Karlynn BrintzenhofeSzoc

The prevalence of psychological distress by cancer site

The goal of this project was to determine the prevalence of psychological distress among a large sample of cancer patients (n=4496). In addition, variations in distress among 14 cancer diagnoses were examined.

Mixed Anxiety/Depression Symptoms in a Large Cancer Cohort: Prevalence by Cancer Type

BACKGROUND Mixed anxiety/depression is associated with poorer psychosocial and treatment outcomes, worse quality of life, pooreradherence to treatment, slower recovery, greater suicide risk, and highercost-utilization. OBJECTIVE This study aimed to examine the cancer-specific prevalence of these symptoms. METHOD Cross-sectional anxiety and depression symptom data were collected with the Brief Symptom Inventory from adult outpatients presenting to a tertiary cancer center (N=8,265). RESULTS Mixed anxiety/depression symptoms were seen in 12.4% of patients; overall depression symptoms in 18.3%, overall anxiety symptoms in 24.0%, pure anxiety symptoms in 11.7%, and pure depression symptoms in 6.0%; 70% had neither. Higher rates of mixed anxiety/depression symptoms were seen with stomach, pancreatic, head and neck, and lung cancers, but lower rates were seen in those with breast cancers. The mixed anxiety/depression phenotype occurs in two-thirds of depressed cancer patients. DISCUSSION The fact that 70% of patients did not meet thresholds for depression or anxiety symptoms can be interpreted as a reflection of the resistance to developing a significant level of these symptoms. However, because stomach, pancreatic, head and neck, and lung cancers have higher levels of mixed anxiety/depression symptoms, the question can be raised as to whether these are associated with a more biological type of anxiety/depression (e.g., due to cytokine release) and whether this phenotype should be actively targeted because of its frequent occurrence in these cancers.

Fractures in children with cerebral palsy.

Introduction: We studied the fracture history in a large population of patients with cerebral palsy to determine which children were at the highest risk for fracture. Methods: The International Classification of Diseases (Ninth Revision) coding identified 763 children with cerebral palsy. Patients and caregivers were contacted for information about fracture history and risk factors for low bone density. Of the 763 children identified, 418 children (54.8%) were available for this study; 243 (58%) had quadriplegia, 120 (29%) diplegia, and 55 (13%) hemiplegia. Three hundred sixty-six children were spastic, 23 mixed tone, 13 athetoid, and 16 classified as others. We identified 50 children (12%) who fractured; 15 of these same children had, over time, multiple fractures. Results: The number of fractures showed a normal distribution by age, with a mean of 8.6 (SD, 4.0). Children with cerebral palsy with mixed tone had a higher rate of fracture (&khgr;2 = 14.7, P < 0.01); &khgr;2 analysis indicated that the children who fractured were, as a group, more likely to use a feeding tube, have a seizure disorder, take valproic acid (VPA), and use standing equipment in therapy. Multiple regression analysis demonstrated older age and VPA use as predictive of fracture and gave the following equation: fracture = −0.01 + (VPA × 0.17) + (age × 0.15). The subgroup that sustained multiple fractures were older at the time of first fracture than the children who had only one reported fracture (t = −2.3, P < 0.05). Conclusions: The main finding of our article is that older age at first fracture and use of VPA are predictive of fractures and define a group of children with cerebral palsy who may benefit from treatment interventions to increase bone density.

Treatment with Zoledronic Acid Ameliorates Negative Geometric Changes in the Proximal Femur following Acute Spinal Cord Injury

Acute spinal cord injury is associated with rapid bone loss and an increased risk of fracture. In this double-blind, randomized, placebo-controlled trial, 17 patients were followed for 1 year after administration of either 4 or 5 mg of zoledronic acid or placebo. Bone mineral density (BMD) and structural analyses of the proximal femur were performed using the hip structural analysis program at entry, 6 months, and 12 months. The 17 subjects completed 12 months of observation, nine receiving placebo and eight zoledronic acid. The placebo group showed a decrease in BMD, cross-sectional area, and section modulus and an increase in buckling ratio at each proximal femur site at 6 and 12 months. Six months after zoledronic acid, BMD, cross-sectional area, and section modulus increased at the femoral neck and intertrochanteric regions and buckling ratio decreased consistent with improved bone stability. However, at 12 months, the femoral narrow-neck values declined to baseline. In contrast to placebo, the intertrochanteric region and femur shaft were maintained at or near baseline through 12 months in the zoledronic acid-treated group. Urine N-telopeptide excretion was increased at baseline and declined in both the placebo and treatment groups during the 12 months of observation. We conclude that a single administration of zoledronic acid will ameliorate bone loss and maintain parameters of bone strength at the three proximal femur sites for 6 months and at the femur intertrochanteric and shaft sites for 12 months.

Decreased orthotic effectiveness in overweight patients with adolescent idiopathic scoliosis

BACKGROUND Many studies have demonstrated that orthotic treatment is effective for the prevention of curve progression in patients with adolescent idiopathic scoliosis. However, the effect of being overweight on the outcome of orthotic treatment has not been reported. The purpose of the present study was to determine whether orthotic treatment of adolescent idiopathic scoliosis is less successful for patients who are overweight than it is for those who are not overweight. METHODS A ten-year multicenter retrospective review of patients in whom adolescent idiopathic scoliosis had been treated with a Boston or a custom-molded thoracolumbosacral orthosis was performed. The inclusion criteria were no previous treatment, skeletal immaturity (a Risser sign of 0, 1, or 2), a curve of 25 degrees to 40 degrees at the time of orthotic initiation, and follow-up to skeletal maturity. Patients were divided into two groups according to body habitus, with overweight patients defined as those with a body mass index in the eighty-fifth percentile or greater. Curve progression was compared between the two groups. Successful orthotic treatment was defined as no more than a 5 degrees increase in the primary curve from the start of orthotic wear to skeletal maturity. Absolute curve progression to 45 degrees or greater also was considered to be an adverse outcome. RESULTS Two hundred and seventy-six consecutive patients from two institutions were analyzed, and thirty-one patients were considered to be overweight. The mean curve progression was 9.6 degrees +/- 7.3 degrees for the patients who were overweight, compared with 3.6 degrees +/- 9.4 degrees for those who were not overweight (p < 0.01). Overweight patients were 3.1 times more likely to have an unsuccessful result than those who were not overweight. Curve progression to 45 degrees or greater occurred in fourteen (45%) of the thirty-one patients who were overweight, compared with sixty-nine (28%) of the 245 patients who were not overweight. CONCLUSIONS The results of the present study suggest that overweight patients with adolescent idiopathic scoliosis will have greater curve progression and less successful results following orthotic treatment than those who are not overweight. The ability of an orthosis to transmit corrective forces to the spine through the ribs and soft tissue may be compromised in overweight patients. This factor should be taken into consideration when making treatment decisions. Additional study is warranted to determine a threshold effect.

The Satisfaction with Life Domains Scale for Breast Cancer (SLDS-BC)

Abstract:  Despite improved overall survival rates, the diagnosis of breast cancer continues to generate fear and turmoil in the lives of many women. All phases related to diagnosis, treatment, and recovery create challenges and problems that patients and survivors must face. Clearly, at the time of diagnosis and during the first phases of treatment, patients experience uncertainty, confusion, and distress. Quality of life (QOL) can be negatively affected by inadequate information, complex decisions, and adverse events related to cancer therapies. As treatment continues, concerns related to physical functioning, body image, mood, sexuality, family, and vocational pursuits quickly emerge. Adjuvant treatments generate additional physiological assaults that further affect body image, sexuality, and family. As women move beyond treatment, the role of patient shifts to that of survivor, with a need for continued focus on overall QOL issues. Throughout this continuum, QOL is a critical factor that must be evaluated and monitored. The Satisfaction with Life Domains Scale for Breast Cancer (SLDS‐BC) is a reliable and valid scale that presents a critical opportunity to assess QOL throughout the various phases of patient care. A principal component factor analysis with a varimax rotation identified the following five QOL factors, explaining 70.8% of the variance: social functioning, physical functioning, internal locus of control, spirituality, and communication with medical providers. Cronbachs alpha for the entire scale was 0.93. Test‐retest produced rs for each factor ranging from 0.45 to 0.91, with an overall r = 0.70. Concurrent and divergent validity were assessed through the Functional Assessment of Cancer Therapies for Breast Cancer (FACT‐B) and the Brief Symptom Inventory (BSI). Significant negative correlations (p < 0.01) were found between the SLDS‐BC and the FACT‐B as well as the BSI. These results indicated strong concurrent and divergent validity. The SLDS‐BC clearly offers a user‐friendly format that can briefly and rapidly assess QOL across the breast cancer continuum of care. 

The Impact of Changes in Employment Status on Psychosocial Well-Being: A Study of Breast Cancer Survivors

ABSTRACT Recent developments in the treatment of cancer have resulted in an increase in the number of cancer survivors. With this increase in the survival rate comes an increase in questions as to how a diagnosis of cancer and its treatment affects survivors and their well-being. Research has emphasized the impact that medical factors related to cancer have on the well-being of cancer survivors. However, the literature also suggests that socioeconomic factors may affect cancer survivors; well-being. This study focuses on the role that employment status plays in relationship to the levels of psychosocial well-being of women diagnosed with and treated for breast cancer. This study was a cross-sectional design utilizing secondary data analysis. The sample consisted of 369 breast cancer survivors from four cancer treatment facilities in the Mid-Atlantic region. The independent variable was employment status during and after treatment and the dependent variables were psychological distress, physical and mental functioning and quality of life. Utilizing analysis of covariance, controlling for age at diagnosis and stage of cancer it was found that there was a statistically significant difference in the dependent variables by employment status. These findings are discussed in terms of clinical and policy implications.

High Prevalence of Cardiometabolic Risk Factors in Women Considered Low Risk by Traditional Risk Assessment

BACKGROUND Cardiovascular disease (CVD) is the leading cause of death in women in the United States. The purpose of this study was to characterize the prevalence and awareness of traditional CVD risk factors, obesity, and coronary heart disease (CHD) risk classification using the Framingham Risk Score (FRS) among women attending the 2006 Sister to Sister National Womans Heart Day event. RESULTS A total of 8936 participants (mean age 49 +/- 14 years) were evaluated. There was a modest prevalence of traditional risk factors on screening, including non-high-density lipoprotein-cholesterol (HDL-C) >160 mg/dL (27%), HDL-C <40 mg/dL (16%), random glucose level >140 mg/dL (6%), uncontrolled blood pressure > or =140/90 mm Hg (12%), current smoking (6%), and a positive family history of CHD (21%). There was a high prevalence of overweight (39%) or obese individuals (35%) (body mass index [BMI] 25-30 and > or =30 kg/m(2), respectively), as well as those with high waist circumference (> or =35 inches) (55%). Women were classified by FRS as low (85%), intermediate (6%), and high risk (9%). When cardiometabolic risk analyses included waist circumference in addition to the FRS, 59% of low-risk and 50% of intermediate-risk women had 1 or 2 risk factors, and 19% and 41% had > or =3 risk factors, respectively. Women were often unaware of risk factors on screening; among women without a previous diagnosis of dyslipidemia or hypertension, 48% and 7%, respectively, were given new diagnoses. CONCLUSIONS Women participating in the 2006 Sister to Sister National Womans Heart Day event have a high prevalence of cardiometabolic risk factors, especially dyslipidemia, obesity, and high central adiposity, that place them at higher risk for the development of CVD and other comorbidities. The newly identified multiple risk factors in this population support the value of community health screening in women.

Historical Threads in the Development of Oncology Social Work

As the Association of Oncology Social Work celebrates its 25th year, we pause to reflect on the many historical threads that contributed to its development and hear from each of the presidents who helped create the organization, as we know it today. Set within hospitals, medical social work was born in the early 20th century. In the 1940s medical social work became necessary for hospital accreditation. Two additional historical shifts, one in medical improvements in treating cancer, the other a shift to a consumer-oriented American Cancer Society, contributed to the push for a greater role for the federal government in funding cancer research. Oncology social work came to full blossom in the 1970s, a result of the physicians’ need for a member of the health care team who understood cancer, its treatment, and the patients need to address his or her psychosocial needs resulting from cancer. Today, oncology social work is a fully developed profession with a national organization providing education and support to oncology social workers’ in their use of psychosocial interventions and research in behalf of cancer patients and their families.

Screening for Psychosocial Distress: A National Survey of Oncology Social Workers

Oncology social workers are the primary providers of psychosocial care for cancer patients, thus they are well positioned to implement and oversee psychosocial distress screening. A national survey of members of the Association of Oncology Social Work was conducted to examine screening knowledge, attitudes, behaviors, and perceived competency. The findings indicated that most participants screened for psychosocial distress using a standardized instrument and identified institutional and individual barriers to implementing screening. Analyses revealed that social workers who perceived patient benefits from screening and were knowledgeable about guidelines were significantly more likely to implement screening procedures and use a standardized instrument.