Participants included 116 adults with TBI between the ages of 18-65, recruited through state brain injury associations in the United States to complete an anonymous online survey. Hierarchical regression analysis was used to examine the incremental impact of psychosocial variables (sense of community, social support, social network, and problem-solving confidence) and employment status on QOL controlling for age and symptom severity. RESULTS: In the final model, employment status, informal and formal support network ties, problem-solving confidence, sense of community, and emotional support explained 59% of the variance in QOL, which is considered a large effect size. Employment status uniquely explained 5% of the variance in QOL. CONCLUSIONS: Findings support the positive benefits of work for adults with TBI. Rehabilitation services that emphasize vocational considerations and employment supports are needed to impact work status and ultimately QOL for individuals with TBI.

A Meta-Ethnography of the Experiences of Adults with Lymphoma During Acute and Chronic Survivorship

OBJECTIVES

The acute and chronic phases of cancer survivorship are the periods of treatment, post-treatment, and early remission. During acute and chronic survivorship, adults with lymphoma have reported both positive and negative changes in health-related quality of life. This meta-ethnography aims to appraise the experiences of adults with lymphoma at the acute and chronic survivorship phases.

DATA SOURCES

This qualitative review used the established meta-ethnography framework from Noblit and Hare and is outlined following the meta-ethnography reporting guidance (eMERGe). A systematic literature search using four unique databases was completed, including the Cumulative Index to Nursing and Allied Health Literature, PubMed, Ovid Emcare, and Clarivate Web of Science.

CONCLUSION

In total, nine research studies were included in this review. Study characteristics and sample evidence were extracted from the included studies to produce the synthesis. The review and synthesis formed three main themes and six subthemes that reflect the challenges of cancer treatment and post-treatment, the communication and support from others, and how lymphoma patients reframe and reprioritize during and following treatment.

IMPLICATIONS FOR NURSING PRACTICE

This meta-ethnography provides a comprehensive analysis of adults' experiences with lymphoma at the acute and chronic survivorship phases. Several approaches for the management and care of lymphoma patients were found in this review, including integrating patient support groups from diagnosis through post-treatment, tailored psychological health care services, personalized care and delivery pathways at post-treatment, and the promotion of strategies to cope with cancer in remission. Additional research should examine younger and older adults to discover age-related issues in lymphoma populations in addition to disparities among minority patients with lymphoma and those from low socioeconomic backgrounds.

N-Ethyl-n-Nitrosourea Induced Leukaemia in a Mouse Model through Upregulation of Vascular Endothelial Growth Factor and Evading Apoptosis

Chemical carcinogens are commonly used to investigate the biology and prognoses of various cancers. This study investigated the mechanism of leukaemogenic effects of n-ethyl-n-nitrosourea (ENU) in a mouse model. A total of 14 3-week-old male Institute of Cancer Research (ICR)-mice were used for the study. The mice were divided into groups A and B with seven mice each. Group A served as the control while group B received intraperitoneal (IP) injections of 80 mg/kg ENU twice with a one-week interval and were monitored monthly for 3 months for the development of leukaemia via blood smear examination. The mice were sacrificed humanely using a CO₂ chamber. Blood, spleen, lymph nodes, liver, kidney and lung samples were collected for blood smear examination and histopathological evaluation. The expression of angiogenic protein (VEGF), and pro and anti-apoptotic proteins (BCL2 and BAX), was detected and quantified using Western blot technique. Leukaemia was confirmed by the presence of numerous blast cells in the peripheral blood smear in group B. Similarly, the VEGF and BCL2 proteins were significantly (p < 0.05) upregulated in group B compared to A. It is concluded that IP administration of 80 mg/kg ENU induced leukaemia in ICR-mice 12 weeks post administration through upregulation of angiogenic and anti-apoptotic proteins: VEGF and BCL2.

Long-term effects and psychological adjustment: study protocol of a large register-based study on quality of life among survivors of hematological malignancies

BACKGROUND

Both incidence and survival rates of hematological cancers are increasing, leading to a growing number of survivors with specific late and long-term effects. However, relevant research in physical, psychological and social aspects of quality of life is scarce. Existing literature shows that a considerable number of cancer survivors report a relatively high quality of life despite a variety of adverse and persistent symptoms. To date, the reasons for this phenomenon as well as moderating and mediating factors are widely unknown. Given these research gaps, we aim to investigate the different domains of quality of life among long-term survivors of hematological cancers and to identify factors predicting high quality of life.

METHODS/DESIGN

This is a large cross-sectional study among hematological cancer survivors at a minimum of 3 years after diagnosis. We will collect 1000 survivors completing a set of self-report-questionnaires encompassing physical, psychological and social domains of quality of life. Participants are clustered in groups according to time since diagnosis and compared with each other. Furthermore, survivors will be compared with the general population. Factors predicting high quality of life will be identified via multiple regression analyses and structure equation modeling.

DISCUSSION

Our study will help to inform health care providers about the specific long-term burden among survivors with hematological malignancies. Identification of factors predicting high quality of life will help to develop adequate intervention strategies to enhance well-being in hematological cancer survivors. Our methodological advantages including the large sample as well as the assessment of different domains of quality of life will ensure novel and robust results. A limitation of the study is the cross-sectional design.

A qualitative study of the post-treatment experiences and support needs of survivors of lymphoma

PURPOSE

To explore the post-treatment experiences and preferences for follow-up support of lymphoma survivors.

METHODS

Two focus groups were conducted with 17 participants to explore informational, psychological, emotional, social, practical and physical needs, 6-30 months post-treatment for lymphoma. Perceptions regarding a potential model of survivorship care were also elicited.

RESULTS

Thematic content analysis revealed five key themes: Information; Loss and uncertainty; Family, support and post-treatment experience; Transition, connectivity and normalcy, and Person-centred post-treatment care. Participants described a sense of loss as they transitioned away from regular interaction with the hospital at the end of treatment, but also talked about the need to find a "new normal". Establishing post-treatment support structures that can provide individualised information, support, reassurance and referrals to community and peer support were identified as a helpful way to navigate the transition from patient to post-treatment survivor.

CONCLUSIONS

Participants in our study articulated a need for a flexible approach to survivorship care, providing opportunities for individuals to access different types of support at different times post-treatment. Specialist post-treatment nurse care coordinators working across acute and community settings may offer one effective model of post-treatment support for survivors of haematological malignancies.

Haematological cancer and quality of life: a systematic literature review

The aim of this study is to examine the impact of haematological cancers on quality of life (QoL). A review of the international literature was conducted from the databases ‘PsycInfo' and 'Medline' using the keywords: 'haematological cancer', 'quality of life', 'physical', 'psychological', 'social', 'vocational', 'professional', 'economic', 'cognitive', and 'sexual'. Twenty-one reliable studies were analysed. Among these studies, 12 showed that haematological cancer altered overall QoL, 8 papers found a deterioration of physical dimension, 8 papers reported on functional and role dimensions, 11 papers reported on the psychological component and 9 on the social component. Moreover, one study and two manuscripts, respectively, reported deteriorated sexual and cognitive dimensions. Our review demonstrates that the different dimensions of QoL are deteriorated by haematological malignancies and, probably, by the side effects of treatment.

Understanding distress in posttreatment adult leukemia and lymphoma survivors: a lifespan perspective

Using in-depth interviews, this paper explores the nature and sources of cancer-specific distress among 51 posttreatment adult leukemia and lymphoma survivors (LLS), focusing on the role of lifespan stage in shaping reported stressors. LLS (all ages) reported physical aftereffects of cancer treatment, with reported sources of emotional and financial distress varying by lifespan stage. Young adult survivors (18-39) reported a greater number of distress sources. Distress may persist up to 4 years posttreatment, particularly among younger LLS, who appear to be at greater risk of distress in multiple domains.

Identification and correlates of unmet service needs in adult leukemia and lymphoma survivors after treatment

PURPOSE

To examine and characterize the psychosocial and health service needs of adult leukemia and lymphoma survivors who had completed active treatment within the past 4 years.

METHODS

Self-report surveys were completed by 477 survivors, age 18 to 85 years, to identify areas and correlates of unmet psychosocial, health, and instrumental service needs. Unmet service needs were rank ordered, and nonparametric tests were run to assess relationships.

RESULTS

The rate of unmet need was highest regarding sexual issues, handling medical and living expenses, emotional difficulties, employment, and health insurance. Women were more likely to report unmet child care needs than men; younger individuals were more likely to report needing help with emotional difficulties and family problems; and lower income was related to greater unmet need regarding medical and living expenses. Relationships were also observed among the service needs, suggesting overlapping areas of unmet need.

CONCLUSION

Adult leukemia and lymphoma survivors demonstrated a diverse range of needs, many of which were related to the psychosocial and physical sequelae of cancer. The findings suggest directions for service provision and development of standards for quality care in this underserved post-treatment population.

Are psychosocial factors associated with quality of life in patients with haematological cancer? A critical review of the literature

BACKGROUND

Haematological cancers differ from other cancers mainly with regard to treatment strategies: surgery is used for diagnostic purposes but rarely for treatment, whereas chemotherapy is of central importance and, in some cases, cures patients. This article reviews studies that examine the relationships between psychosocial factors and quality of life (QoL) in haematological cancer patients.

METHODS

A review of the literature was conducted from the databases 'PsycInfo', 'Medline' and 'Science Direct' using the keywords 'lymphoma', 'leukaemia', 'myeloma', 'quality of life', 'psychosocial factors', 'coping', 'social support', 'personality', 'anxiety,' 'depression', 'locus of control' and 'alexithymia'.

RESULTS

Fourteen studies were analysed. One study found positive relationships between sense of coherence and health-related QoL, whereas another showed a positive link between self-esteem and QoL. Another study suggested that a high external health locus of control was related to a better QoL. Fighting spirit had a positive impact on QoL for two studies, and helplessness-hopelessness was positively related to emotional distress in one study. Two studies indicated the relationships between emotional distress and QoL. Satisfaction with information about disease determined emotional distress in another study. Social support, general health perceptions, global meaning or spirituality were found to improve QoL in four other reports.

CONCLUSION

Literature about the relationships between psychosocial factors and QoL is lacking. Sense of coherence, self-esteem and health locus of control, coping strategies, social support, global meaning or emotional distress are associated with QoL. Results concerning coping and social support should be interpreted with caution because of level II evidence in studies.

Psychometric evaluation of the Impact of Cancer (IOC-CS) scale for young adult survivors of childhood cancer

INTRODUCTION

Psychosocial outcomes derived from standardized and disease-specific measures are often used in pediatric oncology; however, the reliability, validity and utility of these instruments in adult survivors of childhood cancer have yet to be established.

PURPOSE

To develop and evaluate a new instrument that measures aspects of long-term survivorship not measured by existing tools.

METHODS

A new candidate instrument--the Impact of Cancer for childhood cancer survivors (IOC-CS)--was administered to childhood cancer survivors aged 18-39 who were 21 years of age or younger when diagnosed with cancer. Psychometric properties of newly derived scales were assessed.

RESULTS

Factor analyses of items derived eight new and specific subscales: Life Challenges, Body/Health, Talking With Parents, Personal Growth, Thinking/Memory Problems, Health Literacy, Socializing and Financial Problems. Internal consistency measurements for these subscales ranged from 0.70 to 0.86. Expected associations within and among the IOC-CS subscales and standardized measures of health-related quality of life (HRQOL) were observed, as were some unexpected findings.

CONCLUSION

Psychometric analyses indicated that this initial version of the IOC-CS measures distinct and relevant constructs for young adult survivors of childhood cancer. Future work is necessary to confirm the responsiveness and further validate the instrument in multiple and representative samples.

Post-traumatic growth: finding positive meaning in cancer survivorship moderates the impact of intrusive thoughts on adjustment in younger adults

OBJECTIVE

We examined whether post-traumatic growth would moderate the impact of intrusive thoughts on a range of dimensions of well-being in a sample of younger adult survivors of various types of cancer.

METHODS

167 participants completed questionnaires regarding intrusive thoughts, post-traumatic growth, mental and physical health-related quality of life, positive and negative affect, life satisfaction, and spiritual well-being. Multiple regression analyses controlling for relevant background and cancer-related variables tested the interaction effects of post-traumatic growth and intrusive thoughts.

RESULTS

Intrusive thoughts were related to poorer adjustment on all indices except physical health-related quality of life. However, post-traumatic growth moderated the effects of intrusive thoughts on positive and negative affect, life satisfaction, and spiritual well-being in a protective fashion. That is, for those higher in post-traumatic growth, higher levels of intrusive thoughts were related to better adjustment.

CONCLUSIONS

The positive meaning that individuals assign to their cancer experience as reflected in their reports of post-traumatic growth appears to be important in determining the impact of intrusive thoughts on post-cancer adjustment.

Role of religious involvement and spirituality in functioning among African Americans with cancer: testing a mediational model

The present study tested a mediational model of the role of religious involvement, spirituality, and physical/emotional functioning in a sample of African American men and women with cancer. Several mediators were proposed based on theory and previous research, including sense of meaning, positive and negative affect, and positive and negative religious coping. One hundred patients were recruited through oncologist offices, key community leaders and community organizations, and interviewed by telephone. Participants completed an established measure of religious involvement, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-SP-12 version 4), the Positive and Negative Affect Schedule (PANAS), the Meaning in Life Scale, the Brief RCOPE, and the SF-12, which assesses physical and emotional functioning. Positive affect completely mediated the relationship between religious behaviors and emotional functioning. Though several other constructs showed relationships with study variables, evidence of mediation was not supported. Mediational models were not significant for the physical functioning outcome, nor were there significant main effects of religious involvement or spirituality for this outcome. Implications for cancer survivorship interventions are discussed.

An exploration of the lived experiences of individuals with relapsed multiple myeloma

The experience of living with relapsed Multiple Myeloma (myeloma) for eight patients accessing treatment within a haematology unit in a large London hospital is explored in this study. Myeloma is recognised as incurable and is sometimes described as an 'incurable chronic disease' with a main treatment option of chemotherapy. Hermeneutic phenomenology was the methodology used in conducting the study and data were collected through open-ended, unstructured interviews. Findings suggest that living with relapsed myeloma in the context of a chronic illness causes an ever-shifting perspective between illness and wellness consequently maintaining a state of uncertainty. The patients in this study placed importance on the emotional aspect of their experience. Hope, intuitive knowing and a fighting spirit were expressed as required positive elements that enabled living with relapsed myeloma. These assisted in maintaining normality, coping with bad news and adjusting to the illness. Pervading through the themes was the need to control uncertainty. Having strong support from significant others provided something to live for and the necessary social support required to promote a new orientation to life.

Surviving cervical cancer: does health-related quality of life influence survival?

OBJECTIVE

This study investigates the association between health-related quality of life (HRQOL) outcomes and survival status among a population-based cohort diagnosed with invasive cancer of the cervix uteri.

METHODS

This study is based on data from 353 multiethnic cervical cancer survivors (CCS) recruited through the California Cancer Surveillance Program. The independent variable is HRQOL measured by the FACT-CX (FACT-G plus additional items) and the SF-12. The dependent variable is survival from date of the HRQOL survey. Kaplan-Meier estimates and univariate and multivariate Cox Proportional Hazards Regression models were used to examine the relationship between HRQOL and survival.

RESULTS

In the Kaplan-Meier analyses, the FACT-CX functional well-being score equal to or above the median score was significantly associated with improved overall survival (X(2)=7.19; p=0.007). Significant differences in survival were observed for the SF-12 physical and mental health component scores. In the multivariate Cox regression analyses, the final model indicated that the FACT-CX total scores, functional well-being, and additional cervical cancer concerns subscales, and the SF-12 physical and mental component summary scores significantly influenced survival, after controlling for medical characteristics. However, the FACT components that do not include cervical cancer specific items including mean standardized FACT-G and physical, emotional, and social/family well-being subscales were not predictors of survival before and after adjustment for covariates.

CONCLUSIONS

The results of this study advance the current scientific knowledge by confirming that HRQOL outcomes, in particular the physical, function and mental health dimensions are associated with survival for CCS. These findings highlight the utility of cancer site specific HRQOL data to inform the psychosocial and symptom management aspects, as well as the medical follow-up care practice and research that may extend life.

Psychosocial Concerns in Patients With Advanced Cancer: An Observational Study at Regional Cancer Centre, India

Introduction: The diagnosis and treatment of cancer is associated with substantial physical, psychological, and social morbidity. The objective of this study was to identify the prevalence of psychosocial concerns in the patients with advanced cancer admitted to our institute. Materials and Methods: A total of 100 patients admitted to the inpatient palliative care unit of our institute were enrolled in this study. A descriptive questionnaire that dealt with the patient’s psychological acceptance of the disease and emotional distress that accompanies the diagnosis was prepared. Patient’s social and spiritual needs were addressed, and the future concerns that the patient is preoccupied with were discussed on a one-on-one basis with the patient himself or herself. Results: It was found that a majority of patients, though aware of their diagnosis, were not aware of the disease prognosis. There was a generalized anxiety regarding the treatment of the disease and fear of suffering. Most patients preferred to keep the revelation of the diagnosis to those close to them and not reveal it publicly. Financial drain out of resources was a major concern. Future concerns about their own fitness, the settlement of their children, and the family’s well-being were seen commonly in almost all the patients. Conclusions: Attention to psychosocial and spiritual health needs of patients with cancer is an integral part of an effective palliation, though they are less commonly expressed but are strongly felt by patients with cancer. It is therefore recommended that all clinicians and health care providers should address psychosocial health needs as a part of their routine practice.

Role of religion in cancer coping among African Americans: a qualitative examination

The present study used qualitative methods to examine if and how African Americans with cancer use religiosity in coping. Patients (N = 23) were recruited from physician offices and completed 1-1(1/2) hour interviews. Themes that emerged included but were not limited to control over one's illness, emotional response, importance of social support, role of God as a healer, relying on God, importance of faith for recovery, prayer and scripture study, and making sense of the illness. Participants had a great deal to say about the role of religion in coping. These themes may have utility for development of support interventions if they can be operationalized and intervened upon.

Post-traumatic Stress Disorder and Quality of Life in Long-term Survivors of Hodgkin's Disease and Non-Hodgkin's Lymphoma in Israel

Post-traumatic stress disorder (PTSD) has not been examined systematically in long-term survivors of lymphoma. In this study, PTSD and health related quality of life (HRQoL) were assessed in 44 patients with Hodgkin's disease (n = 8) or non-Hodgkin's lymphoma (n = 36). Forty-four individuals who had experienced traumatic events as defined by the Diagnostic and Statistical Manual-IV (DSM-IV) as possible triggers for PTSD served as controls. The study participants were administered two questionnaires-the PTSD inventory scale and the Short Form-36 (SF-36) HRQoL instrument measuring physical and mental HRQoL. Full PTSD was defined as meeting the DSM-IV criteria for the diagnosis in all three symptom groups measured on the PTSD inventory scale-intrusion, avoidance and hyper-arousal and partial PTSD as meeting the diagnostic criteria in two of the symptom groups. There was a significant increase in the hyper-arousal scale in the lymphoma survivor group (F 5, P < 0.05). Overall, full or partial PTSD was found in 14 lymphoma survivors (32%) and in 11 individuals (25%) in the control group (difference not significant). Survivors whose disease had started at an earlier age suffered significantly more intensive intrusion and avoidance symptoms. The lymphoma survivor group had a significantly lower physical HRQoL than the control group independent of PTSD symptoms. In both groups, the presence of PTSD symptoms correlated with a lower HRQoL. These results suggest that lymphoma is a trauma similar to other more accepted definitions of trauma which can lead to PTSD, and is associated with more severe hyper-arousal symptoms. Psychological interventions in the early stages of treatment or follow-up may help reduce the morbidity from PTSD and improve quality of life.

Acculturation, social support, and quality of life for Korean immigrant breast and gynecological cancer survivors

OBJECTIVES

This study examines the direct and/or indirect pathways among acculturation, social support, depressive symptoms, and quality of life (QOL) for Korean immigrant breast and gynecological cancer survivors.

DESIGN

The QOL-Cancer Survivor measure was translated and then administered to 51 survivors. This tool measured acculturation by assessing westernization, language barriers, and length of stay. In addition, the Brief Symptom Inventory-18 was used to assess depressive symptoms. Social support components were conceptualized as comprising both functional social support and social network structures.

RESULTS

Structural equation modeling identified significant relationships among acculturation, social support, depressive symptoms, and QOL. Higher acculturation was associated with positive network structures (larger network size, diversity, and closer social ties) and lower depressive symptoms, which in turn contributed to better QOL. Simultaneously, positive social network structures strongly correlated with better emotional support and, thus, influenced lower depressive symptoms.

CONCLUSIONS

The evidence that acculturation influences QOL through social support for Korean immigrant cancer survivors should serve as a rationale for developing psychosocial interventions that enhance immigrant cancer survivors' social participation and adjustment in the unfamiliar US environment.

Different pathways in social support and quality of life between Korean American and Korean breast and gynecological cancer survivors

PURPOSE

The purpose of this study was to investigate: (1) how social support influences quality of life (QOL) and (2) whether or not the pathways for predicting QOL outcomes differ between Korean American and Korean survivors of breast and gynecological cancer.

METHOD

To identify multiple dimensions of health status and psychosocial outcomes, two standardized QOL and psychological distress measures were administered to 51 Korean Americans and 110 Koreans. Social support was measured by items assessing functional social support and social network structures. Hierarchical multiple regression and path analyses were employed to investigate the effects of social support on outcomes and to compare between Korean Americans and Koreans.

RESULTS

The findings indicate that functional social support directly influences QOL and psychological distress, and social network structures are directly and/or indirectly associated with outcomes. Moreover, the two groups showed different pathways from social support to outcomes.

CONCLUSION

This study provides practical research information by illuminating the relationships between social support components influencing QOL for Korean American and Korean survivors. This study may increase the utility and efficacy of the research and interventions to enhance cancer survivors' social participation and to diminish barriers to follow-up care, considering the different living conditions between the United States and Korea.

Developing an outcome measurement for meaning-making intervention with Chinese cancer patients

Psychosocial programs designed for cancer patients often facilitate the search for meaning as one of the therapeutic components. This study aimed to develop a self-report instrument, namely Chinese Cancer Coherence Scale (CCCS), which measures the patients' meaning-making process with reference to the concept of coherence. A panel of eight veteran social workers and psychologists generated statements pertaining to the cancer experience. Results from a two-phase study involving 390 breast cancer patients revealed a two-factor structure of the CCCS, namely incoherent-embittered and coherent-enlightened. The use of the CCCS by practitioners and researchers is recommended in order to understand how Chinese cancer patients make sense of their cancer experience.

Self-Administered Stress Management Training in Patients Undergoing Radiotherapy

Purpose

This study sought to continue research on psychosocial interventions for patients being treated with radiation therapy across multiple centers and to replicate positive findings of a single-center study of patients being treated with chemotherapy. The primary objective of this study was to determine if a stress management intervention was effective in improving quality of life and decreasing psychological distress in patients undergoing radiotherapy for cancer.

Patients and Methods

A total of 310 patients about to begin radiotherapy treatment were randomly assigned to receive usual care only or self-administered stress management training. Quality-of-life assessments occurred at baseline and for 3 weeks after the beginning of radiotherapy treatment.

Results

Overall, patients assigned to receive stress management training did not report significantly less psychological distress on the Medical Outcomes Study 36-Item Short Form (SF-36) Mental Component Summary Scale than did those assigned to usual care. When divided into subgroups based on the SF-36 Mental Component Summary Scale scores immediately after their first radiotherapy treatment, patients with above-average levels of psychological distress (scores ≤ 50) who were randomly assigned to the intervention condition reported significant improvement in their distress compared with those assigned to usual care only on the SF-36 Mental Health Subscale and the Center for Epidemiologic Studies Depression Scale.

Conclusion

This study found that self-administered stress management training is effective only in those radiotherapy patients with initially higher levels of psychological distress. Additional research should examine the benefits of stress management training targeted specifically to patients experiencing heightened distress.

Factors associated with health-related quality of life in pediatric cancer survivors

BACKGROUND

Childhood cancer survivors are at risk for late effects of disease and treatment that may be attributed to multiple causes. This study describes health-related quality of life (HRQOL) in childhood cancer survivors and identifies factors related to poor quality of life outcomes.

PROCEDURE

Patients age 8-18 years, who attended the long-term information, follow-up, and evaluation (LIFE) clinic at Childrens Hospital Los Angeles during a 1-year time-period were eligible for the study. Eighty-six survivors (mean time off-treatment=7.8 years) completed the Pediatric Quality of Life Inventory 4.0 Generic Core Scales, a LIFE Clinic Intake Questionnaire and rated their fatigue using a 10-point scale. Oncology nurses independently rated subjects' late effects using a 3-point severity scale. Linear regression procedures were used to evaluate the association between demographic and medical factors and HRQOL.

RESULTS

Fatigue and more severe late effects were associated with poorer physical functioning (fatigue, P<0.02; late effects, P<0.01). Fatigue, ethnic minority status, and a brain tumor diagnosis were associated with poorer psychosocial functioning (fatigue, P<0.0001; minority status, P<0.04; brain tumor, P<0.01). Fatigue was the only factor related to both poor physical and psychosocial HRQOL.

CONCLUSIONS

Long-term follow-up clinics for childhood cancer survivors are in a unique position to monitor HRQOL over time. Factors associated with poorer HRQOL include fatigue, ethnic minority status, a brain tumor diagnosis, and more severe late effects. Future studies need to clarify relationships between ethnicity, socioeconomic status (SES), and HRQOL in cancer survivors.

Late effects of cancer and hematopoietic stem-cell transplantation on spouses or partners compared with survivors and survivor-matched controls

PURPOSE

Little is known about the long-term effects of cancer and hematopoietic stem-cell transplantation (HCT) on spouses or partners. The purpose of this study was to examine the health-related quality of life and post-traumatic growth (PTG) of spouses/partners compared with survivors and controls and to identify factors associated with those outcomes.

PATIENTS AND METHODS

HCT survivor/partner pairs (n = 177), coupled continuously since HCT, were drawn from 40 North American transplantation centers. Married peer-nominated acquaintances (of survivors) served as controls (n = 133). Outcomes were measured a mean of 6.7 years after HCT (range, 1.9 to 19.4 years).

RESULTS

As expected, self-reported partner physical health was similar to controls and better than survivors (P < .001). However, partners reported more fatigue and cognitive dysfunction than controls (P < .001 for both), although less than survivors. Partners and survivors reported more depressive symptoms and sleep and sexual problems than controls (P < .001, P < .01, and P < .01, respectively). Odds of partner depression were nearly 3.5 times that of controls (P < .002). Depressed partners were less likely than depressed survivors to receive mental health treatment (P < .04). Partners reported less social support (P < .001), dyadic satisfaction (P < .05), and spiritual well-being (P < .05) and more loneliness (P < .05) than both survivors and controls. In contrast to survivors, partners reported little PTG (P < .001). Factors associated with partner outcomes included partner health problems, coping, female sex, social constraint, survivor depression, optimism, multiple life changes, and social support.

CONCLUSION

Spouses/partners experience similar emotional and greater social long-term costs of cancer and HCT than survivors without the potential compensatory benefits of PTG. Some of the factors associated with partner outcomes are amenable to intervention.

Quality of life among long-term non-Hodgkin lymphoma survivors

BACKGROUND

The objective of this population-based study was to document the long-term effects (5-15 years postdiagnosis) of non-Hodgkin lymphoma and its treatment on health-related quality of life (HRQL) and social problems.

METHODS

The population-based Eindhoven Cancer Registry was used to select all patients who were diagnosed with non-Hodgkin lymphoma from 1989 to 1998. Three hundred sixty patients were invited to complete the 36-item Short Form Health Survey (SF-36) and the Quality of Life-Cancer Survivors questionnaire, and 294 patients (82%) responded.

RESULTS

Patients who had received chemotherapy reported significantly worse psychological and social well-being and health-related quality of life (HRQL) than patients who had not received chemotherapy. Radiotherapy and watchful waiting were not associated significantly with HRQL outcomes. Patients who were diagnosed from 10 to 15 years earlier reported better social well-being than patients who were diagnosed from 5 to 9 years earlier. Compared with an age-matched, normative sample from the general population, patients reported significantly worse general health and less vitality, but they reported less bodily pain. Practical problems were reported with work (41%), obtaining health care insurance (6%) and life insurance (15%), and obtaining a home mortgage (22%).

CONCLUSIONS

From 5 to 15 years after diagnosis, the general health perceptions and vitality levels of non-Hodgkin lymphoma survivors remained significantly lower than those of their peers in the of general population. In addition, survivors faced practical problems with work and finances that deserve additional attention during the period of rehabilitation.

Health-Related Quality of Life for Latino Survivors of Childhood Cancer

This study compared the similarities and differences in health-related quality of life (HRQOL) among Latino and non-Latino adult long-term survivors of childhood cancer using the qualitative methodologies of focus groups and individual semistructured telephone interviews. The study also compared the sample's HRQOL, as measured by the Short-form 12 to the general, healthy United States population normative data. The data suggest that Latino survivors are reporting good HRQOL similar to the non-Latinos. The findings suggest that the paradigm of negative consequences of cure should be expanded to one, which also includes the positive impact of cure for ethnically diverse populations of childhood cancer survivors.

Assessing the impact of cancer: development of a new instrument for long-term survivors

OBJECTIVE

To develop and evaluate a new instrument that measures aspects of long-term survivorship not measured by existing tools.

METHODS

In qualitative interviews, 47 long-term cancer survivors (LTS) detailed ways that cancer has impacted their lives. Content analysis resulted in the creation of 325 candidate items for inclusion in a new Impact of Cancer (IOC) instrument. Following expert review, item reduction and pilot testing, 81 items were administered with other established health status and quality of life (QOL) instruments to 193 LTS of breast, prostate, colorectal cancers and lymphoma. Internal consistency reliability and validity of newly-derived scales was assessed.

RESULTS

Factor analysis of items using a priori QOL domains resulted in the derivation of ten new and specific subscales: Health Awareness, Body Changes, Health Worries, Positive and Negative Self-Evaluation, Positive and Negative Life Outlook, Social Life Interferences, Relationships, and Meaning of Cancer. Internal consistency measurements for these subscales ranged from 0.67 to 0.89. Expected associations within and among the IOC subscales and standardized measures of health status and QOL were observed, as were some unexpected findings.

CONCLUSIONS

Psychometric analysis indicated that this initial version of the Impact of Cancer instrument measures distinct and relevant constructs for LTS. Future work is necessary to confirm the factor structure, responsiveness and further validation of the instrument.

Appraisal of the cancer experience by family members and survivors in long-term survivorship

This study assessed the appraisal of the stressfulness of the cancer experience and its correlates for family members and older survivors living in the long-term survivorship phase of the disease. On average, family members appraised the cancer experience as more stressful than their surviving relatives. Beliefs about the effect of the diagnosis and treatment on family members were important correlates for both family members and survivors in the appraisal process. Cancer characteristics were not related to appraisal for survivors, but stage at diagnosis was associated with a more stressful appraisal for family members. Demographic characteristics were unrelated to appraisal for family members, but being African-American was linked to a less stressful appraisal for survivors. These findings highlight the stressful impact of the cancer experience on family members and can help guide health care interventions which include family members from African-American and White ethnicities.

The Strength-Focused and Meaning-Oriented Approach to Resilience and Transformation (SMART): A body-mind-spirit approach to trauma management

This article introduces the Strength-focused and Meaning- oriented Approach to Resilience and Transformation (SMART) as a model of crisis intervention, which aims at discovering inner strengths through meaning reconstruction. Limitations of conventional crisis management and current findings in post-traumatic growth research are discussed. Instead of adopting a pathological framework, the SMART approach holds a holistic view of health, employs facilitative strategies, and promotes dynamic coping. Intervention components include Eastern spiritual teachings, physical techniques such as yoga and meditation, and psycho-education that promotes meaning reconstruction. Efficacy of the SMART model is assessed with reference to two pilot studies conducted in Hong Kong at the time when the SARS pandemic caused widespread fear and anxiety in the community. Response to potential criticisms of the SMART model is attempted.

Social networks and quality of life for long-term survivors of leukemia and lymphoma

GOALS

This study examined the relationship between personal and medical characteristics and quality of life (QOL) for long-term survivors (LTS) of leukemia and lymphoma, and how social networks influence this relationship.

PATIENTS AND METHODS

Fifty three LTS, at least 10 years postdiagnosis, were administered a standardized psychometric instrument, the Quality of Life--Cancer Survivors, to assess multidimensional aspects of QOL. Social network characteristics were measured by items assessing social support satisfaction, use of supportive care services, network size, and reliance on formal and informal social ties.

MAIN RESULTS

A hierarchical regression model explained 52.4% of the variance in QOL for the final model, including all important predictors. Social support satisfaction (beta=0.393, p=0.001) and the use of supportive care services (beta=-0.262, p=0.047) significantly predicted QOL after controlling for confounding variables. Social network structures (including network size and reliance on formal and informal social ties) were indirectly associated with QOL through the use of supportive care services.

CONCLUSIONS

The results indicate that the use of supportive care services, satisfaction with social support, network size, and reliance on formal and informal social ties affect QOL for long-term cancer survivors. Enhancing cancer survivors' social networks may ultimately improve their QOL.

Quality of life 5 or more years post-autologous hematopoietic stem cell transplant

This cross-sectional study used a mailed survey to evaluate the quality of life (QOL) of individuals at least 5 years post-autologous stem cell transplant and to determine instrument preference. Instruments selected were the Medical Outcomes Study-Short Form (MOS-SF-36) as the generic measure and the City of Hope-Quality of Life-Bone Marrow Transplant (COH-BMT) and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) as transplant-specific measures. Subjects received the MOS-SF-36 and were randomized to receive (1) COH-BMT, (2) FACT-BMT, or (3) COH-BMT and FACT-BMT. Ninety-two subjects returned completed forms, for a 56% response rate. A study-specific form indicated subjects preferred the BMT-specific instruments. The health of the majority of subjects (85%) was similar to or somewhat better than what it was the previous year. Their MOS-SF-36 scores for physical functioning, role-physical, bodily pain, and general health subscales were lower than the values for the general population, but those for the other subscales were not significantly different. When compared to the data reported by Hann and colleagues for posttransplant in breast cancer, study subjects scored significantly lower on all scales except General Health and Mental Health. COH-BMT scores compared with those reported by Whedon and Ferrel (Semin Oncol Nurs. 1994;10:42-57) were higher for Physical Well-Being, Spiritual Well-Being, and Global QOL. FACT-BMT results compared with those reported by McQuellen et al (Bone Marrow Transplant. 1997;19:357-368) showed that Physical, Social/Family, Emotional, and Functional Scores were similar; only BMT scores were significantly different. Research is needed to determine when QOL plateaus and whether instrument preference changes over time. Awareness of long-term effects that affect QOL can guide program revisions and facilitate decisions regarding the need for supportive rehabilitative services.

Appraisal of the cancer experience by older long-term survivors

Cancer survivorship is best viewed as a process that continues across the life span. Appraisals of cancer change over time and may not be explicit until long after treatment completion. The current study, using the Lazarus and Folkman (1984) stress-appraisal-coping framework, explored factors related to both a stressful and an irrelevant appraisal of the cancer experience by older long-term survivors. Hierarchical regression analysis investigated the individual and cumulative effects of person factors (survivors' demographic characteristics, beliefs about the effect of cancer on family members) and situation factors (characteristics of cancer) on survivors' appraisals that cancer was a stressful life event. The strongest correlates of the stress appraisal were person factors. A more stressful appraisal was associated with: (1). the belief that diagnosis/treatment caused greater family distress, (2). being younger, and (3). being White. The irrelevant appraisal had a marginally significant correlate in bivariate analysis and was not included in regression analysis. Implications for health-care professionals and patient/family interventions are discussed.

Social problems in oncology

A study was undertaken to describe, evaluate and categorise the social problems experienced by cancer patients. Ninety-six adult cancer patients at all stages of disease participated in either a telephone focus group discussion, a face to face focus group or an individual interview which were tape recorded and transcribed. Six experts analysed the transcripts. A total of 32 social problems were identified categorized under eight headings plus four single items. The categories were: problems with (1) managing in the home, (2) health and welfare services, (3) finances, (4) employment, (5) legal matters, (6) relationships, (7) sexuality and body image and (8) recreation. Problems with relationships and communication were the most frequently reported with financial, employment, body image and domestic problems also being widely endorsed. Female groups, younger patient groups and groups where the aim of treatment was palliative reported more social problems than other groups. Social problems are common and important to cancer patients. The social problems identified in this study will contribute to an item pool generated for developing a Social Problems Inventory that may be included in patient centred assessment as part of routine oncology practice.

Comparisons between cancer survivors and family members on meaning of the illness and family quality of life

PURPOSE/OBJECTIVES

To explore the meaning of the illness to the family and family quality of life (QOL) for survivors and family members and to describe similarities and differences between survivors' and family members' meaning of the illness and family QOL.

RESEARCH APPROACH

Descriptive, qualitative.

SETTING

Homes of survivors and family members in an urban metropolitan area in the midwestern United States.

PARTICIPANTS

A sample of 123 Caucasian and African American cancer survivors, one to six years after treatment had ended, and their family members (N = 246). Four cancer diagnoses (i.e., breast, colon, prostate, and uterine) were represented.

METHODOLOGIC APPROACH

Two open-ended questions derived from a family model of survivorship. Content analysis was used to analyze the responses.

MAIN RESEARCH VARIABLES

Meaning of the illness and family QOL.

FINDINGS

The positive dimensions of survivorship in meaning of the illness and family QOL were seen for patients and family members, although long-term stressors also were reported. More similarities than differences in meaning and QOL were noted between survivors and family members.

CONCLUSIONS

Patients' and family members' perspectives of the meaning of the illness and family QOL are important to assess during survivorship to address both individual- and family-level perspectives in cancer care.

IMPLICATIONS FOR NURSING

Nurses should offer opportunities for patients and family members to search for positive meaning in the cancer illness, develop strategies to handle stressors that are present during survivorship, and enhance family strengths and resources to promote family QOL.