Severity of Financial Toxicity for Patients Receiving Palliative Radiation Therapy

Introduction: Financial toxicity has negative implications for patient well-being and health outcomes. There is a gap in understanding financial toxicity for patients undergoing palliative radiotherapy (RT). Methods: A review of patients treated with palliative RT was conducted from January 2021 to December 2022. The FACIT-COST (COST) was measured (higher scores implying better financial well-being). Financial toxicity was graded according to previously suggested cutoffs: Grade 0 (score ≥26), Grade 1 (14-25), Grade 2 (1-13), and Grade 3 (0). FACIT-TS-G was used for treatment satisfaction, and EORTC QLQ-C30 was assessed for global health status and functional scales. Results: 53 patients were identified. Median COST was 25 (range 0-44), 49% had Grade 0 financial toxicity, 32% Grade 1, 15% Grade 2, and 4% Grade 3. Overall, cancer caused financial hardship among 45%. Higher COST was weakly associated with higher global health status/Quality of Life (QoL), physical functioning, role functioning, and cognitive functioning; moderately associated with higher social functioning; and strongly associated with improved emotional functioning. Higher income or Medicare or private coverage (rather than Medicaid) was associated with less financial toxicity, whereas an underrepresented minority background or a non-English language preference was associated with greater financial toxicity. A multivariate model found that higher area income (HR .80, P = .007) and higher cognitive functioning (HR .96, P = .01) were significantly associated with financial toxicity. Conclusions: Financial toxicity was seen in approximately half of patients receiving palliative RT. The highest risk groups were those with lower income and lower cognitive functioning. This study supports the measurement of financial toxicity by clinicians.

Clinical, demographic factors, and substance use among Hispanic and non-Hispanic young adult childhood cancer survivors

PURPOSE

The purpose of this study is to examine the protective and risk factors of substance use behaviors (tobacco, marijuana, e-cigarette, and alcohol) among young adult childhood cancer survivors. The study focused on clinical (receipt of cancer-related follow-up care, treatment intensity, late effects, depressive symptoms, self-rated health) and demographic (race/ethnicity, neighborhood socioeconomic status) factors and their associations with substance use.

METHODS

Participants were from the Project Forward cohort, a population-based study of young adult survivors of childhood cancers. Participants (N = 1166, Mage = 25.1 years) were recruited through the Los Angeles Cancer Surveillance Program (Cancer Registry covering Los Angeles County, California). Multivariate path analyses were performed with substance use as the outcome variables and clinical and demographic factors as independent variables. Covariates included age and sex.

FINDING

Substance use was positively associated with depressive symptoms, and inversely associated with cancer-related follow-up care, female sex, age, Hispanic ethnicity, treatment intensity, and self-rated health. Neighborhood SES was inversely associated with tobacco use, while being positively associated with binge drinking and e-cigarette use. The results highlight the interrelationship between the clinical and demographic variables and their associations with different substance use.

CONCLUSION

Findings support the need for effective interventions targeting substance use behavior among CCS. This will help improve long-term outcomes and mitigate the risk for early morbidity.

The utility of coping through emotional approach: A meta-analysis

OBJECTIVE

A systematic review and meta-analysis was conducted to examine associations between attempts to cope with stressors through the two facets of emotional approach coping (EAC; i.e., processing and expressing stressor-related emotions) and indicators of physical and mental health.

METHOD

EBSCO databases including MEDLINE, PsycINFO, and Cochrane Collections were searched from inception to November 2022. In all, 86 studies were included in a meta-analytic evaluation using a random-effects model and meta-regression analysis.

RESULTS

EAC was associated with better overall health (r = .05; p = .04; 95% confidence interval = [.003, .10]). Emotional expression (EE) and emotional processing (EP) also were positively associated with better overall health, although these relationships were not statistically significant. In meta-regressions examining specific health domains, EAC was linked to better health in biological/physiological, physical, and resilience-related psychological adjustment domains, as well as to worse outcomes in the risk-related psychological adjustment and mental/emotional distress domains. Results for EE and EP mirrored this pattern; however, only EP was associated with more engagement in health-promoting behaviors.

CONCLUSIONS

Coping with stressors through emotional approach appears to be associated with better mental and physical health, with some observed differences for EE and EP. The literature on EAC and health is marked by heterogeneity across study methodologies and measures. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Goal-Focused Emotion-Regulation Therapy (GET) in Young Adult Testicular Cancer Survivors: A Randomized Pilot Study

BACKGROUND

Young adult testicular cancer survivors experience adverse impacts after treatment. We developed Goal-focused Emotion-regulation Therapy (GET) to improve distress symptoms, emotion regulation, and goal navigation skills.

PURPOSE

This pilot study examined GET versus an active control intervention in young adult survivors of testicular cancer.

METHODS

Seventy-five eligible survivors treated with chemotherapy were randomized to receive GET or Individual Supportive Listening (ISL). Study acceptability, engagement, and tolerability were examined, and intervention fidelity and therapeutic alliance were compared between arms. Preliminary efficacy was evaluated by effect sizes for between-group changes in primary (anxiety and depressive symptoms) and secondary (career confusion, goal navigation, and emotion regulation) outcomes from baseline to immediately and 3-month post-intervention.

RESULTS

Among the 38 men randomized to GET, 81.1% completed all study sessions compared with 82.4% of the 37 men assigned to ISL. Fidelity to the intervention was 87% in GET. Therapeutic alliance wassignificantly higher among those receiving GET versus ISL. Participants exhibited a medium group-by-time effect size with greater reductions in depressive (d = 0.45) and anxiety (d = 0.29) symptoms for those in GET versus ISL, with a similar pattern at 3 months for depressive (d = 0.46) and anxiety (d = 0.46) symptoms.

CONCLUSIONS

GET is a feasible and acceptable intervention for reducing adverse outcomes after testicular cancer for young adults. Observed effect sizes preliminarily suggest meaningful change, though should be interpreted with caution in small samples. GET may be a developmentally-matched behavioral approach to improve psychosocial function in this cancer group.

CLINICAL TRIAL INFORMATION

Clinicaltrials.gov, NCT04150848. Registered on October 28, 2019.

Disparities in health-related quality of life among lesbian, gay, and bisexual cancer survivors

OBJECTIVE

This study compared health-related quality of life (HRQOL) among lesbian, gay, and bisexual (LGB) cancer survivors and their heterosexual counterparts in a US population-based sample of cancer survivors.

METHODS

The study utilized data from the All of Us research program. LGB survivors (n = 885) were matched for age, gender identity, marital status, income, education, and cancer site with heterosexual survivors (n = 885) using 1:1 propensity matching. Physical, mental, and social HRQOL were assessed with items from the Patient-Reported Outcomes Measurement Information System (PROMIS).

RESULTS

Relative to heterosexuals, LGB cancer survivors reported lower HRQOL in mental and social domains, but not in physical HRQOL. Older age was associated with higher HRQOL across domains. LGB survivors identifying as Black/African American were more likely to experience lower social HRQOL than White survivors.

CONCLUSIONS

This study highlights several disparities in HRQOL that exist between LGB and heterosexual cancer survivors.

Peer victimization and relationships to approach and avoidance coping to health and health behaviors

Peer victimization during high school is a common experience associated with engagement in risky health behaviors and elevated depressive symptoms. Mechanisms linking peer victimization to health outcomes remain inadequately understood. In the current study, latent class analysis was used to identify latent subclasses of college students who display similar patterns of responses to frequent peer victimization experiences during high school. We also examined moderating and mediating effects of coping (approach/avoidance) on relationships between victimization class and health outcomes (i.e., binge drinking, current smoking, depressive symptoms). College students completed questionnaire measures of peer victimization, approach and avoidance coping, binge drinking, smoking, and depressive symptoms. Four distinct patterns of peer victimization were identified among college students (Low, High, Moderate, and Social/Verbal). Moderation models revealed significant interactions of moderate victimization x approach coping on depressive symptoms and high victimization x avoidance coping on binge drinking. Mediation models revealed a significant indirect effect of avoidance coping on depressive symptoms for those in the high victimization class. Findings provide a greater understanding of the complex patterns of peer victimization. Coping efforts among varying peer victimization classes had different relationships with health outcomes during the college years. Interventions aimed at reducing health-risk and depressive symptoms among college student might benefit from increased attention to high school victimization experiences and current coping processes.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.1946468 .

A randomized controlled trial of emotion regulation therapy for cancer caregivers: A mechanism-targeted approach to addressing caregiver distress

BACKGROUND

Caregivers of patients with cancer play a crucial role in the health of the person they care for, and in the healthcare system at large. Family caregivers receive minimal support, despite being at greater risk for anxiety and depression than patients themselves. Cognitive behavioral therapy (CBT), an effective therapy for anxiety and depression, has shown mixed efficacy when delivered to cancer caregivers. Emotion Regulation Therapy (ERT), a contemporary CBT, may uniquely target processes underlying distress associated with caregiving. Therefore, we adapted both CBT and ERT to target the needs of caregivers (i.e., CBT-C and ERT-C) and are conducting a multi-site randomized trial to examine the comparative efficacy of these interventions.

METHODS

Family cancer caregivers (n = 200) reporting distress related to caregiving are recruited from two academic cancer centers and randomly assigned to either ERT-C or CBT-C. Caregivers in both interventions engage in eight weekly one-hour sessions by videoconference with a trained interventionist. Caregiver participants complete study assessments at baseline, post-treatment, 3-and 6-months follow-up. Patients of each caregiver can also enroll in the study and complete assessments at baseline and 3-months follow-up. Outcome measures include psychosocial constructs such as anxiety, depression, quality of life, as well as proposed mechanistic constructs and salivary markers of stress and inflammation.

CONCLUSIONS

The results of this study will advance the science of caregiving interventions in cancer by addressing a critical gap in our ability to mitigate anxiety and depression in caregivers, as well as further our understanding of how these changes may influence patients' outcomes.

Social constraints and cancer-related quality of life in single and partnered young adult testicular cancer survivors: a contextual approach

To examine the context of relationship status on the link between friends/family social constraints (SC_ff) and cancer-related quality-of-life (QOL) among young adult testicular cancer survivors.

Participants completed the Functional Assessment of Cancer Therapy (general version), the Social Constraints Scale (friends/family), and demographic questions.

The sample included 162 young adult testicular cancer survivors.

SC_ff, but not relationship status, significantly predicted QOL when controlling for age, time since diagnosis, education, and income. The SC_ff X relationship status interaction was significant such that SC_ff were more strongly related to lower QOL for single survivors than for partnered survivors.

Focusing on friends and family support of young adult survivors, findings highlight the vulnerability of single survivors to social constraints within their diffuse social network. Interventions that target supportive exchanges in friends and family networks may be useful in improving QOL in single young adult cancer survivors.

A Randomized Controlled Trial of Goal-Focused Emotion-Regulation Therapy for Young Adult Survivors of Testicular Cancer: Effects on Salivary and Inflammatory Stress Markers

Despite the substantial adverse psychological impact of testicular cancer, few interventions have sought to improve psychosocial functioning and stress-related biomarkers in young adult survivors. Goal-focused Emotion-regulation Therapy (GET) is designed to improve distress symptoms, emotion regulation, and goal navigation skills, which would be expected to improve regulation of stress-sensitive biomarkers. The aim was to examine the effects of GET versus an active control intervention on salivary stress and circulating inflammatory markers in young adult survivors of testicular cancer. Young adult men with testicular cancer (N = 44) who had undergone chemotherapy within the last 2 years were randomized to GET or individual supportive therapy (ISP) delivered over 8 weeks. Saliva samples were collected for 2 consecutive days at baseline and post-intervention (awakening, 8 hr later, bedtime) to measure diurnal rhythm. Circulating plasma levels of CRP, IL-6, IL-1ra, TNFαRII, and VEGF were measured at baseline and post-intervention. Regression modeling demonstrated a significant group effect on daily output of salivary cortisol (area under the curve) (β = −57, p < .05), with cortisol output decreasing from baseline to post-intervention for those receiving GET (Cohen’s d = 0.45). There were no significant intervention effects in salivary alpha-amylase. Plasma levels of IL-1ra were significantly lower post-intervention in GET compared to ISP; no other significant plasma effects were observed. GET, an intervention designed to promote goal-related and emotion-focused self-regulation, has potential to mitigate stress-related processes and inflammation in this young adult survivor group. More research is needed to determine efficacy.

Emotion regulation therapy for cancer caregivers-an open trial of a mechanism-targeted approach to addressing caregiver distress

Informal caregivers (ICs) are integral to care provided to patients facing life-threatening or incurable illnesses. This responsibility causes considerable burden, as approximately one half of ICs report clinically significant symptoms of depression and/or anxiety that persist when left untreated. Psychosocial interventions containing efficacious treatment principles (e.g., cognitive behavior therapy [CBT]) show disappointing results in reducing anxiety and depression in ICs. This may reflect failure of these interventions to specifically target crucial mechanisms underlying the central feature of distress caused by the patient's illness-notably, perseverative negative thinking (PNT). Emotion Regulation Therapy (ERT) is an efficacious CBT developed to explicitly target mechanisms underlying PNT and the emotional concomitants that arise in response to stressful situations. This open trial was conducted to evaluate the acceptability and initial efficacy of ERT adapted to the experience of cancer ICs (ERT-C). Thirty-one ICs provided informed consent and completed eight weekly individual sessions of ERT-C. Participants completed self-report measures of depression and anxiety symptoms, PNT, emotion regulation deficits, and caregiver burden before and after treatment. ERT-C was well tolerated as indicated by 22 treatment completers and feedback provided in exit interviews. ICs demonstrated reduced depression and anxiety symptoms, PNT, and emotion regulation deficits with moderate to large effect sizes (Hedge's g range: 0.36-0.92). Notably, caregiver burden was not reduced but ICs expressed more ability to confront caregiving-related challenges. Findings offer promising but preliminary support for ERT-C as a conceptual model and treatment modality for distressed cancer ICs.

Emotional processing writing and physiological stress responses: understanding constructive and unconstructive processes

Writing about emotions related to a life stressor is thought to promote coping via emotional processing. However, all styles of emotional processing may not be beneficial to managing stress. Such styles can include constructive (planning/problem-solving, meaning-making) and unconstructive (rumination, worry) forms. This study utilised a randomised experimental design to examine the physiological impact (as indexed by heart rate variability, salivary cortisol reactivity and recovery) of expressive writing with guidance to promote constructive and discourage unconstructive styles (EP+) versus expressive writing with no guidance (EP). Participants (N = 151) engaged in three sessions of expressive writing anchored to a self-nominated stressor over three days. Stress reactivity was measured two weeks later in response to a stress recall task. There was no effect of group on cortisol reactivity, cortisol recovery, or HRV reactivity. However, there was a significant interaction of group and subjective stressfulness of the nominated stressor was observed, such that EP+ was associated with greater cortisol recovery. Those with more taxing stressors may be better equipped to process emotions with guidance on emotional processing styles.

Emotional approach coping among young adults with cancer: Relationships with psychological distress, posttraumatic growth, and resilience

OBJECTIVE

Cancer, particularly, during young adulthood, can evoke difficult emotions, interfere with normative developmental activities, and challenge coping responses. Emotion-regulating coping efforts aimed at active emotional processing (EP) and emotional expression (EE) can be beneficial to cancer adjustment and perceptions of positive growth. However, it may be that EP and EE work differently to influence well-being. This study examines relationships of EP and EE with psychological distress, posttraumatic growth (PTG), and resilience. We expect that EP will be positively associated with PTG and resilience, whereas EE will be negatively associated with psychological distress.

METHODS

Young adults with cancer (M age  = 34.68, N = 57) completed measures of emotional; approach coping (EP and EE), psychological distress (depressive symptoms, fear of cancer; recurrence [FCR]) and indicators of positive adjustment and growth (resilience and PTG).

RESULTS

Greater use of EP was associated with higher resilience (β = 0.48, p = 0.003) and PTG (β = 0.27, p = 0.05), whereas greater use of EE was associated with lower resilience (β = -0.33, p = 0.04). The EE × EP interaction was significant for FCR (β = 0.29, p = 0.04) such that low EE was associated with lower FCR in those with high EP. Interaction effects were not significant for depressive symptoms, resilience, or PTG.

CONCLUSIONS

Findings highlight differing relationships between EP and EE among young adults with cancer. Interventions aimed at increasing emotion-regulating coping strategies may prove useful in facilitating positive adjustment and growth, strengthening young adults' ability to cope with the diverse effects of disease, treatment, and survivorship.

Furthering the Focus on Translational Sleep Science in Behavioral Medicine

Translational sleep science has become a critical and fundamental focus in the field of behavioral medicine. This is the second issue in the special series of the International Journal of Behavioral Medicine focused on the physiological, psychological, social, and environmental concomitants of sleep and human health. The articles included in this issue draw further attention to the range and significance of sleep as a marker of health status and as a target of behavioral intervention. The research included in this series highlights the pervasive manner in which sleep health is intrinsically connected to health risk, behavior, and outcomes. The next decade promises to further behavioral medicine approaches to improving the provision of care and the overall public health through the implementation of translational sleep science research.

Biobehavioral Psycho-Oncology Interventions

Interventions in psycho-oncology have strong evidence for improving health-related quality of life, reducing distress, and enhancing emotional and physical well-being across the cancer trajectory. An expansion of this work has taken a biobehavioral focus. Biobehavioral interventions target the biological mechanisms and processes underlying cancer-relevant outcomes. The goals of such biobehavioral interventions have included altering physiological processes of stress and distress, relieving cancer-related symptoms by targeting common biological mechanisms, and promoting slower disease progression. This chapter provides a brief overview of this work including conceptual frameworks, an introduction to the commonly targeted intervention-sensitive biomarkers, and an examination of current evidence for biobehavioral intervention efficacy. Developing the evidence base and enhancing the clinical impact of biobehavioral interventions are discussed.

An experimental examination of worry and relaxation on cardiovascular, endocrine, and inflammatory processes

BACKGROUND

Worry increases risk for long-term health issues by prolonging the physiological stress response. In contrast, relaxation may ameliorate the psychological and physiological burden resulting from worry. This study examined the impact of experimentally induced worry and relaxation on cortisol, heart rate variability (HRV), and inflammation.

METHOD

Participants (N = 80) completed both a worry and relaxation induction (presented in a fixed order) while HRV was collected continuously. Three blood samples were taken (at baseline, after the worry induction, and after the relaxation induction) to measure IL-6, IFN-γ, TNF-α and serum cortisol.

RESULTS

There were significant changes in IL-6 (p < 0.001), IFN-γ (p < 0.01), HRV (p < .001), and cortisol (p <  .001) but not in TNF-α (p = 0.65) across conditions. HRV decreased significantly from baseline to worry and then increased following relaxation. IL-6 was higher during relaxation compared to worry and baseline. Cortisol decreased significantly across conditions. Several patterns of covariance between inflammation and HRV and/or cortisol also emerged.

CONCLUSIONS

These findings offer novel insight into how worry influences the immune system and emphasize the utility of a multi-methods approach to understanding the impact of worry on physical health.

Salivary Bioscience and the Future of Behavioral Medicine

Behavioral medicine research from across the globe has been catalyzed by the quest to understand the interactions between psychological, social, and physiological factors underlying disparities in human health. A more complete biopsychosocial model increasingly integrates advanced clinical and laboratory assessments of relevant environmental chemicals, biological mediators of inflammation, cardiometabolic and endocrine markers, infectious disease exposure, and genetic polymorphisms determined from saliva specimens. The overarching aims are to identify mechanisms, decode moderating processes that translate adversity into risk, and verify the impact of clinical intervention. This special issue of the International Journal of Behavioral Medicine highlights novel contributions of salivary bioscience with emphasis on research utilizing varied research designs (i.e., experimental, longitudinal, dyadic), incorporating a broad array of salivary analytes, and investigating the influence of psychological and social factors on human health.

Goal-focused Emotion-Regulation Therapy for young adult survivors of testicular cancer: Feasibility of a behavioral intervention

Young adult cancer testicular survivors experience impairing, distressing, and modifiable physical, behavioral, and psychosocial adverse outcomes that persist long after the completion of primary medical treatment. These include psychological distress and poor psychosocial adjustment, impaired navigation of life goals, persistent treatment side effects, and fear associated with elevated risk of secondary malignancies and chronic illness. This paper describes the feasibility and acceptability of a novel intervention, Goal-focused Emotion-Regulation Therapy (GET) aimed at improving distress symptoms, emotion regulation, and goal navigation skills in young adult testicular cancer patients.

METHODS

Participants (N = 6) were recruited from a large comprehensive cancer center and received the GET intervention that included six individual sessions across eight weeks. Following all sessions, participants underwent a qualitative interview.

RESULTS

Results supported the feasibility in recruitment and retention and overall positive satisfaction, working alliance, and helpfulness of the intervention. Clinically meaningful change was observed in both depression and anxiety.

CONCLUSION

With slight adaptation, results support the feasibility of a future clinical trial.

The experience of financial stress among emerging adult cancer survivors

Objective: The experience of cancer-related financial stress was examined within the developmental context of emerging adulthood.Methodological approach: This study is a secondary analysis of data drawn from two samples of testicular or hematologic cancer survivors. In-depth interviews from 52 emerging adult (EA) cancer survivors, ages 18-29, were coded by combining thematic analysis with an abductive approach.Findings: Emergent themes included some common to most age groups, including worries about medical costs and availability of health insurance, as well as specific age-related concerns, such as fertility preservation. Financial stress appeared to interrupt developmental tasks of emerging adulthood, including completing an education, establishing independence, and managing relationships. Surprisingly, financial stress was experienced as a benefit for some participants.Conclusion: Financial stress affects EA cancer survivors in unique ways. To provide support, health professionals should consider survivors' developmental life stage to understand their financial stress, and ultimately, to improve quality of life.

Emotional approach coping in older adults as predictor of physical and mental health

Emotional approach coping involves active attempts at emotional expression and processing in response to stressful circumstances. This study tested whether dispositional emotional approach coping processes predict changes in physical and mental health in community-dwelling older adults, particularly within the context of higher perceived stress. To test this, older adults (N = 150) completed assessments of emotional expression and emotional processing at study entry. They also completed measures of perceived stress, depressive symptoms, and ill-health (a composite of subjective and objective physical health indicators, which included blood draw for collection of biomarkers), every 6 months over 4.5 years. Emotional processing and emotional expression were not related significantly to ill-health at study entry. However, emotional processing (but not emotional expression) significantly predicted changes in ill-health. At higher levels of emotional processing, ill-health remained low and stable; at lower levels of emotional processing, ill-health increased over time. However, when perceived stress was high, higher emotional processing and emotional expression were related to lower depressive symptoms at study entry, but higher emotional processing was associated with increasing depressive symptoms over time. Emotional approach coping processes evidence prospective relations with health outcomes, which are partially conditioned by stress perceptions. Emotional processing appears to have a protective impact against declining physical health. Predictive relationships for depressive symptoms are more complex. Older adults with chronically high perceived stress might benefit from interventions that target emotion-regulating coping processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Goal-Focused Emotion-Regulation Therapy (GET) for young adult survivors of testicular cancer: a pilot randomized controlled trial of a biobehavioral intervention protocol

Background

Testicular cancer diagnosis and treatment, especially given its threat to sexuality and reproductive health, can be distressing in the formative period of young adulthood and the majority of young survivors experience impairing, distressing, and modifiable adverse outcomes that can persist long after medical treatment. These include psychological distress, impairment in pursuit of life goals, persistent physical side effects, elevated risk of secondary malignancies and chronic illness, and biobehavioral burden (e.g., enhanced inflammation, dysregulated diurnal stress hormones). However, few targeted interventions exist to assist young survivors in renegotiating life goals and regulating cancer-related emotions, and none focus on reducing the burden of morbidity via biobehavioral mechanisms. This paper describes the methodology of a randomized controlled biobehavioral trial designed to investigate the feasibility and preliminary impact of a novel intervention, Goal-focused Emotion-Regulation Therapy (GET), aimed at improving distress symptoms, emotion regulation, goal navigation skills, and stress-sensitive biomarkers in young adult testicular cancer patients.

Methods

Participants will be randomized to receive six sessions of GET or Individual Supportive Therapy (ISP) delivered over 8 weeks. In addition to indicators of intervention feasibility, we will measure primary (depressive and anxiety symptoms) and secondary (emotion regulation and goal navigation skills, career confusion) psychological outcomes prior to (T₀), immediately after (T₁), and 12 weeks after (T₂) intervention. Additionally, identified biomarkers will be measured at baseline and at T₂.

Discussion

GET may have the potential to improve self-regulation across biobehavioral domains, improve overall cancer adjustment, and address the need for targeted supportive care interventions for young adult cancer survivors.

Trial registration

Clinicaltrials.gov, NCT04150848. Registered on 28 October 2019.

Emotional Processing Coping Methods and Biomarkers of Stress in Young Adult Testicular Cancer Survivors

Coping through emotional processing (EP) with cancer-related circumstances can take several forms, including methods thought to be constructive (e.g., planning, meaning making) and unconstructive (e.g., rumination). These forms can have differential relationships with experiences of stress. Associations of coping through constructive and unconstructive EP in expressive writing with salivary stress biomarkers were examined among young adult testicular cancer survivors. Constructive processing was significantly associated with less overall daily cortisol output and smaller salivary alpha-amylase awakening response; unconstructive processing was also associated with lower daily cortisol output. These preliminary results from this exploratory study inform future research associating emotion-regulation coping and biological stress reactivity.

Cancer-related masculinity threat in young adults with testicular cancer: the moderating role of benefit finding

Background and Objectives: Perceiving benefit from a health-related stressor such as cancer has been associated with better psychological adjustment in various cancer populations; however, it has not been studied in the context of young adulthood or gender-related cancer threat. This study investigated the role of benefit finding in psychological adjustment among young adults with testicular cancer, and whether BF moderates cancer-related masculine threat.Design: This study utilizes a cross-sectional design with a diverse sample of young adult testicular cancer survivors.Methods: Men with a history of testicular cancer (N = 171; M age = 25.2, SD = 3.32) completed questionnaires of benefit finding, cancer-related masculine threat, and indicators of psychological adjustment.Results: Multiple regression analysis revealed that cancer-related masculine threat was associated with worse adjustment across indicators and that benefit finding was related to higher positive affect and lower depressive symptoms. Benefit finding attenuated the potentially adverse effect of cancer-related masculine threat on negative affect and depressive symptoms such that cancer-related masculine threat demonstrated a stronger association with negative affect and depressive symptoms for people with relatively low BF.Conclusions: For young adult men with testicular cancer, finding benefit appears to promote well-being in the face of masculine cancer threat.

Relational processes and psychological adjustment among young adults with cancer: The role of technology-related communication

OBJECTIVE

Little attention has been paid to understanding how engaging in cancer-related interpersonal exchanges via varying modes of communication influences psychological well-being among young adults with cancer. This study explored the moderating role of communication mode on the relationship of relational processes of disclosure and responsiveness with psychological well-being.

METHODS

61 young adults with cancer (M_age = 34.59, SD = 4.82) completed a questionnaire about their most recent cancer-related conversation. Participants reported on communication mode (ie, face-to-face, text message, and phone call) and relational processes of self- and support member- disclosure of thoughts, information, and feelings and how accepted, cared for, and understood they felt within the cancer-related conversation. Cancer adjustment measures included functional well-being and depressive symptoms.

RESULTS

There were no main effects of communication mode or relational processes. However, communication mode did moderate the relationship between relational processes and cancer adjustment. Greater relational processes of disclosure and responsiveness were associated with better functional well-being and lower depressive symptoms only among those who engaged in their most recent cancer-related conversation through technology-related communication and not for those engaged in face-to-face communication.

CONCLUSION

Relational processes that are likely to benefit psychological adjustment after cancer appear to be particularly advantageous over technology-based communication. Young adults commonly report feelings of social isolation and psychological distress after cancer. These findings suggest that technology-related communication holds promise as a way to strengthen support-related communication and protect against distress.

Adult self-image and well-being after testicular cancer: The role of agency and meaning

OBJECTIVE

Cancer during young adulthood can limit the extent to which one adopts an adult self-image. However, the relationship of adult self-image to cancer-related adjustment remains unexplored. The current study examines relationships of adult self-image and social/emotional well-being and job-related problems in young testicular cancer survivors. Factors thought to facilitate future-oriented goals (i.e. agency and meaning) are examined as intermediary processes.

DESIGN

Testicular cancer survivors (N = 171) between the ages of 18 and 29 completed questionnaire measures of adult self-image, agency, sense of meaning and indicators of adjustment.

MAIN OUTCOME MEASURES

Social and emotional well-being were measured by the Functional Assessment of Cancer Therapy-General. Job problems were assessed using the EORTC's testicular cancer supplement (EORTC QLQ-TC26).

RESULTS

Path model results revealed direct associations of survivors' adult self-image with social (β = .20, p < .05), but not emotional well-being (β = .14, p < .01). Both agency and meaning mediated the relationship of adult self-image and well-being indicators. Finally, the relationship between adult self-image and job problems was only significant for those who were employed or in school (β = -.19, p < .05).

OUTCOMES

Assessment of adult self-image might be useful in identifying risk for poor adjustment. Interventions that target agency and meaning might facilitate developmental goals.

Sexual well-being and diurnal cortisol after prostate cancer treatment

Sexual dysfunction and psychological distress are common after prostate cancer. Research has not examined the role of neuroendocrine markers of stress (e.g. cortisol). This study examines whether sexual functioning or sexual bother is associated with diurnal cortisol. Men treated for prostate cancer completed the University of California-Los Angeles Prostate Cancer Index and provided saliva samples four times daily for cortisol assessment. Higher sexual bother, but not sexual functioning, was associated with steeper cortisol slope. Better sexual functioning, and not sexual bother, was significantly associated with the cortisol awakening response. Assessment of stress and stress-reducing interventions might be warranted in sexual rehabilitation after prostate cancer.

Using a Biopsychosocial Model to Understand Long-Term Outcomes in Persons With Burn Injuries

OBJECTIVE

To determine the importance of preburn adjustment, injury-related variables, and selection of coping style in various outcome measures using a biopsychosocial model.

DESIGN

Longitudinal study.

SETTING

Outpatient burn clinics.

PARTICIPANTS

Burn survivors (N=231) who participated in this study as part of a larger burn model system study of 645 patients with major burn injuries.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The 36-Item Short-Form Health Survey was used to assess preburn adjustment. Other outcome measures entered into the model included the Ways of Coping Checklist Revised, the Brief Symptom Inventory, the Beck Depression Inventory-II, and the Davidson Trauma Scale.

RESULTS

Correlational and mediational analyses revealed that preburn emotional health predicted better adjustment at year 1 and more posttraumatic stress disorder symptoms at year 2. Better preburn emotional health was also related to less use of avoidance coping strategies, which was found to be a mediator of the effect of preburn emotional health and posttraumatic stress disorder symptoms. Burn injury characteristics were not significantly associated with psychological adjustment at either year 1 or year 2.

CONCLUSIONS

The results indicate that there is a complex relation between premorbid mental health and the selection of coping strategies that affect long-term adjustment in persons recovering from a burn injury. This relation seems to have greater effect on long-term outcomes than does preburn emotional or physical health alone or the severity of the burn.

Benefit finding and diurnal cortisol after prostate cancer: The mediating role of positive affect

OBJECTIVE

Benefit finding (BF) has exhibited a salutary effect on psychological adjustment to cancer. However, few studies have examined its relationship with physiology or have examined BF in men with cancer. This study investigated whether BF is associated with hypothalamic-pituitary-adrenal axis activity (ie, diurnal salivary cortisol) in men treated for prostate cancer. Positive affect (PA) is proposed as a potential pathway linking BF to diurnal salivary cortisol.

METHODS

A sample of 66 men treated for localized prostate cancer within the prior 2 years completed questionnaires and collected salivary cortisol 3 times per day over 3 consecutive days. Hierarchical linear modeling was used for estimating the effects of BF and PA on cortisol responses as measured by diurnal slope and area under the curve (AUCg). Confidence intervals for indirect effects were estimated using the Monte Carlo method for mediation testing.

RESULTS

BF was significantly associated with diurnal cortisol slope, controlling for body mass index and age (B = -.12, P = .03), such that greater BF was associated with steeper cortisol slope. Analyses revealed that PA mediated the effect of BF on cortisol slope (Monte Carlo estimation 95% CI = -0.087, -0.001); negative affect did not mediate this relationship. BF was not significantly associated with AUCg.

CONCLUSIONS

Deriving more benefit from one's experience with prostate cancer is associated with a healthier diurnal cortisol rhythm. Through its potential to enhance PA, the relationship of BF and physiological processes underscores the health relevant value of BF in prostate cancer survivors.

Gay men's experiences with prostate cancer: Implications for future research

Gay men's experiences with prostate cancer and its impact on health-related quality of life are poorly understood. This qualitative study explored gay men's experience with prostate cancer with a focus on the emotional, physical, and sexual impact of cancer; support needs; and healthcare interactions. Three semi-structured focus groups of gay men with prostate cancer were conducted. A conventional content analytic approach was used to identify six primary content areas that described poignant aspects of the men's experience with prostate cancer: minority stress, intimacy and sexuality concerns, impact on life outlook, healthcare experiences, social support and the gay community, and intersectional identities.

Cancer-Related Worry and Physical Well-Being in the Context of Perceived Stress in Young Adults with Testicular Cancer

Uncertainty associated with cancer can foster future-focused worry and ultimately diminish physical well-being, especially among young adult survivors. Stress perceptions might exacerbate the association of worry and physical well-being. Young adults with testicular cancer (N = 171) completed measures of physical well-being, perceived stress, and future cancer-related worry. Perceived stress and future worry were both negatively associated with physical well-being. Perceived stress moderated the relationship; more perceived stress was related to lower physical well-being in those with high worry. Interventions aimed at worry reduction might benefit from reducing global stress perceptions.

An emotional processing writing intervention and heart rate variability: the role of emotional approach

Expressing and understanding one's own emotional responses to negative events, particularly those that challenge the attainment of important life goals, is thought to confer physiological benefit. Individual preferences and/or abilities in approaching emotions might condition the efficacy of interventions designed to encourage written emotional processing (EP). This study examines the physiological impact (as indexed by heart rate variability (HRV)) of an emotional processing writing (EPW) task as well as the moderating influence of a dispositional preference for coping through emotional approach (EP and emotional expression (EE)), in response to a laboratory stress task designed to challenge an important life goal. Participants (n = 98) were randomly assigned to either EPW or fact control writing (FCW) following the stress task. Regression analyses revealed a significant dispositional EP by condition interaction, such that high EP participants in the EPW condition demonstrated higher HRV after writing compared to low EP participants. No significant main effects of condition or EE coping were observed. These findings suggest that EPW interventions may be best suited for those with preference or ability to process emotions related to a stressor or might require adaptation for those who less often cope through emotional approach.

The Relationship between Intolerance of Uncertainty and Anxiety in Men on Active Surveillance for Prostate Cancer

PURPOSE

Anxiety may serve as a major barrier to participation in active surveillance. Intolerance of uncertainty, that is the tendency to perceive the potential for negative events as threatening, has been linked to cancer related worry. Accordingly we explored prospectively the relationship of intolerance of uncertainty with anxiety along with other clinical factors among men treated with active surveillance for prostate cancer.

MATERIALS AND METHODS

A total of 119 men with D'Amico low risk prostate cancer participating in active surveillance completed the HADS (Hospital Anxiety and Depression Scale), MAX-PC (Memorial Anxiety Scale for Prostate Cancer), IUS (Intolerance of Uncertainty Scale) and I-PSS (International Prostate Symptom Score) surveys from 2011 to 2014. We evaluated the relationship between anxiety and IUS score after adjusting for patient characteristics, cancer information and I-PSS using bivariable and multivariable analyses.

RESULTS

Of the men 18 (15.1%) and 17 (14.3%) reported clinically significant anxiety on the generalized and prostate cancer specific scales, respectively. On bivariable analysis men with moderate/severe urinary symptoms and higher IUS scores reported more generalized and prostate cancer specific anxiety than men with mild urinary symptoms and lower IUS scores, respectively (p ≤0.008). Men with depressive symptoms (p = 0.024) or a family history of prostate cancer (p = 0.006) experienced greater generalized anxiety. On multivariable analysis IUS score was significantly associated with generalized and prostate cancer specific anxiety (OR 1.22, 95% CI 1.09-1.38 and OR 1.29, 95% CI 1.13-1.49, respectively) while moderate/severe urinary symptoms were associated with prostate cancer specific anxiety (OR 6.89, 95% CI 1.33-35.68).

CONCLUSIONS

Intolerance of uncertainty and urinary symptoms may promote anxiety in men on active surveillance for prostate cancer. Patient education, management of lower urinary tract symptoms and behavioral interventions may lessen anxiety related to uncertainty intolerance and help maintain patient engagement in active surveillance.

Sleep quality and depressive symptoms after prostate cancer: The mechanistic role of cortisol

A substantial portion of men treated for prostate cancer report clinically significant sleep problems and disturbance in sleep quality constitutes significant risk for the development of depressive symptoms in survivors. Dysregulation in biological stress processes underlies the impact of poor sleep on the onset and/or progression of depressive symptoms, yet few studies have sought to identify potential neurobiological mechanisms (e.g., HPA axis activation) underlying this association in PC survivors. The present study examines the relationships between sleep disturbance, depressive symptoms, and indices of diurnal cortisol patterns among men treated for prostate cancer. In total, 66 men (84.8% White; mean age = 65.8 years, SD = 9.04) treated in the prior 2 years for localized prostate cancer were recruited. They completed questionnaires to measure sleep quality and depressive symptoms at study entry (T1) and 4 months later (T2). They also provided 4 saliva samples per day, over 3 days, at T1. Three cortisol indices were computed: diurnal slope, area under the curve (AUCg), and cortisol awakening response (CAR). Analyses indicate that, controlling for body mass index and age, worse sleep quality at T1 was significantly associated with higher levels of depressive symptoms at T2. Significant indirect effects were observed for cortisol slope (indirect effect = -.17, 95% CI [-.61, -.01]) and AUCg (indirect effect = -.14, 95% CI [-.43, -.01]), but not CAR. Results suggest that dysregulation in HPA activity acts as a neurobiological mechanism of the impact of sleep disruption on depressive symptoms in men with prostate cancer. (PsycINFO Database Record

Mechanisms of navigating goals after testicular cancer: meaning and emotion regulation

OBJECTIVE

The navigation of major life goals can be challenging to cancer survivors, particularly during young adulthood. This study examined the relationships of goal navigation skills (e.g., goal identification, goal clarification, and goal adjustment) with having a sense of life meaning, emotion regulation coping processes, and physical and psychological health indicators in young adult survivors of testicular cancer.

METHODS

Men ages 18 to 29 years (N = 171; M age = 25.2, SD = 3.32) with a history of testicular cancer were recruited via the California State Cancer Registry and completed questionnaire measures including assessments of goal navigation, sense of meaning, emotional approach coping, and indicators of physical and psychological well-being.

RESULTS

Goal navigation skills were negatively related to depressive symptoms (r = -0.41, p < 0.01) and positively related to physical functioning (r = 0.28, p < 0.01). Controlling for participant age and months since diagnosis, mediation models revealed significant indirect effects of sense of meaning on depressive symptoms (-0.50, p < 0.05) and physical functioning (0.34, p < 0.05). Similarly, emotion-regulating coping had significant indirect effects on depressive symptoms (-0.08, p < 0.05) and physical functioning (0.11, p < 0.05) CONCLUSIONS: Consistent with a self-regulation framework, goal navigation skill is related to physical and psychological well-being via its association with maintenance of a sense of meaning as well as successful attempts at regulation of emotions. The study provides preliminary evidence that these skill-based processes relate to adjustment to cancer in young adults. Copyright © 2016 John Wiley & Sons, Ltd.

Let's talk about sex after cancer: exploring barriers and facilitators to sexual communication in male cancer survivors

OBJECTIVE

Changes to sexuality are a primary concern amongst cancer survivors, leading to psychological distress and impacting long-term quality of life. Effective sexual communication has been found to be critical in improving sexual satisfaction post-treatment. However, research suggests that many men struggle to disclose sexual concerns and preferences. This study aimed to qualitatively explore the common barriers and facilitators to sexual communication in male cancer survivors (MCSs).

METHODS

Seventeen MCSs participated in semi-structured telephone interviews, which were transcribed and coded using Grounded Theory methodology.

RESULTS

The emergent theory described that those MCSs with lower quality sexual communication experienced diminished perceived masculinity following cancer-related sexual dysfunction. These feelings of inadequacy were compounded by inadequate partner support. Contrastingly, participants reporting effective sexual communication expressed the importance of a stable self-esteem and flexible partner support.

CONCLUSIONS

This study challenges the notion that men naturally struggle with intimate dyadic communication and suggests that adequate partner support and a stable sense of self can mitigate MCSs' communicative behaviour, subsequently bolstering self-esteem. Future research should more broadly explore the diverse experiences of MCSs to enhance the efficacy of psychosexual interventions. Copyright © 2015 John Wiley & Sons, Ltd.

Approach and avoidance coping: diurnal cortisol rhythm in prostate cancer survivors

Psychological coping responses likely modulate the negative physiological consequences of cancer-related demands. This longitudinal, observational study examined how approach- and avoidance-oriented strategies for coping with cancer are associated with diurnal cortisol rhythm in prostate cancer (PC) survivors. Sixty-six men (M age=65.76; SD=9.04) who had undergone radical prostatectomy or radiation therapy for localized PC within the prior two years reported their use of approach and avoidance coping via questionnaire at study entry (T1). Participants provided saliva samples (3 times per day over 3 days) for diurnal cortisol assessment at T1 and again 4 months later (T2). When controlling for relevant biobehavioral covariates, cancer-related avoidance-oriented coping was associated with flatter cortisol slopes at T1 (B=.34, p=.03) and at T2 (B=.30, p=.02). Approach-oriented coping was not associated with cortisol slopes. Post-hoc analyses revealed a significant interaction between avoidant coping and time since completion of cancer treatment on T2 cortisol slope (B=-.05, p=.04). Men who used relatively more avoidance-oriented coping who were further in time from treatment demonstrated a flatter cortisol slope. High avoidance-oriented coping is associated with dysregulation of cortisol responses, which may be an important target for reducing stress during PC survivorship.

Processing coping methods in expressive essays about stressful experiences: Predictors of health benefit

This study distinguished constructive (e.g. planning/problem-solving) and unconstructive (e.g. worry) processing in expressive essays and their impact on depressive symptoms, healthcare visits, and physical symptoms. Affect labeling, achievement orientation, and insight utilization were examined as mediators. Essays from 43 medical students were coded; mediators were identified through linguistic text analysis. Outcomes were assessed at baseline and 3 months. Constructive processing predicted declining depressive symptoms (β = −.33, p < .05) and healthcare visits (β = −.61, p < .01). Unconstructive processing predicted increasing healthcare visits (β = .42, p < .05). Higher affect labeling mediated the effect of constructive processing, and lower achievement orientation mediated the effect of unconstructive processing.

American Cancer Society prostate cancer survivorship care guidelines

Prostate cancer survivors approach 2.8 million in number and represent 1 in 5 of all cancer survivors in the United States. While guidelines exist for timely treatment and surveillance for recurrent disease, there is limited availability of guidelines that facilitate the provision of posttreatment clinical follow-up care to address the myriad of long-term and late effects that survivors may face. Based on recommendations set forth by a National Cancer Survivorship Resource Center expert panel, the American Cancer Society developed clinical follow-up care guidelines to facilitate the provision of posttreatment care by primary care clinicians. These guidelines were developed using a combined approach of evidence synthesis and expert consensus. Existing guidelines for health promotion, surveillance, and screening for second primary cancers were referenced when available. To promote comprehensive follow-up care and optimal health and quality of life for the posttreatment survivor, the guidelines address health promotion, surveillance for prostate cancer recurrence, screening for second primary cancers, long-term and late effects assessment and management, psychosocial issues, and care coordination among the oncology team, primary care clinicians, and nononcology specialists. A key challenge to the development of these guidelines was the limited availability of published evidence for management of prostate cancer survivors after treatment. Much of the evidence relies on studies with small sample sizes and retrospective analyses of facility-specific and population databases.

Sexual self-schema and depressive symptoms after prostate cancer

INTRODUCTION

The years following prostate cancer treatment are characterized by changes in sexual functioning and risk for depressive symptoms. Sexual self-schema (SSS) is a cognitive generalization about sexual aspects of the self that are associated with sexual behavior, affect, and the processing of sexually relevant information. This study tested if men's SSS moderates the impact of sexual morbidity on depressive symptoms.

METHODS

Men (N = 66) treated for localized prostate cancer in the preceding 2 years were assessed at T1 and 4 months later (T2). Questionnaires included the Center for Epidemiologic Studies Depression Scale, Sexual Self-schema Scale for Men, Sexual Experience Scale, and Expanded Prostate Cancer Index Composite.

RESULTS

Regressions controlled for age, sexual activity, and T1 depressive symptoms revealed no significant effect of SSS on depressive symptoms; however, better sexual functioning was related to fewer depressive symptoms (B = -0.25, p < 0.05). Results showed significant interactions between SSS and sexual outcomes. Among men with high SSS, poor sexual functioning was associated with increased depressive symptoms; loss of sexual function was particularly distressing. There was no significant effect of sexual functioning. Among men with high SSS, there was an inverse relationship between sexual engagement and depressive symptoms. Among men with lower SSS, greater frequency of sexual behavior was associated with increased depressive symptoms.

CONCLUSIONS

SSS may be an important individual difference in determining the impact of sexual morbidity on psychological adjustment. Men high on SSS are more vulnerable to psychological consequences of lower sexual functioning and less engagement in sexual activities.

Cancer-related masculine threat, emotional approach coping, and physical functioning following treatment for prostate cancer

OBJECTIVE

Aspects of masculinity and gender role, particularly those that are traditional and restrictive, are related to poorer physical and psychological outcomes in men with cancer. This longitudinal study uses a cancer-specific assessment to determine whether cancer-related masculine threat (CMT) predicts prostate-related (i.e., urinary, bowel, sexual) functioning over time, and whether cancer-related emotional approach coping (EAC) processes explain these relationships. Whether coping self-efficacy and emotional suppression explain effects of CMT on EAC also is tested.

METHODS

Sixty-six men (M age = 65.76; SD = 9.04) who underwent radical prostatectomy and/or radiation therapy for localized prostate cancer within two years were assessed on physical and psychological variables at study entry (T1), and two (T2) and four (T3) months later.

RESULTS

Analyses controlling for baseline functioning and age revealed that CMT predicted declines in (T1 to T3) urinary (B = -.21, p < .05), bowel (B = -.24, p < .05), and sexual (B = -.17, p < .05) function. CMT also predicted decreased emotional processing (T1 to T2), but not emotional expression. Decreased emotional processing predicted declining prostate-related functioning and helps explain the effect of CMT on bowel and sexual (but not urinary) functioning. Low coping self-efficacy (p < .05), but not emotional suppression, was a mechanism by which CMT predicted emotional processing.

CONCLUSIONS

The extent to which men believe that cancer is inconsistent with their masculinity exacerbates declines in prostate-related functioning following cancer treatment. CMT likely shapes coping responses and negatively affects the efficacy of emotion-directed coping. Emotion-regulating coping processes, particularly the ability to process cancer-related emotions, appears to be one pathway through which gender role affects recovery from prostate cancer.

Inflammatory biomarkers and emotional approach coping in men with prostate cancer

OBJECTIVE

Emotion-regulating coping is associated with improvements in psychological and physical health outcomes. Yet in the context of prostate cancer-related stressors, limited research has characterized associations of emotion-regulating coping processes (emotional expression, emotional processing) and inflammatory processes that are related to disease risk. This investigation examined the relation of Emotional Approach Coping (EAC) with markers of inflammation to test the hypothesis that higher EAC scores at study entry (T1) would be associated with lower proinflammatory markers four months later (T2), specifically sTNF-RII, CRP, and IL-6.

METHODS

Forty-one men (M age=66.62 years; SD=9.62) who had undergone radical prostatectomy or radiation therapy for localized prostate cancer within two years completed questionnaires, including assessments of EAC, at T1, and provided blood samples for immune assessments at T2.

RESULTS

When controlling for relevant biobehavioral controls, emotional processing predicted lower IL-6 (B=-.66, p<.01), sTNF-RII (B=-.43, p<.05), and CRP (B=-.43, p<.10), whereas emotional expression was significantly associated with higher levels of sTNF-RII (B=.55, p<.05). Associations of emotional expression and IL-6 (B=.38, p<.10), and CRP (B=.44, p<.10) approached significance. Probing interactions of emotional processing and expression (though only approaching significance) suggested that expression of emotion is associated with higher inflammation (CRP and sTNF-RII) only in the context of low emotional processing.

CONCLUSIONS

Attempts at emotion regulation via emotional processing appear to modulate inflammatory processes. Understanding, making meaning of, and working through emotional experience may be a promising target of intervention to reduce inflammation with potential effects on psychological and cancer outcomes in men with prostate cancer.

Gender representation of cancer patients in medical treatment and psychosocial survivorship research: changes over three decades

BACKGROUND

Prior studies raise concern about gender bias in cancer research, including insufficient inclusion of women or men, or studying women and men differently. The 1993 National Institutes of Health Revitalization Act aimed to eliminate gender bias in medicine. To examine changes in medical and psychological literature, this study reviews gender representation in biomedical treatment studies and psychosocial survivorship studies published in a single year.

METHODS

Research published in Cancer in 2007, and all empirical psychological studies about cancer published that year, provided a 15-year update to findings reported by Meyerowitz and Hart. The gender distribution and context of included articles were coded and compared with findings from 1983 and 1992.

RESULTS

Across biomedical studies, 34.3% of subjects were women (vs 47% of new cancers and 48% of cancer deaths). Among men, 41.3% had sex-specific cancers (vs 12.5% [1983] and 12.3% [1992]). Among women, 46.1% had sex-specific cancers (vs 69.1% [1983] and 64.6% [1992]). Fewer women (36.8%) were represented in sex-nonspecific cancer studies (vs 41.4% [1983] and 42.5% [1992]); however, fewer studies had a significant (>20%) gender disparity. Across psychosocial studies, representation of men increased to 47.9% (vs 30.4% [1983] and 29.9% [1992]). The proportion of men in studies of feelings/relationships increased to 47% (vs 22.9% [1992]); the proportion of women in studies assessing physical/functional ability increased to 58.3% (vs 45.4%).

CONCLUSIONS

Women remain under-represented in sex-nonspecific biomedical research, whereas men's representation in sex-specific research increased substantially. Psychosocial research trends suggest movement from research questions supporting traditional stereotypes that women feel and men act.

Post-traumatic disorder symptoms and blunted diurnal cortisol production in partners of prostate cancer patients

Prostate cancer (PC) is the most common cancer diagnosed in men, and research suggests that coping with this illness can cause significant distress in patients as well as their partners. This study examined the relationship of caregiving for a partner with PC with diurnal cortisol output in women between the ages of 42 and 75 years old. Participants were women whose partners had PC (n = 19) and women who were in relationships with men with no diagnosed medical illness (n = 26). Women provided saliva samples (4 times per day over 3 days) in their natural environment. The Structured Clinical Interview for DSM-IV Axis-I Disorders was also conducted to assess for the presence of post-traumatic stress disorder (PTSD) and major depression. Partners of men with PC had lower daily cortisol output across the three days than controls, F(1,444.08) = 20.72, p<.001). They were also more likely to report PTSD symptoms with 68.4% of PC partners fulfilling criteria for sub-threshold PTSD as compared to 23.1% of controls (χ(2) = 11.30, p = .01). Mixed model analyses revealed that the presence of sub-threshold PTSD symptoms significantly predicted cortisol production, F(1,419.64) = 5.10, p<.01). Regardless of caregiver status, women who reported at least sub-threshold PTSD symptoms had lower cortisol production than those with no PTSD symptoms. Major depression did not explain differences in cortisol production between partners of PC patients and controls. Although these findings are preliminary, they highlight the importance of developing interventions aimed at reducing risk of psychopathology in partners of men with PC.

Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer

BACKGROUND

Cancer patients are at increased risk for depression compared with individuals with no cancer diagnosis, yet few interventions target depressed cancer patients.

METHODS

Efficacy of psychotherapeutic and pharmacologic interventions for depression in cancer patients who met an entry threshold for depressive symptoms was examined by meta-analysis. Five electronic databases were systematically reviewed to identify randomized controlled trials meeting the selection criteria. Effect sizes were calculated using Hedges' g and were pooled to compare pre- and postrandomization depressive symptoms with a random effects model. Subgroup analyses tested moderators of effect sizes, such as comparison of different intervention modalities, with a mixed effects model. All statistical tests were two-sided.

RESULTS

Ten randomized controlled trials (six psychotherapeutic and four pharmacologic studies) met the selection criteria; 1362 participants with mixed cancer types and stages had been randomly assigned to treatment groups. One outlier trial was removed from analyses. The random effects model showed interventions to be superior to control conditions on reducing depressive symptoms postintervention (Hedges' g = 0.43, 95% confidence interval = 0.30 to 0.56, P < .001). In the four psychotherapeutic trials with follow-up assessment, interventions were more effective than control conditions up to 12-18 months after patients were randomly assigned to treatment groups (P < .001). Although each approach was more effective than the control conditions in improving depressive symptoms (P < .001), subgroup analyses showed that cognitive behavioral therapy appeared more effective than problem-solving therapy (P = .01), but not more effective than pharmacologic intervention (P = .07).

CONCLUSIONS

Our findings suggest that psychological and pharmacologic approaches can be targeted productively toward cancer patients with elevated depressive symptoms. Research is needed to maximize effectiveness, accessibility, and integration into clinical care of interventions for depressed cancer patients.

Gender representation of cancer patients in medical treatment and psychosocial survivorship research: changes over three decades

BACKGROUND

Prior studies raise concern about gender bias in cancer research, including insufficient inclusion of women or men, or studying women and men differently. The 1993 National Institutes of Health Revitalization Act aimed to eliminate gender bias in medicine. To examine changes in medical and psychological literature, this study reviews gender representation in biomedical treatment studies and psychosocial survivorship studies published in a single year.

METHODS

Research published in Cancer in 2007, and all empirical psychological studies about cancer published that year, provided a 15-year update to findings reported by Meyerowitz and Hart. The gender distribution and context of included articles were coded and compared with findings from 1983 and 1992.

RESULTS

Across biomedical studies, 34.3% of subjects were women (vs 47% of new cancers and 48% of cancer deaths). Among men, 41.3% had sex-specific cancers (vs 12.5% [1983] and 12.3% [1992]). Among women, 46.1% had sex-specific cancers (vs 69.1% [1983] and 64.6% [1992]). Fewer women (36.8%) were represented in sex-nonspecific cancer studies (vs 41.4% [1983] and 42.5% [1992]); however, fewer studies had a significant (>20%) gender disparity. Across psychosocial studies, representation of men increased to 47.9% (vs 30.4% [1983] and 29.9% [1992]). The proportion of men in studies of feelings/relationships increased to 47% (vs 22.9% [1992]); the proportion of women in studies assessing physical/functional ability increased to 58.3% (vs 45.4%).

CONCLUSIONS

Women remain under-represented in sex-nonspecific biomedical research, whereas men's representation in sex-specific research increased substantially. Psychosocial research trends suggest movement from research questions supporting traditional stereotypes that women feel and men act.

HIV/AIDS-related institutional mistrust among multiethnic men who have sex with men: effects on HIV testing and risk behaviors

OBJECTIVE

To investigate relationships between institutional mistrust (systematic discrimination, organizational suspicion, and conspiracy beliefs), HIV risk behaviors, and HIV testing in a multiethnic sample of men who have sex with men (MSM), and to test whether perceived susceptibility to HIV mediates these relationships for White and ethnic minority MSM.

METHOD

Participants were 394 MSM residing in Central Arizona (M age = 37 years). Three dimensions of mistrust were examined, including organizational suspicion, conspiracy beliefs, and systematic discrimination. Assessments of sexual risk behavior, HIV testing, and perceived susceptibility to HIV were made at study entry (T1) and again 6 months later (T2).

RESULTS

There were no main effects of institutional mistrust dimensions or ethnic minority status on T2 risk behavior, but the interaction of systematic discrimination and conspiracy beliefs with minority status was significant such that higher levels of systematic discrimination and more conspiracy beliefs were associated with increased risk only among ethnic minority MSM. Higher levels of systematic discrimination were significantly related to lower likelihood for HIV testing, and the interaction of organizational suspicion with minority status was significant such that greater levels of organizational suspicion were related to less likelihood of having been tested for HIV among ethnic minority MSM. Perceived susceptibility did not mediate these relationships.

CONCLUSION

Findings suggest that it is important to look further into the differential effects of institutional mistrust across marginalized groups, including sexual and ethnic minorities. Aspects of mistrust should be addressed in HIV prevention and counseling efforts.

Unmitigated agency, social support, and psychological adjustment in men with cancer

Unmitigated agency (UA), a gender-linked characteristic, has been associated with poorer cancer adjustment. Support from one's social network typically predicts adjustment but may be poorly matched to UA. The influence of UA on the utility of social support on adjustment over time is examined. Men with cancer (N=55) were assessed initially and 6 months later on three indicators of adjustment. Multilevel modeling analyses varied by adjustment indicator. UA was associated with increased cancer-related psychosocial symptoms but not depressive symptoms or cancer-related thought intrusion. Social support predicted fewer depressive symptoms and less cancer-related thought intrusion. However, a cross-level interaction revealed that the utility of social support on cancer-related thought intrusion was weaker for men with greater levels of UA. Men with cancer likely respond differently to changes in social support depending on their endorsement of UA.