Kathryn M. Kash

The role of religious and spiritual beliefs in coping with malignant melanoma

This study investigated the role of spiritual and religious beliefs in ambulatory patients coping with malignant melanoma. One‐hundred and seventeen patients with melanoma being seen in an outpatient clinic completed a battery of measurements including the newly validated Systems of Belief Inventory (SBI‐54). No correlation was found between SBI‐54 scores and levels of distress. However, there was a correlation between greater reliance on spiritual and religious beliefs and use of an active–cognitive coping style (r=0.46, p<0.0001). Data suggest that use of religious and spiritual beliefs is associated with an active rather than passive form of coping. We suggest that such beliefs provide a helpful active–cognitive framework for many individuals from which to face the existential crises of life‐threatening illness. Copyright

Predictors of intrusive thoughts and avoidance in women with family histories of breast cancer

Having a family history of cancer is an important predictor of lifetime cancer risk. Individuals with family histories of cancer have been reported to experience symptoms of general distress and to have frequent intrusive thoughts and avoidance regarding cancer. To date, little is known about predictors of such distress. A relation between perception of cancer risk and distress has been suggested, but the possibility that prior cancer-related events may contribute to distress in these women has received little attention. The major aim of the study was to examine the contribution of the past experience of the death of a parent from cancer to distress in women at familiar risk for breast cancer.Women with family histories of breast cancer (Risk Group, N=46) were assessed on the day of their yearly mammography screening and four to eight weeks after normal result notification in order to confirm the generalizability of their distress. Their levels of intrusive thoughts, avoidance, and perceived lifetime risk for breast cancer were significantly higher than those of women with no family histories of cancer who were not undergoing mammography (Comparison Group, N=43), and this was true on both assessment days. Among the women in the Risk Group, those whose parent (s) had died of cancer had the highest levels of intrusive thoughts, avoidance, and perceived risk. Results suggested that perceived risk mediated the effect of this event on intrusive thoughts and avoidance regarding breast cancer. The findings are discussed in terms of theories of cognitive responses to traumatic and stressful life events. Implications for future research and interventions are discussed.

The role of religious and spiritual beliefs in coping with malignant melanoma: an Israeli sample

This preliminary study examined the possible relationship between a newly developed instrument, the Spiritual Beliefs Inventory (SBI‐54), and the coping style of a group of cancer patients in Israel. The sample consisted of 100 malignant melanoma patients diagnosed at stages I and II, A and B. Patients were individually interviewed at home and completed seven self‐reports. The present report focuses on the relationship of the SBI‐54 with other measures of coping, psychological distress and social support. Findings showed that there was a significantly positive correlation between the SBI‐54 and the active‐cognitive coping style (r=0.48, p<0.0l). Copyright

Perception of breast cancer risk and psychological distress in women attending a surveillance program

Women at high risk of developing breast cancer who attend surveillance programs (SP) overestimate their risk and are highly anxious; those who are anxious are less likely to perform breast self‐examination (BSE). We attempted to determine if counseling by a breast surgeon could increase womens accuracy of risk perception and hence decrease their anxiety and increase their likelihood of performing BSE. We also tested the efficacy of a series of four informative newsletters in reducing anxiety. All 145 women who scheduled an initial appointment during one year for our SP were asked to participate; 94 women completed a self‐report questionnaire containing validated instruments before their first SP visit. Of these, 41 women were randomly selected to receive the newsletter. Women were mailed follow‐up questionnaires at 2 and 4 months after their initial visit. Of the sample, 76% overestimated their risk of developing breast cancer by at least doubling their actual risk as measured with empiric risk tables. Their psychological distress was between 0.5 to 1 standard deviation above normative scores. Being older and having greater confidence in the ability to perform BSE were the only variables that predicted performance of BSE. A follow‐up assessment performed 4 months after the initial visit showed a significant improvement in the accuracy of perception of risk (p < 0.01) and a reduction of cancer anxiety (p < 0.05), but no significant change in performance of BSE. The newsletters produced no significant effect. Women attending a breast surveillance program showed a significant improvement in their ability to estimate the risk of developing breast cancer and a reduction in their anxiety after counseling, but no significant change in performance of BSE. The possibility that improvement in risk perception and reduction of cancer anxiety can lead to greater adherence to screening behaviors needs to be tested with a larger number of women and over a longer time period.

Changes in cerebral blood flow and anxiety associated with an 8-week mindfulness programme in women with breast cancer.

This study employed functional magnetic resonance imaging to evaluate changes in cerebral blood flow (CBF) associated with the Mindfulness-based Art Therapy (MBAT) programme and correlate such changes to stress and anxiety in women with breast cancer. Eighteen breast cancer patients were randomized to the MBAT or education control group. The patients received the diagnosis of breast cancer between 6 months and 3 years prior to enrollment and were not in active treatment. The age of participants ranged from 52 to 77 years. A voxel-based analysis was performed to assess differences at rest, during meditation and during a stress task. The anxiety sub-scale of the Symptoms Checklist-90-Revised was compared with changes in resting CBF before and after the programmes. Subjects in the MBAT arm demonstrated significant increases in CBF at rest and during meditation in multiple limbic regions, including the left insula, right amygdala, right hippocampus and bilateral caudate. Patients in the MBAT programme also had a significant correlation between increased CBF in the left caudate and decreased anxiety scores. In the MBAT group, responses to a stressful cue resulted in reduced activation of the posterior cingulate. The results demonstrate that the MBAT programme was associated with significant changes in CBF, which correlated with decreased anxiety over an 8-week period.

Psychosocial benefits of a novel mindfulness intervention versus standard support in distressed women with breast cancer.

It is well documented that stress is associated with negative health outcomes in cancer patients. The purpose of this study was to assess the effects of a novel mindfulness intervention called mindfulness‐based art therapy (MBAT) versus standard educational support, on indices of stress and quality of life in breast cancer patients with high stress levels.

Decision Making about Cancer Screening: An Assessment of the State of the Science and a Suggested Research Agenda from the ASPO Behavioral Oncology and Cancer Communication Special Interest Group

Broad participation in screening is key to cancer prevention and early detection. Unfortunately, screening rates are low for many modalities. At its core, successful screening involves an individual deciding to take action (e.g., completing self-exams or scheduling appointments). Therefore, the

Genetic and environmental risk assessment for colorectal cancer risk in primary care practice settings: a pilot study.

Purpose: The assessment of genetic variants and environmental exposures (i.e., genetic and environmental risk assessment) may permit individualized risk stratification for common diseases as part of routine care. A pilot study was conducted to assess the uptake of, and response to, testing for colorectal cancer risk among average risk patients in primary care practice settings.Methods: Physicians in primary care practices identified patients eligible for colorectal cancer screening and referred them to the study. Research staff administered a baseline survey to consenting patients. At a scheduled office visit, participants underwent decision counseling with a trained nurse educator to facilitate informed decision making about being tested for methylene tetrahydrofolate reductase status and red blood cell folate level. Combined assessment can stratify colorectal cancer risk. Test results were disclosed within 2 weeks after the visit. Postvisit and 1-month endpoint surveys were administered. Univariable analyses of survey data were performed to assess changes from baseline in genetic and environmental risk assessment and colorectal cancer screening-related knowledge and perceptions.Results: Of the 57 patients who were referred to the study, 25 (44%) consented to participate, and all but one were tested. Participant knowledge about genetic and environmental risk assessment and colorectal cancer screening, perceived colorectal cancer screening response efficacy, and perceived social support for colorectal cancer screening increased significantly from baseline. Participants reported low levels of intrusive thoughts about CRC.Conclusion: Knowledge and favorable perceptions of colorectal cancer screening increased, as did knowledge about genetic and environmental risk assessment, after exposure to the study intervention. Further research is needed to assess genetic and environmental risk assessment uptake and impact at the population level.

Preparing African American women for breast biopsy.

Breast cancer, the second leading cause of cancer deaths among African American women,1-3 is commonly diagnosed as a result of a biopsy procedure performed as follow-up to an abnormal mammography result.4,5 Lack of knowledge, anxiety about undergoing breast biopsy, and inadequate social support have been associated with delay in screening and follow-up.6-9 There have been a number of calls for interventions that would help to address psychosocial issues related to breast biopsy and to minimize delay in diagnosis.10-13 However, little research has been reported on the development of effective, theory-based methods for addressing these issues. In this paper we present results of a pilot study, Breast Biopsy Education Study, which was intended to develop and test methods to prepare African American women for the breast biopsy experience. Specific aims of the Breast Biopsy Education Study were (1) to test the feasibility of enrolling African American women in an educational counseling intervention, (2) to develop a brief educational counseling intervention that involves a trained nurse educator and an African American woman who has been recommended to have a breast biopsy, and (3) to assess intervention effects on biopsy-related knowledge, affective moods, and perceived social support among participating women. The pilot study was designed as a one-group, pretest/posttest study. Eligibility criteria for participation included being an African American woman aged 40 to 74 years with no personal history of breast cancer and having a recommendation to undergo a breast biopsy to follow up an abnormal mammography result. Study participants were patients identified at the Breast Imaging Center of a university hospital located in an urban area of the northeastern United States. The educational intervention was developed using the preventive health model, which is based on selfregulation theory.14 Self-regulation theory asserts that cognitive and psychological representations (ie, mental images) affect personal anticipatory reactions to a pending experience.15,16 Intervention materials developed and pretested for acceptability, relevancy, usefulness, understandability, and ease of administration17 included a 20-page informational booklet, Having a Breast Biopsy: Plain Talk for Women Who Have Been Advised to Have a Breast Biopsy, and a brief in-person educational counseling session conducted by a nurse educator. Consistent with self-regulation theory, the booklet, written at an 8th-grade reading level, provides concrete objective information about steps involved in preparing for a breast biopsy experience. It also includes descriptions of major types of breast biopsy procedures and information intended to acknowledge and address affective representations about the breast biopsy experience. The counseling session engaged patients in considering how to manage personal informational, emotional, and support needs.