Monique Lefebvre

Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study.

BackgroundEvidence suggests that fear of cancer recurrence (FCR) is one of the most frequently cited unmet needs among cancer survivors and is associated with psychological distress, stress-response symptoms, and lower quality of life, as well as increased use of health care resources. Despite these factors, few manualized interventions exist to address FCR among cancer survivors.PurposeTo develop, manualize, and pilot test the feasibility and preliminary efficacy of a 6-week cognitive-existential (CE) group intervention designed to address FCR in women with breast or ovarian cancer.MethodsThis study was a single-arm multi-site study with pre-, post-, and 3-month follow-up measurement occasions.ResultsA total of 56 breast or ovarian cancer survivors enrolled in the study; 44 completed the CE group intervention. Following the intervention, women experienced a reduction in the primary study outcome measure of FCR and secondary study outcome measures of cancer-specific distress and uncertainty. They also reported improvements in secondary study outcome measures of quality of life and coping. The effect sizes of the observed changes were for the most part in the medium to large effect range; furthermore, almost all changes were sustained at 3-month follow-up.ConclusionThis brief intervention appears feasible and has shown promising results in addressing FCR and related secondary outcomes of cancer-specific distress, uncertainty, quality of life, and coping; however, it should be further tested using a randomized controlled study design to more definitively assess its efficacy.Implications for Cancer SurvivorsFCR is a near-universal worry for cancer survivors that, when left unaddressed, tends to remain stable over time. This study has important implications for all cancer survivors as it is the first published intervention that provides preliminary evidence of its efficacy in decreasing fear of cancer recurrence.

Sexual health and gynecological cancer: conceptualizing patient needs and overcoming barriers to seeking and accessing services

Objective: The current study explored the subjective experiences of women treated for a gynecological cancer, with a focus on filling gaps in the current literature. Topics explored were: (1) women’s own definitions of healthy sexuality; (2) services desired to meet needs; and (3) barriers to participation in sexual health-related services. Methods: Fifteen women participated in a one-on-one, semistructured interview. Data collection and analysis were based on guidelines of interpretive description. Results: Definitions of healthy sexuality included emotional intimacy, body image, sexual self-schema, and sexual response. Unmet sexual needs were reported when women’s current sexual experiences did not correspond with their subjective perceptions of healthy sexuality. Most women desired informational services, delivered one-on-one or through written material. Younger women often did not utilize services due to practical barriers and emotional avoidance, while older women reported that shyness and stigma discouraged them from discussing sexuality with their health care team. Conclusions: In order to understand patient needs and desire for help, health care providers should assess current sexual health and patient perceptions of healthy sexuality. To increase effectiveness of distress screening and treatment interventions, potential barriers must be evaluated and addressed.

Supportive Care Needs After Gynecologic Cancer: Where Does Sexual Health Fit in?

DESIGN Descriptive, cross-sectional study. SETTING Follow-up clinic of a gynecologic oncology program in a regional cancer center. SAMPLE 113 women treated for gynecologic cancer. METHODS Data were collected using standardized instruments and analyzed through descriptive and correlation statistics. MAIN RESEARCH VARIABLES Supportive care needs, sexual health needs, vaginal changes, desire for help, and socio-demographic and medical factors. FINDINGS Forty percent of the sample was worried about the status of their sex life and many wished to meet one-on-one with a health professional or to receive written information. Younger age, premenopausal status at diagnosis, and lower sexual satisfaction and more vaginal changes after treatment were associated with greater sexual health needs and desire for help. CONCLUSIONS Several sexual health needs were among the highest reported supportive care needs. Certain subgroups may report higher needs and desire for help; this domain merits additional research. Needs were extremely diverse, reflecting the use of an individual approach to screening for and meeting survivor needs. IMPLICATIONS FOR NURSING Personal perceptions of the implications and meaning of sexual health and vaginal changes create the subjective experience of a need. Discussions of the womens perceptions of their needs and their views of healthy sexuality will help develop effective treatment plans.

Erratum to: An exploratory study of the worst-case scenario exercise as an exposure treatment for fear of cancer recurrence

Purpose The worst-case scenario (WCS) exercise is part of a manualized cognitive-existential group intervention for fear of cancer recurrence (FCR). It requires cancer survivors to describe the scenario they most fear when they think about the possibility of their cancer returning and to re-read the scenario daily for 1 week as homework. The purpose of this study was to present this novel clinical treatment for FCR and to examine whether at-home repeated exposure to the WCS was related to pre- and post-therapy FCR levels.

Towards the validation of a new, blended theoretical model of fear of cancer recurrence

Fear of cancer recurrence (FCR) is defined as “fear, worry, or concern about cancer returning or progressing”. To date, only the seminal model proposed by Lee‐Jones and colleagues has been partially validated, so additional model testing is critical to inform intervention efforts. The purpose of this study is to examine the validity of a blended model of FCR that integrates Leventhals Common Sense Model, Mishels Uncertainty in Illness Theory, and cognitive theories of worry.

Filling in the gaps: Sociodemographic and medical predictors of sexual health and other supportive care needs, and desire for help in gynecological cancer survivors

Purpose The goal of the present study was to evaluate predictors of unmet supportive care needs and readiness for help among gynecological cancer patients. Methods A sample of 113 gynecological cancer survivors completed a measure of needs and desire for help. Regression analyses identified sociodemographic and medical predictors of patient needs and desire for help. Results Younger age and shorter time since treatment were the strongest predictors of many unmet needs. Younger age and chemotherapy predicted greater unmet sexual health needs. Shorter time since treatment predicted readiness for help with informational needs. Conclusions Post-treatment unmet needs are diverse and may be greater in younger and recently treated survivors. Chemotherapy treatment may contribute to greater sexual health needs.