Lois C. Friedman

The relationship of dispositional optimism, daily life stress, and domestic environment to coping methods used by cancer patients

The relationship of dispositional optimism, daily life stress, and domestic environment to two types of coping methods was examined in a group of 94 cancer patients. As expected, dispositional optimism and domestic environment made significant contributions to the prediction of avoidance coping. Dispositional optimism contributed significantly to the prediction of active-behavioral coping. Specifically, a significant positive relationship was obtained between active-behavioral coping and optimism. A significant positive relationship also was found between avoidance coping and both daily stress and domestic environment. Avoidance coping was negatively related to dispositional optimism. In multivariate analyses, gender and disease-related variables did not make significant contributions to the prediction of coping method. Suggestions for future research were made.

The rates of chemotherapy-induced amenorrhea in patients treated with adjuvant doxorubicin and cyclophosphamide followed by a taxane

Objective:Adjuvant chemotherapy in premenopausal women with breast cancer may induce amenorrhea, which can affect fertility, choice of hormonal therapy, and increase the risk of late toxicity. The incidence of chemotherapy-induced amenorrhea (CIA) resulting from doxorubicin and cyclophosphamide (AC) followed by a taxane (T) is poorly characterized. Methods:We retrospectively surveyed women who were premenopausal and less than age 50 at initiation of chemotherapy to determine the rates of CIA in women receiving AC followed by T compared with AC alone. Results:One hundred ninety-one eligible women completed the survey. The rate of CIA in women who received AC followed by T was 64% (95% confidence interval [CI] = 55–72%) compared with 55% (95% CI = 43–66%) in AC alone. As expected, CIA rates were higher in older than younger women (82% vs. 55%, P = 0.004). Multivariate logistic regression analysis revealed that age >40 was associated with a 4.6-fold increased risk of CIA (95% CI = 1.7–12.1, P = 0.002). It also revealed that receiving T after AC was associated with an odds ratio of 1.9 for CIA as compared with receiving AC alone (95% CI = 1.0–3.5, P = 0.05). Despite ≥6 months of amenorrhea, many women ≤40 resumed menses (40%). CIA was more likely to be irreversible in those >40. The addition of taxanes did not alter the rate of reversibility for the group as a whole (P = 0.36). Conclusions:Older age and the addition of taxane to AC increased the risk of CIA and the amenorrhea was more likely to be irreversible for women >40. Women ≤40 often resume menstruation even after 6 months of amenorrhea, and the addition of T does not play a role. Subsequent resumption of menstrual function must be considered when initiating appropriate hormonal therapy.

Self-forgiveness, spirituality, and psychological adjustment in women with breast cancer

We evaluated whether a self-forgiving attitude and spirituality were related to psychological adjustment among 81 women being treated for breast cancer at a medical oncology clinic in a county general hospital. Both a self-forgiving attitude and spirituality were unique predictors of less mood disturbance and better quality of life (ps < 0.001). These results are consistent with previous research that has demonstrated a positive relationship between spirituality and well-being. The findings also suggest that self-forgiveness should be explored experimentally to determine whether it can protect against the psychological effects of breast cancer-related stress. Interventions targeting these characteristics could improve the quality of life and alleviate stress, especially in women with breast cancer in public sector settings.

Women with breast cancer: perception of family functioning and adjustment to illness

&NA; Fifty‐seven women with breast cancer completed measures of family adaptability and cohesion, marital adjustment, and psychosocial adjustment to illness. Using a circumplex model of family systems, we examined whether subjects who perceived their families at moderate levels of cohesion and adaptability reported better psychosocial adjustment than subjects from families with extreme levels of cohesion and adaptability. The results indicated that the patients who reported the best adjustment to breast cancer and in their marriages, also reported the highest levels of family cohesion. There was not a significant relationship between adjustment to illness and adaptability. The implications for the treatment of women with breast cancer and for the families of these patients were discussed.

Entertainment education for breast cancer surgery decisions: a randomized trial among patients with low health literacy.

OBJECTIVE To evaluate an entertainment-based patient decision aid for early stage breast cancer surgery in low health literacy patients. METHODS Newly diagnosed female patients with early stage breast cancer from two public hospitals were randomized to receive an entertainment-based decision aid for breast cancer treatment along with usual care (intervention arm) or to receive usual care only (control arm). Pre-decision (baseline), pre-surgery, and 1-year follow-up assessments were conducted. RESULTS Patients assigned to the intervention arm of the study were more likely than the controls to choose mastectomy rather than breast-conserving surgery; however, they appeared better informed and clearer about their surgical options than women assigned to the control group. No differences in satisfaction with the surgical decision or the decision-making process were observed between the patients who viewed the intervention and those assigned to the control group. CONCLUSIONS Entertainment education may be a desirable strategy for informing lower health literate women about breast cancer surgery options. PRACTICE IMPLICATIONS Incorporating patient decision aids, particularly computer-based decision aids, into standard clinical practice remains a challenge; however, patients may be directed to view programs at home or at public locations (e.g., libraries, community centers).

Use of an educational computer program before genetic counseling for breast cancer susceptibility: Effects on duration and content of counseling sessions

Purpose: Patients seeking genetic testing for inherited breast cancer risk are typically educated by genetic counselors; however, the growing demand for cancer genetic testing will likely exceed the availability of counselors trained in this area. We compared the effectiveness of counseling alone versus counseling preceded by use of a computer-based decision aid among women referred to genetic counseling for a family or personal history of breast cancer.Methods: We developed and evaluated an interactive computer program that educates women about breast cancer, heredity, and genetic testing. Between May 2000 and September 2002, women at six study sites were randomized into either: Counselor Group (n = 105), who received standard genetic counseling, or Computer Group (n = 106), who used the interactive computer program before counseling. Clients and counselors both evaluated the effectiveness of counseling sessions, and counselors completed additional measures for the Computer Group. Counselors also recorded the duration of each session.Results: Baseline characteristics did not differ significantly between groups. Participants and counselors both rated the counseling sessions as highly effective, whether or not the sessions were preceded by computer use. Computer use resulted in significantly shorter counseling sessions among women at low risk for carrying BRCA1/2 mutations. In approximately half of the sessions preceded by clients’ computer use, counselors indicated that clients’ use of the computer program affected the way they used the time, shifting the focus away from basic education toward personal risk and decision-making.Conclusion: This study shows that the interactive computer program “Breast Cancer Risk and Genetic Testing” is a valuable adjunct to genetic counseling. Its use before counseling can shorten counseling sessions and allow counselors to focus more on the clients’ individual risks and specific psychological concerns. As the demand for counseling services increases, a program such as this can play a valuable role in enhancing counseling efficiency.

Breast cancer screening: Racial/ethnic differences in behaviors and beliefs

Racial/ethnic differences in breast cancer screening behaviors and beliefs were examined in 259 asymptomatic women, 50 years old or older, who participated in a no-cost worksite breast cancer screening program. Hispanics were more likely than African Americans to report having had mammography in the past year. Caucasians and Hispanics were more likely than African Americans to report having had a clinical breast examination in the past year. African Americans to report having had a clinical breast examination in the past year. African Americans and Hispanics were more likely to practice monthly breast self-examination than were Caucasians. African Americans were more likely to report cancer-related fears and worries as barriers to mammography, whereas Caucasians were more likely to report being too busy, inconvenience, and procrastination as barriers. African Americans also were more likely to evaluate their physicians and other health professionals positively than were Caucasians. These results suggest a need to make a special effort to address cancer-related fears as barriers to screening among African Americans, and time-related barriers to screening among Caucasians.

Medical and Psychosocial Predictors of Delay in Seeking Medical Consultation for Breast Symptoms in Women in a Public Sector Setting

We examined demographic, medical and psychosocial factors related to delay in seeking medical consultation for breast symptoms. In this cross-sectional survey, 124 women with breast symptoms attending an outpatient breast surgery clinic in a county general hospital completed questionnaires measuring demographic, medical and psychosocial variables. Our outcome variable was delay in seeking medical consultation. Younger age (p ≤ 0.05), less education (p ≤ 0.01), absence of a lump (p ≤ 0.05), lower perceived risk (p ≤ 0.001), less spirituality (p ≤ 0.01), cost (p ≤ 0.001) and not wanting to think about breast symptom(s) (p ≤ 0.05) were related to delay. Multivariate analyses showed absence of a breast lump by education interaction (p ≤ 0.05), risk perception (p ≤ 0.001), spirituality (p ≤ 0.01) and cost (p ≤ 0.001) collectively accounted for 38.4% of the variance in delay. Health promotion programs targeting low-income populations should emphasize the importance of breast symptoms other than lumps, especially to younger and less educated women.

Early detection of skin cancer: Racial/ethnic differences in behaviors and attitudes

Data from 384 individuals participating in a worksite skin cancer screening program were used to assess racial/ethnic differences in attitudes toward and practice of prevention and early detection of skin cancer. Caucasians and Hispanics were more likely than African Americans to report having used a sunscreen during the past year. Caucasians performed skin self-examination more frequently than Hispanics, but African Americans did not differ in their frequency of skin self-examination from the other two groups. African Americans and Hispanics reported that they would be less likely than Caucasians to seek immediate follow-up care for suspicious skin lesions. Both similarities and differences were found in a variety of health belief variables across the three groups. These findings suggest a need for intensified efforts at primary and secondary prevention of skin cancer among African Americans.

Attitudes to cancer: Psychometric properties of fighting spirit and denial

Higher rates of recurrence-free survival at 5- and 10-year follow-up have been reported for breat cancer patients who initially responded to cancer with attitudes of “fighting spirit” or denial. We report here a factor analytic attempt, utilizing questionnaire data, to objectify these attitudes. A reliable factor structure replicated in breast and mixed cancer samples, yielding three factors: (1) Fighting Spirit or belief in the ability to fight back, conquer, and recover from cancer; (2) Information-Seeking behavior; and (3) Denial. Adequate 1-month test-retest correlations were obtained for Fighting Spirit and Information Seeking factor scores. A pattern of differential correlations with other measures (affect, coping, and optimism) distinguished Fighting Spirit and Information Seeking. The Denial factor appeared to be less stable and did not correlate significantly with other measures.