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Davis S, Serfaty M, Low J, Armstrong M, Kupeli N, Lanceley A. Experiential Avoidance in Advanced Cancer: a Mixed-Methods Systematic Review. Int J Behav Med 2023; 30:585-604. [PMID: 36284042 PMCID: PMC10522753 DOI: 10.1007/s12529-022-10131-4] [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] [Accepted: 09/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND People with advanced cancer experience psychological distress due to physical symptoms, functional decline, and a limited prognosis. Difficult thoughts, feelings, and emotions may exacerbate distress and lead to avoidance of these experiences which is sometimes referred to as experiential avoidance (EA). Advanced cancer patients may be more likely to engage in EA especially when no obvious solutions to their problems exist. This study aims to examine the terms used to describe EA, the processes that might indicate EA, associations between EA and psychological distress, and to understand why individuals might engage in EA. METHODS A mixed-methods review. Literature search of Medline, Embase, Psych INFO, and CINAHL 1980-October 2019. INCLUSION adults ≥ 18 years; advanced cancer not amenable to cure. EXCLUSION no measures of EA or psychological distress. Risk of bias and study quality assessed. Evidence of statistical techniques collected. Themes coded, grouped, and developed based on meaning. RESULTS Nineteen studies identified, 13 quantitative studies and 6 qualitative. The quantitative of which 6 compared early-stage cancers with advanced cancers and examined subscales of EA alongside mood, quality of life, and psychological distress. EA covers a range or terms of which 'avoidant coping' is the commonest. EA is manifest as cognitive, behavioural, and emotional avoidance. A thematic synthesis suggests the function of EA is to protect people from distress, and from confronting or expressing difficult emotions by avoiding communication about cancer, controlling negative information, and maintaining normality and hope and optimism. CONCLUSIONS EA may be beneficial in the short term to alleviate distress, but in the longer term, it can impair function and limit engagement in life. Greater clinical awareness of the complexity of EA behaviours is needed. Clinicians and researchers should define EA precisely and be aware of the function it may serve in the short and longer term. Future research studies may consider using specific measures of EA as a primary outcome, to assess the impact of psychological interventions such as ACT.
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Affiliation(s)
- Sarah Davis
- Division of Psychiatry, Marie Curie Palliative Care Research Dept, University College London, Maple House, Tottenham Court Road, London, W1T 7NF, UK.
| | - Marc Serfaty
- Division of Psychiatry, University College London, London, UK
| | - Joe Low
- Division of Psychiatry, Marie Curie Palliative Care Research Dept, University College London, Maple House, Tottenham Court Road, London, W1T 7NF, UK
| | - Megan Armstrong
- Primary Care and Population Health, University College London, London, UK
| | - Nuriye Kupeli
- Division of Psychiatry, Marie Curie Palliative Care Research Dept, University College London, Maple House, Tottenham Court Road, London, W1T 7NF, UK
| | - Anne Lanceley
- EGA Institute for Women's Health, Department of Women's Cancer, University College London, London, UK
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Birkás B, Kiss B, Coelho CM, Zsidó AN. The role of self-reported fear and disgust in the activation of behavioral harm avoidance related to medical settings. Front Psychiatry 2023; 14:1074370. [PMID: 36761866 PMCID: PMC9902716 DOI: 10.3389/fpsyt.2023.1074370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/03/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Although adaptive defense mechanisms are useful in helping us avoid getting injured, they are also triggered by medical interventions and procedures, when avoidance is harmful. A body of previous results showed that both fear and disgust play a pivotal role in medical avoidance. However, the underlying mechanisms are not fully understood. Thus, the aim of the current study was to examine the effects of experience, perceived control, and pain on medical avoidance with disgust and fear as mediating factors from an evolutionary perspective. METHODS We assessed participants' knowledge of and experience with medical procedures, former negative medical experiences, and health-related information; their life history strategy variation; pain-related fear and anxiety of medical procedures; perceived control over emotional reactions and extreme threats; disgust sensitivity; blood-injury-injection phobia and medical treatment avoidance. RESULTS We found that more knowledge, experience, and a slower life strategy were linked to a greater level of perceived control and attenuated emotional reactions. Further, better ability to control affective and stress reactions to negative experiences was linked to reduced disgust and fear of pain, and thus might mitigate the level of perceived threat, and diminish fear and disgust reactions. DISCUSSION More knowledge and experiences, better perceived control together with reduced disgust and fear of pain can decrease the probability of avoiding medical situations. Implications to treatment are discussed. Results support the importance of targeting these contextual factors in prevention to increase the likelihood of people attending regular screenings or seeking medical care when needed.
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Affiliation(s)
- Béla Birkás
- Department of Behavioural Sciences, Medical School, University of Pécs, Pécs, Hungary
| | - Botond Kiss
- Faculty of Human and Social Sciences, Institute of Psychology, University of Pécs, Pécs, Hungary
| | - Carlos M Coelho
- Department of Psychology, Faculty of Human and Social Sciences, Azores University, Ponta Delgada, Portugal.,Center for Psychology, Porto University, Porto, Portugal
| | - András N Zsidó
- Faculty of Human and Social Sciences, Institute of Psychology, University of Pécs, Pécs, Hungary.,Szentagothai Research Centre, University of Pécs, Pécs, Hungary
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Fodor LA, Todea D, Podina IR. Core Fear of Cancer recurrence symptoms in Cancer Survivors: a network approach. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Helgeson VS, Naqvi JB, Seltman H, Vaughn AK, Korytkowski M, Hausmann LRM, Gary-Webb TL. Links of communal coping to relationship and psychological health in type 2 diabetes: actor-partner interdependence models involving role, sex, and race. Ann Behav Med 2021; 54:346-359. [PMID: 31773151 DOI: 10.1093/abm/kaz052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Communal coping is one person's appraisal of a stressor as shared and collaboration with a partner to manage the problem. There is a burgeoning literature demonstrating the link of communal coping to good relationships and health among persons with chronic disease. PURPOSE We examined links of communal coping to relationship and psychological functioning among couples in which one person was recently diagnosed with type 2 diabetes. We distinguished effects of own communal coping from partner communal coping on both patient and spouse relationship and psychological functioning, as well as whether communal coping effects were moderated by role (patient, spouse), sex (male, female), and race (White, Black). METHODS Participants were 200 couples in which one person had been diagnosed with type 2 diabetes (46% Black, 45% female) within the last 5 years. Couples completed an in-person interview, participated in a discussion to address diabetes-related problems, and completed a postdiscussion questionnaire. RESULTS Own communal coping and partner communal coping were related to good relationship and psychological functioning. Interactions with role, sex, and race suggested: (i) partner communal coping is more beneficial for patients than spouses; (ii) own communal coping is more beneficial for men, whereas partner communal coping is more beneficial for women; and (iii) White patients and Black spouses benefit more from own communal coping than Black patients and White spouses. CONCLUSION These findings demonstrate the benefits of communal coping across an array of self-report and observed indices, but suggest there are differential benefits across role, sex, and race.
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Affiliation(s)
- Vicki S Helgeson
- Psychology Department, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Jeanean B Naqvi
- Psychology Department, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Howard Seltman
- Statistics Department, Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - Mary Korytkowski
- Department of Medicine, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tiffany L Gary-Webb
- Departments of Behavioral and Community Health Services and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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Biopsychosocial Correlates of Adjustment to Cancer during Chemotherapy: The Key Role of Health-Related Quality of Life. ScientificWorldJournal 2019; 2019:9750940. [PMID: 30983914 PMCID: PMC6431483 DOI: 10.1155/2019/9750940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/21/2019] [Indexed: 12/18/2022] Open
Abstract
Background Patients adjust to cancer in a continuous process that follows the course of the disease. Previous research has considered several illness-related variables and demographics, quality of life, personality, and social factors as predictors of adjustment to cancer, which can be maladaptive (e.g., helplessness-hopelessness and anxious preoccupation) or adaptive (e.g., fighting spirit). Aims Assuming a biopsychosocial view, we test an empirical model in which disease stage, patient's age, and gender are viewed as the distal antecedents of positive and negative adjustment to cancer for chemotherapy patients. Health-related quality of life (HRQoL) has a key role, interposing between the distal antecedents and adaptational outcomes. Social support and positive thinking are also included in the model as related to adjustment. Methods One-hundred-sixty-two consecutive cancer patients receiving adjuvant or standard chemotherapy participated in the study. Patients completed the Mini-Mental Adjustment to Cancer, the Brief-COPE, the Social Provision Scale, and the SF-12 Health Survey. Partial least squares structural equation modeling (PLS-SEM) was applied for model building and hypotheses testing. Results We found a negative association between advanced stage and physical functioning, a strong positive link between physical functioning and mental health, and significant relations between mental health and helpless-hopelessness, anxious preoccupation, and cognitive avoidance. Social support and positive thinking were related to fighting spirit and fatalism. Cancer stage and female gender were indirectly associated with adaptational outcomes through HRQoL. The patient's age had no significant relationships in the model. Discussion HRQoL (both physical and mental) is a key factor for preventing maladjustment in chemotherapy patients. Social support and positive thinking coping style fosters fighting spirit and fatalism on health outcomes. Two potential lines of action seem promising: preventing maladaptive and promoting adaptive adjustments working on patient's mental health individually and involving significant others in supportive care, respectively.
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Mukherjee A, Mazumder K, Ghoshal S. Impact of Different Sociodemographic Factors on Mental Health Status of Female Cancer Patients Receiving Chemotherapy for Recurrent Disease. Indian J Palliat Care 2018; 24:426-430. [PMID: 30410253 PMCID: PMC6199836 DOI: 10.4103/ijpc.ijpc_64_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context: Deterioration in mental health and poor quality of life (QOL) among women suffering from breast and ovarian cancer is not a direct result of the illness but mediated by many other psychosocial variables. Aims: The study intended to examine if there was any effect of educational level, residential status, family type, duration of treatment, and income level of family on anxiety, depression, and QOL among the breast and ovarian cancer patients, undergoing second- or subsequent-line chemotherapy. Subjects and Methods: Forty married female cancer patients with breast and ovarian cancer, aging between 40 and 60 years, education level ranges from no formal education to postgraduate degree, income level ranges from Rs. 1000 per month to Rs. 20000 per month, and undergoing second- or subsequent-line chemotherapy for the past 1–10 years were studied. Levels of anxiety and depression were determined by Hospital Anxiety and Depression Scale. The QOL was measured by using WHO QOLBREF scale. Statistical Analysis Used: Mean and standard deviation and Levene's F values were calculated. If Levene's F value was significant, then Mann–Whitney U-test was done or else independent samples t-test was used. Results: Among all the variables, education, residential status, and income affect significantly on anxiety, depression, and QOL. Conclusions: Early detection of psychosocial variables is essential for better screening of the cancer patients undergoing chemotherapy, and therefore, further psychological intervention can be planned accordingly.
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Affiliation(s)
- Anindita Mukherjee
- Department of Radiotherapy and Oncology, Postgraduate Medical Education and Research, Chandigarh, India
| | - Koustav Mazumder
- Department of Radiotherapy and Oncology, Postgraduate Medical Education and Research, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiotherapy and Oncology, Postgraduate Medical Education and Research, Chandigarh, India
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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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Ratcliff CG, Milbury K, Chandwani KD, Chaoul A, Perkins G, Nagarathna R, Haddad R, Nagendra HR, Raghuram NV, Spelman A, Arun B, Wei Q, Cohen L. Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy. Integr Cancer Ther 2016; 15:250-62. [PMID: 26867802 PMCID: PMC4972683 DOI: 10.1177/1534735415624141] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Hypothesis. This study examines moderators and mediators of a yoga intervention targeting quality-of-life (QOL) outcomes in women with breast cancer receiving radiotherapy.Methods. Women undergoing 6 weeks of radiotherapy were randomized to a yoga (YG; n = 53) or stretching (ST; n = 56) intervention or a waitlist control group (WL; n = 54). Depressive symptoms and sleep disturbances were measured at baseline. Mediator (posttraumatic stress symptoms, benefit finding, and cortisol slope) and outcome (36-item Short Form [SF]-36 mental and physical component scales [MCS and PCS]) variables were assessed at baseline, end-of-treatment, and 1-, 3-, and 6-months posttreatment. Results. Baseline depressive symptoms (P = .03) and sleep disturbances (P < .01) moderated the Group × Time effect on MCS, but not PCS. Women with high baseline depressive symptoms in YG reported marginally higher 3-month MCS than their counterparts in WL (P = .11). Women with high baseline sleep disturbances in YG reported higher 3-months MCS than their counterparts in WL (P < .01) and higher 6-month MCS than their counterparts in ST (P = .01). YG led to greater benefit finding than ST and WL across the follow-up (P = .01). Three-month benefit finding partially mediated the effect of YG on 6-month PCS. Posttraumatic stress symptoms and cortisol slope did not mediate treatment effect on QOL. Conclusion. Yoga may provide the greatest mental-health–related QOL benefits for those experiencing pre-radiotherapy sleep disturbance and depressive symptoms. Yoga may improve physical-health–related QOL by increasing ability to find benefit in the cancer experience.
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Affiliation(s)
- Chelsea G Ratcliff
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Kathrin Milbury
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alejandro Chaoul
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - George Perkins
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Robin Haddad
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - N V Raghuram
- Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India
| | - Amy Spelman
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Banu Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qi Wei
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Mystakidou K, Parpa E, Tsilika E, Panagiotou I, Theodorakis PN, Galanos A, Gouliamos A. Self-Efficacy and Its Relationship to Posttraumatic Stress Symptoms and Posttraumatic Growth in Cancer Patients. JOURNAL OF LOSS & TRAUMA 2014. [DOI: 10.1080/15325024.2013.838892] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Boehmer U, Glickman M, Winter M, Clark MA. Coping and Benefit Finding among Long-Term Breast Cancer Survivors of Different Sexual Orientations. WOMEN & THERAPY 2014. [DOI: 10.1080/02703149.2014.897548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Milbury K, Spelman A, Wood C, Matin SF, Tannir N, Jonasch E, Pisters L, Wei Q, Cohen L. Randomized controlled trial of expressive writing for patients with renal cell carcinoma. J Clin Oncol 2014; 32:663-70. [PMID: 24470003 DOI: 10.1200/jco.2013.50.3532] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE This randomized controlled trial examined the quality-of-life benefits of an expressive writing (EW) intervention for patients with renal cell carcinoma (RCC) and identified a potential underlying mechanism of intervention efficacy. PATIENTS AND METHODS Patients (N = 277) with stage I to IV RCC were randomly assigned to write about their deepest thoughts and feelings regarding their cancer (EW) or about neutral topics (neutral writing [NW]) on four separate occasions. Patients completed the Center for Epidemiologic Studies Depression Scale (CES-D), MD Anderson Symptom Inventory (MDASI), Brief Fatigue Inventory (BFI), Pittsburgh Sleep Quality Index (PSQI), Medical Outcomes Study Short Form-36 (SF-36), and Impact of Event Scale (IES) at baseline and 1, 4, and 10 months after the intervention. RESULTS The mean age of participants (28% stage IV; 41% female) was 58 years. Multilevel modeling analyses, using a Bonferroni-corrected α = .021 for six outcomes adjusted for the correlation among outcomes, revealed that, relative to the NW group, patients in the EW group reported significantly lower MDASI scores (P = .003) and higher physical component summary scores on the SF-36 (P = .019) at 10 months after the intervention. Mediation analyses revealed that significant group differences for MDASI scores at 10 months were mediated by lower IES scores at 1 month after the intervention in the EW group (P = .042). No significant group differences were observed in the BFI, CES-D, PSQI, and mental component summary of the SF-36. CONCLUSION EW may reduce cancer-related symptoms and improve physical functioning in patients with RCC. Evidence suggests that this effect may occur through short-term improvements in cognitive processing.
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Affiliation(s)
- Kathrin Milbury
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
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Rissanen R, Arving C, Ahlgren J, Cernvall M, Nordin K. Cognitive processing in relation to psychological distress in women with breast cancer: a theoretical approach. Psychooncology 2013; 23:222-8. [DOI: 10.1002/pon.3392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 08/16/2013] [Accepted: 08/18/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Ritva Rissanen
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Cecilia Arving
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Johan Ahlgren
- Department of Oncology, Gävle Hospital, Gävle, Sweden and Centre of Clinical Research; Uppsala University and County of Gävleborg; Sweden
| | - Martin Cernvall
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Karin Nordin
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
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Woo JA, Maytal G, Stern TA. Clinical Challenges to the Delivery of End-of-Life Care. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 8:367-72. [PMID: 17245459 PMCID: PMC1764519 DOI: 10.4088/pcc.v08n0608] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dyadic effects of fear of recurrence on the quality of life of cancer survivors and their caregivers. Qual Life Res 2011; 21:517-25. [DOI: 10.1007/s11136-011-9953-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2011] [Indexed: 10/18/2022]
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Andrykowski MA, Pavlik EJ. Response to an abnormal ovarian cancer-screening test result: test of the social cognitive processing and cognitive social health information processing models. Psychol Health 2011; 26:383-97. [PMID: 20419561 PMCID: PMC2911487 DOI: 10.1080/08870440903437034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
All cancer screening tests produce a proportion of abnormal results requiring follow up. Consequently, the cancer-screening setting is a natural laboratory for examining psychological and behavioural response to a threatening health-related event. This study tested hypotheses derived from the social cognitive processing and cognitive-social health information processing models in trying to understand response to an abnormal ovarian cancer (OC) screening test result. Women (n = 278) receiving an abnormal screening test result a mean of 7 weeks earlier were assessed prior to a repeat screening test intended to clarify their previous abnormal result. Measures of disposition (optimism, informational coping style), social environment (social support and constraint), emotional processing, distress, and benefit finding were obtained. Regression analyses indicated greater distress was associated with greater social constraint and emotional processing and a monitoring coping style in women with a family history of OC. Distress was unrelated to social support. Greater benefit finding was associated with both greater social constraint and support and greater distress. The primacy of social constraint in accounting for both benefit finding and distress was noteworthy and warrants further research on the role of social constraint in adaptation to stressful events.
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Affiliation(s)
- Michael A Andrykowski
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY 40536-0086, USA.
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Vos MS, Putter H, van Houwelingen HC, de Haes HC. Denial and social and emotional outcomes in lung cancer patients: The protective effect of denial. Lung Cancer 2011; 72:119-24. [DOI: 10.1016/j.lungcan.2010.07.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/10/2010] [Accepted: 07/14/2010] [Indexed: 11/25/2022]
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Abstract
This article presents an overview of statistical mediation analysis and its application to psychosomatic medicine research. The article begins with a description of the major approaches to mediation analysis and an evaluation of the strengths and limits of each. Emphasis is placed on longitudinal mediation models, and an application using latent growth modeling is presented. The article concludes with a description of recent developments in mediation analysis and suggestions for the use of mediation for future work in psychosomatic medicine research.
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Geller MA, Downs LS, Judson PL, Ghebre R, Argenta PA, Carson LF, Jonson AL, Godfrey K, Vogel RI, Petzel SV. Learning about ovarian cancer at the time of diagnosis: Video versus usual care. Gynecol Oncol 2010; 119:370-5. [DOI: 10.1016/j.ygyno.2010.06.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 06/28/2010] [Accepted: 06/29/2010] [Indexed: 10/19/2022]
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Morris BA, Shakespeare-Finch J. Rumination, post-traumatic growth, and distress: structural equation modelling with cancer survivors. Psychooncology 2010; 20:1176-83. [PMID: 20731009 DOI: 10.1002/pon.1827] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 07/06/2010] [Accepted: 07/06/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Theoretical models of post-traumatic growth (PTG) have been derived in the general trauma literature to describe the post-trauma experience that facilitates the perception of positive life changes. To develop a statistical model identifying factors that are associated with PTG, structural equation modelling (SEM) was used in the current study to assess the relationships between perception of diagnosis severity, rumination, social support, distress, and PTG. METHOD A statistical model of PTG was tested in a sample of participants diagnosed with a variety of cancers (N=313). RESULTS An initial principal components analysis of the measure used to assess rumination revealed three components: intrusive rumination, deliberate rumination of benefits, and life purpose rumination. SEM results indicated that the model fit the data well and that 30% of the variance in PTG was explained by the variables. Trauma severity was directly related to distress, but not to PTG. Deliberately ruminating on benefits and social support were directly related to PTG. Life purpose rumination and intrusive rumination were associated with distress. CONCLUSIONS The model showed that in addition to having unique correlating factors, distress was not related to PTG, thereby providing support for the notion that these are discrete constructs in the post-diagnosis experience. The statistical model provides support that post-diagnosis experience is simultaneously shaped by positive and negative life changes and that one or the other outcome may be prevalent or may occur concurrently. As such, an implication for practice is the need for supportive care that is holistic in nature.
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Fear of cancer recurrence: specific profiles and nature of intrusive thoughts. J Cancer Surviv 2010; 4:361-71. [PMID: 20617394 DOI: 10.1007/s11764-010-0136-8] [Citation(s) in RCA: 161] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 06/12/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Although the fear of cancer recurrence (FCR) is to varying degrees almost universal in cancer survivors, few studies have been carried out specifically on this issue partly because of the complexity and the heterogeneity of the phenomenon. PURPOSE To explore the presence of specific profiles of FCR and to describe the nature of intrusive thoughts associated with FCR. METHODS A medical database was used to randomly select a large pool of French-Canadian patients who had been treated for breast, prostate, lung, or colorectal cancer within the past ten years. A sample of 1 984 participants completed, by mail, the Fear of Cancer Recurrence Inventory (FCRI) and the Cognition Intrusive Questionnaire (CIQ). RESULTS Cluster analysis revealed four distinct groups of FCR patients: Mild FCR-Low Copers, Mild FCR-High Copers, Moderate FCR-High Copers and High FCR-High Copers. Percentages of endorsement obtained on CIQ items suggested that intrusive thoughts associated with FCR share many characteristics with worries (i.e., egosyntonic, verbal content). However, intrusive thoughts associated with High FCR presented more characteristics of obsessions. CONCLUSION There are different profiles of FCR, which vary according to its severity and the type of coping strategies used. Characteristics of intrusive thoughts associated with FCR suggested different targets for FCR specific intervention.
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Goldsmith RE, Jandorf L, Valdimarsdottir H, Amend KL, Stoudt BG, Rini C, Hershman D, Neugut A, Reilly JJ, Tartter PI, Feldman SM, Ambrosone CB, Bovbjerg DH. Traumatic stress symptoms and breast cancer: the role of childhood abuse. CHILD ABUSE & NEGLECT 2010; 34:465-70. [PMID: 20400179 PMCID: PMC4392906 DOI: 10.1016/j.chiabu.2009.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 10/20/2009] [Accepted: 10/21/2009] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The present study investigated relations between reported childhood abuse and recent traumatic stress symptoms in women newly diagnosed with breast cancer (n=330). METHODS As part of a larger ongoing study, patients from eight public and private hospitals were referred by their physicians and completed the Childhood Trauma Questionnaire (CTQ), and the Impact of Events Scale-breast cancer (IES), which measured breast cancer-related intrusive and avoidant symptoms. RESULTS Emotional abuse, physical abuse, and sexual abuse were correlated with intrusive symptoms. Cancer-related avoidant symptoms approached significance in their relation to emotional and sexual abuse. Multivariate analysis, controlling for age and time since diagnosis, revealed that childhood emotional abuse was an independent predictor of breast cancer-related intrusive symptoms, but that childhood physical abuse and sexual abuse were not significant predictors. CONCLUSIONS Childhood emotional, physical, and sexual abuse were associated with breast cancer-related intrusive symptoms. Emotional abuse uniquely predicted intrusive symptoms after controlling for other predictors. Results suggest that a cancer diagnosis may trigger cognitive and emotional responses that relate to patients' prior trauma experiences. PRACTICE IMPLICATIONS Physicians and psychologists treating women with breast cancer should be aware that a history of childhood abuse may exacerbate patients' cancer-related intrusive symptoms. Interventions for women affected by both childhood abuse and breast cancer may be most effective when they address both stressors and associated emotional responses. Findings highlight the importance of additional research to explore links between prior trauma and distress following a cancer diagnosis stress.
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Affiliation(s)
- Rachel E Goldsmith
- Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA
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Shapiro JP, McCue K, Heyman EN, Dey T, Haller HS. Coping-Related Variables Associated with Individual Differences in Adjustment to Cancer. J Psychosoc Oncol 2010; 28:1-22. [DOI: 10.1080/07347330903438883] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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23
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Greer JA, Park ER, Prigerson HG, Safren SA. Tailoring Cognitive-Behavioral Therapy to Treat Anxiety Comorbid with Advanced Cancer. J Cogn Psychother 2010; 24:294-313. [PMID: 21234281 PMCID: PMC3018827 DOI: 10.1891/0889-8391.24.4.294] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patients with advanced cancer often experience debilitating anxiety symptoms that interfere with quality of life and relate to worse medical outcomes. Although cognitive behavioral therapy (CBT) is an empirically-validated, first-line treatment for anxiety disorders, clinical trials of CBT for anxiety typically exclude patients with medical comorbidities in general, and those with terminal illnesses, such as advanced cancer, in particular. Moreover, CBT has generally targeted unrealistic fears and worries in otherwise healthy individuals with clinically significant anxiety symptoms. Consequently, traditional CBT does not sufficiently address the cognitive components of anxiety in patients with cancer, especially negative thought patterns that are rational but nonetheless intrusive and distressing, such as concerns about pain, disability and death, as well as management of multiple stressors, changes in functional status and burdensome medical treatments. In this paper, we describe a treatment approach for tailoring CBT to the needs of this population. Three case examples of patients diagnosed with terminal lung cancer are presented to demonstrate the treatment methods along with outcome measures for anxiety and quality of life.
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Affiliation(s)
- Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School
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24
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QUOTEchemo: A patient-centred instrument to measure quality of communication preceding chemotherapy treatment through the patient’s eyes. Eur J Cancer 2009; 45:2967-76. [DOI: 10.1016/j.ejca.2009.06.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 05/30/2009] [Accepted: 06/09/2009] [Indexed: 11/23/2022]
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25
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Yang HC, Schuler TA. Marital quality and survivorship: slowed recovery for breast cancer patients in distressed relationships. Cancer 2009; 115:217-28. [PMID: 18951520 DOI: 10.1002/cncr.23964] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although marital distress has been implicated in difficulties with adjustment to a breast cancer diagnosis, its long-term effects, especially on physical recovery, are unknown. METHODS Longitudinal data from newly diagnosed breast cancer patients (N=100) who were married or cohabiting were used. Patients were assessed after diagnosis and surgery (baseline) and then reassessed every 4 or 6 months for the next 5 years. Women in stable, distressed relationships (n=28) were compared with those in stable, nondistressed relationships (n=72). Stress, health behavior, and health outcomes were examined using mixed-effects modeling. RESULTS Overall, marital distress was associated with slowed recovery trajectories and poor outcomes. At baseline, both groups had equivalent, high levels of stress, but diverged thereafter. Stress declined more slowly for the Distressed group, and by 5 years it remained significantly higher. Differential reductions in physical activity were also observed. With regard to health, the Distressed group was found to have a slower recovery in performance status and more symptoms/signs of illness and treatment side effects through 3 years. Finally, all the effects were observed above and beyond reductions occurring with depressive symptomatology, which was significantly higher in the Distressed group. CONCLUSIONS Marital distress is not only associated with worse psychologic outcomes for breast cancer survivors, but poorer health and a steeper decline in physical activity. These novel data demonstrate recovery trajectories for breast cancer survivors to be constrained for those also coping with ongoing difficulties in their marriage.
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Affiliation(s)
- Hae-Chung Yang
- Department of Psychology, the Ohio State University, Columbus, Ohio 43210-1222, USA.
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Kvåle K. Do cancer patients always want to talk about difficult emotions? A qualitative study of cancer inpatients communication needs. Eur J Oncol Nurs 2007; 11:320-7. [PMID: 17446134 DOI: 10.1016/j.ejon.2007.01.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 01/09/2007] [Accepted: 01/22/2007] [Indexed: 10/23/2022]
Abstract
The aim of this study was to find out, through qualitative in depth interviews, if cancer patients in an Oncology ward always want to talk about their feelings and difficult emotions regarding the disease and their future while they are inpatients, and if not, to identify the reasons why. People with cancer often face emotional and spiritual distress, but try to cope with their life situation optimally. It is therefore important to determine their communication needs when they are inpatients. Giorgi's approach to phenomenology was used as research method. Twenty inpatients with various cancer diagnoses in different stages and with different prognoses were interviewed. The findings revealed that cancer patients did not always want to talk to the nurses about their difficult feelings regarding the future when they were inpatients in an Oncology ward. The main themes identified why were: cognitive avoidance and distancing; normalization, finding meaning and living in the present, and support from family and friends. The patients wanted to talk about normal life, their hobbies and their families. This conversation seemed to support their coping strategies by helping them to find meaning and hope, and must be recognized as important aspects of spiritual and emotional care.
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Affiliation(s)
- Kirsti Kvåle
- Institute for Postgraduate Studies, Betanien Diaconal College of Nursing, Vestlundsveien 19, 5145 Fyllingsdalen, Norway.
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Quartana PJ, Laubmeier KK, Zakowski SG. Psychological Adjustment Following Diagnosis and Treatment of Cancer: An Examination of the Moderating Role of Positive and Negative Emotional Expressivity. J Behav Med 2006; 29:487-98. [PMID: 16958005 DOI: 10.1007/s10865-006-9069-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Accepted: 07/10/2006] [Indexed: 10/24/2022]
Abstract
In support of cognitive processing models, emotional expression appears to reduce associations between intrusions and psychological distress. Past research has focused primarily on the role of the expression of negative emotion, or emotion in general, in cognitive processing and adjustment. In the present study, we examined the role of both positive and negative emotional expressivity on relations between intrusions and both distress and avoidance among 93 individuals diagnosed with and treated for cancer. We hypothesized stronger negative associations between intrusive thoughts and both distress and avoidance for those individuals lower in positive or negative expressivity. Results generally supported hypotheses with regard to relations of intrusions and distress in association with positive expressivity. Negative expressivity, however, moderated relations between intrusions and distress, but not intrusions and avoidance. These findings underscore the importance of examining the impact of individual differences in negative, as well as positive, emotional expression on cognitive processing and psychological adjustment.
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Affiliation(s)
- Phillip J Quartana
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, Illinois 60064, USA.
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Abstract
Denial is a clinically relevant concept in cancer patients. It has been investigated and discussed extensively. Its definition, however, has been subject to different theoretical trends over time. From a psychoanalytical viewpoint, denial is a pathological, ineffective defence mechanism. On the other hand, according to the stress and coping model denial can be seen as an adaptive strategy to protect against overwhelming events and feelings. In this explorative review the different concepts and the prevalence of denial in cancer patients are described. The relationship between denial and background characteristics and the influence of denial on quality of life are reviewed also. The prevalence of denial of diagnosis in cancer patients ranged from 4 to 47%, denial of impact occurred 8-70% and denial of affect in 18-42% of patients. Elderly cancer patients were more likely to deny. Cultural background seemed to play a role in the prevalence of denial. Neither type of cancer nor gender seemed to be related to denial. At the most, men might be more likely to deny during the terminal phase. In a limited number of longitudinal studies, a gradual reduction in denial was found over the course of the illness. The effect of denial on physical and social functioning remained unclear while the effect on psychological functioning seemed to depend on the concept of denial used. Distractive strategies were found to reduce distress, whereas passive escape mechanisms turned out to decrease psychological well-being. Future research on the prevalence and the (mal)adaptive properties of denial in cancer patients has to be based on a clear concept, longitudinal designs and careful recording of background variables.
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Affiliation(s)
- M S Vos
- Department of Psychiatry, Bronovo Hospital, The Hague, The Netherlands.
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29
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Andersen BL, Shapiro CL, Farrar WB, Crespin T, Wells-Digregorio S. Psychological responses to cancer recurrence. Cancer 2005; 104:1540-7. [PMID: 16118802 PMCID: PMC2151214 DOI: 10.1002/cncr.21309] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a dearth of knowledge regarding the psychological responses to a diagnosis of cancer recurrence. METHODS An ongoing randomized clinical trial provided the context for prospective study. Women with Stage II/III breast carcinoma (N = 227) were initially assessed after their diagnosis/surgery and before adjuvant therapy and then reassessed every 6 months. Eight years into the trial, 30 patients had recurred (R) and were assessed shortly after receiving their second diagnosis. Their data were compared with a sample of trial patients who had no evidence of disease (disease free [DF]; n = 90). The groups were matched on study arm, disease stage, estrogen receptor status, menopausal status, and time since initial diagnosis. RESULTS As hypothesized, patients' cancer-specific stress at recurrence in the R group was higher (P < 0.05) than stress levels for the DF group at the equivalent point in time. Importantly, the R group reported stress for their recurrent diagnosis equivalent to that reported for their initial diagnosis. Identical results were found for measures of health status and symptomatology. In contrast, analyses for emotional distress and social functioning showed no pattern of disruption for the R group at cancer recurrence and levels equivalent to that of the DF group. CONCLUSIONS To the authors' knowledge, this was the first controlled, prospective psychological analysis of patients' responses to cancer recurrence. The findings were consistent with a learning theory conceptualization of the cancer stressor. Patients' stress was "compartmentalized" and did not, at least in the early weeks, result in diffuse emotional distress and quality of life disruption, underscoring the resilience of patients when confronted with cancer recurrence.
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Affiliation(s)
- Barbara L Andersen
- Department of Psychology, The Ohio State University, Columbus, Ohio 43210-1222, USA.
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30
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Cameron LD, Booth RJ, Schlatter M, Ziginskas D, Harman JE, Benson SRC. Cognitive and affective determinants of decisions to attend a group psychosocial support program for women with breast cancer. Psychosom Med 2005; 67:584-9. [PMID: 16046371 DOI: 10.1097/01.psy.0000170834.54970.f5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This prospective study assesses the roles of illness beliefs, emotion regulation factors, and sociodemographic characteristics in decisions to participate in a group support program for women recently diagnosed with breast cancer. METHOD Women recruited during clinic visits 2 to 4 weeks after diagnosis completed measures of affective and cognitive factors identified by Leventhal's Common-Sense Model of illness self-regulation: cancer-related distress, avoidance tendencies, beliefs that the breast cancer was caused by stress and altered immunity, and personal control beliefs. Measures of general anxiety and depression, social support, and demographic characteristics were also completed; prognostic status information was obtained from medical records. All women were encouraged to participate in a free, 12-week program offering coping skills training and group support. Participation was recorded by program staff. RESULTS Of the 110 women, 54 (49%) participated in the group support program and 56 (51%) did not. Logistic regression analyses revealed that participation was predicted by stronger beliefs that the cancer was caused by altered immunity, higher cancer-related distress, lower avoidance tendencies, and younger age. CONCLUSIONS Participation in the group psychosocial support program appeared to be guided by cognitive and affective factors identified by the Common-Sense Model. Psychosocial support programs and informational materials promoting their use may attract more participants if they are tailored to focus on resolving cancer-related distress rather than on general anxiety or depression, appeal to those with high avoidance tendencies, address the role of immune function in cancer progression, and meet the needs of older participants.
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Affiliation(s)
- Linda D Cameron
- Department of Psychology, University of Auckland, Tamaki Campus, Auckland, New Zealand.
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Wade TD, Lee C. The Impact of Breast Cancer on the Lives of Middle-Aged Women: Results From the Australian Longitudinal Study of Women's Health. Health Psychol 2005; 24:246-51. [PMID: 15898859 DOI: 10.1037/0278-6133.24.3.246] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article investigated the impact of breast cancer (BC) in middle-aged Australian women (45-50 years). Two waves of data collected 2 years apart from a longitudinal survey of 12,177 women identified 3 groups: (a) 11,933 (98%) who reported never having had BC, (b) 181 (1.5%) who reported a diagnosis of BC at Time 1, and (c) 63 (0.5%) who reported onset of BC between Time 1 and Time 2. Repeated measures analysis of variance was used to compare the 3 groups. Women with recent onset of BC experienced significant changes across a range of functioning compared with the other 2 groups. Compared with women with no BC, women with longer established onset of BC had significantly worse health and social outcomes, but these were associated with small effect sizes. Both groups of women with BC reported less impact on mental and emotional health than on other areas of functioning.
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Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, Adelaide, SA, Australia.
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McInerney-Leo A, Biesecker BB, Hadley DW, Kase RG, Giambarresi TR, Johnson E, Lerman C, Struewing JP. BRCA1/2 testing in hereditary breast and ovarian cancer families: Effectiveness of problem-solving training as a counseling intervention. ACTA ACUST UNITED AC 2004; 130A:221-7. [PMID: 15378542 DOI: 10.1002/ajmg.a.30265] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
It remains uncertain whether members of hereditary breast and ovarian cancer (HBOC) families experience psychological distress with genetic testing and whether pre-test counseling can have a moderating effect on client well-being. One purpose of this study was to assess change in psychological well-being from baseline to 6-9 months follow-up and the effect of a problem-solving training (PST) intervention on psychological well-being. Two hundred and twelve members of 13 HBOC families were offered BRCA1/2 testing for a previously identified family mutation. Participants received education and were randomized to one of two counseling interventions; PST or client-centered counseling. Psychological well-being was assessed at baseline and again at 6-9 months following the receipt of test results, or at the equivalent time for those participants who chose not to undergo testing. Well-being was assessed using measures of depressive symptoms (CESD), intrusive thoughts (IES), cancer worries, and self-esteem. Comparisons were made between those who chose testing and those who did not as well as between those who received positive and negative test results. One hundred eighty one participants elected to undergo genetic testing (85%) and 47 of these (26%) were identified as BRCA1/2 mutation carriers. Breast and ovarian cancer worries decreased significantly (p = 0.007 and 0.008, respectively) in those who tested negative while there was no appreciable change in psychological well-being from baseline to follow-up in either those who tested positive or in non-testers. Among all participants, particularly testers, those randomized to PST had a greater reduction in depressive symptoms than those randomized to client-centered counseling (p < 0.05 and p = 0.02, respectively). Regardless of the decision to test, individuals with a personal history of cancer (n = 22) were more likely to have an increase in breast cancer worries compared to those who had never been diagnosed with cancer (p < 0.001). Results suggest that a problem-solving counseling intervention may help to enhance psychological well-being following testing and that a personal history of cancer may increase psychological distress associated with genetic testing.
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Mohr DC, Moran PJ, Kohn C, Hart S, Armstrong K, Dias R, Bergsland E, Folkman S. Couples therapy at end of life. Psychooncology 2003; 12:620-7. [PMID: 12923802 DOI: 10.1002/pon.746] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study reports on a preliminary uncontrolled study of a treatment for couples in which one partner is diagnosed with a terminal illness. In this study nine couples, in which one partner was diagnosed with a terminal illness and had less than 18 months to live, were offered eight sessions of couples therapy. Follow-up data were available for six couples. Two patients died during treatment and a third patient moved out of the area prior to completing the follow-up assessment. Significant decreases were seen in the patients' distress about dying and the frequency of partners' worry about their partner dying. Improvements were also seen in relationship quality. While the size of the study precludes generalizing these findings to a larger population, this study supports further exploration of couples therapy as a potentially useful adjunct to end of life care.
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Affiliation(s)
- David C Mohr
- University of California, San Francisco, CA, USA.
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Metcalfe KA, Esplen MJ, Goel V, Narod SA. Psychosocial functioning in women who have undergone bilateral prophylactic mastectomy. Psychooncology 2003; 13:14-25. [PMID: 14745742 DOI: 10.1002/pon.726] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to determine the current psychosocial functioning of women who had previously had a bilateral prophylactic mastectomy. Women in the province of Ontario who had undergone prophylactic mastectomy between 1991 and 2000 were asked to complete questionnaires that assessed psychological distress, sexual activity, overall satisfaction with decision to have a prophylactic mastectomy, and body image. Ninety-seven percent of the women were satisfied with their decision to have a prophylactic mastectomy, but young women (<50 years) were less likely to report satisfaction than older women (p=0.001). Women with a strong family history of breast cancer or a BRCA1 or BRCA2 mutation experienced more cancer-related distress than those with a limited family history. Women who had reconstruction following mastectomy reported higher levels of satisfaction with general body shape and appearance than those without reconstruction. In conclusion, the majority of women were satisfied with their decision to undergo prophylactic mastectomy and were not experiencing abnormal levels of psychological distress, low levels of sexual activity, or difficulties with body image.
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Affiliation(s)
- Kelly A Metcalfe
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
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Matthews BA. Role and gender differences in cancer-related distress: a comparison of survivor and caregiver self-reports. Oncol Nurs Forum 2003; 30:493-9. [PMID: 12719748 DOI: 10.1188/03.onf.493-499] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine role and gender differences on measures of psychological distress as a consequence of dealing with cancer. DESIGN Cross-sectional, descriptive, quantitative analyses of retrospective survey data. SETTING A large, nonprofit, volunteer-based cancer organization. The sample was recruited through an online cancer survivor's network (61%), a rural event (24%), and hospital registries (15%). SAMPLE Convenience sample of 135 cancer survivors matched to their family caregivers (N = 270). METHODS Dyads (i.e., survivors and family caregivers) completed matched questionnaires requesting demographic and medical information and measures of cancer-related distress. MAIN RESEARCH VARIABLES Role (i.e., survivor or caregiver), gender, and psychological distress. FINDINGS Caregiver means on overall psychological distress were significantly higher than those shown for survivors. Caregiver scores were significantly higher on distress for diagnosis and fear of cancer recurrence. Females scored higher than male caregivers on cancer-related anxiety, future uncertainties, fear of recurrence, and future diagnostic tests. Gender differences were not found for survivor distress. CONCLUSIONS Results suggest a need for gender-specific, dyad-tailored cancer support services. IMPLICATIONS FOR NURSING As expert caregivers, nurses can provide valuable assistance with the caregiving process that may decrease distress during the family's cancer experience and adaptation period.
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Affiliation(s)
- B Alex Matthews
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.
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Gurevich M, Devins GM, Rodin GM. Stress response syndromes and cancer: conceptual and assessment issues. PSYCHOSOMATICS 2002; 43:259-81. [PMID: 12189252 DOI: 10.1176/appi.psy.43.4.259] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Stress response syndromes have begun to receive research attention in cancer, including melanoma, Hodgkin's disease, breast cancer, and mixed-diagnosis samples. This paper focuses on conceptual and assessment issues in the application of the trauma model to adaptation to cancer. Among the central considerations: differentiating cancer from other traumatic events, the utility of conceptualizing stress responses along a continuum in this population, diagnostic issues, and preliminary recommendations for therapeutic interventions.
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Affiliation(s)
- Maria Gurevich
- Psychosocial Oncology, University Health Network, Toronto, Canada.
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