Zeev Rosberger

Impact of computerized quality of life screening on physician behaviour and patient satisfaction in lung cancer outpatients.

The purpose of this paper was to determine if providing patient specific Quality of Life (QL) information to clinic staff before a clinic appointment improved patient care in a lung cancer outpatient clinic. Patients were sequentially assigned to either a usual care control group or the experimental group, which completed a computerized version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ‐C30 questionnaire in order to provide the clinic staff with QL information prior to the clinic appointment. The control group completed the EORTC QLQ‐C30 paper version after the clinic appointment. Outcome measures were patient satisfaction, the degree to which issues identified on the QL questionnaire were addressed in the appointment, and a chart audit, which measured charting of QL issues and actions taken by the clincian relating to QL. In the experimental group, more QL issues identified by the patient on the EORTC QLQ‐C30 were addressed during the clinic appointment than in the control group. As well, marginally more categories were charted and a trend towards more actions being taken was seen in the experimental group. Patients reported being equally and highly satisfied with the treatment in both groups. The clinical implication is that the computerized administration of the EORTC QLQ‐C30 questionnaire and providing staff with a report highlighting patient‐specific QL deficits is a simple, time‐effective and acceptable means of improving patient–provider communication in a busy outpatient clinic. Large trials studying its effectiveness in different patient populations and regions would further elucidate the nature of this effect and potentially improve the overall quality of care that patients receive.

Coping with cancer during the first year after diagnosis. Assessment and intervention.

The emotional coping of 205 patients newly diagnosed with cancer was evaluated every 4 months during a 1‐year period. Patients received a psychosocial intervention either immediately (early intervention, EI), or after a 4‐month delay (later intervention, LI). No significant differences were found between the two groups, except at 8 months, when the LI group was significantly less depressed, anxious, and worried, and felt more in control than the EI group. The LI group continued to have less worry related to illness at, 12 months. Patients with high ego strength had low levels of distress at baseline and may not have needed the intervention. The emotional coping of patients with breast cancer improved during the year regardless of the intervention timing. Patients with other diagnoses appeared to benefit most from the LI. It was concluded that patients with low ego strength and diagnoses other than breast cancer might be at higher risk for psychosocial complications and could benefit from the intervention.

Resource use in women completing treatment for breast cancer.

Objective: To explore resources used by women completing treatment for breast cancer, how they learned about them, and the psychological factors that predicted their use. Copyright

Waiting for a breast biopsy. Psychosocial consequences and coping strategies.

OBJECTIVE The aim of this pilot/feasibility study was to describe the experience of women presenting with a suspicious mammogram who are waiting for a breast biopsy and to identify those at risk for distress. METHODS Participants (n=25) were interviewed at two time points: immediately after being put on the waiting list (T1) and again immediately before their biopsy approximately 6 weeks later (T2). Self-report measures of distress and coping were used. Perceived personal risk of a positive biopsy finding and information needs were assessed through open-ended questions. RESULTS Distress levels were high in this sample. Using cognitive-avoidant coping strategies, being employed, history of previous biopsies, and having a family history of breast cancer were associated with greater distress. Perceived personal risk of a positive biopsy finding was overestimated in one half of the cases and was correlated with greater distress. CONCLUSION Waiting period between suspicious mammogram and breast biopsy may be a time of high distress for many women.

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.

Lessons learned: Outcomes and methodology of a coping skills intervention trial comparing individual and group formats for patients with cancer

Objective: Nucare, a short-term psychoeducational coping skills training intervention was evaluated in a randomized controlled clinical trial (RCT) of 225 newly diagnosed breast and colon cancer patients. Method: Measures of psychosocial distress, well being and optimism were evaluated every four months during a one-year period. Patients were randomized to one of four arms: Nucare presented in an individual basis; Nucare presented in a group format; a non-directive supportive group; and a no-intervention control. The interventions were provided in five sessions of ninety minutes each. Results: Patients with breast cancer who received Nucare presented in an individual format showed more significant improvements in well-being over time compared to those in the control and group arms. Conclusions: We were unable to develop functioning groups within the RCT. Partial explanations for the latter finding include the structural limitations of the RCT: the groups were small, difficult to schedule and patients indicated that they would have preferred to choose whether or not to participate in a group. The positive changes in women with breast cancer who received Nucare persisted at 12 months.

Human Papillomavirus Vaccination Intentions and Uptake in College Women

OBJECTIVE Using the health belief model (HBM) and theory of planned behavior (TPB) as theoretical frameworks, the objectives of this study were: (a) to identify correlates of human papillomavirus (HPV) vaccination intentions and (b) to explore differences between correlates of HPV vaccination intentions and uptake. METHODS Undergraduate women (N = 447) who did not intend to receive (n = 223), intended to receive (n = 102), or had received (n = 122) the HPV vaccine were surveyed. Logistic regressions were conducted to examine the correlates of vaccination intentions and uptake. RESULTS Negative health consequences of the vaccine, physicians recommendation, positive attitudes toward the vaccine, and subjective norms were significant correlates of vaccination intentions. When comparing correlates of vaccination intentions to correlates of vaccination uptake, physicians recommendation, subjective norms, and perceived susceptibility to HPV were unique correlates of uptake. CONCLUSION Differences between correlates of vaccination intentions and uptake suggest that social influences of liked and trusted individuals may make an important and unique contribution in motivating young women to receive the HPV vaccine beyond other variables from the HBM and TPB. Future utilization of longitudinal designs is needed to understand which factors may cause individuals to decide to receive the HPV vaccine.

Prevalence of emotional distress in newly diagnosed lung cancer patients.

Goals of workDistress is defined by the National Comprehensive Cancer Network as a multifactorial unpleasant emotional experience of a psychological, social, and/or spiritual nature that may interfere with the ability to cope effectively with cancer. We investigated the prevalence and associated symptoms of distress in newly diagnosed lung cancer patients.Patients and methodsBetween November 2005 and July 2007, 98 newly diagnosed lung cancer patients completed an assessment. The Distress Thermometer (DT) and Edmonton Symptom Assessment Scale (ESAS) were used as screening tools.Main resultsFifty (51%) patients reported clinically significant distress (≥4) on the DT. Of those, 26 (52%) patients reported high levels of depression, nervousness, or both on ESAS. The remaining 24 (48%) patients had elevated levels of distress but no significant depression or nervousness. A correlation between the DT and the total ESAS score was observed (Pearson correlation = 0.46). The ten items of the ESAS together explained 46% of the variability in DT scores. The depression and nervousness ESAS items were significant predictors of DT score (p < 0.01 for both items). However, once the two psychosocial items, depression and nervousness, were removed from the total ESAS score, leaving only physical symptoms and the sleeplessness item, the predictive power of the model decreased to R² = 0.12.ConclusionsThe prevalence of distress in lung cancer patients is high. The DT appears to discriminate between physical and emotional distress. This easily measured score may determine which patients require further intervention for emotional distress.

How to Inform: Comparing Written and Video Education Interventions to Increase Human Papillomavirus Knowledge and Vaccination Intentions in Young Adults

Abstract Objective: To compare the efficacy of 2 human papillomavirus (HPV) educational interventions on increasing HPV knowledge and vaccination intentions in college students. Participants: Male (n = 60) and female (n = 140) undergraduates (M age = 20.4, SD = 2.3) recruited from a university in Montreal, Quebec, Canada, from October 2009 to March 2010. Methods: Using theory-based interventions, participants were randomly assigned to either a written HPV pamphlet, an HPV video, or a control. HPV knowledge and vaccination intentions were assessed pre and postintervention. Results: Low baseline knowledge and intentions were found across groups. Postintervention, participants in the written and video interventions had significantly higher knowledge and intentions than the control. No differences were found between written and video interventions on knowledge or intentions. Conclusion: This study, a first in comparing HPV educational formats, suggests that both written and video interventions are equally effective in educating about HPV and increasing young adults’ vaccination intentions.

Predicting stress-related problems in long-term breast cancer survivors

INTRODUCTION Little is known about the early clinical and psychosocial factors associated with subsequent stress-related problems in breast cancer survivors. METHODS We used data collected at 3, 7, 11, and 15 months post-diagnosis to predict stress-related problems in 86 breast cancer survivors at 6 years post-diagnosis. We examined two common stress-related problems: (a) emotional distress and (b) intrusion and avoidance. Hypothesized risk factors included perceived stressfulness of the cancer; fear of the future; poor perceived health; initial stress-related problems; avoidance coping; and second cancer experience. Hypothesized protective factors included active coping (seeking social support; positive problem solving); optimism; and social support. RESULTS Hierarchical multiple regression analyses, controlling for age and education, indicated that positive problem-solving coping at 3 months and emotional distress at 7 months significantly predicted 6-year emotional distress (R(2)=.24, P<.01). Second cancer experience and 3-month intrusion and avoidance significantly predicted 6-year intrusion and avoidance (R(2)=.38, P<.001). In both cases, risk and/or protective factors measured at 11 and 15 months did not add significantly to the regression equations. DISCUSSION/CONCLUSION Symptoms of intrusion and avoidance should be monitored carefully during the first 3 months following diagnosis because they signal the risk that these symptoms will persist in the long-term. Elevated emotional distress at 7-months post-diagnosis and second-cancer experiences may signal the need for psychosocial intervention. Overreliance on positive problem solving to cope early in the disease trajectory may be detrimental in the longer term.