Uncertainty management intervention for older African American and caucasian long-term breast cancer survivors

Psychological interventions for women with non-metastatic breast cancer

BACKGROUND

Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015.

OBJECTIVES

To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer.  SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles.

SELECTION CRITERIA

Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer.

DATA COLLECTION AND ANALYSIS

Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes.

MAIN RESULTS

We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months.  Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies.

AUTHORS' CONCLUSIONS

Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.

Adapting and avoiding coping strategies for women with ovarian cancer during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has resulted in unprecedented challenges for people living with cancer, impacting not only physical health but psychological well-being. The psychological response affects the individual as well as the community and can persist long after the outbreak. We aim to assess coping strategies employed by women with ovarian cancer during the COVID-19 pandemic.

METHODS

Women with a current or prior diagnosis of ovarian cancer completed an online survey which included a query about coping strategies during the COVID-19 pandemic. The survey was distributed from March 30th through April 13, 2020 through survivor networks and social media.

RESULTS

Six hundred and three women visited the survey website during the study period and 555 (92.0%) completed the survey. Four hundred and eight (73.5%) provided information on coping strategies utilized during COVID-19. Among those who responded, the median age was 58 years (range 20-85) and 150 participants (40.8%) were undergoing active cancer treatment. Commonly utilized adaptive coping strategies included emotional support (159, 39.0%), self care (148, 36.3%), hobbies (139, 34.1%), planning (87, 21.3%), positive reframing (54, 13.2%), religion (50, 12.3%) and instrumental support (38, 9.3%). Many participants also relied on avoidance coping strategies including self distraction (111, 27.2%) and substance use (19, 4.7%).

CONCLUSIONS

Most ovarian cancer survivors are using adaptive, problem-focused coping strategies during the COVID-19 pandemic, however many are practicing avoidance strategies as well. As coping mechanisms profoundly impact quality of life, oncology providers must assist patients in identifying coping strategies that optimize physical and psychological well-being.

Development of an audio and computer cognitive behavioral therapy for depression in older adults

Background: The purpose of this paper is to discuss the development of two novel technology-based interventions for depression in older adults while comparing older adults' preferences for audio-based and computer-based cognitive behavioral therapy for depressive symptoms. The audio program consisted of eight compact discs and a workbook while the computer program consisted of 11 modules of similar duration provided on a tablet PC. Both interventions consisted of the following topics: 1) introduction, 2) identifying and changing unhelpful thoughts, 3) addressing feelings, 4) relaxation, 5) engaging in pleasant events, 6) assertiveness, and 7) problem-solving. Methods: Fifty-one older adults were recruited from medical settings and rural communities and randomly assigned to an immediate treatment group (computer or audio) with minimal contact or a four-week minimal contact delayed treatment control condition. Results: Participants rated computer-based and audio-based cognitive behavioral therapy fairly equally, with 75% of those who received audio treatment and 85% of those who received computer-based treatment indicating benefits to their mood.Discussion: Computer-based or audio-based cognitive behavioral treatments may be valuable, low-cost modalities to deliver psychotherapy to older adults with depressive symptoms within a health care setting. Both modalities seem to be accepted by older adults.

Psychological interventions for women with non-metastatic breast cancer

BACKGROUND

Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer.

OBJECTIVES

To assess the effects of psychological interventions on psychological morbidities, quality of life and survival among women with non-metastatic breast cancer.

SEARCH METHODS

We searched the following databases up to 16 May 2013: the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO; and reference lists of articles. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) search portal and ClinicalTrials.gov for ongoing trials in addition to handsearching.

SELECTION CRITERIA

Randomised controlled trials that assessed the effectiveness of psychological interventions for non-metastatic breast cancer in women.

DATA COLLECTION AND ANALYSIS

Two review authors independently appraised and extracted data from eligible trials. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcome.

MAIN RESULTS

Twenty-eight randomised controlled trials comprising 3940 participants were included. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. A wide range of interventions were evaluated, with 24 trials investigating a cognitive behavioural therapy and four trials investigating psychotherapy compared to control. Pooled standardised mean differences (SMD) from baseline indicated less depression (SMD -1.01, 95% confidence interval (CI) -1.83 to -0.18; P = 0.02; 7 studies, 637 participants, I(2) = 95%, low quality evidence), anxiety (SMD -0.48, 95% CI -0.76 to -0.21; P = 0.0006; 8 studies, 776 participants, I(2) = 64%, low quality evidence) and mood disturbance (SMD -0.28, 95% CI -0.43 to -0.13; P = 0.0003; 8 studies, 1536 participants, I(2) = 47%, moderate quality evidence) for the cognitive behavioural therapy group than the control group. For quality of life, only an individually-delivered cognitive behavioural intervention showed significantly better quality of life than the control with an SMD of 0.65 (95% CI 0.07 to 1.23; P = 0.03; 3 studies, 141 participants, I(2) = 41%, very low quality evidence). Pooled data from two group-delivered studies showed a non-significant overall survival benefit favouring cognitive behavioural therapy compared to control (pooled hazard ratio (HR) 0.76, 95% CI 0.25 to 2.32; P = 0.63; 530 participants, I(2) = 84%, low quality evidence). Four studies compared psychotherapy to control with one to two studies reporting on each outcome. The four studies were assessed as high risk of bias and provided limited evidence of the efficacy of psychotherapy. Adverse events were not reported in any of the included studies.

AUTHORS' CONCLUSIONS

A psychological intervention, namely cognitive behavioural therapy, produced favourable effects on some psychological outcomes, in particular anxiety, depression and mood disturbance. However, the evidence for survival improvement is still lacking. These findings are open to criticism because of the notable heterogeneity across the included studies and the shortcomings of the included studies.

Watchful waiting: role of disease progression on uncertainty and depressive symptoms in patients with chronic hepatitis C

BACKGROUND AND AIMS

New therapies for HCV are rapidly emerging and providers are advising select patients to defer treatment and elect 'watchful waiting'. During the watchful waiting period, patients have been shown to have high rates of illness uncertainty and depression. We sought to answer the question of whether reassuring histological data (showing minimal fibrosis or no fibrosis progression over time) is associated with less illness uncertainty and depressive symptoms.

METHODS

This was a single-centre outpatient prospective cohort study to determine whether stage of fibrosis, fibrosis progression and reasons for treatment deferral were related to illness uncertainty and depressive symptoms in patients following watchful waiting.

RESULTS

Illness uncertainty was significantly related to depressive symptoms (r = 0.49, P < 0.01). More than half of the participants (54%) had moderate levels of uncertainty. About 40% of the participants were at risk for clinical depression (21.7% at mild to moderate risk and 18.5% at high risk). Treatment naïve subjects had lower mean scores on both the CES-D (depressive symptoms measure) and the MUIS-A (illness uncertainty measure) total score, MUIS-A Ambiguity subscale and MUIS-A Inconsistency subscale than subjects who failed treatment or were interferon intolerant or ineligible. Surprisingly, liver fibrosis stage and progression were not significantly associated with overall illness uncertainty or depressive symptoms.

CONCLUSION

Patients with chronic hepatitis C on watchful waiting are at high risk for significant illness uncertainty and depressive symptoms. Reassuring histological data does not seem to correlate with less uncertainty or depressive symptoms.

Psychosocial interventions addressing the needs of Black women diagnosed with breast cancer: a review of the current landscape

BACKGROUND

Poorer health outcomes and lower survival rates have been well documented among African American/Black (Black) women diagnosed with breast cancer. Black women are 41% more likely to die from breast cancer than White women despite a lower incidence rate. Apart from pharmacotherapy, psychosocial interventions are recommended by the Institute of Medicine as standard medical care for breast cancer patients at all phases of treatment. The current review is the first attempt to systematically evaluate the literature on the influence of psychosocial interventions for Black women diagnosed with breast cancer.

METHODS

This systematic review aimed to adhere to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A comprehensive computerized literature search of CINAHL, PsycINFO, PubMed, and Web of Science was conducted to obtain relevant studies.

RESULTS

Interventions demonstrated improved mood, decreased distress, increased ability to cope with intrusive thoughts and cancer-related stress, personal growth, and improved social well-being. However, aspects unique to this population require additional scientific inquiry. Over 80% of empirical interventions focused on Black women diagnosed with breast cancer have been concentrated on the posttreatment phase. There is a paucity of work at the time of diagnosis and during treatment.

CONCLUSIONS

To address gaps in the scientific literature, more work is needed to better understand how psychosocial interventions can improve the health trajectory for Black women diagnosed with breast cancer particularly in the areas of seeking help and support, identifying culturally acceptable methods for engaging support networks, and identifying best practices for enhancing coping skills.

Living with cancer-related uncertainty: associations with fatigue, insomnia, and affect in younger breast cancer survivors

PURPOSE

Uncertainty in cancer patients and survivors about cancer-related symptoms, treatment, and disease course has been related to poorer mental and physical health. However, little is known about whether cancer-related uncertainty relates with specific disease and treatment-related outcomes such as fatigue, insomnia, and affect disruptions. In this paper, we report these associations in younger survivors aged 50 years or less, a population increasing in prevalence.

METHODS

Participants included 313 breast cancer survivors (117 African-Americans and 196 Caucasians) who were aged 24 to 50 years and were 2 to 4 years posttreatment. Self-reported cancer-related uncertainty (Mishel Uncertainty in Illness Scale-Survivor Version), fatigue (Piper Fatigue Scale-Revised), insomnia (Insomnia Severity Index), and negative and positive affect (Positive and Negative Affect Schedule (PANAS)) measures were collected upon study entry.

RESULTS

Hierarchical regression analyses controlled for relevant sociodemographic variables include the following: race, age, years of education, number of children, employment status, marital status, monthly income, smoking status, family history of cancer, endorsement of treatment-induced menopause, and religiosity. Over and above these factors, higher cancer-related uncertainty was significantly associated with more self-reported fatigue (β = .43), insomnia (β = .34), negative affect (β = .43), as well as less positive affect (β = -.33), all ps < .01.

CONCLUSIONS

Younger breast cancer survivors who are 2-4 years posttreatment experience cancer-related uncertainty, with higher levels associated with more self-reported psychophysiological disruptions. Cancer survivors who present in clinical settings with high uncertainty about recurrence or management of long-term effects of treatment may thus benefit from assessment of fatigue, insomnia, and affect.

Mindful movement program for older breast cancer survivors: a pilot study

BACKGROUND

Older breast cancer survivors (BCSs) are at risk for late and long-term treatment effects on quality of life (QOL), including lower physical functioning and fear of recurrence. Two promising approaches to address this include dance/movement therapy and mindfulness.

OBJECTIVE

The purpose of this 2-group randomized controlled pilot feasibility study was to test short-term effects of a 12-week Mindful Movement Program (MMP) intervention combining mindfulness with self-directed movement on QOL and mindfulness in female BCSs 50 years or older and at 12 months or more following treatment.

METHODS

Consented participants were randomized to an experimental group (EG) (12 weekly MMP sessions) or a control group (no sessions). All completed questionnaires 3 times. The EG participants kept home practice diaries. Analysis was conducted after intervention for immediate effects on outcome variables and 6 weeks later for maintenance of effects.

RESULTS

Participants (n = 49) ranged in age from 50 to 90 years (average, 65.6 years) and were at 9.8 years since diagnosis (range, 1-32 years), and the majority were white, unpartnered, and retired. After intervention, EG participants showed improved QOL via decreased fear of recurrence and increased mindfulness attitude. At 6 weeks, initial effects were retained.

CONCLUSIONS

The MMP appears to benefit older BCSs by reducing fear of recurrence and improving mindfulness attitude. Although these findings are promising, a larger study is needed to determine more specifically what short- and long-term effects are possible.

IMPLICATIONS FOR PRACTICE

The combination of self-directed movement and mindfulness, as tested here, may be a valuable tool for promoting health and well-being in older long-term survivors of breast cancer.

Coping strategies of African American head and neck cancer survivors

A cross-sectional study was conducted with 50 African American head and neck cancer survivors. Common coping strategies were identified and examined in relation with quality of life and relationship well-being. Coping through support from God, seeking emotional support from family and friends, and helping others were the most commonly used strategies. Having emotional support, being strong and self-reliant, and engaging in distracting activities with family and friends had strongest associations with quality of life. Coping through emotional support, help from God, assistance from one's church family to maintain religious practices, helping others, and engaging in distracting activities with others was more strongly associated with relationship well-being. Future intervention studies should consider these strategies and their possible impact on the physical, psychological, and relationship well-being of this population.

Internet interventions for improving psychological well-being in psycho-oncology: review and recommendations

OBJECTIVE

Too few cancer patients and survivors receive evidence-based interventions for mental health symptoms. This review examines the potential for Internet interventions to help fill treatment gaps in psychosocial oncology and presents evidence regarding the likely utility of Internet interventions for cancer patients.

METHODS

The authors examined available literature regarding Internet interventions tailored to cancer patients' mental health needs and reviewed elements of Internet interventions for mental health relevant to advancing psycho-oncology Internet intervention research.

RESULTS

Few rigorous studies focusing on mental health of cancer patients have been conducted online. A growing body of evidence supports the efficacy, accessibility, and acceptability of mental health Internet interventions for a variety of general and medical patient populations. The authors present recommendations and guidelines to assist researchers in developing, testing, and disseminating Internet interventions for cancer patients and survivors, to manage and improve their mental health. Issues unique to Internet interventions-including intervention structure, customization, provider interaction, and privacy and confidentiality issues-are discussed. These guidelines are offered as a step toward establishing a set of "best practices" for Internet interventions in psycho-oncology and to generate further discussion regarding the goals of such interventions and their place in cancer care.

CONCLUSIONS

Internet interventions have the potential to fill an important gap in quality cancer care by augmenting limited available mental health services. These interventions should be developed in a manner consistent with best practices and must be empirically tested and validated. Copyright © 2011 John Wiley & Sons, Ltd.

Uncertainty during the transition from cancer patient to survivor

This prospective study evaluated the impact that uncertainty has on quality of life as cancer patients end the active phase of their treatment. The transition from patient status to survivor may be a particularly important point in recovery because it may affect how much stress cancer survivors experience. Guided by a within-subjects design framework, 53 cancer patients (predominantly breast cancer) participated in the present study as they approached the end of adjuvant treatment and were followed for 4 months. Distress levels increased the further patients moved away from the end-of-active treatment; however, preceding these ascending scores of distress was a period characterized by little unrest-best described as a "honeymoon" phase. Using hierarchical linear modeling, greater uncertainty 1 month after treatment ended predicted more functional and physical impairment 4 months after the completion of adjuvant treatment. In both cases, uncertainty accounted for nearly 70% of the variance of these changes over time. A period of rest may emerge as active treatment ends, but that it is short-lived, particularly if uncertainty regarding health emerges. Furthermore, uncertainty may a represent a key mechanism (and target for intervention) during the transition from cancer patient to survivor.

Benefits of the uncertainty management intervention for African American and White older breast cancer survivors: 20-month outcomes

In a 2 x 2 randomized block repeated measure design, this study evaluated the follow-up efficacy of the uncertainty management intervention at 20 months. The sample included 483 recurrence-free women (342 White, 141 African American women; mean age = 64 years) who were 5-9 years posttreatment for breast cancer. Women were randomly assigned to either the intervention or usual care control condition. The intervention was delivered during 4 weekly telephone sessions in which survivors were guided in the use of audiotaped cognitive-behavioral strategies and a self-help manual. Repeated measures MANOVAs evaluating treatment group, ethnic group, and treatment by ethnic interaction effects at 20 months indicated that training in uncertainty management resulted in improvements in cognitive reframing, cancer knowledge, and a variety of coping skills. Importantly, the 20-month outcomes also demonstrated benefits for women in the intervention condition in terms of declines in illness uncertainty and stable effects in personal growth over time.

Providing Psychosocial Group Support for Young Women with Breast Cancer

This article describes our experience offering a collaborative, wellness-based group support program for young women with breast cancer. Goals were (1) to identify needs and priorities of young women with breast cancer; (2) to test the feasibility of a collaboration between an academic medical center, a regional cancer center, and a community-based agency; and (3) to positively influence participants' overall quality of life (QOL), emotional distress, and psychological well-being. The group intervention consisted of presentation of various topics, group discussion, and relaxation exercises. No significant changes on QOL or emotional measures were seen. Participants rated the session on symptom management as most useful and identified two areas for potential improvement (more homogeneity of participants, suggestions for additional topics).

Benefits of the uncertainty management intervention for African American and White older breast cancer survivors: 20-month outcomes

In a 2 x 2 randomized block repeated measure design, this study evaluated the follow-up efficacy of the uncertainty management intervention at 20 months. The sample included 483 recurrence-free women (342 White, 141 African American women; mean age = 64 years) who were 5-9 years posttreatment for breast cancer. Women were randomly assigned to either the intervention or usual care control condition. The intervention was delivered during 4 weekly telephone sessions in which survivors were guided in the use of audiotaped cognitive-behavioral strategies and a self-help manual. Repeated measures MANOVAs evaluating treatment group, ethnic group, and treatment by ethnic interaction effects at 20 months indicated that training in uncertainty management resulted in improvements in cognitive reframing, cancer knowledge, and a variety of coping skills. Importantly, the 20-month outcomes also demonstrated benefits for women in the intervention condition in terms of declines in illness uncertainty and stable effects in personal growth over time.