C.F. van Uden-Kraan

Cancer patients’ experiences with and perceived outcomes of yoga: results from focus groups

PurposeYoga is a “mind–body” exercise, a combination of physical poses with breathing and meditation, and may have beneficial effects on physical and psychosocial symptoms. We aimed to explore cancer patients’ motives for practicing yoga, experiences of practicing yoga, and perceived physical and psychosocial outcomes.MethodsParticipants (n = 45) following yoga classes for cancer patients were asked to participate in focus group interviews, of whom 29 participated. The focus groups (n = 5) were audio taped with prior consent and transcribed verbatim. Data were analyzed by two coders and independently coded into key issues and themes.ResultsMean age of the participants was 53.8 (SD 10.8) years, of whom 25 were women, and 18 were diagnosed with breast cancer. Motives for participation in yoga were relaxation, the will to be physically active, the wish to pay more attention to one’s body, coping with psychosocial symptoms, contributing to their cancer rehabilitation process, and combing physical and mental processes. Main physical and psychosocial experiences of yoga mentioned by patients were regaining body awareness, raising attention to the inner self, learning how to relax, enjoyment, and finding recognition and understanding. Increased physical fitness and function, mental strength and resilience, increased coping, being more relaxed, and happiness were frequently mentioned experiences of patients.ConclusionsPatients with different types of cancer perceived several benefits on physical and psychosocial outcomes by practicing yoga. Therefore, yoga can be a valuable form of supportive care for cancer patients.

Efficacy of meaning-centered group psychotherapy for cancer survivors: a randomized controlled trial

BACKGROUND The aim of this study was to assess the efficacy of meaning-centered group psychotherapy for cancer survivors (MCGP-CS) to improve personal meaning, compared with supportive group psychotherapy (SGP) and care as usual (CAU). METHOD A total of 170 cancer survivors were randomly assigned to one of the three study arms: MCGP-CS (n = 57); SGP (n = 56); CAU (n = 57). The primary outcome measure was the Personal Meaning Profile (PMP; total score). Secondary outcome measures were subscales of the PMP, psychological well-being (Scales of Psychological Well-being; SPWB), post-traumatic growth (Posttraumatic Growth Inventory), Mental Adjustment to Cancer (MAC), optimism (Life Orientation Test-Revised), hopelessness (Becks Hopelessness Scale), psychological distress (anxiety and depression, Hospital Anxiety and Depression Scale; HADS) and quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; EORTC QLQ-C30). Outcome measures were assessed before randomization, post-intervention, and after 3 and 6 months of follow-up (FU). RESULTS Linear mixed model analyses (intention-to-treat) showed significant differences between MCGP-CS, SGP and CAU on the total PMP score, and on (sub)scales of the PMP, SPWB, MAC and HADS. Post-hoc analyses showed significantly stronger treatment effects of MCGP-CS compared with CAU on personal meaning (d = 0.81), goal-orientedness (d = 1.07), positive relations (d = 0.59), purpose in life (d = 0.69); fighting spirit (d = 0.61) (post-intervention) and helpless/hopeless (d = -0.87) (3 months FU); and distress (d = -0.6) and depression (d = -0.38) (6 months FU). Significantly stronger effects of MCGP-CS compared with SGP were found on personal growth (d = 0.57) (3 months FU) and environmental mastery (d = 0.66) (6 months FU). CONCLUSIONS MCGP-CS is an effective intervention for cancer survivors to improve personal meaning, psychological well-being and mental adjustment to cancer in the short term, and to reduce psychological distress in the long run.

Needs and Preferences of Partners of Cancer Patients Regarding a Web-Based Psychological Intervention: A Qualitative Study

Background Evidence-based, easily accessible, supportive interventions for partners of cancer patients are limited, despite the fact that they often suffer from diminished emotional, social, physical, and relational functioning. To develop a new intervention that will fit their demands, it is important to consult potential users. Objective To examine partners’ interest in a Web-based psychological intervention and to identify their needs and wishes regarding such an intervention. Methods Semistructured interviews were conducted with 16 partners of cancer patients, who varied in terms of age, gender, education, employment, type, and stage of disease. Partners were asked (1) whether they would use a psychological Web-based intervention and which preconditions (maximum time, structure, participate alone or with their partner) it should meet; (2) which functionalities (information, peer support, online psychological counseling) the intervention should contain; and (3) which topics (eg, taking care of oneself) should be addressed. Data were coded by 2 coders independently. Results The need for a Web-based intervention varied. Arguments for being interested in a Web-based intervention included the need for acknowledgement; the need for someone they could talk to; and the need for information, tips, and support. Based on their experiences as a partner of a cancer patient, participants would prefer an intervention that is not too time-consuming (about 1-2 hours a week) and which is based on a “step-by-step” approach, meaning that the content of the intervention should match the stage of their partner’s disease. Also, they would prefer a positive approach, which means that the intervention should be a source of hope and energy. Most participants stated that they would prefer to participate without their ill spouse, because they do not want to burden their partners with their own problems. An intervention should contain information and optional peer support. Participants’ opinions about online psychological counseling in the intervention were divided. Arguments for online psychological counseling were that a professional could check on them and they were able to ask questions. Arguments against online counseling were that partners were not in need for guidance or they had enough support from usual care. Topics with the highest priority were “coping with feelings and emotions,” “should I or shouldn’t I spare my partner?,” “communicating with each other,” “asking for help and refusing help,” and “moving on with life after cancer treatment.” Furthermore, participants suggested additional topics of “dare to enjoy” and “acceptance of the patient’s disease.” Conclusions A Web-based intervention can be a valuable addition to existing support initiatives for partners of cancer patients. This study provides important information about the content and form of such an intervention. Flexibility and a positive approach seem to be the most important features.

User-centered Design: Development of a Web-based Self-help Intervention for Partners of Cancer Patients

 Background/purpose: Many people living with cancer experience depression. Research suggests that the therapeutic effect of exercise on depression is similar to pharmacotherapy or psychological intervention, yet cancer survivors are under-exercising compared to recommended doses. Self-efficacy may be a factor to explain exercise engagement. This cross-sectional study investigated whether exercise task self-efficacy (ETSE) was associated with exercise engagement, further examining differences between cancer survivors with and without elevated depressive symptoms. Methods: Ninety-seven cancer survivors (60.8 ±9.9 years) were mailed self-report questionnaires on ETSE, exercise engagement, and depressive symptoms. A Hospital Anxiety and Depression Scale D cutoff score (≥8) was used to assign participants to a symptomatic (n = 34) or non-symptomatic group (n = 63). An independent t-test was used to examine differences in ETSE between groups. Correlational analyses were used to examine relationships between exercise task self-efficacy and exercise engagement. Results: There was a significant difference in the degree of exercise task self-efficacy between cancer survivors with (M=35.74, SD= 31.47) and without (M=57.30, SD= 26.71) depressive symptoms, t(95) =_3.56, p<0.01, with a large effect size (d =0.74). A positive association was found between ETSE and exercise engagement, r(95)= 0.49, p<0.01, which was similar for both groups. Conclusions: Exercise task self-efficacy appears to influence exercise engagement independently of mood status, but people with higher levels of depression symptoms tend to have lower self-efficacy. Therefore, future research should examine interventions to enhance exercise task self-efficacy, thereby potentially increasing exercise engagement in cancer survivors. Research Implications: These findings demonstrated that cancer survivors with depressive symptoms have low ETSE and that ETSE can predict exercise engagement. This suggests a role for enhancing ETSE to influence exercise engagement in cancer survivors. Future research could investigate causality between ETSE and exercise engagement and interventions to enhance ETSE. The findings of the present study could assist with more definitive research which could aid clinicians interested in behavioral change with regard to exercise engagement and improvement of depressive symptomatology in cancer survivors. Practice Implications: The findings illustrate that exercise self-efficacy predicts exercise engagement, independently of mood. Therefore, clinicians working with depressed or non-depressed cancer survivors should initially target increasing exercise self-efficacy as opposed to reinforcing the positive health benefits of increased physical activity.

An online psychological intervention for partners of cancer patients: interest, influencing factors and preferences

Nadine Köhle 1, Constance Drossaert2, Cornelia van Uden-Kraan3, Irma Verdonck -de Leeuw4, Ernst Bohlmeijer5 1University of Twente, Enschede, Overijssel, The Netherlands, 2University of Twente, Enschede, Overijssel, The Netherlands, 3VU University, Amsterdam, Noord-Holland, The Netherlands, 4VU University, Amsterdam, Noord-Holland, The Netherlands, 5University of Twente, Enschede, Overijssel, The NetherlandsFrom Vision to Action - Innovation and Implementation of an Integrated Cancer Rehabilitation Within Clinical Practice