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Little RB, Carter SJ, Motl RW, Hunter G, Cook A, Liu N, Krontiras H, Lefkowitz EJ, Turan B, Schleicher E, Rogers LQ. Role of Gut Microbe Composition in Psychosocial Symptom Response to Exercise Training in Breast Cancer Survivors (ROME) study: protocol for a randomised controlled trial. BMJ Open 2024; 14:e081660. [PMID: 38702085 PMCID: PMC11086582 DOI: 10.1136/bmjopen-2023-081660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/12/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Breast cancer survivors have an increased risk for chronic fatigue and altered gut microbiota composition, both with negative health and quality of life affects. Exercise modestly improves fatigue and is linked to gut microbial diversity and production of beneficial metabolites. Studies suggest that gut microbiota composition is a potential mechanism underlying fatigue response to exercise. Randomised controlled trials testing the effects of exercise on the gut microbiome are limited and there is a scarcity of findings specific to breast cancer survivors. The objective of this study is to determine if fitness-related modifications to gut microbiota occur and, if so, mediate the effects of aerobic exercise on fatigue response. METHODS AND ANALYSIS The research is a randomised controlled trial among breast cancer survivors aged 18-74 with fatigue. The primary aim is to determine the effects of aerobic exercise training compared with an attention control on gut microbiota composition. The secondary study aims are to test if exercise training (1) affects the gut microbiota composition directly and/or indirectly through inflammation (serum cytokines), autonomic nervous system (heart rate variability) or hypothalamic-pituitary-adrenal axis mediators (hair cortisol assays), and (2) effects on fatigue are direct and/or indirect through changes in the gut microbiota composition. All participants receive a standardised controlled diet. Assessments occur at baseline, 5 weeks, 10 weeks and 15 weeks (5 weeks post intervention completion). Faecal samples collect the gut microbiome and 16S gene sequencing will identify the microbiome. Fatigue is measured by a 13-item multidimensional fatigue scale. ETHICS AND DISSEMINATION The University of Alabama at Birmingham Institutional Review Board (IRB) approved this study on 15 May 2019, UAB IRB#30000320. A Data and Safety Monitoring Board convenes annually or more often if indicated. Findings will be disseminated in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT04088708.
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Affiliation(s)
- Rebecca B Little
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stephen J Carter
- Department of Kinesiology, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Gary Hunter
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abby Cook
- Baylor Scott & White Medical Center Temple, Temple, Texas, USA
| | - Nianjun Liu
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Helen Krontiras
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elliot J Lefkowitz
- Department of Computer Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Erica Schleicher
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Laura Q Rogers
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Capaldi JM, Shabanian J, Finster LB, Asher A, Wertheimer JC, Zebrack BJ, Shirazipour CH. Post-traumatic stress symptoms, post-traumatic stress disorder, and post-traumatic growth among cancer survivors: a systematic scoping review of interventions. Health Psychol Rev 2024; 18:41-74. [PMID: 36632776 DOI: 10.1080/17437199.2022.2162947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
The detrimental effects of Post-Traumatic Stress Symptoms (PTSS) and Post-Traumatic Stress Disorder (PTSD) and the benefits of Post-Traumatic Growth (PTG) are well established for cancer survivors. Increased cancer survival rates necessitate an understanding of how these two paradoxical outcomes, PTSS/PTSD and PTG, are targeted through interventions. This systematic scoping review aims to (a) examine existing evidence on interventions targeting PTSS/PTSD and/or PTG among cancer survivors and (b) identify knowledge gaps to inform future research. Following the six steps of a scoping review, 76 articles met the inclusion criteria. Quantitative articles were examined using descriptive analysis. Frequency counts of the collated data were tabulated into summary tables. Qualitative articles were reviewed using meta-synthesis. Most articles were quantitative (n = 52) and targeted PTG (n = 68) through promising intervention approaches such as psychotherapy, mindfulness, physical activity, and psilocybin-assisted therapy. Three key implications for future research and practice were synthesized: (1) mechanistic considerations for intervention design that provide a roadmap for rigorous and theoretically-grounded research; (2) the need for improved representation of cancer survivors in trials; and (3) potential facilitators of intervention efficacy. Together, these findings can direct future research to optimize interventions to reduce PTSS/PTSD and promote PTG achievement among cancer survivors.
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Affiliation(s)
- Jessica M Capaldi
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Julia Shabanian
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Laurel B Finster
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Arash Asher
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Celina H Shirazipour
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Yao G, Lai JS, Garcia SF, Yount S, Cella D. Positive and negative psychosocial impacts on cancer survivors. Sci Rep 2023; 13:14749. [PMID: 37679401 PMCID: PMC10485019 DOI: 10.1038/s41598-023-41822-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 08/31/2023] [Indexed: 09/09/2023] Open
Abstract
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.
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Affiliation(s)
- Grace Yao
- Department of Psychology, College of Science, National Taiwan University, Taipei, 106319, Taiwan (R.O.C.)
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Department of Pediatrics, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave, 21St Floor, Chicago, IL, 60611, USA.
| | - Sofia F Garcia
- Department of Medical Social Sciences, Department of Psychiatry and Behavioral Sciences, Center for Patient-Centered Outcomes, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Susan Yount
- Department of Medical Social Sciences, Department of Psychiatry and Behavioral Sciences, Center for Patient-Centered Outcomes, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - David Cella
- Department of Medical Social Sciences, Center for Patient-Centered Outcomes, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, 60611, USA
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Mazor M, Nelson A, Mathelier K, Wisnivesky JP, Goel M, Harris YT, Lin JJ. Racial and ethnic differences in post-traumatic stress trajectories in breast cancer survivors. J Psychosoc Oncol 2023; 42:1-15. [PMID: 37655715 PMCID: PMC10840938 DOI: 10.1080/07347332.2023.2253229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
PURPOSE To describe differences in post-traumatic stress (PTS) symptoms over time among racial and ethnic minoritized breast cancer survivors (BCS) with comorbid diabetes. DESIGN In a multisite longitudinal study, post-traumatic stress was evaluated at baseline, 6 and 12 months through self-reported questionnaires (Impact of Events Scale-Revised [IES-R]). PARTICIPANTS One hundred and seventy-eight post-treatment BCS with diabetes were recruited from three tertiary medical centers. FINDINGS Relative to non-Hispanic White women, minoritized women reported higher total IES-R scores at all time points. In the adjusted model, Latina women reported persistently higher IES-R total scores and Latina, and 'Other' women reported higher avoidance scores. CONCLUSIONS Minoritized BCS with comorbid diabetes report higher rates of cancer related PTS that persist over 12 months. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Post diagnosis PTS evaluation and support is important in survivorship and primary care practices. Linkage to socially and culturally sensitive community support may be warranted.
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Affiliation(s)
- Melissa Mazor
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Krystina Mathelier
- Lienhard School of Nursing, College of Health Professions, Pace University, Pleasantville, New York, USA
| | - Juan P. Wisnivesky
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mita Goel
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yael Tobi Harris
- Division of Endocrinology, Diabetes & Metabolism, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Jenny J. Lin
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Le HD, Wolinska JM, Baertschiger RM, Himidan SA. Complication Is Inevitable, but Suffering is Optional-Psychological Aspects of Dealing with Complications in Surgery. Eur J Pediatr Surg 2023; 33:181-190. [PMID: 36948212 DOI: 10.1055/s-0043-1767830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Surgical complications remain common in health care and constitute a significant challenge for hospitals, surgeons, and patients. While they cause significant physical, financial, and psychological harm to patients and their families, they also heavily burden the involved physicians. This phenomenon, known as the "second victim," results in negative short and long-term physical, cognitive, and psychological consequences on the surgeon. In this review, we explored the intricate connections between the surgeons' emotional response to adverse events concerning the patient outcome, perceived peer reaction, and existing social and institutional support systems. Using a selective literature review coupled with personal experiences, we propose a model of this complex interaction and suggest specific interventions to ameliorate the severity of response within this framework. The institution of the proposed interventions may improve the psychological well-being of surgeons facing complications and promote a cultural shift to better support physicians when they occur.
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Affiliation(s)
- Hau D Le
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Justyna M Wolinska
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharifa A Himidan
- Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, Humber River Hospital, Toronto, Ontario, Canada
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Lu Q, Yeung NCY, Tsai W, Kim JHJ. The effects of culturally adapted expressive writing interventions on depressive and anxiety symptoms among Chinese American breast cancer survivors: A randomized controlled trial. Behav Res Ther 2023; 161:104244. [PMID: 36592575 DOI: 10.1016/j.brat.2022.104244] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/27/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Expressive writing interventions confer mental health benefits for non-Hispanic Whites. However, research is lacking in adapting this paradigm for minoritized groups. This study evaluated the impacts of two culturally adapted expressive writing interventions on depressive and anxiety symptoms and potential mediators (perceived stress and intrusive thoughts) among Chinese American breast cancer survivors (CABCS). METHODS AND RESULTS CABCS (N = 136) were randomly assigned to one of three conditions to write three weekly essays: enhanced self-regulation condition (ESR) to write about stress and coping (Week 1), deepest feelings (Week 2), and finding benefits (Week 3); self-regulation condition (SR) to write about deepest feelings (Week 1), stress and coping (Week 2), and finding benefits (Week 3); and control condition to write about facts relevant to their cancer experience (Weeks 1-3). Compared with the control condition, the ESR but not SR, reduced depressive and anxiety symptoms at all follow-up time points (1, 3, and 6-months) through reductions in perceived stress. CONCLUSION A cultural adaptation altering the order of expressive writing prompts resulted in the greatest benefit for CABCS' depressive and anxiety symptoms. Research testing both the content and ordering of components may be vital to advance cultural adaptation science and optimize intervention efficacy. CLINICAL TRIAL REGISTRATION NUMBER NCT02946619.
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Affiliation(s)
- Qian Lu
- Department of Health Disparities Research, the University of Texas MD Anderson Cancer Center, Houston, TX, USA. Address: 1400 Pressler St. Unit 1440, Houston, TX 77030-3906, USA.
| | - Nelson C Y Yeung
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong Address: Room 508, Postgraduate Education Centre, Prince of Wales Hospital, the New Territories, Hong Kong.
| | - William Tsai
- Department of Applied Psychology, New York University, New York, NY, USA: Address: 246 Greene Street 8th Floor, New York, NY 10003, USA.
| | - Jacqueline H J Kim
- Department of Medicine, University of California, Irvine, CA, USA. Address: 100 Theory, Suite 100, Irvine, CA 92617, USA.
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Roche KN, Cooper D, Armstrong TS, King AL. The link between psychological distress and survival in solid tumor patients: A systematic review. Cancer Med 2023; 12:3343-3364. [PMID: 36602400 PMCID: PMC9939126 DOI: 10.1002/cam4.5200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Research has demonstrated that solid tumor patients experience high levels of psychological distress at the time of diagnosis. While distress has been associated with many adverse clinical outcomes, little is known about how this symptom may influence the disease trajectory for cancer patients, affecting outcomes such as progression, recurrence, and survival. The purpose of this systematic review was to explore the literature linking distress with survival in solid tumor patients, which may guide future work exploring clinical outcomes as a function of distress. METHODS A systematic search of PubMed, Embase, and Web of Science was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with predefined eligibility criteria. Thirteen studies met the inclusion criteria and were selected for review. RESULTS Findings from this review demonstrated a weak-to-moderate relationship between cancer patients' experience of distress and overall survival, with most included studies (11/13) finding at least one predictive analysis to be significant when controlling for confounders. However, significant heterogeneity in the literature, particularly with study sample characteristics and varying methodologies, made direct comparisons across studies challenging. CONCLUSION Findings from this review suggest that psychological distress may have an impact on disease-related outcomes, including (but not limited to) survival. Future work should consider performing disease-specific analyses controlling for key prognostic factors to better understand the nuanced relationship between distress and clinical outcomes, which may allow further understanding of the biological underpinnings of this relationship and enable the development of targeted interventions for improving distress.
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Affiliation(s)
- Kayla N. Roche
- Neuro‐Oncology BranchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Diane Cooper
- National Institutes of Health LibraryBethesdaMarylandUSA
| | - Terri S. Armstrong
- Neuro‐Oncology BranchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Amanda L. King
- Neuro‐Oncology BranchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
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Cancer Patients’ Age-Related Benefits from Mobile Neurofeedback-Therapy in Quality of Life and Self-efficacy: A Clinical Waitlist Control Study. Appl Psychophysiol Biofeedback 2022; 48:217-227. [DOI: 10.1007/s10484-022-09571-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
AbstractElectroencephalographic neurofeedback (EEG NF) can improve quality of life (QoL) and reduce distress by modifying the amplitude of selected brain frequencies. This study aims to investigate the effects of NF therapy on QoL and self-efficacy in cancer patients and to explore age-related reactions. In a waitlist control paradigm, psychometric data (EORTC QLQ-C30, General Self-Efficacy Scale) of 20 patients were collected at three different time points, each five weeks apart. An outpatient 10-session NF intervention (mobile) was conducted between the second and third measurement point. QoL and self-efficacy changed significantly over time (QoL: F(2,36) = 5.294, p < .05, η2 = .227; Self-efficacy: F(2,26) = 8.178, p < .05, η2 = .386). While QoL increased in younger patients, older patients initially showed a decrease in QoL, which then increased during intervention. Younger patients did not differ from older patients in QoL in both waitlist control (T0-T1) and intervention phase (T1–T2). QoL in older patients significantly differed between waitlist control and intervention phase (Z = − 2.023, p < .05, d = 1.085). Self-efficacy increased in both age categories. Younger and older patients did not differ in self-efficacy in waitlist control, but in intervention phase (F(1,16) = 7.014, p < .05, η2 = .319). The current findings suggest that NF therapy is a promising treatment modality for improving QoL in cancer patients. Our study reveals NF being a tool to influence self-efficacy, which should receive more appreciation in clinical care. However, the effect of NF in different age groups as well as the influence on further cancer-related symptoms should be investigated in future research.
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Pang X, Li F, Zhang Y. The Role of Mental Adjustment in Mediating Post-Traumatic Stress Disorder Symptoms and Social Support in Chinese Ovarian Cancer Patients: A Cross-Sectional Study. Psychol Res Behav Manag 2022; 15:2183-2191. [PMID: 35983022 PMCID: PMC9380830 DOI: 10.2147/prbm.s372660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Post-traumatic stress disorder (PTSD) can manifest in individuals following a traumatic event. There is a paucity of studies focusing on PTSD symptoms in ovarian cancer (OC) patients. This study aimed to investigate the association of social support, mental adjustment and PTSD symptoms in Chinese OC patients with a view to exploring whether mental adjustment could mediate the relationship. Methods A cross-sectional study was conducted from January 2015 to December 2016. A total of 171 OC subjects were recruited and the effective response rate was 81.3%. The PTSD Checklist-Civilian Version (PCL-C), Mini-Mental Adjustment to Cancer scale (Mini-MAC) and Duke-UNC Functional Social Support Questionnaire were disseminated to the patients. The Chinese Mini-MAC was used in this study focusing on three components, namely negative emotion, positive attitude, and cognitive avoidance. Hierarchical linear regression analyses were employed to investigate the association of social support and PTSD symptoms, and the role of mental adjustment in their mediation. Results The prevalence of PTSD symptoms was 17.3% in OC patients. PTSD symptoms were negatively related with both social support and positive attitude, and positively associated with negative emotion and cognitive avoidance. Social support was negatively associated with negative emotion and cognitive avoidance, and positively related with positive attitude. In addition, negative emotion and positive attitude mediated the association between social support and PTSD symptoms. Conclusion PTSD symptoms in OC patients should be paid attention to. Social support and mental adjustment were positive resources associated with PTSD symptoms. Moreover, mental adjustment could mediate the relation between social support and PTSD symptoms in OC patients. Therefore, intervention management that focusing on improving perceived social support as well as strengthening mental adjustment, especially negative emotion and positive attitude, may be useful for reducing PTSD symptoms in this context.
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Affiliation(s)
- Xiaoyan Pang
- Department of Gynecology, the First Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China
| | - Fangmei Li
- Department of Gynecology, the First Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China
| | - Yi Zhang
- Department of Gynecology, the First Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China
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Panobianco MS, Gaspar LM, Prado MAS, Berzuini GA. Pandemia de Covid-19 e Transtorno de Estresse Pós-traumático em Mulheres com Câncer de Mama. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n2.2234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introdução: Pacientes com câncer possuem um risco maior de contrair covid-19 e apresentar piores resultados. Objetivo: Avaliar o estresse pós-traumático advindo da pandemia de covid-19 em mulheres com câncer de mama. Método: Escala do Impacto do Evento – Revisada (IES-R) composta por 22 itens, em três subescalas (evitação, intrusão e hiperestimulação), que contemplam os critérios de avaliação de transtornos de estresse pós-traumáticos. O convite foi enviado via WhatsApp ou nas reuniões on-line de um núcleo de reabilitação para o câncer de mama juntamente com um link de um formulário do Google Docs e o Termo de Consentimento Livre e Esclarecido. Resultados: Participaram do estudo 50 mulheres que apresentaram idade entre 34 e 81 anos, 88% faziam uso de algum tipo de medicação para comorbidades e 10% usavam antidepressivos. As participantes não apresentaram transtornos de estresse pós-traumáticos, no entanto, os números mostraram que mulheres com idades mais avançadas apresentaram índices menores de transtornos de estresse pós-traumáticos: escala total (p=0,002), subescalas intrusão (p=0,001) e hiperestimulação (p=0,003). Houve também uma diferença significativa quanto a medicação antidepressiva para a escala total (p=0,032) e para as subescalas intrusão (p=0,026) e hiperestimulação (p=0,030). Conclusão: As participantes não apresentaram estresse pós-traumático, o que pode ter sido em razão de já frequentarem um núcleo de reabilitação para o câncer de mama que oferece uma assistência integral, inclusive durante a pandemia (atendimento on-line).
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Martino ML, Lemmo D, Testoni I, Iacona E, Pizzolato L, Freda MF, Neimeyer RA. Anticipatory Mourning and Narrative Meaning-Making in the Younger Breast Cancer Experience: An Application of the Meaning of Loss Codebook. Behav Sci (Basel) 2022; 12:bs12040093. [PMID: 35447665 PMCID: PMC9025731 DOI: 10.3390/bs12040093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
Breast cancer (BC) in women under 50 is a potentially traumatic experience that can upset a woman’s life during a crucial phase of her lifespan. Anticipatory mourning linked to the diagnosis of BC can produce a series of inevitable losses similar to those of the bereaved. Narration can be one tool to construct meaning, to grow through the experience, and reconfigure time perspectives during and after the illness. The aim of this study was to apply the Meaning of Loss Codebook (MLC) to the narrative context of young women with BC. An ad hoc narrative interview was administered to 17 women at four times during the first year of treatment. A thematic analysis was performed using the MLC, adopting a bottom-up and top-down methodology. The results highlight the MLC’s usefulness in capturing the experiences of the women, allowing for a greater appreciation of the nuances of the meanings embodied in their narratives. The thematic categories grounded in the MLC cover the whole experience of BC during the first year of treatment, attesting to the possibility of extending the use of the MLC to observe the longitudinal elaboration of the psychic experience of BC in addition to its established validity in the context of bereavement and loss.
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Affiliation(s)
- Maria Luisa Martino
- Department of Humanities, Federico II University, 80133 Naples, Italy; (D.L.); (M.F.F.)
- Correspondence: ; Tel.: +39-0812535517
| | - Daniela Lemmo
- Department of Humanities, Federico II University, 80133 Naples, Italy; (D.L.); (M.F.F.)
| | - Ines Testoni
- FISPPA Department, University of Padua, 35131 Padova, Italy; (I.T.); (E.I.); (L.P.)
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | - Erika Iacona
- FISPPA Department, University of Padua, 35131 Padova, Italy; (I.T.); (E.I.); (L.P.)
| | - Laura Pizzolato
- FISPPA Department, University of Padua, 35131 Padova, Italy; (I.T.); (E.I.); (L.P.)
| | - Maria Francesca Freda
- Department of Humanities, Federico II University, 80133 Naples, Italy; (D.L.); (M.F.F.)
| | - Robert A. Neimeyer
- Department of Psychology, University of Memphis, Memphis, TN 38152, USA;
- Portland Institute for Loss and Transition, Portland, OR 97219, USA
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Martino ML, Lemmo D, Gargiulo A, Barberio D, Abate V, Freda MF. Processing Breast Cancer Experience in Under-Fifty Women: Longitudinal Trajectories of Narrative Sense Making Functions. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2022. [DOI: 10.1080/10720537.2022.2043208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Daniela Lemmo
- Department of Humanities, Federico II University Naples, Naples, Italy
| | - Anna Gargiulo
- Department of Humanities, Federico II University Naples, Naples, Italy
| | - Daniela Barberio
- Clinical Psychology Unit, National Cancer Institute “Fondazione G. Pascale”, Naples, Italy
| | - Valentina Abate
- Clinical Psychology Unit, National Cancer Institute “Fondazione G. Pascale”, Naples, Italy
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Martino ML, Lemmo D, Gargiulo A. A review of psychological impact of breast cancer in women below 50 years old. Health Care Women Int 2021; 42:1066-1085. [PMID: 34357855 DOI: 10.1080/07399332.2021.1901901] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A breast cancer diagnosis is a critical event with a potentially traumatic nature. In recent years there has been an increase of this illness in women aged under-fifty, a group of particular scientific interest. In this article the authors review the recent scientific literature on psychological impact of breast cancer experiences in under-50 women. Our results highlight three trajectories: clinical psychological risks; feminine-specific concerns; resources between individual and relational aspects. This overview illustrates the complexity of the effects of breast cancer in under-50women allowing to think about theoretical and psychosocial models to provide support for under-50 women during the illness experience.
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Affiliation(s)
- Maria Luisa Martino
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Daniela Lemmo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Anna Gargiulo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
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14
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Ganz PA, Bower JE, Partridge AH, Wolff AC, Thorner ED, Joffe H, Irwin MR, Petersen L, Crespi CM. Screening for Depression in Younger Breast Cancer Survivors: Outcomes From Use of the 9-item Patient Health Questionnaire. JNCI Cancer Spectr 2021; 5:pkab017. [PMID: 34164605 PMCID: PMC8216636 DOI: 10.1093/jncics/pkab017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background Major cancer organizations recommend depression screening in patients and survivors. The 9-item Patient Health Questionnaire (PHQ-9) is often suggested, with limited information about its use. Methods Enrollment data collected from younger breast cancer survivors participating in a behavioral intervention trial were used to examine the relationship between PHQ-9 scores (range = 0-27), patient characteristics, and responses to standardized psychosocial assessment tools. Major depressive disorder criterion was met if responses to the first 2 PHQ-9 items (range = 0-6) were 3 or greater. The sample was categorized by total PHQ-9 scores: less than 5 (minimal depressive symptoms), 5-9 (mild to moderate depressive symptoms), and 10 or greater (moderate to severe depression). PHQ-9 category associations with medical, demographic, psychosocial, and behavioral characteristics were examined using analysis of variance for continuous variables and χ2 tests for categorical variables. Results A total of 231 women met the study prescreening eligibility criterion of mild depressive symptoms and enrolled in the study. On average, they were 45.2 years old and 2.6 years since diagnosis. At enrollment, 22.1% met the screening criterion for possible major depressive disorder; among those with PHQ-9 scores of 10 or greater, 58.3% met this criterion. Anxiety, fatigue, insomnia, and intrusive thoughts about cancer were frequent and were associated with depressive symptom severity (all P < .001). In contrast, neither demographic nor cancer treatment characteristics were associated with depressive symptoms. Conclusions Depressive symptoms in this selected sample of younger breast cancer survivors were independent of demographic characteristics or cancer treatment history, suggesting that depression screening is necessary to detect uncontrolled depressive symptoms.
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Affiliation(s)
- Patricia A Ganz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Department of Medicine (Hematology-Oncology), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Julienne E Bower
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles, CA, USA.,Department of Psychology, UCLA, Los Angeles, CA, USA.,Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA, USA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Elissa D Thorner
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael R Irwin
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles, CA, USA.,Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA, USA
| | - Laura Petersen
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Catherine M Crespi
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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15
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Changes of narrative meaning-making markers
during the different phases of breast cancer
treatment for women below 50 years old. HEALTH PSYCHOLOGY REPORT 2021. [DOI: 10.5114/hpr.2021.105363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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16
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Maraqa BN, Ahmead M. Quality of life and post-traumatic stress disorder among adult females with cancer in Palestine: a cross-sectional study. Eur J Psychotraumatol 2021; 12:1904699. [PMID: 36877470 PMCID: PMC9754040 DOI: 10.1080/20008198.2021.1904699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Little research has been conducted on the quality of life (QoL), functional status, and traumatic symptoms related to the diagnosis and treatment of cancer in the Arab region, particularly in Palestine, where the psychological problems in patients with cancer are often neglected.Objective: The aim of the study was to assess QoL and post-traumatic stress disorder (PTSD) symptoms among adult female patients with cancer attending Beit-Jala Governmental Hospital in Bethlehem.Method: Participants were recruited from 4 April 2015 to the end of July 2015. The sample included 253 female patients with cancer attending Beit-Jala Governmental Hospital in Bethlehem. Data were collected using self-reported questionnaires, including a socio-demographic data sheet, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and the post-traumatic stress disorder checklist for PTSD symptoms.Results: The current study showed poor global QoL (57.4%) and poor physical function (48.5%) for female patients with cancer. Insomnia, fatigue, and loss of appetite were the most troublesome symptoms that the participants complained about. The prevalence of PTSD symptoms was 3%. Regarding PTSD symptom severity, 2% reported severe symptoms, 23.3% reported moderate symptoms, and (68.8%) reported mild symptoms, based on a 1991 classification of PTSD symptom severity scores. Finally, Pearson's test revealed a strong, statistically significant, inverse relationship between QoL domains and PTSD.Conclusion: The study found that the overall QoL of female patients with cancer was low and strongly associated with PTSD symptoms, suggesting that early detection and treatment of these symptoms is critical.
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Affiliation(s)
| | - Muna Ahmead
- Faculty of Public Health, Al-Quds University, Jerusalem, Palestine
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17
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MDMA-assisted psychotherapy for treatment of anxiety and other psychological distress related to life-threatening illnesses: a randomized pilot study. Sci Rep 2020; 10:20442. [PMID: 33235285 PMCID: PMC7686344 DOI: 10.1038/s41598-020-75706-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 10/14/2020] [Indexed: 02/08/2023] Open
Abstract
The success of modern medicine creates a growing population of those suffering from life-threatening illnesses (LTI) who often experience anxiety, depression, and existential distress. We present a novel approach; investigating MDMA-assisted psychotherapy for the treatment of anxiety in people with an LTI. Participants with anxiety from an LTI were randomized in a double-blind study to receive MDMA (125 mg, n = 13) or placebo (n = 5) in combination with two 8-h psychotherapy sessions. The primary outcome was change in State-Trait Anxiety Inventory (STAI) Trait scores from baseline to one month post the second experimental session. After unblinding, participants in the MDMA group had one open-label MDMA session and placebo participants crossed over to receive three open-label MDMA sessions. Additional follow-up assessments occurred six and twelve months after a participant’s last experimental session. At the primary endpoint, the MDMA group had a greater mean (SD) reduction in STAI-Trait scores, − 23.5 (13.2), indicating less anxiety, compared to placebo group, − 8.8 (14.7); results did not reach a significant group difference (p = .056). Hedges’ g between-group effect size was 1.03 (95% CI: − 5.25, 7.31). Overall, MDMA was well-tolerated in this sample. These preliminary findings can inform development of larger clinical trials to further examine MDMA-assisted psychotherapy as a novel approach to treat individuals with LTI-related anxiety. Trial Registration: clinicaltrials.gov Identifier: NCT02427568, first registered April 28, 2015.
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18
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Renna ME, Shrout MR, Madison AA, Alfano CM, Povoski SP, Lipari AM, Agnese DM, Carson WE, Kiecolt-Glaser JK. Within-person changes in cancer-related distress predict breast cancer survivors' inflammation across treatment. Psychoneuroendocrinology 2020; 121:104866. [PMID: 32947247 PMCID: PMC7572735 DOI: 10.1016/j.psyneuen.2020.104866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Among breast cancer survivors, elevated inflammation has been linked to greater recurrence risk. Psychological processes, such as cancer-related distress, can pose threats to a survivor's longevity and wellbeing. Although distress can heighten inflammation, little is known about how fluctuations in distress during and after treatment impact a woman's own inflammation - the primary question of this study. METHODS Breast cancer survivors (n = 165, stages 0-III) completed a baseline visit before treatment and two follow-up visits 6 and 18 months after. At each visit, women completed the Impact of Events Scale to assess cancer-related distress, and a blood sample was collected to measure proinflammatory cytokines IL-6, TNF-α, IL-1β, and IL-8. This longitudinal study related fluctuations in survivor's own cancer-related distress (i.e., within-person effects), as well as average effects of cancer-related distress between survivors (i.e., between-person effects) to inflammatory changes across visits. RESULTS Women had elevated inflammation at visits where they expressed more cancer-related distress than what was typical. In contrast, the average cancer-related distress was not associated with inflammation. CONCLUSION Larger increases in a women's cancer-related distress was linked with higher inflammation across visits. Comparing a survivor's own cancer-related distress to her average levels may prove useful in identifying links between distress and inflammation.
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Affiliation(s)
- Megan E. Renna
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA,Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Corresponding author at: Institute of Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, 43210, United States. (M.E. Renna)
| | - M. Rosie Shrout
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Annelise A. Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Psychology, The Ohio State University, Columbus, OH, USA
| | | | - Stephen P. Povoski
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Adele M. Lipari
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Doreen M. Agnese
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - William E. Carson
- Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Janice K. Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA,Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
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19
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GOG 244 - The Lymphedema and Gynecologic cancer (LeG) study: The impact of lower-extremity lymphedema on quality of life, psychological adjustment, physical disability, and function. Gynecol Oncol 2020; 160:244-251. [PMID: 33109392 DOI: 10.1016/j.ygyno.2020.10.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/19/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess quality of life (QOL) in patients who developed lower-extremity lymphedema (LLE) after radical gynecologic cancer surgery on prospective clinical trial GOG 244. METHODS The prospective, national, cooperative group trial GOG-0244 determined the incidence of LLE and risk factors for LLE development, as well as associated impacts on QOL, in newly diagnosed patients undergoing surgery for endometrial, cervical, or vulvar cancer from 6/4/2012-11/17/2014. Patient-reported outcome (PRO) measures of QOL (by the Functional Assessment of Cancer Therapy [FACT]), body image, sexual and vaginal function, limb function, and cancer distress were recorded at baseline (within 14 days before surgery), and at 6, 12, 18, and 24 months after surgery. Assessments of LLE symptoms and disability were completed at the time of lower limb volume measurement. A linear mixed model was applied to examine the association of PROs/QOL with a Gynecologic Cancer Lymphedema Questionnaire (GCLQ) total score incremental change ≥4 (indicative of increased LLE symptoms) from baseline, a formal diagnosis of LLE (per the GCLQ), and limb volume change (LVC) ≥10%. RESULTS In 768 evaluable patients, those with a GCLQ score change ≥4 from baseline had significantly worse QOL (p < 0.001), body image (p < 0.001), sexual and vaginal function (p < 0.001), limb function (p < 0.001), and cancer distress (p < 0.001). There were no significant differences in sexual activity rates between those with and without LLE symptoms. CONCLUSIONS LLE is significantly detrimental to QOL, daily function, and body image. Clinical intervention trials to prevent and manage this chronic condition after gynecologic cancer surgery are needed.
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20
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Andrijauskaite K, Wargovich MJ. Role of natural products in breast cancer related symptomology: Targeting chronic inflammation. Semin Cancer Biol 2020; 80:370-378. [PMID: 32891720 DOI: 10.1016/j.semcancer.2020.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 08/03/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common cancer in women worldwide. There have been many advancements in the treatment of breast cancer leading to an increased population of patients living with this disease. Accumulating evidence suggests that cancer diagnosis and aftermath experienced stress could not only affect the quality of life of cancer patients, but it could also influence their disease outcome. The magnitude of stress experienced by breast cancer patients is often compared to the post-traumatic stress disorder-like symptoms suggested to be mediated by the chronic inflammation including NF-κB, AKt, p53 and other inflammatory pathways. Here, we describe the symptomology of PTSD-like symptoms in breast cancer patients and argue that they may in fact be caused by or maintained through aspects of chronic inflammation mediated by the pro-inflammatory markers. Evidence exists that natural products that might attenuate or lessen the effects of chronic inflammation abound in the diet. We summarize some possible agents that might abate the genesis of symptoms experienced by breast cancer patients while mitigating the effect of inflammation.
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Affiliation(s)
- Kristina Andrijauskaite
- Department of Molecular Medicine, UT Health San Antonio, San Antonio, TX, 78229, United States.
| | - Michael J Wargovich
- Department of Molecular Medicine, UT Health San Antonio, San Antonio, TX, 78229, United States
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21
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Vazquez D, Rosenberg S, Gelber S, Ruddy KJ, Morgan E, Recklitis C, Come S, Schapira L, Partridge AH. Posttraumatic stress in breast cancer survivors diagnosed at a young age. Psychooncology 2020; 29:1312-1320. [PMID: 32515073 DOI: 10.1002/pon.5438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/08/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Young breast cancer patients experience greater psychosocial distress compared with older patients, which raises concern for their risk of posttraumatic stress disorder (PTSD). We sought to characterize the prevalence of clinically significant symptoms of PTSD and associated factors among breast cancer survivors diagnosed at a young age. METHODS The Young Women's Breast Cancer Study, an ongoing prospective cohort study, enrolled 1302 women diagnosed with breast cancer at age ≤ 40 between 2006 and 2016. Participants complete serial surveys, and we obtained additional information from medical record review. Socio-demographics, anxiety and depression, social support, and psychiatric co-morbidities and medications were assessed at study baseline (median, 5 months post-diagnosis). We defined a participant as having clinically significant posttraumatic stress symptoms (PTSS) by scoring ≥50 on the PTSD Checklist-Specific Version, administered on the 30-month survey. RESULTS Among 700 women with stage 1-3 disease, the prevalence of PTSS was 6.3% (95%CI = 4.5-8.1). In multivariable analyses, PTSS was significantly associated with anxiety (OR 12.43, 95%CI = 5.81-26.59, P < .0001) and stage 2 vs 1 disease (OR 2.26, 95%CI = 1.04-4.93, P = .04). PTSS was inversely associated with having a college degree (OR 0.29, 95%CI = 0.13-0.62, P = .002) and greater social support (OR 0.44, 95%CI = 0.21-0.94, P = .03). CONCLUSIONS We found similar rates of cancer-related PTSS in breast cancer survivors diagnosed at a young age compared with the general breast cancer population despite their well-documented increased risk of overall distress. Nevertheless, factors associated with posttraumatic stress should be considered at diagnosis and in survivorship to identify young patients who may benefit from psychosocial resources.
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Affiliation(s)
- Danny Vazquez
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Shoshana Rosenberg
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Shari Gelber
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Evan Morgan
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christopher Recklitis
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Steven Come
- Harvard Medical School, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
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22
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Abstract
BACKGROUND Depression and post-traumatic stress disorder (PTSD) are leading causes of disability and loss of life by suicide. Currently, there are less than satisfactory medical solutions to treat these mental disorders. Here, we explore recent preclinical and clinical studies demonstrating the potential of using buprenorphine to treat major depressive disorder, treatment-resistant depression, and PTSD. METHOD Bibliographic databases were searched to include preclinical and clinical studies demonstrating the therapeutic potential of buprenorphine and the involvement of the kappa opioid receptor (KOR) in mediating these effects. RESULTS Original clinical studies examining the effectiveness of buprenorphine to treat depression were mixed. The majority of participants in the PTSD studies were males and suffer from chronic pain and/or substance use disorders. Nonetheless, these recent studies and analyses established proof of concept warranting farther investigations. Additionally, KOR likely mediates the antidepressant and some of the anxiolytic effects of buprenorphine. Still, it appears that the full spectrum of buprenorphine's beneficial effects might be due to activity at other opioid receptors as well. CONCLUSIONS Pharmaceuticals' abilities to treat medical conditions directly relates to their ability to act upon the endogenous biological systems related to the conditions. Thus, these recent findings are likely a reflection of the central role that the endogenous opioid system has in these mental illnesses. Further studies are necessary to study the involvement of endogenous opioid systems, and specifically KOR, in mediating buprenorphine's beneficial effects and the ability to treat these medical conditions while minimizing risks for misuse and diversion.
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Affiliation(s)
- Caitlin A Madison
- Behavioral and Cellular Neuroscience, Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX77843, USA
| | - Shoshana Eitan
- Behavioral and Cellular Neuroscience, Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX77843, USA
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23
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Sager ZS, Wachen JS, Naik AD, Moye J. Post-Traumatic Stress Disorder Symptoms from Multiple Stressors Predict Chronic Pain in Cancer Survivors. J Palliat Med 2020; 23:1191-1197. [PMID: 32228350 DOI: 10.1089/jpm.2019.0458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Despite the association between chronic pain and post-traumatic stress disorder (PTSD), little is known about the longitudinal course of pain and PTSD during cancer treatment. Objectives: We examined the prevalence of PTSD and chronic pain at three time periods in veterans with a diagnosis of cancer, and the relationship between the experience of pain and PTSD. Methods: Participants (N = 123) with oral-digestive cancers were recruited from the Veterans Healthcare System (age M = 65.31 and SD = 9.13; 98.4% male) and completed face to face interviews at 6, 12, and 18 months post-diagnosis. Measures included the Post-traumatic Stress Disorder Checklist-Stressor-Specific version (PCL-S), Primary care PTSD (PC-PTSD), and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Impact Scale. Results: About one-third (26.8%) of the sample had chronic pain, defined as elevated pain at two time periods. About one-fifth (20.3%) endorsed symptoms of combat-related PTSD at 6 months, and 22.8% endorsed symptoms of cancer-related PTSD, exceeding a clinical cutoff for older adults (12 months = 21.1%, 18 months = 23.1%). Changes over time were observed for cancer-related PTSD symptom clusters of hyperarousal (F = 3.85 and p = 0.023) and emotional numbing (F = 4.06 and p = 0.018) with a statistically significant quadratic function increasing at 18 months. In logistic regression, individuals with both combat and cancer-related PTSD symptoms at six months had 8.49 times higher odds of experiencing chronic pain (χ2 = 25.91 and p < 0.001; R2 = 0.28). Conclusions: Persisting pain may be a concern in veterans with cancer. Individuals who have experienced traumatic events with persisting PTSD symptoms may be at elevated risk for chronic pain. Veterans with PTSD symptoms from both cancer and combat are at the highest risk to experience chronic pain.
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Affiliation(s)
- Zachary S Sager
- VA New England GRECC and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Wachen
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System and Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Aanand D Naik
- Health Services Research and Development, Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer Moye
- VA New England GRECC and Harvard Medical School, Boston, Massachusetts, USA
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24
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Fekih-Romdhane F, Bouali S, Balti M, Labbane R, Cheour M. Évaluation des symptômes de stress post-traumatique chez les femmes atteintes d’un cancer du sein nouvellement diagnostiqué. PSYCHO-ONCOLOGIE 2020. [DOI: 10.3166/pson-2019-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : Le diagnostic du cancer du sein est un événement potentiellement mortel associé à une détresse importante. La présente étude visait à évaluer la prévalence et la sévérité des symptômes de stress post-traumatique ; et à analyser l’association entre les symptômes de stress posttraumatique et la dépression, les données relatives à la maladie cancéreuse et les données sociodémographiques chez ces femmes.
Méthodes : Soixante et une femmes atteintes d’un cancer du sein nouvellement diagnostiqué ont rempli deux questionnaires : l’Impact of Event Scale révisé (IES-R) et la souséchelle DASS–Dépression des échelles de dépression, de stress et d’anxiété (DASS-21). Les femmes ont été interrogées quatre semaines après l’annonce du diagnostic. Les patientes étaient âgées de 18 à 65 ans et avaient un cancer du sein histologiquement confirmé et sans antécédents d’autres cancers.
Résultats : L’âge moyen des patientes incluses dans cette étude était de 46,5 ans. La majorité d’entre elles vivaient en milieux urbains (82 %) et avaient un niveau socioéconomique moyen (83,6 %). Trente-six pour cent des patientes atteintes d’un cancer du sein ont été diagnostiquées à un stade avancé (III et IV) et ont reçu un traitement chirurgical dans 73,8 % des cas. 57,4 % des patientes atteintes d’un cancer du sein nouvellement diagnostiqué présentaient des symptômes de stress post-traumatique supérieurs au seuil (score IER-S > 33) et 18,0 %des symptômes dépressifs (score DASS-dépression > 9). L’absence de revenu (notamment être sans profession ou étudiante) et la dépression étaient les meilleurs prédicteurs des symptômes du trouble de stress post-traumatique dans notre population.
Conclusion : L’observation de la complexité du vécu des patientes atteintes de cancer du sein renforce l’idée de la nécessité d’un accompagnement spécifique. Une évaluation précoce des besoins psychoémotionnels des patientes atteintes de cancer du sein et une intervention précoce pourraient être particulièrement utiles.
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Pereira L, Sampson J, DiCola K. Factors Related to Linguistic Content in Video Narrative of Adolescents with Cancer and Healthy Controls. JOURNAL OF PSYCHOLINGUISTIC RESEARCH 2019; 48:1185-1201. [PMID: 31222472 DOI: 10.1007/s10936-019-09652-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A long history exists of the utilization of narratives to help young people cope with stress and illness. Research is beginning to focus on video based story-telling for the purpose of intervention, however little research has been conducted to look at factors that influence the narrative content of these films. As a pilot, and within the context of a larger study, the current research was conducted with n = 10 adolescents with cancer and n = 10 healthy peers exploring participant characteristics (e.g. personality, quality of life, etc.) and their relationship with linguistic consent of the film. Despite little to no differences identified in demographic characteristics, results identified distinct differences between each group, suggesting that linguistic aspects of film narratives differ in adolescents with and without cancer. This research can serve to motivate future directions of exploration surrounding the content of film narratives and their relationship to patient well-being.
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26
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Edward KL, Chipman M, Giandinoto JA, Robinson K. Quality of life and personal resilience in the first two years after breast cancer diagnosis: systematic integrative review. ACTA ACUST UNITED AC 2019; 28:S4-S14. [PMID: 31116589 DOI: 10.12968/bjon.2019.28.10.s4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this systematic integrative review was to examine the early impacts of a breast cancer diagnosis (up to 2 years after diagnosis) in relation to quality of life and personal resilience. The bibliographic databases of Medline, CINAHL, Cochrane, and Psychology and Behavioral Science Collection were searched using predetermined search criteria. Research studies published up to February 2019 were considered and following appraisal 36 articles were included in the review. Younger age, disease progression at first presentation, personality factors such as optimism, and moderators such as social support, clinical interventions and development of self-management abilities predicted better quality of life and personal resilience. Not recovering from the physical and psychological impacts of a new diagnosis has implications for future mental and physical health. This systematic, integrative review highlighted that building resilience and working with women's strengths should be the focus for contemporary clinical interventions for women in the early period after diagnosis of breast cancer.
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Affiliation(s)
- Karen-Leigh Edward
- Professor of Nursing and Practice Based Research, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Mitchell Chipman
- Oncologist, Victorian Breast and Oncology Care, East Melbourne, Australia
| | - Jo-Ann Giandinoto
- PhD Student, Faculty of Health Science, Australian Catholic University, Melbourne, Australia
| | - Kayte Robinson
- Research Assistant, Victorian Breast and Oncology Care, East Melbourne, Australia
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Emotional adjustment among parents of adolescents and young adults with cancer: the influence of social constraints on cognitive processing and fear of recurrence. J Behav Med 2019; 43:237-245. [DOI: 10.1007/s10865-019-00072-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
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Ochoa Arnedo C, Sánchez N, Sumalla EC, Casellas-Grau A. Stress and Growth in Cancer: Mechanisms and Psychotherapeutic Interventions to Facilitate a Constructive Balance. Front Psychol 2019; 10:177. [PMID: 30778323 PMCID: PMC6369350 DOI: 10.3389/fpsyg.2019.00177] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/18/2019] [Indexed: 12/14/2022] Open
Abstract
Post-traumatic stress and growth are common responses to adverse life events such as cancer. In this article, we establish how cancer becomes a "fertile land" for the emergence of stress and growth responses and analyze the main mechanisms involved. Stress-growth responses on adjusting to cancer is potentially determined by factors like the phase of the illness (e.g., initial phases vs. period of survivorship), patient's coping strategies, meaning-making, and relationships with significant others. We also review the mechanisms of constructive and adaptative stress-growth balances in cancer to study the predictors, interrelated associations, triggering mechanisms, long-term results, and specific trajectories of these two responses to cancer. Finally, we update the evidence on the role of these stress-growth associations in psychologically adjusting to cancer. Together with this evidence, we summarize preliminary results regarding the efficacy of psychotherapeutic interventions that aim to facilitate a constructive psychological balance between stress and growth in cancer patients. Recommendations for future research and gaps in knowledge on stress-growth processes in this illness are also highlighted. Researchers are encouraged to design and use psychotherapeutic interventions according to the dynamic and changeable patients' sources of stress and growth along the illness. Relevant insights are proposed to understand the inconsistency of stress-growth literature and to promote psychotherapeutic interventions to facilitate a constructive balance between these key responses in cancer.
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Affiliation(s)
- Cristian Ochoa Arnedo
- Psycho-oncology Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.,Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Barcelona, Spain
| | | | - Enric C Sumalla
- Psycho-oncology Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Casellas-Grau
- Psycho-oncology Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
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Rakici SY, Karaman E. Colorful Screams of Silent Emotions: A Study with Oncological Patients. Indian J Palliat Care 2019; 25:361-366. [PMID: 31413449 PMCID: PMC6659539 DOI: 10.4103/ijpc.ijpc_79_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Art, as a product of human behavior, is the expression of emotions from inner states and may provide catharsis, purification, and release. Several branches of art, most notably music, dance, and painting, can be used for treatment purposes, especially in the case of psychological disorders. Cancer, which is defined as uncontrolled cell growth, has been an important health issue throughout history, but the recent increase in its frequency has made it one of the most significant public health problems. Both the physiological distress the disease subjects the body to and the accompanying emotional distress are important factors to be considered in cancer treatment. Aims: In this study, the role of art in expressing emotions of oncological patients was investigated. Materials and Methods: During the treatment period, patients were interviewed about their experiences, feelings, expectations and perceptions. The picture was used as an expression of emotions. Results: Communication between the patient and doctor is one of the most important elements in the treatment process, and it has come to the fore in branches of medicine, such as oncology, because of its positive contribution to treatment compliance. In general, the study showed a pronounced positivity and expectations on the part of patients from the hope-life-healing process rather than oncological treatment. Conclusion: In this study, we aim to demonstrate how the artistic expression of emotions, in particular, through painting, has a positive effect on healing, hope, and the interactions between cancer patients under oncological treatment and medical professionals.
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Affiliation(s)
- Sema Yilmaz Rakici
- Department of Radiation Oncology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Elanur Karaman
- Department of Internal Medicine, Clinic of Medical Oncology, Training and Research Hospital, Recep Tayyip Erdogan University, Rize, Turkey
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30
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Nipp RD, El-Jawahri A, D'Arpino SM, Chan A, Fuh CX, Johnson PC, Lage DE, Wong RL, Pirl WF, Traeger L, Cashavelly BJ, Jackson VA, Ryan DP, Hochberg EP, Temel JS, Greer JA. Symptoms of posttraumatic stress disorder among hospitalized patients with cancer. Cancer 2018; 124:3445-3453. [PMID: 29905935 DOI: 10.1002/cncr.31576] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/01/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with cancer experience many stressors placing them at risk for posttraumatic stress disorder (PTSD) symptoms, yet little is known about factors associated with PTSD symptoms in this population. This study explored relationships among patients' PTSD symptoms, physical and psychological symptom burden, and risk for hospital readmissions. METHODS We prospectively enrolled patients with cancer admitted for an unplanned hospitalization from August 2015-April 2017. Upon admission, we assessed patients' PTSD symptoms (Primary Care PTSD Screen), as well as physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire 4 [PHQ-4]) symptoms. We examined associations between PTSD symptoms and patients' physical and psychological symptom burden using linear regression. We evaluated relationships between PTSD symptoms and unplanned hospital readmissions within 90-days using Cox regression. RESULTS We enrolled 954 of 1,087 (87.8%) patients approached, and 127 (13.3%) screened positive for PTSD symptoms. The 90-day hospital readmission rate was 38.9%. Younger age, female sex, greater comorbidities, and genitourinary cancer type were associated with higher PTSD scores. Patients' PTSD symptoms were associated with physical symptoms (ESAS physical: B = 3.41; P < .001), the total symptom burden (ESAS total: B = 5.97; P < .001), depression (PHQ-4 depression: B = 0.67; P < .001), and anxiety symptoms (PHQ-4 anxiety: B = 0.71; P < .001). Patients' PTSD symptoms were associated with a lower risk of hospital readmissions (hazard ratio, 0.81; P = .001). CONCLUSIONS A high proportion of hospitalized patients with cancer experience PTSD symptoms, which are associated with a greater physical and psychological symptom burden and a lower risk of hospital readmissions. Interventions to address patients' PTSD symptoms are needed and should account for their physical and psychological symptom burden. Cancer 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Ryan D Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Sara M D'Arpino
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andy Chan
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Charn-Xin Fuh
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - P Connor Johnson
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Daniel E Lage
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Risa L Wong
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - William F Pirl
- Department of Psychiatry, Sylvester Comprehensive Cancer Center and University of Miami, Miami, Florida
| | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Barbara J Cashavelly
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Vicki A Jackson
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - David P Ryan
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Ephraim P Hochberg
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Temel
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Kosola S, McCarthy MC, McNeil R, Orme LM, Drew S, Sawyer SM. Early Education and Employment Outcomes After Cancer in Adolescents and Young Adults. J Adolesc Young Adult Oncol 2018; 7:238-244. [DOI: 10.1089/jayao.2017.0045] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Silja Kosola
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Murdoch Children's Research Institute, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Maria C. McCarthy
- Murdoch Children's Research Institute, Melbourne, Australia
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
| | - Robyn McNeil
- Murdoch Children's Research Institute, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Lisa M. Orme
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sarah Drew
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Susan M. Sawyer
- Murdoch Children's Research Institute, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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32
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Carleton RN, Duranceau S, McMillan KA, Asmundson GJG. Trauma, Pain, and Psychological Distress. J PSYCHOPHYSIOL 2018. [DOI: 10.1027/0269-8803/a000184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract. Posttraumatic stress disorder (PTSD) and chronic musculoskeletal pain (CMP) are highly prevalent ( Breslau, 2002 ) and comorbid disorders ( Otis, Keane, & Kerns, 2003 ). The shared vulnerability model explains this overlap in part through a common attentional bias toward threat ( Asmundson, Coons, Taylor, & Katz, 2002 ). The current study made use of the acoustic startle to assess cognitive bias to threat in participants (n = 106; 64% women) who reported experiencing a motor vehicle accident (MVA). Participants were divided into five groups based on their diagnoses: PTSD, CMP, both PTSD and CMP, any general (i.e., non-PTSD) anxiety disorder with no CMP, and a no-disorder Control group. Self-report measures were used to assess psychological symptoms, trauma response, and pain-related factors. Word stimuli (i.e., trauma, sensory pain, health, pleasant, neutral) were presented visually prior to onset of the acoustic startle probe to assess for diagnosis-congruent attentional biases (e.g., persons with PTSD respond differently to trauma words). Relative to the general anxiety and control group, persons with PTSD or chronic pain demonstrated delayed startle peak and greater startle intensity across all word stimuli types; the results suggest there may be psychophysiologically measurable differences associated with PTSD and pain. The startle probe paradigm remains relatively nascent for such research, but has potential utility for assessment and treatment monitoring. Comprehensive results, discussion, and implications are analyzed.
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Taft TH, Ballou S, Bedell A, Lincenberg D. Psychological Considerations and Interventions in Inflammatory Bowel Disease Patient Care. Gastroenterol Clin North Am 2017; 46:847-858. [PMID: 29173526 PMCID: PMC5726536 DOI: 10.1016/j.gtc.2017.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The presence of psychological comorbidities, specifically anxiety and depression, is well documented in inflammatory bowel disease (IBD). The drivers of these conditions typically reflect 4 areas of concern: disease impact, treatment concerns, intimacy, and stigma. Various demographic and disease characteristics increase risk for psychological distress. However, the risk for anxiety and depression is consistent throughout IBD course and is independent of disease activity. Early intervention before psychological distress becomes uncontrolled is ideal, but mental health often is unaddressed during patient visits. Understanding available psychological treatments and establishing referral resources is an important part of the evolution of IBD patient care.
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Affiliation(s)
- Tiffany H Taft
- Division of Gastroenterology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street #1400, Chicago, IL 60611, USA.
| | - Sarah Ballou
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Alyse Bedell
- Division of Gastroenterology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street #1400, Chicago, IL 60611, USA
| | - Devin Lincenberg
- Oak Park Behavioral Medicine LLC, 101 N. Marion Street #313, Oak Park, IL 60301, USA
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34
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Bauer MR, Wiley JF, Weihs KL, Stanton AL. Stuck in the spin cycle: Avoidance and intrusions following breast cancer diagnosis. Br J Health Psychol 2017. [DOI: 10.1111/bjhp.12252] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Margaret R. Bauer
- Department of Psychology University of California, Los Angeles California USA
| | - Joshua F. Wiley
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences Monash University Melbourne Victoria Australia
| | - Karen L. Weihs
- Department of Psychiatry University of Arizona Tucson Arizona USA
- University of Arizona Cancer Center Tucson Arizona USA
| | - Annette L. Stanton
- Department of Psychology University of California, Los Angeles California USA
- Department of Psychiatry and Biobehavioral Sciences University of California, Los Angeles California USA
- Center for Cancer Prevention and Control Research Jonsson Comprehensive Cancer Center University of California, Los Angeles California USA
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Fuzesi S, Cano SJ, Klassen AF, Atisha D, Pusic AL. Validation of the electronic version of the BREAST-Q in the army of women study. Breast 2017; 33:44-49. [PMID: 28279888 PMCID: PMC5551502 DOI: 10.1016/j.breast.2017.02.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/04/2017] [Accepted: 02/22/2017] [Indexed: 11/17/2022] Open
Abstract
Women undergoing surgery for primary breast cancer can choose between breast conserving therapy and mastectomy (with or without breast reconstruction). Patients often turn to outcomes data to help guide the decision-making process. The BREAST-Q is a validated breast surgery-specific patient-reported outcome measure that evaluates satisfaction, quality of life, and patient experience. It was originally developed for paper-and-pencil administration. However, the BREAST-Q has increasingly been administered electronically. Therefore, the aim of this study was to evaluate the psychometric properties of an electronic version of the BREAST-Q in a large online survey. Women with a history of breast cancer surgery recruited from the Love/AVON Army of Women program completed an electronic version of the BREAST-Q in addition to the Impact of Cancer Survey and PTSD Checklist. Traditional psychometric analyses were performed on the collected data. BREAST-Q data were collected from 6748 women (3497 Breast Conserving Therapy module, 1295 Mastectomy module, 1956 Breast Reconstruction module). Acceptability was supported by a high response rate (82%), low frequency of missing data (<5%), and maximum endorsement frequencies (<80%) in all but 17 items. Scale reliability was supported by high Cronbach's α coefficients (≥0.78) and item-total correlations (range of means, 0.65-0.91). Validity was supported by interscale correlations, convergent and divergent hypotheses as well as clinical hypotheses. The electronically administered BREAST-Q yields highly reliable, clinically meaningful data for use in clinical outcomes research. The BREAST-Q can be used in the clinical setting, whether administered electronically or using paper-and-pencil, at the choice of the patient and surgeon.
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Affiliation(s)
- Sarah Fuzesi
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Stefan J Cano
- Modus Outcomes, Spirella Building, Letchworth Garden City, SG6 4ET, UK
| | - Anne F Klassen
- McMaster University, 3N27, 1200 Main Street W, Hamilton, ON L8N 3Z5, Canada
| | - Dunya Atisha
- Henry Ford Health System, 2799 W. Grand Blvd, K-16, Detroit, MI 48202, USA
| | - Andrea L Pusic
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
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36
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Lansing AE, Plante WY, Beck AN. Assessing stress-related treatment needs among girls at risk for poor functional outcomes: The impact of cumulative adversity, criterion traumas, and non-criterion events. J Anxiety Disord 2017; 48:36-44. [PMID: 27745922 PMCID: PMC5382128 DOI: 10.1016/j.janxdis.2016.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 11/18/2022]
Abstract
Despite growing recognition that cumulative adversity (total stressor exposure, including complex trauma), increases the risk for psychopathology and impacts development, assessment strategies lag behind: Adversity-related mental health needs (symptoms, functional impairment, maladaptive coping) are typically assessed in response to only one qualifying Criterion-A traumatic event. This is especially problematic for youth at-risk for health and academic disparities who experience cumulative adversity, including non-qualifying events (separation from caregivers) which may produce more impairing symptomatology. Data from 118 delinquent girls demonstrate: (1) an average of 14 adverse Criterion-A and non-Criterion event exposures; (2) serious maladaptive coping strategies (self-injury) directly in response to cumulative adversity; (3) more cumulative adversity-related than worst-event related symptomatology and functional impairment; and (4) comparable symptomatology, but greater functional impairment, in response to non-Criterion events. These data support the evaluation of mental health needs in response to cumulative adversity for optimal identification and tailoring of services in high-risk populations to reduce disparities.
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Affiliation(s)
- Amy E Lansing
- University of California, San Diego, Psychiatry Department, 8950 Villa la Jolla Dr, Suite A109, La Jolla, CA 92037, USA; San Diego State University, Sociology Department, 5500 Campanile Dr, San Diego, CA 92182, USA.
| | - Wendy Y Plante
- University of California, San Diego, Psychiatry Department, 8950 Villa la Jolla Dr, Suite A109, La Jolla, CA 92037, USA; San Diego State University, Sociology Department, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Audrey N Beck
- San Diego State University, Sociology Department, 5500 Campanile Dr, San Diego, CA 92182, USA
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Cordova MJ, Riba MB, Spiegel D. Post-traumatic stress disorder and cancer. Lancet Psychiatry 2017; 4:330-338. [PMID: 28109647 PMCID: PMC5676567 DOI: 10.1016/s2215-0366(17)30014-7] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/14/2016] [Accepted: 11/17/2016] [Indexed: 11/28/2022]
Abstract
Being diagnosed with and treated for cancer is highly stressful and potentially traumatic. An extensive literature has evaluated the prevalence, predictors, and correlates of cancer-related post-traumatic stress disorder (PTSD) symptoms and diagnoses. In this qualitative review of cancer-related PTSD literature, we highlight conceptual, methodological, and diagnostic issues, and identify clinical implications and areas for future research. Cancer-related PTSD has been documented in a minority of patients with cancer and their family members, is positively associated with other indices of distress and reduced quality of life, and has several correlates and risk factors (eg, prior trauma history, pre-existing psychiatric conditions, poor social support). The literature on treatment of cancer-related PTSD is sparse. Existing literature on cancer-related PTSD has used DSM-IV-TR diagnostic criteria; the revised DSM-5 PTSD criteria have important implications for the assessment of cancer-related distress. Application of PTSD diagnosis to patients with cancer has been critiqued on conceptual and methodological grounds, and important differential diagnosis considerations should be taken into account. Psychosocial assessment of patients with cancer should include careful evaluation of pre-cancer diagnosis trauma and psychiatric history, and diagnostic interviewing should consider concurrent conditions (eg, adjustment disorder). Treatment of cancer-related PTSD should be approached with caution and be informed by existing evidence-based approaches for traumatic stress.
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Affiliation(s)
| | - Michelle B Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - David Spiegel
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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Sawyer SM, McNeil R, McCarthy M, Orme L, Thompson K, Drew S, Dunt D. Unmet need for healthcare services in adolescents and young adults with cancer and their parent carers. Support Care Cancer 2017; 25:2229-2239. [DOI: 10.1007/s00520-017-3630-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/06/2017] [Indexed: 02/01/2023]
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Romeo A, Ghiggia A, Tesio V, Di Tella M, Torta R, Castelli L. Post-traumatic growth, distress and attachment style among women with breast cancer. J Psychosoc Oncol 2017; 35:309-322. [PMID: 28145810 DOI: 10.1080/07347332.2017.1289291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Annunziata Romeo
- Department of Psychology, University of Turin, Turin, Italy
- Clinical Psychology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Ada Ghiggia
- Department of Psychology, University of Turin, Turin, Italy
| | | | | | - Riccardo Torta
- Clinical Psychology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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40
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McCarthy MC, McNeil R, Drew S, Dunt D, Kosola S, Orme L, Sawyer SM. Psychological Distress and Posttraumatic Stress Symptoms in Adolescents and Young Adults with Cancer and Their Parents. J Adolesc Young Adult Oncol 2016; 5:322-329. [DOI: 10.1089/jayao.2016.0015] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maria C. McCarthy
- Murdoch Childrens Research Institute, Parkville, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - Robyn McNeil
- Murdoch Childrens Research Institute, Parkville, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
| | - Sarah Drew
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - David Dunt
- School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Silja Kosola
- Murdoch Childrens Research Institute, Parkville, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
| | - Lisa Orme
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Susan M. Sawyer
- Murdoch Childrens Research Institute, Parkville, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
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Yang H, Brand JS, Fang F, Chiesa F, Johansson ALV, Hall P, Czene K. Time-dependent risk of depression, anxiety, and stress-related disorders in patients with invasive and in situ breast cancer. Int J Cancer 2016; 140:841-852. [PMID: 27859142 DOI: 10.1002/ijc.30514] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/25/2016] [Indexed: 11/07/2022]
Abstract
Despite concerns about the mental health of breast cancer patients, little is known regarding the temporal risk pattern and risk factors of common mental disorders among these patients. We estimated standardized incidence ratios (SIRs) of depression, anxiety and stress-related disorders in a Swedish nationwide cohort of 40,849 women with invasive and 4,402 women with in situ breast cancer (2001-2010, median follow-up = 4.5 years). The impact of patient, tumor and treatment characteristics was analyzed using flexible parametric survival models in a regional cohort of 7,940 invasive breast cancer patients (2001-2013, median follow-up = 7.5 years). Women with invasive breast cancer showed increased rates of depression, anxiety and stress-related disorders [overall SIR (95% CI) = 1.57 (1.46-1.69), 1.55 (1.43-1.68) and 1.77 (1.60-1.95), respectively]. SIRs were highest shortly after diagnosis, but remained increased up to 5 years. Younger age at diagnosis, comorbidity, higher-grade disease, lymph node involvement and chemotherapy were independently associated with the risk of depression and anxiety in invasive cancer patients, with chemotherapy and higher-grade disease conferring short-term risk only, while comorbidities were mainly associated with late-onset events. No clinical risk factors were identified for stress-related disorders except for a greater risk associated with younger age. Patients with in situ cancer only showed an increased incidence of stress-related disorders during the first 6 months after diagnosis [SIR (95% CI) = 2.76 (1.31-5.79)]. The time-dependent risk profile of invasive cancer patients may guide health care professionals for timely and targeted psycho-oncologic interventions.
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Affiliation(s)
- Haomin Yang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Flaminia Chiesa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Rebholz WN, Cash E, Zimmaro LA, Bayley-Veloso R, Phillips K, Siwik C, Chagpar AB, Dhabhar FS, Spiegel D, Bell BS, Sephton SE. Distress and quality of life in an ethnically diverse sample awaiting breast cancer surgery. J Health Psychol 2016; 23:1438-1451. [PMID: 27466289 DOI: 10.1177/1359105316659916] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Poor breast cancer-related quality of life is associated with flattened cortisol rhythms and inflammation in breast cancer survivors and women with advanced disease. We explored the associations of cancer-specific distress (Impact of Events Scale), mood (Profile of Mood States), activity/sleep (wake after sleep onset, 24-hour autocorrelation coefficient) and cortisol (diurnal slope) circadian rhythms, and inflammation (interleukin-6) with quality of life (Functional Assessment of Cancer Therapy-Breast) among patients awaiting breast cancer surgery ( N = 57). Models were adjusted for differences in age and cancer stage. Distress and mood disturbance were significantly correlated with lower quality of life. Ethnic differences in the relationship between distress and mood disturbance with global quality of life and subscales of quality of life were observed. Actigraphic measures showed that in comparison with non-Hispanic patients, African Americans had significantly poorer activity/sleep (wake after sleep onset, 24-hour autocorrelation coefficient). Circadian disruption and inflammation were not associated with quality of life. Physiological dysregulation and associated comorbidities may take time to develop over the course of disease and treatment.
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Giese-Davis J, Bliss-Isberg C, Wittenberg L, White J, Star P, Zhong L, Cordova MJ, Houston D, Spiegel D. Peer-counseling for women newly diagnosed with breast cancer: A randomized community/research collaboration trial. Cancer 2016; 122:2408-17. [DOI: 10.1002/cncr.30036] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/01/2016] [Accepted: 03/22/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Janine Giese-Davis
- Psychosocial Oncology Division, Department of Oncology; University of Calgary; Calgary Alberta Canada
- Psychosocial Resources; Tom Baker Cancer Centre; Calgary Alberta Canada
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Stanford California
| | | | - Lynne Wittenberg
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Stanford California
| | - Jennifer White
- Psychosocial Oncology Division, Department of Oncology; University of Calgary; Calgary Alberta Canada
- Psychosocial Resources; Tom Baker Cancer Centre; Calgary Alberta Canada
| | | | - Lihong Zhong
- Psychosocial Oncology Division, Department of Oncology; University of Calgary; Calgary Alberta Canada
- Psychosocial Resources; Tom Baker Cancer Centre; Calgary Alberta Canada
| | - Matthew J. Cordova
- Martinez Outpatient Clinic and Community Living Center; VA Northern California Health Care System; Martinez California
| | | | - David Spiegel
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine; Stanford California
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McKnight PE, Monfort SS, Kashdan TB, Blalock DV, Calton JM. Anxiety symptoms and functional impairment: A systematic review of the correlation between the two measures. Clin Psychol Rev 2016; 45:115-30. [DOI: 10.1016/j.cpr.2015.10.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/23/2015] [Accepted: 10/29/2015] [Indexed: 01/01/2023]
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Voigt V, Neufeld F, Kaste J, Bühner M, Sckopke P, Wuerstlein R, Hellerhoff K, Sztrókay-Gaul A, Braun M, von Koch FE, Silva-Zürcher E, Hasmüller S, Bauerfeind I, Debus G, Herschbach P, Mahner S, Harbeck N, Hermelink K. Clinically assessed posttraumatic stress in patients with breast cancer during the first year after diagnosis in the prospective, longitudinal, controlled COGNICARES study. Psychooncology 2016; 26:74-80. [PMID: 26898732 DOI: 10.1002/pon.4102] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE There is ongoing debate whether cancer qualifies as traumatic stressor. We investigated prevalence and course of posttraumatic stress in patients with early breast cancer (BC) during their first year after diagnosis and determined effects of mastectomy and chemotherapy. METHODS Patients with stage 0-III BC aged ≤65 years were evaluated with the Structured Clinical Interview for DSM-IV modules for acute and posttraumatic stress disorder (ASD and PTSD, respectively) before treatment, after chemotherapy, and 1 year after diagnosis. Matched controls were assessed at matched intervals. Effects of time, mastectomy, and chemotherapy on BC-related PTSD symptom severity were tested with linear mixed model analysis. RESULTS Stress disorder (ASD or PTSD) related to BC was diagnosed in 6 (3.6%) of 166 patients before treatment and in 3 patients (2.0%) 1 year later. The rate of patients who experienced PTSD symptoms related to BC decreased from 82.5 to 57.3% (p < 0.001), and the mean of BC-related PTSD symptoms diminished from 3.1 to 1.7 (p < 0.001). Only university education significantly predicted the course of BC-related PTSD symptom severity (p = 0.009). In 60 controls, no diagnosis of stress disorder, a rate of 18% women experiencing PTSD symptoms, and a mean of 0.4 PTSD symptoms (p vs. patients <0.001) were found. CONCLUSIONS Most newly diagnosed patients with BC experience PTSD symptoms, whereas full diagnoses of DSM-IV stress disorder are rare. Symptoms diminish somewhat within 1 year furthered by university education but independently from mastectomy and chemotherapy. Throughout the year after diagnosis, having BC entails markedly increased PTSD symptom burden. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Varinka Voigt
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Franziska Neufeld
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Judith Kaste
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Markus Bühner
- Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany
| | - Philipp Sckopke
- Department of Psychology, Division of Psychological Methods and Assessment, Ludwig Maximilian University of Munich, Munich, Germany
| | - Rachel Wuerstlein
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Karin Hellerhoff
- Institute for Clinical Radiology, CCCLMU University Hospital of Munich, Munich, Germany
| | - Anikó Sztrókay-Gaul
- Institute for Clinical Radiology, CCCLMU University Hospital of Munich, Munich, Germany
| | - Michael Braun
- Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany
| | - Franz Edler von Koch
- Breast Center, Department of Gynecology and Obstetrics, Dritter Orden Hospital, Munich, Germany
| | - Eliane Silva-Zürcher
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Stephan Hasmüller
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany.,Breast Center, Department of Gynecology and Obstetrics, District Hospital of Ebersberg, Ebersberg, Germany
| | - Ingo Bauerfeind
- Breast Center, Department of Gynecology and Obstetrics, Hospital of Landshut, Landshut, Germany
| | - Gerlinde Debus
- Breast Center, Department of Gynecology and Obstetrics, Helios Amper Hospital Dachau, Dachau, Germany
| | - Peter Herschbach
- Department of Psychosomatic Medicine and Psychotherapy, Division of Psychosocial Oncology, Roman Herzog Comprehensive Cancer Center, Technical University of Munich, Munich, Germany
| | - Sven Mahner
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
| | - Kerstin Hermelink
- Breast Center, Department of Gynecology and Obstetrics, CCCLMU University Hospital of Munich, Munich, Germany
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Liu L, Yang YL, Wang ZY, Wu H, Wang Y, Wang L. Prevalence and Positive Correlates of Posttraumatic Stress Disorder Symptoms among Chinese Patients with Hematological Malignancies: A Cross-Sectional Study. PLoS One 2015; 10:e0145103. [PMID: 26669841 PMCID: PMC4679613 DOI: 10.1371/journal.pone.0145103] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 11/28/2015] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Positive psychological constructs have been given increasing attention in research on the coping resources of cancer-related distresses. However, little research is available on posttraumatic stress disorder (PTSD) in patients with hematological malignancies. The purposes of this study were to assess the prevalence of PTSD symptoms and to explore the associations of perceived social support (PSS), hope, optimism and resilience with PTSD symptoms among Chinese patients with hematological malignancies. METHODS A cross-sectional study was conducted during the period from July 2013 through April 2014. A total of 225 inpatients with hematological malignancies, which were eligible for the study, completed the Post-traumatic Stress Checklist-Civilian Version, Multidimensional Scale of Perceived Social Support, Adult Hope Scale, Life Orientation Scale-Revised, and Resilience Scale. Hierarchical regression analysis was performed to explore the correlates of PTSD symptoms. RESULTS Overall, the prevalence of PTSD symptoms was 10.7%. Initially, PSS was negatively associated with PTSD symptoms (β = -0.248, P < 0.01). However, when positive psychological variables were added, optimism was negatively associated with PTSD symptoms (β = -0.452, P < 0.01), and gender had a significant effect on PTSD symptoms. Women were more vulnerable to these symptoms than men (β = 0.123, P < 0.05). When the analysis was performed separately by gender, only optimism showed a significantly negative association with PTSD symptoms in both men (β = -0.389, P < 0.01) and women (β = -0.493, P < 0.01). CONCLUSIONS Some patients with hematological malignancies suffer from PTSD symptoms. The positive effects of PSS and optimism on PTSD symptoms suggest that an integrated approach to psychosocial intervention from both external and internal perspectives could have practical significance. Gender difference should be considered in developing potential interventions in reducing cancer-related PTSD symptoms.
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Affiliation(s)
- Li Liu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Yi-Long Yang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Zi-Yue Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Hui Wu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Yang Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Lie Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
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Salsman JM, Schalet BD, Andrykowski MA, Cella D. The impact of events scale: a comparison of frequency versus severity approaches to measuring cancer-specific distress. Psychooncology 2015; 24:1738-45. [PMID: 25773193 PMCID: PMC4568176 DOI: 10.1002/pon.3784] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 01/16/2015] [Accepted: 01/25/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The Impact of Events Scale (IES) is one of the most widely used measures of event-specific distress. The IES assesses the frequency with which respondents experience intrusive thoughts and avoidant behaviors over the past week. Our aim is to demonstrate the benefit of a severity-based measurement approach of the IES compared with a frequency-based measurement approach. METHODS A mixed group of post-treatment cancer survivors (N = 325; M = 31.8 years old) completed measures assessing quality of life (Functional Assessment of Cancer Therapy-General), psychological adjustment (Mental Health Inventory), and cancer-related distress (IES). The IES was keyed to the cancer experience and administered with standard (frequency) and modified (severity) response options. RESULTS Classical reliability analyses and bifactor modeling were conducted on both versions of the IES. Reliability estimates suggest that the IES severity items were more highly intercorrelated than the IES frequency items. Both versions of the IES were highly correlated (r = 0.82), showing the presence of a dominant general factor. Bifactor modeling suggested that the severity items generally provided higher levels of discrimination than the frequency items. Validity correlations with the Functional Assessment of Cancer Therapy-General and Mental Health Inventory demonstrated that the IES severity performed as good as or better than the IES frequency. CONCLUSIONS Given the high correlations and similarity in content, the IES severity items largely assess the same construct as the IES frequency items. However, IES severity items generally showed improved psychometric properties and similar or higher correlations with quality of life and psychological adjustment. The IES severity approach appears to be a more informative method for assessing cancer-specific distress.
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Affiliation(s)
- John M. Salsman
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Benjamin D. Schalet
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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Adellund Holt K, Jensen PT, Gilså Hansen D, Elklit A, Mogensen O. Rehabilitation of women with gynaecological cancer: the association between adult attachment, post-traumatic stress disorder and depression. Psychooncology 2015; 25:691-8. [PMID: 26449611 DOI: 10.1002/pon.3996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 09/05/2015] [Accepted: 09/07/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We hypothesised that being diagnosed with gynaecological cancer influences adult attachment and occurrence of depression and post-traumatic stress disorder (PTSD). The main aim of the study was to assess changes in the attachment dimensions, PTSD and depression from baseline to 5-month post-treatment. Further, we evaluated the association between attachment avoidance/anxiety dimensions and PTSD/depression among women newly diagnosed with ovarian, endometrial, or cervical cancer. METHODS Consecutive Danish-speaking women aged 20 to 75 years and treated surgically for primary gynaecological cancer were eligible. All patients were offered a rehabilitation programme consisting of two face-to-face sessions and two phone calls carried out by a nurse. Patients were asked to complete the Revised Adult Attachment Scale, the Harvard Trauma Questionnaire and the Major Depression Inventory at baseline and at 5-month follow-up. In all, 151 women consent to participate in the sessions where 51 fulfilled Revised Adult Attachment Scale questionnaire and contribute with socio-demographic data. RESULTS We found significant positive changes within the attachment anxiety dimension among women with ovarian cancer, a significant reduction of PTSD among endometrial cancer patients and insignificant changes in depression among all cancer types. The attachment anxiety dimension significantly increased the odds for PTSD and depression. CONCLUSIONS Depression and PTSD were prevalent among ovarian and cervical cancer patients. The adjustment of rehabilitation according to patients' attachment anxiety dimension contains possibilities for indirect impact on PTSD and depression symptoms. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- K Adellund Holt
- Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
| | - P T Jensen
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark.,Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
| | - D Gilså Hansen
- Department of Public Health, National Research Centre of Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - A Elklit
- National Center of Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - O Mogensen
- Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
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Cash E, Sephton SE, Chagpar AB, Spiegel D, Rebholz WN, Zimmaro LA, Tillie JM, Dhabhar FS. Circadian disruption and biomarkers of tumor progression in breast cancer patients awaiting surgery. Brain Behav Immun 2015; 48:102-14. [PMID: 25728235 DOI: 10.1016/j.bbi.2015.02.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 02/09/2015] [Accepted: 02/20/2015] [Indexed: 02/08/2023] Open
Abstract
Psychological distress, which can begin with cancer diagnosis and continue with treatment, is linked with circadian and endocrine disruption. In turn, circadian/endocrine factors are potent modulators of cancer progression. We hypothesized that circadian rest-activity rhythm disruption, distress, and diurnal cortisol rhythms would be associated with biomarkers of tumor progression in the peripheral blood of women awaiting breast cancer surgery. Breast cancer patients (n=43) provided actigraphic data on rest-activity rhythm, cancer-specific distress (IES, POMS), saliva samples for assessment of diurnal cortisol rhythm, cortisol awakening response (CAR), and diurnal mean. Ten potential markers of tumor progression were quantified in serum samples and grouped by exploratory factor analysis. Analyses yielded three factors, which appear to include biomarkers reflecting different aspects of tumor progression. Elevated factor scores indicate both high levels and strong clustering among serum signals. Factor 1 included VEGF, MMP-9, and TGF-β; suggesting tumor invasion/immunosuppression. Factor 2 included IL-1β, TNF-α, IL-6R, MCP-1; suggesting inflammation/chemotaxis. Factor 3 included IL-6, IL-12, IFN-γ; suggesting inflammation/TH1-type immunity. Hierarchical regressions adjusting age, stage and socioeconomic status examined associations of circadian, distress, and endocrine variables with these three factor scores. Patients with poor circadian coordination as measured by rest-activity rhythms had higher Factor 1 scores (R(2)=.160, p=.038). Patients with elevated CAR also had higher Factor 1 scores (R(2)=.293, p=.020). These relationships appeared to be driven largely by VEGF concentrations. Distress was not related to tumor-relevant biomarkers, and no other significant relationships emerged. Women with strong circadian activity rhythms showed less evidence of tumor promotion and/or progression as indicated by peripheral blood biomarkers. The study was not equipped to discern the cause of these associations. Circadian/endocrine aberrations may be a manifestation of systemic effects of aggressive tumors. Alternatively, these results raise the possibility that, among patients with active breast tumors, disruption of circadian activity rhythms and elevated CAR may facilitate tumor promotion and progression.
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Affiliation(s)
- E Cash
- Department of Surgery, Division of Otolaryngology-HNS, University of Louisville School of Medicine, Louisville, KY, United States; Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States; James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States
| | - S E Sephton
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States; James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States.
| | - A B Chagpar
- The Breast Center - Smilow Cancer Hospital at Yale-New Haven, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - D Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - W N Rebholz
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States
| | - L A Zimmaro
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States
| | - J M Tillie
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - F S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States; Institute for Immunity, Transplantation, and Infection, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States.
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50
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Lu Q, Man J, You J, LeRoy AS. The link between ambivalence over emotional expression and depressive symptoms among Chinese breast cancer survivors. J Psychosom Res 2015; 79:153-8. [PMID: 25697586 PMCID: PMC4913274 DOI: 10.1016/j.jpsychores.2015.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 01/02/2015] [Accepted: 01/15/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Ambivalence over emotional expression (AEE) is the conflict between wanting to express emotion yet fearing the consequences of such expression. Recent literature reveals a close link between AEE and depressive symptoms among college students. Although cancer survivors experience intense emotions, few studies have examined the relationship between AEE and depressive symptoms and the underlying mechanisms among cancer survivors. Furthermore, relevant research is absent among Asians, whose culture discourages emotional expression. The present study investigated AEE's associations with depressive symptoms in Asian breast cancer survivors, and examined intrusive thoughts as a mediator. Intrusive thoughts are repetitive and unwanted thoughts about stressful events. We hypothesized that AEE would increase intrusive thoughts which in turn would increase depressive symptoms. METHODS A total of 118 Chinese American breast cancer survivors completed a questionnaire packet containing the Ambivalence over Emotional Expression Questionnaire (AEQ), Brief Symptom Inventory (BSI), and the Impact of Event Scale (IES). RESULTS AEE was positively associated with depressive symptoms (β=.45, p<.001) and intrusive thoughts (β=.41, p<.001). Additionally, intrusive thoughts partially explained the relationship between AEE and depressive symptoms (z=3.77, p<.001). CONCLUSIONS These results suggest that Chinese breast cancer survivors who are highly ambivalent over emotional expression may have increased risk for depressive symptoms, and such relationships can be partially explained by a cognitive mechanism: intrusive thoughts. Future research may explore other mediators and design interventions specifically targeted at reducing AEE and intrusive thoughts with the ultimate goal of reducing depression.
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