Yasmin Asvat

Do Community Health Worker Interventions Improve Rates of Screening Mammography in the United States? A Systematic Review

Background: Community health workers (CHW) are lay individuals who are trained to serve as liaisons between members of their communities and health care providers and services. Methods: A systematic review was conducted to synthesize evidence from all prospective controlled studies on effectiveness of CHW programs in improving screening mammography rates. Studies reported in English and conducted in the United States were included if they: (i) evaluated a CHW intervention designed to increase screening mammography rates in women 40 years of age or older without a history of breast cancer; (ii) were a randomized controlled trial (RCT), case–controlled study, or quasi-experimental study; and (iii) evaluated a CHW intervention outside of a hospital setting. Results: Participation in a CHW intervention was associated with a statistically significant increase in receipt of screening mammography [risk ratio (RR): 1.06 (favoring intervention); 95% CI: 1.02–1.11, P = 0.003]. The effect remained when pooled data from only RCTs were included in meta-analysis (RR: 1.07; 95% CI: 1.03–1.12, P = 0.0005) but was not present using pooled data from only quasi-experimental studies (RR: 1.03; 95% CI: 0.89–1.18, P = 0.71). In RCTs, participants recruited from medical settings (RR: 1.41; 95% CI: 1.09–1.82, P = 0.008), programs conducted in urban settings (RR: 1.23; 95% CI: 1.09, 1.39, P = 0.001), and programs where CHWs were matched to intervention participants on race or ethnicity (RR: 1.58, 95% CI: 1.29–1.93, P = 0.0001) showed stronger effects on increasing mammography screening rates. Conclusions: CHW interventions are effective for increasing screening mammography in certain settings and populations. Impact: CHW interventions are especially associated with improvements in rate of screening mammography in medical settings, urban settings, and in participants who are racially or ethnically concordant with the CHW. Cancer Epidemiol Biomarkers Prev; 20(8); 1580–98. ©2011 AACR.

Cognitive Functioning in Men Receiving Androgen Deprivation Therapy for Prostate Cancer: A Systematic Review and Meta-Analysis

PurposePrior research examining the impact of androgen deprivation therapy (ADT) for prostate cancer on cognitive performance has found inconsistent relationships. The purpose of this study was to systematically review the existing literature and determine the effect of ADT on performance across seven cognitive domains using meta-analysis.MethodsA search of PubMed Medline, PsycINFO, Cochrane Library, and Web of Knowledge/Science databases yielded 157 unique abstracts reviewed by independent pairs of raters. Fourteen studies with a total of 417 patients treated with ADT were included in the meta-analysis. Objective neuropsychological tests were categorized into seven cognitive domains: attention/working memory, executive functioning, language, verbal memory, visual memory, visuomotor ability, and visuospatial ability.ResultsSeparate effect sizes were calculated for each cognitive domain using pairwise comparisons of patients who received ADT with (1) prostate cancer patient controls, (2) noncancer controls, or (3) ADT patients’ own pre-ADT baselines. Patients treated with ADT performed worse than controls or their own baseline on visuomotor tasks (g = −0.67, p = .008; n = 193). The magnitude of the deficits was larger in studies with a shorter time to follow-up (p = .04). No significant effect sizes were observed for the other six cognitive domains (p = .08–.98).ConclusionsProstate cancer patients who received ADT performed significantly worse on visuomotor tasks compared to noncancer control groups. These findings are consistent with the known effects of testosterone on cognitive functioning in healthy men. Knowledge of the cognitive effects of ADT may help patients and providers better understand the impact of ADT on quality of life.

Acculturation and depressive symptoms in Muslim university students: Personal–family acculturation match

The relationships of personal acculturation and of personal-family acculturation match to depressive symptoms were investigated in a sample of 68 Muslim university students. Two dimensions of personal and family acculturation were assessed: heritage and mainstream culture identification. Participants completed the Vancouver Index of Acculturation (Ryder, Alden, & Paulhus, 2000 ) and the depressive disorder subscale of the Psychiatric Diagnostic Screening Questionnaire (Zimmerman & Mattia, 1999 ). For personal acculturation, individuals with high personal heritage culture identification reported fewer lifetime (but not past-year) depressive symptoms. In contrast, individuals with high personal mainstream culture identification reported more past-year (but not lifetime) depressive symptoms. The hypothesis that a match between personal and family acculturation orientation would be associated with fewer depressive symptoms was supported for heritage culture identification only. For past-year depression, the two match conditions (low or high personal and family heritage culture identification) were associated with significantly fewer depressive symptoms than a low personal/high family mismatch but did not differ from a high personal/low family mismatch. For lifetime depression, a high personal/high family match was associated with significantly fewer depressive symptoms than all other conditions. Findings suggests that, for Muslims, a match of high personal and high family heritage culture identification may act as a protective factor for the experience of depressive symptoms both in the short term (past year) and in the long term (lifetime).

Appearance-Based Tanning Motives, Sunbathing Intentions, and Sun Protection Intentions in Adolescents

A dolescents engage in behaviors, including intentional sunbathing, that result in increased UV exposure and therefore increased risk for skin cancer. A survey of approximately 10 000 adolescents (aged 12-18 years) from all 50 states found that the prevalence of routine sunscreen use was 34.4% and that 83% of those surveyed reported at least 1 sunburn during the previous summer. The recent work of our research group with adults has focused on a multidimensional model of appearance-based tanning motives, including appearance reasons to tan (eg, enhancing overall appearance or body shape, covering up acne), appearance reasons not to tan (eg, skin aging), and sociocultural influences to tan (ie, media, peer, and family influences). Appearance and sociocultural tanning influences are significantly related to sunbathing and sun protection intentions in samples of female college students, thus explaining variance beyond that attributable to skin type and perceived susceptibility to developing skin cancer. The primary goal of the present investigation was to extend our group’s previous work on appearance-based tanning motives as attitudinal predictors of sunbathing and sun protection intentions to include an examination of middle school– and high school–aged adolescents. In particular, we wanted to determine if the factor structure of our new measure (the Physical Appearance Reasons for Tanning Scale, or PARTS) would replicate in a younger sample, and we also wanted to determine whether appearance motives would be related to sunbathing and sun protection intentions after controlling for more extensively researched factors such as skin type and perceived susceptibility to skin cancer.

A systematic review and meta-analysis of changes in cognitive functioning in adults undergoing hematopoietic cell transplantation

Evidence is mixed regarding the effects of hematopoietic cell transplantation (HCT) on changes in cognitive functioning among adults. Meta-analysis, which is designed to help reconcile conflicting findings, has not yet been conducted on studies of adults receiving HCT. To fill this gap, the current study provides a systematic review and meta-analysis of cognitive functioning in adults receiving HCT. A search of PubMed, PsycInfo, CINAHL, and Cochrane Library yielded 732 abstracts, which were independently evaluated by pairs of raters. Seventeen studies were systematically reviewed; 11 were retained for meta-analysis. There was agreement that cognitive impairments are evident for a subset of patients before HCT. Meta-analytical findings of 404 patients revealed no significant changes in cognitive functioning pre- to post HCT (P-values >0.05). Age, time since transplant and TBI were not associated with changes in cognitive functioning. Patients who received autologous transplants were more likely to demonstrate improvements in attention (P=0.004). The systematic review identified several limitations of existing literature, including small, clinically heterogeneous samples. Large, cooperative group studies are needed to address these design limitations. Nevertheless, results from the current meta-analysis suggest that cognitive functioning does not significantly change following HCT.

Distress, delay of gratification and preference for palliative care in men with prostate cancer.

Patient‐centered cancer care standards include routine psychosocial distress screening and referral for supportive care services. Although many cancer patients report psychosocial distress that could be alleviated by supportive services including palliative care, patients often decline such services for reasons that are poorly understood. Research on decision‐making suggests that during periods of acute distress, individuals have more difficulty prioritizing long‐term over immediate gains. Thus, distressed cancer patients may prioritize immediate gains (e.g., avoidance of palliative care discussions in the moment) over longer‐term gains (e.g., improved quality of life in the future).

Evaluation of the psychometric properties of the PROMIS Cancer Fatigue Short Form with cancer patients

OBJECTIVE Fatigue is common among cancer patients and adversely impacts quality of life. As such, it is important to measure fatigue accurately in a way that is not burdensome to patients. The 7-item Patient Reported Outcome Measurement Information System (PROMIS) Cancer Fatigue Short Form scale was recently developed using item response theory (IRT). The current study evaluated the psychometric properties of this scale in two samples of cancer patients using classical test theory (CTT). METHODS Two samples were used: 121 men with prostate cancer and 136 patients scheduled to undergo hematopoietic cell transplantation (HCT) for hematologic cancer. All participants completed the PROMIS Cancer Fatigue Short Form as well as validated measures of fatigue, vitality, and depression. HCT patients also completed measures of anxiety, perceived stress, and a clinical interview designed to identify cases of cancer-related fatigue. RESULTS PROMIS Cancer Fatigue Short Form items loaded on a single factor (CFI=0.948) and the scale demonstrated good internal consistency reliability in both samples (Cronbachs alphas>0.86). Correlations with psychosocial measures were significant (p values<.0001) and in the expected direction, offering evidence for convergent and concurrent validity. PROMIS Fatigue scores were significantly higher in patients who met case definition criteria for cancer-related fatigue (p<.0001), demonstrating criterion validity. CONCLUSION The current study provides evidence that the PROMIS Cancer Fatigue Short Form is a reliable and valid measure of fatigue in cancer patients.

Validity of the Multidimensional Fatigue Symptom Inventory-Short Form in an African American Community-Based Sample

Objectives. This study examined the psychometric properties of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) in a community-based sample of African-Americans. Design. A sample of 340 African-Americans (116 men, 224 women) ranging in age from 18–81 years were recruited from the community (e.g., churches, health fairs, and beauty salons). Participants completed a brief demographic survey, the MFSI-SF and the Positive and Negative Affect Schedule. Results. The structural validity of the MFSI-SF for a community-based sample of African-Americans was not supported. The five dimensions of fatigue (General, Emotional, Physical, Mental, Vigor) found for Whites in prior research were not found for African-Americans in this study. Instead, fatigue, while multidimensional for African-Americans, was best represented by a unique four-four profile in which general and emotional fatigue are collapsed into a single dimension and physical fatigue, mental fatigue, and vigor are relatively distinct. Hence, in the absence of modifications, the MFSI-SF cannot be considered to be structurally invariant across ethnic groups. A modified four-factor version of the MFSI-SF exhibited excellent internal consistency reliability and evidence supports its convergent validity. Using the modified four-factor version, gender, and age were not meaningfully associated with MFSI-SF scores. Conclusion. Future research should further examine whether modifications to the MFSI-SF would, as the findings suggest, improve its validity as a measure of multidimensional fatigue in African-Americans.

Rates and Predictors of Psychotherapy Utilization after Psychosocial Evaluation for Stem Cell Transplant

Although standard of care prior to hematopoietic stem cell transplantation (HSCT) includes a psychosocial evaluation, little is known about the rate and predictors of psychotherapy utilization among patients presenting for pre‐HSCT evaluations. This study aimed to examine the proportion of patients undergoing pre‐HSCT evaluations who subsequently utilize psychotherapy services and to explore predictive factors, including distress, anxiety, depression, and quality of life (QoL).

Coping, stress, and insomnia in hematopoietic stem cell transplant candidates

Hematopoietic stem cell transplant (HSCT) is an intensive but potentially curative treatment for hematologic and lymphatic cancers. The pre-transplant period is often characterized by elevated stress due to factors such as anxiety and side effects of previous treatments [1], and stress has been associated with insomnia [2]. Coping, which has been conceptualized as approach oriented or avoidance oriented (cognitive and emotional activity oriented toward or away from the stressor), may influence perceptions of stress. In the Transactional Model of Stress and Coping [3], effectiveness of coping and degree of perceived stress influence outcomes (e.g., insomnia). Although literature on sleep disorder prevalence among HSCT candidates is limited, data suggests sleep disturbance during the pre-transplant period affects approximately 32–50% of patients [4]. However, few studies include comparison groups, many assess sleep using a single item, and few are specific to allogeneic transplant patients (i.e., cells obtained from a donor rather than from the patient). This study compared insomnia in allogeneic HSCT candidates relative to cancer-free controls, hypothesizing that HSCT candidates would report greater insomnia. It also explored whether perceived stress and coping strategies represent differentiating factors for insomnia in HSCT candidates, hypothesizing that avoidance coping would be associated with worse sleep, mediated by greater perceived stress.