Karen Clark

Anterior Hypopituitarism in Adult Survivors of Childhood Cancers Treated With Cranial Radiotherapy: A Report From the St Jude Lifetime Cohort Study

PURPOSEnTo estimate the prevalence of and risk factors for growth hormone deficiency (GHD), luteinizing hormone/follicle-stimulating hormone deficiencies (LH/FSHD), thyroid-stimulatin hormone deficiency (TSHD), and adrenocorticotropic hormone deficiency (ACTHD) after cranial radiotherapy (CRT) in childhood cancer survivors (CCS) and assess the impact of untreated deficiencies.nnnPATIENTS AND METHODSnRetrospective study in an established cohort of CCS with 748 participants treated with CRT (394 men; mean age, 34.2 years [range, 19.4 to 59.6 years] observed for a mean of 27.3 years [range, 10.8 to 47.7 years]). Multivariable logistic regression was used to study associations between demographic and treatment-related risk factors and pituitary deficiencies, as well as associations between untreated deficiencies and cardiovascular health, bone mineral density (BMD), and physical fitness.nnnRESULTSnThe estimated point prevalence was 46.5% for GHD, 10.8% for LH/FSHD, 7.5% for TSHD, and 4% for ACTHD, and the cumulative incidence increased with follow-up. GHD and LH/FSHD were not treated in 99.7% and 78.5% of affected individuals, respectively. Male sex and obesity were significantly associated with LH/FSHD; white race was significant associated with LH/FSHD and TSHD. Compared with CRT doses less than 22 Gy, doses of 22 to 29.9 Gy were significantly associated with GHD; doses ≥ 22 Gy were associated with LH/FSHD; and doses ≥ 30 Gy were associated with TSHD and ACTHD. Untreated GHD was significantly associated with decreased muscle mass and exercise tolerance; untreated LH/FSHD was associated with hypertension, dyslipidemia, low BMD, and slow walking; and both deficits, independently, were associated with with abdominal obesity, low energy expenditure, and muscle weakness.nnnCONCLUSIONnAnterior pituitary deficits are common after CRT. Continued development over time is noted for GHD and LH/FSHD with possible associations between nontreatment of these conditions and poor health outcomes.

Implementing touch-screen technology to enhance recognition of distress

Objective: The University of California, San Diego, Moores Cancer Center implemented a systematic approach for patients to communicate with their health‐care team in real‐time regarding psychosocial problem‐related distress using touch‐screen technology. The purpose of this report is to describe our experience in implementing touch‐screen problem‐related distress screening as the standard of care for all outpatients in a health‐care setting. Although early identification of distress has recently gained wide attention, the practical issues of implementing psychosocial screening with and without the use of technology have not been fully addressed or investigated.

Psychological distress in patients with pancreatic cancer—an understudied group

Background: Pancreatic cancer is the fourth leading cause of cancer‐related death in the United States, unsuccessful in significantly improving 5‐year survival. A diagnosis of pancreatic cancer may be associated with increased psychological distress, yet remarkably little is known about the degree of psychological distress experienced by these patients at the time of diagnosis and treatment.

Factors associated with high burden in caregivers of older adults with cancer.

Older adults with cancer are vulnerable to functional decline, which places greater onus on caregivers. Few studies have prospectively examined burden in caregivers of older cancer patients. The objective of this study was to determine the factors associated with high caregiver burden.

Validation of a needs‐based biopsychosocial distress instrument for cancer patients

People with cancer may experience distress related to diagnoses, disease‐related symptoms, and treatment side effects. Assessment of cancer‐related needs can facilitate timely triage and intervention and contribute to individualized comprehensive cancer care. This study assessed the internal consistency, test–retest reliability and construct validity of the Cancer Needs Distress Inventory (CaNDI), a self‐report, needs‐based measure of cancer‐related distress.

Role of biopsychosocial screening in cancer care.

This review focuses on the aspects of biopsychosocial screening that have specific and significant implications for supportive care related to cancer care and research. There is a robust literature relating to the unmet supportive care needs of cancer patients and their families and the clinical interventions needed to effectively manage many of their problems. The Zeitgeist movement, which promotes the idea that the resources of this planet are the inherent right of all peoples, is also uniquely aligned to see supportive care services in oncology bringing significant value (cost and quality) to a health care system that is experiencing great uncertainty. Overall, there is a broadening of perspective within the supportive care community that there needs to be greater levels of interdisciplinary integration. More significantly, there is a growing realization that for cancer care to be truly patient and family centered and even minimally efficient, disease-directed care and supportive care need to be integrated from the time of diagnosis. The coordination of these services should not be based on the stage of the disease but rather tailored to the needs of the patient, family, and social context. Biopsychosocial screening programs have the potential to be the connective tissue of these patient- and family-centered systems.

Biopsychosocial problem-related distress in cancer: examining the role of sex and age.

The current study explores how sex and age relate to biopsychosocial distress by applying a large‐scale analysis among individuals diagnosed with a variety of cancers.

Addressing psychosocial needs of partners of breast cancer patients: a pilot program using social workers to improve communication and psychosocial support

IntroductionPsychosocial (PsySoc) distress in caregivers is a well-described entity, with some caregivers experiencing more distress than patients themselves. The American College of Surgeons’ Commission on Cancer mandates that psychosocial services be provided to all cancer patients and their caregivers, through the entire continuum of cancer care.MethodsWe developed a program for newly diagnosed breast cancer patients and their partners. Both were screened for biopsychosocial stressors. The couple was then paired with two clinican-educators trained in communication and gender differences, who educated the couple in communication-based problem solving and provided referrals to supportive services.ResultsEighty-six patients and 82 partners returned surveys. Compared to partners, patients were more likely to report feeling anxious or fearful (59 vs. 38xa0%, pu2009=u20090.014), report difficulty in managing their emotions (46 vs. 11xa0%, pu2009=u20090.003), and experience distress over being unable to take care of themselves (37 vs. 6xa0%, pu2009=u20090.000). Interestingly, there was no difference between patients and partners in feeling unsupported by their partner (6 vs. 5xa0%, pu2009=u20090.85) or in feeling down or depressed (29 vs. 30xa0%, pu2009=u20090.96).DiscussionBoth patients and partners experience significant distress after a breast cancer diagnosis. We found that partners are equally likely to feel unsupported by their partner (patient) and feel down or depressed. Further study is needed to learn about both patients’ and partners’ significant distress over lack of support. Partner-focused PsySoc interventions should be initiated in all cancer centers to address the emotional needs of both breast cancer patients and their partners.

Partners' clinic: an innovative gender strengths‐based intervention for breast cancer patients and their partners immediately prior to initiating care with their treating physician

It is well documented that women with breast cancer report high levels of distress [1]. However, partners of breast cancer patients are often as distressed as patients themselves [2]. A partner is an important component of the patient’s support system during a breast cancer diagnosis and throughout treatment [1]. Women have better psychological adjustment to their illness if their partners are emotionally supportive, but this is often where partners struggle the most [3,4]. Furthermore, positive relationships with many supportive friends do not compensate for a problematic partner relationship [3,5]. Despite this knowledge, there are few successful therapeutic models that foster an environment where women and their partners can identify their unique contributions to coping and make positive emotional connections during times of acute stress. The purpose of this correspondence is to describe a unique gender strengths-based intervention (Partners’ Clinic), report distress screening and satisfaction data for both the patient and their partners, and demonstrate the feasibility of providing a couples intervention early in the treatment continuum. Partners’ Clinic engages women and their partners in a psychoeducational consultation with clinician-educators immediately prior to their initial surgical consultation. Partners’ Clinic was developed using a psychoeducational and gender strengths-based theoretical framework. Educating pairs about their illness, treatment, and coping skills while integrating cognitive-behavioral and supportive therapeutic components can lead to reduced illness related distress [4,6]. The foundation of a gender strength-based approach is based on the belief that positive change occurs in the context of authentic relationships, every person has unique strengths, the importance of valuing differences, and the need to collaborate [6,7]. The goal is to maximize the ability of women and men to increase their emotional connection and problem solving skills despite the challenges of cancer. (See examples in Intervention)

A Unique Interactive Cognitive Behavioral Training Program for Front-Line Cancer Care Professionals

For between one third and one half of all cancer survivors, disturbances in mood and cognition do not end with the conclusion of treatment. Recognizing this problem, the Institute of Medicine emphasized in its 2008 report, the importance of addressing psychosocial issues, such as distress, to providing quality cancer care. The National Cancer Institute (NCI) has recognized that there is a severe lack of trained professionals who can address these needs. In response to this need, an interactive training program was developed and implemented to teach frontline cancer care professionals Cognitive Behavioral Therapy (CBT) skills. This training includes a structured curriculum, centered around a 3-day training workshop that includes didactic discussion, small group interactive sessions, role playing, post course support, and follow-up evaluation. Four of the planned eight workshops have been conducted thus far and indicate successful recruitment and implementation of a unique training model related to the CBT skills learned.