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Kwok G, Reese S, Dugad S, Donovan KA, Tsui J, Sahler OJZ, Levonyan-Radloff K, Barnett ME, Manne S, Ohman-Strickland P, Devine KA. Factors Associated with COVID‑19 Vaccine Uptake Among Adolescents and Young Adults Recently Diagnosed with Cancer. J Adolesc Young Adult Oncol 2024; 13:352-357. [PMID: 36367717 PMCID: PMC10998015 DOI: 10.1089/jayao.2022.0113] [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: 11/13/2022] Open
Abstract
Adolescents and young adults (AYAs) recently diagnosed with cancer are medically vulnerable but little is known about vaccine uptake/intent in this group. AYAs reported on their COVID-19 vaccine uptake/intent. Logistic regression models examined factors associated with vaccine uptake. Higher education (adjusted odds ratio [aOR] = 1.9, 95% confidence interval [CI]: 1.0-3.5) and knowing someone diagnosed with COVID-19 (aOR = 7.2, 95% CI: 1.6-33.5) were associated with increased vaccine uptake. Prior personal diagnosis of COVID-19 (aOR = 0.1, 95% CI: 0.1-0.7) was associated with lower odds of uptake. Targeted interventions may be needed to improve uptake among this group. (ClinicalTrials.gov Identifier: NCT04585269).
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Affiliation(s)
- Gary Kwok
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Samantha Reese
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Sanjana Dugad
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Olle Jane Z. Sahler
- Department of Pediatrics, Hematology and Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Marie E. Barnett
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sharon Manne
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Pamela Ohman-Strickland
- Department of Biostatistics and Epidemiology, Rutgers University School of Public Health, Piscataway, New Jersey, USA
| | - Katie A. Devine
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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2
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Reese S, Bono MH, Díaz DB, Donovan KA, Sahler OJZ, Barnett ME, Levonyan-Radloff K, Devine KA. Stop and Think: A Case Study Illustrating the Implementation of Bright IDEAS-YA Being Delivered via Telehealth to a Young Adult Cancer Patient. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10004-w. [PMID: 38491206 DOI: 10.1007/s10880-024-10004-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 03/18/2024]
Abstract
Bright IDEAS-Young Adults (Bright IDEAS-YA) is a problem-solving skills training intervention that has been adapted for young adults with cancer. Presently, a multisite randomized control trial is being conducted to determine Bright IDEAS-YA's efficacy in supporting a young adult population. This case study demonstrates the young adult adaptation of Bright IDEAS - Bright IDEAS-YA - being delivered to a young adult cancer patient via telehealth. Telehealth is a novel delivery method for Bright IDEAS and Bright IDEAS-YA that was established due to COVID-19 safety precautions. The patient, who reported challenges in several life domains, was taught how to apply the Bright IDEAS-YA framework over six telehealth sessions. After completing the Bright IDEAS-YA framework, the patient reported increased feelings of confidence in managing new stressors, which was corroborated through outcome measures delivered during and following intervention. This case illustrates how early psychosocial intervention following a cancer diagnosis, delivered via telehealth, can help patients develop and implement personal strategies to reduce stress levels.
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Affiliation(s)
- Samantha Reese
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
- , 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
| | - Madeline H Bono
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Diana B Díaz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kristine A Donovan
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Olle Jane Z Sahler
- Department of Pediatrics, Hematology and Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Marie E Barnett
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Katie A Devine
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Bouchard EG, Prince MA, McCarty C, Vincent PC, Patel H, LaValley SA, Collins RL, Sahler OJZ, Krenz T, Kelly KM. Understanding social network support, composition, and structure among cancer caregivers. Psychooncology 2023; 32:408-417. [PMID: 36588195 PMCID: PMC10520919 DOI: 10.1002/pon.6087] [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] [Received: 07/28/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We examined the social network support, composition, and structure of pediatric cancer caregivers. METHODS We used a self-report survey to collect egocentric social network data from 107 caregivers of pediatric cancer patients and calculated descriptive statistics to examine cancer-related support network composition, function, and structure. We then ran logistic regressions to examine the relationships between network characteristics and overall satisfaction with social support. RESULTS Family members were the most common source of emotional support and logistical support, and health care providers were the most common source of informational support. Participants perceived the "most helpful" forms of support as being: (1) emotional support from family and health care providers; (2) informational support from health care providers and other cancer caregivers; and (3) logistical support from family. Overall, caregivers wished that 9.8% of their network ties had provided more support, with family members being the most common alter type to disappoint caregivers and offer less support than needed/expected. Caregivers who reported higher network disappointment (having network members who offered less support than needed/expected) were significantly less satisfied with emotional support than those with lower network disappointment (Odds Ratio = 0.18, p = 0.02), and caregivers with higher network disappointment were significantly less satisfied with logistical support compared to those with lower network disappointment (Odds Ratio = 0.14, p = 0.01). CONCLUSION Our results show differences in the nature of social support provided by different types of network members. These findings have implications for tailoring social network interventions to improve caregiver and family outcomes.
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Affiliation(s)
- Elizabeth G. Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | | | | | - Paula C. Vincent
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | - Hital Patel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | - Susan A. LaValley
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | | | | | - Till Krenz
- UHealth Information Technology, Sylvester Comprehensive Cancer Center
| | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center
- Department of Pediatrics, University at Buffalo
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Voll M, Fairclough DL, Morrato EH, McNeal DM, Embry L, Pelletier W, Noll RB, Sahler OJZ. Dissemination of an evidence-based behavioral intervention to alleviate distress in caregivers of children recently diagnosed with cancer: Bright IDEAS. Pediatr Blood Cancer 2022; 69:e29904. [PMID: 35929012 PMCID: PMC9420785 DOI: 10.1002/pbc.29904] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Four multisite randomized clinical trials of > 1400 caregivers of children newly diagnosed with cancer showed that the Bright IDEAS (BI) paradigm of problem-solving skills training is an acceptable and efficacious approach to alleviating the high levels of distress they experience. To facilitate providing evidence-based caregiver support as recommended in the pediatric oncology standards of care, the project described here was designed to disseminate BI to 200 psychosocial professionals. PROCEDURE We partnered with the Children's Oncology Group (COG), Association of Pediatric Oncology Social Workers (APOSW), Association of Pediatric Hematology/Oncology Nurses (APHON), and special interest group in pediatric hematology/oncology of the Society for Pediatric Psychology (SPP). Membership surveys revealed substantial enthusiasm for training in BI. We structured training to include review of the evidence base for BI, role plays, and strategies for implementation at individual sites. Four conference calls designed to enhance implementation were held one, two, three, and five months after training. RESULTS Ten 1.5-day workshops were held in conjunction with annual meetings of COG, APOSW, APHON, and SPP. A total of 209 psychosocial clinicians from 134 sites were trained. Evaluations were highly favorable. Trainees had provided BI to 545 individuals as of the last conference call. CONCLUSIONS Initial dissemination goals were met. BI is now available at numerous pediatric oncology centers, but it has not become part of routine care. Future work focused on implementation might consider top-down approaches that include direct communication with pediatric oncologists and hospital leaders about the benefits of incorporating this evidence-based intervention systemically.
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Affiliation(s)
- Megan Voll
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, Pennsylvania
| | - Diane L. Fairclough
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus Aurora, Aurora, Colorado
| | - Elaine H. Morrato
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois
| | - Demetria M. McNeal
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Leanne Embry
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, Texas
| | - Wendy Pelletier
- Pediatric Hematology/Oncology/Transplant Program, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Robert B. Noll
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, Pennsylvania
| | - Olle Jane Z. Sahler
- University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Division of Pediatric Hematology/Oncology, Rochester, New York
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Bouchard EG, Collins RL, Vincent PC, Patel H, Sahler OJZ, McCarty C, Prince MA, Kelly KM. An initial investigation of using smartphone-enabled micro-temporal data collection to increase acceptability, feasibility, and validity of research on cancer caregiving. Pediatr Blood Cancer 2022; 69:e29886. [PMID: 35869890 PMCID: PMC10273258 DOI: 10.1002/pbc.29886] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Smartphone-enabled micro-temporal data collection has potential to increase reliability, validity, and feasibility of participant-reported data and is a promising strategy for pediatric oncology supportive care and quality-of-life research. Given the demands of pediatric cancer caregiving, we sought to understand the feasibility and acceptability of smartphone data collection that included short surveys administered daily for 14 days via text message link. METHODS We recruited pediatric cancer caregivers, whose children (ages 0-18 years) were on active treatment, to complete a 14-day daily survey study via smartphone. We implemented our study procedures and examined feasibility through study enrollment rates, reasons for refusal, retention rates, number of reminders and number of completed surveys. We examined acceptability using caregiver ratings of survey length, burden, and ease of completion on a smartphone. RESULTS We recruited (N = 75) caregivers to the study and had an 84% enrollment rate. Reasons for declining participation included passive refusal (n = 13) and too busy (n = 1). The participant retention rate was 100% and compliance with daily survey completion was 99%. Most surveys were completed following two prompts and took participants 5 minutes or less to complete. Caregivers rated the surveys as easy to complete, low burden, and just right in length. CONCLUSION A daily self-report, using a brief (≤5 minutes) survey administered on a smartphone via text message prompt, is a feasible and acceptable method. Future research should extend these findings to understand the generalizability across pediatric cancer caregiving contexts.
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Affiliation(s)
- Elizabeth G. Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | | | - Paula C. Vincent
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | - Hital Patel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | | | | | | | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Noyes K, Zapf AL, Depner RM, Flores T, Huston A, Rashid HH, McNeal D, Constine LS, Fleming FJ, Wilding GE, Sahler OJZ. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study. Cancer Treat Res Commun 2022; 31:100552. [PMID: 35358820 PMCID: PMC9106910 DOI: 10.1016/j.ctarc.2022.100552] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 05/13/2023]
Abstract
PURPOSE Cancer patients experience significant distress and burden of decision-making throughout treatment and beyond. These stressors can interfere with their ability to make reasoned and timely decisions about their care and lead to low physical and social functioning and poor survival. This pilot study examined the impact of offering Problem-Solving Skills Training (PSST) to adult cancer survivors to help them and their caregivers cope more successfully with post-treatment decision-making burden and distress. PATIENTS AND METHODS Fifty patients who completed their definitive treatment for colorectal, breast or prostate cancer within the last 6 months and reported distress (level > 2 on the National Comprehensive Cancer Network distress thermometer) were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions. Patients were invited to include a supportive other (n = 17). Patient and caregiver assessments at baseline (T1), end of intervention or 3 months (T2), and at 6 months (T3) focused on problem-solving skills, anxiety/depression, quality of life and healthcare utilization. We compared outcomes by study arm and interviewed participants about PSST burden and skill maintenance. RESULTS Trial participation rate was 60%; 76% of the participants successfully completed PSST training. PSST patients reported reduction in anxiety/depression, improvement in QoL (p < 0.05) and lower use of hospital and emergency department services compared to CAU patients (p = 0.04). CONCLUSIONS The evidence from this pilot study indicates that a remotely delivered PSST is a feasible and potentially effective strategy to improve mood and self-management in cancer survivors in community oncology settings.
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Affiliation(s)
- Katia Noyes
- University at Buffalo, Buffalo, NY, United States of America.
| | - Alaina L Zapf
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Rachel M Depner
- Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Tessa Flores
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
| | - Alissa Huston
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hani H Rashid
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Demetria McNeal
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Louis S Constine
- University of Rochester Medical Center, Rochester, NY, United States of America
| | - Fergal J Fleming
- University of Rochester Medical Center, Rochester, NY, United States of America
| | | | - Olle Jane Z Sahler
- University of Rochester Medical Center, Rochester, NY, United States of America
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7
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McNeal DM, Sahler OJZ, Noll RB, Fairclough DL, Voll ME, Bhat S, Morrato EH. Core functions and forms of Bright IDEAS: A multi-methods evaluation of the adoption of an evidence-based psychosocial training program through iterative adaptation. Front Health Serv 2022; 2:928580. [PMID: 36925829 PMCID: PMC10012676 DOI: 10.3389/frhs.2022.928580] [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] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Background Despite efforts to widely disseminate interventions designed to increase access to quality supportive care to pediatric cancer patients and their families, many of these interventions fail to meet expectations once deployed in real-life clinical settings. This study identifies the functions and forms of Bright IDEAS: Problem-Solving Skills Training, an evidence based psychosocial intervention for caregivers of children recently diagnosed with cancer, to identify pragmatic program adaptations in its real-world clinical implementation. We compare intervention adoption before and after adaptations to the Bright IDEAS training program as part of a national training program designed to disseminate the intervention. Methods 209 pediatric psychosocial oncology practitioners representing 134 unique institutions were trained during 10 in-person 8-hour workshops (2015-2019). Functions and forms of Bright IDEAS were identified, and adaptations made to the training agenda and curriculum based on practitioner feedback following implementation in local institutions. Mixed method evaluation included longitudinal surveys at 6- and 12-months post training; and qualitative interviews among a subgroup of practitioners (N = 47) to understand and compare perspectives on intervention adoption and barriers to implementation before and after adaptations to the Bright IDEAS training program. The RE-AIM framework was used to guide dissemination evaluation. Results A total of four adaptations were tailored to the identified forms of the intervention: case studies; pre-training reading materials; training videos; and letters of institutional support from primary supervisor. Pre- and post-training adaptations to the Bright IDEAS training program were mapped to RE-AIM constructs. Quantitative findings demonstrate that adaptations appeared to improve adoption and usage overall. Conclusion This study provides insight into how contextual factors influence psychosocial practitioners' capacity to adopt, implement, and maintain Bright IDEAS in the clinical setting. This study demonstrates the use of real-time stakeholder feedback to guide intervention translation from research to practice settings.
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Affiliation(s)
- Demetria M McNeal
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Olle Jane Z Sahler
- Division of Pediatric Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Golisano Children's Hospital, Rochester, NY, United States
| | - Robert B Noll
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Diane L Fairclough
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Megan E Voll
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shubha Bhat
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elaine H Morrato
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
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Winter MA, Greenlee J, Al Ghriwati N, Garr KN, Sahler OJZ, O’Connor TG. Children's appraisals of threat in pediatric cancer. SSM - Mental Health 2021; 1. [PMID: 35252903 PMCID: PMC8896501 DOI: 10.1016/j.ssmmh.2021.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Marcia A. Winter
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
- Corresponding author. Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284-2033. (M.A. Winter)
| | - Jessica Greenlee
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
| | - Nour Al Ghriwati
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
| | - Katlyn N. Garr
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA, 23284, USA
| | - Olle Jane Z. Sahler
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Thomas G. O’Connor
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, USA
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9
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Dolgin MJ, Devine KA, Tzur-Bitan D, Askins MA, Fairclough DL, Katz ER, Noll RB, Phipps S, Sahler OJZ. Responsivity to Problem-Solving Skills Training in Mothers of Children With Cancer. J Pediatr Psychol 2021; 46:413-421. [PMID: 33367833 DOI: 10.1093/jpepsy/jsaa117] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Bright IDEAS (BI) is a problem-solving skills training (PSST) program that has been demonstrated in earlier randomized controlled trials (RCTs) to be an effective and specific intervention for improving problem-solving skills and reducing negative affect in caregivers of children with cancer. The objectives of this study were to (a) offer an approach to defining meaningful treatment response and to determine the rates of responsivity to PSST; and (b) identify characteristics of PSST responders and nonresponders. METHODS Data from 154 mothers receiving the BI intervention were analyzed. Drawing on the literature on minimal clinically important differences, two criteria for determining responsivity were calculated for the primary outcome of problem-solving skills: (a) The reliable change index (RCI) based on group data, and; (b) The effect size (ES) of each participant's pre/postintervention change score as a function of the group's baseline SD. RESULTS Thirty-three percent of the sample met both responsivity criteria immediately posttreatment (39% at follow-up) and 38% (39% at follow-up) met neither. An additional 29% demonstrated a small or greater ES (≥ 0.2) but did not meet the RCI criteria, suggesting possible benefit. The single consistent predictor of responsivity was participants' pretreatment problem-solving skills, with lower skills at baseline predicting greater improvement (p < .001). CONCLUSIONS These findings highlight the need to go beyond group data in interpreting RCTs and to incorporate measures of meaningful treatment response. Our ability to predict and screen for meaningful treatment response is critical to more precise targeting, enhanced outcomes, and better resource allocation.
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Affiliation(s)
| | - Katie A Devine
- Cancer Control and Prevention Program, Rutgers Cancer Institute of New Jersey
| | | | | | - Diane L Fairclough
- Department of Biometrics and Informatics, Colorado School of Public Health
| | - Ernest R Katz
- Department of Pediatrics, Children's Hospital Los Angeles
| | - Robert B Noll
- Department of Child Development, School of Medicine, University of Pittsburgh
| | - Sean Phipps
- Department of Behavioral Medicine, St. Jude children's Research Hospital
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10
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Devine KA, Viola A, Levonyan-Radloff K, Mackowski N, Bozzini B, Chandler A, Xu B, Ohman-Strickland P, Mayans S, Farrar-Anton A, Sahler OJZ, Masterson M, Manne S, Arent S. Feasibility of FitSurvivor: A technology-enhanced group-based fitness intervention for adolescent and young adult survivors of childhood cancer. Pediatr Blood Cancer 2020; 67:e28530. [PMID: 32589339 PMCID: PMC7674223 DOI: 10.1002/pbc.28530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/05/2020] [Revised: 05/23/2020] [Accepted: 06/08/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study evaluated the feasibility of a technology-enhanced group-based fitness intervention for adolescent and young adult (AYA) survivors of childhood cancer. PROCEDURE AYA survivors ages 13-25 years were randomized to the intervention (eight in-person group sessions with mobile app and FitBit followed by 4 weeks of app and FitBit only) or waitlist control. Assessments were at 0, 2, 3, 6, and 9 months. Feasibility was evaluated by enrollment, retention, attendance, app engagement, and satisfaction. Secondary outcomes included physical activity, muscular strength/endurance, cardiorespiratory fitness, health-related quality of life, and fatigue. RESULTS A total of 354 survivors were mailed participation letters; 68 (19%) were screened, of which 56 were eligible and 49 enrolled (88% of those screened eligible, 14% of total potentially eligible). Forty-nine survivors (Mage = 18.5 years, 49% female) completed baseline assessments and were randomized (25 intervention, 24 waitlist). Thirty-seven (76%) completed the postintervention assessment and 32 (65%) completed the final assessment. On average, participants attended 5.7 of eight sessions (range 1-8). Overall intervention satisfaction was high (M = 4.3, SD = 0.58 on 1-5 scale). Satisfaction with the companion app was moderately high (M = 3.4, SD = 0.97). The intervention group demonstrated significantly greater improvement in lower body muscle strength compared to the waitlist postintervention, and small but not statistically significant changes in other secondary measures. CONCLUSIONS A group-based intervention with a mobile app and fitness tracker was acceptable but has limited reach due to geographical barriers and competing demands experienced by AYA survivors.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sherri Mayans
- Hackensack Meridian Health, Hackensack University Medical Center
| | | | | | | | | | - Shawn Arent
- Rutgers, The State University of New Jersey,University of South Carolina
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11
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Phipps S, Fairclough DL, Noll RB, Devine KA, Dolgin MJ, Schepers SA, Askins MA, Schneider NM, Ingman K, Voll M, Katz ER, McLaughlin J, Sahler OJZ. In-person vs. web-based administration of a problem-solving skills intervention for parents of children with cancer: Report of a randomized noninferiority trial. EClinicalMedicine 2020; 24:100428. [PMID: 32637901 PMCID: PMC7327899 DOI: 10.1016/j.eclinm.2020.100428] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/06/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Bright IDEAS (BI) problem-solving skills training is an evidence-based intervention designed to help parents manage the demands of caring for a child with cancer. However, the resource intensiveness of this in-person intervention has limited its widespread delivery. We conducted a multicenter, randomized trial with a noninferiority design to evaluate whether a web-based version of BI requiring fewer resources is noninferior to in-person administration. METHODS 621 caregivers of children with newly diagnosed cancer were randomly assigned to standard BI delivered face-to-face or a web-based version delivered via mobile device. The primary outcome was caregiver-reported problem-solving skills. The noninferiority margin was defined as 0.2 standard deviation units of the change from baseline to end of intervention. Secondary outcomes included caregiver-reported mood disturbance, depression, and posttraumatic stress symptoms. The study was registered with ClinicalTrials.gov Identifier: NCT01711944. FINDINGS The effect of the standard treatment was preserved; parents in the standard BI arm improved their problem-solving (effect size = 0.53, t = 8.88, p < .001). Parents in the web-based BI group also improved their problem-solving (effect size = 0.32, t = 5.32, p < .001). Although the web-based intervention preserved 60% of the standard treatment effect, the test of noninferiority was non-significant (effect size = -0.21, p = 0.55). Similarly, the web-based intervention preserved > 60% of the standard intervention effect on all secondary outcomes; however, tests of noninferiority were non-significant. INTERPRETATION Noninferiority of web-based BI relative to standard face-to-face administration was not established. Further development of the web-based BI is needed before it can be recommended as a stand-alone intervention. However, the documented benefits of the web-based intervention as well as the advantages of low resource utilization and ease of delivery suggest that further development of web-based BI is indicated, and that it may play a valuable role in alleviating distress in caregivers of children with serious or chronic illness. FUNDING National Institutes of Health (U.S.), R01 CA159013 (P.I. Sahler).
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Affiliation(s)
- Sean Phipps
- Department of Psychology, St. Jude children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, United States
- Corresponding author.
| | | | - Robert B. Noll
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Katie A. Devine
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | | | - Sasja A. Schepers
- Department of Psychology, St. Jude children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, United States
| | | | - Nicole M. Schneider
- Baylor College of Medicine/Texas Children's Hospital, Houston, TX, United States
| | - Kathleen Ingman
- Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Megan Voll
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Ernest R. Katz
- Children's Hospital Los Angeles, Los Angeles, CA, United States
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Dupuis LL, Tamura RN, Kelly KM, Krischer JP, Langevin AM, Chen L, Kolb EA, Ullrich NJ, Sahler OJZ, Hendershot E, Stratton A, Sung L, McLean TW. Risk factors for chemotherapy-induced nausea in pediatric patients receiving highly emetogenic chemotherapy. Pediatr Blood Cancer 2019; 66:e27584. [PMID: 30561134 DOI: 10.1002/pbc.27584] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/10/2018] [Revised: 11/12/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Little is known regarding risk factors for chemotherapy-induced nausea (CIN) in pediatric patients. PROCEDURE A secondary analysis was conducted of a previously published multicenter, prospective, randomized, single-blind, sham-controlled trial assessing the efficacy of acupressure in preventing CIN in pediatric patients receiving highly emetogenic chemotherapy. The primary outcome was nausea severity, self-reported using the Pediatric Nausea Assessment Tool. The relationships between acute and delayed nausea severity and patient- (sex, race, age, and cancer diagnosis) and treatment-related (chemotherapy, antiemetic prophylaxis, CIN, and vomiting control) factors were analyzed by a proportional odds generalized estimating equation approach. The acute phase started with administration of the first and continued for 24 hours after the last chemotherapy dose. The delayed phase started at the end of the acute phase and continued until the next chemotherapy block (maximum seven days). RESULTS In the acute and delayed phases, 165 and 144 patients provided data for analysis, respectively. Nonwhite race was significantly associated with higher acute phase nausea severity (OR, 1.7; 95% CI, 1.1-2.6). Poor CIN control in the acute phase (OR, 16; 95% CI, 4.0-64.6), diagnosis of a cancer other than a central nervous system (CNS) tumor (OR, 2.5; 95% CI, 1.2-5.3), and cisplatin administration (OR, 3.7; 95% CI, 2.1-6.0) were significantly associated with higher delayed phase nausea severity. CONCLUSION Acute phase CIN was associated with nonwhite race. Delayed phase CIN was associated with poor acute phase CIN control, diagnosis of non-CNS cancer, and receipt of cisplatin. These findings will inform future antiemetic trial design.
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Affiliation(s)
- L Lee Dupuis
- Department of Pharmacy and Research Institute, The Hospital of Sick Children, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Roy N Tamura
- Health Informatics Institute, University of South Florida, Tampa, Florida
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Cancer Institute and Division of Pediatric Hematology/Oncology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Jeffrey P Krischer
- Health Informatics Institute and College of Medicine, University of South Florida, Tampa, Florida
| | - Anne-Marie Langevin
- Division of Pediatric Hematology/Oncology, University of Texas Health Science Centre at San Antonio, San Antonio, Texas
| | - Lu Chen
- Department of Information Sciences, City of Hope, Duarte, California
| | - E Anders Kolb
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Nicole J Ullrich
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | - Olle Jane Z Sahler
- Pediatric Hematology/Oncology, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York
| | - Eleanor Hendershot
- Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Ann Stratton
- Department of Cancer and Blood Disorders, Akron Children's Hospital, Akron, Ohio
| | - Lillian Sung
- Department of Paediatrics, Division of Haematology/Oncology, The Hospital of Sick Children and Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Thomas W McLean
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Viola A, Taggi-Pinto A, Sahler OJZ, Alderfer MA, Devine KA. Problem-solving skills, parent-adolescent communication, dyadic functioning, and distress among adolescents with cancer. Pediatr Blood Cancer 2018; 65:e26951. [PMID: 29316232 PMCID: PMC5867217 DOI: 10.1002/pbc.26951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 06/27/2017] [Revised: 11/17/2017] [Accepted: 12/05/2017] [Indexed: 12/20/2022]
Abstract
Some adolescents with cancer report distress and unmet needs. Guided by the disability-stress-coping model, we evaluated associations among problem-solving skills, parent-adolescent cancer-related communication, parent-adolescent dyadic functioning, and distress in adolescents with cancer. Thirty-nine adolescent-parent dyads completed measures of these constructs. Adolescents were 14-20 years old on treatment or within 1 year of completing treatment. Better problem-solving skills were correlated with lower adolescent distress (r = -0.70, P < 0.001). Adolescent-reported cancer-related communication problems and dyadic functioning were not significantly related to adolescent distress (rs < 0.18). Future work should examine use of problem-solving interventions to decrease distress for adolescents with cancer.
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Affiliation(s)
- Adrienne Viola
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | - Melissa A. Alderfer
- Nemours Children’s Health System, Wilmington, Delaware,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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14
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Dupuis LL, Kelly KM, Krischer JP, Langevin AM, Tamura RN, Xu P, Chen L, Kolb EA, Ullrich NJ, Sahler OJZ, Hendershot E, Stratton A, Sung L, McLean TW. Acupressure bands do not improve chemotherapy-induced nausea control in pediatric patients receiving highly emetogenic chemotherapy: A single-blinded, randomized controlled trial. Cancer 2017; 124:1188-1196. [PMID: 29266260 DOI: 10.1002/cncr.31198] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 09/13/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chemotherapy-induced nausea and vomiting remain common, distressing side effects of chemotherapy. It has been reported that acupressure prevents chemotherapy-induced nausea in adults, but it has not been well studied in children. METHODS In this multicenter, prospective, randomized, single-blind, sham-controlled trial, the authors compared acute-phase nausea severity in patients ages 4 to 18 years who were receiving highly emetic chemotherapy using standard antiemetic agents combined with acupressure wrist bands, the most common type of acupressure, versus sham bands. Patients wore acupressure or sham bands continuously on each day of chemotherapy and for up to 7 days afterward. Chemotherapy-induced nausea severity in the delayed phase and chemotherapy-induced vomiting control in the acute and delayed phases also were compared. RESULTS Of the 187 patients randomized, 165 contributed nausea severity assessments during the acute phase. Acupressure bands did not reduce the severity of chemotherapy-induced nausea in the acute phase (odds ratio [OR], 1.33; 95% confidence limits, 0.89-2.00, in which an OR <1.00 favored acupressure) or in the delayed phase (OR, 1.23; 95% CL, 0.75-2.01). Furthermore, acupressure bands did not improve daily vomiting control during the acute phase (OR, 1.57; 95% CL, 0.95-2.59) or the delayed phase (OR, 0.84; 95% CL, 0.45-1.58). No serious adverse events were reported. CONCLUSIONS Acupressure bands were safe but did not improve chemotherapy-induced nausea or vomiting in pediatric patients who were receiving highly emetic chemotherapy. Cancer 2018;124:1188-96. © 2017 American Cancer Society.
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Affiliation(s)
- L Lee Dupuis
- Department of Pharmacy and Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Cancer Institute, Buffalo, New York.,Division of Pediatric Hematology/Oncology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Jeffrey P Krischer
- Health Informatics Institute, University of South Florida, Tampa, Florida.,College of Medicine, University of South Florida, Tampa, Florida
| | - Anne-Marie Langevin
- Division of Pediatric Hematology/Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Roy N Tamura
- Health Informatics Institute, University of South Florida, Tampa, Florida
| | - Ping Xu
- Health Informatics Institute, University of South Florida, Tampa, Florida
| | - Lu Chen
- Department of Information Sciences, City of Hope, Duarte, California
| | - E Anders Kolb
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Nicole J Ullrich
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Olle Jane Z Sahler
- Pediatric Hematology/Oncology, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York
| | - Eleanor Hendershot
- Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Ann Stratton
- Department of Cancer and Blood Disorders, Akron Children's Hospital, Akron, Ohio
| | - Lillian Sung
- Department of Pediatrics, Division of Hematology/Oncology and Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas W McLean
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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15
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Knight JM, Szabo A, Zhao S, Lyness JM, Sahler OJZ, Liesveld JL, Sander T, Rizzo JD, Hillard CJ, Moynihan JA. Circulating endocannabinoids during hematopoietic stem cell transplantation: A pilot study. Neurobiol Stress 2015; 2:44-50. [PMID: 26114153 PMCID: PMC4476410 DOI: 10.1016/j.ynstr.2015.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Indexed: 12/12/2022] Open
Abstract
Objective Hematopoietic stem cell transplantation (HCT) is a stressful and rigorous medical procedure involving significant emotional and immune challenges. The endocannabinoid (eCB) signaling system is involved in regulation of both the immune system and emotional reactivity, yet little is known about its function during HCT. We investigated the role of the eCB signaling system in a group of HCT recipients. Methods A total of 19 HCT recipients were enrolled and provided psychosocial data and blood samples at three peri-transplant time points: prior to transplant, hospital discharge, and approximately 100 days post-transplant. Psychosocial factors, inflammatory molecules, and the eCBs were determined and assessed for changes over this period and association with each other. Results HCT recipients demonstrated significant changes over the peri-transplant period in inflammatory molecules and psychosocial functioning, but not in circulating concentrations of the eCBs. Associations among these variables were most likely to be present pre-transplant and least likely to be present immediately post-transplant, with depressive symptoms and inflammation most significantly associated. The eCB 2-arachidonoylglycerol (2-AG) was significantly, positively associated with both interleukin (IL)-6 and C-reactive protein (CRP) and negatively associated with depressive symptoms. Conclusions The eCB signaling system may have alternative sources and regulatory mechanisms in addition to the immune system. Given the significant associations with inflammatory molecules and depressive symptoms in the peri-transplant period, it is important to better understand this system and its potential implications in the setting of complex and stressful medical procedures such as HCT.
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Affiliation(s)
- Jennifer M Knight
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin
| | - Shi Zhao
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin
| | - Jeffrey M Lyness
- Rochester Center for Mind-Body Research, Department of Psychiatry, University of Rochester Medical Center
| | - Olle Jane Z Sahler
- Division of Hematology/Oncology, Department of Pediatrics, University of Rochester Medical Center ; Medical Humanities, University of Rochester Medical Center
| | - Jane L Liesveld
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Tara Sander
- Pediatric Pathology, Medical College of Wisconsin
| | - J Douglas Rizzo
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin
| | - Cecilia J Hillard
- Neuroscience Research Center and Department of Pharmacology and Toxicology, Medical College of Wisconsin
| | - Jan A Moynihan
- Rochester Center for Mind-Body Research, Department of Psychiatry, University of Rochester Medical Center
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16
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Knight JM, Moynihan JA, Lyness JM, Xia Y, Tu X, Messing S, Hunter BC, Huang LS, Obi RO, Gaisser D, Liesveld JL, Sahler OJZ. Peri-transplant psychosocial factors and neutrophil recovery following hematopoietic stem cell transplantation. PLoS One 2014; 9:e99778. [PMID: 24915544 PMCID: PMC4051840 DOI: 10.1371/journal.pone.0099778] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 01/19/2014] [Accepted: 05/19/2014] [Indexed: 12/21/2022] Open
Abstract
Objective Multiple psychosocial factors appear to affect cancer progression in various populations; however, research investigating the relationship between psychosocial factors and outcomes following hematopoietic stem cell transplantation (HCT) is scarce. Subject to adverse immunological and psychological conditions, HCT patients may be especially vulnerable to psychosomatic health sequelae; therefore, we studied whether optimism and anxiety influence the pertinent clinical outcome of days to neutrophil engraftment (DTE). Method 54 adults undergoing either autologous or allogeneic HCT completed self-report questionnaires measuring optimism and anxiety. We assessed the association between these psychosocial variables and DTE. Results Greater optimism and less anxiety were associated with the favorable outcome of fewer DTE in autologous HCT recipients, though this relationship was no longer significant when reducing the sample size to only subjects who filled out their baseline survey by the time of engraftment. Conclusion Our findings are suggestive that optimism and anxiety may be associated with time to neutrophil recovery in autologous, but not allogeneic, adult HCT recipients. Further investigation in larger, more homogeneous subjects with consistent baseline sampling is warranted.
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Affiliation(s)
- Jennifer M. Knight
- University of Rochester Medical Center, Department of Psychiatry, the Rochester Center for Mind-Body Research, Rochester, New York, United States of America
- * E-mail:
| | - Jan A. Moynihan
- University of Rochester Medical Center, Department of Psychiatry, the Rochester Center for Mind-Body Research, Rochester, New York, United States of America
| | - Jeffrey M. Lyness
- University of Rochester Medical Center, Department of Psychiatry, the Rochester Center for Mind-Body Research, Rochester, New York, United States of America
| | - Yinglin Xia
- University of Rochester Medical Center, Department of Biostatistics and Computational Biology, Rochester, New York, United States of America
| | - Xin Tu
- University of Rochester Medical Center, Department of Biostatistics and Computational Biology, Rochester, New York, United States of America
| | - Susan Messing
- University of Rochester Medical Center, Department of Biostatistics and Computational Biology, Rochester, New York, United States of America
| | - Bryan C. Hunter
- Nazareth College, Department of Music Therapy, Rochester, New York, United States of America
| | - Li-Shan Huang
- University of Rochester Medical Center, Department of Biostatistics and Computational Biology, Rochester, New York, United States of America
| | - Rosemary O. Obi
- University of Rochester Medical Center, Department of Pediatrics, Division of Hematology/Oncology, Rochester, New York, United States of America
| | - D'Arcy Gaisser
- University of Rochester Medical Center, Department of Cardiology, Rochester, New York, United States of America
| | - Jane L. Liesveld
- University of Rochester Medical Center, Department of Medicine, Division of Hematology/Oncology, Rochester, New York, United States of America
| | - Olle Jane Z. Sahler
- University of Rochester Medical Center, Department of Pediatrics, Division of Hematology/Oncology, Rochester, New York, United States of America
- University of Rochester Medical Center, Department of Medicine, Division of Hematology/Oncology, Rochester, New York, United States of America
- University of Rochester Medical Center, Department of Psychiatry, Rochester, New York, United States of America
- University of Rochester Medical Center, Department of Medical Humanities, Rochester, New York, United States of America
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17
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Knight JM, Lyness JM, Sahler OJZ, Liesveld JL, Moynihan JA. Psychosocial factors and hematopoietic stem cell transplantation: potential biobehavioral pathways. Psychoneuroendocrinology 2013; 38:2383-93. [PMID: 23845514 PMCID: PMC3812389 DOI: 10.1016/j.psyneuen.2013.06.016] [Citation(s) in RCA: 36] [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: 12/06/2012] [Revised: 06/12/2013] [Accepted: 06/12/2013] [Indexed: 01/23/2023]
Abstract
While psychosocial factors are known to affect cancer progression via biobehavioral pathways in many patient populations, these relationships remain largely unexplored in hematopoietic stem cell transplant (HCT) patients. The purpose of this paper is to critically review the literature regarding psychosocial and endocrine/immune aspects of HCT, with an emphasis on exploring pathways that may mediate the associations between psychosocial factors and disease outcomes. These include the roles of catecholamines, glucocorticoids, inflammation, vascular endothelial growth factor (VEGF), immune reconstitution and infectious susceptibility, as well as the new opportunities available in genomics research. We also discuss the implications for potential immunomodulating psychosocial interventions. Elucidating the biological pathways that account for the associations between psychosocial factors and clinical course could ultimately lead to improved outcomes for this psychologically and immunologically vulnerable population.
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Affiliation(s)
- Jennifer M. Knight
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin
| | - Jeffrey M. Lyness
- Rochester Center for Mind-Body Research, Department of Psychiatry, University of Rochester Medical Center
| | - Olle Jane Z. Sahler
- Division of Hematology/Oncology, Department of Pediatrics, University of Rochester Medical Center,Medical Humanities
| | - Jane L. Liesveld
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Jan A. Moynihan
- Rochester Center for Mind-Body Research, Department of Psychiatry, University of Rochester Medical Center
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18
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Butler RW, Fairclough DL, Katz ER, Kazak AE, Noll RB, Thompson RD, Sahler OJZ. Intellectual functioning and multi-dimensional attentional processes in long-term survivors of a central nervous system related pediatric malignancy. Life Sci 2013; 93:611-6. [PMID: 23727455 DOI: 10.1016/j.lfs.2013.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 11/13/2012] [Revised: 05/02/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
AIMS Central nervous system (CNS) malignancies and/or their treatment in pediatric cancer survivors are known to be associated with deficits in neuropsychological functions. We report findings from a nation-wide study of childhood cancer survivors to investigate intelligence and attention/concentration from a multi-dimensional perspective in a diverse sample from this population. MAIN METHODS Four hundred forty-four pediatric cancer survivors between 6 and 17 years of age, who had suffered CNS involvement associated with their malignancy, were evaluated. All patients completed a measure of general intelligence. Attention was measured by a continuous performance test (CPT) and by parental report using a standardized psychological inventory. KEY FINDINGS Social economic status (SES) was a significant predictor of intellectual functioning and scores on independent measures of attention. After controlling for SES, cranial radiation therapy (CRT) was strongly predictive of impairments in intellectual functioning. Patients who had completed a transplant procedure did not have significant impairments in intellectual functioning when compared to other participants. CPT performance was most clearly influenced by a younger age at diagnosis and the presence of a supratentorial brain tumor. Reaction time was lower in patients who had received CRT. Gender did not correlate with CPT performance, but caregiver reports of deficits in attentional functioning were more prevalent in girls compared to boys. SIGNIFICANCE These findings are important given the large, representative sample and multi-dimensional assessment of attentional functioning. The presence of a very strong SES effect on all dependent variables must be addressed in studies of this nature.
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Affiliation(s)
- Robert W Butler
- Austin Hatcher Foundation for Pediatric Cancer, Chattanooga, TN, USA.
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Devine KA, Heckler CE, Katz ER, Fairclough DL, Phipps S, Sherman-Bien S, Dolgin MJ, Noll RB, Askins MA, Butler RW, Sahler OJZ. Evaluation of the psychometric properties of the Pediatric Parenting Stress Inventory (PPSI). Health Psychol 2013; 33:130-8. [PMID: 23544994 DOI: 10.1037/a0032306] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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 work evaluated the psychometric properties of the Pediatric Parenting Stress Inventory (PPSI), a new measure of problems and distress experienced by parents of children with chronic illnesses. METHOD This secondary data analysis used baseline data from 1 sample of English-, Spanish-, and Hebrew-speaking mothers of children recently diagnosed with cancer (n = 449) and 1 sample of English- and Spanish-speaking mothers of children recently diagnosed with cancer (n = 399) who participated in 2 problem-solving skills training interventions. The PPSI was administered at baseline with other measures of maternal distress. Factor structure was evaluated using exploratory factor analysis (EFA) on the first sample and confirmatory factor analysis (CFA) on both samples. Internal consistency was evaluated using Cronbach's alpha. Construct validity was assessed via Spearman correlations with measures of maternal distress. RESULTS EFA resulted in a stable four-factor solution with 35 items. CFA indicated that the four-factor solution demonstrated reasonable fit in both samples. Internal consistency of the subscales and full scale was adequate to excellent. Construct validity was supported by moderate to strong correlations with measures of maternal distress, depression, and posttraumatic stress symptoms. CONCLUSIONS The PPSI demonstrated good psychometric properties in assessing current problems and distress experienced by mothers of children newly diagnosed with cancer. This tool may be used to identify individualized targets for intervention in families of children with cancer. Future studies could evaluate the utility and psychometrics of the PPSI with other pediatric populations.
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Affiliation(s)
- Katie A Devine
- Department of Radiation Oncology, University of Rochester Medical Center
| | - Charles E Heckler
- Department of Radiation Oncology, University of Rochester Medical Center
| | - Ernest R Katz
- Children's Center for Cancer and Blood Diseases, Children's Hospital of Los Angeles
| | | | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital
| | | | | | - Robert B Noll
- Department of Pediatrics, Children's Hospital of Pittsburgh
| | - Martha A Askins
- Department of Pediatrics, The Children's Cancer Hospital at MD Anderson Cancer Center
| | | | - Olle Jane Z Sahler
- Division of Hematology/Oncology, Department of Pediatrics, University of Rochester Medical Center
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Sahler OJZ, Dolgin MJ, Phipps S, Fairclough DL, Askins MA, Katz ER, Noll RB, Butler RW. Specificity of problem-solving skills training in mothers of children newly diagnosed with cancer: results of a multisite randomized clinical trial. J Clin Oncol 2013; 31:1329-35. [PMID: 23358975 DOI: 10.1200/jco.2011.39.1870] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Diagnosis of cancer in a child can be extremely stressful for parents. Bright IDEAS, a problem-solving skills training (PSST) intervention, has been shown to decrease negative affectivity (anxiety, depression, post-traumatic stress symptoms) in mothers of newly diagnosed patients. This study was designed to determine the specificity of PSST by examining its direct and indirect (eg, social support) effects compared with a nondirective support (NDS) intervention. PATIENTS AND METHODS This randomized clinical trial included 309 English- or Spanish-speaking mothers of children diagnosed 2 to 16 weeks before recruitment. Participants completed assessments prerandomization (T1), immediately postintervention (T2), and at 3-month follow-up (T3). Both PSST and NDS consisted of eight weekly 1-hour individual sessions. Outcomes included measures of problem-solving skill and negative affectivity. RESULTS There were no significant between-group differences at baseline (T1). Except for level of problem-solving skill, which was directly taught in the PSST arm, outcome measures improved equally in both groups immediately postintervention (T2). However, at the 3-month follow-up (T3), mothers in the PSST group continued to show significant improvements in mood, anxiety, and post-traumatic stress; mothers in the NDS group showed no further significant gains. CONCLUSION PSST is an effective and specific intervention whose beneficial effects continue to grow after the intervention ends. In contrast, NDS is an effective intervention while it is being administered, but its benefits plateau when active support is removed. Therefore, teaching coping skills at diagnosis has the potential to facilitate family resilience over the entire course of treatment.
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Hunter BC, Oliva R, Sahler OJZ, Gaisser D, Salipante DM, Arezina CH. Music therapy as an adjunctive treatment in the management of stress for patients being weaned from mechanical ventilation. J Music Ther 2011; 47:198-219. [PMID: 21275332 DOI: 10.1093/jmt/47.3.198] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This project investigated music therapy (MT) in managing anxiety associated with weaning from mechanical ventilation. The use of sedation to treat anxiety during weaning is problematic because side effects (e.g., respiratory depression) are precisely the symptoms that cause the weaning process to be interrupted and consequently prolonged. Study goals were to determine the feasibility of incorporating MT into the weaning process and to evaluate the efficacy of the intervention, based on levels of anxiety, Days to Wean (DTW), and patient/nurse satisfaction. Adult patients received multiple MT sessions per week while undergoing weaning trials from mechanical ventilation. Feasibility was determined by successful enrollment in the study and nurse survey. Efficacy was evaluated through anxiety, as measured by heart rate, respiratory rate, and patient/nurse survey; DTW; and patient/nurse satisfaction. Nurse surveys reported that MT was successfully incorporated into the milieu and 61 subjects were enrolled. Significant differences in heart rate and respiratory rate were found from the beginning to the end of MT sessions (p < .05 and p < .0001, respectively), indicating a more relaxed state. No significant difference in mean DTW was found between study and control subjects. Patient/nurse satisfaction was high. Music therapy can be used successfully to treat anxiety associated with weaning from mechanical ventilation. Limitations and suggestions for further research are discussed.
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Abstract
Children's concept of death is influenced by experience, culture, and developmental stage. Dying children benefit from open communication about death, based on research findings and clinical experience (summarized in Hurwitz, 2004). Everyone in the family is affected by the loss of a loved one, even the youngest family members. Pediatricians can help families by listening and supporting them during the processes of loss and bereavement.
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Affiliation(s)
- Jennifer S Linebarger
- Division of Adolescent Medicine, Golisano Children's Hospital, the University of Rochester Medical Center, Rochester, NY, USA
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23
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Johns AL, Oland AA, Katz ER, Sahler OJZ, Askins MA, Butler RW, Dolgin MJ. Qualitative analysis of the role of culture in coping themes of Latina and European American mothers of children with cancer. J Pediatr Oncol Nurs 2009; 26:167-75. [PMID: 19398713 DOI: 10.1177/1043454209334416] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
It has been well established that mothers of children diagnosed with cancer experience high levels of distress. Latina mothers may be at risk for higher levels of distress related to language barriers, cultural factors, and economic, immigration, and acculturation stressors. Despite the increasing US Latino population, few studies have examined the role of culture within pediatric oncology, including how mothers cope with their child's cancer. This study used qualitative analysis of 24 sessions from 3 Latina and 3 European American mothers of children recently diagnosed with cancer. The session transcripts were divided into a total of 2328 thought segments that were then analyzed for themes using a collaborative iterative process. Analysis identified 9 shared coping themes that included, with some variations: gathering information, professional help-seeking, activities, problem solving, positive thinking, present orientation, reframing, avoidance, and religion. Three themes were culture specific: only European American mothers discussed compromise, whereas normalization and perspective taking were unique to the Latina mothers and suggest that the cultural value of simpatía influences coping. Clinical and research recommendations are discussed.
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Affiliation(s)
- Alexis L Johns
- University of Southern California University Center for Excellence in Developmental Disabilities Mental Health Center, CA, USA.
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24
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Butler RW, Sahler OJZ, Askins MA, Alderfer MA, Katz ER, Phipps S, Noll RB. Interventions to improve neuropsychological functioning in childhood cancer survivors. ACTA ACUST UNITED AC 2009; 14:251-8. [PMID: 18924157 DOI: 10.1002/ddrr.33] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A very brief historical review on the identification of neurocognitive deficits in patients treated for a pediatric malignancy that involved CNS disease, treatment, or a combination is provided. This review is particularly directed toward providing a foundation upon which the introduction of specific brain injury rehabilitation efforts and subsequent research were introduced into this population of patients. Three primary methods by which clinicians and researchers have attempted to improve neurocognitive functioning with survivors of pediatric cancer that have suffered a CNS insult are identified. From a pharmacological perspective, research is reviewed that documents the potential beneficial effects of stimulant medication. Results of two drug trials that used double-blind crossover methodology are reviewed, and it is highly likely that medications may be of significant benefit to pediatric cancer survivors who are experiencing attentional deficits, impairment in social functioning, and also declines in academic achievement. We next describe psychologically based brain injury rehabilitation efforts, including on-treatment schooling and reentry, within the survivor population. A phase III clinical trial of a comprehensive rehabilitation approach is discussed in detail. New directions in the area of brain injury rehabilitation for childhood cancer survivors are presented, and the need for professionals in this area to work toward a team approach is emphasized.
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Affiliation(s)
- Robert W Butler
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon 97239, USA.
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25
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Iobst EA, Alderfer MA, Sahler OJZ, Askins MA, Fairclough DL, Katz ER, Butler RW, Dolgin MJ, Noll RB. Problem solving and maternal distress at the time of a child's diagnosis of cancer in two-parent versus lone-parent households. J Pediatr Psychol 2009; 34:817-21. [PMID: 19129268 DOI: 10.1093/jpepsy/jsn140] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine negative affectivity and problem-solving abilities for lone mothers and those who are married/partnered subsequent to a child's diagnosis with cancer. METHODS Negative affectivity and problem-solving strategies were assessed for 464 mothers (87 lone and 377 married/partnered) within 2-16 weeks of their child's diagnosis with cancer. RESULTS The two groups of mothers did not differ significantly on measures of perceived posttraumatic stress or problem-solving; lone mothers reported significantly more symptoms of depression. This difference was no longer significant when maternal education was taken into account. CONCLUSIONS Negative affectivity and problem-solving abilities were similar for lone mothers and those that are married/partnered shortly after their child has been diagnosed with cancer. Findings are discussed within the context of contemporary strategies to assess marital status as proxy variable for various underlying constructs.
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Affiliation(s)
- Emily A Iobst
- Children's Hospital of Pittsburgh, Child Development Unit, Pittsburgh, PA 15213, USA
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26
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Askins MA, Sahler OJZ, Sherman SA, Fairclough DL, Butler RW, Katz ER, Dolgin MJ, Varni JW, Noll RB, Phipps S. Report from a multi-institutional randomized clinical trial examining computer-assisted problem-solving skills training for English- and Spanish-speaking mothers of children with newly diagnosed cancer. J Pediatr Psychol 2008; 34:551-63. [PMID: 19091804 DOI: 10.1093/jpepsy/jsn124] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility and efficacy of a handheld personal digital assistant (PDA)-based supplement for maternal Problem-Solving Skills Training (PSST) and to explore Spanish-speaking mothers' experiences with it. METHODS Mothers (n = 197) of children with newly diagnosed cancer were randomized to traditional PSST or PSST + PDA 8-week programs. Participants completed the Social Problem-Solving Inventory-Revised, Beck Depression Inventory-II, Profile of Mood States, and Impact of Event Scale-Revised pre-, post-treatment, and 3 months after completion of the intervention. Mothers also rated optimism, logic, and confidence in the intervention and technology. RESULTS Both groups demonstrated significant positive change over time on all psychosocial measures. No between-group differences emerged. Despite technological "glitches," mothers expressed moderately high optimism, appreciation for logic, and confidence in both interventions and rated the PDA-based program favorably. Technology appealed to all Spanish-speaking mothers, with younger mothers showing greater proficiency. CONCLUSIONS Well-designed, supported technology holds promise for enhancing psychological interventions.
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Affiliation(s)
- Martha A Askins
- Department of Pediatrics, Unit 87, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA.
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27
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Butler RW, Copeland DR, Fairclough DL, Mulhern RK, Katz ER, Kazak AE, Noll RB, Patel SK, Sahler OJZ. A multicenter, randomized clinical trial of a cognitive remediation program for childhood survivors of a pediatric malignancy. J Consult Clin Psychol 2008; 76:367-78. [PMID: 18540731 DOI: 10.1037/0022-006x.76.3.367] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.7] [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
Survivors of childhood cancer whose malignancy and/or treatment involved the central nervous system may demonstrate a consistent pattern of neurocognitive deficits. The present study evaluated a randomized clinical trial of the Cognitive Remediation Program (CRP). Participants were 6- to 17-year-old survivors of childhood cancer (N = 161; 35% female, 18% Hispanic, 10% African American, 64% Caucasian, 8% other) who were at least 1 year off treatment and who manifested an attentional deficit. They were enrolled at 7 sites nationwide. Two thirds of the participants were randomly assigned to cognitive remediation. All participants were assessed using a battery of academic achievement/neurocognitive tests and parent/teacher measures of attention. The CRP resulted in parent report of improved attention and statistically significant increases in academic achievement. Effect sizes were modest but were comparable with those for other clinical trials of brain injury rehabilitation and for psychological interventions in general. The CRP is presented as a potentially beneficial treatment for many survivors of pediatric cancer. Long-term clinical significance remains unproven. Further work is needed to improve effect sizes and treatment compliance and to address the needs of other populations with pediatric brain injury.
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Affiliation(s)
- Robert W Butler
- Department of Pediatric Hematology/Oncology, Oregon Health & Science University, Portland, OR 97239, USA.
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28
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Dolgin MJ, Phipps S, Fairclough DL, Sahler OJZ, Askins M, Noll RB, Butler RW, Varni JW, Katz ER. Trajectories of Adjustment in Mothers of Children with Newly Diagnosed Cancer: A Natural History Investigation. J Pediatr Psychol 2007; 32:771-82. [PMID: 17403910 DOI: 10.1093/jpepsy/jsm013] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [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: 11/12/2022] Open
Abstract
OBJECTIVES The objectives of this study were (a) to assess negative affectivity and posttraumatic symptomatology in mothers following the diagnosis of cancer in their children; (b) to examine sociodemographic and psychosocial variables associated with change in distress over time; and (c) to identify distinct subgroups of mothers whose patterns and trajectories of adjustment can be distinguished according to available predictor data. METHODS Two hundred and twelve mothers at seven sites were assessed just following their child's diagnosis, and again 3 months and 6 months later. Primary outcomes included measures of mood disturbance, depressive symptoms, and symptoms of posttraumatic stress. RESULTS Overall, mothers demonstrated a pattern of mildly elevated negative affectivity and posttraumatic symptomatology initially, with steady improvements evident at 3- and 6-month follow-up. Distinct adjustment trajectories were evident within the sample as a whole, indicating subgroups of mothers with high-declining, moderate-stable, and low-stable distress levels. CONCLUSIONS These findings highlight considerable resilience among mothers facing the stress of childhood cancer. Intervention efforts aimed at reducing maternal distress might best be targeted towards the subgroup of mothers who may be predicted to exhibit the highest level of distress.
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Affiliation(s)
- Bryan C Hunter
- Music Therapy, Nazareth College, 4245 East Avenue, Rochester, New York 14618, USA
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30
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Sahler OJZ, Fairclough DL, Phipps S, Mulhern RK, Dolgin MJ, Noll RB, Katz ER, Varni JW, Copeland DR, Butler RW. Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: report of a multisite randomized trial. J Consult Clin Psychol 2005; 73:272-83. [PMID: 15796635 DOI: 10.1037/0022-006x.73.2.272] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.1] [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
Mothers of children with cancer experience significant distress associated with their children's diagnosis and treatment. The efficacy of problem-solving skills training (PSST), a cognitive-behavioral intervention based on problem-solving therapy, was assessed among 430 English- and Spanish-speaking mothers of recently diagnosed patients. Participants were randomized to usual psychosocial care (UPC; n=213) or UPC plus 8 sessions of PSST (PSST; n=217). Compared with UPC mothers, PSST mothers reported significantly enhanced problem-solving skills and significantly decreased negative affectivity. Although effects were largest immediately after PSST, several differences in problem-solving skills and distress levels persisted to the 3-month follow-up. In general, efficacy for Spanish-speaking mothers exceeded that for English-speaking mothers. Findings also suggest young, single mothers profit most from PSST.
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Affiliation(s)
- Olle Jane Z Sahler
- Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY 14642, USA.
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31
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Sahler OJZ, Hunter BC, Liesveld JL. The effect of using music therapy with relaxation imagery in the management of patients undergoing bone marrow transplantation: a pilot feasibility study. Altern Ther Health Med 2003; 9:70-4. [PMID: 14618861] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
CONTEXT Bone marrow/stem cell transplantation is becoming an increasingly common treatment for a variety of hematologic disorders. The treatment process is not benign. Both physiologic and psychological regimen-related side effects are common, painful, and even life threatening. Music therapy is the prescribed use of music to aid in the prevention or amelioration of physical, psychological, or cognitive problems. Relaxation imagery, as used in this study, consisted of simple visualization and direct imagery-based suggestions. The mechanism of action of the intervention is hypothesized to be reduction of the stress response through neuroendocrine pathways. OBJECTIVE To determine the feasibility of providing a combined music therapy and relaxation imagery intervention to patients on a bone marrow transplant (BMT) unit and to examine the effects on the frequency and intensity of pain and nausea, the two most common side effects associated with transplantation. DESIGN Case controlled study. SETTING University hospital-based bone marrow transplant unit serving patients of all ages. PARTICIPANTS Transplant recipients aged 4 years or older. INTERVENTION 45-minute music-assisted relaxation and relaxation imagery sessions provided twice a week by a trained music therapist from date of enrollment into the study to discharge. MAIN OUTCOME MEASURES Pre/post music/relaxation imagery intervention measures of pain and nausea using a visual analog scale; determination of time-to-engraftment.
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32
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Sahler OJZ, Varni JW, Fairclough DL, Butler RW, Noll RB, Dolgin MJ, Phipps S, Copeland DR, Katz ER, Mulhern RK. Problem-solving skills training for mothers of children with newly diagnosed cancer: a randomized trial. J Dev Behav Pediatr 2002; 23:77-86. [PMID: 11943969 DOI: 10.1097/00004703-200204000-00003] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mothers of children with serious illnesses have lower levels of well-being than mothers in the general population. Problem-solving therapy (PST), a cognitive-behavioral intervention, has been shown to be effective in treating negative affectivity (depression, anxiety) and other manifestations of reduced well-being. This report describes a problem-solving skills training (PSST) intervention, based on problem-solving therapy, for mothers of newly diagnosed pediatric cancer patients. Ninety-two mothers were randomly assigned to receive PSST or to receive standard psychosocial care (Control Group). After the 8-week intervention, mothers in the PSST Group had significantly enhanced problem-solving skills and significantly decreased negative affectivity compared with controls. Analysis revealed that changes in self-reports of problem-solving behaviors accounted for 40% of the difference in mood scores between the two groups. Interestingly, PSST had the greatest impact on improving constructive problem solving, whereas improvement in mood was most influenced by decreases in dysfunctional problem solving. The implications of these findings for refinement of the PSST intervention and for extension to other groups of children with serious illnesses are discussed.
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Affiliation(s)
- Olle Jane Z Sahler
- Division of Hematology/Oncology, Strong Children's Hospital/University of Rochester Medical Center, New York 14642, USA.
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