Emotions and Emotion Regulation in Breast Cancer Survivorship

The validity of a new resilience scale: the Japan Resilience Scale (J-RS) for mothers with a focus on cultural aspects

BACKGROUND

Resilience has been recognized as a potential outcome for preserving mental health and preventing postpartum depression. Social connection and emotional regulation have been identified as possible factors in resilience from social and cultural perspectives. Therefore, it is necessary to develop a scale that is adapted to the Japanese cultural milieu.

OBJECTIVE

To establish the validity and reliability of the new resilience scale, questionnaires were administered to mothers raising children aged 0-5 years.

METHODS

The Japan Resilience Scale (J-RS) is a newly created, 25-item, self-report scale designed to assess resilience. The J-RS includes six subscales (Joy, Anger, Apprehension, Grief, Fear, and Social connection) that are rated on a 5-point Likert scale (0-4). To validate the J-RS, data were collected from 238 mothers (mean age 35.3 ± 4.7 years), and its relationships with other measures, such as the Resilience Scale (RS) and the Center for Epidemiologic Studies Depression (CES-D) scale, were examined. Internal consistency (reliability) of the J-RS was assessed using Cronbach's alpha coefficient, and the final model was determined via confirmatory factor analysis (CFA). Multiple logistic regression analysis was then used to identify depressive symptoms using the CES-D.

RESULTS

A total of 238 mothers, with 18.5% exhibiting depressive symptoms, were analyzed. The mean J-RS score was 61.3 ± 14.2. J-RS was positively correlated with RS (r = 0.71, p < 0.01) and negatively with CES-D (r = -0.62, p < 0.01). These results demonstrate the construct validity of the J-RS. CFA confirmed the six-factor model's good fit for emotion and social connection. The J-RS was effective in distinguishing individuals at risk of depression (AUC = 0.83, 95% CI: 0.75-0.91). At a cutoff of 59/60, sensitivity, specificity, positive predictive value, and negative predictive value were 84.1%, 63.9%, 34.6%, and 94.7% respectively.

CONCLUSIONS

The J-RS appears to be the optimal index for assessing resilience, and would allow screening for postpartum depression among Japanese mothers. This study also showed that emotional control and social connectedness are important components of resilience.

Mindfulness-Based Cancer Recovery (MBCR) training: the efficacy on fatigue and sleep quality of Iranian female patients with cancer

OBJECTIVE

The present study aimed to examine the efficacy of Mindfulness-Based Cancer Recovery (MBCR) training on fatigue and sleep quality of Iranian female patients with cancer.

METHOD

Thirty female patients with cancer were randomized to one of the MBCR and control groups. Subjects of the MBCR group received 8 sessions of MBCR training, while subjects of the control group received a 1-day didactic stress management seminar (SMS). All participants responded to the Cancer Fatigue Scale (CFT) and the Pittsburgh Sleep Quality Scale (PSQL) as pre- and post-test measures.

RESULTS

Using MANCOVA for analyzing data revealed a significant improvement in the level of fatigue among subjects of the MBCR group compared to the controls; however, MBCR had no significant effect on the level of sleep quality.

CONCLUSION

The Mindfulness-Based Cancer Recovery program can be considered an effective approach to reducing fatigue for Iranian female patients with cancer. The clinical implications of this finding require further investigation.

TRIAL REGISTRATION

The study was registered with the Iranian Registry of Clinical Trials (IRCT) on 24 June 2024; see [IRCT20240315061296N1].

Iterative Development of an Interactive Website to Support Shared Decision-Making in Metastatic Breast Cancer

Recent treatment advances have resulted in significantly increased survival times following metastatic breast cancer (MBC) diagnosis. Novel treatment approaches-and their related side effects-have changed the landscape of MBC treatment decision-making. We developed a prototype of an online educational tool to prepare patients with MBC for shared decision-making with their oncologists. We describe the five phases of tool development: (1) in-depth, semi-structured qualitative interviews and (2) feedback on storyboards of initial content with patients with MBC and oncology providers. This was followed by three phases of iterative feedback with patients in which they responded to (3) initial, non-navigable website content and (4) a beta version of the full website. In the final phase (5), patients newly diagnosed with MBC (N = 6) used the website prototype for 1 week and completed surveys assessing acceptability, feasibility, treatment knowledge, preparation for decision-making, and self-efficacy for decision-making. Participants in Phase 1 characterized a cyclical process of MBC treatment decision-making and identified key information needs. Website content and structure was iteratively developed in Phases 2-4. Most participants in Phase 5 (n = 4) accessed the website 2-5 times. All participants who accessed the website at least once (n = 5) felt they learned new information from the website prototype and would recommend it to others newly-diagnosed with MBC. After using the website prototype, participants reported high preparation and self-efficacy for decision-making. This multiphase, iterative process resulted in a prototype intervention designed to support decision-making for MBC patients.

Anxiety and fear of cancer recurrence as predictors of subsequent pain interference in early cancer survivorship: Exploring the moderating roles of cognitive and emotional factors

Following treatment, cancer survivors often experience pain that negatively impacts their quality of life. Although both anxiety and fear of cancer recurrence (FCR) have been shown to exacerbate pain interference, less is known about either the temporal relationship between anxiety/FCR and pain interference or modifiable cognitive/emotional factors that might moderate that relationship among cancer survivors. This longitudinal study aims to advance our understanding of the impact of both anxiety and FCR following primary cancer treatment on subsequent pain interference. We also examined potentially modifiable moderators (i.e., cancer-related illness beliefs and emotion regulation difficulties) of the relationship between anxiety/FCR and subsequent pain interference. Adults (N = 397; 67% female; Mage = 59.1 years) diagnosed with breast, colorectal, or prostate cancer completed self-report measures at baseline (average of 2.5 months following treatment completion) and at 6-month follow-up. Both greater anxiety and FCR not only predicted subsequent pain interference, but also predicted increases in pain interference over time. Additionally, complex interaction patterns were observed between anxiety and the potential moderators on pain interference. Specifically, lower Personal Control beliefs and higher Consequences beliefs were associated with greater pain interference for those with lower levels of anxiety/FCR. Emotion regulation difficulties also moderated the anxiety-pain interference link (i.e., was more strongly associated with greater pain interference at lower levels of anxiety), but not the FCR-pain link. Chronicity beliefs did not interact with anxiety or FCR in predicting pain interference. This study advances our understanding of the role of anxiety/FCR on pain interference over time as well as potential psychological treatment targets for individuals at greater risk for longer-term pain following cancer treatment.

Emotional awareness amplifies affective sensitivity to social support for women with breast cancer

Emotional awareness (EA) is thought to facilitate psychological health by aiding emotion regulation in oneself and garnering social support from others. This study tested these potential relationships within a one-year longitudinal study of 460 women (age 23-91 years, mean 56.4 years) recently diagnosed with breast cancer (i.e., within four months). The women completed measures of emotional awareness, social support, social stress, affective symptoms, and well-being. Linear models tested EA as a moderator of social support and stress on affective symptoms and well-being. In those with higher EA, low social support was associated with greater depression and lower optimism. There was some evidence that higher EA predicted greater depression at baseline but lower depression at nine-month follow-up. These results support the idea that EA increases sensitivity to available social support and facilitates emotional adjustment over time, suggesting that assessment of EA could help guide clinicians in identifying those at greatest risk of adverse mental health outcomes in this population.

Social support moderates the relationship between emotion regulation and health-related quality of life in cancer patients

The relationship between emotion regulation (cognitive reappraisal and expressive suppression) and HRQoL in cancer patients is currently gaining momentum, yet, no research to date has investigated the nature of this relationship. The purpose of this study was to investigate the moderating role of social support in the relationship between ER and HRQoL in Nigerian cancer patients. Participants included 361 cancer patients (female = 56.79%, mean age = 41.61, SD 15.47) conveniently drawn from the oncology unit of the University Teaching Hospital, Nigeria. They completed the measures of Functional Assessment of Cancer Therapy-General (FACT-G), emotion regulation and Perceived Social Support. The moderated regression analysis via PROCESS procedures for SPSS Version 3 was used for data analysis. The results showed that cognitive reappraisal significantly predicted HRQoL (β = 2.12, t = 4.39, p = .000). Social support also significantly predicted HRQoL (β = .73, t = 4.57, p = .000). Most importantly, social support moderated the relationship between cognitive reappraisal and HRQoL (β = -.034, t= -4.23, p = .000), but not between expressive suppression and HRQoL (β = -.015, t= -1.61, p = .10). The moderation slope revealed that cognitive reappraisal significantly predicted HRQoL particularly at lower and moderate levels of social support. These findings reveal that the effect of emotion regulation on HRQoL depends much on an individual's level of perceived social support. It also means that social support boosted the positive impact of emotion regulation on HRQoL. The findings highlighted the importance of social-support and emotion regulation particularly, cognitive-reappraisal in improving health-related quality of life in cancer patients.

What Promotes Positive Parenting During Breast Cancer? A Cross-Sectional Analysis of Social Support, Emotion Regulation, and Meaning in Life

BACKGROUND

Motherhood and maintaining the child-parent relationship are top priorities for mothers with breast cancer (BC). The current study aimed to assess the positive intra- and inter-personal resources related to positive parenting among mothers with BC, as these may be promotive factors for positive parenting. Specifically, we examined whether social support (family, friend, spiritual), emotion regulation, and a sense of meaning in life are related to positive parenting among mothers undergoing BC treatments.

METHODS

The sample consisted of 100 Israeli mothers (mean age = 46.02 years, SD = 6.06 years) who were undergoing treatment for BC. Participating mothers had at least one child aged 6-17 years. Participants were recruited via closed social media groups to complete a questionnaire containing: the Alabama Parenting Questionnaire, Cancer Perceived Agents of Social Support tool, Emotion Regulation Questionnaire, Meaning in Life Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and sociodemographic and clinical questions. We used structural equation modeling to regress the study variables on positive parenting.

RESULTS

Friend support (β = .35, p = .009) and meaning in life (β = .30, p = .012) were significantly related to positive parenting. Family support, spiritual support, cognitive reappraisal, and the sociodemographic and clinical variables were not related to positive parenting.

CONCLUSIONS

Our study suggests that promoting meaning in life and friend support may be key to helping mothers to sustain positive parenting behaviors throughout their cancer treatment. Future research may examine whether psychosocial interventions which foster meaning in life and friend support impact positive parenting among mothers with BC.

Combined oral low-dose cyclophosphamide endocrine therapy may improve clinical response among patients with metastatic breast cancer via Tregs in TLSs

Despite limited research on refractory and/or endocrine therapy failure in elderly metastatic breast cancer (MBC) patients, a prior study showed that low-dose oral cyclophosphamide (CY) can improve the overall survival rate of MBC patients, possibly through the immunoregulation of regulatory T cells (Tregs). We preliminarily investigated the combination of endocrine therapy (ET) with oral low-dose CY as salvage therapy in elderly patients via peripheral blood regulatory T-cell analyses. In addition, we evaluated the associations of tumor tertiary lymphoid structures (TLSs) with therapeutic outcomes. HR+/HER2- advanced breast cancer patients who received low-dose CY combined with ET or ET only from April 2015 to August 2021 were enrolled in this retrospective study. The primary outcome was the clinical control rate (CCR), and the secondary outcome was progression-free survival (PFS). Circulating T lymphocyte subpopulations represented by Tregs were monitored during treatment by flow cytometry methods. TLSs wereconfirmed by hematoxylin-eosin staining of pretreatment specimens, and CD3, CD4, and Foxp3 were detected using Opal multicolor immunofluorescence. A total of 85 patients who received CY + ET and 50 patients who received ET only were enrolled, the percentage of patients who received CCR was 73% (62/85) vs. 70% (45/50), and the objective response rate (ORR) was 28% (24/85) vs. 24% (12/50). No deaths occurred during the study period. The mean PFS time was 13 vs. 11 months (P = 0.03). In the CY + ET group, decreases in CD4+/CD25+/Foxp3+ T cells (P < 0.001) were favorable for both clinical control and prolonged PFS (P < 0.001). Compared with patients without TLSs, those with TLSs were more likely to have better clinical control and PFS (mean time = 6 months), and a greater number of Treg cells during TLS pretreatment correlated with longer PFS (P = 0.043). Oral low-dose CY combined with standard ET exerts immunological effects by decreasing Treg levels to achieve improved clinical responses. Moreover, patients with TLSs might benefit more from such therapy than those without TLSs, and a high Treg cell count in TLSs before treatment predicts better therapeutic efficacy.

A Process Evaluation of a Palliative Care Social Work Intervention for Cancer Patients in Skilled Nursing Facilities

Background: Assessing and Listening to Individual Goals and Needs (ALIGN) is a palliative care social work intervention that aims to improve delivery of goal-concordant care for hospitalized older adults with cancer discharged to skilled nursing facilities. Objective: Explore processes through which ALIGN may improve delivery of goal-concordant care to substantiate the conceptual model grounding the intervention and to inform mechanistic hypotheses of how the intervention might be effective. Design: A process evaluation triangulating findings from patient and caregiver interviews with a matrix analysis of ALIGN social worker notes. Setting/Participants: Patients (n = 6) and caregivers (n = 13) who participated in a single-arm pilot study of ALIGN in the United States and 113 intervention notes (n = 18 patients) written by 2 ALIGN social workers. Measurement: Qualitative thematic content analysis Results: Themes included the following: (1) ALIGN helped reconcile participants' misaligned expectations of rehabilitation with the reality of the patient's progressive illness; (2) ALIGN helped participants manage uncertainty and stress about forthcoming medical decision making; (3) the longitudinal nature of ALIGN allowed for iterative value-based goals of care discussions during a time when patients were changing their focus of treatment; and (4) ALIGN activated participants to advocate for their needs. Conclusions: ALIGN offers support in prognostic understanding, communication, and decision making during a pivotal time when patient and caregivers' goals have not been met and they are reassessing priorities. A larger trial is needed to understand how these processes may improve the ability of participants to make value-based decisions and aide in delivery of goal-concordant care. Clinical Trial Registration Number: NCT04882111.

Universal, school-based transdiagnostic interventions to promote mental health and emotional wellbeing: a systematic review

OBJECTIVE

This systematic review aims to evaluate the effectiveness of universal school-based transdiagnostic interventions in promoting the mental health of children and adolescents. It compares and discusses interventions targeting the prevention of mental disorders versus the promotion of mental health. Additionally, the roles of teachers and psychologists as intervention conductors are examined.

METHODS

A comprehensive search of the Psycinfo, Pubmed, and Web of Science databases was conducted without any time restrictions to identify relevant literature on universal school-based transdiagnostic interventions promoting children and adolescents' mental health.

RESULTS AND DISCUSSION

The findings reveal that universal school-based transdiagnostic promotion/prevention programs have a small to medium overall effect size. These interventions demonstrate a broad coverage of different aspects of children and adolescents' mental health. However, the relative effectiveness of teacher-led versus psychologist-led interventions remains unclear. Interventions focused on preventing mental disorders exhibit a higher effect size, albeit on a narrower range of mental health aspects for children and adolescents.

SIGNIFICANCE

This study enhances our understanding of universal school-based transdiagnostic interventions and their impact on children and adolescents' mental health. Further research is needed to elucidate the comparative efficacy of teacher-led and psychologist-led interventions and to explore the specific dimensions of mental health targeted by these interventions.

Contributing factors to well-being in a sample of long-term survivors of childhood acute lymphoblastic leukemia: the role of social support in emotional regulation

Objectives: To understand why some long-term childhood cancer survivors experience positive adjustment in the long run,[Q1] this study aimed to (1) explore associations between well-being, health status, social support, and emotion regulation (ER) strategies in a cohort of long-term childhood lymphoblastic leukemia (cALL) survivors, (2) identify the individual contribution of each ER strategy to well-being (3) and their interaction with social support. Methods: We used data from 92 participants from the PETALE cohort (51% female, aged 24 ± 7 years). Measures included well-being (WHO-5), health status (15D), social support (SSQ-6), cognitive reappraisal and expressive suppression (ERQ), and emotional processing and expression (EAC). We modeled the odds of high well-being adjusting for health status in logistic regressions and explored the moderating role of social support with bootstrap techniques. Independent of clinical history, high well-being was associated with better health status, higher social support, more frequent use of cognitive reappraisal and emotional processing. Results: We found a main contribution of emotional processing to well-being (OR = 2.12, 95% CI = 1.09-5.37). The interaction between low suppression and high social support was significant (OR = .40, 95% CI = .13-.79). Probabilities for high well-being were 96% when expressive suppression was low and social support was high. Results suggest approaching one's own emotions may contribute to well-being in long-term childhood cancer survivors. Clinical implications: Combining curbing emotional suppression with promoting supportive social environment could be a promising target for future supportive care interventions in survivors.

Communication preferences and perceptions of cancer patient during their first medical oncology appointment

BACKGROUND

The first medical oncology appointment serves as a platform for patients to comprehend their diagnosis and prognostic implications of cancer. This study aimed to determine patients' communication preferences during their first medical oncology appointment and to assess the disparities between patients' preferences and perceptions.

METHODS

A total of 169 cancer patients participated by completing the Communication in First Medical Oncology Appointment Questionnaire (C-FAQ), a two-section questionnaire designed to assess patients' preferences and perceptions regarding Content (information provided and its extent), Facilitation (timing and location of information delivery), and Support (emotional support) during their first medical oncology appointment. A comparative analysis was conducted to assess the variations between preferences and perceptions.

RESULTS

Content emerged as the most significant dimension compared to Facilitation and Support. The physician's knowledge, honesty, and ability to provide clear information were considered the most important attributes. Patients evaluated most of their preferences as "very important". Patients' perception of the communication dimensions present during their appointment was below preferences for 11 items, indicating significant discrepancies in clinical practice.

CONCLUSIONS

Patients highly valued their preferences concerning Content, Facilitation, and Support dimensions of communication. However, patient preferences were more prominently oriented towards the Content dimension. The discrepancies between preferences and perceptions should be viewed as an opportunity for enhancing communication skills through training.

Targeting emotional regulation using an Internet-delivered psychological intervention for cancer survivors: A randomized controlled trial

OBJECTIVES

This trial assessed the efficacy of an emotion-focused, modular, Internet-delivered adaptation of the Unified Protocol (UP) in improving cancer survivors' emotion regulation strategies.

DESIGN

A two-arm randomized controlled trial (1:1) was used to compare the efficacy of two Internet-based interventions: UP-adapted CanCope Mind (CM) and lifestyle-focused active control CanCope Lifestyle (CL).

METHODS

N = 224 cancer survivors randomized to CM or CL were assessed at baseline, between-modules, at post-intervention and 3-month follow-up on emotion regulation outcomes targeted by each CM module (Module 1: beliefs about emotions; Module 2: mindfulness; Module 3: cognitive reappraisal skills, catastrophizing, refocus on planning; Module 4: experiential avoidance). Primary analyses were intention-to-treat linear regressions using Fisher randomization tests for p-values and intervals were used to compare groups with standardized mean difference (SMD) effect sizes.

RESULTS

CanCope Mind participants (n = 61 completers) experienced moderate-to-large improvements (SMDs from .44-.88) across all outcomes at post-intervention. CM's effects were larger than CL's (n = 75 completers) immediately post-intervention and at 3-month follow-up for beliefs about emotions, mindfulness, cognitive reappraisals and experiential avoidance (all p's < .05). CM experienced greater improvements in catastrophizing immediately post-intervention, with a trending effect at follow-up. However, we could not reject the null hypothesis of identical between-group effects for refocusing on planning both immediately post-intervention and at follow-up. Exploratory analyses revealed inconsistent between-module effects.

CONCLUSIONS

In its entirety, CM is a promising intervention for improving and maintaining cancer survivors' adaptive emotion regulation, especially for mindfulness and experiential avoidance. This may have important clinical implications for promoting cancer survivors' emotional functioning and general well-being.

Predicting real-world emotion and health from spontaneously assessed linguistic distancing using novel scalable technology

Individuals who are better at regulating their emotions have been shown to have better physical and mental health outcomes. One promising emotion regulation strategy is psychological distancing, which involves appraising a stimulus with objectivity or spatial/temporal distance. Language-based psychological distancing (linguistic distancing [LD]) refers to the degree to which one implements psychological distancing naturally via language. A crucial, underexamined mechanism that may account for real-world emotion and health self-reports is spontaneous (i.e., implicit) LD. Using HealthSense, a novel, scalable, mobile health assessment application, we collected lexical transcriptions for personally specific negative and positive events as well as emotion and health-relevant data over 14 days (data collected in 2021) and examined how implicit LD during negative and positive events relates to well-being over time. Primary analyses revealed that higher LD during negative events was associated with lower levels of stress as well as greater emotional and physical well-being within persons. LD during positive events on 1 day predicted greater reports of happiness 2 days later within persons. LD during positive events was associated with fewer symptoms of depression and LD during negative events was associated with greater physical well-being among persons. Exploratory analyses revealed that average depression, rumination, and perceived stress across the 2 weeks were significantly negatively associated with LD during negative events between persons. The present results expand understanding of the relationship between LD and mental and physical health risks and motivate future research on low-burden, scalable interventions involving LD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adaptation to the disease, resilience and optimism in woman with breast cancer

This research aims to determine the relationship between the variables adaptation to the disease, resilience and dispositional optimism in women with breast cancer in Montería (Colombia). This study is a descriptive-correlational type, evaluating 116 participants. The instruments applied were the Font Quality of Life Questionnaire, to assess the Index of Adaptation to Disease, Wagnild and Young's Resilience Scale (RS) and the Life Orientation Test-Revised (LOT-R). The statistical program SPSS 25.0 was used for the analysis of the data. A normality test was performed which led to the application of the Spearman correlation coefficient. Findings indicated the presence of adaptation in the participants and resilient and optimistic characteristics, however, there is no significant relationship between these variables and adaptation to the disease.

Subjective cancer-related cognitive impairments and salience network connectivity in breast cancer survivors

PURPOSE

Little is known about the neural basis of subjective cancer-related cognitive changes. The purpose of this study was to explore salience network connectivity in relation to subjective executive and memory dysfunction in breast cancer survivors compared to controls.

METHODS

A retrospective cross-sectional analysis of neuroimaging, subjective cognitive, clinical, and demographic data in chemotherapy-treated primary breast cancer survivors compared to frequency matched controls was used. Functional connectivity within salience network hubs (anterior cingulate, bilateral insula) was determined using resting state functional MRI. Mann-Whitney U tests were used to evaluate group differences and Spearman's rho correlations were examined among the behavioral measures and salience network connectivity.

RESULTS

We included 65 breast cancer survivors and 71 controls. Survivors demonstrated greater subjective executive dysfunction and memory complaints (p < .001) and lower salience network connectivity (p < .05) than controls. Executive functioning correlated with bilateral insula and left anterior cingulate connectivity (rho >  - 0.29, p < .05). Distress did not correlate with salience network connectivity.

CONCLUSION

These findings suggest that salience network connectivity may represent a biomarker of subjective cancer-related cognitive changes.

IMPLICATIONS FOR CANCER SURVIVORS

Subjective cancer-related cognitive changes are common following treatment and associated with objective changes in brain connectivity.

Using the emotional functioning in clinical practice to detect psychological distress in patients with advanced thoracic and colorectal cancer

PURPOSE

Patients with advanced cancer suffer significant decline of their psychological state. A rapid and reliable evaluation of this state is essential to detect and treat it and improve quality of life. The aim was to probe the usefulness of the emotional function (EF) subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EF-EORTC-QLQ-C30) to assess psychological distress in cancer patients.

METHODS

This is a multicenter, prospective, observational study involving 15 Spanish hospitals. Patients diagnosed with unresectable advanced thoracic or colorectal cancer were included. Participants completed the Brief Symptom Inventory 18 (BSI-18), the current the gold standard, and the EF-EORTC-QLQ-C30 to assess their psychological distress prior to initiating systemic antineoplastic treatment. Accuracy, sensitivity, positive predictive value (PPV), specificity, and negative predictive value (NPV) were calculated.

RESULTS

The sample comprised 639 patients: 283 with advanced thoracic cancer and 356 with advanced colorectal cancer. According to the BSI scale, 74% and 66% displayed psychological distress with an EF-EORTC-QLQ-C30 accuracy of 79% and 76% in detecting psychological distress in individuals with advanced thoracic and colorectal cancer, respectively. Sensitivity was 79 and 75% and specificity was 79 and 77% with a PPV of 92 and 86% and a NPV of 56 and 61% (scale cut-off point, 75) for patients with advanced thoracic and colorectal cancer, respectively. The mean AUC for thoracic cancer was 0.84 and, for colorectal cancer, it was 0.85.

CONCLUSION

This study reveals that the EF-EORTC-QLQ-C30 subscale is a simple and effective tool for detecting psychological distress in people with advanced cancer.

Integrative Oncology's 30-Year Anniversary: What Have We Achieved? A North American Naturopathic Oncology Perspective

In 1991 the U.S. Congress mandated that the National Institutes of Health (NIH) form the Office of Alternative Medicine to study alternative medical therapies, especially in oncology care. Shortly after, the National Cancer Institute (NCI) created its own division of complementary and alternative medicine (Office of Complementary and Alternative Medicine). At the genesis of the field 30 years ago, what were we hoping to see accomplished by now? In this article we take a look back at milestones, shortfalls and future directions. Exciting opportunities exist to direct our established subspeciality's future directions and we have made valuable advances the field of integrative oncology over the last 30 years: 1, IV high dose ascorbate has clinical research-based applications when used concurrently with some chemotherapeutic agents. 2. Whole body, extracorporeal and locoregional hyperthermia are being applied in treating solid tumors, including brain tumors. 3. PDL-1 tumor microenvironment testing and PDL-1 inhibitor immunotherapies have surprisingly excellent outcomes in a subgroup of cancer patients. 4. Tumor DNA sequencing (resected tumor and circulating tumor DNA in blood) has led to personalized precision targeted treatments. 5. Glucose metabolism's role in cancer progression is better understood and better therapies are available (e.g., intermittent fasting, metformin). 6. Medical cannabis has a larger role in treating chemotherapy-related side effects and shows promise for anti-proliferative effects. 8. Greater understanding has been gained of the interdependence and mutual regulation of processes in psychoneuroendocrinoimmunology (PNEI). The burgeoning field of PNEI has exponentially expanded the discussion of tumorigenesis, apoptosis, and introduced to the field the investigation of more holistic approaches to immune regulation and cancer care. 8. Psychedelic-assisted psychotherapy is gaining traction especially for cancer patients facing demoralization, existential and spiritual distress, anxiety, depression and trauma related to the diagnosis and treatment of their cancer. 9. Spiritual health of cancer patients is more commonly addressed and measurable with an NIH validated scale. 10. Mind-Body therapies are efficacious for reducing cancer-related distress and are included in many cancer care programs.

The alterations in event-related potential responses to pain empathy in breast cancer survivors treated with chemotherapy

Background

Previous findings indicated that breast cancer patients often have dysfunction in empathy and other cognitive functions during or after chemotherapy. However, the manifestations and possible neuro-electrophysiological mechanisms of pain empathy impairment in breast cancer patients after chemotherapy were still unknown.

Objective

The current study aimed to investigate the potential correlations between pain empathy impairment and event-related potentials (ERP) in breast cancer patients undergoing chemotherapy.

Methods

Twenty-two breast cancer patients were evaluated on a neuropsychological test and pain empathy paradigm before and after chemotherapy, containing the Chinese version of the Interpersonal Reactivity Index (IRI-C), while recording ERP data.

Results

The empathic concern scores were lower and personal distress scores were higher on IRI-C task compared with those before chemotherapy (t = 3.039, p < 0.01; t = −2.324, p < 0.05, respectively). Meanwhile, the accuracy rates were lower than those before chemotherapy for both pain and laterality tasks on the pain empathy paradigm (F = 5.099, P = 0.035). However, the response time was no significant differences before and after chemotherapy (F = 0.543, P = 0.469). Further, the amplitude of the N1 component was significantly increased (F = 38.091, P < 0.001), and the amplitude of the P2 component was significantly decreased (F = 15.046, P = 0.001) in the subsequent ERP study. A linear mixed effect model was used to analyze the correlation, the average amplitude of N1 and P2 were positively correlated with the accuracy rates in laterality tasks (r = 1.765, r = 1.125, respectively, P < 0.05).

Conclusion

The results indicated that pain empathy impairment was performed in chemotherapeutic breast cancer patients, which was possibly correlated to the changes of N1 and P2 components in ERP. These findings provide neuro-electrophysiological information about chemo-brain in breast cancer patients.

Emotion Regulation Flexibility and Electronic Patient-Reported Outcomes: A Framework for Understanding Symptoms and Affect Dynamics in Pediatric Psycho-Oncology

Simple Summary

The individual’s ability to conceive and regulate the broad spectrum of their human emotions is closely linked to their mental health. The implications of a serious disease such as cancer represent an extraordinary burden to these internal coping mechanisms, especially in the case of young patients. Regarding their well-being and support, it is therefore of particular interest for caregivers to be able to follow the dynamics of the patient’s emotional world and perceptions. Technical progress enables new possibilities for data collection through tools for digital patient self-reports while simultaneously creating new challenges. Within the scope of this article, we provide an overview of the literature on this topic, outlining the current strengths and weaknesses and possible perspectives on digital aids, especially in terms of capturing the flexibility, fluctuations and early detection of symptom changes.

Abstract

Emotion dysregulation is regarded as a driving mechanism for the development of mental health problems and psychopathology. The role of emotion regulation (ER) in the management of cancer distress and quality of life (QoL) has recently been recognized in psycho-oncology. The latest technological advances afford ways to assess ER, affective experiences and QoL in child, adolescent and young adult (CAYA) cancer patients through electronic patient-reported outcomes (ePRO) in their daily environment in real-time. Such tools facilitate ways to study the dynamics of affect and the flexibility of ER. However, technological advancement is not risk-free. We critically review the literature on ePRO in cancer existing models of ER in pediatric psycho-oncology and analyze strength, weaknesses, opportunities and threats of ePRO with a focus on CAYA cancer research and care. Supported by personal study-based experiences, this narrative review serves as a foundation to propose a novel methodological and metatheoretical framework based on: (a) an extended notion of ER, which includes its dynamic, adaptive and flexible nature and focuses on processes and conditions rather than fixed categorical strategies; (b) ePRO as a means to measure emotion regulation flexibility and affect dynamics; (c) identifying early warning signals for symptom change via ePRO and building forecasting models using dynamical systems theory.

Assessing an Internet-Delivered, Emotion-Focused Intervention Compared With a Healthy Lifestyle Active Control Intervention in Improving Mental Health in Cancer Survivors: Protocol for a Randomized Controlled Trial

BACKGROUND

Cancer survivors are vulnerable to experiencing symptoms of anxiety and depression and may benefit from accessible interventions focused on improving emotion regulation. CanCope Mind (CM) was developed as an internet-delivered intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors.

OBJECTIVE

This protocol aims to provide an outline of the CanCope Study, a trial comparing the efficacy of a Unified Protocol-adapted internet-delivered intervention (CM) designed for cancer survivors compared with an active control condition-an internet-delivered healthy lifestyle intervention, CanCope Lifestyle (CL). The primary aim is to assess and compare the efficacy of both interventions in improving emotion regulation, anxiety and depressive symptoms, and quality of life. The secondary aims involve assessing the mechanisms of the CM intervention.

METHODS

This trial is a 2-arm randomized controlled trial that allocates cancer survivors to either CM or CL. Both interventions comprise 4 web-based modules and are expected to take participants at least 8 weeks to complete. Participants' mental and physical health will be assessed via self-reported surveys at baseline (T0), between each module (T1, T2, and T3), immediately after the intervention (T4), and at 3-month follow-up (T5). The study aims to recruit 110 participants who have completed T4.

RESULTS

The CanCope study began recruitment in September 2020. A total of 224 participants have been randomized to the CM (n=110, 49.1%) and CL (n=114, 50.9%) groups.

CONCLUSIONS

This is one of the first trials to develop and investigate the efficacy of a web-based intervention for cancer survivors that specifically targets emotion regulation.

TRIAL REGISTRATION

Australian Clinical Trials ACTRN12620000943943; https://tinyurl.com/b3z9cjsp.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/36658.

Idiosyncratic Profile of Perceived Emotional Intelligence and Post-Traumatic Growth in Breast Cancer Survivors: Findings of a Multiple Mediation Model

Psycho-oncology research suggests that positive personal changes can occur after experiencing breast cancer. These changes can be understood as post-traumatic growth (PTG) and seem to be determined by emotional self-efficacy perception. This study aims to investigate the existence of different profiles of PTG and perceived emotional intelligence (PEI) among breast cancer survivors (BCSs) and healthy controls. Moreover, it aims to study the mechanisms through which PEI may mediate the relationship between disease survival and PTG. The total sample was 636 women divided into two groups: 56 BCS and 580 healthy controls who completed TMMS-24 and PTGI. The results displayed that BCSs apparently show a different profile of PTG and PEI compared to healthy women. The mediation analyses showed that survivorship explained 1.9% of PTG, increasing to 26.5% by the effect of PEI. An indirect effect showed that cancer survival predicts reduced levels of emotional attention, decreasing PTG. However, the most statistical indirect effect evidenced that BCSs regulate their emotions appropriately, having a powerful effect on PTG and counteracting the negative effects of poor emotional attention. Knowing the implications of PEI on PTG could improve follow-up from the time of diagnosis and supporting the patient to cope with the sequelae of the disease.

Relations between emotion regulation strategies and affect in daily life: A systematic review and meta-analysis of studies using ecological momentary assessments

Emotion regulation (ER) is a central target in the study of psychological and neurobiological processes of emotions for numerous psychological disorders. Ecological momentary assessments, overcoming retrospective self-reports, allow a better understanding of the relation between the use of ER strategies and daily life affective experiences. A systematic review and meta-analyses of studies testing these relations through experience sampling methods (ESM) and daily diaries were conducted. ESM studies showed significant large effect sizes in contemporaneous relations between negative affect (NA) and rumination, suppression, and worry, and in both contemporaneous and prospective relations between positive affect (PA) and reappraisal; medium effect sizes in prospective relations between NA and rumination, and PA and distraction; and a small effect size in the prospective relation between NA and suppression. Daily diary studies showed significant large effect sizes in contemporaneous relations between NA and rumination and suppression, and in both contemporaneous and prospective relations between PA and reappraisal; medium effect sizes in contemporaneous relations between PA and acceptance, and problem-solving; and a small effect size in the prospective relation between NA and reappraisal. These findings shed light on the temporal relations between the use of ER strategies and affective experiences and highlight conceptual and methodological limitations in the field.

Integrated, cross-sectoral psycho-oncology (isPO): a new form of care for newly diagnosed cancer patients in Germany

Background

The annual incidence of new cancer cases has been increasing worldwide for many years, and is likely to continue to rise. In Germany, the number of new cancer cases is expected to increase by 20% until 2030. Half of all cancer patients experience significant emotional and psychosocial distress along the continuum of their disease, treatment, and aftercare, and also as long-term survivors. Consequently, in many countries, psycho-oncological programs have been developed to address this added burden at both the individual and population level. These programs promote the active engagement of patients in their cancer therapy, aftercare and survivorship planning and aim to improve the patients' quality of life.

In Germany, the “new form of care isPO” (“nFC-isPO”; integrated, cross-sectoral psycho-oncology/integrierte, sektorenübergreifende Psycho-Onkologie) is currently being developed, implemented and evaluated. This approach strives to accomplish the goals devised in the National Cancer Plan by providing psycho-oncological care to all cancer patients according to their individual healthcare needs. The term “new form of care" is defined by the Innovation Fund (IF) of Germany's Federal Joint Committee as “a structured and legally binding cooperation between different professional groups and/or institutions in medical and non-medical care”.

The nFC-isPO is part of the isPO project funded by the IF. It is implemented in four local cancer centres and is currently undergoing a continuous quality improvement process. As part of the isPO project the nFC-isPO is being evaluated by an independent institution: the Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Germany.

The four-year isPO project was selected by the IF to be eligible for funding because it meets the requirements of the federal government's National Cancer Plan (NCP), in particular, the “further development of the oncological care structures and quality assurance" in the psycho-oncological domain. An independent evaluation is required by the IF to verify if the new form of care leads to an improvement in cross-sectoral care and to explore its potential for permanent integration into the German health care system.

Methods

The nFC-isPO consists of six components: a concept of care (C1), care pathways (C2), a psycho-oncological care network (C3), a care process organization plan (C4), an IT-supported documentation and assistance system (C5) and a quality management system (C6). The two components concept of care (C1) and care pathways (C2) represent the isPO clinical care program, according to which the individual cancer patients are offered psycho-oncological services within a period of 12 months after program enrolment following the diagnosis of cancer. The remaining components (C3-C6) represent the formal-administrative aspects of the nFC-isPO that are intended to meet the legally binding requirements of patient care in the German health care system. With the aim of systematic development of the nFC-isPO while at the same time enabling the external evaluators to examine its quality, effectiveness and efficiency under conditions of routine care, the project partners took into consideration approaches from translational psycho-oncology, practice-based health care research and program theory. In order to develop a structured, population-based isPO care program, reference was made to a specific program theory, to the stepped-care approach, and also to evidence-based guideline recommendations.

Results

The basic version, nFC-isPO, was created over the first year after the start of the isPO project in October 2017, and has since been subject to a continuous quality improvement process. In 2019, the nFC-isPO was implemented at four local psycho-oncological care networks in the federal state North Rhine-Westphalia, in Germany. The legal basis of the implementation is a contract for "special care" with the German statutory health insurance funds according to state law (§ 140a SCB V; Social Code Book V for the statutory health insurance funds). Besides the accompanying external evaluation by the IMVR, the nFC-isPO is subjected to quarterly internal and cross-network quality assurance and improvement measures (internal evaluation) in order to ensure continuous quality improvement process. These quality management measures are developed and tested in the isPO project and are to be retained in order to ensure the sustainability of the quality of nFC-isPO for later dissemination into the German health care system.

Discussion

Demands on quality, effectiveness and cost-effectiveness of in the German health care system are increasing, whereas financial resources are declining, especially for psychosocial services. At the same time, knowledge about evidence-based screening, assessment and intervention in cancer patients and about the provision of psychosocial oncological services is growing continuously. Due to the legal framework of the statutory health insurance in Germany, it has taken years to put sound psycho-oncological findings from research into practice. Ensuring the adequate and sustainable financing of a needs-oriented, psycho-oncological care approach for all newly diagnosed cancer patients, as required by the NCP, may still require many additional years. The aim of the isPO project is to develop a new form of psycho-oncological care for the individual and the population suffering from cancer, and to provide those responsible for German health policy with a sound basis for decision-making on the timely dissemination of psycho-oncological services in the German health care system.

Trial registration

The study was pre-registered at the German Clinical Trials Register (https://www.drks.de/DRKS00015326) under the following trial registration number: DRKS00015326; Date of registration: October 30, 2018.

Allostatic Load as an Insight into the Psychological Burden after Primary Treatment in Women with Breast Cancer: Influence of Physical Side Effects and Pain Perception

Breast cancer (BC) diagnosis and treatment have become a cumulative long-standing chronic disease impairment, causing stress and turning into an allostatic load (AL) framework. This study aimed to investigate the relationship between physical issues and mental health in patients with BC after medical treatment. We conducted an observational study of 61 female patients with BC, and clinical and psychological markers have been detected. We conducted descriptive statistics, ANOVA analyses, correlations, and mediation analyses to verify the effect of the comorbidity index on psychological dimensions. The findings showed high levels of distress and moderate pain, and 32.8% of the patients showed moderate physical impairment. Significant effects of “age” and “physical issues” were found. The adult group reported a higher incidence of physical issues, and the group of patients reporting moderate physical impairment seemed more depressed than patients with mild physical issues. Finally, the comorbidity condition mediated the presence of signs of depression. Patients with BC seemed to experience negative emotions related to comorbidities associated with compromised activities of daily living. Our findings highlighted allostatic overload as a predictive framework to better understand the mental health of women with BC diagnoses to tailor effective psychological treatments for enhanced recovery.

Psychometric properties of the Chinese version of the Courtauld Emotional Control Scale in women newly diagnosed with breast cancer

PURPOSE

Emotional control, the attempt to suppress the expression of negative effects, is an essential factor in the prevalence of psychological distress in women with breast cancer. The Courtauld Emotional Control Scale (CECS) is a commonly used self-report tool for assessing emotional suppression in both clinical and general groups. This study aimed to validate the Chinese version of the Courtauld Emotional Control Scale (CECS) in women newly diagnosed with breast cancer.

METHODS

The study involved 680 women newly diagnosed with breast cancer aged 25 to 76 (mean age = 48.19, standard deviation (SD) = 8.57) from Changsha (China). Data analysis included Cronbach's alpha coefficients, the intraclass correlation coefficient (ICC), Pearson's correlations, Independent-Samples T test, confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were conducted to determine the optimal model. For the best fitting model stability was assessed with tests for invariance across age, educational level, and employment status.

RESULTS

Internal consistency (α = 0.987) and test-retest reliability (ICC = 0.715) of the CECS were presented. Results confirm the structure of the Chinese version of the CECS with 21 items divided into three dimensions, anger suppression (CECS_AG), depression suppression (CECS_MD), and anxiety suppression (CECS_AX). Convergent and known-groups validity were acceptable. Additionally, this model remained invariant across age, educational levels, and employment status.

CONCLUSIONS

The Chinese version of the CECS has good psychometric properties in terms of reliability and validity, remaining invariant across age, educational levels, and employment status in women newly diagnosed with breast cancer.

Prognostic Value of Negative Emotions on the Incidence of Breast Cancer: A Systematic Review and Meta-Analysis of 129,621 Patients with Breast Cancer

Breast cancer (BC) is one of the common malignant tumors in women and affects 1.6 million new cases globally each year. Investigators have recently found that negative emotions (NEs) and their impacts have greatly influenced the incidence and risk of BC. The present study aims to provide an association between NEs and the incidence of BC with possible risk factors. A total of 9343 studies were screened; nine studies met all inclusion criteria that were considered for the meta-analysis. The qualitative studies were measured by the Newcastle-Ottawa Scale; the observational studies were included with relative risks (RR) and corresponding 95% confidence intervals (CI). Besides the NEs and BC, the possible risk factors were evaluated. We analyzed data from 129,621 women diagnosed with NEs of which 2080 women were diagnosed with BC and their follow-up year ranges were from 4–24 years. NEs were significantly (p < 0.0001) associated with a higher incidence of BC with RR = 1.59, 95% CI:1.15–2.19, with other high-risk factors including, geographical distribution, emotion types, standard diagnosis of NEs, and follow-up duration. This study suggests that NEs significantly increase the risk for the incidence of BC, which can be supportive of the prognosis of the disease.

Self-Management About Adjuvant Therapy in Breast Cancer Survivors: A Qualitative Study

OBJECTIVE

This study aims to describe the experience and connotations of self-management about adjuvant therapy (AT) in Chinese breast cancer survivors (BCS) and explore possible factors that affect their self-management level.

METHODS

Semi-structured interviews were conducted in postoperative BCS undergoing AT using a qualitative description method. The conceptual structure and connotations were extracted after researchers collected and coded interview transcripts.

RESULTS

After interviewing 29 patients, the conceptual framework of self-management in BCS during AT was optimized with three major themes: medical-related, emotion, and role management. Medical-related management includes AT-related adverse reactions; medical cooperation and knowledge acquisition; recovery and protection of affected limb; medical compliance; body image; sexual function and fertility; healthy lifestyle; catheter daily protection; and AT-related financial burdens. Emotion management includes recognition, prevention, and regulation of negative emotions. Role management consists of three aspects: family role, social role, and work role.

CONCLUSION

The conceptual structure and connotations formed in this study can help researchers to evaluate and intervene in the self-management ability of BCS during AT, so as to formulate the best model of care to improve their quality of life and clinical outcomes.

Resilience across the Transition to Cancer Survivorship

Resilience is highly relevant in the context of cancer, and understanding how survivors adapt and potentially thrive following their diagnosis and treatment may provide insights into better supports and interventions to promote healthier survivorship. In this paper, we characterize two different ways to conceptualize and study resilience in cancer survivorship, as a trait and as a process. We focus specifically on the transition from active treatment to post-treatment survivorship. We present data from 225 cancer patients transitioning from active treatment (baseline assessment) to early survivorship (6-month follow-up). Results demonstrate that resilience assessed as a trait at baseline was unrelated to changes in survivors' mental or physical wellbeing at follow-up, but did predict a decline in social satisfaction and spiritual wellbeing over time. However, when resilience is conceptualized as a dynamic process, the sample showed substantial resilience on multiple aspects of wellbeing. We suggest that different ways of conceptualizing resilience--as a trait versus as a dynamic process--may lead to very different conclusions and discuss future research directions for cancer survivors and for science of resilience.

Signs of Central Hypersensitivity, Stress, and Anxiety following Treatment for Breast Cancer: A Case Control Study

Background

With treatment for breast cancer, women treated may present significant sensory abnormalities in the upper extremity. However, there are no conclusive studies that have evaluated pressure pain thresholds (PPT) in the shoulder of postoperated women for breast cancer. The aim of this study was to compare PPT in the shoulder, stress, anxiety, depression symptoms, and quality of sleep among postoperated women for breast cancer (PO group) and asymptomatic women of shoulder pain (control group).

Methods

40 women participated (n = 20, PO group, age: average ± standard deviation, 49.2 ± 8.3 years; body mass index (BMI): 27.5 ± 3.0 kg/cm²; surgery time: 22.2 ± 34.4 months; n = 20, control group, 46.9 ± 8.1 years; BMI: 26.8 ± 3.5 kg/cm²). The PPT was evaluated with a digital algometer at 32 points in the shoulder region and one control point in the tibialis anterior. Stress, anxiety, and depression were evaluated with the Depression, Anxiety and Stress Scale 21 (DASS-21) and the quality of sleep by the Pittsburgh Sleep Quality Index.

Results

Significant differences were observed over 1.5 kgf/cm² in 33 points evaluated (p < 0.01) with a small to high effect size (Cliff's delta range = 0.16; 0.92) and higher levels of anxiety and stress in the PO group (anxiety: median [first; third quartile], 5[3; 12.5]; stress: 9.7 ± 4.7 (7.8; 11.8)) in comparison with the control group (anxiety: 2.5[1; 4.8]; stress: 6.7 ± 3.31 (5.2; 8.3), (p < 0.05)). No significant differences were found between the groups in depression and sleep quality (p > 0.05).

Conclusion

Postoperated women for breast cancer present hyperalgesia in the shoulder anterior and posterior region, low PPT in the tibialis anterior, and higher levels of stress and anxiety compared to the control group.

At the Heart of It All: Emotions of Consequence for the Conceptualization of Caregiver-Reported Outcomes in the Context of Colorectal Cancer

Colorectal cancer (CRC) can be demanding for primary caregivers; yet, there is insufficient evidence describing the caregiver-reported outcomes (CROs) that matter most to caregivers. CROs refer to caregivers' assessments of their own health status as a result of supporting a patient. The study purpose was to describe the emotions that were most impactful to caregivers of patients with CRC, and how the importance caregivers attribute to these emotions changed from diagnosis throughout treatment. Guided by qualitative Interpretive Description, we analyzed 25 caregiver and 37 CRC patient interviews, either as individuals or as caregiver-patient dyads (six interviews), using inductive coding and constant comparative techniques. We found that the emotional aspect of caring for a patient with CRC was at the heart of caregiving. Caregiver experiences that engendered emotions of consequence included: (1) facing the patient's life-changing diagnosis and an uncertain future, (2) needing to be with the patient throughout the never-ending nightmare of treatment, (3) bearing witness to patient suffering, (4) being worn down by unrelenting caregiver responsibilities, (5) navigating their relationship, and (6) enduring unwanted change. The broad range of emotions important to caregivers contributes to comprehensive foundational evidence for future conceptualization and the use of CROs.

Adaptation to the Disease, Resilience and Optimism in Woman with Breast Cancer

This research aims to determine the relationship between the variables adaptation to the disease, resilience and dispositional optimism in women with breast cancer in Montería (Colombia). This study is a descriptive-correlational type, evaluating 116 participants. The instruments applied were the Font Quality of Life Questionnaire, to assess the Index of Adaptation to Disease, Wagnild and Young's Resilience Scale (RS) and the Life Orientation Test-Revised (LOT-R). The statistical program SPSS 25.0 was used for the analysis of the data. A normality test was performed which led to the application of the Spearman correlation coefficient. Findings indicated the presence of adaptation in the participants and resilient and optimistic characteristics, however, there is no significant relationship between these variables and adaptation to the disease.

Associations Between Global Mental Health and Response to an App-Based Meditation Intervention in Myeloproliferative Neoplasm Patients

Background: Depression, anxiety, and sleep disturbance are common problems that greatly affect quality of life for many myeloproliferative neoplasm (MPN) patients. App-based mindfulness meditation is a feasible nonpharmacologic approach for managing symptoms. However, previous research has not considered how patients’ overall mental health may influence their responsiveness to these interventions. Objective: The purpose of this study was to conduct an exploratory, secondary analysis of the effects of a smartphone meditation app, Calm, on depression, anxiety, and sleep disturbance in MPN patients based on patients’ baseline levels of Global Mental Health (GMH). Methods: Participants (N = 80) were a subset of MPN patients from a larger feasibility study. Patients were enrolled into an intervention (use Calm for 10 minutes daily for 4 weeks) or educational control group. Results: In multilevel models, there were significant 3-way interactions between time, group, and baseline GMH for depression and anxiety symptoms, with participants in the meditation intervention who reported the poorest baseline GMH experiencing the greatest reduction in symptoms over time. For both intervention and control participants, poorer initial GMH was associated with increases in sleep disturbance symptoms over time. Conclusions: Mindfulness meditation apps, such as Calm, may be effective in reducing depression and anxiety symptoms in MPN patients, particularly for those experiencing mental health difficulties. Given the need for accessible tools to self-manage chronic cancer–related symptoms, especially strong negative emotions, these findings warrant larger efficacy studies to determine the effects of app-based meditation for alleviating depression and anxiety in cancer populations.

Posttreatment Anxiety, Depression, Sleep Disorders, and Associated Factors in Women Who Survive Breast Cancer

Objective

Breast Cancer Survivors (BCSs) experience negative effects on their physical and mental health, including sleep disorders, after the completion of treatment and over the whole spectrum of survival. The aim of this study was to investigate the levels of posttreatment anxiety, depression, and sleep disorders exhibited by women who have survived breast cancer.

Methods

A descriptive, cross-sectional study was conducted with a population of 170 BCSs, who were monitored as outpatients by two surgical departments of a central Athens hospital for between one and five-5 years after completing their therapy. The data were collected between November 2019 and March 2020 and included demographic and clinical characteristics, as well as the Athens Insomnia Scale to measure sleep disorders and the Hospital Anxiety and Depression Scale to assess the incidence of mental disorders.

Results

The majority of the patients were aged 61-70 years (41.4%), married (56.9%), with two children (56.3%), and graduates of higher education (41.8%). Of the total population, 53.5% had sleep disorders, 29.4% anxiety, and 18.2% depression. Insomnia had a moderately positive correlation with both anxiety and depression (r = 0.598, P < 0.001 and r = 0.584, P < 0.001, respectively), while a strongly positive correlation was found between depression and anxiety (r = 0.683, P < 0.001). Sleep disorders were associated with factors such as profession (P < 0.001), income (P = 0.01), the number of minor children (P = 0.021), and the number of pathological problems (P = 0.003); anxiety was related to the number of minor children (P = 0.008) and the use of drug therapy to treat mental disorders (P = 0.038); while for depression, the relevant factors were the duration of treatment (P = 0.029), the number of minor children (P < 0.001), the use of medication for treatment of mental disorders (P = 0.008), and sleep disorders (P = 0.003).

Conclusions

Women who have survived breast cancer in Greece show a high rate of anxiety and depression related to the disease, as well as sleep problems that are partly associated with their psychological status, but are also affected by parameters such as income, type of profession, and the presence of minor children in the household.

Understanding the Perceptions of Omani Women Regarding Life After a Breast Cancer Diagnosis

Objectives

There is a rising burden of breast cancer (BC) in the Eastern Mediterranean Region (EMR), and its sociopsychological impact is a quickly growing health concern in this region. Because understanding cancer patients’ perceptions of life is integral to their treatment, they are also a concern for healthcare providers. This qualitative study, therefore, explored changes in Omani women’s perceptions of life after a BC diagnosis.

Methods

Semi-structured interviews were conducted individually with 21 Omani women undergoing treatment for BC at the Oncology Ward of Muscat’s Royal Hospital from March to May 2017. The collected data were subjected to qualitative content analysis.

Results

After their cancer diagnosis, the women appeared to pass through three main stages in their coping processes. First, they passed through a stage of severe psychosocial distress and diminishment in personal identity. Next, they evolved strategies for coping based on cultural, religious and family resources. Finally, the women experienced acceptance and submission to the reality of the cancer as God’s will with changes in attitudes and perceptions of the meaning of life.

Conclusion

A BC diagnosis impacts Omani women severely, affecting their lives dramatically. They adopt coping strategies based on cultural, religious and spiritual beliefs. Healthcare providers need to acknowledge and facilitate women’s spiritual and cultural coping strategies as an integral part of their treatment which holds potential to improve their prognosis. Such strategies should be individualised to suit each woman’s experiences, perceptions and needs.

Role of Metacognition Thinking and Psychological Traits in Breast Cancer Survivorship

Longer survivorship is possible due to advances enabling early detection and treatment. However, cancer survivors are faced with prognostic uncertainty regarding survival, long-term symptoms, surveillance, and consequences of treatment. This study aimed at investigating emotional traits of women after breast cancer (BC) diagnosis from a three-year perspective of the disease. We intended to examine the emotional trend within longer survivorship after the primary treatment for BC. A sample of 72 women diagnosed with breast cancer (age range 30–55 years) was evaluated based on metacognition (Metacognitive Questionnaire—30 test), psychological distress (Psychological Distress Inventory test), anxiety, stress, and depression (Depression, Anxiety and Stress Scale—21 test). The data analysis applied was descriptive analysis, ANOVA, MANOVA, and ANCOVA comparing MCQ-30 variables and psychological traits (PDI, DASS-21). The results indicated positive recovery after primary care despite emotional fragility in survivorship owing to negative thoughts; correlations among metacognitive factors, anxiety, and distress not only confirmed the negative emotional pattern just after primary care, but also showed women regaining a positive emotional pattern in daily life. The survivors exhibited emotional fragility during certain specific points of time during the course of their survivorship. Based on our findings, the fear of recurrence and cancer-specific psychological treatment is a better framework to boost and improve clinical practice.

Breast cancer survivors living with chronic neuropathic pain show improved brain health following mindfulness-based stress reduction: a preliminary diffusion tensor imaging study

PURPOSE

The present study explores the benefits of an 8-week mindfulness-based stress reduction (MBSR) program to white matter integrity among breast cancer survivors experiencing chronic neuropathic pain (CNP).

METHODS

Twenty-three women were randomly assigned to either a MBSR treatment group (n = 13) or a waitlist control group (n = 10). Participants were imaged with MRI prior to and post-MBSR training using diffusion tensor imaging.

RESULTS

Compared with controls, the MBSR group showed a significant increase in fractional anisotropy (FA), particularly in the left subcortical regions including the uncinate fasciculus, amygdala, and hippocampus, as well as in the external capsule and in the left sagittal stratum. No decreases to FA were found in any brain regions following MBSR training. The FA values also negatively correlated with the pain severity and pain interference scores from the BRIEF pain questionnaire.

CONCLUSIONS

The present findings demonstrate that MBSR training may enhance the integrity of cerebral white matter that coincides with a reduction in pain perception. Further research with a larger sample size is required.

IMPLICATIONS FOR CANCER SURVIVORS

This study highlights the potential for MBSR, as a non-pharmacological intervention, to provide both brain health improvement and pain perception relief for female breast cancer survivors experiencing CNP.

Study protocol of OncoTolk: an observational study on communication problems in language-mediated consultations with migrant oncology patients in Flanders (Belgium)

INTRODUCTION

Effective doctor-patient communication in oncology settings can be challenging due to the complexity of the cancer disease trajectory. The challenges can become greater when doctors and patients do not share a common language and need to rely on language mediators. The aim of this study is to provide evidence-based recommendations for healthcare professionals, patients and language mediators on how to interact with each other during language-mediated consultations in oncology settings.

METHODS AND ANALYSIS

A systematic review of the literature on communication problems in monolingual and multilingual oncology settings will be conducted. Thirty language-mediated consultations with Turkish-speaking or Arabic-speaking cancer patients, language mediators and Dutch-speaking oncologists/haematologists will be video-recorded in three urban hospitals in Flanders, Belgium. All participants will be interviewed immediately after the consultation and 2 weeks after it by means of video-stimulated recall. Multimodal interaction analysis will be combined with qualitative content analysis to allow for the identification of communication practices when communication problems occur.

ETHICS AND DISSEMINATION

The study has been approved by the following ethics committees: Ghent University Hospital, Antwerp University Hospital, Antwerp Hospitals Network (ZNA). Results will be published via (inter)national peer-reviewed journals and the findings of the study will be communicated using a comprehensive dissemination strategy aimed at healthcare professionals, patients and language mediators.

A Novel Mobile Phone App Intervention With Phone Coaching to Reduce Symptoms of Depression in Survivors of Women's Cancer: Pre-Post Pilot Study

BACKGROUND

Psychological distress is a major issue among survivors of women's cancer who face numerous barriers to accessing in-person mental health treatments. Mobile phone app-based interventions are scalable and have the potential to increase access to mental health care among survivors of women's cancer worldwide.

OBJECTIVE

This study aimed to evaluate the acceptability and preliminary efficacy of a novel app-based intervention with phone coaching in a sample of survivors of women's cancer.

METHODS

In a single-group, pre-post, 6-week pilot study in the United States, 28 survivors of women's cancer used iCanThrive, a novel app intervention that teaches skills for coping with stress and enhancing well-being, with added phone coaching. The primary outcome was self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale). Emotional self-efficacy and sleep disruption were also assessed at baseline, 6-week postintervention, and 4 weeks after the intervention period. Feedback obtained at the end of the study focused on user experience of the intervention.

RESULTS

There were significant decreases in symptoms of depression and sleep disruption from baseline to postintervention. Sleep disruption remained significantly lower at 4-week postintervention compared with baseline. The iCanThrive app was launched a median of 20.5 times over the intervention period. The median length of use was 2.1 min. Of the individuals who initiated the intervention, 87% (20/23) completed the 6-week intervention.

CONCLUSIONS

This pilot study provides support for the acceptability and preliminary efficacy of the iCanThrive intervention. Future work should validate the intervention in a larger randomized controlled study. It is important to develop scalable interventions that meet the psychosocial needs of different cancer populations. The modular structure of the iCanThrive app and phone coaching could impact a large population of survivors of women's cancer.

Connecting cognition, cardiology, and chromosomes: Cognitive reappraisal impacts the relationship between heart rate variability and telomere length in CD8+CD28- cells

Individuals who poorly regulate emotion exhibit premature aging and worse general health. Telomere shortening, a prognostic biomarker of physical health, is related to aging, poor immunocompetence and autonomic nervous system functioning. Cognitive reappraisal is one type of emotion regulation strategy, which involves changing one's appraisal of an aversive situation to modify its emotional impact. Heart rate variability (HRV; i.e., oscillations in heart rate) relates to emotion regulatory processes, such that higher HRV typically reflects greater regulatory capacity. Previous research has identified a positive association between HRV and telomere length. Importantly, the association between HRV and telomere length may change depending on how often an individual uses cognitive reappraisal. One hundred and thirty-seven healthy participants completed measures of cognitive reappraisal frequency, HRV, and underwent blood draws to measure telomere length (computed with the relative ratio of telomere repeat copy number to single copy gene number) in the T cell effector population, CD8+CD28-. Cognitive reappraisal moderated the relationship between telomere length and HRV such that individuals with high cognitive reappraisal frequency had a significant positive association between HRV and telomere length, while individuals with average and less than average frequency did not exhibit this relationship. The results suggest that frequent usage of cognitive reappraisal enhances the already positive influence of HRV on chromosomal integrity in CD8+CD28- T lymphocytes. Although future research is needed to test these effects causally, these findings suggest that regularly using emotion regulation techniques may buffer the relationship between autonomic nervous system functioning and chromosomal integrity in immune cells.

Stress, Inflammation and Cancer Prognosis: New Evidence-Based Effective Treatments

This article introduces the general model of stress, coping and adaptation applied to cancer, and biological mechanisms mediating psychological factors and cancer prognosis. The role of the vagus nerve as a possible bridge and therapeutic target in psycho-oncology is reviewed. Finally, the effects of brief psychological interventions (e.g., stress management) on cancer prognosis are presented. Psycho-oncology education and practice need to shift to a more evidence-based proactive approach, to help cancer patients adapt and possibly improve their quality and quantity of life.

Contribution of Sociodemographic, Clinical, and Psychological Variables to Quality of Life in Women with Cervical Cancer in the Follow-Up Phase

This study evaluates the contribution of sociodemographic, clinical, and psychological variables to quality of life (QoL) of women with cervical cancer in the follow-up phase. This cross-sectional study, conducted at the Portuguese Oncology Institute of Lisbon, included 200 women with cervical cancer during follow-up. Patients were assessed on QoL (EORTC QLQ-C30), body image and specific symptoms (EORTC QLQ-CX24), psychological morbidity (HADS), social support (SSSS), emotional expression (CECS), and spirituality (SpREUK). Education and social support contributed positively to QoL, whereas body image and symptoms contributed negatively. Body image played a moderating role in the relationship between depression and QoL, but not between anxiety and QoL. Spirituality and emotional expression did not moderate the relationship between anxiety/depression and QoL. Health professionals should reference and monitor women with cervical cancer, providing support at the diagnosis and follow-up phase since physical and psychological symptoms, resulting from the disease, remain after the end of treatment and contribute negatively to their QoL. Interventions should focus on these particular outcomes to promote patients' QoL.

Factor Structure and Measurement Invariance for the Cognitive Emotion Regulation Questionnaire (CERQ) Among Women Newly Diagnosed With Breast Cancer

Background

Given that emotion regulation counts for much in breast cancer, it is important to fully understand its construct. The cognitive emotion regulation questionnaire (CERQ) is a widely applied instrument for measuring conscious cognitive coping strategies in both general and clinical samples; however, there are no data on its factor structure in women with breast cancer, not to mention evidence of measurement invariance (MI) across sociodemographic variables. Thus, the purpose of the present study was to examine the latent factor structure and MI between different sociodemographic groups for CERQ in specific patients.

Methods

The sample consisted of 1032 women newly diagnosed with breast cancer, with a mean age of 47.54 years (SD = 8.51). The latent factor structure for CERQ was tested using confirmatory factor analysis (CFA). Further, MI various sociodemographic variables was evaluated by a series of multiple-group CFA process.

Results

The nine-factor CFA model was an adequate fit for the data collected in women with breast cancer. Also, this nine-factor structure had strong factorial invariance across age, place of residence, educational levels, and employment status.

Conclusion

This study firstly examined the latent factor structure for CERQ among Chinese women with malignancy and MI across various sociodemographic variables, which deepens the understanding of the construct for CERQ as a useful tool for assessing patients’ conscious cognitive component of emotion regulation based on self-report.

Exploring emotion regulation as a mediator of the relationship between resilience and distress in cancer

OBJECTIVES

Distress in patients with cancer is a significant problem that affects up to 32% of patients. Yet research indicates that 35% of cancer patients do maintain high levels of well-being. Resilience is one psychological factor implicated as being protective against distress; however, the mechanisms for this relationship are currently unknown. The present study aimed to explore emotion regulation as a potential mediator of the relationship between resilience and distress.

METHODS

A cross-sectional survey examining emotional regulation, resilience, and distress was completed by 227 patients from two hospitals with heterogeneous cancer types. Measures included the Difficulties in Emotion Regulation Scale (DERS), the Connor Davidson Resilience Scale, and the Depression, Anxiety, Stress Scale.

RESULTS

Difficulties in emotion regulation and resilience explained 33.2% of the variance in distress. Resilience had a significant direct effect on distress, accounting for 15.8% of the variance. However, this effect was no longer significant when difficulties in emotion regulation were controlled for. The indirect effect through difficulties in emotion regulation was significant, b = 0.009, 95% CI [-0.013,-0.007], suggesting that the effect of resilience on distress was fully mediated by emotion regulation. Parallel mediation analyses also examined the differential effects of the six DERS subscales on the relationship between resilience and distress.

CONCLUSION

These findings suggest that emotion regulation is an important mediator of resilience in cancer. Hence, in patients with cancer, difficulties in emotion regulation (and the DERS specifically) might be a useful focus for screening for patients at risk of distress.

A preventive intervention to modify depression risk targets after breast cancer diagnosis: Design and single-arm pilot study

OBJECTIVE

Apply the National Institutes of Health (NIH) Stage Model to design and test an intervention to prevent depression in breast cancer patients at risk for depression.

METHODS

We identified mindful emotion awareness, along with approach and avoidance strategies for cancer-related coping and emotion regulation, as targets for a preventive intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Patients' preferences for individual, in-person, and time-efficient sessions informed the design. Patients at risk for depression received a 6-week, 5-hour intervention with daily exercises. Intervention targets were assessed at baseline, before each session, and 4-weeks post intervention. Mixed effects analysis of variance (ANOVA) assessed change over the follow-up period, controlling for age, partnered status, and disease stage.

RESULTS

Fifty-five percent (40/72) of women screened within 6 months of diagnosis had elevated depression risk. Of these, 24 (60%) signed consent. Sixteen received intervention after five were excluded for current depressive disorder, cognitive impairment, or death. Three dropped out. Ninety-eight percent attendance and 77% practice days indicated feasibility. Effect sizes (Cohen's d) corrected for regression to the mean (RTM) were 0.82 for cancer-related acceptance coping, 0.65 for cancer-related emotional expression, and 0.32 and 0.42 for decreased cancer-related avoidance coping and depressive symptoms, respectively. Effect sizes for variables lacking data to correct for RTM were 1.0, 0.7, and 0.5 for decreased rumination, experiential avoidance, and fear of depression, respectively, and 1.3, 0.6, and 0.4 for increased cognitive flexibility, distress tolerance, and describing/not judging emotions, respectively.

CONCLUSIONS

The feasibility of this intervention and malleability of its targets support its further investigation.