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Kim JHJ, Kagawa Singer M, Bang L, Ko A, Nguyen B, Chen Stokes S, Lu Q, Stanton AL. Supportive Care Needs in Chinese, Vietnamese, and Korean Americans With Metastatic Cancer: Mixed Methods Protocol for the DAWN Study. JMIR Res Protoc 2024; 13:e50032. [PMID: 38648633 DOI: 10.2196/50032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/06/2024] [Accepted: 03/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Asian Americans with metastatic cancer are an understudied population. The Describing Asian American Well-Being and Needs in Cancer (DAWN) Study was designed to understand the supportive care needs of Chinese-, Vietnamese-, and Korean-descent (CVK) patients with metastatic cancer. OBJECTIVE This study aims to present the DAWN Study protocol involving a primarily qualitative, convergent, mixed methods study from multiple perspectives (patients or survivors, caregivers, and health care professionals). METHODS CVK Americans diagnosed with solid-tumor metastatic cancer and their caregivers were recruited nationwide through various means (registries, community outreach newsletters, newspapers, radio advertisements, etc). Potentially eligible individuals were screened and consented on the web or through a phone interview. The study survey and interview for patients or survivors and caregivers were provided in English, traditional/simplified Chinese and Cantonese/Mandarin, Vietnamese, and Korean, and examined factors related to facing metastatic cancer, including quality of life, cultural values, coping, and cancer-related symptoms. Community-based organizations assisted in recruiting participants, developing and translating study materials, and connecting the team to individuals for conducting interviews in Asian languages. Health care professionals who have experience working with CVK patients or survivors with metastatic solid cancer were recruited through referrals from the DAWN Study community advisory board and were interviewed to understand unmet supportive care needs. RESULTS Recruitment began in November 2020; data collection was completed in October 2022. A total of 66 patients or survivors, 13 caregivers, and 15 health care professionals completed all portions of the study. We completed data management in December 2023 and will submit results for patients or survivors and caregivers to publication outlets in 2024. CONCLUSIONS Future findings related to this protocol will describe and understand the supportive care needs of CVK patients or survivors with metastatic cancer and will help develop culturally appropriate psychosocial interventions that target known predictors of unmet supportive care needs in Chinese, Vietnamese, and Korean Americans with metastatic cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50032.
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Affiliation(s)
- Jacqueline H J Kim
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Marjorie Kagawa Singer
- Department of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lisa Bang
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Amy Ko
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Becky Nguyen
- Vietnamese American Cancer Foundation, Fountain Valley, CA, United States
| | - Sandy Chen Stokes
- Chinese American Coalition for Compassionate Care, Cupertino, CA, United States
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
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Williamson TJ, Garon EB, Irwin MR, Choi AK, Goldman JW, Stanton AL. Sleep Disturbance as a Mediator of Lung Cancer Stigma on Psychological Distress and Physical Symptom Burden. Psychosom Med 2024:00006842-990000000-00196. [PMID: 38436657 DOI: 10.1097/psy.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE This study tested sleep disturbance as a mediator through which stigma and discrimination predict psychological distress and physical symptom burden in adults with lung cancer. METHODS Lung cancer patients on active oncological treatment (N = 108; 74.1% Stage IV) completed questionnaires on lung cancer stigma, sleep, distress, and physical symptoms at study entry and at 6- and 12-week follow-up. Mediation analyses were conducted to investigate whether stigma and discrimination predicted distress and physical symptoms at study entry and across 12 weeks through disrupted sleep. RESULTS Higher discrimination (b = 5.52, 95% CI [2.10, 8.94]) and constrained disclosure (b = 0.45, 95% CI [0.05, 0.85]) were associated significantly with higher sleep disruption at study entry. Sleep disruption, in turn, was associated with higher distress (b = 0.19, 95% CI [0.09, 0.29]) and physical symptoms (b = 0.28, 95% CI [0.17, 0.40]) at study entry. Sleep disruption significantly mediated relationships between higher discrimination and the outcomes of distress (indirect effect = 1.04, 95% CI [0.13, 1.96]) and physical symptoms (indirect effect = 1.58, 95% CI [0.37, 2.79]) at study entry. Sleep disruption also mediated relationships between constrained disclosure and the outcomes of distress (indirect effect = 0.85, 95% CI [<0.01, 0.17]) and physical symptoms (indirect effect = 0.13, 95% CI [0.01, 0.25]). CONCLUSIONS Lung cancer patients evidenced pronounced sleep disruption, which mediated relationships between indicators of lung cancer stigma and distress and physical symptoms at study entry. Research is needed to test additional mechanisms through which lung cancer stigma predicts these outcomes longitudinally.
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Hoyt MA, Llave K, Wang AWT, Darabos K, Diaz KG, Hoch M, MacDonald JJ, Stanton AL. The utility of coping through emotional approach: A meta-analysis. Health Psychol 2024:2024-52600-001. [PMID: 38330307 DOI: 10.1037/hea0001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE A systematic review and meta-analysis was conducted to examine associations between attempts to cope with stressors through the two facets of emotional approach coping (EAC; i.e., processing and expressing stressor-related emotions) and indicators of physical and mental health. METHOD EBSCO databases including MEDLINE, PsycINFO, and Cochrane Collections were searched from inception to November 2022. In all, 86 studies were included in a meta-analytic evaluation using a random-effects model and meta-regression analysis. RESULTS EAC was associated with better overall health (r = .05; p = .04; 95% confidence interval = [.003, .10]). Emotional expression (EE) and emotional processing (EP) also were positively associated with better overall health, although these relationships were not statistically significant. In meta-regressions examining specific health domains, EAC was linked to better health in biological/physiological, physical, and resilience-related psychological adjustment domains, as well as to worse outcomes in the risk-related psychological adjustment and mental/emotional distress domains. Results for EE and EP mirrored this pattern; however, only EP was associated with more engagement in health-promoting behaviors. CONCLUSIONS Coping with stressors through emotional approach appears to be associated with better mental and physical health, with some observed differences for EE and EP. The literature on EAC and health is marked by heterogeneity across study methodologies and measures. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Michael A Hoyt
- Department of Population Health and Disease Prevention, University of California, Irvine
| | - Karen Llave
- Department of Population Health and Disease Prevention, University of California, Irvine
| | | | - Katie Darabos
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health
| | - Karina G Diaz
- Graduate School of Education, University of Pennsylvania
| | - Megan Hoch
- Department of Psychology, University of California, Los Angeles
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Sepucha K, Rudkin A, Baxter-King R, Stanton AL, Wenger N, Vavreck L, Naeim A. Perceptions of COVID-19 Risk: How Did People Adapt to the Novel Risk? Med Decis Making 2024; 44:163-174. [PMID: 38217398 DOI: 10.1177/0272989x231221448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND There is limited understanding of how risk perceptions changed as the US population gained experience with COVID-19. The objectives were to examine risk perceptions and determine the factors associated with risk perceptions and how these changed over the first 18 mo of the pandemic. METHODS Seven cross-sectional online surveys were fielded between May 2020 and October 2021. The study included a population-weighted sample of 138,303 US adults drawn from a market research platform, with an average 68% cooperation rate. Respondents' risk perception of developing COVID in the next 30 days was assessed at each time point. We examined relationships between 30-day risk perceptions and various factors (including sociodemographic features, health, COVID-19 experience, political affiliation, and psychological variables). RESULTS COVID risk perceptions were stable across the 2020 surveys and showed a significant decrease in the 2021 surveys. Several factors, including older age, worse health, high COVID worry, in-person employment type, higher income, Democratic political party affiliation (the relatively more liberal party in the United States), low tolerance of uncertainty, and high anxiety were strongly associated with higher 30-d risk perceptions in 2020. One notable change occurred in 2021, in that younger adults (aged 18-29 y) had significantly higher 30-d risk perceptions than older adults did (aged 65 y and older) after vaccination. Initial differences in perception by political party attenuated over time. Higher 30-d risk perceptions were significantly associated with engaging in preventive behaviors. LIMITATIONS Cross-sectional samples, risk perception item focused on incidence not severity. CONCLUSIONS COVID risk perceptions decreased over time. Understanding the longitudinal pattern of risk perceptions and the factors associated with 30-d risk perceptions over time provides valuable insights to guide public health communication campaigns. HIGHLIGHTS The study assessed COVID-19 risk perceptions at 7 time points over 18 mo of the pandemic in large samples of US adults.Risk perceptions were fairly stable until the introduction of vaccines in early 2021, at which point they showed a marked reduction.Higher COVID-19 30-d risk perceptions were significantly associated with the preventive behaviors of masking, limiting social contact, avoiding restaurants, and not entertaining visitors at home.
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Affiliation(s)
- Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron Rudkin
- Department of Political Science, University of California Los Angeles (UCLA) Health Sciences, Los Angeles, CA, USA
| | - Ryan Baxter-King
- Department of Political Science, University of California Los Angeles (UCLA) Health Sciences, Los Angeles, CA, USA
| | - Annette L Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Neil Wenger
- Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lynn Vavreck
- Departments of Political Science and Communication, UCLA, Los Angeles, CA, USA
| | - Arash Naeim
- Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- UCLA Center for SMART Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Shahrour L, Martinez J, Chicaiza A, Omar R, Bovbjerg K, Stanton AL, Valdimarsdottir H, Yanez B, Munshi P, Rowley SD, Rini C, Graves KD. Greater Social Isolation and Social Constraints Prior to Hematopoietic Stem Cell Transplant Are Associated with Greater Anxiety and Depressive Symptoms. Int J Behav Med 2023:10.1007/s12529-023-10232-8. [PMID: 38017317 DOI: 10.1007/s12529-023-10232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (hereafter "HCT") is a physically and psychologically difficult treatment for patients with hematological cancers. This study examined relationships among patients' reports of pre-transplant social isolation, social constraints, and psychological distress. METHOD We used baseline data from a multisite randomized controlled trial evaluating the effects of expressive helping writing to reduce physical and emotional symptoms in HCT patients. We collected data prior to randomization and before either allogenic or autologous HCT using validated scales to assess social constraints, social isolation, anxiety, and depressive symptoms. We analyzed data using bivariate analysis and multivariate linear regression. We also explored whether social isolation mediated the effect of social constraints on both of our outcomes: anxiety and depressive symptoms. RESULTS Among 259 adults recruited prior to transplant, 43.6% were women (mean age = 57.42 years, SD = 12.34 years). In multivariate analysis controlling for relevant covariates, both social isolation (β = 0.24, p < 0.001) and social constraints (β = 0.28, p < 0.001) were associated with anxiety. When both social constraints and social isolation were in the model, only greater social isolation (β = 0.79, p < 0.001) was associated with depressive symptoms. Social isolation fully mediated the association between social constraints and anxiety and depressive symptoms. CONCLUSION For patients awaiting either allogenic or autologous HCT, the negative association between social constraints and anxiety and depressive symptoms may be related, in part, to the mechanism of perceived social isolation. Interventions prior to and during HCT are needed to support patients' psychological health and sense of social connectedness.
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Affiliation(s)
| | | | - Anthony Chicaiza
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C, USA
| | - Rahma Omar
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katrin Bovbjerg
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Heiddis Valdimarsdottir
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Pashna Munshi
- MedStar Georgetown University Hospital, Washington, D.C, USA
| | - Scott D Rowley
- John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Christine Rini
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Kristi D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C, USA.
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Hoch MM, MacDonald JJ, Jorge-Miller A, McCannel TA, Beran TM, Stanton AL. Depression in Uveal Melanoma Survivorship: Examining Psychological Predictors of Adjustment in the First Year Following Diagnosis. Ann Behav Med 2023; 57:1081-1096. [PMID: 37874742 DOI: 10.1093/abm/kaad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND A rare cancer, uveal melanoma (UM) affects 5 in 1 million adults annually. Research on predictors of mental health in UM survivors is scarce. PURPOSE In this prospective study, we tested models that postulate interactions between illness perceptions and coping processes in predicting depressive symptoms 1 year following UM diagnosis. METHODS Participants' approach- and avoidance-oriented coping processes and illness perceptions specific to control and chronicity were assessed. Participants (N = 107) completed assessments prior to diagnosis (T0), and 1 week (T1), 3 months (T2), and 12 months after UM diagnosis (T3). RESULTS At T1, a significant avoidance coping × chronicity perception interaction (b = 1.84, p = .03) indicated that the link between higher avoidance coping and greater T3 depressive symptoms was stronger for participants with prolonged chronicity perceptions (b = 17.13, p < .001). Chronicity perceptions at T2 interacted significantly with approach-oriented coping at all time points; the link between higher approach coping and lower T3 depressive symptoms was stronger for participants with prolonged chronicity perceptions at T2. Interactions between control perceptions and coping did not significantly predict T3 depressive symptoms. CONCLUSIONS Findings lend partial support to predictive models that consider the combined, interacting influence of chronicity perceptions and coping processes on depressive symptoms in survivors of eye cancer.
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Affiliation(s)
- Megan M Hoch
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - James J MacDonald
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Tara A McCannel
- Department of Ophthalmology, Retina Division and Ocular Oncology Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tammy M Beran
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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Marziliano A, Miller SM, Fleisher LG, Ropka ME, Stanton AL, Wen KY, Cornelius T, Lapitan E, Diefenbach MA. Examining the impact of a multimedia intervention on decisional conflict and psychological distress among early-stage breast cancer patients: results from a nationwide RCT. Transl Behav Med 2023; 13:727-735. [PMID: 37379519 PMCID: PMC10538468 DOI: 10.1093/tbm/ibad037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
We conducted a nationwide, randomized controlled trial to evaluate the impact of Healing Choices, a novel interactive education and treatment decision program rooted in the self-regulation theory framework, on decisional conflict and psychological distress at 2-month post-intervention in women with early-stage breast cancer. Patients were randomized to receive the National Cancer Institute's standard print material (control) or standard print material plus Healing Choices (the intervention). The final sample at 2-month post-intervention consisted of N = 388 participants (intervention: n = 197; control: n = 191). There were no significant differences in decisional conflict or its subscales; however, psychological distress was higher in the intervention group (16.09 ± 10.25) than in the control group (14.37 ± 8.73) at follow-up, B = 1.88, 95% CI [-0.03, 3.80], t(383) = 1.94, p = .05. Upon further examination, we found that engagement with the intervention was low-41%-prompting as-treated analyses, which showed no difference in distress between users and nonusers and a positive impact of Healing Choices on decisional conflict: decisional support subscale: users (35.36 ± 15.50) versus nonusers (39.67 ± 15.99), B = -4.31 (s.e. = 2.09), p = .04. Multiple recommendations for moving ahead stem from this work: (i) intent-to-treat analyses appeared to cause distress, cautioning against interventions that may lead to information overload; (ii) engagement with the intervention is low and future work needs to focus on increasing engagement and monitoring it throughout the study; and (iii) in studies with low engagement, as-treated analyses are critical.
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Affiliation(s)
- Allison Marziliano
- Institute of Health System Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Suzanne M Miller
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Linda G Fleisher
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Mary E Ropka
- Public Health Sciences, University of Virginia School of Medicine, Emeritus, Charlottesville, VA, USA
| | - Annette L Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Kuang-Yi Wen
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Talea Cornelius
- Division of General Medicine, Department of Medicine, Columbia University, New York, NY, USA
| | - Emmanuel Lapitan
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Michael A Diefenbach
- Institute of Health System Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
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Denyse T, Martin KJ, Kim JHJ, Pageot YK, Owoyemi P, DeLuz KD, Stanton AL. "No Complaining, No Crying": A Qualitative Study of the Strong Black Woman Schema in the Breast Cancer Context. Ann Behav Med 2023; 57:733-742. [PMID: 37318273 PMCID: PMC10441856 DOI: 10.1093/abm/kaad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Black women have the highest mortality from breast cancer compared with other racial/ethnic groups. Black women with breast cancer also evidence compromised quality of life in some domains. Culturally relevant aspects of their experience are understudied. PURPOSE The goal of this qualitative study was to examine the relevance of the Strong Black Woman schema in the cancer context. METHODS Three Gatherings (i.e., culturally curated focus groups) were conducted with Black women who had been diagnosed with breast cancer and recruited from cancer-related listservs and events. A five-person team conducted reflexive thematic analysis of Gathering transcripts. RESULTS The 37 participants ranged in age (30 to 94 years) and in diagnosis duration (2 months to 29 years). Reflexive thematic analysis yielded six themes that characterized the women's experience: historical legacy of the Strong Black Woman, navigating intersecting Strong Black Woman identities, everyday challenges encountered on the battlefield by Strong Black Women, Strong Black Woman in action during the breast cancer journey, the complexities of seeking and accepting support, and the liberated Strong Black Woman. The schema's negative consequences included the oncologic team and others expecting the participants to be strong and not to need support. Expectations to suppress emotions and continue caring for others to the neglect of the self also were evident. Positive consequences included engaging in self-advocacy in the oncologic context and redefining strength to include expressing emotions and accepting help. CONCLUSIONS The Strong Black Woman schema is highly relevant in the breast cancer context and could be addressed in culturally centered interventions.
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Affiliation(s)
| | - Kimberly J Martin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jacqueline H J Kim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yrvane K Pageot
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Praise Owoyemi
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Martin KJ, Stanton AL, Johnson KL. Current health care experiences, medical trust, and COVID-19 vaccination intention and uptake in Black and White Americans. Health Psychol 2023; 42:541-550. [PMID: 36227310 DOI: 10.1037/hea0001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The COVID-19 pandemic spotlighted Black Americans' inequitable health care experiences. Across two studies, we tested the associations between health care experiences, historical knowledge of medical mistreatment, medical trust, and COVID-19 vaccination intention and uptake in Black and White Americans. We hypothesized that Black Americans' worse current health care experiences (rather than historical knowledge) and lower medical trust would be associated with lower COVID-19 vaccination intention (Study 1) and that feeling less cared for by their personal physician would be associated with Black Americans' lower medical trust (Study 2). METHOD In convenience (Study 1, December 2020) and nationally representative samples (Study 2, March-April 2021), participants completed online surveys. RESULTS In Study 1 (N = 297), Black (relative to White) Americans reported lower vaccination intention (Cohen's d = -.55, p < .001) and lower medical trust (Cohen's d = -.72, p < .001). Additionally, less positive health care experiences among Black participants (Cohen's d = -.33, p = .022) were associated with less medical trust and in turn lower vaccination intention. Tuskegee Study knowledge was not associated with vaccination intention or medical trust. Study 2 (N = 12,757) data revealed no statistically significant racial differences in COVID-19 vaccination receipt or intention. Black (relative to White) Americans reported feeling less cared for by their personal physician (Cohen's d = -.44, p < .001), which was associated with lower medical trust (Cohen's d = -.51, p < .001). CONCLUSION Findings highlight factors that may contribute to Black Americans' vaccination hesitancy and medical trust. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | - Kerri L Johnson
- Department of Psychology, University of California, Los Angeles
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Martin KJ, Denyse T, Pageot YK, Kim JHJ, Owoyemi P, DeLuz KD, Stanton AL. "I'm Fighting for My Life": Exploring Interactions Between Black Women with Breast Cancer and Healthcare Providers. Qual Health Res 2023:10497323231168581. [PMID: 37212719 DOI: 10.1177/10497323231168581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Black Americans face a multitude of problems in the healthcare system, including challenges during interactions with healthcare providers. The present study examined the quality of healthcare provider-Black patient interactions in a sample of Black American women with a breast cancer diagnosis. More specifically, the study examined potential contributors to Black Americans' current healthcare experiences and lack of trust by identifying their specific negative and positive encounters in the healthcare system. Three in-person Gatherings (i.e., culturally curated focus groups; N = 37) were conducted as part of a community-academic research partnership, Project SOAR (Speaking Our African American Realities). Four themes were identified through reflexive thematic analysis: Individual and Systemic Injustice Directed at Black Breast Cancer Survivors; Protecting Myself from an Untrustworthy Medical System; Stereotypes Interfered with My Care; and Good Care Should Include Compassion, Respect, Shared Decision Making, and Tailored Support. The present findings highlight the importance of addressing systemic and individual injustice toward Black Americans in healthcare settings generally, and Black women diagnosed with breast cancer specifically.
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Andersen BL, Lacchetti C, Ashing K, Berek JS, Berman BS, Bolte S, Dizon DS, Given B, Nekhlyudov L, Pirl W, Stanton AL, Rowland JH. Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update. J Clin Oncol 2023:JCO2300293. [PMID: 37075262 DOI: 10.1200/jco.23.00293] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
PURPOSE To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors. METHODS A multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted. RESULTS The evidence base consisted of 17 systematic reviews ± meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials. Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety. Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent. The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations. RECOMMENDATIONS It is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity. All oncology patients should be offered education regarding depression and anxiety. For patients with moderate symptoms of depression, clinicians should offer cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions. For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions. For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy. Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
| | | | | | | | | | - Sage Bolte
- Inova Health Foundation, Falls Church, VA
| | - Don S Dizon
- Legorreta Cancer Center at Brown University and Lifespan Cancer Institute, Providence, RI
| | | | - Larissa Nekhlyudov
- Brigham and Women's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
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Denyse T, Martin KJ, Pageot YK, Luz DD, Owoyemi P, Stanton AL, Kim JH. Abstract P6-05-46: Project SOAR (Speaking Our African American Realities): A qualitative study of the Strong Black Woman schema in the breast cancer context. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-05-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Marked disparities exist for African American women, relative to non-Latina white women, in the five-year survival rate for breast cancer. Black women breast cancer survivors also demonstrate relative disadvantage in specific quality of life (QOL) domains, persisting through at least two years after diagnosis. Although Black women have higher QOL in the spiritual domain relative to white women, disparities include lower physical QOL, as well as more pronounced depressive symptoms, perceived stress, fear of dying, unmet supportive care needs, and financial distress, with younger Black women (< 50 years) particularly at risk. African American breast cancer survivors also report receiving too little information from their oncologists during diagnosis, treatment, and follow-up care. Sociodemographic and medical factors only partially explain the QOL disparities. The goal of Project SOAR (Speaking Our African American Realities), a community-academic partnership, is to interrogate the potential relevance of the Strong Black Woman (or Black Superwoman) schema in the breast cancer context. The schema involves historically grounded expectations to prioritize caregiving over self-care, suppress emotions, present an image of strength, decline support, and strive to achieve success without adequate resources. Method: Black women were recruited via relevant email listservs and flyers distributed at local breast cancer events to take part in a study “to understand the unique experiences of African American women and their views on the Strong Black Woman concept as it applies during their breast cancer experience.” Eligibility criteria were self-identification as being: 1) an African American woman (or a Black woman living in the United States); 2) diagnosed with breast cancer (any stage, any diagnosis duration); 3) at least 21 years old; and 4) able to communicate in English. Three Gatherings (i.e., culturally curated focus groups) were held as half-day experiences in intimate settings (e.g., private homes, a church) in three California cities (Sacramento, Oakland, Los Angeles). Gatherings provided an entirely Black women’s space to discuss the breast cancer experience and the relevance and consequences of the Strong Black Woman schema, break bread together, and engage in an inspiring activity. Reflexive thematic analysis was conducted on the Gatherings transcripts with a critical realist, contextualist approach. Results: All participants (N = 37; age range = 30-94 years; M = 59 years) had heard of the concept of the Strong Black Woman. Reflexive thematic analysis yielded six themes: 1) historical legacy of Strong Black Woman; 2) navigating intersecting Strong Black Woman identities; 3) everyday challenges encountered on the battlefield by Strong Black Women; 4) Strong Black Woman in action during the breast cancer journey; 5) the complexities of seeking and accepting support; and 6) the liberated Strong Black Woman. Participants linked both negative and positive consequences with the Strong Black Woman schema. Negative consequences included the oncologic team and others expecting them to be strong and not to need support, as well as expectations of themselves to suppress emotions and to continue caring for others to the neglect of caring for themselves. Positive consequences included engaging in self-advocacy in the oncologic context, having a sense of resilience, and redefining strength to include expressing emotions and accepting help from others. Conclusion: Qualitative analysis revealed the relevance of the Strong Black Woman schema in the breast cancer context, as well as its negative and positive consequences. Future research can assess whether oncologic professionals’ awareness of the schema is useful in ensuring they offer support and refer Black women diagnosed with breast cancer to culturally relevant supportive resources.
Citation Format: Tammie Denyse, Kimberly J. Martin, Yrvane K. Pageot, Praise Owoyemi, Annette L. Stanton, Jacqueline H. Kim. Project SOAR (Speaking Our African American Realities): A qualitative study of the Strong Black Woman schema in the breast cancer context [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-46.
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Naeim A, Guerin RJ, Baxter-King R, Okun AH, Wenger N, Sepucha K, Stanton AL, Rudkin A, Holliday D, Rossell Hayes A, Vavreck L. Strategies to increase the intention to get vaccinated against COVID-19: Findings from a nationally representative survey of US adults, October 2020 to October 2021. Vaccine 2022; 40:7571-7578. [PMID: 36357290 PMCID: PMC9464582 DOI: 10.1016/j.vaccine.2022.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES We examined COVID-19 vaccination status, intention, and hesitancy and the effects of five strategies to increase the willingness of unvaccinated adults (≥18 years) to get a COVID vaccine. METHODS Online surveys were conducted between October 1-17, 2020 (N = 14,946), December 4-16, 2020 (N = 15,229), April 8-22, 2021 (N = 14,557), June 17-July 6, 2021 (N = 30,857), and September 3-October 4, 2021 (N = 33,088) with an internet-based, non-probability opt-in sample of U.S. adults matching demographic quotas. Respondents were asked about current COVID-19 vaccination status, intention and hesitancy to get vaccinated, and reasons for vaccine hesitancy. Unvaccinated respondents were assigned to treatment groups to test the effect of five strategies (endorsements, changing social restrictions, financial incentives, vaccine requirements for certain activities, and vaccine requirements for work). Chi-square tests of independence were performed to detect differences in the response distributions. RESULTS Willingness to be vaccinated (defined as being vaccinated or planning to be) increased over time from 47.6 % in October 2020 to 81.1 % in October 2021. By October 2021, across most demographic groups, over 75 % of survey respondents had been or planned to be vaccinated. In terms of strategies: (1) endorsements had no positive effect, (2) relaxing the need for masks and social distancing increased Intention to Get Vaccinated (IGV) by 6.4 % (p < 0.01), (3) offering financial incentives increased the IGV between 12.3 and 18.9 % (p <.001), (4) vaccine requirements for attending sporting events or traveling increased IGV by 7.8 % and 9.1 %, respectively (p = 0.02), and vaccine requirement for work increased IGV by 35.4 %. The leading causes (not mutually exclusive) for hesitancy were concerns regarding vaccine safety (52.5 %) or side effects (51.6 %), trust in the government's motives (41.0 %), and concerns about vaccine effectiveness (37.6 %). CONCLUSIONS These findings suggest that multiple strategies may be effective and needed to increase COVID-19 vaccination among hesitant adults during the pandemic.
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Affiliation(s)
- Arash Naeim
- Center for SMART Health, Clinical and Translational Science Institute, University of California, Los Angeles, United States.
| | - Rebecca J Guerin
- Division of Science Integration, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, United States
| | - Ryan Baxter-King
- Department of Political Science, University of California, Los Angeles, United States
| | - Andrea H Okun
- Division of Science Integration, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, United States
| | - Neil Wenger
- Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine at UCLA, United States
| | - Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, United States
| | - Annette L Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences, UCLA, United States
| | - Aaron Rudkin
- Departments of Political Science, Trinity College, Dublin, Ireland; Department of Political Science, University of California, Los Angeles, United States
| | - Derek Holliday
- Department of Political Science, University of California, Los Angeles, United States
| | | | - Lynn Vavreck
- Departments of Political Science and Communication, University of California, Los Angeles, United States
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Denyse T, Martin KJ, Stanton AL. The Ubuntu Approach in Project SOAR (Speaking Our African American Realities): Building a robust community-academic partnership and culturally curated focus groups. Soc Sci Med 2022; 314:115452. [PMID: 36274454 DOI: 10.1016/j.socscimed.2022.115452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
Community-academic partnerships to enable research within minoritized communities are ever more important. Building on community-based participatory research frameworks, the Ubuntu Approach is offered as a set of principles for initiating and supporting meaningful and productive community-academic research partnerships. Particularly pertinent when the research is for and about systemically oppressed groups, the action principles are: 1) take risks; 2) identify and align core values; 3) create connection; 4) convey respect; 5) cultivate trust; and 6) put the work (i.e., benefit to the community) first, all of which are designed to create a culture for the partnership. These principles formed the foundation for the authors' community-academic partnership that resulted in Project SOAR (Speaking Our African American Realities), research to advance the understanding of the nature and consequences of the Strong Black Woman schema, and other culturally-relevant constructs, in the context of the breast cancer experience. Data from the first, qualitative phase of Project SOAR, in which 37 Black women diagnosed with breast cancer took part in culturally curated Gatherings (i.e., focus groups), provide evidence that steps toward the goal of benefiting the community were accomplished and that the Ubuntu Approach can be an effective method for community-academic partnerships.
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Affiliation(s)
- Tammie Denyse
- Carrie's TOUCH, 5960 S. Land Park Dr., #225, Sacramento, CA, 95822, USA.
| | - Kimberly J Martin
- Department of Psychology, 502 Portola Plaza, 1285 Psychology Building, University of California Los Angeles (UCLA), Los Angeles, CA, 90095-1563, USA
| | - Annette L Stanton
- Department of Psychology, 502 Portola Plaza, 1285 Psychology Building, University of California Los Angeles (UCLA), Los Angeles, CA, 90095-1563, USA; Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, 90095-6900, USA; Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA, 90095, USA.
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Bright EE, Genung SR, Stanton AL, Arch JJ. A mixed-methods study of the technical feasibility and patient acceptability of a real-time adherence monitor in breast cancer survivors taking adjuvant endocrine therapy. Breast Cancer Res Treat 2022; 195:393-399. [PMID: 35962148 PMCID: PMC9901531 DOI: 10.1007/s10549-022-06705-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Oral anti-cancer medications are increasingly common and endocrine therapies represent the most common oral anti-cancer medications in breast cancer. Adjuvant endocrine therapies reduce the likelihood of recurrence and mortality in the approximately 80% of women diagnosed with hormone-receptor-positive breast cancer, thus rendering adherence essential. Real-time medication adherence monitors, such as the Wisepill electronic pillbox, transmit adherence data remotely, allowing for early intervention for non-adherence. However, their feasibility and acceptability have yet to be examined among breast cancer survivors taking endocrine therapies. METHODS This study presents quantitative patient-report and technical support data and qualitative patient acceptability data on Wisepill, a common real-time adherence monitor, among 88 breast cancer survivors prescribed adjuvant endocrine therapy. RESULTS This mixed-methods study of a common real-time adherence monitor, among the first in breast cancer survivors taking adjuvant endocrine therapy, demonstrates its technical feasibility and patient acceptability. CONCLUSION The use of wireless medication monitors that transmit real-time adherence data is uniquely promising for maximizing the benefits of adjuvant endocrine therapy by allowing for continuous tracking, ongoing communication with oncologic or research teams, and early intervention. This study demonstrates the feasibility and patient acceptability of one such real-time adherence monitor.
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Affiliation(s)
- Emma E Bright
- Department of Psychology and Neuroscience, University of Colorado, Box 345, Boulder, CO, 80309-0345, USA.
| | - Sarah R Genung
- Department of Psychology and Neuroscience, University of Colorado, Box 345, Boulder, CO, 80309-0345, USA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado, Box 345, Boulder, CO, 80309-0345, USA
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16
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Arch JJ, Crespi CM, Levin ME, Genung SR, Nealis M, Mitchell JL, Bright EE, Albright K, Magidson JF, Stanton AL. Randomized Controlled Pilot Trial of a Low-Touch Remotely-Delivered Values Intervention to Promote Adherence to Adjuvant Endocrine Therapy Among Breast Cancer Survivors. Ann Behav Med 2022; 56:856-871. [PMID: 35323853 PMCID: PMC9345183 DOI: 10.1093/abm/kaab118] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Oral anti-cancer treatments such as adjuvant endocrine therapies (AET) for breast cancer survivors are commonly used but adherence is a challenge. Few low-touch, scalable interventions exist to increase ET adherence. PURPOSE To evaluate the acceptability, feasibility, and initial efficacy of a low-touch, remotely-delivered values plus AET education intervention (REACH) to promote AET adherence. METHODS A mixed-methods trial randomized 88 breast cancer survivors 1:1 to REACH or Education alone. Wisepill real-time electronic adherence monitoring tracked monthly AET adherence during a 1-month baseline through 6-month follow-up (FU) (primary outcome). Patient-reported outcomes were evaluated through 3- and 6-month FU (secondary). Multiple indices of intervention feasibility and acceptability were evaluated. Qualitative exit interviews (n = 38) further assessed participants' perceptions of feasibility/acceptability and recommendations for intervention adaptation. RESULTS The trial showed strong feasibility and acceptability, with an eligible-to-enrolled rate of 85%, 100% completion of the main intervention sessions, and "good" intervention satisfaction ratings on average. For Wisepill-assessed AET adherence, REACH outperformed Education for Month 1 of FU (p = .027) and not thereafter. Participants in REACH maintained high adherence until Month 4 of FU, whereas in Education, adherence declined significantly in Month 1. Conditions did not differ in self-reported adherence, positive affective attitudes, future intentions, or necessity beliefs. REACH trended toward less negative AET attitudes than Education at 3-month FU (p = .057) reflecting improvement in REACH (p = .004) but not Education (p = .809). Exploratory moderator analyses showed that average to highly positive baseline AET affective attitudes and oncologist-patient communication each predicted higher adherence following REACH than Education; low levels did not. Participants identified recommendations to strengthen the interventions. CONCLUSIONS REACH, a low-touch values intervention, showed good feasibility and acceptability, and initial promise in improving objectively-assessed AET adherence among breast cancer survivors (relative to education alone). Future research should target improving REACH's tailoring and endurance.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Muenzinger, Boulder, CO, 80309-0345, USA
- Division of Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, USA
| | - Catherine M Crespi
- Fielding School of Public Health, Department of Biostatistics, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael E Levin
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Sarah R Genung
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Muenzinger, Boulder, CO, 80309-0345, USA
| | - Madeline Nealis
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Muenzinger, Boulder, CO, 80309-0345, USA
| | | | - Emma E Bright
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Muenzinger, Boulder, CO, 80309-0345, USA
| | - Karen Albright
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Annette L Stanton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
- Semel Institute for Neuroscience, Cousins Center for Psychoneuroimmunology, University of California Los Angeles, Los Angeles, CA, USA
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Arch JJ, Slivjak E, Bright EE, Crespi CM, Levin ME, Genung SR, Nealis M, Albright K, Mitchell JL, Sheth AD, Magidson JF, Stanton AL. Leveraging values to promote adherence to endocrine therapy among breast cancer survivors: A mixed-methods investigation. Journal of Contextual Behavioral Science 2022. [DOI: 10.1016/j.jcbs.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rini C, Waltz M, Bovbjerg K, Farrell D, Yanez B, Chicaiza A, Hartstein ML, Omar R, Thompson R, Rowley SD, Stanton AL, Valdimarsdottir H, Austin J, Van Denburg AN, Graves KD. Optimizing use of Written Peer Support as a Supportive Resource in Cancer: FOCUS GROUP INSIGHTS. Psychooncology 2022; 31:1589-1596. [PMID: 35765696 PMCID: PMC9452473 DOI: 10.1002/pon.5991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/13/2022] [Accepted: 06/24/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Cancer survivors frequently describe wanting to learn from others who have had similar diagnoses or treatments (peer support). We conducted focus groups to investigate hematopoietic stem cell transplant survivors' attitudes and preferences regarding accessing written peer support through a website. Although written peer support does not allow for interpersonal interactions with peers, it could increase transplant recipients' access to evidence-based benefits of informational and emotional peer support. METHODS We conducted four videoconference focus groups with 34 adult transplant survivors who were diverse in their medical and sociodemographic characteristics and geographic location. Discussions were recorded, transcribed, and content analyzed. RESULTS Many participants reported need for information about transplant beyond what they received from their healthcare providers. Needs varied across participants, as did preferences for characteristics and timing of information optimally provided through peer support. Participants were enthusiastic about the value of written peer support but emphasized that it should be delivered in a way that accommodates variation in transplant experiences, underscores its trustworthiness, and pairs it with useful psychoeducational content. CONCLUSIONS Findings provide guidance for making written peer support an accessible, supportive resource for transplant survivors. Future research should evaluate personalized online delivery of written peer support paired with psychoeducational content that enhances its benefits. IMPLICATIONS FOR CANCER SURVIVORS Written peer support delivered online could be a useful, valued resource for transplant survivors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Christine Rini
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Margaret Waltz
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Katrin Bovbjerg
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Anthony Chicaiza
- Department of Oncology, Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Madison L Hartstein
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rahma Omar
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rebecca Thompson
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Scott D Rowley
- Department of Oncology, Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA.,John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Annette L Stanton
- Department of Psychiatry/Biobehavioral Science, University of California at Los Angeles, Los Angeles, CA, USA.,Department of Psychology, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Heiddis Valdimarsdottir
- Department of Psychology, Reykjavik University, Reykjavík, Iceland.,Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jane Austin
- Department of Psychology, William Paterson University, Wayne, NJ, USA
| | - Alyssa N Van Denburg
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristi D Graves
- Department of Oncology, Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
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Fishbein JN, Judd CM, Genung S, Stanton AL, Arch JJ. Intervention and mediation effects of target processes in a randomized controlled trial of Acceptance and Commitment Therapy for anxious cancer survivors in community oncology clinics. Behav Res Ther 2022; 153:104103. [DOI: 10.1016/j.brat.2022.104103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
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Wenger NS, Stanton AL, Baxter-King R, Sepucha K, Vavreck L, Naeim A. The Impact of COVID-19 on Routine Medical Care and Cancer Screening. J Gen Intern Med 2022; 37:1450-1456. [PMID: 35013931 PMCID: PMC8744580 DOI: 10.1007/s11606-021-07254-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND COVID-19 restrictions and fear dramatically changed the use of medical care. Understanding the magnitude of cancelled and postponed appointments and associated factors can help identify approaches to mitigate unmet need. OBJECTIVE To determine the proportion of medical visits cancelled or postponed and for whom. We hypothesized that adults with serious medical conditions and those with higher anxiety, depressive symptoms, and avoidance-oriented coping would have more cancellations/postponements. DESIGN Four nationally representative cross-sectional surveys conducted online in May, July, October, and December 2020. PARTICIPANTS 59,747 US adults who completed 15-min online surveys. 69% cooperation rate. MEASURES Physical and mental health visits and cancer screening cancelled or postponed over prior 2 months. Plan to cancel or postpone visits over the next 2 months. Relationship with demographics, medical conditions, local COVID-19 death rate, anxiety, depressive symptoms, coping, intolerance of uncertainty, and perceived COVID-19 risk. KEY RESULTS Of the 58% (N = 34,868) with a medical appointment during the 2 months before the survey, 64% had an appointment cancelled or postponed in May, decreasing to 37% in December. Of the 41% of respondents with scheduled cancer screening, 20% cancelled/postponed, which was stable May to December. People with more medical conditions were more likely to cancel or postpone medical visits (OR 1.19 per condition, 95% CI 1.16, 1.22) and cancer screening (OR 1.20, 95% CI 1.15, 1.24). Race, ethnicity, and income had weak associations with cancelled/postponed visits, local death rate was unrelated, but anxiety and depressive symptoms were strongly related to cancellations, and this grew between May and December. CONCLUSIONS Cancelled medical care and cancer screening were more common among persons with medical conditions, anxiety and depression, even after accounting for COVID-19 deaths. Outreach and support to ensure that patients are not avoiding needed care due to anxiety, depression and inaccurate perceptions of risk will be important.
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Affiliation(s)
- Neil S Wenger
- Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue #804, Los Angeles, CA, 90024, USA.
| | - Annette L Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Ryan Baxter-King
- Department of Political Science, UCLA College, Los Angeles, CA, USA
| | - Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lynn Vavreck
- Departments of Political Science and Communication, UCLA College, Los Angeles, CA, USA
| | - Arash Naeim
- UCLA Center for SMART Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Williamson TJ, Garon EB, Shapiro JR, Chavira DA, Goldman JW, Stanton AL. Facets of stigma, self-compassion, and health-related adjustment to lung cancer: A longitudinal study. Health Psychol 2022; 41:301-310. [PMID: 35324247 PMCID: PMC9030259 DOI: 10.1037/hea0001156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to investigate whether three facets of lung cancer stigma (internalized stigma, constrained disclosure, and perceived subtle discrimination) uniquely predicted psychological and physical health-related adjustment to lung cancer across 12 weeks. Additionally, self-compassion was tested as a moderator of the stigma-health relationship. METHOD Adults receiving oncologic treatment for lung cancer (N = 108) completed measures of lung cancer stigma, self-compassion, depressive symptoms, cancer-related stress, and physical symptom bother. Multivariable linear regression models were used to investigate cross-sectional and longitudinal relationships (at 6- and 12-week follow-up) between indicators of stigma and health-related outcomes, controlling for covariates. Self-compassion was tested as a moderator of these relationships. RESULTS At study entry, higher internalized stigma, constrained disclosure, and perceived subtle discrimination were associated significantly and uniquely with higher depressive symptoms (all p < .05). Constrained disclosure and perceived subtle discrimination were also associated significantly with higher cancer-related stress and higher physical symptom bother at study entry (all p < .05). Furthermore, higher internalized stigma predicted significant increases in depressive symptoms across 12 weeks and in cancer-related stress across 6 and 12 weeks (all p < .05). Higher self-compassion significantly moderated relationships between perceived discrimination and psychological health outcomes at study entry as well as between internalized stigma and increasing depressive symptoms across 12 weeks (all p < .05). CONCLUSIONS Results indicated robust relationships between distinct facets of stigma and health-related adjustment to lung cancer. Supportive care programs that bolster self-compassion may be useful for reducing lung cancer stigma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Timothy J. Williamson
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Edward B. Garon
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| | - Jenessa R. Shapiro
- Department of Psychology, University of California, Los Angeles
- Anderson School of Management, University of California, Los Angeles
| | | | - Jonathan W. Goldman
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| | - Annette L. Stanton
- Department of Psychology, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
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MacDonald JJ, Baxter-King R, Vavreck L, Naeim A, Wenger N, Sepucha K, Stanton AL. Depressive Symptoms and Anxiety During the COVID-19 Pandemic: Large, Longitudinal, Cross-sectional Survey. JMIR Ment Health 2022; 9:e33585. [PMID: 35142619 PMCID: PMC8834874 DOI: 10.2196/33585] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/26/2021] [Accepted: 12/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has influenced the mental health of millions across the globe. Understanding factors associated with depressive symptoms and anxiety across 12 months of the pandemic can help identify groups at higher risk and psychological processes that can be targeted to mitigate the long-term mental health impact of the pandemic. OBJECTIVE This study aims to determine sociodemographic features, COVID-19-specific factors, and general psychological variables associated with depressive symptoms and anxiety over 12 months of the pandemic. METHODS Nationwide, cross-sectional electronic surveys were implemented in May (n=14,636), July (n=14,936), October (n=14,946), and December (n=15,265) 2020 and March/April 2021 (n=14,557) in the United States. Survey results were weighted to be representative of the US population. The samples were drawn from a market research platform, with a 69% cooperation rate. Surveys assessed depressive symptoms in the past 2 weeks and anxiety in the past week, as well as sociodemographic features; COVID-19 restriction stress, worry, perceived risk, coping strategies, and exposure; intolerance of uncertainty; and loneliness. RESULTS Across 12 months, an average of 24% of respondents reported moderate-to-severe depressive symptoms and 32% reported moderate-to-severe anxiety. Of the sociodemographic variables, age was most consistently associated with depressive symptoms and anxiety, with younger adults more likely to report higher levels of those outcomes. Intolerance of uncertainty and loneliness were consistently and strongly associated with the outcomes. Of the COVID-19-specific variables, stress from COVID-19 restrictions, worry about COVID-19, coping behaviors, and having COVID-19 were associated with a higher likelihood of depressive symptoms and anxiety. CONCLUSIONS Depressive symptoms and anxiety were high in younger adults, adults who reported restriction stress or worry about COVID-19 or who had had COVID-19, and those with intolerance of uncertainty and loneliness. Symptom monitoring as well as early and accessible intervention are recommended.
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Affiliation(s)
- James J MacDonald
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ryan Baxter-King
- Department of Political Science, College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lynn Vavreck
- Department of Political Science, College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Communication, College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Arash Naeim
- Center for SMART Health, Clinical and Translational Science Institute, University of California, Los Angeles, Los Angeles, CA, United States
| | - Neil Wenger
- Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Abstract
Objective: Insomnia and fatigue are common, although not inevitable, during breast cancer. This study is one of the first aiming to describe distinct trajectory classes of insomnia and fatigue symptoms, and their correlates, from diagnosis through treatment.Methods: This longitudinal cohort study was conducted at a comprehensive cancer center and community oncology practices. Participants (N = 460) were women diagnosed with any stage of breast cancer in the previous 4 months. Primary outcomes for this ancillary study of the existing cohort were self-reported insomnia and fatigue symptoms assessed repeatedly across 12 months.Results: Four distinct classes of insomnia symptoms emerged: persistently very high, clinically elevated symptoms (13.7%); high, clinically elevated symptoms (65.9%); stable low (17.2%) or very low (2.6%) symptoms. Five fatigue symptom classes included high, increasing fatigue (9.6%), two recovery classes starting at high (26.3%), or moderate (18.0%) severity at diagnosis, stable low (33.3%) or very low (12.2%) classes. In multivariate analyses, higher depressive symptoms, anxiety, and chronic life stress were associated with being in the very high insomnia class versus the low symptom class. Oncologic factors were not associated with insomnia class membership. Receiving chemotherapy was linked significantly to high and recovery fatigue symptom classes versus the low class. Higher chronic life stress was associated with more persistent fatigue symptoms.Conclusions: Distinct classes of insomnia and fatigue symptoms were evident; 79.6% of the women had clinically elevated, persistent insomnia symptoms, 53.9% had elevated fatigue. A substantial minority evidenced low symptoms, suggesting targeted or stepped-care approaches to symptom management.
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Affiliation(s)
- Helena R Bean
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University
| | - Justine Diggens
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne
| | - Maria Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne
| | - Karen L Weihs
- Department of Psychiatry, University of Arizona.,University of Arizona Cancer Center
| | - Annette L Stanton
- Department of Psychology, University of California Los Angeles.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University
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Whitmore L, Schulte T, Bovbjerg K, Hartstein M, Austin J, Luta G, McFarland L, Rowley SD, Nyirenda T, Lewis-Thames M, Stanton AL, Valdimarsdottir H, Graves K, Rini C. Efficacy of expressive helping in adult hematologic cancer patients undergoing stem cell transplant: protocol for the Writing for Insight, Strength, and Ease (WISE) study's two-arm randomized controlled trial. Trials 2021; 22:722. [PMID: 34670600 PMCID: PMC8527764 DOI: 10.1186/s13063-021-05676-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background During, shortly after, and sometimes for years after hematopoietic stem cell transplant, a large proportion of hematological cancer patients undergoing transplant report significant physical and psychological symptoms and reduced health-related quality of life. To address these survivorship problems, we developed a low-burden, brief psychological intervention called expressive helping that includes two theory- and evidence-based components designed to work together synergistically: emotionally expressive writing and peer support writing. Building on evidence from a prior randomized control trial showing reductions in physical symptoms and distress in long-term transplant survivors with persistent survivorship problems, the Writing for Insight, Strength, and Ease (WISE) trial will evaluate the efficacy of expressive helping when used during transplant and in the early post-transplant period, when symptoms peak, and when intervention could prevent development of persistent symptoms. Methods WISE is a multi-site, two-arm randomized controlled efficacy trial. Adult hematological cancer patients scheduled for a hematopoietic stem cell transplant will complete baseline measures and then, after hospitalization but prior to transplant, they will be randomized to complete either expressive helping or a time and attention “neutral writing” task. Both expressive helping and neutral writing involve four brief writing sessions, beginning immediately after randomization and ending approximately 4 weeks after hospital discharge. Measures of symptom burden (primary outcome), distress, health-related quality of life, and fatigue (secondary outcomes) will be administered in seven assessments coinciding with medically relevant time points from baseline and to a year post-intervention. Discussion The steady and continuing increase in use of stem cell transplantation has created growing need for efficacious, accessible interventions to reduce the short- and long-term negative physical and psychosocial effects of this challenging but potentially life-saving treatment. Expressive helping is a psychological intervention that was designed to fill this gap. It has been shown to be efficacious in long-term transplant survivors but could have even greater impact if it is capable of reducing symptoms during and soon after transplant. The WISE study will evaluate these benefits in a rigorous randomized controlled trial. Trial registration Clinicaltrial.govNCT03800758. Registered January 11, 2019
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Affiliation(s)
- Lauren Whitmore
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA.
| | - Taylor Schulte
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Katrin Bovbjerg
- Department of Medical Social Sciences, Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Madison Hartstein
- Department of Medical Social Sciences, Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Jane Austin
- Department of Psychology, William Paterson University, Wayne, NJ, USA
| | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Lily McFarland
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Scott D Rowley
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Themba Nyirenda
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Marquita Lewis-Thames
- Department of Medical Social Sciences, Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Annette L Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Heiddis Valdimarsdottir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland.,Department of Oncological Sciences, Icahn School of Medicine at Sinai School, New York, NY, USA
| | - Kristi Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Christine Rini
- Department of Medical Social Sciences, Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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Lu Q, Warmoth K, Chen L, Wu CS, Chu Q, Li Y, Gallagher MW, Stanton AL, Kagawa Singer M, Young L, Loh A. A Culturally Sensitive Social Support Intervention for Chinese American Breast Cancer Survivors (Joy Luck Academy): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e30950. [PMID: 34550088 PMCID: PMC8495571 DOI: 10.2196/30950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Breast cancer is the most prevalent type of cancer among Asian American women. Chinese American immigrant breast cancer survivors face unique challenges because of cultural and socioecological factors. They report emotional distress and the need for social, emotional, and spiritual support. However, culturally and linguistically appropriate information for managing survivorship health care is often unavailable. Objective To improve the health outcomes for this underserved and understudied population, we developed, designed, and launched a randomized controlled trial to test the health benefits of a culturally sensitive social support intervention (Joy Luck Academy). In this paper, we describe the research protocol. Methods This randomized controlled trial will enroll Chinese-speaking, stage 0 to 3 breast cancer survivors who have completed treatment within the previous 36 months using a community-based participatory research approach. We will randomly assign 168 participants to the intervention or control group. The intervention arm will attend 7 weekly 3.5-hour peer mentor and educational sessions. The control group will receive the educational information. We will assess health outcomes at baseline, immediately after the Joy Luck Academy, and at 1- and 4-month follow-ups. The primary outcome is quality of life, as measured by the Functional Assessment of Cancer Therapy scale. Secondary outcomes include depressive symptoms, positive affect, fatigue, and perceived stress. We will also explore how the intervention influences cortisol levels. To identify how and to whom the program is effective, we will measure social and personal resources and theorized mechanisms and perform qualitative interviews with a subsample of participants to enhance the interpretation of quantitative data. Results Recruitment began in February 2015, and data collection was completed in February 2019. We expect to complete data management by August 2021 and publish results in 2022. Conclusions If the Joy Luck Academy is demonstrated to be effective, it may be easily disseminated as an intervention for other groups of Asian American immigrant breast cancer survivors. Furthermore, similar programs could be integrated into other diverse communities. Trial Registration ClinicalTrials.gov NCT02946697; http://clinicaltrials.gov/ct2/show/NCT02946697. International Registered Report Identifier (IRRID) DERR1-10.2196/30950
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Affiliation(s)
- Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Psychology, University of Houston, Houston, TX, United States
| | - Krystal Warmoth
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Lingjun Chen
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Christine S Wu
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Qiao Chu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Annette L Stanton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Marjorie Kagawa Singer
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Lucy Young
- Herald Cancer Association, San Gabriel, CA, United States
| | - Alice Loh
- Herald Cancer Association, San Gabriel, CA, United States
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MacDonald JJ, Jorge-Miller A, Enders CK, McCannel TA, Beran TM, Stanton AL. Visual impairment and depression in uveal melanoma: Optimism and pessimism as moderators. Health Psychol 2021; 40:408-417. [PMID: 34323543 DOI: 10.1037/hea0001080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Uveal melanoma, a rare eye cancer, presents potential vision loss and life threat. This prospective, longitudinal study interrogated the predictive utility of visual impairment, as moderated by optimism/pessimism, on depressive symptoms in 299 adults undergoing diagnostic evaluation. METHOD Depressive symptoms (Center for Epidemiologic Studies Depression Scale), subjective (Measure of Outcome in Ocular Disease vision subscale) and objective (logarithm of the minimum angle of resolution) visual impairment, and optimism/pessimism (Life Orientation Test-Revised) were assessed before diagnostic evaluation and 1 week, 3 months, and 12 months after diagnosis. Multilevel modeling, with repeated measures (Level 1) nested within individuals (Level 2) and imputation of missing data (Blimp software), was performed. RESULTS Depressive symptoms were significantly more elevated 1 week after diagnosis in cancer patients (n = 107) versus patients not diagnosed with cancer (n = 192). Higher subjective (but not objective) visual impairment predicted greater depressive symptoms (p < .001). Across the entire sample, the two-way (Optimism/Pessimism × Subjective Visual Impairment) interactions were statistically significant (ps < .05), but not the three-way interaction (with diagnosis). The positive association between subjective visual impairment and depressive symptoms was significant at low and moderate levels of optimism (ps < .001), but not at high optimism (p > .05). The association was significant at high and moderate levels (ps < .001), but not low (p > .05) levels of pessimism. CONCLUSIONS Elevated depressive symptoms are evident in adults who do (vs. do not) receive a diagnosis of uveal melanoma but appear to remit within 3 months. Perceived impaired vision, especially coupled with low optimism or high pessimism, predicts depressive symptoms over time, with implications for intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Craig K Enders
- Department of Psychology, University of California, Los Angeles
| | - Tara A McCannel
- Department of Ophthalmology and Ocular Oncology, Stein and Doheny Eye Institutes, University of California, Los Angeles
| | - Tammy M Beran
- Department of Psychology, University of California, Los Angeles
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Arch JJ, Mitchell JL, Genung SR, Judd CM, Andorsky DJ, Bricker JB, Stanton AL. Randomized trial of acceptance and commitment therapy for anxious cancer survivors in community clinics: Outcomes and moderators. J Consult Clin Psychol 2021; 89:327-340. [PMID: 34014694 DOI: 10.1037/ccp0000630] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Anxiety symptoms are common among cancer survivors. This study evaluated whether an acceptance-based group intervention delivered by social workers in community oncology clinics improved anxiety and related symptoms, and healthcare use, relative to enhanced usual care (EUC). METHOD This multi-site trial included 135 survivors of various cancers with moderate to high anxiety about cancer/survivorship, 1.5-24 months after treatment. Participants were randomized 1:1 to a 7-session acceptance and commitment therapy (ACT)-based group (Valued Living) or EUC (access to onsite supportive care plus resource list). Questionnaires were administered at baseline, 1, 2, 5, and 8 months post-randomization, diagnostic interviews at baseline, 2, and 8 months, and healthcare use tracked throughout. Outcomes included anxiety symptoms (primary), related symptoms, and healthcare use. Putative moderators included age, anxiety, and avoidance. RESULTS In intent-to-treat comparisons to EUC, Valued Living (VL) showed a nonsignificant pattern of greater improvement on anxiety symptoms (p = .08), improved significantly more on cancer-related post-traumatic stress (p = .002), fear of recurrence (p = .003), and energy/fatigue (p = .02), and missed significantly fewer medical appointments (p < .05). Conditions improved similarly on depressive symptoms, sense of meaning, and most severe anxiety or depressive disorder. Effects were moderated: VL participants with higher baseline anxiety or avoidance (+1SD) improved more on anxiety, meaning (ps ≤ .01), and disorder severity (p = .05) than their EUC counterparts. CONCLUSIONS An acceptance-based group intervention delivered in community oncology clinics enhanced psychological recovery and energy levels, and reduced missed medical appointments for anxious cancer survivors, with stronger effects for more distressed participants. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Abstract
Asian Americans are the fastest growing U.S. immigrant group, projected to become the largest immigrant group by 2065, but the quantity of research on Asian Americans' health has not mirrored changing demographics. Asian Americans have been understudied for more than 25 years, with only 0.17% of National Institutes of Health (NIH) expenditures allocated to projects including Asian American, Native Hawaiian, and Pacific Islander populations (Ðoàn et al., 2019). This disproportionality may result in part from the model minority stereotype (MMS) being extended to health, perpetuating the ideas that Asian Americans are well-positioned with regard to health status and that associated research is not essential. Accordingly, the aims for this article are threefold: (a) bring attention to the inadequate representation of the Asian American population in health-related science, (b) question the MMS in health, and (c) outline potential pathways through which the MMS limits what is knowable on Asian American health issues and needs. We discuss the limited meaningfulness of nonrepresentative aggregated statistics purporting the model minority image and provide counterexamples. We also present a stereotype-constraints model with the MMS contributing to a bottleneck for Asian American health-related knowledge, accompanied by present-day circumstances (e.g., sparse data, few psychologists/behavioral medicine scientists focused on Asian American health). We conclude with initial recommendations for addressing MMS-associated constraints in psychology and more broadly. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center
| | - Annette L. Stanton
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
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Naeim A, Baxter-King R, Wenger N, Stanton AL, Sepucha K, Vavreck L. Effects of Age, Gender, Health Status, and Political Party on COVID-19-Related Concerns and Prevention Behaviors: Results of a Large, Longitudinal Cross-sectional Survey. JMIR Public Health Surveill 2021; 7:e24277. [PMID: 33908887 PMCID: PMC8080961 DOI: 10.2196/24277] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/26/2020] [Accepted: 01/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background With conflicting information about COVID-19, the general public may be uncertain about how to proceed in terms of precautionary behavior and decisions about whether to return to activity. Objective The aim of this study is to determine the factors associated with COVID-19–related concerns, precautionary behaviors, and willingness to return to activity. Methods National survey data were obtained from the Democracy Fund + UCLA Nationscape Project, an ongoing cross-sectional weekly survey. The sample was provided by Lucid, a web-based market research platform. Three outcomes were evaluated: (1) COVID-19–related concerns, (2) precautionary behaviors, and (3) willingness to return to activity. Key independent variables included age, gender, race or ethnicity, education, household income, political party support, religion, news consumption, number of medication prescriptions, perceived COVID-19 status, and timing of peak COVID-19 infections by state. Results The data included 125,508 responses from web-based surveys conducted over 20 consecutive weeks during the COVID-19 pandemic (comprising approximately 6250 adults per week), between March 19 and August 5, 2020, approved by the University of California, Los Angeles (UCLA) Institutional Review Board for analysis. A substantial number of participants were not willing to return to activity even after the restrictions were lifted. Weighted multivariate logistic regressions indicated the following groups had different outcomes (all P<.001): individuals aged ≥65 years (COVID-19–related concerns: OR 2.05, 95% CI 1.93-2.18; precautionary behaviors: OR 2.38, 95% CI 2.02-2.80; return to activity: OR 0.41, 95% CI 0.37-0.46 vs 18-40 years); men (COVID-19–related concerns: OR 0.73, 95% CI 0.70-0.75; precautionary behaviors: OR 0.74, 95% CI 0.67-0.81; return to activity: OR 2.00, 95% CI 1.88-2.12 vs women); taking ≥4 medications (COVID-19–related concerns: OR 1.47, 95% CI 1.40-1.54; precautionary behaviors: OR 1.36, 95% CI 1.20-1.555; return to activity: OR 0.75, 95% CI 0.69-0.81 vs <3 medications); Republicans (COVID-19–related concerns: OR 0.40, 95% CI 0.38-0.42; precautionary behaviors: OR 0.45, 95% CI 0.40-0.50; return to activity: OR 2.22, 95% CI 2.09-2.36 vs Democrats); and adults who reported having COVID-19 (COVID-19–related concerns: OR 1.24, 95% CI 1.12-1.39; precautionary behaviors: OR 0.65, 95% CI 0.52-0.81; return to activity: OR 3.99, 95% CI 3.48-4.58 vs those who did not). Conclusions Participants’ age, party affiliation, and perceived COVID-19 status were strongly associated with their COVID-19–related concerns, precautionary behaviors, and willingness to return to activity. Future studies need to develop and test targeted messaging approaches and consider political partisanship to encourage preventative behaviors and willingness to return to activities.
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Affiliation(s)
- Arash Naeim
- Center for SMART Health, Departments of Medicine and Bioengineering, David Geffen School of Medicine at UCLA and Samueli School of Engineering and Applied Science, Los Angeles, CA, United States
| | - Ryan Baxter-King
- Department of Political Science, College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Neil Wenger
- Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, United States
| | - Annette L Stanton
- Department of Psychology and Psychiatry, College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Lynn Vavreck
- Departments of Political Science and Communication, College of Letters and Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Abstract
OBJECTIVE Cognitive difficulties are a common complaint among patients with breast cancer and may adversely affect psychological well-being. In particular, problems with executive functioning (EF) may interfere with coping, which is known to influence depressive symptoms. The current study was designed to examine correlations between EF, coping, and depressive symptoms in breast cancer survivors and to longitudinally test the hypothesis that coping mediates the relationship between EF and depressive symptoms. METHODS Participants included 171 women with early-stage breast cancer assessed at the end of primary treatment with surgery, radiation, and/or chemotherapy and at 6 months, 1 year, and 2 years after treatment follow-ups as part of the Mind-Body Study. Participants completed questionnaires to assess subjective EF, approach and avoidant coping, and depressive symptoms, and neuropsychological testing was conducted to assess objective EF. Bivariate correlations were used to examine associations between EF, coping, and depressive symptoms. Mediation analyses were conducted using a bootstrapping approach (PROCESS). RESULTS At 1 year after treatment, objective and subjective EFs were correlated with avoidant coping (r = -0.172 [p = .024] and r = 0.297 [p < .001], respectively). In longitudinal analyses, use of the avoidant strategy behavioral disengagement at 1 year mediated the association between objective (95% bootstrap confidence interval = -0.282 to -0.042) and subjective (95% bootstrap confidence interval = 0.020 to 0.254) EFs at 6 months and depressive symptoms at 2 years. CONCLUSIONS This study highlights how problems with EF during survivorship are associated with avoidant coping and depressive symptoms. Thus, these findings identify potential cognitive and affective targets for depression intervention in this population.
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Affiliation(s)
- Arielle Radin
- From the Department of Psychology (Radin, Stanton, Bower), Schools of Medicine and Public Health (Ganz), Jonsson Comprehensive Cancer Center (Ganz, Van Dyk, Stanton, Bower), Department of Psychiatry and Biobehavioral Sciences (Van Dyk, Stanton, Bower), and Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior (Stanton, Bower), University of California, Los Angeles, Los Angeles, California
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Laird KT, Stanton AL. Written expressive disclosure in adults with irritable bowel syndrome: A randomized controlled trial. Complement Ther Clin Pract 2021; 43:101374. [PMID: 33826992 DOI: 10.1016/j.ctcp.2021.101374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The benefits of written expressive disclosure (WED) to health are documented in a variety of healthy and clinical populations. This study investigates the effect of WED on health-related outcomes in irritable bowel syndrome (IBS). METHODS Adults (N = 189) meeting Rome III criteria for IBS were randomly assigned to write about their: (1) deepest thoughts and feelings about the most stressful life event of the past five years (n = 67), (2) deepest thoughts and feelings about their IBS (n = 61) or (3) daily activities in an objective manner (control condition; n = 61). Participants completed four 20-min writing sessions over 2-6 weeks. Gastrointestinal (GI) symptoms, healthcare utilization, health-related quality of life (HR-QOL), pain catastrophizing, and pain self-efficacy were assessed at baseline, one month post-writing completion, and three months post-writing completion. RESULTS A significant group (combined WED vs. control) X time interaction was detected for healthcare utilization, F(1,147) = 6.16, p = 0.014, η2 = 0.04. Specifically, number of GI-related medical appointments significantly increased from baseline to 3-month follow-up in the control group, while no significant change was observed in the combined WED group. Among the WED group, individuals assigned to write about their IBS experienced greater improvements in pain self-efficacy than those assigned to write about a life stressor, F(1,92) = 3.89, p = 0.024, η2 = 0.08. GI symptom severity, HR-QOL, and pain catastrophizing improved significantly across groups over time, with no significant between-group differences. CONCLUSION Writing about one's deepest thoughts and feelings about IBS may increase pain self-efficacy and reduce healthcare utilization compared to control writing in adults with IBS.
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Affiliation(s)
- Kelsey T Laird
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA; School of Professional Psychology and Health, California Institute of Integral Studies, San Francisco, CA, 94103, USA.
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, USA.
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Kim JHJ, Cole SW, Weihs KL, Stanton AL. Abstract PD12-02: Chronic interpersonal stress predicts depressive outcomes in the first year of invasive breast cancer: Moderation by the serotonin-transporter polymorphism. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd12-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Depression in cancer patients predicts lower survival, and early identification of individuals at highest risk for depression is needed. In the general population, depression is higher in contexts of both childhood adversity and chronic interpersonal stress, but their collective influence on depressive outcomes in the first year after breast cancer diagnosis is unknown. Genetic polymorphisms related to socioemotional functioning (e.g., the serotonin transporter) may moderate the associations among childhood adversity, chronic interpersonal stress, and depressive outcomes, specifying which women are most at risk.
Methods: 460 women with invasive breast cancer were assessed for depressive symptoms and major depressive episodes (MDEs) seven times across one year. Associations between depressive symptoms and childhood adversity, chronic interpersonal stress, and the 5-HTTLPR polymorphism were examined. We used multilevel modeling for predicting longitudinal depressive symptoms, logistic regression for predicting any MDEs over the year, and multinomial logistic regression for predicting odds of belonging to Low/Recovery/High depressive symptom trajectory classes (Stanton et al., 2015). Models controlled for known sociodemographic and clinical confounding variables such as age, ethnicity, SES, cancer stage, treatments received, medical comorbidities, history of depression, and neuroticism.
Results: Higher chronic interpersonal stress predicted greater depressive symptoms at study entry (b=4.56, 95% CI [2.60,6.52]), greater odds for belonging to a High vs. Low depressive trajectory class (OR=3.16, [1.53, 6.51]), and greater odds of having an MDE (OR=2.28, [1.10, 4.73]). 5-HTTLPR moderated the influence of chronic interpersonal stress on depressive symptoms over time (b=0.24, [0.06,0.41]), with no decline in symptoms for SS genotype women under high chronic interpersonal stress vs. significant improvement in symptoms despite high chronic interpersonal stress for LL/LS genotype women. There were no significant effects of childhood adversity on depressive outcomes considered.
Conclusion: Women with greater chronic interpersonal stress are at risk for high, unremitting depressive symptom trajectories and MDEs in the first year after invasive breast cancer diagnosis. Unchanged depressive symptoms across the year were most pronounced for women bearing the SS allele of the 5-HTTLPR polymorphism. Women with high chronic interpersonal stress and the SS genotype may benefit from early intervention to prevent depression after breast cancer diagnosis.
Citation Format: Jacqueline HJ Kim, Steve W Cole, Karen L Weihs, Annette L Stanton. Chronic interpersonal stress predicts depressive outcomes in the first year of invasive breast cancer: Moderation by the serotonin-transporter polymorphism [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD12-02.
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Kim JHJ, Drake BL, Accortt EE, Pollin IS, Bairey Merz CN, Stanton AL. Younger Women Living with Chronic Disease: Comparative Challenges, Resiliencies, and Needs in Heart Disease and Breast Cancer. J Womens Health (Larchmt) 2021; 30:1288-1302. [PMID: 33428530 DOI: 10.1089/jwh.2020.8506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Younger women with chronic disease (<60 years of age), especially women with stereotypically "men's" heart disease (HD), are understudied. Unique difficulties may occur with HD, which is less commonly associated with women, compared with breast cancer (BC). Similarities may also exist across younger women, as chronic disease is less normative in younger people. Intersections of gender, age, and the specific disease experience require greater attention for improving women's health. This exploratory qualitative study compared younger women's experiences of HD or BC. Methods: Semistructured interviews with 20 women (n = 10 per disease) were analyzed using applied thematic analysis. Results: Amidst building careers, intimate relationships, and families, women felt thwarted by disease-related functional problems. Cognitive-behavioral coping strategies spurred resilience, including integrating the illness experience with self-identity. Barriers arose when medical professionals used representativeness heuristics (e.g., chronic disease occurs in older age). Important experiences in HD included worsened self-image from disability, negative impact of illness invisibility, and persisting isolation from lacking peer availability. Initial medical care reported by women with HD may reflect gender biases (e.g., HD missed in emergency settings and initial diagnostics). New information provided by the younger women includes limited illness-related optimism in women with HD facing age and gender stereotypes, as well as the advantages and disadvantages of peer availability in BC. Conclusions: Greater public awareness of younger women with chronic disease, alongside structural support and connection with similarly challenged peers, is suggested. As advocacy for BC awareness and action has strengthened over past decades, similar efforts are needed for younger women with HD.
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Affiliation(s)
- Jacqueline H J Kim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Brittany L Drake
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Eynav E Accortt
- Department of Obstetrics and Gynecology and Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Irene S Pollin
- Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences and University of California, Los Angeles, Los Angeles, California, USA.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California, USA
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Herts KL, Jorge-Miller A, Beran TM, McCannel TA, Wiley JF, Stanton AL. A prospective study of cancer-related benefit finding in uveal melanoma patients. J Behav Med 2020; 44:131-137. [PMID: 32939680 DOI: 10.1007/s10865-020-00175-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/18/2020] [Indexed: 11/29/2022]
Abstract
Little is known about contributors to the psychosocial impact of uveal melanoma, a rare cancer. Predictors and outcomes of benefit finding, a potentially favorable outcome, were investigated. Adults (n = 107) completed assessments prior to diagnosis of uveal melanoma and one week, three months and 12 months after diagnosis. Path analyses with the full information maximum likelihood estimation method were conducted. Objective disease impact on vision did not predict benefit finding (p > .05). Approach-oriented coping prior to diagnosis and one week later significantly predicted greater benefit finding 12 months later (p < .01). Avoidance-oriented coping at three months moderated the concurrent relationship of benefit finding and positive affect at 12 months (p < .001). This first study of predictors of benefit finding in uveal melanoma patients suggests that greater approach-oriented coping prospectively predicts higher benefit finding. Further, avoidance may condition the association of benefit finding with psychosocial outcomes.
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Affiliation(s)
- Kate L Herts
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Alexandra Jorge-Miller
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Tammy M Beran
- Department of Psychology, UCLA, Los Angeles, CA, USA
| | - Tara A McCannel
- Department of Ophthalmology and Stein Eye Institute, UCLA, Los Angeles, CA, USA
| | - Joshua F Wiley
- Monash Institute for Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Annette L Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences, Jonsson Comprehensive Cancer Center, UCLA, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA.
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Arch JJ, Genung SR, Ferris MC, Kirk A, Slivjak ET, Fishbein JN, Schneider RL, Stanton AL. Presence and predictors of anxiety disorder onset following cancer diagnosis among anxious cancer survivors. Support Care Cancer 2020; 28:4425-4433. [PMID: 31925530 PMCID: PMC7347435 DOI: 10.1007/s00520-020-05297-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/03/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Despite cancer survivors' frequent endorsement of anxiety symptoms, assessing the full range of anxiety disorders (AD), their timing of onset relative to cancer diagnosis, co-morbidity with mood disorder, and predictors of post-cancer onset, is rare or absent to date. This study provides a step toward addressing these gaps. METHODS Cancer survivors at re-entry after primary treatment completion who screened positively for anxiety symptoms (N = 133) and sought care through an intervention trial completed standardized diagnostic interviews, dimensional assessment of disorder severity, and timing of disorder onset relative to cancer diagnosis. We evaluated sociodemographic and medical predictors of developing a first AD after cancer diagnosis. RESULTS Most ADs began after cancer diagnosis (58%); for 68% of affected patients, this represented their first AD episode. The most common was generalized anxiety disorder (GAD; 41%), where "cancer-focused GAD" was distinguished from "typical GAD"; the next most common were specific phobia (14%) and social anxiety disorder (13%). A minority (31%) of ADs were comorbid with major depression. Relative to having no AD, experiencing more lingering treatment side effects predicted developing a first AD after cancer diagnosis. Relative to having an AD that began before cancer diagnosis, reporting a higher cancer stage predicted developing a first AD after diagnosis. CONCLUSIONS Cancer survivors at re-entry seeking care for anxiety symptoms manifested a broad range of ADs which most commonly developed after cancer diagnosis and were prompted by the experience of cancer. Such disorders represent an unusually late-life, cancer-linked etiology that warrants further investigation and clinical attention.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA.
- Division of Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, 80045, USA.
| | - Sarah R Genung
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Michelle C Ferris
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Alex Kirk
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Elizabeth T Slivjak
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Joel N Fishbein
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Rebecca L Schneider
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, 80309-0345, USA
| | - Annette L Stanton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, 90095, USA
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Kim JHJ, Bright EE, Williamson TJ, Krull JL, Weihs KL, Stanton AL. Correction to: Transitions in coping profiles after breast cancer diagnosis: implications for depressive and physical symptoms. J Behav Med 2020; 44:144-145. [PMID: 32797337 PMCID: PMC10173952 DOI: 10.1007/s10865-020-00173-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jacqueline H J Kim
- Department of Psychology, University of California (UCLA), Los Angeles, CA, USA.
| | - Emma E Bright
- Department of Psychology, University of California (UCLA), Los Angeles, CA, USA
| | | | - Jennifer L Krull
- Department of Psychology, University of California (UCLA), Los Angeles, CA, USA
| | - Karen L Weihs
- Department of Psychiatry, University of Arizona Cancer Center, The University of Arizona, Tucson, AZ, USA
| | - Annette L Stanton
- Department of Psychology, University of California (UCLA), Los Angeles, CA, USA.,UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California (UCLA), Los Angeles, CA, USA.,Cousins Center for Psychoneuroimmunology, Los Angeles, CA, USA
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Kim JHJ, Bright EE, Williamson TJ, Krull JL, Weihs KL, Stanton AL. Transitions in coping profiles after breast cancer diagnosis: implications for depressive and physical symptoms. J Behav Med 2020; 44:1-17. [PMID: 32535673 DOI: 10.1007/s10865-020-00159-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/14/2020] [Indexed: 12/17/2022]
Abstract
The objective of this study was to determine whether: (a) cancer-related coping profiles change across time; (b) coping profile transition types predict changes in depressive and physical symptoms. Latent transition analysis was conducted with repeated measures of seven cancer-related coping processes from 460 women recently diagnosed with breast cancer. In multilevel models, coping profile transition groups were entered as predictors of symptoms across 12 months. Three coping profiles emerged at study entry, with two profiles at later assessments. Forty-eight percent of women maintained high-moderate approach-oriented coping over time. Specific factors (e.g., age, acceptance of emotions) differentiated the transition groups. Women who increased and then maintained high-moderate approach-oriented coping had relatively high initial depressive symptoms that declined steeply. When cancer-related acceptance predominated, women experienced increasing physical symptoms. Distinct cancer-related coping patterns are related to the level of and change in depressive and physical symptoms longitudinally. Early intervention to increase approach-oriented coping strategies could yield favorable outcomes.
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Affiliation(s)
- Jacqueline H J Kim
- Department of Psychology, University of California (UCLA), Los Angeles, CA, USA.
| | - Emma E Bright
- Department of Psychology, University of California (UCLA), Los Angeles, CA, USA
| | | | - Jennifer L Krull
- Department of Psychology, University of California (UCLA), Los Angeles, CA, USA
| | - Karen L Weihs
- Department of Psychiatry, University of Arizona Cancer Center, The University of Arizona, Tucson, AZ, USA
| | - Annette L Stanton
- Department of Psychology, University of California (UCLA), Los Angeles, CA, USA.,UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California (UCLA), Los Angeles, CA, USA.,Cousins Center for Psychoneuroimmunology, Los Angeles, CA, USA
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Hoyt MA, Wang AWT, Boggero IA, Eisenlohr-Moul TA, Stanton AL, Segerstrom SC. Emotional approach coping in older adults as predictor of physical and mental health. Psychol Aging 2020; 35:591-603. [PMID: 32271069 PMCID: PMC8199838 DOI: 10.1037/pag0000463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Emotional approach coping involves active attempts at emotional expression and processing in response to stressful circumstances. This study tested whether dispositional emotional approach coping processes predict changes in physical and mental health in community-dwelling older adults, particularly within the context of higher perceived stress. To test this, older adults (N = 150) completed assessments of emotional expression and emotional processing at study entry. They also completed measures of perceived stress, depressive symptoms, and ill-health (a composite of subjective and objective physical health indicators, which included blood draw for collection of biomarkers), every 6 months over 4.5 years. Emotional processing and emotional expression were not related significantly to ill-health at study entry. However, emotional processing (but not emotional expression) significantly predicted changes in ill-health. At higher levels of emotional processing, ill-health remained low and stable; at lower levels of emotional processing, ill-health increased over time. However, when perceived stress was high, higher emotional processing and emotional expression were related to lower depressive symptoms at study entry, but higher emotional processing was associated with increasing depressive symptoms over time. Emotional approach coping processes evidence prospective relations with health outcomes, which are partially conditioned by stress perceptions. Emotional processing appears to have a protective impact against declining physical health. Predictive relationships for depressive symptoms are more complex. Older adults with chronically high perceived stress might benefit from interventions that target emotion-regulating coping processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Bamishigbin ON, Stein KD, Leach CR, Stanton AL. Spirituality and depressive symptoms in a multiethnic sample of cancer survivors. Health Psychol 2020; 39:589-599. [PMID: 32378960 DOI: 10.1037/hea0000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to (a) examine the relationships of 3 facets of spirituality (i.e., meaning, peace, faith), and their interaction, with depressive symptoms among Black, Latino, and White cancer survivors; and (b) test fear of cancer recurrence (FCR) and social support (SS) as mediators of these relationships. METHOD Data were analyzed from the American Cancer Society's Study of Cancer Survivors-I, a longitudinal population-based study of cancer survivors' quality of life. A national sample of Black (n = 194), Latino (n = 90), and White (n = 2,775) survivors of the top 10 incident cancers completed measures 1 year (Time 1, T1), 2 years (Time 2, T2), and 9 years (Time 3, T3) postdiagnosis. RESULTS After controlling for T1 depressed mood and demographic and medical characteristics, T1 lower meaning and lower peace, but not faith, predicted greater depressive symptoms at T3 in the total sample. A significant interaction showed that higher faith predicted greater depressive symptoms specifically in the context of lower meaning. Race/ethnicity did not affect these relationships. FCR at T2 partially mediated the relationships of T1 meaning and peace with T3 depressive symptoms, and SS partially mediated the relationship between T1 meaning and T3 depressive symptoms. CONCLUSIONS Cancer survivors with greater meaning and peace appear better able to integrate the cancer experience into their lives. An interaction between T1 meaning and faith on T3 depressive symptoms replicated previous findings. Future research should treat spirituality as a multidimensional construct and focus on identifying and influencing malleable mechanisms of the associations between spirituality and mental health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Kevin D Stein
- Department of Behavioral Sciences and Health Education
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Rosenberg SM, Petrie KJ, Stanton AL, Ngo L, Finnerty E, Partridge AH. Interventions to Enhance Adherence to Oral Antineoplastic Agents: A Scoping Review. J Natl Cancer Inst 2020; 112:443-465. [PMID: 31899790 PMCID: PMC7225676 DOI: 10.1093/jnci/djz244] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 11/11/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As new targeted oral antineoplastic therapies have emerged in recent years, the development of effective strategies that promote optimal adherence to cancer medication regimens has become an important priority. METHODS We conducted a scoping literature review to search for English language articles published through July 15, 2019, to identify studies that reported the testing and/or evaluation of interventions to improve adherence to oral antineoplastic agents. RESULTS A total of 56 articles were selected for review. Of the studies evaluated, 14 were randomized trials. All interventions except two targeted adult patients. Thirty-three studies enrolled fewer than 100 patients. Most interventions were education- and counseling-based and centered on provision of information about the drug and strategies to manage side effects. Only eight studies used an mHealth tool and/or text messages to target nonadherence. Among studies with a comparison sample, fewer than one-half (44.7%) reported statistically significant improvements in adherence or persistence associated with the intervention; however, some pharmacist-directed programs, particularly those that integrated monitoring or routine follow-up with a provider, did demonstrate efficacy. CONCLUSION Although the development of adherence-promoting interventions for oral antineoplastic therapies has increased recently, few have been rigorously tested. The nascent literature suggests those that are pharmacist directed and use regular monitoring show promise, though additional prospective studies are needed. Study methodology, population selection, and potential challenges that may be encountered in the implementation and dissemination phases should be considered when developing new interventions to address nonadherence to oral antineoplastic treatment.
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Affiliation(s)
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Annette L Stanton
- Jonsson Comprehensive Cancer Center, Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry/Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Lan Ngo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Emma Finnerty
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Boyle CC, Stanton AL, Eisenberger NI, Seeman TE, Bower JE. Effects of stress-induced inflammation on reward processing in healthy young women. Brain Behav Immun 2020; 83:126-134. [PMID: 31580931 PMCID: PMC7324155 DOI: 10.1016/j.bbi.2019.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/19/2019] [Accepted: 09/29/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Anhedonia, or loss of interest or pleasure, is a feature of depression and transdiagnostic construct in psychopathology. Theory and compelling evidence from preclinical models implicates stress-induced inflammation as a psychobiological pathway to anhedonic behavior; however, this pathway has not been tested in human models. Further, although anhedonia may reflect dysregulation in multiple dimensions of reward, the extent to which stress-induced inflammation alters these dimensions is unclear. Thus, the current experimental study used a standardized laboratory stressor task to elicit an inflammatory response and evaluate effects of stress-induced inflammation on multiple behavioral indices of reward processing. METHODS Healthy young women (age 18-25) completed behavioral reward tasks assessing reward learning, motivation, and sensitivity and were randomized to undergo an acute psychosocial stressor (n = 37) or a no-stress active control (n = 17). Tasks were re-administered 90-120 min post-stress to coincide with the peak of the stress-induced inflammatory response. Blood samples were collected for assessment of the pro-inflammatory cytokine interleukin-6 (IL-6) at baseline and 90 and 120 min post stressor. RESULTS Stress-induced IL-6 was associated with increased response bias during reward learning and increased motivation when probability of receiving a reward was low. Sensitivity to reward in the context of a motivation task was not altered in association with stress-induced IL-6. CONCLUSIONS Contrary to hypotheses, mild increases in IL-6 following acute stress were associated with increased reward responsiveness during reward learning and selective increases in motivation. Results contribute to an emerging and nuanced literature linking inflammation to reward processing, and demonstrate that behavioral effects of stress-induced inflammation may be detected in the laboratory setting. CLINICAL TRIAL REGISTRATION NCT03828604.
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Affiliation(s)
- Chloe C. Boyle
- Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Behavior, University of California, Los Angeles, CA 90095, United States,Corresponding author at: Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Behavior, Medical Plaza 300, University of California, Los Angeles, CA 90095, United States. (C.C. Boyle)
| | - Annette L. Stanton
- Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Behavior, University of California, Los Angeles, CA 90095, United States,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, United States,Department of Psychology, University of California, Los Angeles, CA 90095, United States
| | - Naomi I. Eisenberger
- Department of Psychology, University of California, Los Angeles, CA 90095, United States
| | - Teresa E. Seeman
- Geffen School of Medicine, University of California, Los Angeles, CA 90095, United States
| | - Julienne E. Bower
- Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Behavior, University of California, Los Angeles, CA 90095, United States,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, United States,Department of Psychology, University of California, Los Angeles, CA 90095, United States
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Williamson TJ, Jorge-Miller A, McCannel TA, Beran TM, Stanton AL. Sociodemographic, Medical, and Psychosocial Factors Associated With Supportive Care Needs in Adults Diagnosed With Uveal Melanoma. JAMA Ophthalmol 2019; 136:356-363. [PMID: 29470565 DOI: 10.1001/jamaophthalmol.2018.0019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Understanding supportive care needs in patients with cancer is important for developing approaches that enhance quality of life and promote satisfaction with care. Objective To characterize the nature and frequency of sociodemographic, medical, and psychosocial factors associated with unmet needs in patients with uveal melanoma 1 week and 3 months after diagnosis. Design, Setting, and Participants This 3-month, prospective, longitudinal survey study was conducted at a university-based ophthalmology practice from June 1, 2007, to July 1, 2011. Data were analyzed in April 2017. Consecutive patients (n = 429) scheduled for diagnostic evaluation for an intraocular abnormality were assessed for eligibility. Participants were ineligible (n = 25) if they were younger than 18 years, had previous advanced cancer, or evidenced cognitive impairment. Of the patients who provided informed consent (n = 306), those subsequently diagnosed with uveal melanoma by an ophthalmologist (n = 107) were included in the analysis. Main Outcomes and Measures Unmet needs (ie, desire for help in psychological, physical, health information, communication, or social domains) were assessed using the Cancer Needs Questionnaire. Multivariable regression analyses determined factors associated with unmet need severity across 3 months. Results One hundred seven patients (58 [54%] men; mean [SD] age, 59.0 [12.8] years) completed the baseline assessment. At 1 week after diagnosis, nearly all patients (85 of 86 [99%]) expressed at least 1 unmet need, as did 68 of 79 (86%) 3 months later. The most frequently endorsed needs were in the health information and psychological domains. Patients' unmet needs declined significantly over 3 months (mean [SD] change, -10.0 [14.4]; 95% CI, -6.4 to -13.6; t = -5.6). Sociodemographic and medical characteristics were unrelated to unmet need severity. However, higher prediagnosis instrumental social support (b = -0.2; 95% CI, -0.3 to -0.1; z = -2.8) and lower neuroticism (b = 0.3; 95% CI, 0.1-0.5; z = 2.9) predicted lower unmet need severity 1 week after diagnosis. Having a smaller social network predicted lower unmet need severity 3 months after diagnosis (b < 0.1; 95% CI, <0.1 to <0.1; z = 2.4) as well as a decline in needs from diagnosis to 3 months later (b < 0.1; 95% CI, <0.1 to <0.1; z = 2.3). Conclusions and Relevance Within 1 week after diagnosis and 3 months later, most patients with uveal melanoma cited important health information and psychological needs. These findings suggest that prior to or at diagnosis, the severity of such needs and psychosocial factors that may be associated can be identified for proactive supportive intervention.
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Affiliation(s)
| | - Alexandra Jorge-Miller
- Department of Psychology, University of California, Los Angeles.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Tara A McCannel
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| | - Tammy M Beran
- Department of Psychology, University of California, Los Angeles
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles.,Cousins Center of Psychoneuroimmunology, Semel Institute, University of California, Los Angeles
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Xie Z, Wenger N, Stanton AL, Sepucha K, Kaplan C, Madlensky L, Elashoff D, Trent J, Petruse A, Johansen L, Layton T, Naeim A. Risk estimation, anxiety, and breast cancer worry in women at risk for breast cancer: A single-arm trial of personalized risk communication. Psychooncology 2019; 28:2226-2232. [PMID: 31461546 DOI: 10.1002/pon.5211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/17/2019] [Accepted: 08/21/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Elevated anxiety and breast cancer worry can impede mammographic screening and early breast cancer detection. Genetic advances and risk models make personalized breast cancer risk assessment and communication feasible, but it is unknown whether such communication of risk affects anxiety and disease-specific worry. We studied the effect of a personalized breast cancer screening intervention on risk perception, anxiety, and breast cancer worry. METHODS Women with a normal mammogram but elevated risk for breast cancer (N = 122) enrolled in the Athena Breast Health risk communication program were surveyed before and after receiving a letter conveying their breast cancer risk and a breast health genetic counselor consultation. We compared breast cancer risk estimation, anxiety, and breast cancer worry before and after risk communication and evaluated the relationship of anxiety and breast cancer worry to risk estimation accuracy. RESULTS Women substantially overestimated their lifetime breast cancer risk, and risk communication somewhat mitigated this overestimation (49% pre-intervention, 42% post-intervention, 13% Gail model risk estimate, P < .001). Both general anxiety and breast cancer worry declined significantly after risk communication in women with high baseline anxiety. Baseline anxiety and breast cancer worry were essentially unrelated to risk estimation accuracy, but risk communication increased alignment of worry with accuracy of risk assessment. CONCLUSIONS Personalized communication about breast cancer risk was associated with modestly improved risk estimation accuracy in women with relatively low anxiety and less anxiety and breast cancer worry in women with higher anxiety. We detected no negative consequences of informing women about elevated breast cancer risk.
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Affiliation(s)
- Zhuoer Xie
- Department of Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Neil Wenger
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Celia Kaplan
- General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Lisa Madlensky
- Division of Medical Genetics, University of California, San Diego, San Diego, California
| | - David Elashoff
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Jacqueline Trent
- Department of Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Antonia Petruse
- Department of Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Liliana Johansen
- Department of Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Tracy Layton
- Department of Biomedical Informatics, University of California, San Diego, San Diego, California
| | - Arash Naeim
- UCLA Center for SMART Health, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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Pieters HC, Green E, Sleven M, Stanton AL. Aromatase inhibitors: The unexpected breast cancer treatment. J Geriatr Oncol 2019; 11:431-436. [PMID: 31471170 DOI: 10.1016/j.jgo.2019.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 06/10/2019] [Accepted: 07/30/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Suboptimal adherence with endocrine treatment for breast cancer is influenced by a number of factors but remains poorly understood. We sought to describe the prior knowledge about and expectations of breast cancer treatments among older women retrospecting on their diagnosis and treatment. METHODS Thematic analysis was used to systematically analyze data obtained with face-to-face, open-ended interviews conducted with 54 women who had filled at least one prescription for an aromatase inhibitor. The average age was 71.9 (65-93) years at diagnosis. RESULTS Three salient themes were described: the sources of information on which preknowledge and expectations surrounding treatment were founded, and two phases of treatment, primary (surgery, chemotherapy and radiation therapy) and anti-hormonal. The main source of information was from family and friends who had been treated for cancer. These peers reported both positive and negative experiences and in many cases contributed to the women having some degree of misinformation. A foundational knowledge of primary treatments was evident (necessity, duration, intensity, side-effects) and that receiving one or more treatments was needed. Compared to primary treatments, anti-hormonal treatment (AHT) was unexpected, the women knew less about it, and felt comparatively under-prepared for this treatment. CONCLUSIONS The transition from primary treatments to adjuvant AHT therapy with receiving a prescription for an aromatase inhibitor caught many participants off guard. Our findings elucidate areas to enhance clinical practice, expand the research agenda to more thoroughly explore AHT information and design of an age-appropriate supportive intervention to improve continuation with AHT.
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Affiliation(s)
- Huibrie C Pieters
- School of Nursing, University of California at Los Angeles, Los Angeles, CA, United States of America.
| | - Emily Green
- School of Nursing, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Miriam Sleven
- Torrance Memorial Medical Center, Torrance, CA, United States of America
| | - Annette L Stanton
- Departments of Psychology and Psychiatry & Biobehavioral Sciences, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, United States of America
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Bamishigbin ON, Dunkel Schetter C, Stanton AL. The antecedents and consequences of adolescent fatherhood: A systematic review. Soc Sci Med 2019; 232:106-119. [DOI: 10.1016/j.socscimed.2019.04.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 03/30/2019] [Accepted: 04/19/2019] [Indexed: 10/27/2022]
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Marroquín B, Nolen-Hoeksema S, Clark MS, Stanton AL. Social influences on cognitive processing in enacted social support: effects on receivers' cognitive appraisals, emotion, and affiliation. Anxiety Stress Coping 2019; 32:457-475. [PMID: 31125286 DOI: 10.1080/10615806.2019.1619702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background and objectives. Social support is linked with psychological health, but its mechanisms are unclear. We examined supporters' influence on recipients' cognitive processing as a mechanism of effects of support on outcomes associated with depression. Design/methods. 2 × 2 between-subjects experiment. 147 participants (1) experienced a negative event (false feedback); (2) received social support modeling one of two contrasting cognitive processing modes (abstract/evaluative or concrete/experiential); (3) generated explanations for the event, later coded for processing mode and internal/external causal attribution; and (4) reported on emotion, perceptions of self and future, and social affiliation. To examine relational effects, half of participants were led to perceive the supporter as similar to themselves via a shared birthday manipulation. Results. Support condition influenced participants' processing mode and causal attributions as predicted. Abstract/evaluative support led to more positive emotion and self-perceptions, and less pessimistic expectancies for the future than concrete/experiential support. Perceived similarity moderated effects on beliefs about an upcoming social interaction, magnifying positive affiliation outcomes of abstract/evaluative versus concrete/experiential support. Conclusions. Processing modes that are generally maladaptive at the intrapersonal level may be adaptive (and vice versa) when they are interpersonally influenced, and perceived similarity may facilitate interpersonal effects of processing mode on affiliation.
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Affiliation(s)
- Brett Marroquín
- a Department of Psychology , Loyola Marymount University , Los Angeles , CA , USA
| | | | - Margaret S Clark
- b Department of Psychology , Yale University , New Haven , CT , USA
| | - Annette L Stanton
- c Department of Psychology , University of California , Los Angeles , CA , USA
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Stinesen Kollberg K, Wiley JF, Ross KM, Jorge-Miller A, Hammen C, Weihs KL, Stanton AL. Chronic Stress in Vocational and Intimate Partner Domains as Predictors of Depressive Symptoms After Breast Cancer Diagnosis. Ann Behav Med 2019; 53:333-344. [PMID: 29931262 PMCID: PMC6594296 DOI: 10.1093/abm/kay045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND After cancer diagnosis, depressive symptoms are elevated on average and decline over time, but substantial variability is apparent. Few studies have examined to what extent chronic stress in distinct life domains affects depressive symptoms. PURPOSE Chronic stress in vocational and intimate partner life domains, and their interaction, were tested as predictors of depressive symptoms after breast cancer diagnosis. METHODS Women (N = 460) completed validated interviews regarding chronic stress in specific life domains shortly after diagnosis and a measure of depressive symptoms every 6 weeks for 6 months. RESULTS In latent growth curve modeling analyses, greater chronic stress in work (b = 2.90; p < .001) and intimate partner domains (b = 1.38, p = .02) was associated with higher depressive symptoms at study entry (intercept), and greater work stress predicted faster recovery from depressive symptoms over time (b = -0.10; p = .01). The two domains of chronic stress also interacted significantly on depressive symptoms at study entry (b = -1.54; p < .02) and over time (b = 0.14; p < .001). Greater work stress was associated with higher depressive symptoms at study entry regardless of intimate partner stress, but greater intimate partner stress was associated with higher depressive symptoms when work stress was low. The decline over 6 months in initially elevated depressive symptoms predicted by high work stress was significantly steeper when intimate partner stress was low. CONCLUSIONS Targeting interventions to recently diagnosed breast cancer patients living with chronically stressful vocational and intimate partner life circumstances could be worthwhile.
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Affiliation(s)
- Karin Stinesen Kollberg
- Department of Psychology, University of California, Los Angeles, Box, Los Angeles, CA, USA
- Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Joshua F Wiley
- School of Psychological Sciences, Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia
| | - Kharah M Ross
- Department of Psychology, University of California, Los Angeles, Box, Los Angeles, CA, USA
| | - Alexandra Jorge-Miller
- Department of Psychology, University of California, Los Angeles, Box, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Constance Hammen
- Department of Psychology, University of California, Los Angeles, Box, Los Angeles, CA, USA
| | - Karen L Weihs
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
- Cancer Prevention and Control Program, University of Arizona Comprehensive Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Box, Los Angeles, CA, USA
- Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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Weihs KL, McConnell MH, Wiley JF, Crespi CM, Sauer-Zavala S, Stanton AL. A preventive intervention to modify depression risk targets after breast cancer diagnosis: Design and single-arm pilot study. Psychooncology 2019; 28:880-887. [PMID: 30803095 DOI: 10.1002/pon.5037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/25/2019] [Accepted: 02/21/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Apply the National Institutes of Health (NIH) Stage Model to design and test an intervention to prevent depression in breast cancer patients at risk for depression. METHODS We identified mindful emotion awareness, along with approach and avoidance strategies for cancer-related coping and emotion regulation, as targets for a preventive intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Patients' preferences for individual, in-person, and time-efficient sessions informed the design. Patients at risk for depression received a 6-week, 5-hour intervention with daily exercises. Intervention targets were assessed at baseline, before each session, and 4-weeks post intervention. Mixed effects analysis of variance (ANOVA) assessed change over the follow-up period, controlling for age, partnered status, and disease stage. RESULTS Fifty-five percent (40/72) of women screened within 6 months of diagnosis had elevated depression risk. Of these, 24 (60%) signed consent. Sixteen received intervention after five were excluded for current depressive disorder, cognitive impairment, or death. Three dropped out. Ninety-eight percent attendance and 77% practice days indicated feasibility. Effect sizes (Cohen's d) corrected for regression to the mean (RTM) were 0.82 for cancer-related acceptance coping, 0.65 for cancer-related emotional expression, and 0.32 and 0.42 for decreased cancer-related avoidance coping and depressive symptoms, respectively. Effect sizes for variables lacking data to correct for RTM were 1.0, 0.7, and 0.5 for decreased rumination, experiential avoidance, and fear of depression, respectively, and 1.3, 0.6, and 0.4 for increased cognitive flexibility, distress tolerance, and describing/not judging emotions, respectively. CONCLUSIONS The feasibility of this intervention and malleability of its targets support its further investigation.
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Affiliation(s)
- Karen L Weihs
- Department of Psychiatry, University of Arizona, Tucson, Arizona
| | | | - Joshua F Wiley
- School of Psychological Sciences, Monash University, Melbourne, Victoria
| | - Catherine M Crespi
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California
| | - Shannon Sauer-Zavala
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
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Arch JJ, Stanton AL. Examining the "usual" in usual care: a critical review and recommendations for usual care conditions in psycho-oncology. Support Care Cancer 2019; 27:1591-1600. [PMID: 30788625 DOI: 10.1007/s00520-019-04677-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/28/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Within psycho-oncology clinical trials, usual care (UC) represents a common and important control condition. Yet recent shifts in oncology, coupled with insufficient description of such conditions, threaten to render UC increasingly difficult to define and interpret. This paper offers evidence of these shifts and recommendations for addressing them. METHODS The broader literature on usual care as a control condition in psychosocial/behavioral intervention trials was assessed, and usual care-controlled trials in psycho-oncology were selectively reviewed, toward to goal of conceptual synthesis. RESULTS We offer evidence that (1) UC control conditions are often insufficiently defined and assessed; and (2) the context of supportive care in oncology has shifted in a manner that contributes to this problem, with implications for interpreting and comparing findings across clinical trials. Three converging findings support these conclusions. First, the scientific literature increasingly documents the diversity in how "usual care" conditions are defined across psychosocial and behavioral trials, with important considerations for trial interpretation. Second, evidence suggests that the availability of psychosocial oncology care has increased over the past few decades. The increasing availability and variety of psychosocial care introduces potential confounds for UC conditions. Third, mental health care trends in the general population affect the supportive interventions available to oncology patients in UC conditions today versus in the past. CONCLUSIONS Shifts in psychosocial oncology and broader mental health care underscore the importance of carefully defining and assessing UC in psycho-oncology trials. Recommendations are offered for improving the design, evaluation, and interpretation of UC conditions, toward the ultimate goal of improving the quality of the evidence in psycho-oncology.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Muenzinger, Boulder, CO, 80309-0345, USA. .,Division of Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, 80045, USA.
| | - Annette L Stanton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, 90095, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, 90095, USA.,Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience, Los Angeles, CA, 90095, USA
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50
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Pieters HC, Green E, Khakshooy S, Sleven M, Stanton AL. A qualitative comparison of how older breast cancer survivors process treatment information regarding endocrine therapy. PLoS One 2019; 14:e0210972. [PMID: 30703119 PMCID: PMC6354984 DOI: 10.1371/journal.pone.0210972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 01/04/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND It remains unclear how information about aromatase inhibitors (AI) impacts women's decision-making about persistence with endocrine therapy. PURPOSE To describe and compare how women treated for primary early stage breast cancer either persisting or not persisting with an AI received, interpreted, and acted upon AI-related information. DESIGN Thematic analysis was used to sort and compare the data into the most salient themes. PARTICIPANTS Women (N = 54; 27 persisting, 27 not persisting with an AI) aged 65-93 years took part in qualitative interviews. RESULTS Women in both subgroups described information similarly in terms of its value, volume, type, and source. Aspects of AI-related information that either differed between the subgroups or were misunderstood by one or both subgroups included: (1) knowledge of AI or tamoxifen prior to cancer diagnosis, (2) use of online resources, (3) misconceptions about estrogen, hormone replacement therapies and AI-related symptoms, and (4) risk perception and the meaning and use of recurrence statistics such as Oncotype DX. CONCLUSIONS Persisters and nonpersisters were similar in their desire for more information about potential side effects and symptom management at AI prescription and subsequent appointments. Differences included how information was obtained and interpreted. Interactive discussion questions are shared that can incorporate these findings into clinical settings.
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Affiliation(s)
- Huibrie C Pieters
- School of Nursing, University of California at Los Angeles, Los Angeles, United States of America
| | - Emily Green
- School of Nursing, University of California at Los Angeles, Los Angeles, United States of America
| | - Sally Khakshooy
- Cedars Sinai Medical Center, Los Angeles, United States of America
| | - Miriam Sleven
- Torrance Memorial Medical Center, Torrance, California, United States of America
| | - Annette L Stanton
- Departments of Psychology and Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, United States of America
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