Catalina Lawsin

Randomized Clinical Trial of Telephone-Administered Cognitive-Behavioral Therapy to Reduce Post-Traumatic Stress Disorder and Distress Symptoms After Hematopoietic Stem-Cell Transplantation

PURPOSE A significant number of survivors of hematopoietic stem-cell transplantation (HSCT) report enduring adverse effects of treatment, including illness-related post-traumatic stress disorder (PTSD) symptoms and general distress. We report results of a randomized clinical trial that tested the effects of a 10-session, telephone-administered cognitive-behavioral therapy (CBT) intervention on PTSD, depression, and distress symptoms. METHODS Survivors who had undergone HSCT 1 to 3 years earlier (N = 408) were assessed for study eligibility. Those who met study eligibility criteria (n = 89) completed a baseline assessment that included a clinical interview and self-report measures of PTSD symptoms (the primary outcome) and depression and general distress (the secondary outcomes). Next, they were randomly assigned to CBT or an assessment-only condition. Survivors in the CBT group completed 10 individual telephone-based CBT sessions (T-CBT) that included strategies to reduce PTSD symptoms, depression, and general distress. Follow-up assessments occurred at 6, 9, and 12 months after the baseline assessment. RESULTS Linear mixed-model analyses revealed that, compared with HSCT survivors in the assessment-only condition, survivors who completed T-CBT reported fewer illness-related PTSD symptoms, including less avoidance (P < .001) and fewer intrusive thoughts (P < .05) as well as less general distress and fewer depressive symptoms (P < .05) even after controlling for potential demographic and medical covariates. These results were consistent across the three follow-up assessments. CONCLUSION A brief, telephone-administered CBT intervention developed for HSCT survivors is an efficacious treatment for reducing illness-related PTSD symptoms and general distress.

The unmet needs of partners and caregivers of adults diagnosed with cancer: a systematic review

Objectives The recognition that a partner or caregiver is typically the patients primary support person and is also deeply affected by the cancer diagnosis has prompted efforts to document their unmet supportive care needs. This review aimed to: (1) quantify the prevalence of unmet needs reported by partners and caregivers, (2) categorise their unmet needs by domain and (3) identify the main variables associated with reporting more unmet needs. Methods Manuscripts were identified through systematically searching electronic databases, checking the reference lists of retrieved publications, online searching of key journals and contacting researchers in this field. Results Unmet need items across 29 manuscripts were clustered into six domains: comprehensive cancer care (prevalence 1.1%–96%), emotional and psychological (3%–93.2%), partner or caregiver impact and daily activities (2.8%–79%), relationship (3.7% and 58%), information (2.2%–86%) and spiritual (2%–43%). Studies of caregivers of palliative care or terminal patients often reported a higher prevalence of unmet needs than studies of caregivers of cancer survivors. Variables associated with higher unmet needs included being female, not being the spouse of the patient, having lower social support or reporting distress. Conclusions Despite the ability to classify unmet needs within broad domains, quantification of unmet needs was challenging. This was mainly due to the diversity in methods used across studies (eg, different measures, variability in conceptualisation of unmet needs, etc). Rigorous, context-specific, longitudinal studies that use validated measures are needed to benefit future intervention research.

Demographic, medical, and psychosocial correlates to CAM use among survivors of colorectal cancer

Goals of workComplementary and alternative medicines (CAM) use among cancer patients is becoming more prevalent; however, our understanding of factors contributing to patients’ decisions to participate in CAM is limited. This study examined correlates of CAM use among colorectal cancer (CRC) survivors, an understudied population that experiences many physical and psychological difficulties.Materials and methodsThe sample was 191, predominantly white, CRC survivors (mean age = 59.9 ± 12.6) who were members of a colon disease registry at a NYC metropolitan hospital. Participants completed assessments of sociodemographic characteristics, psychosocial factors [e.g., psychological functioning, cancer specific distress, social support (SS), quality of life (QOL)], and past CAM use (e.g., chiropractic care, acupuncture, relaxation, hypnosis, and homeopathy).Main resultsSeventy-five percent of participants reported using at least one type of CAM; most frequently reported was home remedies (37%). Younger (p < 0.01) or female patients (p < 0.01) were more likely to participate in CAM than their older male counterparts. Among psychosocial factors, poorer perceived SS (p = 0.00), more intrusive thoughts (p < 0.05), and poorer overall perceived QOL (p < 0.05) were associated to CAM use. In a linear regression model (including age, gender, SS, intrusive thoughts, and perceived QOL), only age remained a significant predictor of CAM use.ConclusionThese findings demonstrate that CAM use is prevalent among CRC survivors and should be assessed routinely by providers. CAMs may serve as a relevant adjunct to treatment among CRC patients as well as an indication of need for additional SS, especially among younger patients.

Peer Mentoring and Survivors' Stories for Cancer Patients: Positive Effects and Some Cautionary Notes

Providing patients with adequate information produces better medical outcomes, less distress, higher quality of life, and better preparation for active involvement in treatment—benefits that have energized research on the effective delivery of information to patients. For the most part, this research has focused on information and statistics relevant to treatment and prognosis. However, patients are increasingly coming into contact with another form of information about which little is known —namely, information describing the experiences of fellow cancer patients, or experiential information. For instance, the Internet makes this information available through patient-oriented chat rooms, bulletin boards, and a growing number of popular Web sites featuring survivors’ stories, case studies, and testimonials. Apart from the Internet, patients learn about other patients’ experiences in the popular media and through peer mentoring or buddy programs made available by treatment centers or cancer organizations. These programs enable patients to receive encouragement, support, and guidance from people with first-hand knowledge of the difficulties and fears they may be experiencing. Peer mentors may, or may not, be formally trained and are free to share any aspect of their experience they deem helpful, including information about their treatment decisions, effects of treatment, coping strategies, and recovery obstacles. In so doing, they attempt to communicate both factual information and information about normal or desirable ways to respond to cancer. Generally speaking, patients like getting experiential information, and many former patients enjoy providing it. At the same time, the informational content of peer mentoring and survivors’ stories has the potential to influence patients in significant ways. Yet little is known about how patients use this information or how it affects them. When does it give them hope, and when does it frighten them? Does it facilitate, or complicate, decision making? Under what circumstances is it helpful versus harmful? To begin investigating the answers to such questions, cancer patients’ responses to interview questions assessing how they communicated their thoughts and emotions during treatment were analyzed. Participants consisted of 20 men and 10 women completing a screening protocol for a multisite trial testing a psychological intervention for hematopoietic stem-cell transplant (HSCT) survivors. All study procedures were approved by the institutional review boards at the study sites, and patients provided signed informed consent. All patients had undergone HSCT 1 to 3 years earlier to treat hematologic malignancies such as multiple myeloma, lymphoma, and leukemia, and all were English speakers who were at least 18 years old at recruitment and at least 16 years old at transplantation. They were, on average, 54 years old, married (n 25), white (n 25), and well-educated (22 had college or graduate degrees). Most (n 25) reported an annual household income of more than

Body image as a predictor of psychopathology in surgical patients with colorectal disease

80,000. Content analysis of their responses to interview questions identified 10 functions of communication. Of the four most commonly mentioned functions, three prominently featured contact with other patients and/or exposure to information about their experiences: preparatory coping, social comparison, and negative effects. This article focuses on results involving these three functions of communication because of their relevance for understanding the effects of experiential information on cancer patients.

“You need something like this to give you guidelines on what to do”: patients' and partners' use and perceptions of a self-directed coping skills training resource

OBJECTIVE This study aimed to test the relevance of a cognitive behavioural model of body image in a prospective study of colorectal surgery patients and to determine if pre-existing body image disturbance influenced psychological adjustment following surgery. METHODS Sixty-seven adult consecutive colorectal surgery patients completed measures assessing psychopathology, body image related beliefs and health related quality of life during pre-admission for surgery using a questionnaire battery. Each participant was followed up three months after surgery. RESULTS Depression and anxiety were positively correlated with body image disturbance and self evaluation at baseline. Those patients who went on to receive stomas experienced a significant deterioration in their body image that was not observed in those whose surgery did not result in the formation of a stoma. In the regression analysis, body image disturbance was a significant predictor of baseline levels of depression and emotional quality of life. Initial levels of body image disturbance remained a significant predictor of depression and anxiety at follow up assessment after medical variables and baseline levels of depression and anxiety, respectively, had been controlled for. CONCLUSION Our findings support the hypothesis that pre-existing vulnerabilities in body image influence emotional adjustment during the recovery phase following surgery. Further research on screening for body image disturbance in surgical patients in order to promote adjustment is warranted.

Burnout and the provision of psychosocial care amongst Australian cancer nurses.

PurposeThis study aims to report on the acceptability of a self-directed coping skills intervention, called Coping-Together, for patients affected by cancer and their partners, including the strengths and limitations of the intervention design.MethodsThis initial version of Coping-Together included a series of four booklets, which aimed to provide practical coping strategies for the day-to-day management of common physical and psychosocial challenges. Thirty semi-structured interviews were conducted with 27 patients and/or 14 partners. Interviews were audiorecorded, transcribed verbatim, and analyzed for content.ResultsParticipants endorsed the self-directed format, and the focus of Coping-Together on practical information was a feature that set it apart from other resources. The majority of participants interviewed felt that the proposed coping strategies were “doable”; however, only half of the participants reported learning new coping skills after reading the booklets. Additional benefits of reading the booklets were increasing awareness of challenges to prepare for, giving hope that something can help you “pull through”, providing a sense of normality, connecting patients and partners to people and services, and complementing support received from health professionals. Despite the general acceptability of the intervention, some aspects of its design were criticized, including the workbook-like exercises, expectations about using the resource together, level of guidance provided, and amount of information included. In general, most participants felt that too much negative information was included, whereas more experiential information was desired.ConclusionsPreliminary evaluation of Coping-Together supported its practical approach and highlighted improvements to enhance its contribution to patient and partner coping.

Latinas' appraisal of participation in breast cancer prevention clinical trials.

PURPOSE To assess the prevalence of burnout amongst Australian cancer nurses as well as investigate the systemic and individual factors associated with burnout, including training and supervision for nurses in psychosocial care. Burnout amongst cancer nurses can have serious consequences for the individual nurse, the hospital and patients. Psychosocial care has been demonstrated in many studies to reduce distress in cancer patients; however, previous studies have suggested that providing psychosocial care can be stressful if nurses feel they lack appropriate training. Psychosocial skill training and supervision may be a way of improving job satisfaction and reducing burnout amongst nurses. METHOD Two hundred and thirty cancer nurses were recruited between November 2010 and April 2011 and completed an online questionnaire. RESULTS Burnout levels within this population were found to be below nursing norms. Adequacy of training and supervision, frequency of supervision and percentage of role spent managing psychosocial care were found to be associated with burnout. Workload, Control, Reward and Community were independent predictors of burnout, and nurses with a greater mismatch in these areas identified as having High levels of burnout. CONCLUSIONS Strategies to reduce burnout include providing cancer nurses with a varied and sustainable workload, awarding financial and social recognition of efforts and encouraging nurses to develop a sense of control over their work. Providing regular training and supervision in psychosocial care that is perceived to be adequate may also assist in reducing burnout.

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

have proposed a conceptual model to under-stand the factors that influence the lack of participationby ethnic minority women and to design outreach inter-ventions to recruit these women more successfully. Themodel outlines the interplay of three factors found to berelevant to the recruitment of ethnic minorities intoresearch studies: awareness, acceptability, and access.Basically, women must have an understanding of theimportance of the research (awareness), an appraisal thatsociety approves of their participation (acceptability),andthe presence of adequate resources to overcome partici-pation barriers (access).Many ethnic minority women,including Latinas,havebeen observed to have limited or no awareness about theimportance of clinical trials research or the proceduresinvolved in such studies. Moreover, their acceptance ofand participation in clinical trials might be dependent ona particular ethnic groups social, psychological, and cul-tural factors related to seeking health care services.Group-specific studies rather than studies that generalizeacross ethnic minority groups may be needed. Access bar-riers might be somewhat more similar across disadvan-taged ethnic minority groups because these barriers aremore likely to be linked to low socioeconomic status,health literacy levels, and institutional practices. Thus, alogical first step in an effort to increase Latinas’participa-tion in clinical trials is to understand their level of clinicaltrials knowledge and their views about what factorswould motivate or discourage them from enrolling andadhering to clinical trials in the context of social,psycho-logical, and cultural variables. The aim of this pilot studyis to contribute to such understanding.

M1043 Sociodemographic Correlates of Stage of Adoption for Colorectal Cancer Screening in African Americans

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).