Personal and illness identity in youth with type 1 diabetes: Developmental trajectories and associations

OBJECTIVE

Having Type 1 diabetes (T1D) may complicate the normative developmental task of personal identity formation in adolescence and emerging adulthood. Besides exploring and committing to identity choices in different life domains, youth with T1D need to integrate their illness into their identity, a process labeled as illness identity. The present study examined whether youth with T1D belonging to different personal identity trajectory classes developed differently on four illness identity dimensions (acceptance, enrichment, engulfment, rejection).

METHOD

This four-wave longitudinal study over a 3-year period used self-report questionnaires to examine how personal identity trajectory classes were related to illness identity over time in youth with T1D (baseline: n = 558; 54% female; age range = 14-25 years). Personal identity trajectory classes were identified using latent class growth analysis. Differential development of the four illness identity dimensions among these personal identity trajectory classes was examined using multigroup latent growth curve modeling.

RESULTS

Five personal identity trajectory classes were identified: achievement, foreclosure, moratorium, carefree diffusion, and troubled diffusion. Individuals in achievement and foreclosure displayed highest levels of diabetes integration (i.e., high levels of acceptance and enrichment; low levels of engulfment and rejection), whereas individuals in troubled diffusion displayed lowest levels of illness integration (i.e., low levels of acceptance and enrichment; high levels of engulfment and rejection).

CONCLUSIONS

The present study confirms that personal identity development relates to illness identity development over time in youth with T1D. Understanding the intricate link between personal and illness identity may help clinicians to tailor their interventions to patients' individual needs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Illness identity and well-being in congenital heart disease: Directionality of effects and developmental trajectories

OBJECTIVE

This longitudinal study explores the relationship between illness identity and well-being in emerging adults with congenital heart disease (CHD), aiming to understand the factors contributing to well-being in individuals with CHD.

METHOD

Dutch-speaking emerging adults with CHD (N = 254, age range = 24-28 years) participated in a three-wave study, which is part of the I-DETACH 2 project. Cross-lagged analyses examined the directionality of effects between illness identity and well-being. Multivariate latent class growth analysis identified developmental trajectory classes of illness identity. Multigroup latent growth curve modeling investigated differences in the development of well-being among these classes.

RESULTS

Bidirectional associations were uncovered between illness identity and well-being. For instance, acceptance predicted better quality of life and less depressive symptoms over time. Three trajectory classes of illness identity were identified: high (i.e., as compared to the sample mean) acceptance and enrichment with low rejection and engulfment (Class 1), high rejection with low levels in the other dimensions (Class 2), and high rejection and engulfment along with high enrichment and low acceptance (Class 3). Individuals in Class 3 experienced the worse well-being. In addition, individuals with complex heart defects were strongly represented in this class.

CONCLUSIONS

This study demonstrates the significance of illness identity in understanding individual differences in well-being among emerging adults with CHD. Additionally, this study provided valuable insight in the development of illness identity and its longitudinal relationship with well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Inhabiting the body: Exploring the link between embodiment and identity in community adolescents

The intricate relationship between the body and identity has been highlighted in previous studies. However, a holistic approach to the body that focuses on embodiment is lacking in research examining body - identity linkages. The current study (N = 917 adolescents; 58% female; Mage = 16.17, range = 14-19 years) examined the psychometric properties of a Dutch translation of the Experience of Embodiment Scale (EES) and explored the link between embodiment and personal identity. First, confirmatory factor analysis revealed a second-order factor structure for the EES and adequate reliability coefficients were obtained. Metric invariance across gender was demonstrated for the first- and second-order factors. Second, path analysis demonstrated that experiencing embodiment was positively associated with adaptive identity work. Third, five identity statuses emerged using cluster analysis. Adolescents in statuses reflecting less adaptive identity functioning displayed lower levels of embodiment. The EES shows promising indications of reliability and factor structure for assessing adolescents' Experience of Embodiment, and the present study demonstrates that embodiment is meaningfully related to identity functioning. These findings support the call for the adoption of a positive psychology framework within this research field, with attention given to more broadly defined body-related concepts such as embodiment.

Psychological functioning of childhood cancer survivors: Longitudinal associations with the parental context

OBJECTIVE

The long-term psychological effects of childhood cancer vary, with childhood cancer survivors reporting depressive symptoms, fear of cancer recurrence, and benefit finding. As cancer is considered a family disease, investigating the parental context may provide insight into such individual differences in psychological functioning of survivors. This study examined the directionality of effects among parental sense of incompetence, parenting dimensions (responsiveness, psychological control, and overprotection), and survivor psychological functioning (depressive symptoms, fear of cancer recurrence, and benefit finding).

METHOD

This three-wave longitudinal study (covering 2 years) included 125 Dutch-speaking childhood cancer survivors (ages 14-24, 95.2% diagnosed < 18 years, and time since diagnosis 2-22 years), 114 mothers, and 91 fathers. Survivors reported (SR) about their psychological functioning and perceived parenting. Mothers reported (MR) and fathers reported (FR) about parenting and sense of incompetence. Cross-lagged panel models were estimated for each informant's perspective on parenting separately.

RESULTS

Different relations were obtained for each informant. Primarily unidirectional relations were found from parental sense of incompetence to maladaptive parenting (psychological control across informants and maternal overprotection SR) and from parenting to survivor functioning. Maternal and paternal responsiveness SR positively predicted survivors' benefit finding and negatively predicted survivors' depressive symptoms, respectively. Responsiveness MR and overprotection MR positively predicted survivors' fear of cancer recurrence and depressive symptoms, respectively. One consistent reverse pathway emerged: maternal and paternal responsiveness SR negatively predicted maternal and paternal sense of incompetence, respectively.

CONCLUSION

The results support parent-driven processes impacting survivors' psychological functioning and stress the need to focus on multiple perspectives when investigating family dynamics. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Identity Formation and General and Cancer-specific Functioning in Adolescent and Emerging Adult Survivors of Childhood Cancer: A Longitudinal Study into Directionality of Effects

BACKGROUND

Adolescent and emerging adult survivors of childhood cancer generally adjust well psychologically similar to their peers. Nevertheless, some survivors are at greater risk for developing psychological and physical difficulties. To shed light on the psychosocial functioning of adolescent and emerging adult survivors of childhood cancer, personal identity formation and its interplay with general and cancer-specific functioning need to be investigated.

PURPOSE

To examine the longitudinal associations linking identity formation to general and cancer-specific functioning in adolescent and emerging adult childhood cancer survivors using three-wave data over a 2-year period.

METHODS

Dutch-speaking survivors (at baseline: n = 125; 53% female; age range: 14-25 years) treated at the pediatric oncology department of the University Hospitals Leuven (Belgium), completed self-report questionnaires at three annual timepoints. Directionality of effects and correlated changes were examined using cross-lagged structural equation modeling.

RESULTS

Regarding general functioning, bidirectional effects occurred. Life satisfaction positively predicted identity synthesis and both life satisfaction and good physical functioning negatively predicted identity confusion over time. Identity synthesis, in turn, positively predicted life satisfaction and identity confusion negatively predicted good physical functioning over time. Regarding cancer-specific functioning, mainly unidirectional effects occurred. Post-traumatic stress symptoms negatively predicted identity synthesis and positively predicted identity confusion over time, whereas the reverse pattern of associations was found for benefit finding. Several correlated changes were found linking identity formation and psychosocial functioning as well.

CONCLUSIONS

The present study uncovered clinically meaningful pathways linking identity formation to psychosocial functioning over time in adolescents and emerging adults who survived childhood cancer.

Abstract P5-18-19: The 2006 Adjuvant Trastuzumab Convention in Belgium: 5 years later

Background: Outside clinical trials, long term follow-up data from large series of women treated with adjuvant trastuzumab are lacking. We here report such data from a Belgian cohort for premature trastuzumab discontinuation and 5 year outcome.

Patients and Methods: A year prior to its reimbursement (June 1st 2007), the Belgian health authorities offered adjuvant trastuzumab to women with a HER-2 amplified breast cancer as given in HERA: following completion of loco-regional therapy, at least 4 cycles of chemotherapy (CT) (neo-adjuvant or adjuvant) or radiotherapy whichever was last. Demographics, histopathologic features, baseline (≥55%) and follow-up left ventricular ejection fraction (LVEF) together with 5 yr breast cancer related events (BCRE) were centrally recorded. Outcome was reported by grade (&lt; or &gt; grade 3), lymph node (pN) status (neg/pos), hormone receptor (HR) status (neg/pos) and timing of CT (adjuvant/neo-adjuvant).

Results: 917 pts were included. Files on histopathology, demographics, LVEF and therapy are available for 887 (97%) pts, outcome for 738 (80%). Median age at diagnosis was 53 years (25–81); 56% of tumors were &gt;pT1, 57% pN+, 72% grade 3, 59% HR-positive for estrogen receptor (ER) and/or progesterone receptor (PR). CT was neo-adjuvant in 20% and adjuvant in 80%. Radiotherapy and endocrine therapy were given respectively in 86% and 50%. Median follow-up was 63 (range 8–90) months. Premature (&lt;1 year) treatment discontinuation occurred in 17% of pts mainly because of decrease in LVEF (asymptomatic in 7.2%; symptomatic in 1.2%). A BCRE appeared in 128 pts (17%) on average 31 months (range 4–76) after diagnosis. BCRE was metastatic in 96 pts (13%) and mostly (71%) limited to one organ at diagnosis. Most likely involved were liver (18%), lung (17%), brain (16%) and bone (13%). 7% of patients died of breast cancer. Patients receiving neo-adjuvant CT had more advanced disease and were more likely to develop a distant BCRE (24%) as were patients receiving adjuvant CT (10%); In both populations, the following parameters further affected distant BCRE: lymph node involvement, grade 3, negative HR, and negative PR in ER-positive disease (table 1).

Abstract P6-05-05: Triple receptor comparison between primary breast cancer and metachronous or synchronous liver metastasis

Background: Decisions about systemic treatment in women with metastatic breast cancer are currently based on the presence of estrogen receptors (ER), progesterone receptors (PR) or Human Epidermal growth factor Receptor 2 (HER2 receptors) in the primary tumor. Recently, several studies have reported significant discordances in ER, PR and HER2 status between the primary tumor and metastatic lesions and this may vary by metastatic site. Prognostic implications remain unclear although alterations in ER, PR and/or HER2 can influence metastatic management. This study represents one of the largest studies evaluating how frequent receptor discordances occur in liver metastasis, whether this alters therapeutic options and impacts prognosis.

Patients and methods: 246 breast cancer patients with histological confirmed liver metastasis were analyzed in this retrospective study. Immunohistochemistry (IHC) and/or FISH were used to determine ER, PR and HER2 receptor status. We excluded patients when comparison between receptors of primary tumor and metastasis was impossible due to missing data (n = 85), when liver metastasis did not originate from breast cancer (n = 36) and when pathology was obtained from autopsy specimens (n = 38).

Results: 87 patients had matched tissue samples of primary tumor and liver metastasis with possible comparison of at least one of the receptors. Table 1 summarizes changes in ER, PR, HER2 between primary and metastatic lesion. Discordance in receptor status was associated with shorter time to death (63.3 months) compared to the concordant group (75.5 months).

Abstract P6-07-29: Independent prognostic value of age depends on breast cancer subtype

Background: Whether age is an independent prognostic factor in early breast cancer remains controversial. Different cut-off values have been suggested in different studies and few studies assessed its value in triple negative breast cancer and other phenotypes.

Methods: We included all primary operable breast cancer patients from our prospectively managed database in UZ Leuven, Belgium. We excluded male patients, patients treated elsewhere first, patients treated with primary systemic treatment first. We assessed the effect of age as a continuous and categorical variable for distant metastasis free interval (DMFI), locoregional free interval (LRRFI) and breast cancer specific survival (BCSS) in multivariable analysis (correcting for phenotype, tumor size, nodal status, chemo−, endocrine−, radiotherapy, type of breast and axillary surgery). We assessed the effect of age for DMFI, LRRFI and BCSS in basal-like breast cancer and other phenotypes.

Results: We included 4318 patients with a mean/median age of 58/ 57 years (1170 patients were younger than 50 years) and with a median follow-up of 6,0 years. Multivariate analysis confirmed age as an independent prognostic variable for LLRFI (HR1.91; 95% CL:1.33–2.74; p = 0.0005), DMFI (HR:1.77; 95% CL:1.33–2.36; P &lt; 0.0001) and BCSS (HR:2.35; 95% CL:1.66–2.74; P &lt; 0.0001). The optimal cut-off value is 41years for LLRFI and BCSS and 44 years for DMFI. We did not find an independent prognostic value for age in triple negative breast cancer regarding DMFI and LRRFI. Results for other subtypes are subject to currently ongoing analyses.

Conclusions: Overall, young age in primary operable breast cancer patients is an independent prognostic value for DMFI, LRRFI and BCSS after adjusting for known prognostic factors. In triple negative breast cancer, age did not retain independent prognostic value for DMFI and LRRFI.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-29.

Applying the 2011 St Gallen panel of prognostic markers on a large single hospital cohort of consecutively treated primary operable breast cancers

BACKGROUND

Many easily measurable and readily available factors are now established as being prognostic in primary operable breast cancer. We here applied the 2011 St Gallen surrogate definition for breast cancer subclassification using tumor grade instead of Ki67.

PATIENTS AND METHODS

Four thousand three hundred and eighteen consecutive patients who had surgery for primary operable breast cancer (1 January 2000 and 31 December 2009) in UZ Leuven excluding primary metastastic male breast cancers and those receiving neoadjuvant therapy. Five different surrogate phenotypes were created using the combined expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 together with tumor grade. Disease-free interval (DFI), distant metastastis-free interval (DMFI), locoregional relapse-free interval (LRRFI), breast cancer-specific survival (BCSS) and overall survival (OS) were calculated.

RESULTS

Surrogate phenotypes present with significant differences in DFI, DMFI, LRRFI, BCSS and OS. 'Luminal A' tumors presented with the best outcome parameters but the effect weakened at longer follow-up.

CONCLUSIONS

The four surrogate markers, agreed upon by the 2011 St Gallen consensus, defined five prognostic surrogate phenotypes in a large series of consecutively treated breast cancer patients. Their prognostic value changed with longer follow-up. The added value of gene expression profile over classical pathological assessment remains to be defined.

P2-17-09: A Prospective Assessment of Loss of Grip Strength by Baseline BMI in Breast Cancer Patients Receiving Adjuvant Aromatase Inhibitors or Tamoxifen

Background The 3rd generation aromatase inhibitors (AIs) induce or enhance musculoskeletal problems. Underlying mechanisms are probably multiple, but remain unknown. We have previously reported that loss of grip strength together with tenosynovial abnormalities are more important in AI- than in tamoxifen-users (Morales et al, JCO 2008) and that musculoskeletal changes in AI-users are more pronounced in women with extremes in baseline BMI (Lintermans et al, Ann Oncol 2011) We here report preliminary results from a larger population and plan to validate findings in patients from University of Michigan.

Patients and methods In this prospective observational study, postmenopausal early breast cancer patients scheduled to start adjuvant hormonal therapy with any of the third generation AIs or tamoxifen were recruited. After providing informed consent, a functional assessment test of grip strength was performed with a modified sphygmomanometer. Re-evaluation was done after 3, 6 and 12 months of therapy. BMI and waist to hip ratio (WHR) were assessed and a rheumatological questionnaire was completed at each visit.

Results Ninety-four (79 AI; 15 tamoxifen) of the planned 200 patients were included in this preliminary study. 18% of AI-users discontinued their treatment due to musculoskeletal symptoms compared with none of the tamoxifen-users. 62% of patients on AI and 35% of tamoxifen patients complained of new or worsened joint pain. Table 1 shows the proportion of patients that attribute their complaints to their endocrine therapy. Grip strength significantly decreased over time (p=0.03), with patients under AI treatment having a larger loss of grip strength than patients under tamoxifen treatment (p=0.04). We confirm our previously reported results on the shape of the curve “BMI AI-induced loss of grip strength”. Years past menopause and age showed a significant effect on grip strength (p&lt;0.001 and p=0.0007, respectively), whereas no significant relationship was found between WHR with grip strength or joint pain. Detailed results will be presented.

P3-14-22: Response to Neoadjuvant Chemotherapy in Elderly Patients with Locally Advanced Breast Cancer

Background

Inoperable, locally advanced breast cancer (LABC) is common in the elderly. Studies have shown good responses with neoadjuvant chemo- and endocrine therapy. However, studies targeting the elderly population are rare.

Aim: To assess complete pathological response rate (pCR) following neoadjuvant chemotherapy (NACT) and to evaluate the effectiveness of this therapeutic option in elderly women with LABC.

Patients: Women (≥70 years) diagnosed at our University Hospital with LABC between 1999 and 2010 and treated with neoadjuvant chemotherapy. After neoadjuvant systemic treatment pCR was assessed if surgery was performed.

Results: 44 women with a mean age of 74.9 (70-93) years were included. Most tumors were ductal (IDA 88.6%), of grade 3 (79.5%) and hormone-receptor (HR) negative (61.4%). Among the 21 tumors (47.7%) that were HER2+ (immunohistochemistry (IHC) 3+ or 2+ and FISH+), all but 3 received neoadjuvant Trastuzumab. Only 4 patients had no surgery (clinical decision or personal choice) while the remaining 40 patients underwent either breast-conserving surgery (17.5%) or mastectomy (82.5%). 23 patients (52.3%) had pathological partial response, 14 patients (31.8%) pCR and 3 patients no response. pCR was more frequently achieved in HR-negative (44.4%) than in HR- positive patients (11.8%). In both groups HER2 positive tumors had better pathological response than HER2 negative tumors. After a mean follow-up of 41 months (5-120) 29 patients (65.9%) had no evidence of disease, 6 patients (13.6%) had (loco)regional recurrence, 12 patients (27.2%) developed metastatic disease and 6 patients (13.6%) died because of breast cancer. Relapse was more frequently seen in patients with a pPR (47.8%) versus patients with a pCR (14.3%).

The partial coherence method for assessment of impaired cerebral autoregulation using near-infrared spectroscopy: potential and limitations

The most important forms of brain injury in premature infants are partly caused by disturbances in cerebral autoregulation. As changes in cerebral intravascular oxygenation (HbD), regional cerebral oxygen saturation (rSO(2)), and cerebral tissue oxygenation (TOI) reflect changes in cerebral blood flow (CBF), impaired autoregulation can be measured by studying the concordance between HbD/rSO(2)/TOI and the mean arterial blood pressure (MABP), assuming no changes in oxygen consumption, arterial oxygen saturation (SaO(2)), and in blood volume. We investigated the performance of the partial coherence (PCOH) method, and compared it with the coherence method (COH). The PCOH method allows the elimination of the influence of SaO(2) on HbD/rSO(2)/TOI in a linear way. We started from long-term recordings measured in the first days of life simultaneously in 30 infants from three medical centres. We then compared the COH and PCOH results with patient clinical characteristics and outcomes, and concluded that PCOH might be a better method for assessing impaired autoregulation.

Surgical closure of the patent ductus arteriosus and its effect on the cerebral tissue oxygenation

AIM

Surgical patent ductus arteriosus (PDA) ligation is considered after failure or contraindication of medical treatment. Till now ligation of the PDA has been associated with low morbidity and mortality although recently concerns have been raised about the possible association of ductal clipping and neurodevelopmental abnormalities later in life. By means of near-infrared spectroscopy (NIRS), we analysed the changes in the cerebral tissue oxygenation index (TOI) and fractional tissue oxygen extraction (FTOE) at the time of clipping as well as after clipping.

METHOD

Ten preterm infants with a symptomatic PDA who underwent surgical ligation were continuously monitored for heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SaO(2)) and TOI from 1 h before up to 1 h after clipping. FTOE and haemoglobin difference (HbD) were calculated. Changes in parameters at 5 min after ligation represent the effect of the clipping itself whereas changes up to 1 h-post-clipping represent the post-clipping effect.

RESULTS

At the exact time of clipping, over the entire group, we found a significant increase in TOI of 2.9% (p = 0.037), in HbD of 12.5 micromol/l (p = 0.047) and in HR of 6.5 bpm (p = 0.012). FTOE significantly decreased by 0.02% (p = 0.013). One hour post-clipping, the cerebral and peripheral parameters were not significantly different from the control values before clipping.

CONCLUSION

The ductal clipping in se has no negative effect on the cerebral oxygenation.