Does psychological adjustment of melanoma survivors differs between genders?

Objective: Survival rates of cancer have significantly increased. However, cancer survivors face physical, psychological and social difficulties, while adjusting to post‐illness status. We examined between‐gender differences in the psychological adjustment (mental well‐being, distress and subjective level of functioning), the putative origin of those differences, and the roles of cognitive appraisal, hardiness and attachment style in the psychological adjustment of melanoma survivors. Methods: Our sample included 300 malignant melanoma survivors (182 women and 118 men). Most were diagnosed in stages IA and IB of the disease, and had no evidence of disease for 5 years or more. Participants completed self‐report questionnaires regarding personal data, adjustment measured by sense of well‐being, distress and subjective functioning, cognitive appraisal (primary and secondary) and personal resources (hardiness and attachment style). Results: Between‐gender differences were revealed in psychological adjustment and in various components of cognitive appraisal and attachment styles. Women revealed more distress, less secondary cognitive appraisal and were more secure in attachment styles. Men showed higher secondary appraisal and were more dismissing‐avoidant in attachment. No between‐group differences were found in mental well‐being, subjective functioning, and primary cognitive appraisal or in the global measure of hardiness. Conclusions: We present social processes that seem to account for gender differences in behavior and response to stress, and psychological explanations for these findings. This study contributes to the field of psycho‐oncology by identifying factors that promote adjustment among melanoma survivors. Copyright © 2010 John Wiley & Sons, Ltd.     

Rural and urban breast cancer patients: health locus of control and psychological adjustment

Objective: This study examines the moderating influence of rural residence on the associations between health locus of control (HLC) beliefs and psychological well‐being. Method: Two hundred and twenty‐four breast cancer patients were surveyed. Results: The results revealed that rurality interacted with HLC beliefs in predicting psychological adjustment. The pattern indicated that, whereas endorsing external forms of locus of control can be detrimental to the psychological well‐being of urban breast cancer patients, the same is not true for rural breast cancer patients. For rural breast cancer patients, powerful others locus of control was beneficial for and chance locus of control was unrelated to well‐being. Conclusions: Implications for future research and medical care are discussed. Copyright © 2007 John Wiley & Sons, Ltd.     

Persistent psychological distress in long-term survivors of pediatric sarcoma: the experience at a single institution

BACKGROUND: The long-term psychological impact of pediatric sarcoma is largely unknown. As part of a cross-sectional study examining the late effects of pediatric sarcoma therapy, we examined whether psychological distress or posttraumatic stress symptoms are present in an adult cohort of pediatric sarcoma survivors. METHOD: Thirty-four patients participated in the study, an average of 17 years after their treatment ended, each completing the SCID module for Posttraumatic Stress Disorder, Impact of Events Scale, Brief Symptom Inventory (BSI) and a questionnaire assessing sociodemographic variables and psychosocial issues. RESULTS: Significant persistent psychological distress characterized this cohort of patients. Seventy-seven percent scored in the clinical range on the BSI. Twelve percent met diagnostic criteria for PTSD. Current psychological distress was associated with intrusive thoughts and avoidant behaviors, male gender, employment, difficulty readjusting to work/school after treatment, and enduring worries about health. No differences were found based on age, presence of metastatic disease or time since diagnosis. CONCLUSIONS: This is the first report of a clinical evaluation of psychological distress in a cohort of pediatric sarcoma survivors treated with intensive multimodal cancer therapy. The results suggest that survivors of pediatric sarcoma might be at high risk for adverse psychological outcomes. Appropriate interventions are proposed.     

Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: a 3-month longitudinal examination of cognitive processing

Introduction: The experience of cancer can be understood as a psychosocial transition, producing both positive and negative outcomes. Cognitive processing may facilitate psychological adjustment. Methods: Fifty‐five post‐treatment, colorectal cancer survivors (M=65.9 years old; SD=12.7), an average of 13 months post‐diagnosis, were recruited from a state cancer registry and completed baseline and 3‐month questionnaires assessing dispositional (social desirability), cognitive processing (cognitive intrusions, cognitive rehearsal), and psychological adjustment variables (posttraumatic growth (PTG), posttraumatic stress disorder (PTSD) symptomatology, depression, anxiety, positive affectivity). Results: PTSD symptomatology was positively associated with depression, anxiety, and negatively associated with positive affectivity. In contrast, PTG scores were unrelated to PTSD symptomatology, depression, anxiety, and positive affectivity. In addition, PTG was independent of social desirability. Notably, after controlling for age at diagnosis and education, multiple regression analyses indicated that cognitive processing (intrusions, rehearsal) was differentially predictive of psychological adjustment. Baseline cognitive intrusions predicted 3‐month PTSD symptomatology and there was a trend for baseline cognitive rehearsal predicting 3‐month PTG. Conclusions: Additional research is needed to clarify the association between PTG and other indices of psychological adjustment, further delineate the nature of cognitive processing, and understand the trajectory of PTG over time for survivors with colorectal cancer. Copyright © 2008 John Wiley & Sons, Ltd.     

Psychological adjustment of survivors of localised prostate cancer: investigating the role of dyadic adjustment, cognitive appraisal and coping style

OBJECTIVES: The aim of this study was to identify the factors that contribute to psychological adjustment in prostate cancer patients two or more years post-treatment. METHOD: One hundred and sixty-seven men who had undergone treatment for localised prostate cancer participated in this study. In the sample 63 participants had undergone external beam radiotherapy (EBRT), 55 radical prostatectomy (RP), 27 EBRT plus hormone therapy (EBRT/HT), and the remainder a combination of treatments. Patients completed the UCLA-PCI, the POMS, CISS, DAS and a threat appraisal questionnaire. RESULTS: The majority of patients reported relatively positive adjustment in most domains except sexual functioning. For those who reported ongoing psychological difficulty mood disturbance was associated with sexual bother, dyadic adjustment, threat appraisal, self-efficacy appraisal and emotion-focussed coping. Lower levels of urinary bother were associated with the use of more task-focussed coping. Emotion-focussed coping and threat appraisal mediated the relationship between sexual bother and mood disturbance. Emotion-focussed coping moderated the influence of dyadic adjustment on mood disturbance. CONCLUSIONS: Dyadic adjustment, threat appraisal and coping style play a significant role in the long-term psychological adjustment of prostate cancer patients. The results of the current study indicate that the use of emotion-focussed coping to manage sexual bother appears to result in poor psychological adjustment, which indicates the need for further education or intervention to manage sexual dysfunction. ETHICS CLEARANCE: Human ethics approval was granted from Southern Health, Peter MacCallum Cancer Centre and the Monash University Ethics Committee before commencement of data collection.     

Type of social support matters for prediction of posttraumatic growth among cancer survivors

Objective: Previous research in people with cancer on social support and psychological well‐being has mainly focused on the short‐term negative outcomes of adjustment. Little is known about the role of social support in the experience of positive outcomes in the long term. This study examined the relation between emotional support in the period following diagnosis and the experience of positive consequences of the illness, so called posttraumatic growth, at 8 years after diagnosis. We focused on three distinct types of emotional support: perceived availability, actual received, and dissatisfaction with received emotional support. Methods: This longitudinal study was conducted in a sample of 206 long‐term cancer survivors. Social support was assessed with the Social Support List (SSL) at 3 months and 8 years after diagnosis. Positive consequences of the illness were assessed with the Silver Lining Questionnaire (SLQ) at 8 years after diagnosis. Correlation‐ and regression analyses were used to examine the associations of initial levels of emotional support with the long‐term report of posttraumatic growth. Results: Regression analyses showed that more received emotional support at 3 months after diagnosis significantly predicted a greater experience of positive consequences of the illness at 8 years after diagnosis. This association remained significant, when controlling for concurrent levels of emotional support at 8 years after diagnosis. Conclusions: The findings suggest that getting support from family and friends, characterized by reassuring, comforting, and problem‐solving, in the period following diagnosis is an important resource that may help cancer survivors to find positive meaning in the cancer experience. Copyright © 2009 John Wiley & Sons, Ltd.     

Relationship of psychological characteristics and self‐efficacy in gastrointestinal cancer survivors

To characterize gastrointestinal cancer survivors' ability to psychologically adjust, we examined the relationship between psychological characteristics (quality of life (QOL), anxiety, depression, and post‐traumatic stress symptoms) and self‐efficacy (perceived ability to initiate coping strategies). Forty‐seven subjects (32 males and 15 females) were recruited from outpatient clinics or general surgical wards after readmission for therapy unrelated to cancer. All had undergone treatment for gastrointestinal cancer. Japanese version of the Functional Assessment of Cancer Therapy—General (FACT‐G), Japanese version of Hospital Anxiety and Depression Scale (HADS), Japanese version of Impact of Event Scale—Revised (IES‐R), and The Self‐Efficacy Scale for Advanced Cancer (SEAC) were administered. Correlation analyses revealed a statistically significant positive correlation between three subscales of SEAC and QOL (total of FACT‐G value) and a significant negative correlation between anxiety, depression (the total of HADS value), post‐traumatic stress symptoms (the total of IES‐R value), and SEAC. In multiple regression analysis, the influence from Affect Regulation Efficacy (subscale of SEAC) was the largest in anxiety and post‐traumatic stress symptoms while the influence from Activities of Daily Living Efficacy (subscale of SEAC) was the largest in QOL and depression. Our findings revealed that a strong relationship between self‐efficacy and psychological adjustment, and that there should be several psychological intervention forms performed at various treatment stages to enhance self‐efficacy in this population of gastrointestinal cancer survivors. These results also imply the effectiveness of interventions on self‐efficacy for gastrointestinal cancer survivors and the influence of psychological factors such as QOL, anxiety, depression, and post‐traumatic stress symptoms. Copyright © 2009 John Wiley & Sons, Ltd.     

Behavioural functioning of retinoblastoma survivors

Objective: To assess behavioural problems in retinoblastoma (RB) survivors. Methods: This population‐based cross‐sectional study included 148 RB survivors (8–35 years), registered in the Dutch national RB register. Survivors and parents were asked to fill in behavioural questionnaires. Prevalence rates were computed, based on both self‐reports and proxy reports. One‐sample T‐tests were applied to analyse differences compared with healthy reference samples. Multiple regression analyses were performed to identify predictors for behavioural problems within the RB sample. Results: Between‐group differences varied across informants and across age groups. Parents reported significantly elevated total problem behaviour in 30% of their offspring (aged 8–17 years); this against 9% in adolescents (12–17 years) and 12% in adults (18–35 years) based on self‐report. Parental reports showed significantly elevated rates of (1) internalising problems in boys and (2) somatic complaints in both girls and boys. Self‐reports indicate significantly lowered levels of (1) externalising problems in adolescent and adult women and (2) thought problems in female adolescents and in adult men. Especially survivors who suffered hereditary RB, who had undergone more intensive treatment, and who came from a single‐parent family were identified to be at most behavioural risk. Conclusion: Perception of severity and the nature of behavioural problems seem to differ between beholder, and to vary between age groups, if not between life stages. Health professionals should be aware that especially those who are confronted with hereditary RB and who subsequently undergo intensive treatment, and who grow up in broken families, run the risk of developing behavioural difficulties. Copyright © 2008 John Wiley & Sons, Ltd.     

Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors

Survival from cancer has improved over the past decade resulting in more long-term survivors. The literature on multi-dimensional quality of life (QOL) among long-term (5+ years) adult survivors is reviewed for each of seven cancer sites (i.e. breast, ovarian, cervical, prostate, colorectal, head and neck, and Hodgkin's disease survivors). Overall, long-term survivors experience good to excellent QOL. Physical domain QOL was the most frequently measured while spiritual domain QOL was the least frequently measured. QOL varies according to treatment received and by age for all groups with older persons (excepting head and neck and Hodgkin's disease survivors) reporting better QOL. QOL improves with time for breast cancer survivors and tends to decrease over time for prostate cancer survivors. Issues regarding sexual functioning affected the social domain-especially for breast and prostate cancer survivors. Social support improves psychological domain QOL for breast, cervical, and colorectal survivors. Review of findings may assist researchers and clinicians wishing to enhance the QOL of the long-term survivor population by identifying the most pressing and widely experienced concerns and by providing directions for future research.