Lisa M. Wu

Pre-bereavement meaning and post-bereavement distress in mothers of children who underwent haematopoietic stem cell transplantation

OBJECTIVES The purpose of this study was to explore the association of meaning-making with psychological adjustment to bereavement among mothers of children who had undergone haematopoietic stem cell transplantation (HSCT). DESIGN A prospective research design was used. Regression analyses were conducted to determine the relations between pre-bereavement variables (distress, searching for meaning, and finding meaning) and distress post-bereavement. METHODS Thirty-five mothers of children who had undergone HSCT were interviewed at the time of their childs HSCT and 3 months post-bereavement. RESULTS Mothers who reported searching for meaning at HSCT reported greater post-bereavement distress, and mothers who reported finding meaning at HSCT reported less post-bereavement distress. Distress at HSCT and the number of days between the time of death and the post-bereavement time point were also found to be significant predictors of post-bereavement distress. CONCLUSIONS This study provides partial support for the role of meaning in adjustment to loss.

Social correlates of distress following hematopoietic stem cell transplantation: Exploring the role of loneliness and cognitive processing

This study investigated whether loneliness and cognitive processing explain the influence of negative (social constraints) and positive (emotional support) relationship qualities on cancer survivors’ distress. Participants were 195 cancer survivors who had undergone hematopoietic stem cell transplantation. Path analysis supported the hypothesis that loneliness and cognitive processing would mediate the association between social constraints and distress. Only loneliness mediated the association between emotional support and distress – an indirect effect significant only when support came from family and friends rather than a partner. Findings suggest that addressing social constraints may enhance cancer survivors’ adjustment.

Harnessing Benefits of Helping Others: A Randomized Controlled Trial Testing Expressive Helping to Address Survivorship Problems After Hematopoietic Stem Cell Transplant

OBJECTIVE Prior research supports the hypothesis that cancer survivors who help others face treatment experience a range of psychosocial and health-related benefits as a result of peer helping. This study investigates an expressive helping (EH) intervention designed to harness those benefits by targeting survivorship problems among cancer survivors treated with hematopoietic stem cell transplant. EH includes two components: (a) emotionally expressive writing (EW; writing ones deepest thoughts and feelings about the transplant experience in a series of brief, structured writing sessions) followed by (b) peer helping (PH; helping other people prepare for transplant by sharing ones own transplant experiences along with advice and encouragement through a written narrative). METHOD EH was compared with neutral writing (NW), EW (without PH), and PH (without EW) in a 4-arm randomized controlled trial in which survivors completed baseline measures, 4 structured writing exercises (with instructions depending on randomization), and postintervention measures including validated measures of general psychological distress, physical symptoms, and health-related quality of life (HRQOL). RESULTS Among survivors with moderate-severe survivorship problems, EH reduced distress (compared with NW and PH; ps < .05) and improved physical symptoms (compared with NW, PH, and EW; ps < .002) and HRQOL (compared with NW; p = .02). CONCLUSIONS Peer helping through writing benefits transplant survivors with moderate-severe survivorship problems, but only if they have first completed expressive writing.

Patient and spouse illness beliefs and quality of life in prostate cancer patients.

Objective: Among married prostate cancer (PC) patients, the spouse is often the primary provider of emotional support and personal care. However, few studies have investigated spouses’ illness beliefs (i.e. about disease duration and treatment control) and their impact on patients’ quality of life (QOL). Spouses’ beliefs about disease duration (timeline) were hypothesised to mediate relationships between spouses’ treatment control beliefs and patients’ QOL six months later. Methods: Fifty-three patients who underwent localised treatment for PC, and their spouses, completed an illness beliefs measure (the revised Illness Perception Questionnaire). Patients completed a QOL measure (the Functional Assessment of Cancer Therapy – General) six months later. Results: Spouse timeline beliefs mediated the association between spouse treatment control beliefs and patient QOL six months later (total indirect effect = −0.71, 95% CI 0.02–2.03). That is, spouse beliefs that the treatment would control their loved ones illness led to beliefs that the disease would be of shorter duration, which in turn led to improved patient QOL six months later. This relationship did not occur with patients’ beliefs. Conclusion: Results highlight the important influence of spouse illness beliefs over time on patient QOL with implications for clinical care and dyadic research.

Systematic Light Exposure in the Treatment of Cancer-Related Fatigue: A Preliminary Study

Psycho-Oncology Psycho-Oncology (2014) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3553 Clinical Correspondence Systematic light exposure in the treatment of cancer-related fatigue: a preliminary study William H. Redd 1 *, Heiddis Valdimarsdottir 1,2 , Lisa M. Wu 1 , Gary Winkel 1 , Emily E. Byrne 1 , Melba A. Beltre 1 , Elizabeth S. Liebman 1 , Tanya Erazo 1 , Judy A. Hayes 1 , Luis Isola 3 , Eileen Scigliano 3 , Yeraz Meschian 1 , Susan Lutgendorf 4 and Sonia Ancoli-Israel 5 Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA Department of Psychology, Reykjavik University, Iceland Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Department of Psychology, University of Iowa, Iowa, IA, USA Departments of Psychiatry and Medicine, University of California, San Diego, CA, USA *Correspondence to: Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA. E-mail: william. redd@mssm.edu Received: 1 October 2013 Revised: 13 March 2014 Accepted: 25 March 2014 Dear Editor, Introduction Cancer-related fatigue (CRF) is the most commonly reported side effect of cancer treatment [1]. It is defined by the National Comprehensive Cancer Network as ‘a distressing, persistent, subjective sense of physical, emotional, and cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity’. Patients feel tired even after resting, have reduced capacity to carry out normal activities, experience slow physical recovery from tasks, and report diminished concentration. Most patients experience CRF during their treatment, and many continue to experience CRF long after all treatment has ended. In our research with survivors of hematopoietic stem cell transplantation (HSCT) 1–3 years off treatment, 40% of those interviewed reported clinically significant CRF. Various pharmacological and nonpharmacological interventions have been studied to treat CRF with generally mild to moderate effect sizes [1]. An alternate intervention may be systematic bright white light (BWL) exposure, which is far less costly and involves less patient burden than other interventions. Reviews and meta-analyses [2] have reported that BWL is effective in reducing sleep and circadian rhythm problems associated with other disorders (e.g., depression and jet lag) but has not been previously tested for the effect on fatigue. Recent research from our group has shown that, when given during chemotherapy, BWL compared with Copyright

Cognitive impairment and potential biological and psychological correlates of neuropsychological performance in recently orchiectomized testicular cancer patients

The aim of this study was to determine the prevalence of cognitive impairment (CI) in newly diagnosed and orchiectomized testicular cancer (TC) patients prior to systemic treatment, and to explore biological and psychological correlates.

Changes in Brain Structural Networks and Cognitive Functions in Testicular Cancer Patients Receiving Cisplatin-Based Chemotherapy

Background Cisplatin-based chemotherapy may have neurotoxic effects within the central nervous system. The aims of this study were 1) to longitudinally investigate the impact of cisplatin-based chemotherapy on whole-brain networks in testicular cancer patients undergoing treatment and 2) to explore whether possible changes are related to decline in cognitive functioning. Methods Sixty-four newly orchiectomized TC patients underwent structural magnetic resonance imaging (T1-weighted and diffusion-weighted imaging) and cognitive testing at baseline prior to further treatment and again at a six-month follow-up. At follow-up, 22 participants had received cisplatin-based chemotherapy (CT) while 42 were in active surveillance (S). Brain structural networks were constructed for each participant, and network properties were investigated using graph theory and longitudinally compared across groups. Cognitive functioning was evaluated using standardized neuropsychological tests. All statistical tests were two-sided. Results Compared with the S group, the CT group demonstrated altered global and local brain network properties from baseline to follow-up as evidenced by decreases in important brain network properties such as small-worldness (P = .04), network clustering (P = .04), and local efficiency (P = .02). In the CT group, poorer overall cognitive performance was associated with decreased small-worldness (r = -0.46, P = .04) and local efficiency (r = -0.51, P = .02), and verbal fluency was associated with decreased local efficiency (r = -0.55, P = .008). Conclusions Brain structural networks may be disrupted following treatment with cisplatin-based chemotherapy. Impaired brain networks may underlie poorer performance over time on both specific and nonspecific cognitive functions in patients undergoing chemotherapy. To the best of our knowledge, this is the first study to longitudinally investigate changes in structural brain networks in a cancer population, providing novel insights regarding the neurobiological mechanisms of cancer-related cognitive impairment.

The Effect of Systematic Light Exposure on Sleep in a Mixed Group of Fatigued Cancer Survivors

STUDY OBJECTIVES Sleep disturbances are commonly reported by cancer survivors. Systematic light exposure using bright light has been used to improve sleep in other populations. In this secondary data analysis, the effect of morning administration of bright light on sleep and sleep quality was examined in a mixed group of fatigued cancer survivors. METHODS Forty-four cancer survivors screened for cancer-related fatigue were randomized to either a bright white light or a comparison dim red light condition. Participants were instructed to use a light box every morning for 30 minutes for 4 weeks. Wrist actigraphy and the Pittsburgh Sleep Quality Index were administered at 4 time points: prior to light treatment (baseline), 2 weeks into the intervention, during the last week of the intervention, and 3 weeks postintervention. Thirty-seven participants completed the end-of-intervention assessment. RESULTS Repeated-measures linear mixed models indicated a statistically significant time × treatment group interaction effect with sleep efficiency improving more in the bright light condition over time compared with the dim light condition (F3,42 = 5.55; P = .003) with a large effect size (partial η2 = 0.28). By the end of the intervention and 3 weeks postintervention, mean sleep efficiency in the bright light group was in the normal range. Medium to large effect sizes were also seen in sleep quality, total sleep time, and wake after sleep onset for participants favoring the bright light condition. CONCLUSIONS The results suggest that systematic bright light exposure in the morning may have beneficial effects on sleep in fatigued cancer survivors. Larger scale efficacy trials are warranted. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov, Title: Treating Cancer-Related Fatigue Through Systematic Light Exposure, Identifier: NCT01873794, URL: https://clinicaltrials.gov/ct2/show/NCT01873794.

I Keep my Problems to Myself: Negative Social Network Orientation, Social Resources, and Health-Related Quality of Life in Cancer Survivors

BackgroundCancer survivors treated with hematopoietic stem cell transplant rely on their social network for successful recovery. However, some survivors have negative attitudes about using social resources (negative social network orientation) that are critical for their recovery.PurposeWe examined the association between survivors’ social network orientation and health-related quality of life (HRQoL) and whether it was mediated by social resources (network size, perceived support, and negative and positive support-related social exchanges).MethodsIn a longitudinal study, 255 survivors completed validated measures of social network orientation, HRQoL, and social resources. Hypotheses were tested using path analysis.ResultsMore negative social network orientation predicted worse HRQoL (p < .001). This association was partially mediated by lower perceived support and more negative social exchanges.ConclusionsSurvivors with negative social network orientation may have poorer HRQoL in part due to deficits in several key social resources. Findings highlight a subgroup at risk for poor transplant outcomes and can guide intervention development.

Advice to patients undergoing stem cell transplant: Content analysis of survivor peer support narratives:

Hematopoietic stem cell transplant survivors often share advice with patients undergoing this difficult treatment. We content analyzed narratives written by 59 transplant survivors given the opportunity to share advice with patients. Analyses described categories of advice they shared and evaluated their perceptions of the helpfulness of advice they had received. We found nine advice categories and evidence for variation in their perceived helpfulness, especially for advice to “be your own advocate,” “have someone you can rely on,” and “think positive.” Findings suggest the need to investigate how seemingly innocuous advice can be unhelpful and potentially distressing to some patients.