Felicity W. K. Harper

A Phase II Trial of 17-Allylamino-17-Demethoxygeldanamycin in Patients with Hormone-Refractory Metastatic Prostate Cancer

Purpose: 17-Allylamino-17-demethoxygeldanamycin (17-AAG) is a benzoquinone ansamycin antibiotic with antiproliferative activity in several mouse xenograft models, including prostate cancer models. A two-stage phase II study was conducted to assess the activity and toxicity profile of 17-AAG administered to patients with metastatic, hormone-refractory prostate cancer. Experimental Design: Patients with at least one prior systemic therapy and a rising prostate-specific antigen (PSA) were eligible. Patients received 17-AAG at a dose of 300 mg/m2 i.v. weekly for 3 of 4 weeks. The primary objective was to assess the PSA response. Secondary objectives were to determine overall survival, to assess toxicity, and to measure interleukin-6, interleukin-8, and maspin levels and quality of life. Results: Fifteen eligible patients were enrolled. The median age was 68 years and the median PSA was 261 ng/mL. Patients received 17-AAG for a median number of two cycles. Severe adverse events included grade 3 fatigue (four patients), grade 3 lymphopenia (two patients), and grade 3 back pain (two patients). The median PSA progression-free survival was 1.8 months (95% confidence interval, 1.3-3.4 months). The 6-month overall survival was 71% (95% confidence interval, 52-100%). Conclusions: 17-AAG did not show any activity with regard to PSA response. Due to insufficient PSA response, enrollment was stopped at the end of first stage per study design. The most significant severe toxicity was grade 3 fatigue. Further evaluation of 17-AAG at a dose of 300 mg/m2 i.v. weekly as a single agent in patients with metastatic, hormone-refractory prostate cancer who received at least one prior systemic therapy is not warranted.

Patient, companion, and oncologist agreement regarding information discussed during triadic oncology clinical interactions

Although people with cancer want and need information from their oncologists, patients and oncologists often disagree about what information was discussed during clinical interactions. Most patients have companions present during oncology visits; we investigated whether companions process information more accurately than patients. Specifically, we examined whether patients and companions differed in agreement with oncologists about what was discussed. We also investigated the effect of topic on agreement and patient/companion self‐reported understanding of discussions.

Children's Positive Dispositional Attributes, Parents’ Empathic Responses, and Children's Responses to Painful Pediatric Oncology Treatment Procedures

Pain/distress during pediatric cancer treatments has substantial psychosocial consequences for children and families. The authors examined relationships between childrens positive dispositional attributes, parents’ empathic responses, and childrens pain/distress responses to treatment procedures. Participants were 41 pediatric cancer patients and parents. Several weeks before treatment, parents rated childrens resilience and positive dimensions of temperament. Parents’ pretreatment empathic affective responses to their children were assessed. Childrens pain/distress during treatments was rated by multiple independent raters. Childrens resilience was significantly and positively associated with parents’ empathic affective responses and negatively associated with childrens pain/distress. Childrens adaptability and attention focusing also showed positive relationships (p < 0.10) with parents’ empathic responses. Parents’ empathic responses mediated effects of childrens resilience on childrens pain/distress. Childrens positive dispositional attributes influence their pain/distress during cancer treatments; however, these effects may be mediated by parents’ empathic responses. These relationships provide critical understanding of the influence of parent–child relationships on coping with treatment.

The importance of contextual factors and age in association with anxiety and depression in Black breast cancer patients

Limited research exists on correlates of psychosocial distress in Black breast cancer patients. The goals of the study were to describe the prevalence of distress (anxiety and depression) in Black women with breast cancer and to examine the influence of demographic, clinical, contextual (e.g., self‐efficacy, medical mistrust), and process of care factors (e.g., patient satisfaction) on womens level of anxiety and depression.

Randomized trial of a question prompt list to increase patient active participation during interactions with black patients and their oncologists

OBJECTIVE Communication during racially-discordant interactions is often of poor quality and may contribute to racial treatment disparities. We evaluated an intervention designed to increase patient active participation and other communication-related outcomes during interactions between Black patients and non-Black oncologists. METHODS Participants were 18 non-Black medical oncologists and 114 Black patients at two cancer hospitals in Detroit, Michigan, USA. Before a clinic visit to discuss treatment, patients were randomly assigned to usual care or to one of two question prompt list (QPL) formats: booklet (QPL-Only), or booklet and communication coach (QPL-plus-Coach). Patient-oncologist interactions were video recorded. Patients reported perceptions of the intervention, oncologist communication, role in treatment decisions, and trust in the oncologist. Observers assessed interaction length, patient active participation, and oncologist communication. RESULTS The intervention was viewed positively and did not increase interaction length. The QPL-only format increased patient active participation; the QPL-plus-Coach format decreased patient perceptions of oncologist communication. No other significant effects were found. CONCLUSION This QPL booklet is acceptable and increases patient active participation in racially-discordant oncology interactions. Future research should investigate whether adding physician-focused interventions might improve other outcomes. PRACTICE IMPLICATIONS This QPL booklet is acceptable and can improve patient active participation in racially-discordant oncology interactions.

Satisfaction with support versus size of network: Differential effects of social support on psychological distress in parents of pediatric cancer patients

This study examined the direct and buffering effects of social support on longer‐term global psychological distress among parents coping with pediatric cancer. In both sets of analyses, we examined whether these effects depended on the dimension of social support provided (i.e., satisfaction with support versus size of support network).

Self-distancing buffers high trait anxious pediatric cancer caregivers against short- and longer-term distress

Pediatric cancer caregivers are typically present at their child’s frequent, invasive treatments, and such treatments elicit substantial distress. Yet variability exists in how even the most anxious caregivers cope. Here we examined one potential source of this variability: caregivers’ tendencies to self-distance when reflecting on their feelings surrounding their child’s treatments. We measured caregivers’ self-distancing and trait anxiety at baseline, anticipatory anxiety during their child’s treatment procedures, and psychological distress and avoidance 3 months later. Self-distancing buffered high (but not low) trait anxious caregivers against short- and long-term distress without promoting avoidance. These findings held when controlling for other buffers, highlighting the unique benefits of self-distancing. These results identify a coping process that buffers vulnerable caregivers against a chronic life stressor while also demonstrating the ecological validity of laboratory research on self-distancing. Future research is needed to explicate causality and the cognitive and physiological processes that mediate these results.

Parent Caregiver Self-Efficacy and Child Reactions to Pediatric Cancer Treatment Procedures

This study examined how parents’ sense of self-efficacy specific to caregiving for their child during cancer treatment procedures affected children’s distress and cooperation during procedures. Potential correlates of caregiver self-efficacy (ie, demographics, child clinical characteristics, parent dispositional attributes, and social support) were also examined. Participants were 119 children undergoing cancer treatment procedures and their parents. Parents’ self-efficacy about 6 procedure-specific caregiver tasks was measured. Parents, children, nurses, and observers rated child distress and parents, nurses and observers rated child cooperation during procedures. Higher parent self-efficacy about keeping children calm during procedures predicted lower child distress and higher child cooperation during procedures. Parent dispositional attributes (eg, enduring positive mood, empathy) and social support predicted self-efficacy. Parent caregiver self-efficacy influences child distress and cooperation during procedures and is associated with certain parent attributes. Findings suggest the utility of identifying parents who would benefit from targeted interventions to increase self-efficacy about caregiving during treatment procedures.

Pediatric Cancer Patients' Treatment-Related Distress and Longer-Term Anxiety: An Individual Differences Perspective

Objective: Although distress during treatment procedures and longer-term treatment-related anxiety are among the most common cancer-related stressors for children and their families, they are not invariant. This study examined whether individual differences in temperament and personality play a role in how children respond to treatment procedures. Attention control, a facet of the effortful control dimension of temperament, and the personality attribute ego-resilience were hypothesized to predict lower levels of distress during procedures. Moreover, ego-resilience and distress during procedures were hypothesized to account for indirect associations between attention control and longer-term treatment-related anxiety. Child gender was examined as a potential moderator of these relationships. Method: Participants were 147 children undergoing treatment for pediatric cancer and their parents. At baseline, parents reported on childrens effortful control and ego-resilience. Multiple raters assessed childrens distress during multiple cancer-related procedures. Treatment-related anxiety was measured 3 and 9 months after the last assessed treatment procedure. Results: Attention control was linked to ego-resilience and lower levels of distress, and these variables, in turn, accounted for indirect associations between attention control and treatment-related anxiety. Associations involving ego-resilience were stronger for boys than girls. Conclusion: Attention control plays an important role in childrens immediate and longer-term responses to cancer-related medical procedures. Medical staff should consider individual differences in child temperament and personality when considering the nature and extent of support to provide to pediatric cancer patients and their families.

Abstract A9: Perceptions of information provided by oncologists in clinical interactions with black and white patients/companions

Purpose: Most patients want and need information about their cancer and their preferred source is a health care provider. Previous studies show the quality of communication between oncologists and black patients is often of lower quality than with white patients. The purpose of this study was to assess differences in perceptions by black and white patients and their companions about information provided during initial oncology interactions. Methods: Data collection occurred in the multidisciplinary outpatient clinic of a comprehensive cancer center serving a majority black population in Detroit. The research was part of a larger study on oncologist-patient-companion communication. Patients were eligible if this was their first visit and they had a companion with them. Patients, oncologists, and companions independently completed questionnaires assessing their perceptions of whether each of 6 topics had been discussed (diagnosis, prognosis, metastasis, treatment, side effects, next steps), and if so, what the oncologist said about the topic. In addition, participants were asked how well the patient understood each of the topics discussed. Patients were also asked how much they agreed with the oncologists’ diagnosis. Results: The sample included 61 oncology patients (18% black, 82% white), their companions, and eight oncologists (all non-black). Black patients were underrepresented because they were much less likely to bring a companion. No black-white differences were found in how often patients and companions agreed with their oncologists as to whether the topics were discussed or what the oncologist said about the topics. For both blacks and whites, the greatest agreement with the oncologist was about diagnosis and the least was about side effects. Although no black-white differences occurred in agreement about whether or not side effects were discussed, pairs that agreed reported that side effects were not discussed in 38% of interactions with blacks and not discussed in only 3% of interactions with whites (p =.002). Companions reported a similar pattern of black-white disparities regarding side effects. No differences were found in oncologist reports of how well black v. white patients understood each topic, but black patients reported significantly less understanding of the discussion of diagnosis than did White patients (p=.001). Further, blacks reported less agreement than whites with their oncologists’ opinions of the seriousness of the cancer (p=.05) and how much it had spread (p Conclusion: We found few black-white differences in patient and companion agreement with oncologists regarding perceptions of what was discussed during the interactions. However, findings suggest oncologists discuss side effects less frequently with blacks than with whites. Also, blacks report less understanding and more disagreement with oncologists than white patients. A limitation was the underrepresentation of blacks because they frequently did not have a companion present; future studies should compare the quality of information exchange between oncologists and black patients with and without companions. This study suggests interventions are needed to improve the quality of information exchange for black patients in cancer clinical interactions. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A9.