Claudia Lampic

Short- and long-term anxiety and depression in women recalled after breast cancer screening

The aim was to investigate the psychological consequences of further investigation after breast cancer screening. Study participants include 509 women (61%) recalled due to suspicious findings on screening mammograms, and a matched control group of 285 women (68%) with normal mammograms. Psychological distress was prospectively assessed with the Hospital Anxiety and Depression Scale (HADS). 46% of the women reported borderline or clinically significant anxiety prior to the recall visit. A few days after the visit, anxiety and depression had decreased significantly (P<0.01) in women informed about normal or benign results at the recall clinic, while reported distress remained at relatively high levels in women referred to surgical biopsy. The results demonstrate the adverse short-term effect of a delay in receiving false-positive results, but do not indicate that the recall experience results in long-term anxiety or depression for a majority of women.

Attitudes toward parenthood and awareness of fertility among postgraduate students in Sweden

BACKGROUNDnPostponing childbirth is becoming increasingly common in Western countries, especially among women with higher education.nnnOBJECTIVEnThe aim of the present study was to investigate female and male postgraduate students attitudes toward parenthood, their intentions to have children, perceived obstacles to having or raising children during postgraduate studies, and their awareness of fertility issues.nnnMETHODSnA 52-question survey was mailed to randomly selected postgraduate students attending a Swedish university. The questionnaire was developed based on earlier research by, and the professional experience of, the authors. Three pilot studies were conducted to test the questionnaires reliability and validity. The t, x2, and Mann-Whitney U tests were used, as appropriate, to analyze responses.nnnRESULTSnTwo hundred female and 200 male postgraduate students aged<or=40 years received questionnaires. The response rate was 71% (n=141) among women and 58% (n=116) among men. Most childless respondents had positive attitudes toward parenthood and wanted to have 2 or 3 children, and a majority of women wanted to have their last child after age 35. Compared with men, women were more pessimistic about the effects of parenthood on their postgraduate studies, and perceived more problems related to balancing work and family life. One of 4 respondents overestimated a womans ability to become pregnant between 35 and 40 years of age, and about half had overly optimistic perceptions of the chances to have a baby by means of in vitro fertilization.nnnCONCLUSIONSnMost postgraduate students wanted to have children in the future. More women than men perceived that having children while completing postgraduate studies was or would be difficult, and that parenthood would negatively affect their status in the labor market. Because many female postgraduate students intend to have children at an age when female fecundity is decreased, information on fertility issues would help them make informed decisions regarding family planning.

Patient and Staff Perceptions of Cancer Patients' Psychological Concerns and Needs

This paper reviews patient and staff perceptions of cancer patients psychological concerns and needs. An extensive literature search resulted in a total of 22 studies. Six of these concern staff ratings of hypothetical average patients, and the main findings are that staff and patients are in relative agreement about the overall spectrum of concerns relevant to cancer patients, but less so regarding which concerns are of most importance to patients. Sixteen studies compare patient ratings with staff ratings of individual patients. The overall pattern of results indicates that staff tend to overestimate patient anxiety and emotional distress and show limited ability adequately to assess patient distress in terms of rank. Staff were able correctly to detect a majority of anxiety cases, while the identification of depression was less accurate. High detection rates for anxiety were obtained partly at the expense of staff also presuming anxiety in many non-distressed patients. Generally, there was better patient-staff agreement on the absence than the presence of patient anxiety and depression. Many studies were found to have serious methodological deficiencies and there is no clear evidence that patient-staff agreement is markedly better in studies fulfilling important methodological criteria. Several explanations of patient-staff discrepancies are discussed. Future research should be aimed at critically testing possible reasons for patient-staff disagreement and at investigating the consequences of such discrepancies.

Anxiety and cancer-related worry of cancer patients at routine follow-up visits.

Anxiety and cancer-related worry were assessed in 197 consecutive cancer patients attending follow-up visits. Participants completed questionnaires on three occasions: at the visit, some days later, and three weeks later. Results show that while a majority of patients feel no or only mild anxiety in conjunction to the follow-up visit, about one-fifth report moderate or strong anxiety. Many patients (46%) worry about suffering a recurrence and about overlooking symptoms of new cancer (33%). Patients who were not in complete remission reported higher levels of cancer-related worry concerning the follow-up visit than did patients in remission. Among patients in remission, those who recently terminated treatment reported more overall distress than patients two or more years since treatment termination.

Coping, Psychosocial Well-Being and Anxiety in Cancer Patients at Follow-up Visits

Coping, psychosocial well-being, situation-specific anxiety and cancer-related worry were assessed in 197 consecutive cancer patients attending follow-up visits. Participants completed questionnaire on three occasions: at the follow-up visit, some days later (n = 175) and three weeks later (n = 125). High levels of coping styles Anxious Preoccupation and Helplessness/Hopelessness were associated with low levels of psychosocial well-being, more situation-specific anxiety and more cancer-related worry. High levels of Fighting Spirit and Fatalistic were found to be associated with high psychosocial well-being and, for Fighting Spirit, also with less cancer-related worry. Patients with a dismal prognosis were found to have higher levels of Helplessness/Hopelessness than patients with a more favorable prognosis. Clinical implications of these findings are discussed.

Positive and negative consequences of childhood cancer influencing the lives of young adults

The aim of the study was to describe how young adults who have survived childhood cancer consider their present life to be influenced by the cancer experience. A cohort of 246 long-term survivors were approached a median of 16 years after diagnosis. Semi-structured telephone interviews were conducted based on the Swedish version of the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW). Interviews were analysed using content analyses. When asked if cancer negatively or positively currently affected their lives, 68% reported at least one negative consequence and 53% at least one positive consequence. The most frequently reported negative consequences include a variety of physical impairments and limitations in participating in activities; positive consequences describe a more positive view of life and of self. Women more often than men reported negative psychological impact, a changed body appearance and positive interaction with others. CNS tumours and combined treatment were somewhat associated to a higher extent of negative consequences. Overall, the results indicate that long-term survivors of childhood cancer are getting along quite well despite shortcomings.

Health related quality of life and psychosocial function among patients with carcinoid tumours. A longitudinal, prospective, and comparative study

BackgroundThe aim was to investigate HRQoL and psychosocial function among patients with carcinoid tumours, longitudinally and prospectively, and to compare HRQoL among patients with carcinoid tumours to that of the Swedish general population. The aim was also to investigate the prevalence of distress during the first year after diagnosis.MethodsAt four assessments during the first year after diagnosis, HRQoL was measured by the EORTC QLQ-C30 3.0, anxiety and depression by the HADS, and prevalence, and worst aspects of distress by an interview guide. ANOVA was performed in order to study changes over time with regard to HRQoL, anxiety and depression. Comparisons regarding HRQoL between patients and the Swedish population were made by the use of one-sample t-tests and changes over time regarding the prevalence of distress was investigated by means of Cochrans Q.ResultsHigh levels of physical-, emotional-, cognitive-, and social function and somewhat lower levels of role function and global quality of life were reported at all assessments. Role- and emotional function increased over time. Patients reported lower role function and global quality of life and more problems with fatigue and diarrhoea than the Swedish general population, at all assessments. Fatigue, limitations to work and pursue daily activities, and worry that the illness will get worse were among the most prevalent aspects at all assessments. At all assessments the majority reported worrying about the familys situation, the ability to care for the family, and worrying before the check-up.ConclusionIt is concluded that HRQoL and psychosocial function among patients with carcinoid tumours remains stable during the first year, that the patients report a lower HRQoL than the Swedish general population, and that a majority of the patients report a number of aspects of emotional distress. In the clinical care, it should be considered that the majority of patients report not only fatigue and diarrhoea but also worries about their prognosis, their families, tests, and examinations. Efforts to reduce these worries should be made.

The influence of a false-positive mammogram on a woman's subsequent behaviour for detecting breast cancer

The aim was to investigate the influence of undergoing further examinations due to a false-positive mammogram on womens re-attendance at the next scheduled screening and their frequency of breast self-examination (BSE). Study participants included 517 women (62% response) recalled due to findings on screening mammograms indicating possible malignancies, and a matched control group of 285 women (68% response) with normal mammograms. Participants completed five and three questionnaires, respectively, during the 2 years following screening participation. While the groups did not differ significantly in screening re-attendance, women recalled due to false-positive mammograms reported significantly higher levels of anxiety related to the next screening than did women with normal mammograms. At the 1-year assessment, women with false-positive mammograms reported a significantly higher frequency of BSE than did women with normal mammograms. The present results indicate that being recalled due to a false-positive mammogram does not seem to negatively affect screening re-attendance, and may have a positive impact on BSE.

Does enhanced information at cancer genetic counseling improve counselees' knowledge, risk perception, satisfaction and negotiation of information to at-risk relatives? : a randomized study

Purpose. The aim of the present randomized intervention study was to investigate the effect of receiving extended cancer genetic information on counselees’ knowledge, risk perception, information sharing and satisfaction with the service. Methods. In total, 147 counselees, affected by cancer and/or a family history of cancer, were randomized to extended or standard information. The levels of counselees’ knowledge and personal risk estimations were measured at four time points. In addition, counselees’ satisfaction with the counseling and sharing of the information to at-risk relatives was assessed. The intervention included meeting a specialist nurse, learning the breaking bad news method, receiving written material and video-taped counseling sessions. Results. A significant increase in the level of knowledge in participants in the “breast cancer group” regardless of the randomization was observed over time. The correct estimation of personal risk increased significantly in both groups after two weeks, but declined at the eight month follow-up. Most of the participants had informed at-risk relatives about their visit at the cancer genetic clinic. The majority of respondents in both groups were highly satisfied with the counseling. The only observed effects of the intervention were that counselees in the intervention group were significantly more satisfied with the content of the given information and with the way of informing relatives. Conclusion. Apparently, the current genetic counseling is managed properly and extended information does not seem necessary in all cases. However, some counselees need additional sessions.

Is satisfaction with doctors’ care related to health‐related quality of life, anxiety and depression among patients with carcinoid tumours? A longitudinal report

The aim of this study was to investigate (i) whether specific aspects of the initial consultation (IC) and/or patients satisfaction with doctors care are related to health-related quality of life (HRQoL), anxiety and depression among patients with carcinoid tumours and (ii) whether patients satisfaction with doctors care changes over time. The study has a longitudinal design. The HRQoL and psychosocial function among patients who met the doctors showing good ability to identify patients worry and wish for information were compared with those patients who met doctors showing less good ability. Patients HRQoL, anxiety, depression and satisfaction with doctors care were assessed longitudinally, shortly after each of the first four admissions to specialist care. Patients who met doctors showing good ability to identify their wish for information at the IC reported higher levels of cognitive function. Higher satisfaction with doctors care was related to higher emotional and cognitive function, to higher global QoL, and to lower levels of problems with diarrhoea, financial difficulties, constipation, anxiety and depression shortly after each of the first three admissions, although not after the fourth admission to the specialist care. Although most patients with carcinoid tumours report high satisfaction with care, it is important to be aware of the fact that some patients may be less satisfied. Doctors should provide patients with information which matches the individual patients needs and preferences as patients satisfaction with doctors provision of information is related to patients HRQoL, anxiety and depression.