Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers

CONTEXT

Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment.

OBJECTIVES

Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time.

METHODS

Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor.

RESULTS

Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms.

CONCLUSION

Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.

Social determinants of health, psychological distress, and caregiver burden among informal cancer caregivers of cancer survivors during treatment

OBJECTIVE

This study compared three ethnic/racial groups of informal cancer caregivers on social determinants of health and tested social determinants of health as predictors of psychological distress and caregiver burden.

METHODS

This study was a secondary analysis of baseline data of a sequential multiple assignment randomized trial (SMART) testing symptom management interventions with caregiver-survivor dyads. Caregivers completed baseline measures of social determinants of health (SDoH), functional limitations, psychological distress, and caregiver burden. Hispanic, non-Hispanic White, and non-Hispanic other races caregivers were compared on these variables. Multivariate tests of associations between SDoH and caregiver burden and psychological distress were conducted in structural equation modeling with caregiver burden and psychological distress as latent variables.

RESULTS

Hispanic caregivers reported significantly higher caregiver burden, specifically for finances, family, and schedules. Caregiver burden was significantly predicted by having income barely or not meeting needs, being female, socially isolated, married, Hispanic, and having poor physical functioning. Significant predictors of caregivers' psychological distress: being female, being socially isolated, and having poor physical functioning.

CONCLUSION

Hispanic caregivers experience significant challenges associated with caregiver burden, especially if they are female, socially isolated, and have poor physical functioning. Assessment of these SDoH is important in caregiver health to provide supportive care during caregiving.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03743415 www.clinicaltrials.gov.

A Sequential Multiple Assignment Randomized Trial of Symptom Management After Chemotherapy

CONTEXT

Many cancer survivors experience a lingering symptom burden after chemotherapy.

OBJECTIVES

In this sequential multiple assignment randomized trial, we tested optimal sequencing of two evidence-based interventions for symptom management.

METHODS

Survivors of solid tumors (N = 451) were interviewed at baseline and stratified as high or low need for symptom management based on comorbidity and depressive symptoms. High need survivors were randomized initially to the 12-week Symptom Management and Survivorship Handbook (SMSH, N = 282) or 12-week SMSH with eight weeks of Telephone Interpersonal Counseling (TIPC, N = 93) added during weeks one to eight. After four weeks of the SMSH alone, non-responders on depression were re-randomized to continue with SMSH alone (N = 30) or add TIPC (N = 31). Severity of depression and summed severity index of 17 other symptoms over weeks one to13 were compared between randomized groups and among three dynamic treatment regimes (DTRs): 1) SMSH for 12 weeks; 2) SMSH for 12 weeks with eight weeks of TIPC from week one; 3) SMSH for four weeks followed by SMSH+TIPC for eight weeks if no response to the SMSH alone on depression at week four.

RESULTS

There were no main effects for randomized arms or DTRs, but there was a significant interaction of trial arm with baseline depression favoring SMSH alone during weeks one to four in the first randomization and SMSH+TIPC in the second randomization.

CONCLUSION

The SMSH may represent a simple effective option for symptom management, adding TIPC only when there is no response to SMSH alone for people with elevated depression and multiple co-morbidities.

Family caregivers of those with cancer: quality of life outcomes from a sequential multiple assignment randomized trial

PURPOSE

To conduct a secondary analysis focused on health-related quality of life (HRQOL) among caregivers engaged in a 12-week complementary therapy sequential multiple assignment randomized trial (SMART) of reflexology and/or meditative practices (MP), to manage cancer patients' symptoms.

METHODS

In this SMART, patient-caregiver dyads were initially randomized to 4 weeks of caregiver-delivered reflexology for the patient (N = 150), MP with the patient (N = 150), or control (N = 47). After 4 weeks, dyads with patients not improving on fatigue (non-responders, n = 69 to reflexology and n = 57 to MP) were re-randomized to continue the same therapy or add the other therapy for an additional 4 weeks. Week-12 caregiver HRQOL was measured using the Patient Reported Outcomes Measurement Information System (PROMIS) Profile-29 and the Caregiver Reaction Assessment Tool (CRAT) for caregiver burden; scores were analyzed using general linear models.

RESULTS

In the comparison of 4 adaptive intervention sequences: reflexology for 8 weeks, reflexology for 4 weeks followed by MP for 4 weeks if no response to reflexology, MP for 8 weeks, and MP for 4 weeks followed by reflexology for 4 weeks if no response to MP, there were no differences in PROMIS-29 scores. However, CRAT domains of impact on schedule, family support, and finances worsened when adding reflexology after the first 4 weeks of MP. The CRAT domain of health worsened by adding either intervention compared to continuing the same one.

CONCLUSIONS

Clinicians should be aware that caregiver engagement in more than one complementary therapy may increase caregiver burden in some domains but not affect other HRQOL domains.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02759146.

Abstract PO-020: An examination of online experiences among young adult cancer patients and caregivers reveals the pervasiveness and influence of diet and supplement-related misinformation

Purpose: Adolescent and young adult (AYA) patients and caregivers identify unmet information needs as a top priority, in part, because they experience disparities throughout cancer, including higher mortality, financial toxicity, lack of support, and late diagnosis. While the Internet is increasingly used by this population for cancer information seeking, the perception of online information among AYAs is not well studied. We describe AYA patients and caregivers' experiences with online cancer information. Methods: From March-July 2021, we recruited participants via online repositories (e.g., ResearchMatch), posted flyers on social media, and a large AYA conference. We conducted telephone interviews with AYA cancer patients and caregivers who spoke English and were ages 18-39 (N=17). We summarized sociodemographic and cancer factors, then categorized feedback about participant's experiences with 1) cancer information/misinformation and 2) the influence of misinformation on their decisions and behaviors. Results: Average age was 32 years (SD: 3.9), 65% identified as female and 53% had a graduate degree. Daily social media use was common: Facebook (65%), Instagram (65%), YouTube (53%), Twitter (47%), LinkedIn (23%), TikTok (23%), Snapchat (18%) and Pinterest (18%). Participants noted that cancer information on social media is problematic because it is non-specialized, inaccurate and/or unhelpful. Over one-third felt cancer information on social media remains very inaccessible because it is vague or not relevant to their cancer diagnosis (e.g., rare cancers). Three participants experienced unsolicited advice or rude/insensitive comments online, including judgements about delaying treatment or pressure to maintain a toxic positivity about the cancer experience. The majority reported online misinformation focused on diet and lifestyle changes including using essential oils, taking supplements-like ESSIAC (e.g., herbal tea alternative to chemotherapy), changing to a vegan or sugar free diet, and/or drinking alkaline water. Misinformation exposure led participants to engage other online sources (i.e., WebMD) and their healthcare providers to investigate online claims. Some participants experimented with diet-related claims they deemed would have no detrimental effect on their health or treatment (i.e., drinking alkaline water). Participants who experienced unsolicited and insensitive comments blocked the user or unadded them from their personal pages, while one participant chose to completely stop posting their cancer experience on social media. Conclusions: AYAs may be especially vulnerable to online information that seeks to alter their perceptions of cancer, cancer treatment, and cancer caregiving, particularly in the context of lifestyle behaviors. If they felt it was safe, participants acted upon information of questionable legitimacy from social media. Other negative aspects of online cancer interactions influenced caregivers' decisions to leave online support communities and modify relationships with their social networks.

Citation Format: Echo L. Warner, Margaret Raber, Ashley Green, Keely Smith, Jennifer Traslavina Jimenez, Terry Badger. An examination of online experiences among young adult cancer patients and caregivers reveals the pervasiveness and influence of diet and supplement-related misinformation [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-020.

Abstract PO-094: Financial hardship associations with presenteeism and absenteeism among survivors and informal caregivers during cancer treatment

Purpose: People with low perceived work performance and those who are absent from work may be at increased risk for negative employment and financial outcomes during cancer treatment. Thus, we evaluated associations between reports of financial hardship and cancer survivors' and caregivers' perceived work performance and absenteeism. Methods: Participants were surveyed during a larger study on symptom management in survivor-caregiver dyads. We limited to respondents who were employed (N=165). Survey variables included employment status, work performance, sociodemographics, perceived work performance in the prior week, performance in the prior year, and absences from work in the prior week using items from the World Health Organization Health and Work Questionnaire, and financial hardship. Financial hardship included four questions asking whether participants' income met their financial needs, adequacy of financial resources to pay for needs, and for caregivers, whether caregiving had caused financial strain. We summarized sociodemographics and conducted regression analyses to evaluate associations between presenteeism and absenteeism and financial hardship, controlling for sociodemographic factors. Results: On average, caregivers were 50.0 years (Standard Deviation (SD): 13.4) and survivors were 53.9 years (SD: 10.4). The most common relationship between survivors and caregivers was caregivers being spouses (41.7%) and children (22.9%). Caregivers reported working at higher rates (53.9% vs 22.1%, p<0.001) and more hours than survivors (Mean=34.8 vs 33.6 hours, p=0.77). Survivors reported their job performance as 79.5% while caregivers reported theirs as 83.1% on a 0-100% scale. In the week prior, survivors reported absence from work for 0.95 hours while caregivers reported 0.84 hours. In the year prior to diagnosis, survivors and caregivers reported higher than current performance (84.4% and 85.2%, respectively). Caregivers whose finances were adequate to pay for the things they needed for caregiving reported 5.8% higher job performance in the prior year compared to those whose finances did not cover their caregiving expenses (95% Confidence Interval: 0.17-11.5, p=0.04), when controlling for sex, ethnicity, race, income, and education. Conclusions: Cancer patients and caregivers suffer work performance problems during cancer treatment, and this may influence their quality of life. Spouses and children of cancer survivors missed work and reported not working up to their prior performance level. Interventions to address symptom management and psychological distress may decrease absenteeism, promote higher perceived job performance, and allow more survivors and their caregivers to maintain or return to stable employment. Young adult cancer survivors and caregivers, who are still establishing themselves in careers and financially, may especially benefit from these interventions and flexible workplace policies.

Citation Format: Echo L. Warner, Jessica G. Rainbow, Alla Sikorski, Chris Segrin, Terry Badger. Financial hardship associations with presenteeism and absenteeism among survivors and informal caregivers during cancer treatment [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-094.

Abstract PO-019: General social media use amongst young adult cancer patients and caregivers

Purpose: Our purpose was to describe the social media platforms and experiences of adolescent and young adult (AYA) cancer patients and caregivers. We aimed to identify the general social media use of this group in order to determine the information seeking and sharing behaviors within the AYA cancer experience. Methods: From March 2021 to July 2021, we recruited participants through online repositories (e.g., ResearchMatch), and posted flyers on social media and at a large adolescent and young adult (AYA) conference. Eligible participants included 1) cancer patients who were between the ages of 18-39 and were diagnosed within this age range, use social media weekly, and speaks English and 2) informal cancer caregivers between the ages of 18-39, use social media weekly, and speaks English. Semi-structured interviews were conducted with participants over the telephone. We summarized sociodemographic and cancer factors, then categorized qualitative and quantitative data about general social media usage into platform use, differences between platform experiences, and information found. Results: There were 50 participants who completed an online screening form regarding social media platform usage, 17 of whom completed the study (36.0% participation rate). Of the 17 participants, Facebook (88.2%), Instagram (82.3%), and Twitter (76.5%) were the most common social media platforms used. Participants described that when using social media during cancer their preferred platforms were Facebook and Instagram, respectively, because of their ease of use and accessibility. This allowed a large population of cancer patients to be active on these platforms. Facebook was used most frequently for finding support through “groups”, from which participants could seek advice, anecdotes, or support from other cancer patients. On Instagram, participants most often interacted with cancer information through cancer specific pages like “Stupid Cancer” or “The Cancer Patient”. These pages target the adolescent-young adult age group. Participants felt as if the aspect of humor, the sharing of survival stories, research findings and opportunities, and fellow cancer survivors within the comments or through direct messages helped support them. The anecdotes/stories that were shared on social media often detailed a patient's treatment regimen, survivorship, and daily life, which helped patients and caregivers analyze their own cancer experiences and routines. Conclusions: Adolescents and young adults are diagnosed at a developmentally unique time in life, where they may seek support and comfort through social media platforms. By studying the types of platforms used, the reasons for using social media, and patterns of social media use this work provides a foundation for targeting AYA cancer patients and caregivers for social media interventions.

Citation Format: Keely K. Smith, Ashley Green, Jennifer Traslavina Jimenez, Terry Badger, Echo L. Warner. General social media use amongst young adult cancer patients and caregivers [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-019.

Abstract PO-014: Online cancer misinformation interventions for young adult cancer patients and caregivers

Purpose: We aimed to identify potential intervention strategies to mitigate the influence of online cancer misinformation among young adult cancer patients and caregivers. Adolescent and young adult (AYA) patients and caregivers suffer from health disparities throughout the cancer experience, including lack of knowledge about resources and support available. Methods: Participants completed an online survey and semi-structured interviews over the telephone, which lasted 19-40 minutes (average= 33.7 minutes). We calculated descriptive statistics on sociodemographic and cancer factors. Participant's expectations and suggestions for interventions that mitigate cancer misinformation were categorized through qualitative description. Results: Of 50 screened participants, 17 completed an interview and an online survey (34% participation rate). Participants were 64.7% female, and relatively diverse: 52.9% White, 29.4% Black, 11.8% Asian, 5.9% American Indian/Alaska Native, and 5.9% preferred not to answer. Participants had multiple suggestions on how to improve social media cancer information for patients and caregivers in three areas: platform suggestions, clinician suggestions, and concerns about privacy. Feedback to resolve platform problems included adding filters/warnings to platforms to block insensitive or inaccurate information, adding more virtual events for cancer patients and caregivers (e.g., zoom calls or online conferences that share resources, personal stories, and provide interaction with fellow AYA patients/caregivers), and having an option to mute ads or suggested pages that contained cancer information. Participants also suggested that clinicians should be more vocal about recommending high quality cancer-based social media pages and online resources. Finally, some participants worried about the confidentiality of their cancer online. For example, some were concerned that online information seeking would lead their cancer diagnoses to be exposed to employers on social media. One suggestion to ameliorate this issue was to have an option of blocking specific accounts from seeing posts or group statuses that contained sensitive information about the cancer experience. Conclusions: Young cancer patients and caregivers are exposed to online cancer misinformation, and this may negatively influence their engagement in cancer care, relationships with others, and self-perception. We identify potential opportunities for social media businesses, health care teams, and legal entities to intervene with young patients and caregivers.

Citation Format: Ashley J. Green, Keely Smith, Jennifer Traslavina Jimenez, Margaret Raber, Terry Badger, Echo L. Warner. Online cancer misinformation interventions for young adult cancer patients and caregivers [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-014.

Abstract PO-095: Improving informal caregivers and cancer survivors' psychological distress, symptom management and health care use follow-up interviews

Purpose: Adolescents and young adults (AYAs) experience disparately higher burden of negative psychological outcomes (e.g., depression, anxiety, stress) during the first six months of cancer compared to older patients and caregivers (i.e., dyads). This is due to their unfamiliarity with severe illness, multiple caregiving responsibilities, and developmental transitions of young adulthood. We aimed to receive feedback about adaptation of a telephone-based interpersonal psychotherapy intervention for AYA cancer dyads. Methods: We conducted semi-structured telephone interviews to elicit feedback about the intervention. Participants ages 18-39 years were eligible if they completed the 12-week intervention study (N=7). Participants were asked to share 1) their overall experience with the intervention content and delivery methods, 2) suggestions on how the intervention content and delivery could be improved, and 3) topics they found especially helpful or 4) they felt should have been included. The interviews were recorded, transcribed, and quality checked. We categorized qualitative feedback through interpretive description. Results: We interviewed 7 participants: 5 women and 2 men; 3 of whom were cancer survivors and 4 were caregivers. The interviews lasted between 5-20 minutes (average=10.5 minutes). Most participants enjoyed the content and found the information provided extremely helpful. Some participants continue to use the information provided after their participation. They explained that although some content was not relevant to them during their participation, it has since become relevant and has helped them navigate later stages of their cancer care. Participants felt that the study team was courteous and would have liked to speak to them more often, if given the opportunity. Suggestions for improving the intervention content delivery were providing a digital version of the handbook that they could access on a kindle or other eBook device, and a website or app with more information related to the intervention. Another suggestion was to provide the option to have video calls, instead of only phone calls, with the counselors, as face-to-face interactions would have helped them feel more connected during their sessions. Stand out topics included a sleep topic which included tips on how to fall asleep faster and stay asleep longer, and family topics which included family bonding tips. A topic that should have been included was how to improve self-confidence with intimate relationships. Conclusions: During their cancer experience, AYA cancer dyads are at a unique stage of life and are undergoing developmental transitions of young adulthood (e.g., completing higher education, establishing a career, developing intimate relationships) which results in disparities in their cancer survival and care. These disparities may be addressed through the adaptation of targeted interventions, specifically those that incorporate technology into the delivery of psychotherapy for addressing psychological sequela of cancer.

Citation Format: Jennifer Traslavina Jimenez, Ashley Green, Keely Smith, Echo L Warner, Terry Badger, Alla Sikorskii, Chris Segrin. Improving informal caregivers and cancer survivors' psychological distress, symptom management and health care use follow-up interviews [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-095.

Exploring Spirituality, Loneliness and HRQoL In Hispanic Cancer Caregivers

Providing care to an aging society in the new normal requires increased attention to the informal caregivers who support the health and well-being of older adults with chronic conditions. Hispanic caregivers carry a high caregiver-associated burden. Health disparities experienced by Hispanics, coupled with the emotional, social and physical demands of caregiving, may set an unprecedented risk for lower health-related quality of life (HRQoL). In a quantitative analysis, we investigated the relationship between spirituality, loneliness and HRQoL in Hispanic cancer caregivers using baseline data from the Support for Latinas with Breast Cancer study (N= 234 Hispanic caregivers). Findings suggested an indirect effect of spirituality on HRQoL through reduced loneliness among more spiritual caregivers, effects that were independent of age. The second study was conducted using qualitative semi-structured interviews (N= 10) with Hispanic caregivers. Interviews evaluated spirituality and HRQoL in Hispanic cancer caregivers who reported variable levels of loneliness. Five themes emerged: caregiver experience, coping strategies, loneliness, religion to gain strength or support, and spirituality to gain strength or support. Results supported the role of spirituality in promoting higher HRQoL in Hispanic cancer caregivers and elucidated pathways to intervene on HRQoL through spirituality. With Hispanics often underutilizing formal services, having an improved understanding of caregiving experiences, particularly related to spirituality, will support the development of culturally-relevant strategies and programming to promote HRQoL for Hispanic caregivers.

Reflexology and meditative practices for symptom management among people with cancer: Results from a sequential multiple assignment randomized trial

Optimal sequencing of complementary therapies can help improve symptom management through nonpharmacological approaches. A 12-week sequential multiple assignment randomized trial comparing home-based reflexology and meditative practices on severity of fatigue and other symptoms was conducted among patients with cancer and their informal caregivers. Dyads were initially randomized to reflexology (N = 150), meditative practices (N = 150), or control (N = 47). If patient's fatigue did not improve (nonresponse) after 4 weeks of reflexology or meditative practices, the dyad was rerandomized to either add the other therapy or continue with the original therapy for weeks 5-8. Four decision rules (DRs) were compared: (1) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, continue with reflexology for another 4 weeks, thus providing a higher dose; (2) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, add meditative practices for the next 4 weeks; (3) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, continue meditative practices for another 4 weeks, thus providing a higher dose; and (4) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, add reflexology for the next 4 weeks. Symptoms were evaluated weekly using the M.D. Anderson Symptom Inventory (MDASI). Clinically, nurses can recommend either therapy since no differences were found among the 4 DRs, with the exception of lower severity for summed MDASI symptoms at week 8 for the use of reflexology only (DR-1) versus DR-2 (sequencing reflexology to meditative practices). Adding the other therapy for nonresponders after 4 weeks may not be warranted.

A Moderating Model of Self-Efficacy in Caregivers of Latina Breast Cancer Survivors

In caregivers of Latina breast cancer survivors, contextual factors such as informational support, Anglo-orientation, and spiritual well-being may affect physical and mental health. The purpose of this study was to test if caregiver self-efficacy moderated relationships between contextual factors and health outcomes. A model, derived from Bandura’s Social Cognitive Theory, included self-efficacy cancer knowledge (survivor) and self-efficacy symptom management (caregiver) as moderators of relationships between contextual factors and global health and depression. Secondary analysis of baseline caregiver data from an experimental study testing two psychoeducational interventions with Latina breast cancer survivors and their caregivers was conducted. Both self-efficacy measures were tested as moderators for relationships between contextual factors and health outcomes with fixed cutoffs (medium: mean, low/high: ±1 SD). Caregiver participants (N=233) were 43 years on average (SD=13), primarily women (70%), low-income (78%), and of Mexican-American ethnicity (55%). Anglo-orientation was significantly associated with global health (r(233)=.27, p<.001) and depression (r(233)=-.13, p=.05). High levels of self-efficacy cancer knowledge strengthened the negative relationship between depression and Anglo-orientation, while a slightly positive relationship was noted at low self-efficacy levels. Informational support was significantly related to global health (r(233)=.39, p<.001) and depression (r(233)=-.43, p<.001). Self-efficacy symptom management strengthened the negative relationship between informational support and depression. Correlational and moderation relationships were not significant for spiritual well-being. Both caregiver- and survivor-focused self-efficacy affected relationships between contextual factors and depression in caregivers of Latina breast cancer survivors. Further research should address both types of self-efficacy in caregiver health.

The Diné (Navajo) Hózhó Lifeway: A Focused Ethnography on Intergenerational Understanding of American Indian Cultural Wisdom

Purpose: Hózhó is the cultural wisdom that guides the Diné lifeway. This study examines understanding of cultural wisdom (CW) across three generations: elders, adults, and adolescents. Method: A focused ethnography was conducted on the Navajo Nation. Twenty-two Diné (Navajo) were recruited through convenience sampling. Data were collected via two semistructured interviews and photovoice methods. Data were analyzed using content analysis, thematic analysis, and participatory visual analysis of photos. Results: The Diné elders embodied the greatest in-depth understanding of CW followed by the adolescents. An unexpected finding was the scarcity of understanding of CW among the adults. Conclusion: The Diné understanding of CW is transferred through discussion with elders, listening to and speaking traditional language, cultural preservation activities, and participation in cultural practices. The Diné believe cultural wisdom is a health sustaining protective factor, therefore strategies to restore, promote, and support the intergenerational transfer of cultural wisdom remains a tribal priority.

Psychological Distress and Social Support Availability in Different Family Caregivers of Latinas With Breast Cancer

Introduction: Latinas with breast cancer draw on a diverse range of family members for informal care. Latin cultures typically prescribe high levels of support and care for an ill family member that leave caregivers vulnerable to compromised well-being. Method: In this cross-sectional survey study, 258 family caregivers of Latinas with breast cancer completed reports of psychological distress, availability of social support, and acculturation. Results: Mothers who provide care to a daughter with breast cancer experience higher levels of psychological distress and report lower availability of informational support than most other types of family caregivers. Mothers’ lower levels of acculturation may at least partially explain these reductions in well-being. Discussion: This study highlights the diverse range of family and fictive kin who participate in family caregiving for Latina breast cancer survivors. Spousal caregivers may not represent a unique population, whereas mothers as caregivers are indeed distinct for their higher distress levels.

Using the RE-AIM framework for dissemination and implementation of psychosocial distress screening

OBJECTIVE

To evaluate the RE-AIM framework's effect on retention of participants and implementation outcomes of a 5-year cancer research education programme on psychosocial distress screening in cancer centres across the United States.

METHODS

A one-group pre-/post-test design was used to evaluate the programme on participant retention and implementation outcomes at 6, 12 and 24 months after enrolling in the programme (baseline) and analysed using descriptive statistics.

RESULTS

Seventy-two cancer centres participated in four cohorts. Participant retention was 100%. At baseline and 24 months, respectively, 52 (72%) and 64 (88%) of the cancer centres had formulated a psychosocial distress screening policy; 51 (71%) and 70 (98%) had started screening in more than one clinic/population; 15 (21%) and 45 (63%) had started auditing health records for documentation of screening. Each outcome rate improved at the cancer-centre level over the 24 months.

CONCLUSION

RE-AIM can be used as a framework for cancer research education programmes. Future research is needed on the use of a randomised adaptive design to test the optimal support for implementation of quality care standards according to cancer centres' needs.

PROMIS and legacy measures compared in a supportive care intervention for breast cancer patients and caregivers: Experience from a randomized trial

OBJECTIVE

Accurate and efficient measurement of patient-reported outcomes is key in cancer symptom management trials. The newer Patient Reported Outcomes Measurement Information System (PROMIS) and previously developed measures of similar conceptual content (legacy) are available to measure symptoms and functioning. This report compares the performance of two sets of measures, PROMIS and legacy, in a recently completed trial of a supportive care intervention that enrolled breast cancer patients and their friend or family caregivers.

METHODS

Patient-caregiver dyads (N = 256) were randomized to either reflexology delivered by caregivers or usual care control. Post-intervention, PROMIS and legacy measures of symptoms and functioning were analyzed in relation to trial arm, while adjusting for baseline values. Responsiveness of the two sets of measures was assessed using effect sizes and P-values for the effect of trial arm on patients' and caregivers' symptom and functioning outcomes.

RESULTS

Similar conclusions about intervention effects were found using PROMIS and legacy measures for pain, fatigue, sleep, anxiety, physical, and social functioning. Different conclusions were obtained for patient and caregiver depression: legacy measures indicated the efficacy of reflexology, while PROMIS depression measure did not.

CONCLUSION

Evidence of similar responsiveness supports the use of either set of measures for symptoms and functioning in clinical and general populations. Differences between PROMIS and legacy measures of depression need to be considered when choosing instruments for use in trials of supportive care interventions and in clinical practice.

Psychosocial Distress Screening: An Educational Program's Impact on Participants' Goals for Screening Implementation in Routine Cancer Care

BACKGROUND

Psychosocial distress screening is a quality care standard in cancer care. Screening implementation may be facilitated by an educational program that uses goals to evaluate progress over time.

OBJECTIVES

This article describes the content and design of the Screening for Psychosocial Distress Program (SPDP), reports on its delivery to 36 paired participants, and evaluates its effects on distress screening activities and goals.

METHODS

The SPDP used a one-group pre-/post-test design. It was delivered at 2 workshops and 10 conference calls during a two-year period. Data on screening and goal achievement were collected at 6, 12, and 24 months. Data on the quality of dyads' relationships were collected at 24 months.

FINDINGS

At 24 months, all 18 dyads had begun screening. Dyads reported working effectively together and being supportive of the other member of the dyad while achieving their goals for implementing psychosocial distress screening.

Using SMART design to improve symptom management among cancer patients: A study protocol

In this in-progress sequential multiple assignment randomized trial (SMART), dyads of solid tumor cancer patients and their caregivers are initially randomized to 4 weeks of reflexology or meditative (mindfulness) practices provided by/with their caregiver in the patient's home or to a control group. After 4 weeks, intervention group dyads in which patients do not show improvement in fatigue (non-responders) are re-randomized to either receive additional time with the same therapy during weeks 5-8 or to add the other therapy. The aims are (1) to compare reflexology and meditative practices groups during weeks 1-4 on patients' fatigue severity, summed symptom inventory score, depressive symptoms, and anxiety, so as to determine the relative effectiveness of these therapies and the characteristics of responders and non-responders to each therapy. (2) Among reflexology non-responders based on fatigue score at week 4, to determine patient symptom outcomes when meditative practices are added during weeks 5-8, versus continuing with reflexology alone. (3) Among meditative practices non-responders based on fatigue score at week 4, to determine patient symptom outcomes when reflexology is added during weeks 5-8, versus continuing with meditative practices alone. (4) To compare improvements in patient symptom outcomes among the three groups created by the first randomization. (5) To explore which dyadic characteristics are associated with optimal patient symptom outcomes, to determine tailoring variables for decision rules of future interventions. The trial has a target of 331 dyads post-attrition and has 150 dyads enrolled. We are overcoming challenges with dyadic recruitment and retention while maintaining fidelity.

The effect of psychosocial interventions delivered by telephone and videophone on quality of life in early-stage breast cancer survivors and their supportive partners

Summary

We examined the effectiveness of two psychosocial interventions for improving QOL in recently diagnosed breast cancer survivors and their partners. The interventions were telephone health education (THE) and interpersonal counselling. The latter was delivered by telephone (TC) or by videophone (VC) in 8 weekly one-to-one sessions. Fifty two dyads composed of a woman with breast cancer and her supportive partner were randomly assigned to THE, TC or VC. The average age of the survivors was 53 years (range 40–66), and they were mainly white, married, with a college education, and employed. Approximately half of the supportive partners were spouses. Surveys of quality of life (QOL) were made at three points in the study, each separated by 8 weeks. There was significantly higher attrition in the THE group compared to the videophone or telephone counselling groups among both survivors (44% vs. 10% and 8%) and partners (44% vs. 10% and 15%). Regardless of group, participants showed increased QOL over time. Survivors’ and partners’ social well-being improved in the telephone and videophone interpersonal counselling treatment groups, but not in the health education group. Telephone-delivered psychosocial interventions can be effective for managing QOL in breast cancer survivors and their supportive partners. There was no evidence of superior outcomes associated with using videophones over the conventional telephone.

Why Latinas With Breast Cancer Select Specific Informal Caregivers to Participate With Them in Psychosocial Interventions

The purpose of this study is to describe the reasons 88 Latinas with breast cancer selected specific supportive others to participate in an 8-week psychosocial intervention. Participants were asked one open-ended question during the baseline assessment for a larger clinical trial: “Could you tell me more about why you selected [insert name] to participate in the study with you?” A content analysis of the responses found three thematic categories: source of informational or emotional support, concern for the informal caregiver’s welfare, and special characteristics or qualities of the informal caregiver. These findings reflected both the cultural value of familism, the woman’s role as caregiver to the family ( marianismo), and the man’s role of provider ( machismo). Findings provide support for including the supportive person identified by the patient during a health crisis rather than the provider suggesting who that should be. Psychosocial services designed and implemented through such a cultural lens are more likely to be successful.

Loneliness and Emotional Support Predict Physical and Psychological Distress in Latinas with Breast Cancer and Their Supportive Partners

Following predictions from the stress process model, associations between loneliness, emotional support, physical health, and psychological distress were tested in 115 Latinas with breast cancer and their supportive partners. Results showed that loneliness and emotional support were predictive of psychological distress and physical symptoms. Additionally, emotional support minimized the association between physical symptoms and psychological distress. There were strong individual-level effects for loneliness and emotional support on physical health and psychological distress, and evidence that a partner’s loneliness also worsened psychological distress in the participants.

The lived experience of depression among culturally Deaf adults

Culturally Deaf adults lost hearing at early ages, communicate primarily in American Sign Language (ASL), and self-identify as culturally Deaf. Communication barriers lead to isolation, low self-esteem, abuse, and inadequate health care. Screening Deaf patients for depressive symptoms poses challenge. Nurses are rarely familiar with ASL, and depression screening tools aren't easily translated from English to ASL. Consequently, Deaf adults are not adequately screened for depression. Qualitative interviews were conducted with culturally Deaf adults, and certified interpreters helped to enhance understanding. Text was generated from interview transcriptions and researcher observations. No novel depressive symptoms were described. Various ASL signs were used to represent depression; two participants used a unique gesture that had no meaning to others. Childhood experiences leading to depression included sexual or physical abuse, feeling ostracized from family and like a burden. Suicidal gestures communicated severity of depression. Adults felt interpreters were unwelcome during mental health encounters. No participants were asked about depressive symptoms despite frank manifestations of depression. Study describes antecedents and consequences of depressive symptoms among Deaf adults. Understanding symptom manifestations and challenges experienced by Deaf patients helps identify those at risk for depression, thereby reducing morbidity and mortality.

A Case Study of Telephone Interpersonal Counseling for Women With Breast Cancer and Their Partners

PURPOSE/OBJECTIVES

To present a case study of one woman with breast cancer and her partner to provide a firsthand account of an innovative telephone interpersonal counseling intervention.

DATA SOURCES

Journal articles, book chapters, research data, and transcriptions of telephone counseling sessions.

DATA SYNTHESIS

Substantial evidence exists that face-to-face psychosocial interventions improve psychological adjustment and health-related quality of life for patients with cancer. Yet psychosocial interventions are not offered routinely, and many patients with cancer do not use face-to-face counseling mechanisms. The telephone may be an innovative and effective method of delivering interventions, and telephone-delivered interpersonal counseling may be an especially effective intervention for women with breast cancer and their partners.

CONCLUSIONS

Despite the fact that the telephone counseling occurred over a brief period of time, the woman and her partner in this case study reported substantial positive changes in their own distress (e.g., symptoms such as depression and anxiety) and the nature of their relationships with each other and their children. This is precisely the effect that would be predicted by interpersonal theories of psychological distress. These results were not atypical for other women and their partners who participated in the study.

IMPLICATIONS FOR NURSING

Family members play a significant role in supporting women through the breast cancer experience; thus, nurses should assess the emotional distress of both partners during the course of treatment and, if needed, provide critical education and referral to psychosocial interventions. This woman and her partner clearly benefited from the intervention, resulting in improved symptom management and quality of life. Although this intervention requires additional training in the advanced practice nursing role, some techniques of the intervention can be used by all nurses, regardless of specialty training.

Interdependent anxiety and psychological distress in women with breast cancer and their partners

The purpose of this study was to determine the extent of interdependence on anxiety within dyads where one person was undergoing treatment for breast cancer. Perceptions of relationship quality were expected to mitigate the anxiety experienced by both members of the dyad. 96 dyads participated in a 3-wave longitudinal study that took place over 10 weeks. Dyads were composed of a woman with stage I-III breast cancer who was currently undergoing treatment, and a partner who she nominated to participate in the study along with her. Results indicated that anxiety felt by women with breast cancer was consistently associated with that of her partner. Structural equation analyses suggest that the within-dyad influence runs mostly from partners' anxiety to the anxiety of women with breast cancer. Partners' anxiety was also associated with other indicators of the women's well being including depression, fatigue, and symptom management. Perceptions of relationship quality from women with breast cancer and their partners were negatively associated with partners' anxiety. However, women's anxiety was only correlated with their partners', but not their own, perceptions of relationship quality. These findings underscore the benefit of having partners who are able to cope with or get help for their own personal distress as women cope with the stress of breast cancer and its treatment.

Depression and Anxiety in Women With Breast Cancer and Their Partners

BACKGROUND

Psychosocial interventions can improve psychological quality of life (symptoms of depression and anxiety) of both women with breast cancer and their partners, but are not offered routinely to women and their partners.

OBJECTIVE

To test the hypotheses that telephone-delivered psychosocial interventions decrease depression and anxiety in women with breast cancer and their partners.

METHODS

The design of the study was a three-wave repeated measures with a between-subjects factor (treatment group). Ninety-six women and their 96 partners were assigned randomly to participate in one of three different 6-week programs: (a) telephone interpersonal counseling (TIP-C); (b) self-managed exercise; or (c) attention control (AC).

RESULTS

The mixed-model analysis of variance for symptoms of depression among women with breast cancer revealed women's depressive symptom scores decreased over time in all groups. For anxiety, women's symptoms of anxiety decreased in the TIP-C and exercise groups over time, but not in the AC group. A parallel set of analyses was conducted on partners' depression and anxiety data. Symptoms of depression and anxiety among the partners decreased substantially over the course of the investigation. Similar to the women, partners' symptoms of anxiety decreased significantly in the TIP-C and exercise groups, but not in the AC group.

DISCUSSION

Findings from this study support that these telephone-delivered psychosocial interventions were effective for decreasing symptoms of depression and anxiety to improve psychological quality of life when compared to an AC group.

Profiles of women with breast cancer: who responds to a telephone interpersonal counseling intervention

The purpose of this paper is to discuss the profiles of women with breast cancer for whom a telephone interpersonal counseling intervention (TIP-C) was beneficial for symptom management and quality of life. This analysis was based on 24 participants who completed the telephone counseling intervention and all three measurements over the course of 10-week pilot study. The typical woman with breast cancer was white, in her mid-fifties and married at the time of the study. The majority was Stage II and was receiving chemotherapy as their primary adjuvant treatment. Preliminary findings suggest that women who were in long-term marriages and reported no previous history of depression or cancer benefited most from the intervention. These women reported less depression, negative affect, symptom distress and fatigue, and improved quality of life. Several theories are proposed for these findings and implications for practice are discussed.

Interpersonal well-being and mental health among male partners of women with breast cancer

The focus of this investigation was on the mental health of men whose partners had recently been diagnosed with breast cancer. In accord with theoretical models that specify the importance of interpersonal relationships in maintaining mental health, men's relationship satisfaction and perceptions of social support were predicted to be positively associated with their mental health during this stressful time. The sample included 63 male partners of women with breast cancer who participated in a three-wave panel study that assessed various indicators of mental health and interpersonal well being at T1, T1 + 6 weeks, and T1 + 10 weeks. Results indicated substantial distress in at least 25% of the men. However this distress subsided over time. Relationship satisfaction was both concurrently and prospectively associated with better mental health. Social support was negatively associated with concurrent mental health but post hoc analyses suggested that men's social networks perhaps provide greater social support to the extent that the men are emotionally distressed.

Telephone interpersonal counseling with women with breast cancer: symptom management and quality of life

PURPOSE/OBJECTIVES

To examine the effectiveness of a telephone interpersonal counseling (TIP-C) intervention compared to a usual care attentional control for symptom management (depression and fatigue) and quality of life (positive and negative affect, stress) for women with breast cancer.

DESIGN

Experimental with repeated measures.

SETTING

Academic cancer center and urban, private oncology offices.

SAMPLE

48 women with breast cancer who were in their mid-50s, married, and employed at the time of the study.

METHODS

Women were assigned to either the six-week TIP-C or attentional usual care groups. Women were matched on stage and treatment. Data were collected at baseline, after the six interventions, and one month postintervention. Measures included the Center for Epidemiologic Studies Depression Scale, Positive and Negative Affect Schedule, Multidimensional Fatigue Inventory, and Index of Clinical Stress.

MAIN RESEARCH VARIABLES

Depression, positive and negative affect, fatigue, and stress.

FINDINGS

Women in the intervention group experienced decreases in depression, fatigue, and stress over time and increases in positive affect.

CONCLUSIONS

The preliminary results partially supported the effectiveness of TIP-C for symptom management and quality of life. The authors hypothesized that decreased depression, reduced negative affect, decreased stress, decreased fatigue, and increased positive affect over time would be the resulting psychosocial effects, given the theoretical underpinnings of the intervention.

IMPLICATIONS FOR NURSING

Nurses need to assess the quantity and quality of the social support network early in treatment; women with less social support need to be referred to counseling and support services. Because these women have limited participation in face-to-face interventions, they should be encouraged to participate in telephone or online support programs or in other programs or organizations (e.g., churches, social clubs) that would provide support.

Consultative intervention to improve outcomes of high utilizers in a public mental health system

PURPOSE

To examine the effectiveness of an academic consultation on outcomes among consumers in a public mental health system and to compare outcomes between high-cost/high-utilizer and midcost consumers.

METHODS

Participants (N = 36) completed all questionnaires during three semistructured interviews. Using a repeated-measures experimental design, the outcomes of global functioning, quality of life, service use and need, costs, and consumer satisfaction were examined.

FINDINGS

The hypothesis that consultation would change medication practices and reduce costs was supported.

CONCLUSIONS

Consultation with a senior clinician helped change medication practices and reduced costs. Consultation may lead to recognition of a new diagnosis (medical, neurologic, or psychiatric) or suggestions for modifying a treatment regimen that could improve functioning and QOL. In a busy public mental health system, there is often little time for consultation and little thought to second opinions. For clients who cost the system the greatest amount, the small additional cost of a consultation is a good potential investment.

Growth hormone-regulated periportal expression of CYP2C7 in rat liver

Most drug- and steroid-metabolizing cytochrome P450 (CYP) enzymes are expressed in the mammalian liver in a characteristic zonated pattern, with high expression in the downstream perivenous (centrilobular) region. Here, we report that CYP2C7, a member of the rat CYP2 family, is expressed preferentially in the opposite, periportal region. CYP2C7 mRNA, as detected by reverse transcription-polymerase chain reaction, was detected almost exclusively in cell lysates obtained from the periportal region, indicating a very steep acinar gradient. The amount of immunoreactive CYP2C7 protein in periportal cell lysates was also higher than in samples from the perivenous region. This gradient was reversed by hypophysectomy, which markedly and selectively reduced the periportal CYP2C7 protein content. Subsequent growth hormone infusion by osmotic minipumps restored the zonation by selectively increasing the amount of periportal CYP2C7 protein. Although hypophysectomy suppressed CYP2C7 mRNA and growth hormone counteracted it, regulation at this level did not appear to occur in a zone-specific fashion. This indicates that growth hormone-mediated zonal regulation of CYP2C7 protein has additional translational or posttranslational components. Ethanol treatment, which has been shown to affect growth hormone levels, significantly induced CYP2C7 mRNA, but not zone specifically. Our results demonstrate that growth hormone up-regulates the CYP2C7 gene by enhancing the expression of the protein specifically in the periportal liver region. Growth hormone may up-regulate other periportally expressed liver genes in a similar fashion.

Endocrine mechanisms underlying reproductive toxicity in the developing rat chronically exposed to dietary lead

A dose-response study was conducted in a rat model to examine the effects of lifetime lead exposure on the development of the reproductive system and the endocrine mechanisms underlying these effects. Time-impregnated female Sprague-Dawley rats (n = 10-15/group) were exposed to lead acetate in the drinking water at levels of 0.05%, 0. 15%, or 0.45% (w/v) initiated on gestational day 5. At birth, litters were culled to four male and four female pups. Exposure of dams to lead was continued until weaning, following which, the pups continued to be exposed to lead acetate in drinking water until sacrifice. One male and one female pup from each litter were sacrificed at age 21, 35, 55, and 85 d. A significant dose-responsive decrease in birth weight and crown-to-rump length was observed in all lead-exposed litters. However, no marked effects were observed on anogenital distance/crown-to-rump length ratios. Lead exposure resulted in a delay in sexual maturity as measured by prostate weight in male pups and time of vaginal opening in female pups, which increased with lead dose. These disruptions in reproductive physiology were accompanied by a significant decrease in neonatal sex steroid levels and suppression of the plasma concentrations of testosterone (male) and estradiol (female) during puberty. In male pups, this was accompanied by a significant decrease in plasma luteinizing hormone (LH), elevated pituitary LH content, and a decrease in plasma testosterone/LH ratios at the highest dose. In female pups, although no effects were observed on plasma LH concentration, a similar significant elevation in pituitary LH content was observed during early puberty. Postpuberty, plasma LH and sex steroid concentrations were unaffected at any dose in spite of continued lead exposure. No significant effects were observed on epididymal sperm count in male pups at 85 d of age. In female pups, estrus cycling was only significantly disrupted at the highest lead dose. These data suggest that the reproductive axis is particularly sensitive to lead during specific developmental periods, resulting in delayed sexual maturation produced by suppression by sex steroid biosynthesis. The mechanisms underlying this appear to involve lead actions on both LH release and gonadal function. At low, environmentally relevant blood lead concentrations, adaptation to the continuous presence of the metal ion occurs and surprisingly little effect is observed on adult reproductive endocrinology and physiology.

An evaluative study of pre-registration nursing students' skills in basic life support

Basic life support is identified as a skill in which the public expects nurses to be competent. However, a review of the literature suggests that many nurses are not competent in this skill. This study describes the performance of nursing students from three branches of nursing in basic life support skills. Individual performances were generally unsatisfactory, and significant differences between students from the different branches were noted. The implications of the study are of concern for all involved in nurse education.

The effect of ethanol or hepatotoxin exposure on rat transferrin desialylation

Serum carbohydrate-deficient transferrin (CDT) is being increasingly used as a biological indicator for excessive alcohol consumption. However, the mechanisms behind the changes in the carbohydrate moiety of transferrin are unclear, although they have been suggested to be mediated by acetaldehyde or liver damage. To study this, an animal model involving alterations in serum isotransferrin concentrations would be needed. The present work examined the changes in the carbohydrate moiety of transferrin in rats after different degrees of ethanol exposure, the effects of chronically elevated acetaldehyde levels, and also the changes, produced with liver toxins (galactosamine) and carbon tetrachloride). Ethanol was administered both in the drinking fluid and by intubation, reaching a dose of 11 g/kg/day over 7 weeks, or 16 g/kg/day over 4 weeks. Serum samples from rats maintained on high ethanol for 10 weeks by intragastric infusion were also analysed. Some rats simultaneously had cyanamide administered to elevate acetaldehyde levels. However, neither ethanol nor acetaldehyde had any effect on transferrin. Intraperitoneal galactosamine, but not carbon tetrachloride, induced transferrin desialylation. Thus, in the rat, neither chronic ethanol consumption nor elevated acetaldehyde induces changes in transferrin microheterogeneity.

Phenethyl isothiocyanate, a new dietary liver aldehyde dehydrogenase inhibitor

Phenethyl isothiocyanate (PEITC) is found in cabbages and other commonly ingested cruciferous vegetables. Isothiocyanates have anticarcinogenic properties, proposed to be mediated in part by their inhibition of several cytochrome P450 (CYP) forms. We administered PEITC to rats treated chronically with ethanol for 38 days by means of total enteral nutrition model to inhibit CYP2E1. We observed that PEITC not only efficiently prevented the ethanol-induced elevation of CYP2E1 apoprotein and mRNA, but also significantly elevated blood acetaldehyde levels. An elevation also was observed in naive animals acutely administered PEITC and ethanol, an effect found to be associated with marked inhibition of liver aldehyde dehydrogenase (ALDH). PEITC (1 mmol/kg) inhibited total liver ALDH activity by more than 70% and inhibition persisted for at least 24 hr. The inhibition was similar to that caused by an equimolar dose of disulfiram. Experiments using subcellular rat liver fractions revealed that both low- and high-Km ALDH forms were inhibited by low concentrations of PEITC (IC50 = 0.8-6.0 microM). Importantly, the mitochondrial low-Km ALDH activity, which is mainly responsible for detoxification of low aldehyde levels, was strongly inhibited (IC50 = 1.4 microM). In contrast, neither alcohol dehydrogenase nor lactate dehydrogenase activity was inhibited by PEITC. Thus, PEITC inhibits liver ALDH with a potency similar to that of disulfiram, suggesting that, in susceptible individuals, ingestion of large amounts of cruciferous vegetables in combination with alcohol could give rise to antabus-like symptoms. This property of PEITC must be taken into account in experimental alcohol research and in evaluating its proposed anticarcinogenic actions on chemical procarcinogens that are activated into potentially carcinogenic aldehydes.

Prenatal dexamethasone or stress but not ACTH or corticosterone alter sexual behavior in male rats

Prenatal maternal stress in rats and mice can demasculinize and feminize the sexual behavior of adult male offspring. Causal mechanisms are unknown, but one attractive hypothesis is that stress activation of maternal adrenal glucocorticoid secretion is the responsible agent. To test this hypothesis, pregnant rats were exposed to a variety of substances which enhance glucocorticoid actions. These included ACTH (20 IU of a gel preparation, SC once daily), corticosterone (CORT; 7 mg/kg SC in oil, three times daily), or dexamethasone (DEX; 0.1 mg/kg, SC once daily). Controls included noninjected dams and a positive stress control group (restraint under bright lights three times daily). All treatments reduced maternal weight gain, DEX most potently. No treatment altered litter size, stillbirths, or sex ratio, but DEX reduced weight at birth, an effect still seen at postnatal day 85. DEX, CORT, and stress reduced male adrenal weight at birth, while DEX and CORT altered sexual differentiation as measured by anogenital distance. Stress impaired adult male sexual performance but not the lordosis quotient following exposure of animals to stud males. DEX affected both measures. No other treatment had any significant effect on sexual behavior. No treatment altered plasma LH levels, either basal or in response to an estrogen challenge in adult gonadectomized males. In adulthood there was no treatment effect on stress reactivity, measured behaviorally or by plasma glucocorticoids. Correlational analysis revealed that weight gain during pregnancy was the single best predictor of subsequent sexual performance. It is concluded that prenatal dexamethasone exposure demasculinizes and feminizes male offspring.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of the aromatase inhibitor delta 1-testolactone on gonadotropin release and steroid metabolism in polycystic ovarian disease

This study was designed to examine the importance of aromatization in the gonadotropin secretory dynamics of polycystic ovarian disease (PCOD) by using the aromatase inhibitor delta 1 testolactone (TL) as a probe and to determine the effects of TL on steroid metabolism in vivo and in vitro. The pulsatile patterns of gonadotropin secretion and peripheral steroid levels were studied in eight women with PCOD before and during TL administration. There was a significant fall in peripheral estrone (E1) levels, a rise in peripheral androstenedione levels, and an increase in the androstenedione/E1 ratio during TL administration in these women. Isotopic determinations of androgen and estrogen production and metabolism before and during TL administration in two women confirmed a 90-95% decrease in the overall rate of aromatization. One patient also had an increase in the production and clearance rates of estradiol and E1 during TL administration, suggesting resistance to TL of the ovarian aromatase enzyme system. There were significant increases in both mean LH pulse amplitude [1.2 +/- 0.3 (SE) mIU/ml LER-907 before vs. 1.7 +/- 0.3 mIU/ml LER-907 during TL, P less than 0.05, paired t test] and frequency per 6 h (median: 3 before vs. 4 during TL, P less than 0.05, Wilcoxon signed rank test). Mean levels of LH and FSH did not, however, change significantly during TL administration. TL maximally inhibited neonatal rat hypothalamic aromatase in vitro at concentrations of 200 microM, a level theoretically obtainable during pharmacological therapy. These data suggest that: 1) in humans TL is a potent inhibitor of peripheral but not ovarian aromatase, and of hypothalamic aromatase in rats; 2) TL administration increases LH pulse amplitude and frequency in PCOD, either directly via hypothalamic aromatase inhibition, or indirectly by alterations in gonadal steroid metabolism; and 3) because of the multiple potential actions of TL, its usefulness as a probe in studies of gonadotropin secretion in PCOD is limited.

Reproductive function during fasting in men

To investigate reproductive function during fasting, six men 20-74% over ideal body weight completed an 18-day study consisting of a 3-day control period, a 10-day total fast, and a 5-day refeeding period. All men lost at least 4.1% of total weight and demonstrated ketonemia and ketonuria. The FSH response to LRH (0.2 microgram/min for 4 h) stimulation was significantly lower (P less than 0.05) during fasting and remained so during refeeding. Serum FSH concentrations were significantly lower (P less than 0.05) during the fast in five of six patients compared to those during the control period, whereas serum LH concentrations were unchanged. The effects of fasting on endogenous LH and FSH pulsations were studied by obtaining serum at 20-min intervals for 6 h on days 2, 11, and 16. Neither the amplitude nor the frequency of LH and FSH pulsations changed significantly during fasting or refeeding. Serum testosterone concentrations were significantly lower (P less than 0.025) by fasting day 9 compared to control values. The 24-h urinary excretion of both LH and FSH increased significantly (P less than 0.05) by fasting day 6 and reached a maximum by fasting day 8. Urinary LH excretion did not return to normal after 3 days of refeeding, whereas urinary FSH excretion returned to baseline by the first day of refeeding. We conclude that during short term fasting in obese men: 1) serum FSH concentrations decrease, 2) the pituitary responsiveness of FSH and LRH is blunted, 3) serum testosterone decreases, and 4) the urinary excretion of both LH and FSH increase.