Linda F. Brown

Cancer-related fatigue and its associations with depression and anxiety: a systematic review.

Background Fatigue is an important symptom in cancer and has been shown to be associated with psychological distress. Objective This review assesses evidence regarding associations of cancer-related fatigue with depression and anxiety. Method Database searches yielded 59 studies reporting correlation coefficients or odds ratios. Results The combined sample size was 12,103. Almost all studies showed a correlation of fatigue with depression and with anxiety. However, 31 different instruments were used to assess fatigue, suggesting a lack of consensus on measurement. Conclusion This review confirms the association of fatigue with depression and anxiety. Directionality needs to be better delineated in longitudinal studies.

The Association of Depression and Anxiety with Health-Related Quality of Life in Cancer Patients with Depression and/or Pain

Objectives: Depression is known to be a major problem in cancer patients, and evidence is emerging about the importance of anxiety. Because the disorders are highly comorbid, we examined the relationship of anxiety and depression with health‐related quality of life (HRQL) in cancer patients.

Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors.

Cancer‐related fatigue (CRF) is one of the most common, persistent, and disabling symptoms associated with cancer and its treatment. Evidence‐based treatments that are acceptable to patients are critically needed. This study examined the efficacy of mindfulness‐based stress reduction (MBSR) for CRF and related symptoms.

Participant Perspectives on Mindfulness Meditation Training for Anxiety in Schizophrenia

Mindfulness meditation training has been found to be helpful across a range of mental and physical health conditions. Research testing mindfulness-based interventions in the psychiatric rehabilitation context has been rare, however—possibly due to concerns about the potential for exacerbation of psychotic symptoms during meditation practice. Fifteen individuals diagnosed with schizophrenia spectrum disorders participated in a pilot study testing a mindfulness-based intervention to reduce anxiety. In this descriptive study of program evaluation interview responses, we examined the feedback participants had provided in face-to-face interviews to determine the degree to which individuals reported finding mindfulness training acceptable and helpful. Two raters systematically coded the data independently. The combined findings led to the identification of themes that surfaced most often overall and the context in which these themes had emerged. Outcomes mentioned most frequently by participants were relaxation, relief from psychological symptoms, cognitive changes, and focus on the present. These findings were consistent with extant literature identifying similar constructs as active ingredients of mindfulness-based interventions. Results suggested that mindfulness meditation training was acceptable to all participants; no one reported worsening of psychotic or other symptoms while meditating. We concluded that mindfulness meditation training should be further tested for its potential to be helpful in recovery from psychiatric disability.

Longitudinal relationships between fatigue and depression in cancer patients with depression and/or pain.

OBJECTIVE Fatigue is one of the most common and debilitating symptoms reported by cancer patients, yet relatively little is understood about its etiology. Recently, as researchers have begun to focus attention on cancer-related fatigue (CRF), depression has emerged as its strongest correlate. Few longitudinal studies, however, have examined directionality of the relationship between the two symptoms. Our aim was to evaluate the directionality of the association between depression and CRF. METHOD The study used a single-group cohort design of longitudinal data (N = 329) from a randomized controlled trial of an intervention for pain and depression in a heterogeneous sample of cancer patients. Participants met criteria for clinically significant pain and/or depression. Our hypothesis that depression would predict change in fatigue over 3 months was tested using latent variable cross-lagged panel analysis. RESULTS Depressive symptoms and fatigue were strongly correlated in the sample (baseline correlation of latent variables = 0.71). Although the model showed good fit to the data, χ(2) (66, N = 329) = 88.16, p = .04, SRMR = 0.030, RMSEA = 0.032, and CFI = 1.00, neither structural path linking depression and fatigue was significant, suggesting neither symptom preceded and predicted the other. CONCLUSIONS Our findings did not support hypotheses regarding the directionality of the relationship between depressive symptoms and fatigue. The clinical implication is that depression-specific treatments may not be sufficient to treat CRF and that instead, interventions specifically targeting fatigue are needed.

Piloting an abbreviated dignity therapy intervention using a legacy-building web portal for adults with terminal cancer: a feasibility and acceptability study

Jennifer Kim Bernat*, Paul R. Helft, Laura R. Wilhelm, Nancy E. Hook, Linda F. Brown, Sandra K. Althouse and Shelley A. Johns School of Nursing, Indiana University, Indianapolis, IN, USA School of Medicine, Indiana University, Indianapolis, IN, USA Department of Behavioral Medicine and Psychiatry, West Virginia University, Charleston, WV, USA Eskenazi Health, Indianapolis, IN, USA Department of Biostatistics, Indiana University, Indianapolis, IN, USA

Acceptability and Feasibility of a Meaning-Based Intervention for Patients With Advanced Cancer and Their Spouses A Pilot Study

Background: Constructing meaning in cancer leads to improved psychosocial outcomes for patients and survivors. Aim: We tested the feasibility and preliminary efficacy of a meaning-based intervention for couples. Design: The single-arm pilot study tested a 4-session, tailored, activities-based couple’s intervention. Setting/Participants: Twelve adults with incurable cancer and their partners participated either in a university office or at the couple’s home. Results: The study showed good feasibility. One of the two patients depressed at baseline was no longer depressed at postintervention. Patients’ threat appraisals decreased and transcendence increased. In partners, depression, anxiety, and challenge appraisal decreased; threat and secondary appraisals and peace with illness increased. Conclusions: Our findings suggest feasibility and efficacy, and further research and continued evaluation of this intervention are warranted.

Feasibility and acceptability of a novel web portal to enhance legacy building for adults with advanced cancer.

140 Background: Being diagnosed with advanced cancer is a painful reality encompassing physical, psychosocial, and spiritual challenges as death draws near. Some patients cope resiliently, while others struggle. Dignity therapy (DT) is an empirically supported intervention where patients reflect on meaningful memories and values during interviews. These interviews are transcribed into a legacy project (LP) that can be edited and shared with loved ones. DT has been shown to benefit patients and LP recipients; however, it requires resources to implement and is not widely available in community settings. We developed a narrative intervention based on DT using a novel web portal (ZarpZ) to disseminate the LPs. This pilot assesses the feasibility, acceptability, and efficacy of our intervention to determine if it could be an affordable, user-friendly, and accessible alternative to traditional DT. METHODS Adults (n=16) with advanced-stage solid malignancies participated in a therapist-led intervention including (1) a modified DT session; (2) orientation to ZarpZ; and (3) brief weekly phone calls to aid self-led online LP building. We collected baseline and post-intervention data on primary (acceptability) and secondary (existential well-being, dignity, demoralization, peaceful acceptance of illness, and family communication) outcomes. RESULTS 69% of participants completed a LP. Participants reported high satisfaction with the LP created (100%) and with the intervention, particularly the home visit with the interventionist (81%). Participants were less satisfied with ZarpZ-only 45% used it. Among ZarpZ users, 40% reported it as somewhat difficult to use. Our sample was not distressed at baseline; thus, post-intervention secondary outcomes did not significantly differ from baseline. CONCLUSIONS Participants found value in the intervention and in the LPs created, but were generally dissatisfied with ZarpZ. Future research should aim to improve usability. Since our sample size was small and participants were not distressed at baseline, we were not able to show significant improvement in secondary outcomes. Future research should examine these outcomes in a larger and more distressed sample.