Anna L. Hawkes

Describing and predicting psychological distress after colorectal cancer

Psychological distress in cancer survivors can be detrimental to treatment adherence and self‐care tasks and is associated with poor health behaviors and decreased overall quality of life. The prevalence, course, and predictors of psychological distress after the diagnosis of colorectal cancer are to date not well described.

Effects of a Telephone-Delivered Multiple Health Behavior Change Intervention (CanChange) on Health and Behavioral Outcomes in Survivors of Colorectal Cancer: A Randomized Controlled Trial

PURPOSE Colorectal cancer survivors are at risk for poor health outcomes because of unhealthy lifestyles, but few studies have developed translatable health behavior change interventions. This study aimed to determine the effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes among colorectal cancer survivors. METHODS In this two-group randomized controlled trial, 410 colorectal cancer survivors were randomly assigned to the health coaching intervention (11 theory-based telephone-delivered health coaching sessions delivered over 6 months focusing on physical activity, weight management, dietary habits, alcohol, and smoking) or usual care. Assessment of primary (ie, physical activity [Godin Leisure Time Index], health-related quality of life [HRQoL; Short Form-36], and cancer-related fatigue [Functional Assessment of Chronic Illness Therapy Fatigue Scale]) and secondary outcomes (ie, body mass index [kg/m(2)], diet and alcohol intake [Food Frequency Questionnaire], and smoking) were conducted at baseline and 6 and 12 months. RESULTS At 12 months, significant intervention effects were observed for moderate physical activity (28.5 minutes; P = .003), body mass index (-0.9 kg/m(2); P = .001), energy from total fat (-7.0%; P = .006), and energy from saturated fat (-2.8%; P = .016). A significant intervention effect was reported for vegetable intake (0.4 servings per day; P = .001) at 6 months. No significant group differences were found at 6 or 12 months for HRQoL, cancer-related fatigue, fruit, fiber, or alcohol intake, or smoking. CONCLUSION The CanChange intervention was effective for improving physical activity, dietary habits, and body mass index in colorectal cancer survivors. The intervention is translatable through existing telephone cancer support and information services in Australia and other countries.

A review of the cost-effectiveness of face-to-face behavioural interventions for smoking, physical activity, diet and alcohol

Objective: To assess the evidence for the cost-effectiveness of health behaviour interventions that address the major behavioural risk factors for chronic disease, including smoking, physical inactivity, poor diet, and alcohol misuse. Methods: Medical and economic databases were searched for relevant economic evaluations. Studies were critically appraised using a published 35-point checklist, and the results are described using a narrative approach, noting methodological limitations. The review included 64 studies from 1995—2005, including 17 reports on multiple behaviour interventions. Results: There was considerable variation among the studies by target populations, intervention components, primary outcomes, and economic methods, but the reported incremental cost-effectiveness ratios were consistently low (e.g. <14,000 per quality-adjusted life-year gained for smoking-cessation programmes in 2006 Euros) as compared to certain preventive pharmaceutical and invasive interventions. Interventions targeting high-risk-population subgroups were relatively better value for money as compared to those targeting general populations. Discussion: In general, the results of this review demonstrate favourable cost-effectiveness for smoking interventions, physical activity interventions and multiple behaviour interventions in high-risk groups. Although alcohol and dietary interventions appeared to be economically favourable, it is difficult to draw conclusions because of the variety in study outcomes. However, methodological limitations weaken the generalizability of findings, and suggest that the results of any given study should be considered carefully when being used to inform resource allocation.

Feasibility of brief psychological distress screening by a community-based telephone helpline for cancer patients and carers.

BackgroundUp to one-third of people affected by cancer experience ongoing psychological distress and would benefit from screening followed by an appropriate level of psychological intervention. This rarely occurs in routine clinical practice due to barriers such as lack of time and experience. This study investigated the feasibility of community-based telephone helpline operators screening callers affected by cancer for their level of distress using a brief screening tool (Distress Thermometer), and triaging to the appropriate level of care using a tiered model.MethodsConsecutive cancer patients and carers who contacted the helpline from September-December 2006 (n = 341) were invited to participate. Routine screening and triage was conducted by helpline operators at this time. Additional socio-demographic and psychosocial adjustment data were collected by telephone interview by research staff following the initial call.ResultsThe Distress Thermometer had good overall accuracy in detecting general psychosocial morbidity (Hospital Anxiety and Depression Scale cut-off score ≥ 15) for cancer patients (AUC = 0.73) and carers (AUC = 0.70). We found 73% of participants met the Distress Thermometer cut-off for distress caseness according to the Hospital Anxiety and Depression Scale (a score ≥ 4), and optimal sensitivity (83%, 77%) and specificity (51%, 48%) were obtained with cut-offs of ≥ 4 and ≥ 6 in the patient and carer groups respectively. Distress was significantly associated with the Hospital Anxiety and Depression Scale scores (total, as well as anxiety and depression subscales) and level of care in cancer patients, as well as with the Hospital Anxiety and Depression Scale anxiety subscale for carers. There was a trend for more highly distressed callers to be triaged to more intensive care, with patients with distress scores ≥ 4 more likely to receive extended or specialist care.ConclusionsOur data suggest that it was feasible for community-based cancer helpline operators to screen callers for distress using a brief screening tool, the Distress Thermometer, and to triage callers to an appropriate level of care using a tiered model. The Distress Thermometer is a rapid and non-invasive alternative to longer psychometric instruments, and may provide part of the solution in ensuring distressed patients and carers affected by cancer are identified and supported appropriately.

Antecedents of domain‐specific quality of life after colorectal cancer

Objective: The present study prospectively assessed the influence of medical, socio‐demographic, psychological, and lifestyle variables on physical, social/family, emotional, functional well‐being and colorectal cancer‐specific concerns in a population‐based sample of colorectal cancer survivors.

Assessing emotional status following acquired brain injury: The clinical potential of the depression, anxiety and stress scales

Primary objective: To investigate the clinical potential of the Depression, Anxiety and Stress Scales (DASS 42) and its shorter version (DASS 21) for assessing emotional status following acquired brain injury. Methods and procedures: Participants included 23 individuals with traumatic brain injury (TBI), 25 individuals with brain tumour and 29 non-clinical controls. Investigations of internal consistency, test–re-test reliability, theory-consistent differences, sensitivity to change and concurrent validity were conducted. Main outcomes and results: Internal consistency of the DASS was generally acceptable (r > 0.70), with the exception of the anxiety scale for the TBI sample. Test–re-test reliability (1–3 weeks) was sound for the depression scale (r > 0.75) and significant but comparatively lower for other scales (r = 0.60–0.73, p < 0.01). Theory-consistent differences were only evident between the brain tumour sample and non-clinical control sample on the anxiety scale (p < 0.01). Sensitivity to change of the DASS in the context of hospital discharge was demonstrated for depression and stress (p < 0.01), but not for anxiety (p > 0.05). Concurrent validity with the Hospital Anxiety and Depression Scale was significant for all scales of the DASS (p < 0.05). Conclusions: While the results generally support the clinical application of the DASS following ABI, further research examining the factor structure of existing and modified versions of the DASS is recommended.

A biopsychosocial perspective on adjustment and quality of life following brain tumor: A systematic evaluation of the literature

Purpose. To systematically evaluate the literature on quality of life and adjustment to brain tumor from a biopsychosocial perspective. Methods. On the basis of the cancer and brain injury literature, a biopsychosocial organisational framework was initially developed to support an evaluative review of the brain tumor literature. This framework consisted of four themes relating to pre-illness characteristics, neuropathology, personal appraisals and reactions and social support. Electronic searches of Medline, PsycINFO and CINAHL databases identified 48 empirical studies (1980–2007) that investigated factors associated with quality of life or the adjustment of adults with brain tumor. A review of studies within each theme appraised these findings and evaluated the quality of methodology and extent to which biopsychosocial perspectives have guided investigations. Results. Overall, the review identified consistent associations between depression, performance status, fatigue and quality of life. Seven multivariate studies with strong methodology that adopted a biopsychosocial perspective were found. In general, the relationships among pre-illness and brain tumor characteristics, psychosocial variables and quality of life were unclear and various gaps in the literature emerged. Conclusions. Empirical findings within a biopsychosocial perspective may guide the development and delivery of support services for individuals with brain tumor; however, many important areas exist for future research.

A telephone-delivered lifestyle intervention for colorectal cancer survivors ‘CanChange’: a pilot study

Objective: To investigate the feasibility and short‐term effectiveness of a lifestyle intervention for colorectal cancer (CRC) survivors.

Acceptability of the Distress Thermometer and Problem List to community-based telephone cancer helpline operators, and to cancer patients and carers

BackgroundCancer can be a distressing experience for cancer patients and carers, impacting on psychological, social, physical and spiritual functioning. However, health professionals often fail to detect distress in their patients due to time constraints and a lack of experience. Also, with the focus on the patient, carer needs are often overlooked. This study investigated the acceptability of brief distress screening with the Distress Thermometer (DT) and Problem List (PL) to operators of a community-based telephone helpline, as well as to cancer patients and carers calling the service.MethodsOperators (n = 18) monitored usage of the DT and PL with callers (cancer patients/carers, >18 years, and English-speaking) from September-December 2006 (n = 666). The DT is a single item, 11-point scale to rate level of distress. The associated PL identifies the cause of distress.ResultsThe DT and PL were used on 90% of eligible callers, most providing valid responses. Benefits included having an objective, structured and consistent means for distress screening and triage to supportive care services. Reported challenges included apparent inappropriateness of the tools due to the nature of the call or level of caller distress, the DT numeric scale, and the level of operator training.ConclusionsWe observed positive outcomes to using the DT and PL, although operators reported some challenges. Overcoming these challenges may improve distress screening particularly by less experienced clinicians, and further development of the PL items and DT scale may assist with administration. The DT and PL allow clinicians to direct/prioritise interventions or referrals, although ongoing training and support is critical in distress screening.

Up to one third of individual cardiac patients have a decline in quality of life post-intervention

Objective. To investigate clinically relevant intra-individual and mean changes in health-related quality of life (HRQoL) with the Short Form-36 Health Survey (SF-36) need to acknowledge that SF-36 is trademarked ie: SF-36® following cardiac intervention for Australian and Danish patients. Design. Prospective observational study in tertiary cardiac centres in Townsville, Queensland, Australia and Copenhagen, Denmark. Two hundred coronary artery bypass graft surgery (CABG) patients of two Townsville hospitals, and 47 CABG or percutaneous coronary intervention (PCI) patients of a Copenhagen hospital. The main outcome measures are eight SF-36 health subscales at baseline and six months post-intervention. Results. Australian and Danish patients experienced similar HRQoL pre-intervention. By six months post-intervention, patients experienced a significant mean improvement in all subscales of the SF-36 survey (p ≤ 0.05), although up to 27% of patients had a clinically significant decline in HRQoL from baseline. Conclusions. These results demonstrate that it is necessary to investigate intra-individual changes in HRQoL as well as group mean changes as they produce different conclusions. In addition, establishing clinically significant intra-individual change standards may assist researchers and clinicians in determining whether an individual may benefit from therapy or intervention.