The psychosocial impact of cancer: evidence in support of independent general positive and negative components

Features of acute COVID-19 associated with post-acute sequelae of SARS-CoV-2 phenotypes: results from the IMPACC study

Post-acute sequelae of SARS-CoV-2 (PASC) is a significant public health concern. We describe Patient Reported Outcomes (PROs) on 590 participants prospectively assessed from hospital admission for COVID-19 through one year after discharge. Modeling identified 4 PRO clusters based on reported deficits (minimal, physical, mental/cognitive, and multidomain), supporting heterogenous clinical presentations in PASC, with sub-phenotypes associated with female sex and distinctive comorbidities. During the acute phase of disease, a higher respiratory SARS-CoV-2 viral burden and lower Receptor Binding Domain and Spike antibody titers were associated with both the physical predominant and the multidomain deficit clusters. A lower frequency of circulating B lymphocytes by mass cytometry (CyTOF) was observed in the multidomain deficit cluster. Circulating fibroblast growth factor 21 (FGF21) was significantly elevated in the mental/cognitive predominant and the multidomain clusters. Future efforts to link PASC to acute anti-viral host responses may help to better target treatment and prevention of PASC.

Positive and negative psychosocial impacts on cancer survivors

The purpose of this study is to understand psychosocial impacts on cancer survivors using the patient-reported outcomes measurement information system (PROMIS) Psychosocial Illness Impact banks. Cancer survivors (n = 509; age: 59.5 ± 1.4; 51.5% men) completed the PROMIS positive and negative illness impact items consisting of four sub-domains: self-concept (SC), social impact (SI), stress response (SR), and spirituality (Sp). Illness impact was defined as changed scores from items measuring "current" experiences to recalled experiences prior to cancer diagnosis. Descriptive statistics, effect sizes (ES), and coefficient of variation (CV) were calculated at item and sub-domain levels. Analysis of variance was used to identify potentially influential factors on the impacts. Our study found survivors reported stronger positive than negative impacts (overall ES mean: 0.30 vs. 0.23) in general; and more moderate (ES ≧ 0.30) positive than negative impacts at the item level, 54.3% (25 of 46) and 40% (16 of 40) for positive and negative items, respectively. Participants reported more positive impacts on SI and Sp but more negative impacts on SR. The CV results showed more individual differences appeared on positive SC items. Younger survivors reported stronger positive and negative impacts. Women reported higher positive impacts. Survivors with higher education levels tended to have higher positive SI impacts, while those with a lower family income reported higher negative SI and negative SR impacts. We conclude positive and negative psychosocial impacts coexisted-the strength of impacts varied across sub-domains. Age, gender, education, and family income influenced the psychosocial impacts reported by survivors. These findings provide a foundation to develop interventions to strengthen positive and minimize negative impacts and improve cancer survivors' overall well-being.

A Developmental Science Approach to Informing Age Subgroups in Adolescent and Young Adult Cancer Research

PURPOSE

Adolescent and young adult (AYA; diagnosed ages 15-39) cancer survivors are developmentally heterogenous, and this population consists of at least three distinct theoretically informed subgroups, as follows: adolescents, emerging adults, and young adults. However, there are limited evidence-based recommendations for delineating the validity of these subgroups in cancer-specific research. We sought to inform recommended chronological age ranges for each subgroup based on developmental processes.

METHODS

The data were collected using a 2x3 stratified sampling design (on-vs. off-treatment; ages 15-17, 18-25, 26-39) and a cross-sectional survey. AYAs (N = 572) completed three subscales of the Inventory of Dimensions of Emerging Adulthood (identity exploration, experimentation/possibilities, and other-focused), and we used regression tree analyses to identify distinct shifts in mean subscale scores that would indicate unique subgroups. Models included (a) chronological age, (b) chronological age + cancer-related variables, and (c) chronological age + sociodemographic/psychosocial variables as predictors of each developmental measure.

RESULTS

The recommended age ranges for AYA survivors receiving active treatment were consistent with prior research as follows: adolescents ages 15-17, emerging adults ages 18-24, and young adults ages 25-39. Models for off-treatment survivors suggested four distinct subgroups: adolescents ages 15-17, emerging adults ages 18-23, and 'younger' (ages 24-32) and 'older' young adults (ages 33-39). No sociodemographic or psychosocial variables meaningfully shifted these recommendations.

DISCUSSION

Our results suggest that three developmental subgroups remain appropriate for on-treatment survivors, but a second young adult subgroup (ages 33-39) emerged for off-treatment survivors. Therefore, development disruptions may be more likely to occur or manifest in post-treatment survivorship.

The Effects of COVID-19 Lockdown on Social Connectedness and Psychological Distress in U.S. Adults with Chronic Diseases

Lockdown measures enacted in 2020 to control the spread of COVID-19 led to increases in the prevalence of mental health problems. Due to their high-risk status, individuals with chronic diseases may be at increased risk and disproportionately adversely affected by the COVID-19 pandemic. The investigators examined associations between having a high-risk chronic condition, social connectedness, and general distress and COVID-19-specific distress among U.S. adults during the COVID-19 lockdown. Baseline measures of a longitudinal survey collected at the beginning of the pandemic (April to June 2020) were analyzed to identify factors associated with loss of social connectedness from pre- to post-lockdown. The associations between social connectedness and both general and COVID-19-specific psychological distress were adjusted for certain high-risk chronic illnesses and interaction effects. The sample available for analysis included 1354 subjects (262 high-risk chronic diseases and 1092 without chronic illness). Those reporting the loss of social connectedness were younger (median = 39 vs. 42) and more likely to be unemployed because of the pandemic (19.4% vs. 11.0%). Adjustment for interaction demonstrated a stronger negative association between social connectedness change and the psychosocial impact of COVID-19 for those with high-risk illness(es) (change in connectedness*chronic illness OR = 0.88, 95%CI: 0.79-0.98, p = 0.020). These findings inform our understanding of the distribution and intersection of responses to public health lockdown orders in the U.S. and build further evidence of the importance of social connectedness on psychological distress.

Assessing the impact of religious resources and struggle on well-being: a report from the American Cancer Society's Study of Cancer Survivors-I

PURPOSE

The current study examined the relationships between religious resources (i.e., certainty of belief in God and attendance at religious services), religious struggle (e.g., belief that cancer is evidence of God's punishment or abandonment), and physical and mental health-related quality of life (HRQoL), including fear of cancer recurrence (FCR), in a large, geographically and clinically diverse sample of long-term survivors of cancer.

METHODS

Participants were 2021 9-year survivors of cancer from the American Cancer Society's Study of Cancer Survivors - I. Religious resources included belief in God and attendance at religious services. Items from the Brief RCOPE and the PROMIS Psychosocial Impact of Illness were combined to assess religious struggle. Survivors also completed the Fear of Cancer Recurrence Inventory, SF-12, and Meaning and Peace subscales of the FACIT-Sp. Regression models were used to predict HRQoL and FCR from religious resources and struggle.

RESULTS

In multivariable models, certain belief in God predicted greater mental HRQoL (B = 1.99, p < .01), and attendance at religious services was associated with greater FCR (B = .80, p < .05) as well as better mental (B = .34, p < .01) and physical (B = .29, p < .05) HRQoL. In addition, religious struggle predicted greater FCR (B = 1.32, p < .001) and poorer mental (B =  - .59, p < .001) and physical (B =  - .29, p < .001) HRQoL. Many of these relationships were mediated through Meaning.

CONCLUSIONS

With the exception of FCR, religious resources predicted better HRQoL outcomes in these long-term survivors of cancer. Conversely, religious struggle consistently predicted poorer HRQoL, including greater FCR.

IMPLICATIONS FOR CANCER SURVIVORS

Given the documented importance of its role in coping with the cancer experience, religion/spirituality should be a consideration in every survivorship care plan. Multidisciplinary assessment and support of religious resources and identification of and referral for religious struggle are needed to ensure the well-being of most long-term survivors of cancer.

Behavioral activation and behavioral inhibition: An examination of function in chronic pain

PURPOSE/OBJECTIVE

The objective of the study was to examine the BIS-BAS model of chronic pain. This model posits that 2 neurophysiological systems-the behavioral inhibition system (BIS) sensitized to and activated by punishment cues and the behavioral activation system (BAS) sensitized to and activated by reward cues-make independent and concurrent contributions to 2 domains of pain-related function: pain interference and positive function despite pain. The study additionally hypothesized that BIS and BAS sensitivity would have different associations with these 2 different aspects of pain-related function. BIS activation would be more strongly correlated with pain interference and BAS would be more strongly correlated with positive function despite pain. Research Method/Design: This was a cohort study consisting of the baseline assessments of 328 veterans enrolled in a large clinical trial examining 3 psychosocial interventions for chronic pain.

RESULTS

In multivariable regression adjusting for demographic factors and pain intensity, BIS was associated with greater pain interference and less positive function despite pain. BAS was associated with greater positive function despite pain but to a lesser degree than BIS.

CONCLUSIONS

As hypothesized, BIS and BAS both contributed to pain-related function; however, BIS displayed stronger associations with both pain interference and positive function despite pain. Thus, the hypothesis that BIS-BAS relationships would differ based on the nature of the functional outcome (BIS resulting in poorer function because of pain and BAS better function despite pain) was only partially supported. Findings of the current study suggest the role of BIS in chronic pain may be more pervasive across functional outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining the impact of cancer on survivors' religious faith: A report from the American Cancer Society study of cancer survivors-I

OBJECTIVES

The impact of religion/spirituality (R/S) on cancer outcomes, including health-related quality of life (HRQoL), has been the topic of much investigation. Reports of the opposite, that is, the impact of cancer on R/S and associations with HRQoL, are few. The current study sought to explore the positive and negative impacts of cancer on the religious faith of survivors as well as the associations of such impacts with HRQoL.

METHODS

Participants included 2309 9-year survivors of cancer from the American Cancer Society's Studies of Cancer Survivors-I. The impact of cancer on R/S was measured using items from the Patient-Reported Outcomes Measurement Information System (PROMIS) psychosocial impact of illness-faith, and HRQoL was measured with the 12-item short form (SF-12). Hierarchical regressions were used to examine the impact of cancer on R/S controlling for medical and demographic covariates.

RESULTS

Consistent with hypotheses, the majority of survivors (70%) reported that cancer had a positive impact on religious faith, while the negative impact of cancer on religious faith was relatively rare (17%). In multivariable models, the negative impact of cancer on faith was associated with poorer HRQoL, both mental and physical, while the positive impact of cancer on faith was associated with greater mental well-being.

CONCLUSIONS

Cancer has a negative impact on religious faith for a minority of survivors. However, when it is reported, such negative impact is indicative of poorer mental and physical well-being. As such, it is important to identify those survivors at risk early in survivorship and provide support and intervention as needed.

The prevalence of altered body image in patients with primary brain tumors: an understudied population

Purpose

Body image (BI) is an important issue for cancer patients, as patients with BI concerns are susceptible to depression, anxiety, difficulty coping, and poor quality of life (QoL). While this concern has been documented in patients with other malignancies, no data exists of this QoL issue in patients with primary brain tumors (PBT).

Methods

A cross-sectional survey of 100 PBT patients was conducted on an IRB approved prospective protocol using structured questionnaires. Participants completed the body image scale (BIS), Appearance Scheme Inventory Revised (ASI-R), MD Anderson Symptom Inventory Brain Tumor (MDASI-BT), and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression, Anxiety, and Psychosocial Impact Positive measures.

Results

The prevalence of clinically significant body image dissatisfaction (BIS ≥ 10) was 28% (95% CI 19–37%), median BIS score was 5 (range 0–27). The median ASI-R composite score was 2.9 (range 1.5–4.7). BIS was significantly correlated with the ASI-R (r = 0.53, 95% CI 0.37 to 0.65). The mean PROMIS Depression score was 48.4 (SD = 8.9), PROMIS Anxiety score was 49.4 (SD = 9.9), and PROMIS Psychosocial Illness Impact Positive score was 48.9 (SD = 9.7). BIS was significantly correlated with age, and trended with BMI and sex. The PROMIS Psychosocial Illness Impact Positive and PROMIS Anxiety scores were the most strongly related to BIS.

Conclusions

This study, the first to explore altered body image in PBT patients, revealed clinically significant body image dissatisfaction in nearly 1/3 of patients, similar to other malignancies. These findings underscore the potential contribution of disease and treatment-related body image concerns on psychosocial wellbeing in patients with PBT.

Electronic supplementary material

The online version of this article (10.1007/s11060-020-03433-8) contains supplementary material, which is available to authorized users.

Health-related quality-of-life assessment in dementia: Evidence of cross-cultural validity in Latin America

All health-related quality-of-life (HRQL) measures for dementia have been developed in high-income countries and none were validated for cross-cultural use. Yet, the global majority of people living with dementia reside in low- and middle-income countries. We therefore investigated the measurement invariance of a set of self- and informant-report HRQL measures developed in the United Kingdom when used in Latin America. Self-reported HRQL was obtained using (DEMQOL) at a memory assessment service in the United Kingdom (n = 868) and a population cohort study in Latin America (n = 417). Informant reports were collected using DEMQOL-Proxy at both sites (n = 909 and n = 495). Multiple-group confirmatory bifactor models for ordered categorical item responses were estimated to evaluate measurement invariance. Results support configural, metric, and scalar invariance for the concept of general HRQL in DEMQOL and DEMQOL-Proxy. The dominant impact of general HRQL on item responses was evident across U.K. English and Ibero American Spanish versions of DEMQOL (ω_h = 0.87–0.90) and DEMQOL-Proxy (ω_h = 0.88–0.89). Ratings of “positive emotion” did not show a major impact on general HRQL appraisal, particularly for Latin American respondents. Item information curves show that self- and informant-reports were highly informative about the presence rather than the absence of HRQL impairment. We found no major difference in conceptual meaning, sensitivity, and relevance of DEMQOL and DEMQOL-Proxy for older adults in the United Kingdom and Latin America. Further replication is needed for consensus over which HRQL measures are appropriate for making cross-national comparisons in global dementia research.

Measuring health-related quality-of-life (HRQL) in older adults living with dementia is important to quantify their burden of disease. Globally more than half of these adults live in low- and middle-income countries, but all HRQL measures for dementia originate from high-income countries. Our study is the first to show for a self- and informant-report HRQL instrument (DEMQOL) that the appraisals are comparable across U.K. (English) and Latin American (Spanish) community samples.

Using Mixed-Methods Research to Study Coping Strategies among Colorectal Cancer Patients

Objective:

The objective was to identify and understand the coping strategies of colorectal cancer (CRC) patients.

Methods:

A mixed-methods approach including quantitative and qualitative methods was used to collect data from Jordanian patients. In the quantitative phase, we aimed to determine the coping strategies employed in a representative sample (n = 200) of Jordanian adult patients with CRC using the Jalowiec Coping Scale. In the qualitative phase, we aimed to understand these coping strategies through an in-depth and detailed exploration. A sample of ten participants was chosen purposefully based on their coping score in the quantitative phase, and interviews were conducted. Quantitative data were analyzed using SPSS software version 23. Qualitative data were analyzed using directed content analysis.

Results:

Results from the quantitative phase indicated that evasive coping strategies were used predominantly, followed by confrontive coping strategies and optimistic coping strategies. In contrast, fatalistic and emotive coping strategies had the lowest scores. In addition, the results indicated that the total scores for the effectiveness of coping strategies ranged from 42 to 143, with a mean of 93.45 (standard deviation 13.67); higher scores reflected greater effectiveness. Content analysis in the qualitative phase identified three themes, and subcategories emerged, including perceived collaborative support, increased awareness of treatment, and internal power.

Conclusions:

CRC patients used different coping strategies to face the new challenge. Oncology nurses can play a pivotal role in enhancing these coping strategies through implementing multidisciplinary programs.

Refining and supplementing candidate measures of psychological well-being for the NIH PROMIS®: qualitative results from a mixed cancer sample

PURPOSE

The Patient-Reported Outcomes Measurement Information System (PROMIS) is a National Institutes of Health initiative designed to improve patient-reported outcomes using state-of-the-art psychometric methods. The aim of this study is to describe qualitative efforts to identify and refine items from psychological well-being subdomains for future testing, psychometric evaluation, and inclusion within PROMIS.

METHOD

Seventy-two items from eight existing measures of positive affect, life satisfaction, meaning & purpose, and general self-efficacy were reviewed, and 48 new items were identified or written where content was lacking. Cognitive interviews were conducted in patients with cancer (n = 20; 5 interviews per item) to evaluate comprehensibility, clarity, and response options of candidate items.

RESULTS

A Lexile analysis confirmed that all items were written at the sixth grade reading level or below. A majority of patients demonstrated good understanding and logic for all items; however, nine items were identified as "moderately difficult" or "difficult" to answer. Patients reported a strong preference for confidence versus frequency response options for general self-efficacy items.

CONCLUSIONS

Altogether, 108 items were sufficiently comprehensible and clear (34 positive affect, 10 life satisfaction, 44 meaning & purpose, 20 general self-efficacy). Future research will examine the psychometric properties of the proposed item banks for further refinement and validation as PROMIS measures.

An evaluation of health-related quality of life in patients with systemic lupus erythematosus using PROMIS and Neuro-QoL

Systemic lupus erythematosus (SLE) is a multi-organ chronic autoimmune disease that can negatively affect patients' health-related quality of life (HRQOL). This study evaluated HRQOL of SLE patients using questionnaires from the Patient-Reported Outcomes Measurement Information System (PROMIS) and Quality of Life in Neurological Disorders (Neuro-QoL). Individuals with SLE completed an online survey consisting of the PROMIS-29 health profile, PROMIS Psychosocial Illness Impact-Negative, and Neuro-QoL Applied Cognition. PROMIS and Neuro-QoL scores have a mean of 50 in the US general population. Patients self-rated SLE disease severity as negligible, mild, moderate, or severe. Of the 333 participants (mean age 45 years; 92% female; 26% Black; mean SLE disease duration 12 years, 56% with SLE disease severity as moderate or severe), mean HRQOL scores were worse than those of the general population by ≥0.5 SD with the greatest deficits observed in the domains of fatigue, applied cognition, psychosocial illness impact-negative, pain interference, and physical function. Greater SLE disease severity was associated with worse mean HRQOL scores (all p < 0.05). Pain severity was also associated with worse HRQOL scores on all domains (p < 0.05) except for satisfaction with social role. Test-retest reliability exceeded 0.70 for all PROMIS and Neuro-QoL scores. PROMIS-29 and Neuro-QoL are valid tools to assess HRQOL in patients with SLE. These patients reported substantial deficits that correlated with their SLE disease severity, with pain being an important independent contributor. These deficits should be monitored in SLE patients during their routine clinical care and evaluated when investigating new therapies.

Is Social Support Associated With Upper Extremity Disability?

BACKGROUND

Pain intensity and disability correlate with psychosocial factors such as depression and pain interference (the degree to which pain interferes with activities of daily living) as much or more than pathophysiology in upper extremity illness. However, other factors like emotional support (perception of being cared for and valued as a person), instrumental support (perception of availability of tangible assistance when needed), positive psychosocial impact (perception and focus on the positive side of a difficult situation, sometimes characterized as posttraumatic growth, benefit-finding, or meaning making), also might be associated with disability in patients with upper extremity orthopaedic illness. This is the first published study, to our knowledge, addressing the potential association of emotional support, instrumental support, and positive psychosocial illness impact with disability in patients with upper extremity illness.

QUESTIONS/PURPOSES

We asked: (1) Is there a correlation between the QuickDASH and the Patient-reported Outcomes Measurement Information System (PROMIS(®)) emotional support Computer Adaptive Testing (CAT)? (2) Is there a correlation between the QuickDASH and PROMIS(®) instrumental support CAT? (3) Is there a correlation between the QuickDASH and PROMIS(®) positive psychosocial illness impact CAT? (4) Among the PROMIS(®) measures of depression, emotional support, instrumental support, positive illness impact, and pain interference, which accounts for the most variance in QuickDASH scores?

METHODS

One hundred ninety-three patients with upper extremity illness (55% women; average age, 51 ± 18 years) of 213 approached (91% recruitment rate) completed the QuickDASH, and five different PROMIS(®) CATs: pain interference (the degree to which pain interferes with accomplishing one's goals), depression, emotional support, psychosocial illness impact, and instrumental support. We recruited patients from the practice of three surgeons in hand service of the department of orthopaedic surgery at a major urban university hospital.

RESULTS

Pearson Product Moment Correlations showed that emotional support (r = -0.18; p = 0.014) and instrumental support (r = -0.19; p = 0.008) were weakly and inversely associated with the QuickDASH), while positive psychosocial illness impact was moderately and inversely associated with the QuickDASH (r = -0.36; p < 0.001). In multivariable analyses, pain interference, but not the social support measures, was the only psychosocial factor associated with the QuickDASH and alone explained 66% of variance.

CONCLUSIONS

Emotional support, instrumental support and positive psychosocial illness impact are all individually associated with disability to a small degree, but pain interference (the degree to which pain interferes with accomplishing one's goals) has the strongest influence on magnitude of disability.

LEVEL OF EVIDENCE

Level 1, prognostic study.

Cancer experiences and health-related quality of life among racial and ethnic minority survivors of young adult cancer: a mixed methods study

PURPOSE

Young adult (YA) racial and ethnic minority survivors of cancer (diagnosed ages 18-39) experience significant disparities in health outcomes and survivorship compared to non-minorities of the same age. However, little is known about the survivorship experiences of this population. The purpose of this study is to explore the cancer experiences and health-related quality of life (HRQOL) among YA racial/ethnic minorities in an urban US city.

METHODS

Racial and ethnic minority YA cancer survivors (0 to 5 years posttreatment) were recruited from a comprehensive cancer center using a purposive sampling approach. Participants (n = 31) completed semi-structured interviews, the FACT-G (physical, emotional, social well-being) and the FACIT-Sp (spiritual well-being). Mixed methods data were evaluated using thematic analysis and analysis of covariance (ANCOVA).

RESULTS

The majority of survivors were women (65 %), single (52 %), and Hispanic (42 %). Across interviews, the most common themes were the following: "changes in perspective," "emotional impacts," "received support," and "no psychosocial changes." Other themes varied by racial/ethnic subgroups, including "treatment effects" (Hispanics), "behavior changes" (Blacks), and "appreciation for life" (Asians). ANCOVAs (controlling for gender and ECOG performance status scores) revealed that race/ethnicity had a significant main effect on emotional (P = 0.05), but not physical, social, or spiritual HRQOL (P > 0.05).

CONCLUSIONS

Our findings suggest that minority YA cancer survivors report complex positive and negative experiences. In spite of poor health outcomes, survivors report experiencing growth and positive change due to cancer. Variations in experiences and HRQOL highlight the importance of assessing cultural background to tailor survivorship care among YA racial and ethnic minorities.

The COPD-SIB: a newly developed disease-specific item bank to measure health-related quality of life in patients with chronic obstructive pulmonary disease

BACKGROUND

Health-related quality of life (HRQoL) is widely used as an outcome measure in the evaluation of treatment interventions in patients with chronic obstructive pulmonary disease (COPD). In order to address challenges associated with existing fixed-length measures (e.g., too long to be used routinely, too short to ensure both content validity and reliability), a COPD-specific item bank (COPD-SIB) was developed.

METHODS

Items were selected based on literature review and interviews with Dutch COPD patients, with a strong focus on both content validity and item comprehension. The psychometric quality of the item bank was evaluated using Mokken Scale Analysis and parametric Item Response Theory, using data of 666 COPD patients.

RESULTS

The final item bank contains 46 items that form a strong scale, tapping into eight important themes that were identified based on literature review and patient interviews: Coping with disease/symptoms, adaptability; Autonomy; Anxiety about the course/end-state of the disease, hopelessness; Positive psychological functioning; Situations triggering or enhancing breathing problems; Symptoms; Activity; Impact.

CONCLUSIONS

The 46-item COPD-SIB has good psychometric properties and content validity. Items are available in Dutch and English. The COPD-SIB can be used as a stand-alone instrument, or to inform computerised adaptive testing.

Negative and positive life changes following treatment completion: Chinese breast cancer survivors' perspectives

PURPOSE

Although we acknowledge the negative and positive aspects of the cancer survivorship experience, we have little information on this issue from the perspective of Chinese breast cancer survivors. This study aimed to explore the perceptions of negative and positive life changes following treatment completion among this population.

METHODS

Using purposive sampling, 29 breast cancer survivors were selected from the attendees of a local cancer self-help organization in middle China and proceeded with semi-structured in-depth interviews. Each interview was transcribed verbatim and analyzed using directed content analysis.

RESULTS

Two predetermined categories were identified to represent participant perception of the breast cancer survivorship experience, namely, negative life changes and positive life changes. The first category included fear of recurrence, symptom experience, poor body image, altered sexuality and intimacy, and financial burden. The second category consisted of new life perspective, personal growth, and enhanced relationships with family.

CONCLUSIONS

Our findings contribute to the emerging evidence on the duality of breast cancer survivorship. This enhanced understanding of the specific negative and positive changes experienced by Chinese breast cancer survivors can assist health professionals in addressing survivorship issues by designing appropriate interventions to minimize negative consequences and enhance positive growth.

Anxiety and health-related quality of life among patients with low-tumor burden non-Hodgkin lymphoma randomly assigned to two different rituximab dosing regimens: results from ECOG trial E4402 (RESORT)

PURPOSE

The purpose of this study was to compare illness-related anxiety among participants in the Rituximab Extended Schedule or Retreatment Trial (RESORT) randomly assigned to maintenance rituximab (MR) versus rituximab re-treatment (RR). A secondary objective was to examine whether the superiority of MR versus RR on anxiety depended on illness-related coping style.

PATIENTS AND METHODS

Patients (N = 253) completed patient-reported outcome (PRO) measures at random assignment to MR or RR (baseline); at 3, 6, 12, 24, 36, and 48 months after random assignment; and at rituximab failure. PRO measures assessed illness-related anxiety and coping style, and secondary end points including general anxiety, worry and interference with emotional well-being, depression, and health-related quality of life (HRQoL). Patients were classified as using an active or avoidant illness-related coping style. Independent sample t tests and linear mixed-effects models were used to identify treatment arm differences on PRO end points and differences based on coping style.

RESULTS

Illness-related anxiety was comparable between treatment arms at all time points (P > .05), regardless of coping style (active or avoidant). Illness-related anxiety and general anxiety significantly decreased over time on both arms. HRQoL scores were relatively stable and did not change significantly from baseline for both arms. An avoidant coping style was associated with significantly higher anxiety (18% and 13% exceeded clinical cutoff points at baseline and 6 months, respectively) and poorer HRQoL compared with an active coping style (P < .001), regardless of treatment arm assignment.

CONCLUSION

Surveillance until RR at progression was not associated with increased anxiety compared with MR, regardless of coping style. Avoidant coping was associated with higher anxiety and poorer HRQoL.

Physical, emotional, and social health differences between posttreatment young adults with cancer and matched healthy controls

BACKGROUND

Young adults (YAs; ages 18-39 years) with cancer face interrupted developmental milestones and increased stressors that can adversely influence psychosocial adjustment. Transitioning from active treatment to posttreatment survivorship can be particularly challenging. The purpose of this study is to describe the health-related quality of life (HRQL) and psychological adaptation of YAs after treatment, relative to young adults without cancer.

METHODS

Three cohorts of YAs of mixed cancer diagnoses (N = 120, 0-12 months after treatment; N = 102, 13-24 months after treatment; and N = 113, 25-60 months after treatment; combined M = 31.8 years old, combined sex = 68% women) and an age-, education-, sex-, and partner status-matched group of healthy control participants (HCs; N = 335) were recruited via an online research panel. All participants completed measures assessing demographic and clinical characteristics, HRQL (physical, emotional, social, and spiritual), and psychological adaptation (anxiety, depression, positive affect, posttraumatic growth). Measure content was slightly modified for applicability to HCs without a cancer history.

RESULTS

Multivariate analysis of covariance found a significant main effect for group (YAs versus HCs) and a significant group-by-cohort interaction. YAs reported poorer physical (P = .005, d = .22) and emotional well-being (P = .011, d = .20) but better social well-being (P < .001, d = .49). YAs reported comparatively stable scores (P = .74) for posttraumatic growth compared to HCs, who reported greater posttraumatic growth across cohorts (P = .01, d = 16).

CONCLUSIONS

Findings underscore the negative and positive sequelae for YAs and highlight the need for comprehensive assessment among YA survivors of cancer. A matched, HC group allows the HRQL and psychological adaptation of YAs to be placed in context, enabling a more precise determination of the impact of cancer on YAs.

Self-reported cognitive concerns and abilities: two sides of one coin?

OBJECTIVE

Patient-reported cognitive function can be measured using negatively worded items (concerns) and positively worded (abilities) items. It is possible that reporting abilities is less subject to the influence of emotional states. This study evaluated the relationship between cognitive concerns and cognitive abilities.

METHODS

Cancer patients (N = 509; mean age = 61 years; 50% men; 86% White) completed concerns and abilities items developed by the National Institutes of Health Patient-Reported Outcomes Information System (PROMIS). Confirmatory factor analysis was used to evaluate the extent to which items were loaded on one single factor (unidimensionality). Multidimensionality was evaluated using bi-factor analysis (local factors: concerns and abilities). Slope parameters from multidimensional item response theory (IRT) and unidimensional IRT were compared to evaluate which factor solution fits best.

RESULTS

Acceptable fit indices were found in both one-factor confirmatory factor analysis (comparative fit index (CFI) = 0.96; root mean squared error of approximation (RMSEA) = 0.062) and bi-factor analysis (CFI = 0.98; RMSEA = 0.043). Thus, abilities and concerns could be considered as a single dimension. Yet, high loadings on the local factor in bi-factor analysis and slope discrepancies between unidimensional IRT and multidimensional IRT indicate that abilities should be considered as a separate factor from concerns.

CONCLUSIONS

Concerns and abilities could be measured using one-unidimensional item bank. Results also support measuring each construct separately. We recommend a conservative approach by measuring and reporting concerns and abilities separately. We therefore recommend two separate but co-calibrated item banks in the PROMIS network: cognitive function item bank-concerns and cognitive function item bank-abilities. Both item banks showed good psychometric properties and are available for research and clinical purposes.

Distress among young adult cancer survivors: a cohort study

PURPOSE

Being diagnosed with cancer as a young adult can lead to significant psychological distress and impaired quality of life. Compared to children and older adults diagnosed with cancer, fewer studies have addressed psychological distress among young adult cancer survivors. This study sought to identify the prevalence of, and factors associated with, distress among young adult cancer survivors (ages 18-39).

METHODS

Young adult cancer survivors (N = 335, mean age = 31.8, women = 68.4%) were recruited from an online research panel and stratified by cohort (time postactive treatment: 0-12, 13-24, and 25-60 months). Participants completed measures assessing demographic and clinical characteristics, global impact of cancer, cancer-related education and work interruption, and cancer-specific distress using the impact of event scale (IES).

RESULTS

The mean score on the IES (M = 31.0, range = 0-75) was above the cut point of 20, suggesting clinically elevated distress. Analysis of covariance revealed significant main effects for cohort, global impact and cancer-related education/work interruption, and an interaction between cohort and cancer-related education/work interruption on distress. Although there was no significant effect of education/work interruption on distress for those in the 0-12 month cohort (p = .88), survivors in the 13-24 and 25-60 month cohorts reporting education/work interruption were significantly more distressed than those not reporting education/work interruption in the respective cohorts (p < .05).

CONCLUSIONS

Young adult cancer survivors face unique challenges. These data underscore the importance of attending to cancer-related distress beyond the completion of treatment and may help inform targeted interventions to prevent or reduce significant distress and related sequelae in this population.

Pre-operative stress, anxiety, depression and coping strategies adopted by patients experiencing their first or recurrent brain neoplasm: an explorative study

The main aims of this study were to evaluate the intensity of stress, anxiety and depression as well as the effectiveness of coping strategies adopted pre-operatively in brain neoplasm patients. A descriptive-explorative study design was undertaken. During 2008, patients admitted to a large Italian hospital neurosurgical unit with their first (n = 21) or recurrent (n = 15) brain neoplasm, on the day before their surgical procedure, were consecutively recruited into the study. The Perceived Stress Scale, the Hospital Anxiety and Depression Scale and the Jalowiec Coping Scale were administered via face-to-face interview. Patients with their first occurrence of neoplasm perceived the same stress intensity as those with recurrent neoplasm (mean ± standard deviation: 14.9 ± 6.7 versus 17.2 ± 8.8, p = 0.36). They also reported the same likelihood of anxiety at a borderline level (odds ratio (OR) 4.88, 95%CI 0.42 to 40.97, p = 0.06) and at a clinically relevant level (OR 0.32, 95%CI 0.01 to 5.37, p = 0.35) as well as the same likelihood of depression at a borderline level (OR 1.25, 95%CI 0.20 to 8.40, p = 0.78). Only one case of clinically relevant depression emerged among patients at their first diagnosis. Patients at their first occurrence, as well as those at recurrence, reported that they adopted optimistic coping strategies (mean 2.20, 95%CI 2.01 to 2.38 versus mean 1.96, 95%CI 1.71 to 2.20) and sought support (mean 1.81, 95%CI 1.58 to 2.05 versus mean 1.89, 95%CI 1.63 to 2.15). According to the findings of this exploratory study, on the pre-operative day, brain neoplasm patients at their first diagnosis and at recurrence wish to confront the situation: they adopt optimistic coping strategies, they seek support and they wish to take a constructive problem-solving approach. Knowledge of the intensity of stress, anxiety and depression as well as the coping strategies adopted by the patients is important for clinicians in their efforts to tailor care to patients' individual needs.

Have a little faith: measuring the impact of illness on positive and negative aspects of faith

BACKGROUND

The importance of faith and its associations with health are well documented. As part of the Patient Reported Outcomes Measurement Information System, items tapping positive and negative impact of illness (PII and NII) were developed across four content domains: Coping/Stress Response, Self-Concept, Social Connection/Isolation, and Meaning and Spirituality. Faith items were included within the concept of meaning and spirituality.

METHODS

This measurement model was tested on a heterogeneous group of 509 cancer survivors. To evaluate dimensionality, we applied two bi-factor models, specifying a general factor (PII or NII) and four local factors: Coping/Stress Response, Self-Concept, Social Connection/Isolation, and Meaning and Spirituality.

RESULTS

Bi-factor analysis supported sufficient unidimensionality within PII and NII item sets. The unidimensionality of both PII and NII item sets was enhanced by extraction of the faith items from the rest of the questions. Of the 10 faith items, nine demonstrated higher local than general factor loadings (range for local factor loadings = 0.402 to 0.876), suggesting utility as a separate but related 'faith' factor. The same was true for only two of the remaining 63 items across the PII and NII item sets.

CONCLUSIONS

Although conceptually and to a degree empirically related to Meaning and Spirituality, Faith appears to be a distinct subdomain of PII and NII, better handled by distinct assessment. A 10-item measure of the impact of illness upon faith (II-Faith) was therefore assembled.