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Hou SHJ, Petrella A, Tulk J, Wurz A, Sabiston CM, Bender J, D’Agostino N, Chalifour K, Eaton G, Garland SN, Schulte FSM. An Evaluation of Racial and Ethnic Representation in Research Conducted with Young Adults Diagnosed with Cancer: Challenges and Considerations for Building More Equitable and Inclusive Research Practices. Curr Oncol 2024; 31:2244-2259. [PMID: 38668069 PMCID: PMC11048902 DOI: 10.3390/curroncol31040166] [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: 03/13/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
The psychosocial outcomes of adolescents and young adults (AYAs) diagnosed with cancer are poorer compared to their peers without cancer. However, AYAs with cancer from diverse racial and ethnic groups have been under-represented in research, which contributes to an incomplete understanding of the psychosocial outcomes of all AYAs with cancer. This paper evaluated the racial and ethnic representation in research on AYAs diagnosed with cancer using observational, cross-sectional data from the large Young Adults with Cancer in Their Prime (YACPRIME) study. The purpose was to better understand the psychosocial outcomes for those from diverse racial and ethnic groups. A total of 622 participants with a mean age of 34.15 years completed an online survey, including measures of post-traumatic growth, quality of life, psychological distress, and social support. Of this sample, 2% (n = 13) of the participants self-identified as Indigenous, 3% (n = 21) as Asian, 3% (n = 20) as "other," 4% (n = 25) as multi-racial, and 87% (n = 543) as White. A one-way ANOVA indicated a statistically significant difference between racial and ethnic groups in relation to spiritual change, a subscale of post-traumatic growth, F(4,548) = 6.02, p < 0.001. Post hoc analyses showed that those under the "other" category endorsed greater levels of spiritual change than those who identified as multi-racial (p < 0.001, 95% CI = [2.49,7.09]) and those who identified as White (p < 0.001, 95% CI = [1.60,5.04]). Similarly, participants that identified as Indigenous endorsed greater levels of spiritual change than those that identified as White (p = 0.03, 95% CI = [1.16,4.08]) and those that identified as multi-racial (p = 0.005, 95% CI = [1.10,6.07]). We provided an extensive discussion on the challenges and limitations of interpreting these findings, given the unequal and small sample sizes across groups. We concluded by outlining key recommendations for researchers to move towards greater equity, inclusivity, and culturally responsiveness in future work.
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Affiliation(s)
- Sharon H. J. Hou
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3V4, Canada
| | - Anika Petrella
- Cancer Clinical Trials Unit, University College Hospital, London NW1 2BU, UK
| | - Joshua Tulk
- Department of Psychology, Faculty of Science, Memorial University, St. John’s, NL A1C 5S7, Canada
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, BC V2S 7M7, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Catherine M. Sabiston
- Department of Exercise Sciences, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada
| | - Jackie Bender
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canadanorma.d’
| | - Norma D’Agostino
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canadanorma.d’
| | | | - Geoff Eaton
- Young Adult Cancer Canada, St. John’s, NL A1A 5B5, Canada
| | - Sheila N. Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John’s, NL A1C 5S7, Canada
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John’s, NL A1B 3V6, Canada
| | - Fiona S. M. Schulte
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
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Lee RM, Rash JA, Seal M, McCarthy J, Garland SN. Early change in fatigue, insomnia, and cognitive impairment and symptom severity 3 years post-treatment in breast cancer survivors. Support Care Cancer 2024; 32:232. [PMID: 38499790 DOI: 10.1007/s00520-024-08418-1] [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: 11/08/2023] [Accepted: 03/01/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Breast cancer is the most common form of cancer among Canadian women. Survivorship challenges include fatigue, sleep disturbance, and cognitive impairment. This study examined (1) symptom trajectory from diagnosis to 3 years; (2) whether symptom change in the first 4 months was associated with prolonged difficulties after 3 years; and (3) which factors were associated with deterioration in symptoms during the first 4 months. METHODS This prospective observational cohort study examined 53 women (Mage = 58.6, 96.2% White, 67.9% stage I) with newly diagnosed breast cancer over 3 years. Women completed assessments before starting treatment, 4 months, and 3 years after diagnosis. Three-way repeated-measures ANOVAs evaluated symptom trajectories. A repeated-measures mediation analysis was performed to determine if change from pre-treatment to 4 months accounted for change from pre-treatment to 3 years. A series of between-subjects ANOVAs were used to determine what variables significantly differed by deterioration status. RESULTS Perceived cognitive impairment and fatigue increased linearly from diagnosis to 3 years. Change in fatigue in the first 4 months fully accounted for its change over 3 years. Insomnia severity and sleep quality deteriorated from diagnosis to 4 months, but returned to pre-treatment levels at 3 years. Those whose fatigue and cognitive ability deteriorated during the first 4 months were younger. CONCLUSION Efforts to identify those who are at risk of experiencing fatigue, sleep disturbance, and cognitive impairment; monitor patients early after receiving a diagnosis; and provide targeted interventions may prevent long-term deterioration and improve well-being.
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Affiliation(s)
- Rachel M Lee
- Department of Psychology, Faculty of Science, Memorial University, 230 Elizabeth Avenue, St. John's, NL, A1C 5S7, Canada
- Beatrice Hunter Cancer Research Institute, Suite 2L-A2, Tupper Link, 5850 College Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Joshua A Rash
- Department of Psychology, Faculty of Science, Memorial University, 230 Elizabeth Avenue, St. John's, NL, A1C 5S7, Canada
| | - Melanie Seal
- Discipline of Oncology, Faculty of Medicine, Memorial University, 230 Elizabeth Avenue, St. John's, NL, A1C 5S7, Canada
| | | | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, 230 Elizabeth Avenue, St. John's, NL, A1C 5S7, Canada.
- Beatrice Hunter Cancer Research Institute, Suite 2L-A2, Tupper Link, 5850 College Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
- Discipline of Oncology, Faculty of Medicine, Memorial University, 230 Elizabeth Avenue, St. John's, NL, A1C 5S7, Canada.
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Mah A, D'Agostino N, Santiago AT, Garland SN, Petrella A, Sabiston CM, Chalifour K, Eaton G, Bender JL. Connectedness to the young adult cancer community and post-traumatic growth: A young adults with cancer in their prime study. Psychooncology 2024; 33:e6325. [PMID: 38502044 DOI: 10.1002/pon.6325] [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: 10/11/2023] [Revised: 02/05/2024] [Accepted: 03/03/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE For young adults (YAs) with cancer, connecting with peer cancer survivors can provide a unique sense of community and may enhance post-traumatic growth (PTG). This study examined the relationship between connectedness to the YA cancer community and PTG among YAs, independent of overall social support. METHODS Data were obtained from the young adults with cancer in their prime study, a cross-Canada survey of YA cancer survivors. Participants were stratified by level of social support into two groups (low/high). Multivariable logistic regression was used to examine the association between PTG and connectedness to the YA community adjusting for respondent characteristics, and the interaction between support and connectedness. RESULTS Of 444 respondents, mean age was 34.2 (SD = 6.0), time-since-diagnosis was 4.8 years (SD = 5.4), and 87% were female. Over two-thirds of respondents (71%) reported feeling connected to the YA community. Level of connectedness to the YA community did not differ by social support group, and interaction between social support and connectedness to the YA community was not significant. In the adjusted regression, connectedness to the YA community (aOR = 2.29, 95% CI: 1.10-4.91), high social support (aOR = 2.98, 95% CI: 1.36-6.74), greater time-since-diagnosis (aOR = 1.09, 95% CI: 1.04-1.15) and female sex (aOR = 2.21, 95% CI: 1.23-4.04) were associated with greater odds of moderate-to-high PTG. CONCLUSIONS Feeling connected to a community of YA cancer peers was associated with moderate-to-high PTG among YAs, independent of overall perceived social support. Future efforts should increase access to YA cancer communities and foster a sense of connectedness among YAs with cancer.
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Affiliation(s)
- Ashley Mah
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Norma D'Agostino
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Anna T Santiago
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Anika Petrella
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Catherine M Sabiston
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Karine Chalifour
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Jacqueline L Bender
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Duthie CJ, Cameron C, Smith-Han K, Beckert L, Delpachitra S, Garland SN, Sparks B, Wibowo E. Reasons for why Medical Students Prefer Specific Sleep Management Strategies. Behav Sleep Med 2024:1-14. [PMID: 38369858 DOI: 10.1080/15402002.2024.2318261] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Insomnia symptoms are common among medical students. This study explored the perspectives of medical students about which sleep management strategies to use. METHODS Medical students responded to an online survey on their thoughts about the use of various sleep management strategies. RESULTS Of the 828 respondents, 568 (69%) provided responses to questions about the most preferred strategies and 450 (54%) provided responses about their least preferred strategies. About 48.5% felt their insomnia symptoms were too mild to see a clinician and 23.9% did not think their symptoms warranted sleep medication. Over 40% of students could not avoid work before sleep, have consistent sleep/wake times, or engage in regular exercise because of their busy and inconsistent schedules. Approximately 40-60% could not improve their sleep environment (e.g. better heating and bed) because of the associated costs. Over 80% reported an inability to change their pre-sleep habits (e.g. using electronics close to bedtime, using bed for activities other than sleep or sex). Half of the students disliked relaxation techniques or felt they would not help. Around 30-50% did not believe that changing caffeine and/or alcohol intake would affect their sleep. CONCLUSIONS Medical students may benefit from additional sleep education. Clinicians may need to discuss which strategies individual students prefer and modify their recommendations accordingly.
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Affiliation(s)
- Cassian J Duthie
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Claire Cameron
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Kelby Smith-Han
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Health Professions Education, University of Western Australia, Perth, Australia
| | - Lutz Beckert
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Sheila N Garland
- Department of Psychology and Discipline of Oncology, Memorial University, Newfoundland, Canada
| | - Bryn Sparks
- Sleep Well Clinic, Christchurch, New Zealand
| | - Erik Wibowo
- Department of Anatomy, University of Otago, Dunedin, New Zealand
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Garland SN, Tulk J, Rodriguez N, Rash JA, Fawcett JM, McCarthy J, Seal M, Laing K. Perceived Executive Functioning Deficits After Diagnosis in Women with Non-Metastatic Breast Cancer Prior to Adjuvant Therapies. Int J Behav Med 2024; 31:31-40. [PMID: 36720774 DOI: 10.1007/s12529-023-10153-6] [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] [Accepted: 01/09/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Perceived deficits in executive functioning are among the many difficulties that women diagnosed with breast cancer experience. This study assessed the presence of perceived deficits in executive functioning among women with breast cancer prior to systemic treatment and radiation and associations between perceived deficits in executive function and comorbid fatigue, sleep, and mood disturbance. METHOD Participants were recruited following their breast cancer diagnosis and assessed using the Behavior Rating Inventory of Executive Function for Adults (BRIEF-A), subjective and objective measures of sleep duration and efficiency, and self-report measures of insomnia severity, sleep quality, fatigue, and mood disturbance. Hierarchical regression was used to examine associations between symptoms, adjusting for age and education. RESULTS The final sample included 92 women with a mean age of 60.7 years and 13.5 years of education. Thirteen percent of participants reported global executive dysfunction. After partitioning out variability from other independent variables, fatigue (p = < .001), perceived sleep quality (p = .030), and symptoms of insomnia (p = .008) accounted for 13.3%, 5.7%, and 8.5% of unique variance in perceived executive functioning, respectively. Emotional fatigue was most strongly associated with perceived deficits in executive functioning. Neither subjective or objective sleep duration or efficiency was associated with perceived deficits in executive functioning. CONCLUSION Fatigue, particularly emotional fatigue, insomnia, and poor sleep quality had the strongest associations with perceived deficits in executive functioning. Sleep interventions and fatigue management strategies may prove useful for women who seek to improve their perceived executive functioning.
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Affiliation(s)
- Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland and Labrador, A1B 3X9, Canada.
- Discipline of Oncology, Faculty of Medicine, Memorial University , St. John's, Newfoundland and Labrador, Canada.
- Beatrice Hunter Cancer Research Institute, Halifax, Nova Scotia, Canada.
| | - Joshua Tulk
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland and Labrador, A1B 3X9, Canada
| | - Nicole Rodriguez
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland and Labrador, A1B 3X9, Canada
| | - Joshua A Rash
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland and Labrador, A1B 3X9, Canada
| | - Jonathan M Fawcett
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland and Labrador, A1B 3X9, Canada
| | - Joy McCarthy
- Discipline of Oncology, Faculty of Medicine, Memorial University , St. John's, Newfoundland and Labrador, Canada
| | - Melanie Seal
- Discipline of Oncology, Faculty of Medicine, Memorial University , St. John's, Newfoundland and Labrador, Canada
| | - Kara Laing
- Discipline of Oncology, Faculty of Medicine, Memorial University , St. John's, Newfoundland and Labrador, Canada
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Wurz A, Petrella A, Tulk J, Sabiston CM, Schulte F, Bender J, D’Agostino N, Hou SHJ, Eaton G, Chalifour K, Garland SN. Describing and Exploring Coping Strategies among Those Diagnosed with Cancer as an Adolescent or Young Adult: A YACPRIME Study. Curr Oncol 2024; 31:685-692. [PMID: 38392044 PMCID: PMC10888435 DOI: 10.3390/curroncol31020050] [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: 11/21/2023] [Revised: 01/09/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
A greater understanding of how young people cope with a cancer diagnosis is needed in order to inform age-appropriate supportive care. This paper describes the coping strategies used and explores relationships between coping strategies and personal, medical, and psychological variables among young adults (YAs) diagnosed with cancer. YAs (n = 547, mean age = 34.05 ± 6.00 years) completed an online survey, including the Brief COPE and measures of psychological functioning. Descriptive statistics and bivariate correlations were computed. Acceptance, self-distraction, positive reframing, and planning were the most used coping strategies by this sample. There were small (r = -0.09) to large (r = 0.51) significant relationships between personal, medical, and psychological variables and selected coping strategies. Coping with a cancer diagnosis early in life remains poorly understood. Identifying additional correlates and exploring inter- and intrapersonal variation in coping strategy use is required.
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Affiliation(s)
- Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, BC V2S 7M7, Canada;
| | - Anika Petrella
- Cancer Clinical Trials Unit, University College Hospital, London NW1 2BU, UK;
| | - Joshua Tulk
- Department of Psychology, Faculty of Science, Memorial University, St. John’s, NL A1C 5S7, Canada
| | - Catherine M. Sabiston
- Department of Exercise Sciences, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON M5R 0A3, Canada;
| | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (F.S.); (S.H.J.H.)
| | - Jackie Bender
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (J.B.)
| | - Norma D’Agostino
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; (J.B.)
| | - Sharon H. J. Hou
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (F.S.); (S.H.J.H.)
- Department of Psychology, BC Children’s Hospital, Vancouver, BC V6H 3N1, Canada
| | - Geoff Eaton
- Young Adult Cancer Canada, St. John’s, NL A1B 3K3, Canada
| | | | - Sheila N. Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John’s, NL A1C 5S7, Canada
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John’s, NL A1C 5S7, Canada
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Tulk J, Wurz A, Hou SHJ, Bender J, Schulte FSM, Eaton G, Chalifour K, Garland SN. Rural-urban differences in distress, quality of life, and social support among Canadian young adult cancer survivors: A Young Adults with Cancer in Their Prime (YACPRIME) study. J Rural Health 2024; 40:121-127. [PMID: 37355833 DOI: 10.1111/jrh.12774] [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: 03/13/2023] [Revised: 05/11/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Geographic location plays a significant role in the health and wellbeing of those with cancer. This project explored the impact of rurality and social support on distress and quality of life in young adults (YAs) with cancer in Canada. METHODS The current research analyzed data from the Young Adults with Cancer in Their Prime (YACPRIME) study. Participants completed measures of emotional distress (10-item Kessler Psychological Distress Scale), quality of life (12-item Short-form Health Survey), and social support (Medical Outcomes Study-Social Support Survey). Rural and urban-dwelling survivors were compared using MANOVAs. Bivariate analyses were conducted to explore associations between distress and social support. FINDINGS Of the sample (N = 379), 26% identified their location as rural. Rural YA cancer survivors reported higher distress and worse physical health-related quality of life (HRQOL) than survivors from urban areas but similar levels of mental-health-related quality of life. Social support appeared to have a marginally greater effect on psychosocial outcomes for urban participants. All types of social support were associated with lower levels of distress. However, different types of social support were associated more strongly with distress depending on a participant's geography. CONCLUSIONS Rural-dwelling YA cancer survivors experience significantly more distress and poorer physical HRQOL than urban-dwelling survivors. Different needs and preferences for social support may influence the psychological health of rural cancer survivors. Additional research is needed to determine how best to understand and address distress in rural YAs with cancer.
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Affiliation(s)
- Joshua Tulk
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Sharon H J Hou
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jacqueline Bender
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Fiona S M Schulte
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Karine Chalifour
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Tulk J, Rash JA, Thoms J, Wassersug R, Gonzalez B, Garland SN. Androgen deprivation therapy and radiation for prostate cancer-cognitive impairment, sleep, symptom burden: a prospective study. BMJ Support Palliat Care 2023; 13:e454-e463. [PMID: 34330793 DOI: 10.1136/bmjspcare-2021-003098] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 04/03/2021] [Accepted: 07/20/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This paper (1) sought to compare sleep, mood and physical symptom profiles of men with prostate cancer (PCa) who experienced subjective and objective cancer-related cognitive impairment (CRCI) during the first year of treatment and (2) examine if fluctuations in mood and physical symptoms are associated with change in subjective or objective CRCI. METHODS This prospective observational cohort study examined 24 new patients with PCa receiving androgen deprivation therapy (ADT) and radiation therapy (RT) during the first 12 months of treatment. Participants completed subjective and objective assessments of cognition, sleep continuity and self-report measures of insomnia, fatigue, depression and anxiety. Independent sample t-tests, correlations and hierarchical regressions were used to compare groups, explore associations, and assess change over time. Effects are reported as corrected Cohen's d (dc). RESULTS Men with objective CRCI reported worse subjective time asleep (dc=0.47) and more depression (dc=0.55). Men with subjective CRCI reported worse insomnia (dc=0.99), hot flashes (dc=0.76), sleep quality (dc=0.54), subjective total sleep time (dc=0.41), wake after sleep onset (dc=0.71), sleep efficiency (dc=0.49), fatigue (dc=0.67) and objectively estimated sleep latency (dc=0.72) than men without subjective CRCI. Declines in perceived cognition was associated with higher anxiety (p=0.05), fatigue (p≤0.01) and symptoms of insomnia (p=0.01). Finally, subjective time awake during the night (p=0.03) and fatigue (p=0.02) were associated with subjective cognitive decline, controlling for objective change. CONCLUSIONS Subjective concerns of CRCI appear more critical to patient experience than objective measurements in men with PCa who have received RT and ADT. Interventions to improve sleep may result in an improved perception of cognition.
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Affiliation(s)
- Joshua Tulk
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Joshua A Rash
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - John Thoms
- Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Richard Wassersug
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Gonzalez
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida, USA
| | - Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Lee RM, Donnan J, Harris N, Garland SN. A cross-sectional survey of the prevalence and patterns of using cannabis as a sleep aid in Canadian cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01474-2. [PMID: 37837502 DOI: 10.1007/s11764-023-01474-2] [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] [Received: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Poor sleep is one of the most common side effects of cancer. It can persist for years beyond treatment and negatively impact quality of life and health. Cannabis is increasingly used to manage cancer treatment-related symptoms, including sleep. This study investigated the use and perceived effects of cannabis as a sleep aid in Canadian cancer survivors. METHODS Adult Canadian cancer survivors (N = 1464) were recruited via the Angus Reid Institute and completed an online, cross-sectional survey including the Insomnia Severity Index and questions about cannabis use for sleep. Standard descriptive statistics, such as means, standard deviations, and ranges were produced for measured variables to assess the ways cancer survivors use cannabis for sleep. Frequencies were tabulated for categorical and ordinal variables. RESULTS On average, participants (Mage = 61.1 years; Women = 50%: Men = 48%) received their cancer diagnosis 12.5 years prior. Of participants, 23.5% (n = 344) currently use cannabis as a sleep aid, with reported benefits including relaxation, reduced time to fall asleep, fewer nocturnal awakenings and improved sleep quality. Two thirds (68.3%, n = 235) only began using cannabis for sleep after their cancer diagnosis. Over a third of participants (36.3%, n = 125) use cannabis as a sleep aid every day. Among the 344, the most common other reasons for using cannabis were pain (31.4%, n = 108), recreational use (24.4%, n = 84), and anxiety (12.5%, n = 43). CONCLUSIONS Given the prevalence and potential impact, research is needed to examine the actual efficacy of cannabis as a sleep aid. IMPLICATIONS FOR CANCER SURVIVORS It is important that cancer survivors have information on methods to help their sleep to avoid impairments to quality of life and health.
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Affiliation(s)
- Rachel M Lee
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
- Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada
| | - Jennifer Donnan
- School of Pharmacy, Memorial University, St. John's, NL, Canada
| | - Nick Harris
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada.
- Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada.
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
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Li X, Mao JJ, Garland SN, Root J, Li SQ, Ahles T, Liou KT. Comparing sleep measures in cancer survivors: Self-reported sleep diary versus objective wearable sleep tracker. Res Sq 2023:rs.3.rs-3407984. [PMID: 37886444 PMCID: PMC10602054 DOI: 10.21203/rs.3.rs-3407984/v1] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Purpose Cancer survivors are increasingly using wearable fitness trackers, but it's unclear if they match traditional self-reported sleep diaries. We aimed to compare sleep data from Fitbit and the Consensus Sleep Diary (CSD) in this group. Methods We analyzed data from two randomized clinical trials, using both CSD and Fitbit to collect sleep outcomes: total sleep time (TST), wake time after sleep onset (WASO), number of awakenings (NWAK), time in bed (TIB) and sleep efficiency (SE). Insomnia severity was measured by Insomnia Severity Index (ISI). We used the Wilcoxon Singed Ranks Test, Spearman's rank correlation coefficients, and the Mann-Whitney Test to compare sleep outcomes and assess their ability to distinguish insomnia severity levels between CSD and Fitbit data. Results Among 62 participants, compared to CSD, Fitbit recorded longer TST by an average of 14.6 (SD = 84.9) minutes, longer WASO by an average of 28.7 (SD = 40.5) minutes, more NWAK by an average of 16.7 (SD = 6.6) times per night, and higher SE by an average of 7.1% (SD = 14.4); but shorter TIB by an average of 24.4 (SD = 71.5) minutes. All the differences were statistically significant (all p < 0.05), except for TST (p = 0.38). Moderate correlations were found for TST (r = 0.41, p = 0.001) and TIB (r = 0.44, p < 0.001). Compared to no/mild insomnia group, participants with clinical insomnia reported more NWAK (p = 0.009) and lower SE (p = 0.029) as measured by CSD, but Fitbit outcomes didn't. Conclusions TST was the only similar outcome between Fitbit and CSD. Our study highlights the advantages, disadvantages, and clinical utilization of sleep trackers in oncology.
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Affiliation(s)
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center
| | | | | | | | - Tim Ahles
- Memorial Sloan Kettering Cancer Center
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Muthumuni D, Scott I, Chochinov HM, Mahar AL, Garland SN, Schulte F, Lambert P, Lix L, Garland A, Oberoi S. Feasibility and Acceptability of a Virtual "Coping with Brain Fog" Intervention for Improving Cognitive Functioning in Young Adults with Cancer. J Adolesc Young Adult Oncol 2023; 12:662-673. [PMID: 37158780 DOI: 10.1089/jayao.2023.0022] [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: 05/10/2023] Open
Abstract
Purpose: Cancer-related cognitive deficits (CRCDs) are common among young adults (YAs) (ages: 18-39) with cancer and can be debilitating. We aimed to determine the feasibility and acceptability of a virtual Coping with Brain Fog intervention among YAs with cancer. Our secondary aims were to explore the intervention's effect on cognitive functioning and psychological distress. Methods: This prospective feasibility study involved eight weekly, 90-minute virtual group sessions. Sessions focused on psychoeducation on CRCD, memory skills, task management, and psychological well-being. The primary outcomes were feasibility and acceptability of the intervention evaluated through attendance (>60% not missing >2 consecutive sessions) and satisfaction (Client Satisfaction Questionnaire [CSQ] score >20). Secondary outcomes included the following: cognitive functioning (Functional Assessment of Cancer Therapy-Cognitive Function [FACT-Cog] Scale) and symptoms of distress (Patient-Reported Outcomes Measurement Information System [PROMIS] Short Form-Anxiety/Depression/Fatigue) and participants' experiences using semistructured interviews. Paired t-tests and summative content analysis were used for quantitative and qualitative data analyses. Results: Twelve participants (five male, mean age = 33 years) were enrolled. All but one participant met feasibility criteria of not missing >2 consecutive sessions (11/12 = 92%). The mean CSQ score was 28.1 (standard deviation 2.5). Significant improvement in cognitive function as measured by FACT-Cog Scale was observed postintervention (p < 0.05). Ten participants adopted strategies from the program to combat CRCD, and eight reported CRCD symptom improvement. Conclusion: A virtual Coping with Brain Fog intervention is feasible and acceptable for the symptoms of CRCD among YAs with cancer. The exploratory data indicate subjective improvement in cognitive function, and will inform the design and implementation of a future clinical trial. ClinicalTrials.gov Registration: NCT05115422.
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Affiliation(s)
- Dhasni Muthumuni
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Harvey Max Chochinov
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Alyson L Mahar
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Fiona Schulte
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pascal Lambert
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Lix
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan Garland
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sapna Oberoi
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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12
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Garland SN, Tulk J, Cotter R, Zhou ES, Daniel LC, Schulte FSM, Bender JL, Chalifour K, Eaton G. Understanding sleep quality in a national cohort of young adult cancer survivors: Results from the YACPRIME study. Sleep Med 2023; 109:293-299. [PMID: 37499465 DOI: 10.1016/j.sleep.2023.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE A cancer diagnosis in young adulthood can negatively impact sleep quality. The present study describes sleep issues in young adults (YAs) and analyzes potential demographic and clinical characteristics related to sleep quality. METHODS Canadian YAs (n = 359) diagnosed with cancer between ages 15-39 participated in the study. Pittsburgh Sleep Quality Index (PSQI) items were examined to identify specific sleep issues that occurred 3+ times per week. Logistic regression was used to examine demographic, clinical, and symptom-related variables associated with poor sleep quality (defined as a PSQI global score >8) and sleep medication use. RESULTS Participants were predominantly female (87.5%) with an average age of 32 years. Of the sample, 52% had poor sleep quality, 55.5% took >30 min to fall asleep, 32.9% slept <7 h, and 54.6% reported a habitual sleep efficiency of <85%. YAs with poor sleep quality were 5.7 times more likely to report severe distress (p=<.001), as well as 1.8 times more likely to report poorer mental (p = .03) and physical functioning (p = .05). Nearly half (44%) of YAs used sleep medication to help them sleep. YAs who reported severe psychological distress were 2.4 times more likely to use sleeping medication (p = .01), whereas those with a household income ≥$100,000/year were half as likely to use medication to help with sleep (p = .04). CONCLUSION Psychological distress is associated with worse sleep quality and sleep medication use in YA cancer survivors. Sleep quality may be a possible target for future research and intervention to promote long-term function and recovery.
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Affiliation(s)
- Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland and Labrador, Canada; Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
| | - Joshua Tulk
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Riley Cotter
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Eric S Zhou
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lauren C Daniel
- Department of Psychology and Health Sciences, Rutgers University, Camden, NJ, USA
| | - Fiona S M Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jacqueline L Bender
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 585 University Avenue, Toronto, Ontario, Canada
| | - Karine Chalifour
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
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13
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Schulte FSM, Hou SHJ, Bender JL, Tulk J, Wurz A, Petrella A, Sabiston CM, D'Agostino N, Chalifour K, Eaton G, Garland SN. An Investigation of Social Status among Adolescents and Young Adults Who Have Been Diagnosed with Cancer in Canada. Cancers (Basel) 2023; 15:3436. [PMID: 37444545 DOI: 10.3390/cancers15133436] [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] [Received: 04/21/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Aims were to: (1) compare social status among AYAs diagnosed with cancer to a community population; (2) describe AYAs' change in employment/education status; and (3) examine predictors of social status. METHOD Social status (i.e., education, employment, relationship status, and living arrangement) was captured from young adults diagnosed with cancer recruited via social media through a community-based organization from across Canada and randomly matched to a community sample by sex, age, province of residence, total household income and race/ethnicity at a ratio of 1:3. RESULTS AYAs with cancer (N = 622) were an average of 4.45 (SD = 5.42) years from the completion of treatment and were less likely to be employed (χ2 = 96.35, p < 0.001) and more likely to be living at home with parents (χ2 = 17.00, p < 0.001). There were no differences in education or relationship status. Overall, 41% and 45% of AYAs reported quitting school or work, respectively. Non-metastatic disease (AOR 3.23, 95% CI 1.08-9.62), and better physical (AOR 1.07 95% CI 1.04-1.10) and mental quality of life (QOL)(AOR 1.06 95% CI 1.03-1.09), were associated with employment. Worse mental QOL (AOR 1.04 95% CI 1.01-1.07), less post-traumatic growth (AOR 1.01 95% CI 1.00-1.03), and social support (AOR 0.27, 95% CI 0.18-0.41) were associated with being single. Non-White race (AOR 3.19 95% CI 1.02-9.97) and less post-traumatic growth (AOR 0.97 95% CI 0.95-0.99) were associated with living with parents. CONCLUSIONS AYAs diagnosed with cancer experience differences in attainment of employment and independent living compared to a community sample. These challenges may have implications for physical and mental QOL.
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Affiliation(s)
- Fiona S M Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Sharon H J Hou
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jacqueline L Bender
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5G 2C1, Canada
| | - Joshua Tulk
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL A1B 3X9, Canada
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, NL A1B 3V6, Canada
| | - Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, BC V2R 0N3, Canada
| | - Anika Petrella
- Cancer Clinical Trials Unit, University College Hospital, London WC1V 6LJ, UK
| | - Catherine M Sabiston
- Department of Exercise Sciences, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON M5S 2C9, Canada
| | - Norma D'Agostino
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | | | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, NL A1B 3K3, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL A1B 3X9, Canada
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, NL A1B 3V6, Canada
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14
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Yan A, Howden K, Mahar AL, Scott I, Glidden C, Deleemans J, Chalifour K, Eaton G, Gupta A, Bolton JM, Garland SN, Oberoi S. Experiences of adolescent and young adult cancer survivors during the COVID-19 pandemic. J Cancer Surviv 2023; 17:370-383. [PMID: 35098486 PMCID: PMC8801282 DOI: 10.1007/s11764-021-01158-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to evaluate the impact of the COVID-19 pandemic on adolescent and young adult (AYA) cancer survivors. METHODS We conducted a cross-sectional survey of AYAs aged 18-49 with cancer in Canada between January and February 2021. Data from survivors, defined as AYAs more than one year off cancer treatment, were analysed. Multiple logistic regression was used to identify factors associated with psychological distress, loneliness and insomnia. RESULTS The analysis included 384 survivors. Moderate-to-severe psychological distress was reported by 257 (68.9%) survivors and was associated with an income ≥ $60,000 (adjusted odds ratio [AOR] 2.15, 95% CI 1.11-4.17) and the presence of a pre-existing chronic physical health condition (AOR 2.05, 95% CI 1.18-3.56). Loneliness was reported by 204 (54.0%) survivors and was associated with being unemployed (AOR 2.26 95%CI 1.18-4.31), pandemic causing finances to be worse (AOR 1.82, 95%CI 1.08-3.06) and the presence of a pre-pandemic mental health condition (AOR 1.88, 95% CI 1.03-3.42). Clinical insomnia was reported by 74 (19.5%) survivors and was associated with employment status as a student (AOR 3.00, 95% CI 1.08-8.29) or unemployed (AOR 3.97, 95% CI 1.46-10.83), earning $60,000 or more in the year 2020 (AOR 4.36, 95% CI 1.43-13.32), having haematologic cancer (AOR 2.21, 95% CI 1.05-4.70) and being single (AOR 2.52, 95% CI 1.08-5.91). Pandemic negatively affected employment, finances, physical activity, cancer care and substance use for 73.9%, 66.5%, 32.5%, 21.8% and 19.2% of survivors, respectively. Worries about finances, contracting COVID-19, cancer treatment increasing the risk of COVID-19 infection, and having poor health outcomes from contracting COVID-19 were reported by 46.0%, 45.6%, 55.0% and 47.3% of survivors, respectively. CONCLUSIONS The COVID-19 pandemic has had a significant impact on AYA cancer survivors, and these individuals report high levels of psychological distress, insomnia and loneliness. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors are at risk for worsening mental and physical health outcomes during the COVID-19 pandemic. Targeted interventions and support programs are urgently needed to support the mental health of AYA cancer survivors and optimize their health outcomes.
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Affiliation(s)
- Adam Yan
- Division of Pediatric Hematology Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Dana-Farber/Boston Children's Blood and Cancer Disorder Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kaitlyn Howden
- Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, 75 McDermot Ave, Winnipeg, MB, ON-2015R3E 0V9, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada
| | - Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, Canada
| | - Camille Glidden
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Julie Deleemans
- Department of Psychosocial Oncology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Karine Chalifour
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Abha Gupta
- Division of Pediatric Hematology Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Princess Margaret Cancer Care Research Institute, Toronto, ON, Canada
| | - James M Bolton
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, 75 McDermot Ave, Winnipeg, MB, ON-2015R3E 0V9, Canada.
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Canada.
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, R3E0V9, Canada.
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15
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Li X, Liou KT, Chimonas S, Bryl K, Wong G, Spiguel E, Li SQ, Garland SN, Bao T, Mao JJ. Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia. Integr Med Res 2023; 12:100922. [PMID: 36843902 PMCID: PMC9944506 DOI: 10.1016/j.imr.2023.100922] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Background Fatigue is a troublesome symptom in cancer survivors that often results from disrupted sleep. We sought to assess whether two insomnia-focused non-pharmacological interventions are also effective for improving fatigue. Methods We analyzed data from a randomized clinical trial comparing cognitive behavioral therapy for insomnia (CBT-I) versus acupuncture for insomnia among cancer survivors. Participants were 109 patients who reported insomnia and moderate or worse fatigue. Interventions were delivered over eight weeks. Fatigue was evaluated at baseline, week 8, and week 20 using the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). We used both mediation analysis and t-tests to explore the extent to which fatigue reduction was attributable to insomnia response. Results Compared to baseline, both CBT-I and acupuncture produced significant reductions in total MFSI-SF scores at week 8 (-17.1 points; 95% confidence interval [CI]: -21.1 to -13.1, and -13.2 points; 95% CI: -17.2 to -9.2, respectively, all p<0.001) and week 20 (-14.6 points; 95% CI: -18.6 to -10.6, and -14.2 points; 95% CI: -18.1 to -10.3. respectively, all p<0.001), with no significant between-group differences. MFSI-SF total scores at week 8 were significantly associated with sleep improvements in both CBT-I and acupuncture groups (p<0.001 and p=0.011, respectively). Insomnia responders demonstrated significantly greater improvements in mean MFSI-SF total scores compared with non-responders in the CBT-I group (p=0.016) but not in the acupuncture group. Conclusion CBT-I and acupuncture produced similar, clinically meaningful, and durable fatigue reductions in cancer survivors with insomnia, primarily through improvements in sleep. Acupuncture may also reduce fatigue through additional pathways.
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Affiliation(s)
- Xiaotong Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Kevin T. Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Susan Chimonas
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, United States,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Karolina Bryl
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Greta Wong
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Eugenie Spiguel
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States,Department of Advanced Practice Providers, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Susan Q. Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Sheila N. Garland
- Department of Psychology and Oncology, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Ting Bao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jun J. Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States,Corresponding author at: Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, 4th Floor, New York, NY 10065, United States.
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16
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Mahon KN, Garland SN, Eaton G, Chalifour K, Lane BE, Fowler K, Gambin L, Clair L. The financial impact of cancer on Canadian young adults. J Cancer Surviv 2023; 17:174-186. [PMID: 33586129 DOI: 10.1007/s11764-021-00998-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/24/2020] [Accepted: 01/29/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To explore the financial impact of cancer in young adults (YAs) compared to matched non-cancer peers. METHODS Five hundred seventy-five YAs from the Young Adults with Cancer in their Prime (YACPRIME) study reported on out-of-pocket cancer costs and missed work. YA cancer survivors were compared to matched peers without cancer on key financial indices based on current age (< 35 vs. 35 + years) and time since diagnosis (< 5 vs. 5 + years). Descriptive statistics, Chi-square tests, and prevalence ratios (PR) were used to compare groups on financial variables. RESULTS Almost 60% of YA survivors spent at least $100/month on cancer-related expenses, and 49% missed at least one year of work. YA survivors were more likely to have outstanding credit card ((< 35 (PR = 1.37, p = 0.001); 35 + (PR = 1.33, p = 0.001)) and line of credit (< 35 (PR = 1.42, p = 0.008); 35 + (PR = 1.27, p = 0.016)) balances. Home ownership was higher among non-cancer peers ((< 35: PR = 1.42, p < 0.001); 35 + (PR = 1.69, p < 0.001); < 5 years (PR = 1.39, p < 0.001); 5 + years (PR = 1.41, p = 0.005)). YA survivors were more likely to not own assets ((< 5 years (PR = 2.25, p < 0.001); 5 + years (PR = 2.25, p = 0.004)). Those diagnosed within 5 years had higher rates of payday loans (PR = 3.91, p = 0.021). CONCLUSION While exploratory, results suggest that YAs are disadvantaged compared to their peers in type and value of assets owned and debts carried. IMPLICATIONS FOR CANCER SURVIVORS Survivorship care plans for YA survivors should include resources to manage the financial impacts of cancer.
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Affiliation(s)
- Kaitlyn N Mahon
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada. .,Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
| | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, NL, Canada
| | | | - Breanna E Lane
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
| | - Ken Fowler
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
| | - Lynn Gambin
- Department of Economics, Faculty of Humanities and Social Sciences, Memorial University, St. John's, NL, Canada
| | - Luc Clair
- Department of Economics, Faculty of Business and Economics, University of Winnipeg, Winnipeg, MB, Canada
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Bender JL, Akinnibosun R, Puri N, D’Agostino N, Drake EK, Tsimicalis A, Howard AF, Garland SN, Chalifour K, Gupta AA. A comparison of the sociodemographic, medical, and psychosocial characteristics of adolescents and young adults diagnosed with cancer recruited in-person and online: A Canadian cross-sectional survey. Digit Health 2023; 9:20552076231205278. [PMID: 37900258 PMCID: PMC10605661 DOI: 10.1177/20552076231205278] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Adolescents and young adults diagnosed with cancer (AYAs) are under-represented in research. The Internet and social media could increase the reach of recruitment efforts but may impact sample characteristics. This study evaluated the characteristics of AYAs recruited in-person at an urban hospital versus the Internet in terms of their sociodemographic and medical characteristics, and psychosocial wellbeing, and offers recommendation for increasing the inclusivity and representativeness of research samples. Methods Participant data from a cross-sectional survey of AYAs in Canada were evaluated. In-person hospital recruitment used a registry to identify patients attending ambulatory clinics. Internet recruitment included notices on hospital, team members', and community partners' social media channels, and email newsletters. Independent sample t-tests and Chi-squared tests were used to identify differences in participant sociodemographic, medical, and psychosocial characteristics based on recruitment source. Results Of 436 participants, 217 (49.8%) were recruited in-person and 219 (50.2%) online. Online participants were more likely: to be white (p < .001), women (p < .001), and Canadian-born (p < .001); to speak English at home (p < .001), live alone (p = .001) and live in rural settings (p = .014); and to be farther from diagnosis (p = .023), diagnosed with breast cancer (p < .001), and cancer free (p < .001) compared to the hospital sample. Online participants also reported higher anxiety, depression, and loneliness (p < .001), and lower social support (p < .001), self-efficacy for coping with cancer (p < .001), and life satisfaction (p = .006). Conclusions Online recruitment yielded a more geographically diverse but less sociodemographically diverse sample of AYAs who were farther from diagnosis and had poorer psychosocial wellbeing than in-person recruitment at an urban hospital. Future research efforts should consider partnering with under-represented communities and using targeted and stratified online and in-person recruitment strategies to achieve an inclusive and representative sample of AYAs.
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Affiliation(s)
- Jacqueline L Bender
- Cancer Rehabilitation and Survivorship, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rukayyah Akinnibosun
- Cancer Rehabilitation and Survivorship, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Natasha Puri
- Cancer Rehabilitation and Survivorship, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Norma D’Agostino
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Emily K Drake
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Argerie Tsimicalis
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - A Fuchsia Howard
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University, St John's, NL,
Canada
| | | | - Abha A Gupta
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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18
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Li X, Bao T, Garland SN, Li SQ, Yu J, Li Y, Mao JJ. Does expectancy affect insomnia treatment response in cancer survivors receiving acupuncture and cognitive behavioral therapy? J Cancer Surviv 2022; 17:826-835. [DOI: 10.1007/s11764-022-01272-2] [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: 12/17/2021] [Accepted: 10/07/2022] [Indexed: 12/05/2022]
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19
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Duthie CJ, Cameron C, Smith-Han K, Beckert L, Delpachitra S, Garland SN, Sparks B, Wibowo E. Sleep Management Strategies Among Medical Students At the University of Otago. Behav Sleep Med 2022:1-12. [PMID: 36178287 DOI: 10.1080/15402002.2022.2127723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES We aim to investigate factors which might affect the sleep of medical students, and how they currently manage their sleep. METHODS An online survey was sent to medical students at the University of Otago. RESULTS After adjusting for gender, ethnicity and age, depressive symptoms (Mild: odds ratio (OR) = 6.3; Moderate: OR = 18.1; Severe: OR = 15.6), and sleep hygiene (OR = 1.07) were associated with insomnia symptoms. Commonly endorsed strategies for sleep management by students were undertaking regular exercise (80.1%), having consistent sleep-wake time (71.3%), and limiting caffeine intake (70.3%). Few were willing to see a clinician (23.4%) or take medication (22.3%). Participants with insomnia symptoms were more likely to prefer limiting their alcohol intake (OR = 1.8), limiting daytime naps (OR = 1.5), seeing clinicians (OR = 1.9), and taking sleep medication (OR = 4.0), but less likely to prefer avoiding intense work (OR = .71) or minimizing using electronics (OR = .60) close to bedtime than those without insomnia symptoms. High sleep self-efficacy was associated with lower odds for having insomnia symptoms (OR = .74 (.70, .77)). CONCLUSIONS Increased awareness and greater resources are needed to support the sleep health of medical students.
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Affiliation(s)
- Cassian J Duthie
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Claire Cameron
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Kelby Smith-Han
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Lutz Beckert
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Sheila N Garland
- Department of Psychology and Discipline of Oncology, Memorial University, St. John's, Newfoundland, Canada
| | - Bryn Sparks
- Department of Sleep Physiology, Sleep Well Clinic, Christchurch, New Zealand
| | - Erik Wibowo
- Department of Anatomy, University of Otago, Dunedin, New Zealand
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20
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Maccora J, Garland SN, Ftanou M, Day D, White M, Lopez VA, Mortimer D, Diggens J, Phillips AJK, Wallace R, Alexander M, Boyle F, Stafford L, Francis PA, Bei B, Wiley JF. The sleep, cancer and rest (SleepCaRe) trial: Rationale and design of a randomized, controlled trial of cognitive behavioral and bright light therapy for insomnia and fatigue in women with breast cancer receiving chemotherapy. Contemp Clin Trials 2022; 120:106877. [PMID: 35961468 DOI: 10.1016/j.cct.2022.106877] [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: 05/04/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Insomnia and fatigue symptoms are common in breast cancer. Active cancer treatment, such as chemotherapy, appears to be particularly disruptive to sleep. Yet, sleep complaints often go unrecognised and under treated within routine cancer care. The abbreviated delivery of cognitive behavioral therapy for Insomnia (CBTI) and bright light therapy (BLT) may offer accessible and cost-effective sleep treatments in women receiving chemotherapy for breast cancer. METHODS The Sleep, Cancer and Rest (SleepCaRe) Trial is a 6-month multicentre, randomized, controlled, 2 × 2 factorial, superiority, parallel group trial. Women receiving cytotoxic chemotherapy for breast cancer at tertiary Australian hospitals will be randomly assigned 1:1:1:1 to one of four, non-pharmacological sleep interventions: (a) Sleep Hygiene and Education (SHE); (b) CBTI; (c) BLT; (d) CBT-I + BLT combined and simultaneously delivered. Each sleep intervention is delivered over 6 weeks, and will comprise an introductory session, a mid-point phone call, and regular emails. The primary (insomnia, fatigue) and secondary (health-related quality of life, rest activity rhythms, sleep-related impairment) outcomes will be assessed via online questionnaires at five time-points: baseline (t0, prior to intervention), mid-point intervention (t2, Week 4), post-intervention (t3, Week 7), 3-months (t4, Week 18), and 6-months follow-up (t5, Week 30). CONCLUSIONS This study will report novel data concerning the comparative and combined efficacy of CBT-I and BLT during chemotherapy. Findings will contribute to the development of evidence-based early sleep and fatigue intervention during chemotherapy for breast cancer. Clinical trial information Registered with the Australian New Zealand Clinical Trials Registry (http://anzctr.org.au/), Registration Number: ACTRN12620001133921.
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Affiliation(s)
- Jordan Maccora
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | | | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Daphne Day
- Department of Oncology Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia.
| | - Michelle White
- Department of Oncology Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia.
| | | | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia.
| | | | - Andrew J K Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | - Rebecca Wallace
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | | | - Lesley Stafford
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | | | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia; Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia.
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21
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Tulk J, Garland SN, Howden K, Glidden C, Scott I, Chalifour K, Eaton G, Mahar A, Oberoi S. Prevalence and factors associated with insomnia symptoms in adolescents and young adults with cancer during the COVID-19 pandemic. Sleep Health 2022; 8:410-416. [PMID: 35729003 PMCID: PMC9212947 DOI: 10.1016/j.sleh.2022.04.005] [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: 11/16/2021] [Revised: 04/22/2022] [Accepted: 04/30/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has been particularly distressing for adolescents and young adults (AYAs) diagnosed with cancer. High levels of distress are associated with sleep disturbances. This study examined the prevalence of insomnia symptoms in AYAs during the COVID-19 pandemic and identified factors related to greater insomnia severity. DESIGN, SETTING, AND PARTICIPANTS An online survey was administered to Canadian AYAs (N = 805) diagnosed with cancer between 15 and 39 years from January to February 2021. MEASUREMENTS The primary measure was the Insomnia Severity Index (ISI). Univariable and multivariable binomial logistic regression examined demographic, clinical, and psychological factors associated with significant insomnia symptoms (ISI score ≥12). RESULTS Three hundred twelve (38.8%) participants reported insomnia symptoms. In the multivariable model, severe psychological distress (ie, depression and anxiety; adjusted odds ratio (AOR) = 28.75, p ≤.001), having a pre-existing mental health condition (AOR = 1.92, p = .03), worsened mental health during the pandemic (AOR = 1.73, p = .02), finished cancer treatment ≥1 year ago (AOR = 1.72, p = .03), and experiencing no changes to schooling during the COVID-19 pandemic (AOR = 2.18, p = .004) were associated with significant insomnia symptoms. Standardized coefficients also indicated that worrying about possible disruptions to cancer care and being a homemaker/caretaker contributed to insomnia symptoms. CONCLUSIONS Nearly 40% of AYAs with cancer reported insomnia symptoms during the COVID-19 pandemic. Insomnia was associated with potentially modifiable factors such as psychological distress, highlighting possible targets for intervention.
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Affiliation(s)
- Joshua Tulk
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Canada; Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, Canada.
| | - Kaitlyn Howden
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Camille Glidden
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, Canada
| | | | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, NL, Canada
| | - Alyson Mahar
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Section of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Canada
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22
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Luigjes-Huizer YL, Tauber NM, Humphris G, Kasparian NA, Lam WWT, Lebel S, Simard S, Smith AB, Zachariae R, Afiyanti Y, Bell KJL, Custers JAE, de Wit NJ, Fisher PL, Galica J, Garland SN, Helsper CW, Jeppesen MM, Liu J, Mititelu R, Monninkhof EM, Russell L, Savard J, Speckens AEM, van Helmondt SJ, Vatandoust S, Zdenkowski N, van der Lee ML. What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta-analysis. Psychooncology 2022; 31:879-892. [PMID: 35388525 PMCID: PMC9321869 DOI: 10.1002/pon.5921] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/14/2022] [Accepted: 03/09/2022] [Indexed: 12/20/2022]
Abstract
Objective Care for fear of cancer recurrence (FCR) is considered the most common unmet need among cancer survivors. Yet the prevalence of FCR and predisposing factors remain inconclusive. To support targeted care, we provide a comprehensive overview of the prevalence and severity of FCR among cancer survivors and patients, as measured using the short form of the validated Fear of Cancer Recurrence Inventory (FCRI‐SF). We also report on associations between FCR and clinical and demographic characteristics. Methods This is a systematic review and individual participant data (IPD) meta‐analysis on the prevalence of FCR. In the review, we included all studies that used the FCRI‐SF with adult (≥18 years) cancer survivors and patients. Date of search: 7 February 2020. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. Results IPD were requested from 87 unique studies and provided for 46 studies comprising 11,226 participants from 13 countries. 9311 respondents were included for the main analyses. On the FCRI‐SF (range 0–36), 58.8% of respondents scored ≥13, 45.1% scored ≥16 and 19.2% scored ≥22. FCR decreased with age and women reported more FCR than men. FCR was found across cancer types and continents and for all time periods since cancer diagnosis. Conclusions FCR affects a considerable number of cancer survivors and patients. It is therefore important that healthcare providers discuss this issue with their patients and provide treatment when needed. Further research is needed to investigate how best to prevent and treat FCR and to identify other factors associated with FCR. The protocol was prospectively registered (PROSPERO CRD42020142185).
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Affiliation(s)
- Yvonne L Luigjes-Huizer
- Helen Dowling Institute, Bilthoven, The Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Nina M Tauber
- Unit for Psychooncology and Health Psychology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Wendy W T Lam
- Division of Behavioural Sciences, School of Public Health, and LKS Faculty of Medicine Jockey Club Institute of Cancer Care, University of Hong Kong, Hong Kong, China
| | - Sophie Lebel
- Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sébastien Simard
- Université du Québec à Chicoutimi (UQAC), Centre Intersectoriel en santé durable, Québec, Québec, Canada
| | - Allan Ben Smith
- Ingham Institute for Applied Medical Research and South West Sydney Clinical Campuses, UNSW, Sydney, New South Wales, Australia
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Yati Afiyanti
- Department of Maternity and Women Health, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Katy J L Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - José A E Custers
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Niek J de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Peter L Fisher
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Jacqueline Galica
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland, Canada
| | - Charles W Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mette M Jeppesen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Jianlin Liu
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Roxana Mititelu
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Evelyn M Monninkhof
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lahiru Russell
- Centre for Quality and Patient Safety Research & Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Josée Savard
- School of Psychology, Université Laval, CHU de Québec-Université Laval Research Center, Université Laval Cancer Research Centre, Quebec, Québec, Canada
| | - Anne E M Speckens
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sanne J van Helmondt
- Helen Dowling Institute, Bilthoven, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
| | - Sina Vatandoust
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Nicholas Zdenkowski
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Marije L van der Lee
- Helen Dowling Institute, Bilthoven, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
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23
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Bender JL, Puri N, Salih S, D’Agostino NM, Tsimicalis A, Howard AF, Garland SN, Chalifour K, Drake EK, Marrato A, McKean NL, Gupta AA. Peer Support Needs and Preferences for Digital Peer Navigation among Adolescent and Young Adults with Cancer: A Canadian Cross-Sectional Survey. Curr Oncol 2022; 29:1163-1175. [PMID: 35200598 PMCID: PMC8870696 DOI: 10.3390/curroncol29020099] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Abstract
Adolescents and young adults (AYA) with cancer desire peer support and require support programs that address their unique needs. This study investigated the need for, and barriers to, peer support and preferences for digital peer navigation among AYA. A cross-sectional survey was administered to AYA, diagnosed with cancer between the ages of 15–39, at a cancer center and through social media. Descriptive summary statistics were calculated. Participants (n = 436) were on average 31.2 years (SD = 6.3), 3.3 years since-diagnosis (SD = 3.8), and 65% (n = 218) were women. Over three-quaters (n = 291, 76.6%) desired peer support from cancer peers, but 41.4% (n = 157) had not accessed peer support. Main access barriers were: Inconvenience of in-person support groups (n = 284, 76.1%), finding AYA with whom they could relate (n = 268, 72.4%), and finding AYA-specific support programs (n = 261, 70.4%). Eighty-two percent (n = 310) desired support from a peer navigator through a digital app, and 63% (n = 231) were interested in being a peer navigator. Participants indicated a greater need for emotional (n = 329, 90.1%) and informational support (n = 326, 89.1%) than companionship (n = 284, 78.0%) or practical support (n = 269, 73.6%) from a peer navigator. Foremost peer matching characteristics were cancer-type (n = 329, 88.4%), specific concerns (n = 317, 86.1%), and age-at-diagnosis (n = 316, 86.1%). A digital peer navigation program was desired by over 80% of a large Canadian sample of AYA and could potentially overcome the barriers AYA experience in accessing peer support. The design of a peer navigation program for AYA should consider the matching characteristics and multidimensional support needs of AYA.
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Affiliation(s)
- Jacqueline L. Bender
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (N.P.); (S.S.); (A.M.); (N.L.M.)
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (N.M.D.); (A.A.G.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M7, Canada
- Correspondence: ; Tel.: +1-416-581-8606
| | - Natasha Puri
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (N.P.); (S.S.); (A.M.); (N.L.M.)
| | - Sarah Salih
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (N.P.); (S.S.); (A.M.); (N.L.M.)
| | - Norma M. D’Agostino
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (N.M.D.); (A.A.G.)
| | - Argerie Tsimicalis
- Ingram School of Nursing, McGill University, Montreal, QC H3A 2M7, Canada;
| | - A. Fuchsia Howard
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Sheila N. Garland
- Department of Psychology, Memorial University, St. John’s, NL A1C 3X9, Canada;
| | | | - Emily K. Drake
- Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Anthony Marrato
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (N.P.); (S.S.); (A.M.); (N.L.M.)
| | - Nikki L. McKean
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada; (N.P.); (S.S.); (A.M.); (N.L.M.)
| | - Abha A. Gupta
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (N.M.D.); (A.A.G.)
- Adolescent and Young Adult Cancer Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada
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24
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Garland SN, Ivers H, Savard J. Prospective Rates, Longitudinal Associations, and Factors Associated With Comorbid Insomnia Symptoms and Perceived Cognitive Impairment. Front Neurosci 2022; 15:817933. [PMID: 35140586 PMCID: PMC8819074 DOI: 10.3389/fnins.2021.817933] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/30/2021] [Indexed: 01/14/2023] Open
Abstract
BackgroundInsomnia and cognitive impairment are both common conditions experienced by people diagnosed with cancer. Individually, these conditions have negative impacts on functioning, but the combined burden has yet to be evaluated. The purpose of this research was to estimate rates of comorbid insomnia and perceived cognitive impairments, examine the longitudinal associations between these two conditions, and identify demographic and clinical factors associated with reporting both insomnia and perceived cognitive impairment.MethodsIn this secondary analysis, a heterogeneous sample of 962 patients completed the Insomnia Severity Index (ISI) and the Cognitive Failures Questionnaire (CFQ) at the time of their cancer surgery (baseline; T1) and then again at 2 (T2), 6 (T3), 10 (T4), 14 (T5), and 18 (T6) months. Correlations and partial correlations, controlling for age and education level, were computed at each time point to assess the relationship between ISI and CFQ scores. Cross-lagged correlations assessed associations between ISI and CFQ scores over time. Proportions of patients with comorbid insomnia and cognitive impairments were calculated and logistic regressions investigated changes over time in these proportions. ANOVAs, logistic regressions, ordinal regressions, and multinomial regressions were used to identify risk factors of having comorbid insomnia and cognitive difficulties.ResultsSignificant and bidirectional correlations between ISI and CFQ scores were observed at each time point and over time. The proportion of patients having both clinical levels of insomnia and perceived cognitive difficulties ranged from 18.73 to 25.84% across time points and this proportion was significantly greater at T1 and T2 than T4, T5, and T6. Participants who reported comorbid insomnia and cognitive impairment were more likely to be younger, female, not currently working, currently receiving chemotherapy, with clinical levels depression and anxiety, and using antidepressants or anxiolytics.ConclusionComorbid insomnia and perceived cognitive impairment affects around one in five patients and is more frequent at the beginning of the cancer care trajectory. The relationship between insomnia and cognitive impairment appears to be bidirectional. Insomnia may represent an important patient level vulnerability that when identified and treated can improve perception of cognitive function.
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Affiliation(s)
- Sheila N. Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John’s, NL, Canada
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John’s, NL, Canada
| | - Hans Ivers
- School of Psychology, Université Laval, Quebec City, QC, Canada
- CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Laval University Cancer Research Center, Quebec City, QC, Canada
| | - Josée Savard
- School of Psychology, Université Laval, Quebec City, QC, Canada
- CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Laval University Cancer Research Center, Quebec City, QC, Canada
- *Correspondence: Josée Savard,
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25
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Glidden C, Howden K, Romanescu RG, Hatala A, Scott I, Deleemans JM, Chalifour K, Eaton G, Gupta AA, Bolton JM, Garland SN, Mahar AL, Oberoi S. Psychological distress and experiences of Adolescents and Young Adults with cancer during the COVID-19 pandemic: A cross-sectional survey. Psychooncology 2022; 31:631-640. [PMID: 34989053 DOI: 10.1002/pon.5849] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/16/2021] [Accepted: 10/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study investigated prevalence of psychological distress, factors associated with distress, and experiences of Adolescents and Young Adults (AYAs) with cancer during the COVID-19 pandemic. It also compared distress in this group to previously surveyed Canadian AYAs with cancer in 2018 by the Young Adults with Cancer in their Prime (YACPRIME) study. METHODS A cross-sectional, online, self-administered survey of AYAs diagnosed with cancer between 15 and 39 years of age was conducted. Psychological distress was measured by the Kessler Psychological Distress Scale (K10). Associations between variables and high psychological distress (K10 ≥ 25), and comparison of prevalence of psychological distress with the YACPRIME study were done using multivariable logistic regression. Summative qualitative content analysis analyzed participant experiences during this pandemic. RESULTS We included 805 participants. High psychological distress was present in over two-thirds of the group (68.0%; 95% CI, 64.7%-71.2%). Employment impact during pandemic (AOR (adjusted odds ratio), 2.16; 95% CI, 1.41-3.31) and hematologic malignancy (AOR, 1.76; 95% CI 1.08-2.97) were associated with higher psychological distress, while older age [AOR, 0.95; 95% CI, 0.92-0.99] and personal income < $40,000 (AOR, 0.38; 95% CI, 0.24-0.58) were associated with lower distress. Adjusted odds of experiencing psychological distress among AYAs with cancer during pandemic compared to pre-pandemic years was 1.85 (95% CI: 1.36-2.53). Overarching themes of pandemic experiences included: inferior quality of life, impairment of cancer care, COVID-19 related concerns and extreme social isolation. CONCLUSION AYAs diagnosed with cancer are experiencing high psychological distress during this pandemic. Distress screening and evidence-based interventions to alleviate distress are essential.
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Affiliation(s)
- Camille Glidden
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kaitlyn Howden
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Razvan G Romanescu
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Hatala
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Julie M Deleemans
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Geoff Eaton
- Young Adult Cancer Canada, St.John's, Newfoundland, Canada
| | - Abha A Gupta
- Princess Margaret Cancer Care Research Institute, Toronto, Ontario, Canada.,Department of Pediatric Hematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University of Newfoundland, St.John's, Newfoundland, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatric Hematology-Oncology/BMT, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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King ER, Willcott Benoit W, Repa LM, Garland SN. Prevalence and factors associated with non-medical prescription stimulant use to promote wakefulness in young adults. J Am Coll Health 2022; 70:174-181. [PMID: 32207639 DOI: 10.1080/07448481.2020.1730851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
Objective: This study examined the prevalence and factors associated with non-medical use of prescription stimulants to promote wakefulness. Participants: We surveyed 3,160 university students aged 18-35 between June 2016 and May 2017. Method: Participants reported whether they used prescription stimulants non-medically to stay awake and completed measures of anxiety and depressive symptoms, sleep quality, insomnia, daytime sleepiness, and attitudes toward non-medical prescription drug use. Univariate and multivariate regression models were used. Results: Prevalence of non-medical prescription stimulant use to promote wakefulness was 3.1%. The following factors remained significant in the multivariate model: alcohol, tobacco, and nicotine vapor use, attitude toward non-medical use of prescription medication, poor sleep quality, and daytime sleepiness. Conclusion: Poor sleep, substance use and more liberal attitudes to non-medical prescription drug use were associated with the misuse of stimulants to promote wakefulness. Prevention/intervention programs should promote sleep hygiene and highlight the risks of using prescription drugs non-medically.
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Affiliation(s)
- Eleanor R King
- Department of Psychology, Memorial University, St. John's, Canada
| | | | - Lily M Repa
- Department of Psychology, Memorial University, St. John's, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Canada
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27
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Yang M, Liou KT, Garland SN, Bao T, Hung TKW, Li SQ, Li Y, Mao JJ. Acupuncture versus cognitive behavioral therapy for pain among cancer survivors with insomnia: an exploratory analysis of a randomized clinical trial. NPJ Breast Cancer 2021; 7:148. [PMID: 34848737 PMCID: PMC8633385 DOI: 10.1038/s41523-021-00355-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023] Open
Abstract
Pain and insomnia often co-occur and impair the quality of life in cancer survivors. This study evaluated the effect of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on pain severity among cancer survivors with comorbid pain and insomnia. Using data from the CHOICE trial that compared acupuncture versus CBT-I for insomnia among cancer survivors, we analyzed the effect of interventions on pain outcomes in 70 patients with moderate to severe baseline pain. Interventions were delivered over eight weeks. We assessed average pain severity (primary outcome) and pain interference at baseline, week 8, and week 20. We further defined insomnia and pain responders as patients who achieved clinically meaningful improvement in insomnia and pain outcomes, respectively, at week 8. We found that compared with baseline, the between-group difference (-1.0, 95% CI -1.8 to -0.2) was statistically significant favoring acupuncture for reduced pain severity at week 8 (-1.4, 95% CI -2.0 to -0.8) relative to CBT-I (-0.4, 95% CI-1.0 to 0.2). Responder analysis showed that 1) with acupuncture, insomnia responders reported significantly greater pain reduction from baseline to week 4, compared with insomnia non-responders (-1.5, 95% CI -2.7 to -0.3); 2) with CBT-I, pain responders reported significantly greater insomnia reduction at week 8, compared with pain non-responders (-4.7, 95% CI -8.7 to -1.0). These findings suggest that among cancer survivors with comorbid pain and insomnia, acupuncture led to rapid pain reductions, which contributed to a decrease in insomnia, whereas CBT-I had a delayed effect on pain, possibly achieved by insomnia improvement.
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Affiliation(s)
- Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Kevin T Liou
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Sheila N Garland
- Department of Psychology and Discipline of Oncology, Memorial University, 232 Elizabeth Avenue, St. John's, NL A1B 3×9, Canada
| | - Ting Bao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Tony K W Hung
- Department of Medicine, Division of Solid Tumor Oncology, Head & Neck Oncology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Susan Q Li
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Jun J Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA.
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28
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Aguirre-Camacho A, Rash JA, Hidalgo B, Wurz A, Garland SN. An experimental study revisiting the link between media attention and breast cancer concern: exploring the role of cognitive fusion. Women Health 2021; 61:976-985. [PMID: 34839804 DOI: 10.1080/03630242.2021.2002999] [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: 10/19/2022]
Abstract
Research examining the link between media attention and breast cancer concern has been frequently conducted with middle/old-age women, even though young women (<40 years old) have been overrepresented media stories about breast cancer. Accordingly, little is known about young women's emotional reactions to breast cancer media messages and the psychological factors modulating such reactions. This study examined the impact of breast cancer media messages and cognitive fusion on negative affect, fear of breast cancer (FBC), and perceived susceptibility to breast cancer. 207 young women were randomly assigned to watch a low- or high-threat video about breast cancer. A MANCOVA revealed that participants who viewed the high-threat video reported greater negative affect and perceived susceptibility, but not FBC; however, participants in both conditions showed moderate/high FBC. Correlational analyses and a MANOVA showed that participants reporting higher cognitive fusion reported higher negative affect across conditions, as well as higher FBC in the high-threat condition. Taken together, these results suggest that young women may show habituation to alarmist media messages, but may nonetheless construe breast cancer as a significant threat. Moreover, young women showing medium/high cognitive fusion seem more likely to show heightened concern upon exposure to alarmist media messages about breast cancer.
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Affiliation(s)
- Aldo Aguirre-Camacho
- Department of Psychology, School of Biomedical Sciences, European University of Madrid, Madrid, Spain
| | - Joshua A Rash
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Beatriz Hidalgo
- Department of Psychology, School of Biomedical Sciences, European University of Madrid, Madrid, Spain
| | - Amanda Wurz
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.,Discipline of Oncology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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29
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Yan AP, Howden K, Glidden C, Romanescu RG, Scott I, Deleemans JM, Chalifour K, Eaton G, Gupta AA, Bolton JM, Garland SN, Mahar AL, Oberoi S. COVID-19-Related Information Sources, Behavioral Changes, and Adherence to Social Distancing Among Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2021; 11:352-359. [PMID: 34597190 DOI: 10.1089/jayao.2021.0126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/23/2022] Open
Abstract
Purpose: This study aimed to assess the sources of COVID-19 information used, behavioral changes in response to the pandemic, and factors associated with adherence to social distancing guidelines among adolescents and young adults (AYAs) with cancer during the COVID-19 pandemic. Methods: We conducted a self-administered online survey of AYAs with cancer (aged 18-39 years) diagnosed between ages 15 and 39 and living in Canada during January and February 2021. Data were summarized using descriptive statistics. Multiple logistic regression was used to identify the factors associated with adherence to the social distancing guidelines. Results: In total, 805 AYAs were included. Participants were most likely to obtain COVID-19-related information from social media (60.5%), news reports (51.6%), and medical professionals (46.5%). The preferred modes of receiving information were websites of cancer organizations (47.9%), social media (44.8%), and medical professionals (40.2%). The common behavioral changes in response to the COVID-19 pandemic included wearing a protective mask (60.2%), avoiding crowded and public places (56.9%), and abiding by social distancing rules (49.4%). On multivariable analysis, participants were more likely to adhere to social distancing rules if they were women, unemployed or collecting disability/unemployment benefits, or had a personal income of <$40,000 in year 2020 (p < 0.05). Conclusion: Social media and websites of cancer organizations are the preferred modes of COVID-19 information. Since many AYAs are nonadherent to preventative health measures, cancer organizations should help develop and disseminate digital resources that provide tailored information to AYAs with cancer during this pandemic.
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Affiliation(s)
- Adam P Yan
- Division of Pediatric Hematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Kaitlyn Howden
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Camille Glidden
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Razvan G Romanescu
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, Canada
| | - Julie M Deleemans
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karine Chalifour
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, St. John's, Canada
| | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, St. John's, Canada
| | - Abha A Gupta
- Division of Pediatric Hematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Adolescent and Young Adult Program, Princess Margaret Cancer Care Research Institute, Toronto, Ontario, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.,Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Canada.,CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Canada
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Squires LR, Bilash T, Kamen CS, Garland SN. Psychosocial Needs and Experiences of Transgender and Gender Diverse People with Cancer: A Scoping Review and Recommendations for Improved Research and Care. LGBT Health 2021; 9:8-17. [PMID: 34495755 DOI: 10.1089/lgbt.2021.0072] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/13/2022] Open
Abstract
The psychosocial needs and experiences of transgender and gender diverse (TGD) people is an understudied area of oncology research. In response to calls to action from past researchers, we conducted a scoping review, which included published and gray literature. From the included articles, the following key themes were identified: (1) lack of coordination between gender-affirming care and cancer care; (2) impact of cancer care on gender affirmation; (3) navigating gendered assumptions; (4) variation in providers' understanding of the needs of TGD patients; and (5) lack of TGD-specific cancer resources. Following this review, we consulted 18 key stakeholders with TGD-relevant personal and/or professional experience to gain further insight into issues that were not encompassed by the original themes. Based on these themes and stakeholder feedback, we offer recommendations for future research and clinical practice to increase awareness of the psychosocial needs of TGD people who have been diagnosed with cancer and to improve patient care.
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Affiliation(s)
- Lauren R Squires
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland, Canada
| | | | - Charles S Kamen
- Cancer Control Unit, Department of Surgery, University of Rochester, Rochester, New York, USA
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland, Canada.,Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
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Genovese TJ, Gehrman P, Yang M, Li Y, Garland SN, Orlow I, Mao JJ. Genetic Predictors of Response to Acupuncture or Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: An Exploratory Analysis. J Pain Symptom Manage 2021; 62:e192-e199. [PMID: 33716034 PMCID: PMC9297333 DOI: 10.1016/j.jpainsymman.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/06/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT Insomnia is a common problem affecting cancer survivors. While effective nonpharmacological treatments are available, it is unknown whether individual genetic characteristics influence treatment response. OBJECTIVES We conducted an exploratory analysis of genetic associations with insomnia treatment response in a randomized trial of cognitive behavioral therapy for insomnia (CBT-I) vs. acupuncture in a heterogeneous group of cancer survivors. METHODS We successfully genotyped 136 participants for 11 genetic variants. Successful treatment response was defined as a reduction in Insomnia Severity Index score of at least eight points from baseline to week 8. We used Fisher exact tests to evaluate associations between genotype and treatment success for each treatment arm, for an alpha level of 0.05 with unadjusted and Holm-Bonferroni-adjusted P-values. RESULTS We found that more carriers of COMT rs4680-A alleles responded to acupuncture compared to the GG carriers (63.6% vs. 27.8%, P = 0.013). More carriers of the NFKB2 rs1056890 CC genotype also responded to acupuncture compared to TT or CT carriers (72.2% vs. 38.9%, P = 0.009). There were no significant differences found between any of the tested gene variants and CBT-I response. None of the results remained statistically significant after adjustment for multiple testing. CONCLUSION In cancer survivors, specific variants in the COMT and NFKB2 genes are potentially associated with response to acupuncture but not to CBT-I. Confirming these preliminary results will help inform precision insomnia management for cancer survivors.
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Affiliation(s)
- Timothy J Genovese
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip Gehrman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - MingXiao Yang
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sheila N Garland
- Departments of Psychology and Oncology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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32
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Garland SN, Savard J, Eisel SL, Wassersug RJ, Rockwood NJ, Thoms J, Jim HSL, Gonzalez BD. A 2-year prospective analysis of insomnia as a mediator of the relationship between androgen deprivation therapy and perceived cognitive function in men with prostate cancer. Cancer 2021; 127:4656-4664. [PMID: 34411294 DOI: 10.1002/cncr.33850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/29/2020] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) may affect cognitive function in men with prostate cancer (PCa). This study examined whether insomnia symptoms mediate the relationship between ADT and perceived cognitive function and whether depressive symptoms, fatigue severity, and physical activity moderate the strength of this relationship. METHODS This was a prospective study of ADT recipients (n = 83) who were matched with control patients with PCa who were not on ADT (n = 92) and with controls with no history of cancer (n = 112) over a 2-year follow-up period. Perceived cognitive function and satisfaction were assessed with the Everyday Cognition Scale. Insomnia was assessed with the Insomnia Severity Index. Multilevel mediation analyses were conducted to estimate the indirect effect of ADT on perceived cognitive function through insomnia symptoms. Exploratory moderated mediation analyses assessed whether the indirect effect of ADT on perceived cognitive function through insomnia symptoms was dependent on levels of fatigue, depression, or physical activity. RESULTS Insomnia symptoms significantly mediated the relationship between receipt of ADT and perceived cognitive function (P < .001) and satisfaction with cognition (P < .001) after controlling for comorbidities. Men with greater fatigue had a more pronounced association of ADT with insomnia severity. Men with greater depressive symptoms had a stronger association between insomnia severity and worse perceived cognitive function. Physical activity was not a significant moderator of the relationship between ADT and perceived cognitive function. CONCLUSIONS Insomnia influenced the relationship between ADT and perceived cognitive abilities. Interventions to address insomnia, fatigue, and depression may improve perceived cognitive function.
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Affiliation(s)
- Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Josée Savard
- School of Psychology, Université Laval, Quebec City, Quebec, Canada.,Laval University Cancer Research Center, Quebec City, Quebec, Canada
| | - Sarah L Eisel
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Richard J Wassersug
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John Thoms
- Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
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Garland SN. A Step in the Right Direction: Making Cognitive-Behavioral Therapy for Insomnia more Accessible to People Diagnosed with Cancer. Sleep 2021; 44:6343146. [PMID: 34357371 DOI: 10.1093/sleep/zsab202] [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: 11/15/2022] Open
Affiliation(s)
- Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL., Canada.,Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, NL, Canada
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34
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Walsh NA, Repa LM, Garland SN. Mindful larks and lonely owls: The relationship between chronotype, mental health, sleep quality, and social support in young adults. J Sleep Res 2021; 31:e13442. [PMID: 34272788 DOI: 10.1111/jsr.13442] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/02/2021] [Revised: 05/22/2021] [Accepted: 06/22/2021] [Indexed: 01/15/2023]
Abstract
Chronotype is related to mental health, with evening chronotypes being more susceptible to psychological disorders than intermediate and morning types. The present study investigated the relationship between chronotype, mental health, sleep quality, and social support in Canadian young adults. We surveyed 3160 university students aged 18-35 years. Participants completed the Morningness-Eveningness Questionnaire, the Hospital Anxiety and Depression Scale, the Mindful Attention Awareness Scale, the Pittsburgh Sleep Quality Index, and the Medical Outcomes Study - Social Support Survey. We conducted Bonferroni-corrected one-way analyses of covariance with post hoc paired comparisons to determine the relationship between the aforementioned variables, with age and sex as covariates. We further looked at the moderation of social support on the relationship between chronotype and sleep quality. Overall, 55%, 36% and 9% of participants were classified as intermediate, evening and morning types, respectively. There was a significant difference between chronotype on levels of depression, anxiety, and sleep quality, with evening types reporting more severe symptomology than morning-types and intermediate types. Morning types reported greater levels of overall social support and mindfulness. Evening types reported the lowest levels of all types of social support. Social support did not moderate the relationship between chronotype and sleep quality. This study further demonstrates the association between worse psychological well-being and eveningness and between more social support, and mindfulness in morning chronotype young adults. Education and intervention are warranted to help evening chronotypes manage the potential negative features of their circadian rhythm, as well as to cultivate a greater sense of social support and mindfulness.
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Affiliation(s)
- Nyissa A Walsh
- Department of Psychology, Faculty of Science, Memorial University of Newfoundland, St. John's, NF, Canada
| | - Lily M Repa
- Department of Psychology, Faculty of Science, Memorial University of Newfoundland, St. John's, NF, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University of Newfoundland, St. John's, NF, Canada
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35
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Dalton K, Waterman M, Wassersug R, Garland SN. Fear of cancer recurrence in males diagnosed with breast cancer. Support Care Cancer 2021; 29:6183-6186. [PMID: 34023951 DOI: 10.1007/s00520-021-06307-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Fear of cancer recurrence (FCR) is a significant problem for individuals diagnosed with a variety of different cancers. To date, FCR has not been studied in males with breast cancer. The objective of this study was to examine the severity of FCR in males with breast cancer. METHODS Males with breast cancer participated in an anonymous online survey and completed the Fear of Cancer Recurrence Inventory-Short Form scale (FCRI-SF). A frequency analysis was used to determine the percentage of participants that fell above or below the clinical cutoff for significant FCR. Regressions explored associations between FCR, age, cancer stage, time since diagnosis, and self-health rating. RESULTS Fifty-nine participants completed the FCRI-SF. The mean age of the sample was 63.5 and 93% reported their race as white. The mean FCR score was 23.9 and 61% reported clinically significant FCR. More than 80% of the sample experienced at least problematic levels of FCR. Increasing age was associated with decreased FCR. CONCLUSION Results of this study suggest that FCR is prevalent in men with breast cancer but larger studies with representative samples should be undertaken to better assess the prevalence of FCR in this population and compare it with other groups of patients. More attention is needed to understand the psychological distress experienced by men diagnosed and treated for breast cancer.
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Affiliation(s)
- Kathryn Dalton
- Department of Psychology, Faculty of Science, Memorial University, 232 Elizabeth Avenue, St. John's, Newfoundland, A1B 3X9, Canada
| | - Meghan Waterman
- Department of Psychology, Faculty of Science, Memorial University, 232 Elizabeth Avenue, St. John's, Newfoundland, A1B 3X9, Canada
| | - Richard Wassersug
- Department of Cellular & Physiological Science, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, 232 Elizabeth Avenue, St. John's, Newfoundland, A1B 3X9, Canada.
- Discipline of Oncology, Faculty of Medicine, Memorial University, 232 Elizabeth Avenue, St. John's, Newfoundland, A1B 3X9, Canada.
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36
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Dalton KL, Garland SN, Miller P, Miller B, Ambrose C, Wassersug RJ. Factors Associated with "Survivor Identity" in Men with Breast Cancer. ACTA ACUST UNITED AC 2021; 28:1696-1705. [PMID: 33946247 PMCID: PMC8161786 DOI: 10.3390/curroncol28030158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
Cancer patients vary in their comfort with the label “survivor”. Here, we explore how comfortable males with breast cancer (BC) are about accepting the label cancer “survivor”. Separate univariate logistic regressions were performed to assess whether time since diagnosis, age, treatment status, and cancer stage were associated with comfort with the “survivor” label. Of the 70 males treated for BC who participated in the study, 58% moderately-to-strongly liked the term “survivor”, 26% were neutral, and 16% moderately-to-strongly disliked the term. Of the factors we explored, only a longer time since diagnosis was significantly associated with the men endorsing a survivor identity (OR = 1.02, p = 0.05). We discuss how our findings compare with literature reports on the comfort with the label “survivor” for women with BC and men with prostate cancer. Unlike males with prostate cancer, males with BC identify as “survivors” in line with women with BC. This suggests that survivor identity is more influenced by disease type and treatments received than with sex/gender identities.
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Affiliation(s)
- Kathryn L. Dalton
- Department of Psychology, Faculty of Science, Memorial University, St. John’s, NL A1B 3X9, Canada; (K.L.D.); (S.N.G.)
| | - Sheila N. Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John’s, NL A1B 3X9, Canada; (K.L.D.); (S.N.G.)
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John’s, NL A1B 3V6, Canada
| | - Peggy Miller
- The Male Breast Cancer Coalition, Prairie Village, KS 66208, USA; (P.M.); (B.M.); (C.A.)
| | - Bret Miller
- The Male Breast Cancer Coalition, Prairie Village, KS 66208, USA; (P.M.); (B.M.); (C.A.)
| | - Cheri Ambrose
- The Male Breast Cancer Coalition, Prairie Village, KS 66208, USA; (P.M.); (B.M.); (C.A.)
| | - Richard J. Wassersug
- Department of Cellular & Physiological Science, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence: ; Tel.: +1-604-563-9915
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King ER, Repa LM, Garland SN. Factors associated with permissive attitudes of university students towards prescription medication misuse. Journal of Substance Use 2021. [DOI: 10.1080/14659891.2021.1905091] [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: 10/21/2022]
Affiliation(s)
- Eleanor R. King
- Department of Psychology, Memorial University, St. John's, Canada
| | - Lily M. Repa
- Department of Psychology, Memorial University, St. John's, Canada
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Liou KT, Garland SN, Li QS, Sadeghi K, Green J, Autuori I, Orlow I, Mao JJ. Effects of acupuncture versus cognitive behavioral therapy on brain-derived neurotrophic factor in cancer survivors with insomnia: an exploratory analysis. Acupunct Med 2021; 39:637-645. [PMID: 33752446 DOI: 10.1177/0964528421999395] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Decreased brain-derived neurotrophic factor (BDNF) is associated with poor sleep. This study examined the effects of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on serum BDNF and sleep outcomes in cancer survivors with insomnia. METHODS This was an exploratory analysis of a randomized clinical trial (n = 160) comparing acupuncture versus CBT-I for cancer survivors with insomnia. Interventions were delivered over 8 weeks. Outcomes were assessed at baseline and week 8. Serum BDNF was evaluated with enzyme-linked immunosorbent assay (ELISA). Sleep was evaluated with the insomnia severity index and consensus sleep diary. Pearson correlations between BDNF and sleep outcomes were calculated. Data analysis was limited to 87 survivors who provided serum samples. RESULTS Among 87 survivors, the mean age was 61.9 (SD: 11.4) years, 51.7% were women, and 24.1% were non-White. Mean serum BDNF did not significantly increase in acupuncture (n = 50) or CBT-I (n = 37) groups. When analysis was restricted to patients with low baseline BDNF (i.e. levels below the sample median of 47.1 ng/mL), the acupuncture group (n = 22) demonstrated a significant 7.2 ng/mL increase in mean serum BDNF (P = 0.03), whereas the CBT-I group (n = 21) demonstrated a non-significant 2.9 ng/mL increase (P = 0.28). Serum BDNF was not significantly correlated with sleep outcomes (all P > 0.05). CONCLUSION Among cancer survivors with insomnia and low baseline BDNF, acupuncture significantly increased serum BDNF levels; however, the clinical significance of this finding requires further investigation.Trial registration no. NCT02356575 (ClinicalTrials.gov).
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Affiliation(s)
- Kevin T Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Sheila N Garland
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Q Susan Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Keimya Sadeghi
- Molecular Epidemiology Laboratory, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jamie Green
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Isidora Autuori
- Molecular Epidemiology Laboratory, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Irene Orlow
- Molecular Epidemiology Laboratory, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
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Riley KE, Garland SN, Mao JJ, Applebaum AJ, Li QS, Gehrman PR, DuHamel KN, Verrico Z. Hyperarousal and Insomnia in Survivors of Cancer. Int J Behav Med 2021; 28:683-691. [PMID: 33629219 DOI: 10.1007/s12529-021-09962-4] [Citation(s) in RCA: 4] [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] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cancer survivors are prone to insomnia due to the physical and psychological sequelae of cancer and treatment. Individuals with insomnia may present symptoms of hyperarousal. Cancer survivors with insomnia and trait hyperarousal may require different clinical treatments than patients with insomnia without trait hyperarousal. To our knowledge, no study has examined these factors previously. This study examined the relation between insomnia and trait hyperarousal in cancer survivors. METHODS The sample included 160 individuals with previous cancer diagnoses who met DSM-5 criteria for insomnia disorder. Measures were collected with cross-sectional batteries of questionnaires, including the Insomnia Severity Index (ISI) and Hyperarousal Scale (HAS). This study is based on baseline data collected in a randomized clinical trial comparing CBT-I to acupuncture for cancer survivors with insomnia (Garland, Gehrman, Barg, Xie, & Mao, 2016). RESULTS Hyperarousal was positively associated with insomnia (ISI total score) in bivariate correlations (r = .350, p < .01) and linear regressions (F = 22.06, p < .001). In bivariate correlations, hyperarousal was related to perceptions about the consequences of disturbed sleep rather than reported sleep patterns. For example, hyperarousal was positively related to reported satisfaction (r = .159, p < .05) and worry about sleep (r = .415, p < .01), but not to falling asleep, staying asleep, or awakening too early. In regressions, younger age, insomnia duration, and worry about sleep were uniquely associated with hyperarousal when adjusting for insomnia (B = 0.200, B = 0.177, B = -0.182, p < .05). CONCLUSIONS Hyperarousal is associated with psychological appraisal of insomnia rather than reported sleep pattern. Younger age and longer duration of insomnia are associated with trait hyperarousal. These findings suggest targeting trait hyperarousal with amplified psychological treatment may lead to more personalized, effective treatment for insomnia.
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Affiliation(s)
- Kristen E Riley
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA.,Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuyen Rd, Piscataway, NJ, 08854, USA
| | - Sheila N Garland
- Department of Psychology, Memorial University of Newfoundland, 232 Elizabeth Avenue, St. John's, St. John's, Newfoundland and Labrador, A1B 3X9, Canada
| | - Jun J Mao
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA
| | - Allison J Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA
| | - Q Susan Li
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA
| | - Philip R Gehrman
- Perelman School of Medicine, University of Pennsylvania, 3600 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Katherine N DuHamel
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA
| | - Zoe Verrico
- Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuyen Rd, Piscataway, NJ, 08854, USA.
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Garland SN, Trevino K, Liou KT, Gehrman P, Spiguel E, MacLeod J, Walker DAH, Glosik B, Seluzicki C, Barg FK, Mao JJ. Multi-stakeholder perspectives on managing insomnia in cancer survivors: recommendations to reduce barriers and translate patient-centered research into practice. J Cancer Surviv 2021; 15:951-960. [PMID: 33606188 DOI: 10.1007/s11764-021-01001-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/12/2020] [Accepted: 02/06/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Insomnia is a debilitating symptom experienced by nearly 60% of cancer survivors. Building on our prior research showing the clinical benefit of cognitive behavioral therapy for insomnia (CBT-I) and acupuncture, we organized a workshop of patient advocates and clinician stakeholders to understand the barriers and develop recommendations for the dissemination and implementation of these interventions. METHODS Participants completed a pre-workshop survey assessing their experiences with insomnia and barriers to insomnia treatment and participated in a workshop facilitated by professionals and patient experts. Responses from the survey were tabulated and the discussions from the workshop were content-analyzed to extract relevant factors that may influence dissemination and implementation. RESULTS Multidisciplinary and stakeholder workshop participants (N = 51) identified barriers and proposed solutions and future recommendations for dissemination and implementation of evidence-based interventions to improve sleep health in cancer survivors. Barriers were identified in four categories: patient (e.g., knowledge, time, cost), clinician (e.g., education, time, capacity), institutional (e.g., space, insurance reimbursement, referrals), and societal (e.g., lack of prioritization for sleep issues). Based on these categories, we made six recommendations for dissemination and implementation of research findings to improve clinical sleep management in oncology. CONCLUSION Dissemination and implementation efforts are necessary to translate research into clinical practice to improve patient care. IMPLICATIONS FOR CANCER SURVIVORS Sleep needs to be prioritized in cancer care, but patient, provider, and institutional/societal barriers remain. Dedicated effort and resources at each of these levels are needed to help millions of people affected by cancer manage their insomnia and improve their quality of life.
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Affiliation(s)
| | - Kelly Trevino
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin T Liou
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Jodi MacLeod
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Betsy Glosik
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Garland SN, Savard J, Dalton K, Walsh NA, Seal M, Rash J, Browne S, Urquhart R, Thoms J, Gadag V, Laing K. Rationale and protocol for a randomized waitlist controlled trial of videoconference delivered cognitive behaviour therapy for insomnia (CBT-I) to improve perceived cognitive impairment (PCI) among cancer survivors. Contemp Clin Trials 2021; 103:106322. [PMID: 33588077 DOI: 10.1016/j.cct.2021.106322] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/11/2021] [Accepted: 02/06/2021] [Indexed: 01/17/2023]
Abstract
Perceived cognitive impairment (PCI) and sleep disturbances (such as insomnia) are commonly reported barriers preventing cancer survivors from resuming normal functioning. Cognitive-behaviour therapy for insomnia (CBT-I) is the treatment of choice for insomnia among cancer survivors. Literature suggests that treatment with CBT-I may lead to an improvement in PCI, but this needs to be tested in a sample of patients with PCI at study entry with cognitive impairments as the primary study outcome. Here we describe the design of a clinical trial to evaluate the efficacy of videoconference-delivered CBT-I for the improvement of PCI among cancer survivors. This project is a randomized waitlist-controlled trial with a recruitment target of 124 adult cancer survivors (solid tumors and hematological malignancies) who have completed primary treatment at least 6 months prior, report PCI and meet criteria for insomnia disorder. Participants will complete assessments at baseline, 4 weeks (mid-treatment), 8 weeks (post treatment), and 3 and 6 months post-treatment. The primary outcome is the Functional Assessment of Cancer Therapy - Cognitive Function (FACT-Cog). Treatment of PCI in cancer patients is a priority for clinicians, researchers, and patients. This research will increase our understanding of the mechanisms of cognitive impairment associated with cancer, and potentially expand currently available treatment options.
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Affiliation(s)
- Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, Newfoundland and Labrador, Canada; Discipline of Oncology, Faculty of Medicine, Memorial University, Newfoundland and Labrador, Canada; Beatrice Hunter Cancer Research Institute, Halifax, Nova Scotia, Canada.
| | - Josée Savard
- École de psychologie, Université Laval and CHU de Québec-Université Laval Research Center, Quebec, Canada
| | - Kathryn Dalton
- Department of Psychology, Faculty of Science, Memorial University, Newfoundland and Labrador, Canada
| | - Nyissa A Walsh
- Department of Psychology, Faculty of Science, Memorial University, Newfoundland and Labrador, Canada; Beatrice Hunter Cancer Research Institute, Halifax, Nova Scotia, Canada
| | - Melanie Seal
- Discipline of Oncology, Faculty of Medicine, Memorial University, Newfoundland and Labrador, Canada
| | - Joshua Rash
- Department of Psychology, Faculty of Science, Memorial University, Newfoundland and Labrador, Canada
| | - Sondria Browne
- Department of Psychology, Faculty of Science, Memorial University, Newfoundland and Labrador, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Canada
| | - John Thoms
- Discipline of Oncology, Faculty of Medicine, Memorial University, Newfoundland and Labrador, Canada
| | - Veeresh Gadag
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Newfoundland and Labrador, Canada
| | - Kara Laing
- Discipline of Oncology, Faculty of Medicine, Memorial University, Newfoundland and Labrador, Canada
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Peoples AR, Pigeon WR, Li D, Garland SN, Perlis ML, Inglis JE, Vinciguerra V, Anderson T, Evans LS, Wade JL, Ossip DJ, Morrow GR, Wolf JR. Association Between Pretreatment Sleep Disturbance and Radiation Therapy-Induced Pain in 573 Women With Breast Cancer. J Pain Symptom Manage 2021; 61:254-261. [PMID: 32768555 PMCID: PMC7854971 DOI: 10.1016/j.jpainsymman.2020.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/31/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Pain can be a debilitating side effect of radiation therapy (RT). Data from the general population have shown that sleep disturbance can influence pain incidence and severity; however, less is known about this relationship in patients with breast cancer receiving RT. OBJECTIVES This secondary analysis examined the association of pretreatment moderate/severe levels of sleep disturbance with subsequent RT-induced pain after adjusting for pre-RT pain. METHODS We report on 573 female patients with breast cancer undergoing RT from a previously completed Phase II clinical trial for radiation dermatitis. Sleep disturbance, total pain, and pain subdomains-sensory pain, affective pain, and perceived pain intensity were assessed at pre-RT and post-RT. At pre-RT, patients were dichotomized into two groups: those with moderate/severe sleep disturbance (N = 85) vs. those with no/mild sleep disturbance (control; N = 488). RESULTS At pre-RT, women with moderate/severe sleep disturbance were younger, less likely to be married, more likely to have had mastectomy and chemotherapy, and more likely to have depression/anxiety disorder and fatigue than the control group (all Ps < 0.05). Generalized estimating equations model, after controlling for pre-RT pain and other covariates (e.g., trial treatment condition and covariates that were significantly correlated with post-RT pain), showed that women with moderate/severe sleep disturbance at pre-RT vs. control group had significantly higher mean post-RT total pain as well as sensory, affective, and perceived pain (effect size = 0.62, 0.60, 0.69, and 0.52, respectively; all Ps < 0.05). CONCLUSION These findings suggest that moderate/severe disturbed sleep before RT is associated with increased pain from pre-to-post-RT in patients with breast cancer.
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Affiliation(s)
- Anita R Peoples
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, New York, USA.
| | - Wilfred R Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Dongmei Li
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Sheila N Garland
- Departments of Psychology and Oncology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julia E Inglis
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | | | | | - Lisa S Evans
- Southeast Clinical Oncology Research Consortium NCORP, Winston-Salem, North Carolina, USA
| | - James L Wade
- Heartland Cancer Research NCORP, Decatur, Illinois, USA
| | - Deborah J Ossip
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, New York, USA; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Gary R Morrow
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA
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Rodriguez N, Fawcett JM, Rash JA, Lester R, Powell E, MacMillan CD, Garland SN. Factors associated with cognitive impairment during the first year of treatment for nonmetastatic breast cancer. Cancer Med 2021; 10:1191-1200. [PMID: 33455070 PMCID: PMC7926005 DOI: 10.1002/cam4.3715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/22/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background Women with breast cancer are more likely to develop cognitive impairment (CI), insomnia, fatigue, and mood disturbance than individuals with other cancers. The main objectives of this study were to establish the prevalence of CI and examine the relationships between CI, insomnia, fatigue, and mood over the first year of breast cancer treatment. Methods Participants were recruited after diagnosis and completed validated measures of insomnia, objective and perceived CI, fatigue, and mood disturbance at four time points during the first year of treatment. A random intercepts cross‐lagged panel model assessed relationships among symptoms over time. Results The sample included 98 women. Prevalence of objective CI ranged from 3.1% to 8.2% throughout the year, whereas 36.7% demonstrated a clinically meaningful decline in perceived CI from baseline to 4 months, which remained relatively stable. Greater perceived CI was associated with more fatigue (β = −0.78, z = 17.48, p < .01) and symptoms of insomnia (β = −0.58, z = 5.24, p < .01). Short‐term fluctuations in perceived CI (p < .05), but not fatigue or insomnia, predicted future perceived CI. Fatigue (p < .001) was a significant predictor of future reported symptoms of fatigue and insomnia. Conclusion Subjective CI is more prevalent than objective impairments. Fatigue, insomnia, and perceived CI remain stable and are associated during the first year of treatment. Changes in insomnia and fatigue may have little effect on future perceived cognition. Women with breast cancer likely require targeted intervention for these side effects.
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Affiliation(s)
- Nicole Rodriguez
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland, Canada
| | - Jonathan M Fawcett
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland, Canada
| | - Joshua A Rash
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland, Canada
| | - Renee Lester
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Erin Powell
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Connor D MacMillan
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland, Canada.,Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
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Schulte FSM, Chalifour K, Eaton G, Garland SN. Quality of life among survivors of adolescent and young adult cancer in Canada: A Young Adults With Cancer in Their Prime (YACPRIME) study. Cancer 2020; 127:1325-1333. [PMID: 33332603 DOI: 10.1002/cncr.33372] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 08/12/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The quality of life (QoL) among survivors of adolescent and young adult (AYA) cancer may be compromised compared with that in the general population. In this study, the authors: 1) assessed for differences in QoL among a national study of AYA cancer survivors compared with the Canadian population and 2) explored the factors associated with poorer QoL in AYA cancer survivors. METHODS For the current research, data from the Young Adults With Cancer in Their Prime study were used. QoL was measured using physical and mental component scores from a 12-item short-form health status measure. A comparison group was derived from the Canadian Community Health Survey. RESULTS AYAs (n = 195; 17.8% male; mean ± SD: 35.62 ± 6.89 years on study, 6.48 ± 5.73 years from treatment) were compared with a comparison sample (n = 665; 21.2% male). Among survivors, 31.8% reported poor physical health, and 49.7% reported poor mental health. Compared with the general population, AYAs had significantly lower physical health (F[1,818] = 52.80; P = .00) and mental health (F[1,818] = 83.54; P = .00), controlling for sex and age. Multivariable logistic regression analyses revealed that an annual income level <$40,000 (adjusted odds ratio [AOR], 8.32; 95% CI, 2.85-24.30), poor sleep quality (AOR, 1.19; 95% CI, 1.06-1.33), worse body image (AOR, 1.08; 95% CI, 1.02-1.14), and higher social support (AOR, 1.02; 95% CI, 1.00-1.05) were significantly associated with poor physical health. Poor sleep quality (AOR, 1.22; 95% CI, 1.08-1.38), body image (AOR, 1.06; 95% CI, 1.01-1.12), fear of cancer recurrence (AOR, 1.13; 95% CI, 1.06-1.21) were associated with poor mental health. CONCLUSIONS The QoL of AYAs requires urgent attention. Sleep, body image, and social support may be important modifiable targets for intervention to improve their QoL.
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Affiliation(s)
- Fiona S M Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Hematology, Oncology, and Transplant program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | - Geoff Eaton
- Young Adult Cancer Canada, St John's, Newfoundland, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University of Newfoundland, St John's, Newfoundland, Canada
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Galvin KT, Garland SN, Wibowo E. The Association between Insomnia and Orgasmic Difficulty for Prostate Cancer Patients - Implication to Sex Therapy. J Sex Marital Ther 2020; 47:174-185. [PMID: 33225866 DOI: 10.1080/0092623x.2020.1848947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sexual dysfunction and insomnia are common side effects of prostate cancer (PCa) treatment, but the link between these symptoms has not been explored. We explore here the association between various sexual parameters and insomnia symptoms in PCa patients. Data were collected via an online survey with recruitment through various PCa organizations. One hundred and forty two patients (age = 67.3 ± 8.9 years) completed the survey. The majority were in a relationship (84.6%), of Caucasian ethnicity (83.1%), and 33% had previously received androgen deprivation therapy (ADT). Control variables-age, number of comorbidities, past ADT use, body mass index, depression, anxiety, fatigue and daytime sleepiness-explained 58.2% of the variance for insomnia symptoms. Including orgasm difficulty in the models accounted for an additional 2.1% in the variance in insomnia symptoms. Conversely, the control variables listed above together with insomnia symptoms predicted 37.7% of the overall variance in orgasm difficulty in PCa patients. These data suggest that sexual rehabilitation programs for PCa patients should assess insomnia symptoms, and therapies to improve sexual function or sleep quality may be beneficial in both functions given the relationship between sleep and orgasm functions in this population.
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Affiliation(s)
| | - Sheila N Garland
- Department of Psychology and Discipline of Oncology, Memorial University, St. John's, Canada
| | - Erik Wibowo
- Department of Anatomy, University of Otago, Dunedin, New Zealand
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Lane B, Fowler K, Eaton G, Chalifour K, Garland SN. Prevalence and factors associated with high levels of distress in young adult cancer survivors compared to matched peers. Support Care Cancer 2020; 29:2653-2662. [PMID: 32970230 DOI: 10.1007/s00520-020-05785-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/29/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Young adulthood can be a difficult period of development and disruption of age-related milestones can impact psychological well-being. This study examined whether psychological distress differs in young adult (YA) cancer survivors compared to their non-cancer peers and identified factors related to high distress in YA cancer survivors. METHODS Canadian YAs (n = 448) diagnosed between the ages of 15 and 39 were compared with age-, sex-, and education-matched controls (n = 448) randomly sampled from the 2012 Canadian Community Health Survey-Mental Health. The primary measure was the Kessler Psychological Distress Scale (K10). Groups were compared using independent-samples t tests and chi-square tests of independence. Logistic regression was used to examine the factors associated with high (moderate/severe) distress for YA cancer survivors. RESULTS YA cancer survivors reported significantly higher distress than their matched peers (24.89 vs. 15.75; p < .0005). In the multivariate model, greater years of education were associated with a decreased likelihood of high distress (adjusted odds ratio (AOR) = 0.84, p = .001). Compared with those working, those in school (AOR = 6.81, p = .003) or not in school/working (AOR = 4.13, p < .0005) reported higher distress. Psychological factors associated with high distress in YA cancer survivors included body image dissatisfaction (AOR = 1.09, p < .0005), poor social support (AOR = 5.19, p = .011), and elevated fears of cancer recurrence (maladaptive: AOR = 6.39, p = .001; clinical: AOR = 12.31, p < .0005). CONCLUSIONS YA cancer survivors experience significantly greater distress than their non-cancer peers. This distress is associated with modifiable factors such as body image dissatisfaction, social support, and fear of cancer recurrence, illustrating key areas for intervention.
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Affiliation(s)
- Breanna Lane
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
| | - Ken Fowler
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
| | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, NL, Canada
| | | | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada. .,Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
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Vani MF, Sabiston CM, Petrella A, Adams SC, Eaton G, Chalifour K, Garland SN. Body image concerns of young adult cancer survivors: A brief report. J Psychosoc Oncol 2020; 39:673-679. [PMID: 32902366 DOI: 10.1080/07347332.2020.1815926] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND The purpose of this study was to describe body image among young adult (YA) cancer survivors and examine relationships between body image and personal, medical, and psychosocial variables. Methods: YAs (n = 522; Mage = 34 ± 6 years) completed an online survey and data were analyzed using descriptive statistics, bivariate correlations, and appropriate tests of mean differences. Results: Higher body image concerns were related to less time since diagnosis, lower post-traumatic growth and social support, greater distress, and a higher number of treatments received (rs = .09 to .42; ps < .05). Body image concerns were higher for those currently on treatment (p < .05). Conclusions: Findings suggest greater attention to YAs' body image is necessary. Specifically, longitudinal research and the development of strategies dedicated to reducing body image concerns among YAs are needed.
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Affiliation(s)
- Madison F Vani
- Department of Exercise Sciences, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Catherine M Sabiston
- Department of Exercise Sciences, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Anika Petrella
- Department of Exercise Sciences, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Scott C Adams
- Department of Exercise Sciences, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Karine Chalifour
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Daniel LC, Sabiston CM, Pitock M, Gupta AA, Chalifour K, Eaton G, Garland SN. Fertility Preservation in Young Adults: Prevalence, Correlates, and Relationship with Post-Traumatic Growth. J Adolesc Young Adult Oncol 2020; 10:389-396. [PMID: 32721255 DOI: 10.1089/jayao.2020.0073] [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
Purpose: This study describes the prevalence of fertility preservation (FP) knowledge, discussions, and engagement in a heterogeneous sample of Canadians diagnosed with cancer in young adulthood and tests the relationship of these variables with later post-traumatic growth (PTG). Methods: Data were taken from the Young Adults with Cancer in their Prime (YACPRIME) study, a national cross-sectional survey of Canadians diagnosed with cancer as young adults. This subanalysis included 463 individuals, ages 20-39 years (mean = 30.28, standard deviation = 4.68, 88% female), diagnosed after 2006. Participants self-reported demographics, responded to questions regarding their experience with FP, and completed the PTG inventory. Results: In total, 81% reported awareness of risk, 52% discussed FP, and 13% pursued FP. PTG was higher for those with knowledge of fertility risk [F (3, 455) = 3.26, p = 0.021], when controlling for sex and on treatment status, but did not differ between those who discussed FP versus not, or made arrangements versus not. Those who reported not engaging in FP because of their own choice [F(3, 402) = 5.98; p = 0.001] or their doctor's recommendation not to delay treatment [F(3, 402) = 3.25; p = 0.022] reported significantly higher PTG, when controlling for sex and on-treatment status. Financial reasons, lack of knowledge about FP, and age were not related to PTG. Conclusions: This study demonstrates that FP discussions and uptake remain low, highlighting the need for continued education and efforts to improve access to intervention. Knowledge of risk, along with making the choice to prioritize treatment over FP, was related to higher PTG, suggesting informed decisions made early in treatment may support positive psychosocial outcomes.
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Affiliation(s)
- Lauren C Daniel
- Department of Psychology, Rutgers University, Camden, New Jersey, USA
| | - Catherine M Sabiston
- Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Morgan Pitock
- Department of Psychology, Rutgers University, Camden, New Jersey, USA
| | - Abha A Gupta
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, Newfoundland, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Newfoundland, Canada
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49
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Walsh NA, Rodriguez N, Repa LM, King E, Garland SN. Associations between device use before bed, mood disturbance, and insomnia symptoms in young adults. Sleep Health 2020; 6:822-827. [PMID: 32674997 DOI: 10.1016/j.sleh.2020.04.004] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Young adults (YAs) are vulnerable to insomnia and mood disturbance. YAs also engage in back-lit device use which has been implicated in the development and maintenance of insomnia. This study explored the association between device use, mood disturbance, and insomnia symptoms in YAs. PARTICIPANTS Two thousand three hundred and ninety students at a Canadian university, aged 18-35 years. DESIGN Cross-sectional online survey MEASUREMENTS: Participants self-reported duration and frequency of back-lit device use before sleep and during the night. The Insomnia Severity Index and the Hospital Anxiety and Depression Scale were used to measure symptoms. Univariate and multivariate logistic regressions explored associations between device use behaviors and insomnia symptoms. A hierarchical regression analysis identified the unique contribution of back-lit device use on insomnia severity adjusting for mood disturbance, age, and sex. RESULTS Using a back-lit device for 1-2 hours after lights out (adjusted odds ratio [AOR] = 1.50, p < 0.001), being awakened by a device (AOR = 1.34, p = 0.002), and believing that device use negatively impacts sleep (AOR = 2.27, p < 0.001) were associated with insomnia symptoms. Depression contributed to the greatest unique variance to insomnia (11.8%), followed by anxiety (7.2%). Duration of device use after lights out, being awakened by a device and a negative perception of device use on sleep accounted for an additional 3%. CONCLUSIONS Device use contributed to insomnia symptoms over and above mood disturbance, age, and biological sex in YAs. Additional research is needed to determine the direction of effect and inform prevention/intervention programs specific to device use and insomnia symptomology in this population.
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Affiliation(s)
- Nyissa A Walsh
- Department of Psychology, Faculty of Science, Memorial University of Newfoundland, St. John's, Canada
| | - Nicole Rodriguez
- Department of Psychology, Faculty of Science, Memorial University of Newfoundland, St. John's, Canada
| | - Lily M Repa
- Department of Psychology, Faculty of Science, Memorial University of Newfoundland, St. John's, Canada
| | - Eleanor King
- Department of Psychology, Faculty of Science, Memorial University of Newfoundland, St. John's, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University of Newfoundland, St. John's, Canada.
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50
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Liou KT, Root JC, Garland SN, Green J, Li Y, Li QS, Kantoff PW, Ahles TA, Mao JJ. Effects of acupuncture versus cognitive behavioral therapy on cognitive function in cancer survivors with insomnia: A secondary analysis of a randomized clinical trial. Cancer 2020; 126:3042-3052. [PMID: 32320061 DOI: 10.1002/cncr.32847] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/02/2019] [Revised: 01/29/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer-related cognitive impairment is a prevalent, disruptive condition potentially exacerbated by sleep disturbances. The current study was performed to evaluate the effects of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on objective and subjective cognitive function in cancer survivors with insomnia. METHODS Using data from a randomized clinical trial (160 survivors) that compared acupuncture versus CBT-I for insomnia occurring in cancer survivors, the authors analyzed cognitive outcomes and their relationship to insomnia symptoms. Analysis was limited to 99 patients who reported baseline cognitive difficulties. Interventions were delivered over 8 weeks. Objective attention, learning, and memory were evaluated using the Buschke Selective Reminding Test. Subjective cognitive function was assessed using the Brown Attention-Deficit Disorder Scales. Insomnia symptoms were assessed using the Insomnia Severity Index. All outcomes were collected at baseline, week 8, and week 20. RESULTS From baseline to week 8, acupuncture produced statistically significant within-group improvements in objective attention (Cohen D, 0.29), learning (Cohen D, 0.31), and memory (Cohen D, 0.33) that persisted to week 20 (all P < .05), whereas CBT-I produced a statistically significant within-group improvement in objective attention from baseline to week 20 (Cohen D, 0.50; P < .05); between-group differences were not statistically significant. Both interventions produced statistically significant within-group improvements in subjective cognitive function at weeks 8 and 20 compared with baseline (all P < .001); between-group differences were not statistically significant. In the acupuncture group, patients with clinically meaningful responses with regard to insomnia symptoms demonstrated a significantly greater improvement in subjective cognitive function compared with those without clinically meaningful insomnia responses (P = .006). CONCLUSIONS Among cancer survivors with insomnia, both acupuncture and CBT-I produced significant improvements in objective and subjective cognitive function. However, the effect sizes varied and only survivors in the acupuncture group demonstrated a significant relationship between cognitive and sleep outcomes. These preliminary findings warrant further investigation to guide the personalized management of patients with cancer-related cognitive impairment.
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Affiliation(s)
- Kevin T Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sheila N Garland
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Jamie Green
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Q Susan Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Philip W Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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