Long-term trajectories of psychological adaptation among women diagnosed with gynecological cancers

Impact of diagnosis and surgical treatment of early stage borderline ovarian tumours on distress, anxiety, and psychosexual health

Women diagnosed with gynecological cancer are likely to face additional consequences beyond those common to all cancer patients leading to significant physical and psychological morbidity. Longitudinal studies addressing the prevalence of psychological distress, anxiety, or psychosexual health during follow-up in patients diagnosed with borderline ovarian tumors are lacking. This study explores this prevalence compared with controls who underwent comparable surgical treatment for benign ovarian tumors. A prospective 1:1 nonmatched case-control study was set up, registered on ClinicalTrials.gov under number NCT04253327. Thirty early stage borderline ovarian tumor patients participated, and 30 controls were included. The study materials consisted of different questionnaires. A general one on patient's sociodemographic and medical information. A questionnaire about anxiety and distress made up of three validated questionnaires: Hospital Anxiety and Depression Scale, Perceived Stress Scale and Body Image Scale. As last one the psychosexual health questionnaire consisted of the Female Sexual Function Index, the Female Sexual Distress Scale and two European Organisation for Research and Treatment of Cancer questionnaires. Both groups were comparable and did not differ significantly in terms of demographic characteristics. Patients with early stage borderline ovarian tumors experience a significant higher burden of mental health issues due to disease and treatment and/or are more worried about their future health. Surprisingly, both early stage borderline ovarian tumor patients and controls showed high levels of anxiety and moderate stress. Many patients in both groups experience sexual dysfunction and distress. These findings support active screening for anxiety, depression and psychosexual perturbance during postoperative follow-up to accommodate this.

Worse Depression Profiles Are Associated With Higher Symptom Burden and Poorer Quality of Life in Patients With Gynecologic Cancer

BACKGROUND

Depression is a pervasive symptom in patients with gynecological cancer undergoing chemotherapy.

OBJECTIVES

Purposes were to identify subgroups of patients with distinct depression profiles and evaluate for differences in demographic and clinical characteristics, severity of common symptoms, and quality of life (QOL) outcomes among these subgroups.

METHODS

Patients with gynecological cancer (n = 231) completed the Center for Epidemiologic Studies-Depression Scale 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was done to identify the distinct depression profiles. Differences were evaluated using parametric and nonparametric tests.

RESULTS

Three distinct profiles were identified: low (60.1%), high (35.1%), and very high (4.8%). Compared with low class, the other 2 classes had lower functional status and were more likely to self-report a diagnosis of depression. Patients in the 2 worse profiles reported a higher comorbidity burden, higher levels of trait and state anxiety, sleep disturbance, and fatigue, as well as lower levels of cognitive function and poorer QOL. State and trait anxiety, evening fatigue, and sleep disturbance scores exhibit a "dose-response effect" (ie, as the depression profile worsened, the severity of these symptoms increased).

CONCLUSIONS

Almost 40% of our sample experienced high or very high levels of depression across 2 cycles of chemotherapy.

IMPLICATIONS FOR PRACTICE

Clinicians can use the identified risk factors to identify high patients risk and provide tailored psychological interventions aimed to decrease symptom burden and prevent decrements in QOL.

Functions of Resiliency Traits and Processes in Differential Effects of CBSM on Quality of Life in Breast Cancer Survivors: A Moderated Mediation Model

BACKGROUND

Although there is evidence that cognitive behavioral therapy (CBT)-based group interventions can improve quality of life (QoL) in women undergoing treatment for breast cancer (BC) little is known about factors that mediate and moderate these effects. We examined a) the mediating role of benefit finding on QoL changes after a Cognitive Behavioral Stress Management (CBSM) intervention, and b) whether this mediation effect differed based on baseline optimism in the first year following surgery for BC.

METHODS

We used data from a prior CBSM trial in 240 women with stage 0-3 BC who completed measures of benefit finding (Benefit Finding Scale, BFS), QoL (Functional Assessment of Cancer Treatment, FACT-G), and optimism (Life Orientation Test-Revised) at baseline (2 - 10 weeks post-surgery), 6-months and 12-months after randomization. CBSM-related changes and mediation and moderation effects were assessed using latent growth curve models.

RESULTS

We found CBSM increased benefit finding (b = 2.65, p < 0.01), emotional (b = 0.53, p < 0.01), and functional QoL (b = 0.71, p < 0.05) over time. CBSM-related changes in emotional QoL were mediated by increased benefit finding (indirect effect = 0.68, 95% bootstrapped CI: 0.17, 1.56) but only among participants with low to moderate optimism at baseline.

CONCLUSION

CBSM intervention improved emotional QoL over the first year of breast cancer treatment by increasing benefit finding among women who reported low trait optimism suggesting those who will most likely benefit from improving benefit finding during this stressful period.

Factors associated with and risk factors for depression in cancer patients - A systematic literature review

Objective

The prevalence of depression in oncological patients is 3, 4-fold compared to the general population. However, the specific risk factors for these prevalence rates are not fully understood.

Methods

A systematic literature review was conducted in nine electronic databases between 2005 and 2020. The quality of the eligible studies was appraised by two persons using the adapted 11-items Downs and Black checklist.

Results

Among 2010 potentially relevant articles, 40 studies were eligible, with 27 studies of high quality and 13 studies of moderate quality. A total of 156 factors associated with depression were identified which were clustered into somatic, psychological, social and sociodemographic factors. Pre-existing depression and personality factors were the most consistent associated factors with depression in cancer patients, while for most somatic and treatment-related factors only modest associations were found.

Conclusions

Grouped as bio-psycho-social associated factors, somatic factors showed a modest influence, whereas social relationship (support) and previous depression are unequivocally significantly associated with depression.

"There's somebody like me": perspectives of a peer-to-peer gynecologic cancer mentorship program

Purpose

The Ovarian Cancer Research Alliance’s Woman to Woman (W2W) program is a peer mentorship program for women with gynecological cancer that was founded in 2004 and has expanded to 43 sites nationwide. An initial program survey was conducted in 2013, but no qualitative studies have investigated patient experiences with peer support programs for gynecologic cancer in the USA. This study examines the match experience at one program site. The aim of this qualitative study was to capture mentor and mentee experiences giving and receiving peer support, including how relationships were initiated and developed.

Methods

Hour-long, semi-structured interviews were conducted with both mentors and mentees. Interviews focused on the dynamics of the mentor–mentee relationship. Interviews were recorded, transcribed verbatim, and open-coded. A qualitative descriptive approach was used to organize findings into themes.

Results

Sixteen participants (N = 16) were interviewed (seven mentors and nine mentees.) Three broad themes emerged: (i) pathways to the program; (ii) how connection occurred; and (iii) themes of compatibility. While program participants universally valued their match experience, frequency and mode of communication, as well as expectations of the match relationship were widely divergent among the program participants.

Conclusion

The W2W peer mentorship program is a valuable resource for patients with gynecologic cancer. Refining the wants and needs of mentees including mode of communication, frequency of communication, type of support desired, identifying topics of mutual interest, and introducing the concept of recurrence may improve the connectivity experienced by mentor–mentee dyads.

"There should be some kind of checklist for the soul"- A qualitative interview study of support needs after end of treatment for gynecologic cancer in young women

PURPOSE

Young women diagnosed with a gynecologic cancer face the risk of significant physical and mental health problems after end of treatment. Still, there is a lack of knowledge regarding specific support needs in this population, and supportive care services provided to young women with a gynecologic cancer have been reported to be insufficient. The aim of this study was therefore to identify support needs experienced by women diagnosed with a gynecologic cancer before the age of 40.

METHOD

Qualitative semi-structured interviews were conducted with participants (n = 10). Interviews were analyzed using content analysis with an inductive approach.

RESULTS

Eight categories and two themes were identified. The themes described if these needs were related to how women wanted the support to be provided, or to what the support should contain, i.e., 'Form' and 'Content', respectively. The categories related to 'Form' included: Outreach support; Long-term specialized support; Support for the whole family; and Peer-support, whereas categories related to 'Content' included needs for: Support for psychological reactions; Support related to reproduction, sexuality, and family life; Information regarding late effects; and Support tailored to younger women.

CONCLUSION

Women diagnosed with a gynecologic cancer during young adulthood report several specific support needs. The results provide important guidance to clinicians and health care providers by outlining these needs both in terms of form and content.

Perceptions of care after end-of-treatment among younger women with different gynecologic cancer diagnoses - a qualitative analysis of written responses submitted via a survey

BACKGROUND

Less attention has been given to younger adults' psycho-oncology care needs than to children and older adults with cancer. The aim was to explore how care following end-of-treatment was perceived by women treated for different gynecologic cancer diagnoses during younger adulthood.

METHODS

A sample of 207 women diagnosed with gynecologic cancer 2008 to 2016, aged 19-39 at time of diagnosis answered one open-ended question regarding important aspects of care after end-of-treatment. The written responses were analyzed with manifest content analysis and presented in relation to the women's diagnoses, i.e., cervical (n = 130), ovarian (n = 57), and other gynecologic cancer diagnoses (n = 20).

RESULTS

The analysis resulted in three categories: Unmet long-term supportive care needs, Satisfying long-term supportive care, and Health care organizational difficulties. Over half of the women (66.7%) described unmet care needs. The corresponding figures were 80.7, 63.1 and 50% for women diagnosed with ovarian, cervical and other gynecologic cancer diagnoses, respectively. Satisfying supportive care were described by approximately one quarter of the women (26.1%). Among women diagnosed with ovarian cancer 14% described satisfying supportive care. The corresponding figures were 26.9 and 30% for women diagnosed with cervical cancer and other gynecological diagnoses, respectively. Approximately one quarter of the women, irrespectively of diagnosis, described aspects related to health care organizational difficulties (28%).

CONCLUSIONS

The results highlight the importance of good quality care linked to the diagnosis and based on an understanding of the woman's need, desire and expectation of support after end-of-treatment.

Facilitating Posttraumatic Growth After Critical Illness

The theory of posttraumatic growth arose from accounts of various trauma survivors experiencing not only distress but also growth and change. An intensive care unit admission is an unplanned, sudden, and traumatic experience, and many survivors have posttraumatic stress that can lead to posttraumatic stress disorder. Survivors leave the intensive care unit with new functional impairments that drive depression, and they frequently experience anxiety. Amidst the stress of understanding the trauma of an intensive care unit admission, survivors can grow in their world views, relationships, and sense of self. Understanding posttraumatic growth in intensive care unit survivors will inform health care providers on how to help survivors understand their new difficulties after an intensive care unit stay and facilitate growth. This article is a conceptual review of posttraumatic growth, identifiers of posttraumatic growth, and how the tenets of the posttraumatic growth theory apply to intensive care unit survivors. Health care professionals, specifically nurses, can incorporate practices into their care during and after the intensive care unit stay that encourage understanding and positive accommodation of new difficulties brought on by the intensive care unit hospitalization to support survivor growth. Opportunities for research include incorporating posttraumatic growth assessments into post-intensive care unit clinics, self-help materials, and various programs or therapies. Outcomes associated with posttraumatic growth are listed to suggest directions for research questions concerning posttraumatic growth in intensive care unit survivors.

The course and predictors of perceived unsupportive responses by family and friends among women newly diagnosed with gynecological cancers

Perceived unsupportive responses from close others play an important role in psychological adaptation of patients with cancer. Little is known about whether these negative responses change after someone experiences a serious life event, and even less is known about the individual characteristics and related factors that might contribute to both the levels of and changes in perceived unsupportive responses over the course of adaptation to an experience. This longitudinal study aimed to evaluate changes in perceived unsupportive behavior from family and friends among women newly with gynecologic cancer as well as initial demographic, disease, and psychological factors that predict the course of perceived unsupportive behavior over time. Women (N = 125) assigned to the usual care arm of a randomized clinical trial comparing a coping and communication intervention with a supportive counseling intervention to usual care completed six surveys over an 18 month period. Growth models using multilevel modeling were used to predict unsupportive responses over time. Average levels of perceived unsupportive responses from family and friends were low. Unsupportive responses varied from patient to patient, but patients did not report a systematic change in perceived unsupportive responses over time. Cultivating meaning and peace and coping efficacy were associated with fewer perceived unsupportive responses as well as reductions in perceived unsupportive responses over time. Emotional distress, cancer concerns, functional impairment, holding back sharing concerns, and cognitive and behavioral avoidance predicted higher perceived unsupportive responses over time. The findings are discussed in terms of the self-presentation theory and social network responses to persons undergoing difficult life events.

Health-related quality of life in locally advanced cervical cancer patients treated with neoadjuvant therapy followed by radical surgery: A single-institutional retrospective study from a prospective database

OBJECTIVE

To evaluate the health-related quality of life (HRQOL) in locally advanced cervical cancer (LACC) patients treated with neoadjuvant concurrent chemoradiation (CCRT) or radiation (RT) alone followed by radical surgery (RS).

METHODS

In a single-center retrospective study from a prospective database, 275 FIGO Stage IB2-IIIB patients who underwent CCRT/RT + RS were included. HRQOL was prospectively assessed by EORTC QLQ-C30 and EORTC QLQ-CX24 prior to any treatment (baseline) and 6 months after surgery, respectively.

RESULTS

A statistically significant and clinically relevant improvement in physical functioning (P < 0.001) and role functioning (P = 0.002, P = 0.031) was observed in patients receiving either CCRT+RS or RT + RS at follow-up. In addition, quality of life (QoL), physical functioning, and social functioning were better in the RT + RS group than the CCRT+RS group after treatment (P = 0.028, P = 0.010, P = 0.014). Symptom scores of fatigue decreased in both groups over time (P < 0.001, P = 0.004) while insomnia decreased only in the RT + RS group (P = 0.042). Worsened menopausal symptoms were documented in both groups at follow-up (P = 0.001, P = 0.047), while lymphedema was deteriorated only in patients receiving CCRT + RS (P < 0.001). Sexuality scores did not differ between groups or over time with the exception of sexual worry, which was deteriorated in patients receiving RT + RS (P = 0.042).

CONCLUSIONS

QLQ-C30 functioning and tumor-related symptoms scores improved while lymphedema and menopausal symptoms worsened 6 months after neoadjuvant CCRT or RT alone followed by RS in LACC patients. Patients treated with RT + RS had a generally better HRQOL compared with those receiving CCRT+RS, though further validation with prospective randomized clinical trials is warranted.

Medical patients' affective well-being after emergency department admission: The role of personal and social resources and health-related variables

Background

Medical emergency admissions are critical life events associated with considerable stress. However, research on patients’ affective well-being after emergency department (ED) admission is scarce. This study investigated the course of affective well-being of medical patients following an ED admission and examined the role of personal and social resources and health-related variables.

Methods

In this longitudinal survey with a sample of 229 patients with lower respiratory tract infections and cardiac diseases (taken between October 2013 and December 2014), positive and negative affect was measured at ED admission (T1) and at follow-up after 7 days (T2), and 30 days (T3). The role of personal and social resources (emotional stability, trait resilience, affect state, and social support) as well as health-related variables (self-rated health, multimorbidity, and psychological comorbidity) in patients’ affective well-being was examined by controlling for demographic characteristics using regression analyses.

Results

The strength of the inverse correlation between positive and negative affect decreased over time. In addition to health-related variables, higher negative affect was predicted by higher psychological comorbidity over time (T1–T3). In turn, lower positive affect was predicted by lower self-rated health (T1–T2) and higher multimorbidity (T3). In terms of personal and social resources, lower negative affect was predicted by higher emotional stability (T2), whereas higher positive affect was predicted by stronger social support (T1–T2).

Conclusion

Knowledge about psychosocial determinants–personal and social resources and health-related variables–of patients’ affective well-being following ED admission is essential for designing more effective routine screening and treatment.

Does social participation accelerate psychological adaptation to health shocks? Evidence from a national longitudinal survey in Japan

PURPOSE

It is well-known that people psychologically adapt to health shocks over time and social participation (SP) has a favourable impact on health. Combining these two understandings, the current study addresses how psychological adaptation to major health shocks was affected by SP experience one year prior to the initial diagnosis.

METHODS

Data were collected from a twelve-wave nationwide panel survey conducted from 2005 to 2016, starting with 34,240 individuals aged 50-59 years. Individuals who were initially diagnosed with cancer, stroke, heart disease or diabetes at any time between the second and twelfth waves and kept diagnosed as such were focused on. Random-effects models were estimated to examine how baseline SP prior to the diagnosis affected the pace of change in psychological distress, which was measured using Kessler 6 (K6) scores (range 0-24; M 3.3 SD 4.2), following immediate responses to the initial diagnosis.

RESULTS

Baseline SP enabled or accelerated psychological adaptation to major health shocks. It is noted that the pace of decline of the K6 score per year after the immediate responses was 0.20 for cancer and 0.09 for diabetes (both p < 0.001) among men with baseline SP, in contrast with non-significant and limited changes among those without it. While the results for women were more mixed than those for men, the former results confirmed favourable impacts of baseline SP on psychological adaptation to health shocks in general.

CONCLUSIONS

The results highlight a favourable impact of SP on psychological adaptation to health shocks.

Perceived utility of an integrated psychological intervention for gynaecological cancer patients admitted for surgery: preliminary data

OBJECTIVE

To investigate patients' satisfaction and perceived utility for psychological consultations delivered by clinical psychologists in a sample of gynaecological cancer patients hospitalised for surgery.

METHODS

A total of 51 gynaecological cancer patients who scored higher than four on the distress thermometer (DT) were proposed and received a psychological consultation during hospitalisation for surgery. After six months from discharge, patients were asked, during a telephone interview, to rate their level of distress post-treatment, their perceived satisfaction, and usefulness of the psychological intervention received.

RESULTS

At the time of the telephone interview, the distress levels stated by patients tended to be lower than those at hospital admission, and around 61% of the patients expressed maximum satisfaction with psychological intervention. Among these, 60.8% rated the psychological consultation useful for dealing with the hospitalisation itself, 45.1% useful for dealing with personal issues and 58.8% for dealing with issues related to returning home. People who were at their first diagnosis and those who had no other reason to be distressed beyond their cancer found psychological support significantly more useful for facing up to personal issues.

CONCLUSIONS

Patients are highly satisfied with integrative psychological interventions delivered by clinical psychologists in a medical setting such as that of gynaecological cancer surgery and from the six-month follow-up, it emerged that such interventions help in promoting patients' adjustment to the phase of hospitalisation and post-hospital discharge.

Resilience, Positive Coping, and Quality of Life Among Women Newly Diagnosed With Gynecological Cancers

BACKGROUND

Resilience has been linked to psychological adaptation to many challenging life events.

OBJECTIVE

The goal was to examine 3 coping strategies--expressing positive emotions, positive reframing of the cancer experience, and cultivating a sense of peace and meaning in life--as potential mechanisms by which resilience translates to quality of life among women recently diagnosed with gynecological cancer.

METHODS

This cross-sectional study utilized baseline data from women diagnosed with gynecological cancer participating in an ongoing randomized clinical trial (n = 281; mean age, 55 years; 80% were white). Participants completed measures of resilience, positive emotional expression, positive reappraisal, cultivating a sense of peace and meaning, and quality of life. Univariate and multiple mediation analyses were conducted.

RESULTS

Greater resilience was related to higher quality of life (P < .001). Multiple mediation analyses indicated that the coping strategies, as a set, accounted for 62.6% of the relationship between resilience and quality of life. When considered as a set, cultivating a sense of peace and meaning had the strongest indirect effect (b = 0.281, SE = 0.073, P < .05).

CONCLUSION

The findings suggested that resilient women may report higher quality of life during gynecological cancer diagnosis because they are more likely to express positive emotions, reframe the experience positively, and cultivate a sense of peace and meaning in their lives.

IMPLICATIONS FOR PRACTICE

Interventions promoting a sense of purpose in one's life and facilitating expression of positive emotions may prove beneficial, particularly for women reporting higher levels of resilience.

Predictors of depression and anxiety symptom trajectories in the 24 months following diagnosis of breast or gynaecologic cancer

OBJECTIVE

To identify predictors of anxiety and depression symptom trajectories, as distinct from general distress, in the 96 weeks following diagnosis of breast or gynaecologic cancer.

METHODS

Participants completed the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) and Centre for Epidemiological Studies Depression Scale (CES-D) at diagnosis and at 8-weekly intervals for 96 weeks. Linear mixed models were used to determine the effects of age, relationship status, tumour stream, cancer stage, living situation, residential area, educational status, current and previous anxiety/depression treatment and neuroticism on symptom trajectories.

RESULTS

Participants were 264 women with a mean (SD) age of 54 (12) years. Compared to non-treatment-receiving counterparts, women who received anxiety/depression treatment in the past had depression and anxiety symptom severity scores that were 4.58 and 1.24 higher, respectively. Women receiving such treatment at cancer diagnosis had depression and anxiety scores that were 4.34 and 2.35 points higher, respectively, than their counterparts. Compared to women with the lowest neuroticism scores, women with the highest scores scored 8.48 and 3.82 higher on the CES-D and HADS-A, respectively. Depressive severity remained stable but anxiety severity decreased as a function of neuroticism.

CONCLUSIONS

In settings with limited resources, women with high neuroticism or a depression/anxiety treatment history should be the initial target of psychological screening. Identification of women with these characteristics at the earliest point of entry into the oncology service followed by heightened surveillance and/or referral to psychosocial services may be useful to prevent chronic psychological morbidity.

Anxiety and depression symptoms in the 2 years following diagnosis of breast or gynaecologic cancer: prevalence, course and determinants of outcome

PURPOSE

The purposes of this study are to examine the course and prevalence of anxiety and depression over 24 months in women with newly diagnosed breast and gynaecologic cancer and, controlling for demographic and clinical confounders, to test the role of neuroticism and psychiatric history in determining outcome 6, 12, 18 and 24 months post-diagnosis.

METHODS

Participants completed the Hospital Anxiety and Depression Scale-anxiety subscale and Centre for Epidemiological Studies Depression Scale on an 8-weekly basis from diagnosis until 96 weeks. Changes over time were analyzed with repeated measures ANOVA. Hierarchical linear regression, adjusted a priori for age, chemotherapy and radiation treatment, living alone, education and tumour stream were used to predict anxiety and depression.

RESULTS

Participants were 105 women (66 breast, 39 gynaecologic). Rates of anxiety (18.1 %) and depression (33.3 %) were highest at diagnosis. Average rates of anxiety and depression were 5.9 and 22.4 %, respectively. Average scores of anxiety and depression were highest at diagnosis, with improvement at 8 and 40 weeks, respectively, subsequently maintained. Morbidity at diagnosis was particularly acute among women with a treatment history of anxiety/depression or with high neuroticism. These three variables were the best and only predictors over 24 months.

CONCLUSIONS

Women are most vulnerable to anxiety and depression at diagnosis, with improvement over time. Morbidity rates are lower than reported elsewhere. Women with high neuroticism and a psychiatric history are at greatest risk for future morbidity after adjusting for confounders. Early identification of these women plus heightened surveillance or early referral to psychosocial services may protect against longer-term morbidity.

PrediQt-Cx: post treatment health related quality of life prediction model for cervical cancer patients

Background

Cervical cancer is the third largest cause of cancer mortality in India. The objectives of the study were to compare the pre and the post treatment quality of life in cervical cancer patients and to develop a prediction model to provide an insight into the possibilities in the treatment modules.

Methodology/Principal Findings

A total of 198 patients were assessed with two structured questionnaires of Health Related Quality of Life (The European Organisation for Research and Treatment of Cancer, EORTC QLQ C-30 and CX-24). The baseline observations were recorded when the patients first reported (T1) and second evaluation was done at 6 months post treatment (T2). The mean age of detection was 50.9 years with the literacy level being non-educated or less than high school. Majority of them were married/cohabiting 179 (90.4%). On histopathological examination (HPE) squamous cell carcinoma was found to be the most common cell type carcinoma 147 (74.2%) followed by Adenocarcinoma 31 (15.7%). Radical hysterectomy was the most common treatment modality 76 (38.4%), followed by Wertheims Hysterectomy 46 (23.2%) and Radiochemotherapy 59 (29.8%). The mean score of global health of cervical cancer patients post treatment was 77.90, which was significantly higher than the pre - treatment score (54.32). Mean “symptoms score” post treatment was 21.69 with an aggravation of 7.32 compared to pre treatment scores. Patients experienced substantial decrease in sexual activity post treatment.

Conclusions/Significance

The prediction model(PrediQt-Cx), based on Support Vector Machine(SVM) for predicting post treatment HRQoL in cervical cancer patients was developed and internally cross validated. After external validation PrediQt-Cx can be easily employed to support decision making by clinicians and patients from north India region, through openly made available for access at http://prediqt.org.

Posttraumatic growth in women one year after diagnosis for gynecologic cancer or benign conditions

The authors sought to examine levels and predictors of posttraumatic growth over one year after surgery in women diagnosed with gynecologic cancer or benign conditions necessitating surgical intervention. Women with advanced-stage cancer (n = 16), early-stage cancer (n = 18), benign gynecologic disease (n = 21), and no disease (n = 14; postannual pelvic exam) completed questionnaires (Perceived Threat, PTSD Checklist [PCL]) 1 week prior to surgery and completed the Posttraumatic Growth Inventory (PTGI) 16 months postsurgery. The four groups' scores varied significantly on the PTGI. The three disease groups reported higher levels of posttraumatic growth than the no disease group. Higher PCL score presurgery and greater disease severity were positively related to posttraumatic growth, and higher income level was negatively related to posttraumatic growth. Women with gynecologic cancer, regardless of stage, and women with benign gynecologic conditions experience posttraumatic growth.

Opinions and expectations of women in the treatment of cervical and uterine cancer in Spain

AIM

To know the experiences, needs and expectations of women in the treatment of cervical and uterine cancer in the Andalusian Health Service.

METHODS

Focus groups and in-depth interviews with women being treated for cervical-uterine cancer within the Andalusian Health Service. Analysis with Nudist Vivo 1.0 (QSR International Pty Ltd, Doncaster, Victoria, Australia).

RESULTS

The needs and expectations detected were: coherence in the promotion strategies and the presence of a proactive approach by health professionals, availability of comprehensive information and understanding, possibility of expressing to health professionals one's doubts and fears, and of participation in decision-making, technical quality, humane treatment and continuity of care and attention to psychosocial aspects.

CONCLUSION

The knowledge of women in the treatment of cancer of the cervix and uterus plays a crucial part in improving the delivery of these services.

Effectiveness of partner social support predicts enduring psychological distress after hematopoietic stem cell transplantation

OBJECTIVE

Hematopoietic stem cell transplant (HSCT) survivors who are 1 to 3 years posttransplant are challenged by the need to resume valued social roles and activities--a task that may be complicated by enduring transplant-related psychological distress common in this patient population. The present study investigated whether transplant survivors who receive adequate social support from their spouse or intimate partner experience lower distress.

METHOD

Effects of receiving a greater quantity of partner support (a common approach to studying enacted support) were compared with effects of receiving more effective partner support (i.e., support that more closely matches their needs in terms of its quantity and quality). Men and women (N = 230) who were 1 to 3 years posttransplant completed measures of partner support quantity (Manne & Schnoll, 2001), partner social support effectiveness (Rini & Dunkel Schetter, 2010), and psychological distress (Brief Symptom Inventory; Derogatis & Spencer, 1982). Potential medical and sociodemographic confounds were controlled in analyses.

RESULTS

As hypothesized, survivors reported less distress when they received more effective partner support (p < .001). Quantity of partner support was not associated with distress (p = .23). An interaction revealed that when partner support was effective, the quantity of support survivors received was not associated with their distress (p = .90); however, when partner support was ineffective, receiving a greater quantity of partner support was associated with substantially elevated distress (p = .002).

CONCLUSIONS

Findings suggest that clinical approaches to addressing or preventing enduring distress after HSCT should target features of partner support related to its appraised effectiveness.

Interplay of concurrent positive and negative interpersonal events in the prediction of daily negative affect and fatigue for rheumatoid arthritis patients

OBJECTIVE

The purpose of this study was to examine the interaction of daily concurrent positive interpersonal events (PIE) and negative interpersonal events (NIE) on the daily experience of negative affect and fatigue in a sample of men and women with rheumatoid arthritis. Two hypotheses were made. The blunting hypothesis predicted that NIE would nullify the beneficial influence of PIE on outcome measures, and the buffering hypothesis predicted that PIE would offset the adverse influence of NIE.

DESIGN

Participants completed up to 30 consecutive daily diaries. Multilevel modeling was used to examine the day-to-day dependencies among study variables.

MAIN OUTCOME MEASURES

The primary outcomes were daily negative affect and fatigue.

RESULTS

In support of the blunting hypothesis, on days when NIE were diminished, PIE were associated with a greater reduction in fatigue. In contrast, consistent with the buffering hypothesis, on days when PIE were elevated, NIE were associated with a lesser increase in negative affect.

CONCLUSION

The examination of concurrent PIE and NIE provides a unique perspective on the role of interpersonal events in affective and physiological outcomes, beyond that which can be gained from the examination of either type of event in isolation.

Perceived threat and PTSD symptoms in women undergoing surgery for gynecologic cancer or benign conditions

OBJECTIVE

We sought to examine levels of perceived threat and traumatic stress symptoms both before and in the short- and long-term period after surgery and associated care in women diagnosed with gynecologic cancer or benign conditions.

METHODS

Women with advanced-stage cancer (n=22), early-stage cancer (n=31), benign gynecologic disease (n=33), and no disease (n=25; post-annual pelvic examination) completed questionnaires (Perceived Threat, Impact of Event Scale (IES), and Post-Traumatic Stress Disorder (PTSD Checklist (PCL)) on three occasions: 1 week before surgery (Time 1), 7 weeks after surgery or comparable time (Time 2), and 16 months after surgery (Time 3).

RESULTS

Perceived threat did not differ across disease groups at Time 1, but there were differences at both later times (F(2, 93.1)=11.83; p<0.001; group × time interaction); women with advanced cancer reported the highest levels. IES scores were consistently higher for the disease groups compared with the no-disease group (F(3,104.2)=11.19; p<0.001), but were not significantly different from one another. IES scores declined over time, most markedly for the three disease groups (group × time interaction (F(6,163.8)=2.60; p=0.02). Survival analysis indicated significant differences across the groups in risk of estimated PTSD [Wilcoxon χ(2) (3, N=96)=7.83, p=0.050] with 34% of advanced cancer, 16% of early cancer, and 15% of benign disease groups reaching estimated PTSD criteria.

CONCLUSIONS

Women with gynecologic cancer, regardless of stage, and women with benign conditions experience heightened traumatic stress at the time of diagnosis, and some continue to be distressed many months afterwards. Broad-based screening and intervention for traumatic stress symptoms may be warranted.