Mark R. Somerfield

Personal changes, dispositional optimism, and psychological adjustment to bone marrow transplantation.

We investigated the number and direction of personal changes experienced by long-term survivors of bone marrow transplantation (BMT) and the relationships of those changes and dispositional optimism to psychological adjustment (current and future life satisfaction and mood). Surveys were returned by 86.0% (N=135) of all eligible long-term survivors; respondents primarily were young males who were 6 to 149 months post-BMT. Subjects reported more positive changes in the relationship and existential/psychological domains and more negative changes in the physical health domain; there was no difference on the plans/activities domain. Negative changes were more strongly related to adjustment than were positive changes. The number of negative changes reported was significantly related to current and future life satisfaction and negative mood after controlling for demographic and illness variables and dispositional optimism. The interaction term for negative and positive changes was significantly related to future life satisfaction after controlling for all other variables.

The Utility of Systems Models of Stress and Coping for Applied Research The Case of Cancer Adaptation

Contemporary conceptual models of stress and coping are intricate systems formulations that depict adaptation as a dynamic, interactional process. The inherent complexity of these models presents conceptual and methodological challenges that make testing a complete model difficult. This article makes the case for a more microanalytic strategy for applied coping research that, by centering attention and available resources on selected high-frequency, high-stress problems, permits more conceptually sophisticated and clinically informative analyses. In this context, the prevailing conceptual models have heuristic value for organizing the holistic study of adaptational processes. The utility of the proposed strategy for the development of problem-specific systems models is illustrated using the example of treatment-induced sterility from research on cancer adaptation.

Consistency of adolescents' self-report of sexual behavior in a longitudinal study

This study examines three issues relevant to adolescent self-reported sexual behavior: the extent to which adolescents rescind reports of sexual intercourse, changes in reporting of lifetime sexual intercourse, and changes in reported age at first sexual intercourse. Data come from a three-year longitudinal study of health-compromising behaviors among a cohort a 758 rural adolescents. Students completed a self-administered questionnaire on health behaviors annually in eighth, ninth, and tenth grades. Findings show that 88.8% of students in eighth grade and 94.3% in ninth grade who reported having had sexual intercourse gave the same answer in a subsequent year. Approximately 15% of students reported fewer numbers of lifetime sexual intercourse experiences in tenth grade than they did in ninth grade. Age at first sexual intercourse was reported inconsistently by 67% of the students. Inconsistency rates differed by racial-gender groups, question sensitivity, and prior sexual experience.

The Reported Health and Functioning of Children Maltreated While in Family Foster Care.

The ability to assess accurately risk factors for maltreatment while in family foster care is essential for developing prevention and intervention strategies. Yet information about children involved in maltreatment episodes while in foster care is severely limited. This correlational study reports on characteristics, health, and functioning parameters of all 78 children with substantiated maltreatment reports between 1984-1988 in an urban foster care program as compared to a random sample of 229 nonmaltreated children in foster care in the same time period. Almost 50% of the substantiated maltreatment was sexual abuse with the remainder physical abuse and neglect. Problems in health, development, and functioning were reported in the social services record for a large number of all children, but children sexually abused while in care were significantly more likely to have a nonkinship placement, and to have mental health and development problems identified. Physical abuse and neglect while in foster care were not associated with child health and functioning characteristics. The implications of these results are discussed within the context of the data source used.

Self-concept and cancer in adults: Theoretical and methodological issues

Research and theory development on the self-concept have increased dramatically over the last decade. Investigators of the psychosocial aspects of cancer have utilized the self-concept as both an independent and dependent variable. This article discusses quantitative adult studies from the self-concept and cancer literature in terms of their correspondence with current conceptualizations of the self-concept in psychology. The wide gap between recent empirical work and self-concept theorizing is discussed and strategies for future investigations of the self-concept/cancer relationship are outlined.

Methodological issues and research strategies in the study of coping with cancer

We explore methodological issues and research strategies and applications in the study of coping with cancer. The major points are addressed within the context of the transactional, or process, model of stress and coping offered by Lazarus and Folkman. Three features of this model are discussed: (a) a focus on what individuals are actually doing and thinking in stressful transactions as opposed to what they usually do or would do; (b) an emphasis on assessing coping behavior in relation to a specific context and; (c) attention to the dynamic nature of coping behavior. We outline each of these three features and discuss its implications for research on coping with cancer; particular attention is given to specific measurement strategies and substantive research questions. We also consider the utility of research on coping with cancer for the design and implementation of coping interventions for individuals with cancer.

Gender differences in injuries among rural youth.

GOAL: This paper presents injury data from the first year of a three year longitudinal study of risk taking behaviors among adolescents. SAMPLE: Study subjects were a cohort of 758 rural students from Marylands Eastern Shore who were in the eighth grade in 1987. METHODS: Students completed a 45 minute, self administered survey in which they reported numbers of injuries experienced in the past year, risk taking behaviors, anger expression, delinquency, alcohol and drug use, physical exercise, work experience, and level of parental supervision. In addition, students had their height and weight measurements taken by trained research staff and completed a self rating of pubertal development using Tanner drawings. RESULTS: Slightly more than half (53.2%) of the boys and over one third (37.7%) of the girls reported experiencing one or more medically attended injuries during the last year. Poisson regression analyses were conducted to estimate the extent to which gender differences in injuries could be accounted for by adolescent behaviors. Gender effects became non-significant when adjustments were made for risk taking, school discipline problems, and exercise frequency. Gender differences in injuries were reduced but remained significant when substance use, employment, and anger were controlled. Poisson regression analyses were conducted separately for males and females to assess whether factors associated with injuries were similar across genders. For boys, risk taking, anger, and school discipline problems were significantly related to number of injuries. Boys with a low body mass index and late pubertal development (mean ratio 3.09), as well as those with high body mass index and early pubertal development (mean ratio 2.16), reported greater numbers of injuries than average boys. For girls, substance use, cruising, risk taking, anger, and exercise frequency were significantly associated with injuries. Girls with an early onset of menses reported, on average, twice the number of injuries than those who were on time. Girls with high body mass index who were late in their pubertal development reported, on average, five times more injuries than other girls. CONCLUSIONS: Although gender is a significant risk factor for injuries, certain behaviors like risk taking, school related delinquency, and physical exercise partially explain the higher number of injuries among adolescent males in this study. For both males and females, indicators of pubertal and physical development are important factors to consider in studies of injuries during early adolescence.

A for Effort: Learning From the Application of the GRADE Approach to Cancer Guideline Development

Few would argue against a methodology that facilitates more explicit and transparent judgments about health care research evidence and the link to practice and policy decisions. In this issue of the JournalofClinicalOncology,DePalmaetal 1 describetheapplicationof one such method, the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach, for the development of clinical practice guidelines for breast, colorectal, and lung cancer treatment. The GRADE approach has emerged in response to concerns about the glut of competing grading systems, their limitations, and the confusion resulting from lack of a common rubric. GRADE (http://www.gradeworkinggroup.org/) provides an explicit method for arriving at recommendations classified according to the quality of supporting evidence. 2-8

Impact of American Society of Clinical Oncology Guidelines for Clinical Use of Colony-Stimulating Factors

However, there was limited evidence that they had any impact on clinical practice. To assess the impact of the ASCO guidelines on CSF prescription in a Paris university hospital involved in cancer care, a ‘‘before-after’’ study was performed in 1996 (the period before implementation of the guidelines) and in 1997 (the period after, when guidelines were implemented for 6 months). In accordance with the previously published guidelines for medical practice, 2,3 they were implemented throughout the hospital with a specific form summarizing the guidelines used at the time of the prescription. All inpatients who received CSF in the oncology, radiotherapy, and lung departments were enrolled onto the study. The main outcome measure was physician compliance, which was considered to be the number of CSF prescriptions that conformed to the guidelines. ASCO guidelines supported CSF use for primary prophylaxis with chemotherapeutic regimens with at least a 40% risk of febrile neutropenia, secondary prophylaxis when dose reduction was undesirable, and therapy administration on a case-by-case basis when febrile neutropenia with complicating factors occurred. Use of CSF for peripheral-blood progenitor cell (PBPC) transplantation and PBPC mobilization was unquestionable.4 Physicians’ compliance with the guidelines increased significantly, from 39% to 62%, between the two periods (P 5 .002) (Table 1). The increase in the number of patients treated with PBPC transplantation, considered to be unquestionable,4 the significant increase in physicians’ compliance in secondary prophylaxis (P 5 .007), and the decrease in the number of CSF prescriptions in therapy explained the improvement in physician compliance with the guidelines after their implementation. However, as previously reported, 5 primary prophylaxis represented the most common reason for CSF administration, even after implementation of the guidelines. Furthermore, we did not observe a significant change in the prescription of CSF in primary prophylaxis between the two periods. Actually, before and after implementation, 88% and 94% of physicians, respectively, did not comply with the guidelines because the chemotherapy regimens did not induce 40% febrile neutropenia, as recommended by the ASCO guidelines. These results were confirmed in time as, in 1998, according to the same methodology, 94% of primary prophylaxis did not comply with the guidelines in our hospital. Furthermore, these results were in accordance with the preliminary results of a prospective study performed in 15 Paris university hospitals involved in cancer care in 1997. Implementation of guidelines might explain the 20% decrease in CSF use between the two periods. However, as in any uncontrolled study, others factors may be involved in the change in medical practice. Even though no significant change was noted in hospital activity between the two periods, we cannot assert that the patients’ conditions before guideline implementation were similar to those observed afterward. Moreover, treatment procedures did not change between the two periods. In addition, CSF caused no serious adverse effects, and the cost of CSF decreased. Although physician compliance with the guidelines increased after their implementation in secondary prophylaxis and therapy, ASCO guidelines did not provide explicit guidance for the use of CSF in primary prophylaxis. Actually, the 40% incidence threshold in particular coincided with the results of cost analyses, showing that at the 40% incidence level, the estimated additional cost of CSF was equal to the estimated cost saving from avoiding hospitalization because of future neutropenia.6 In addition, although ASCO occasionally took into account risk factors for chemotherapy-induced infectious complications, criteria to precisely identify risk factors were still missing. To precisely identify risk factors, Blay et al 7 proposed a predictive method to select patients who will experience febrile neutropenia. Although other factors may be involved, implementation of guidelines seems to have an impact on medical practice, although a causal relationship could not be demonstrated. Our study shows that primary prophylaxis was the major clinical situation in which physicians could benefit from guidance about whether or not to use a CSF. A better definition of patients who should receive CSF in primary prophylaxis would enhance the impact of the ASCO guidelines on medical