Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia

Objective: Insomnia is a common complaint among cancer survivors. Fortunately, cognitive‐behavioral therapy for insomnia (CBT‐I) has been shown to be an effective treatment in this population. However, it is rarely implemented given its limited availability. To address this barrier, we examined the ability of an easily accessible online CBT‐I program to improve insomnia symptoms in cancer survivors. Methods: Twenty‐eight cancer survivors with insomnia were randomly assigned to either an Internet insomnia intervention (n = 14) or to a waitlist control group (n = 14). The online program, Sleep Healthy Using The Internet, delivers the primary components of CBT‐I (sleep restriction, stimulus control, cognitive restructuring, sleep hygiene, and relapse prevention). Pre‐ and post‐assessment data were collected via online questionnaires and daily sleep diaries. Results: Participants in the Internet group showed significant improvements at post‐assessment compared with those in the control group in overall insomnia severity (F_1,26 = 22.8; p<0.001), sleep efficiency (F_1,24 = 11.45; P = 0.002), sleep onset latency (F_1,24 = 5.18; P = 0.03), soundness of sleep (F_1,24 = 9.34; P = 0.005), restored feeling upon awakening (F_1,24 = 11.95; P = 0.002), and general fatigue (F_1,26 = 13.88; P = 0.001). Although other group × time interactions were not significant, overall adjusted effect sizes for all sleep variables as well as for fatigue, depression, anxiety, and quality of life ranged from small to large. Conclusions: CBT‐I delivered through an interactive, individually tailored Internet intervention may be a viable treatment option for cancer survivors experiencing insomnia. Copyright © 2011 John Wiley & Sons, Ltd.     

Evaluation of a group cognitive behavioural intervention for women suffering from menopausal symptoms following breast cancer treatment

Objective: To evaluate a group cognitive behavioural intervention to alleviate menopausal symptoms in women who have had treatment for breast cancer. Methods: A single group design was used with pre‐ and post‐treatment assessment and a 3‐months follow‐up. Seventeen women who had completed active breast cancer treatment were treated. Following a 2‐week daily diary assessment they were offered 6 (90 min) weekly sessions of Group cognitive behaviour therapy (CBT). The CBT included information and discussion, relaxation and paced breathing and CBT to reduce stress and manage hot flushes (HF), night sweats (NS) and sleep. The primary outcome measure was Hot Flush Frequency and Hot Flush Problem Rating; secondary outcomes included the Women's Health Questionnaire (WHQ) and health‐related quality of life (SF 36). Beliefs about HF were monitored in order to examine the effects of cognitive therapy. Results: HF and NS reduced significantly following treatment (38% reduction in frequency and 49% in problem rating) and improvements were maintained at 3 months follow‐up (49% reduction in frequency and 59% in problem rating). Depressed mood, anxiety and sleep (WHQ) significantly improved, as did aspects of quality of life (SF 36) (emotional role limitation, energy/vitality and mental health). There was a significant reduction in negative beliefs about HF, NS and sleep following CBT. Conclusions: These results suggest that CBT delivered in groups might offer a viable option for women with troublesome menopausal symptoms following breast cancer treatment, but further controlled trials are needed. Copyright © 2008 John Wiley & Sons, Ltd.     

Individualised mindfulness‐based stress reduction for head and neck cancer patients undergoing radiotherapy of curative intent: a descriptive pilot study

People with head and neck cancer (HNC) experience elevated symptom toxicity and co‐morbidity as a result of treatment, which is associated with poorer psychosocial and quality‐of‐life (QoL) outcomes. This Phase I study examined whether an individualised mindfulness‐based stress reduction (IMBSR) programme could be successfully used with HNC patients undergoing curative treatment. Primary aims were to explore feasibility, compliance, acceptability and fidelity. Secondary aims were to determine whether (1) participation in the intervention was associated with changes in post‐intervention mindfulness and (2) post‐intervention mindfulness was associated with post‐intervention distress and QoL. Nineteen HNC patients participated in a seven‐session IMBSR programme with pre‐ and post‐test outcome measures of psychological distress, depression, anxiety and QoL. Primary aims were assessed by therapists or participants. Mindfulness, distress and QoL were assessed using self‐report questionnaires at pre‐ and post‐intervention. Longer time spent meditating daily was associated with higher post‐intervention mindfulness. After controlling for pre‐intervention mindfulness, there was an association between higher post‐intervention mindfulness and lower psychological distress and higher total, social and emotional QoL. This study offers important preliminary evidence than an IMBSR intervention can be administered to HNC patients during active cancer treatment. A randomised controlled trial is warranted to confirm these findings.     

Implications of a needs assessment intervention for people with progressive cancer: impact on clinical assessment, response and service utilisation

Objective: To assess the impact of the systematic use of the Palliative Care Needs Assessment Guidelines and Needs Assessment Tool: Progressive Disease‐Cancer (NAT: PD‐C) on clinical assessment, response and service utilisation. Study setting: Three major oncology treatment centres in NSW, Australia. Study design: Between March 2007 and December 2009, 219 people with advanced cancer were recruited to complete bi‐monthly telephone interviews. The intervention, introduced after at least two baseline interviews, involved training health professionals to complete the NAT: PD‐C with patients approximately monthly. Data collection: Rates of service use and referrals were compared pre‐ and post‐introduction of the NAT: PD‐C. Rates of completion of the tool; its impact on consultation length; and the types of needs and follow‐up care to address these were also assessed. Principal findings: The NAT: PD‐C had a high rate of completion; identified needs consistent with those self‐reported by patients in interviews; and did not alter consultation length. No changes in the number of health professionals seen by patients were found pre‐ and post‐intervention. Conclusion: The NAT: PD‐C is an efficient and acceptable strategy for supporting needs‐based cancer care that can potentially be incorporated into standard routine care without increasing the burden on care providers. Copyright © 2011 John Wiley & Sons, Ltd.     

The ONE‐MIND Study: Rationale and protocol for assessing the effects of ONlinE MINDfulness‐based cancer recovery for the prevention of fatigue and other common side effects during chemotherapy

Cancer patients often experience poor quality of life (QoL) during chemotherapy (CT) treatments due to side effects including fatigue, insomnia, pain and nausea/vomiting. Mindfulness‐based cancer recovery (MBCR) is an evidence‐based intervention for treating such symptoms, but has not been investigated as an adjunctive treatment during CT. This study aims to determine the efficacy of an online group MBCR programme delivered during CT in 12 real‐time interactive weekly sessions for managing fatigue (primary outcome). Secondary outcomes include sleep disturbance, pain, nausea/vomiting, mood, stress and QoL. Exploratory outcomes include cognitive function, white blood cell counts and return to work. The study is a two‐armed randomised controlled waitlist trial with 2:1 allocation to treatment (online group MBCR during CT) or control (waitlist usual care; online MBCR following CT completion) with a target sample size of N = 178. Participants are breast or colorectal cancer patients undergoing common CT regimens in Calgary, Canada. Online assessments using validated self‐reported instruments will take place at baseline, post‐MBCR, post‐CT and 12 months’ post‐baseline. If online MBCR delivered during CT significantly reduces fatigue in cancer patients’ post‐CT and also impacts secondary symptoms, this would provide evidence for including mindfulness training as an adjunctive symptom management therapy during CT.     

The development and impact of insomnia on cancer survivors: a qualitative analysis

Objectives: To conduct the first qualitative analysis of the development and impact of insomnia on a cohort of cancer survivors. Methods: Twenty‐one cancer survivors with a history of chronic insomnia contributed to four focus groups held at the University of Glasgow Sleep Research Centre. Participants' perceptions of the onset, evolution and effects of insomnia were elicited and qualitatively explored using content analysis. Results: Most participants reported insomnia onset following cancer diagnosis. Participants who had a pre‐existing insomnia reported that cancer diagnosis significantly aggravated their sleep complaint. Active cancer treatment was a major contributor to poor sleep quality due to the disruption of normal daily routines. This poor sleep pattern became persistent once active treatment had ceased and participants reported becoming particularly concerned about their sleep when they were discharged into follow‐up cancer care. The impact of insomnia was significant for all participants in the study and six major areas emerged as being particularly affected; mood, physical health, relationships, sleep quality, sleep‐related behaviour and cognition. Conclusions: The majority of cancer survivors in this study developed disturbed sleep as a result of cancer diagnosis and their sleep disruption was exacerbated by active cancer treatment. Insomnia also had a significant impact upon quality of life and these effects persisted long beyond the cessation of active anti‐cancer therapy. Early identification of insomnia symptoms in cancer care settings must be a priority to ensure that sleep disturbance is not overlooked or poorly managed. Copyright © 2010 John Wiley & Sons, Ltd.     

Development of CBT for chemotherapy-related cognitive change: results of a waitlist control trial

Objective: To evaluate the efficacy of a brief cognitive‐behavioral therapy (CBT) that is being developed for management of cognitive dysfunction following chemotherapy among breast cancer survivors. Memory and Attention Adaptation Training (MAAT) is a brief CBT designed to improve the quality of life and function among cancer survivors with post‐chemotherapy cognitive complaints. Methods: An initial, two‐group (MAAT versus waitlist, no treatment control), randomized clinical trial (RCT) was conducted. Forty stage I and II female breast cancer survivors (mean age = 50; SD = 6.4) were randomized to conditions and assessed at baseline, post‐treatment (8 weeks) and 2‐month follow‐up assessment points on measures of: (1) self‐reported daily cognitive failures; (2) quality of life; and (3) neuropsychological performance. Participants were also assessed for satisfaction with MAAT. Results: With education and IQ as covariates, MAAT participants made significant improvements relative to controls on the spiritual well‐being subscale of the quality of life measure and on verbal memory, but statistical significance was not achieved on self‐report of daily cognitive complaints. However, moderate‐to‐large effect sizes were observed on these outcomes. Participants gave MAAT high satisfaction ratings. Conclusions: Although this initial RCT is a small study, MAAT participants appear to improve on one measure of quality of life and verbal memory performance relative to no treatment controls and rate MAAT with high satisfaction. These data are encouraging and support the continued development and evaluation of MAAT efficacy.Copyright © 2010 John Wiley & Sons, Ltd.     

Changes in breast cancer patients after psychosocial intervention as indicated in drawings

Objective: The present study attempts to understand the experience of breast cancer patients who had participated in an Eastern‐based body–mind–spirit (BMS) psychosocial intervention program by observing changes in the images made by the patients. Methods: Pre‐ and post‐intervention drawings on the theme of ‘my cancer’ were collected from 67 primary breast cancer patients. Two creative art therapists compared the drawings according to the structural and formal art elements (body), the symbols used (mind), and the emotions and feelings presented in the drawings (spirit). Numbers of pre‐ and post‐intervention drawings, showing the presence of each element in these three dimensions, were also counted and compared. Results: There were several changes noted between pre‐ and post‐intervention drawings. The use of color, space, and multiplicity increased from 12 to 17%. Images of breasts decreased from 13 to 0%. Representations of cancer decreased from 15 to 7%. There was a slight increase in symbolic representations of natural, landscapes, and social support in post‐drawings (3–6%). The portrayal of negative emotions was greatly reduced from 52 to 3%, while positive emotions increased from 28 to 93% in post‐drawings. Conclusions: The comparison of pre‐ and post‐intervention drawings revealed changes in subject matter and accompanying emotions. Overall, there was a trend in changes toward a more peaceful and hopeful attitude. Through the use of realistic and symbolic images, participants depicted a range of emotions. Limitations and recommendations for using art–making, as an assessment tool and intervention, are addressed. Copyright © 2009 John Wiley & Sons, Ltd.     

Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects.

PURPOSE: Chronic insomnia is highly prevalent in cancer patients. Cognitive-behavioral therapy (CBT) is considered the treatment of choice for chronic primary insomnia. However, no randomized controlled study has been conducted on its efficacy for insomnia secondary to cancer. Using a randomized controlled design, this study conducted among breast cancer survivors evaluated the effect of CBT on sleep, assessed both subjectively and objectively, and on hypnotic medication use, psychological distress, and quality of life. PATIENTS AND METHODS: Fifty-seven women with insomnia caused or aggravated by breast cancer were randomly assigned to CBT (n = 27) or a waiting-list control condition (n = 30). The treatment consisted of eight weekly sessions administered in a group and combined the use of stimulus control, sleep restriction, cognitive therapy, sleep hygiene, and fatigue management. Follow-up evaluations were carried out 3, 6, and 12 months after the treatment. RESULTS: Participants who received the insomnia treatment had significantly better subjective sleep indices (daily sleep diary, Insomnia Severity Index), a lower frequency of medicated nights, lower levels of depression and anxiety, and greater global quality of life at post-treatment compared with participants of the control group after their waiting period. Results were more equivocal on polysomnographic indices. Therapeutic effects were well maintained up to 12 months after the intervention and generally were clinically significant. CONCLUSION: This study supports the efficacy of CBT for insomnia secondary to breast cancer.     

Mindfulness-based cognitive therapy reduces chronic cancer-related fatigue: a treatment study

Introduction: About one‐third of cancer survivors suffer from severe chronic fatigue. Aim of this study was to evaluate the efficacy of mindfulness‐based cognitive group therapy in reducing severe chronic fatigue in cancer survivors with mixed diagnoses. Patients and Methods: Participants (n = 100) were randomly selected from a cohort and allocated to an intervention and a waiting list condition. Analyses were based on 59 participants in the intervention condition and 24 in the waiting‐list condition. Fatigue severity (Checklist Individual Strength), functional impairment (Sickness Impact Profile) and well being (Health and Disease‐Inventory) were assessed before and after the 9‐week intervention. The intervention group had a follow‐up 6 months following the intervention. Results: At post‐treatment measurement the proportion of clinically improved participants was 30%, versus 4% in the waiting list condition ( χ ² (1) = 6.71; p = 0.007). The mean fatigue score at post‐measurement was significantly lower in the intervention group than in the waiting list group corrected for pre‐treatment level of fatigue. The mean well‐being score at post‐measurement was significantly higher in the intervention group than in the waiting list group corrected for pre‐treatment level of well‐being. The treatment effect was maintained at 6‐month follow‐up. No difference between the two conditions was found in functional impairment. Discussion: Mindfulness‐based cognitive therapy is an effective treatment for chronic cancer‐related fatigue. Copyright © 2010 John Wiley & Sons, Ltd.     

Social adjustment among Chinese women following breast cancer surgery

Background: How breast cancer surgery affects social adjustment among Chinese women is unknown, as are factors predicting such adjustment. Methods: 405 Chinese women receiving surgery for localized breast cancer completed Social Adjustment Scales (Ch‐SAS) at 1‐, 4‐ and 8‐months post‐operatively. Subscale scores were regressed on baseline (days 3–12 post‐operatively) measures of treatment decision‐making difficulty (TDMD), self‐efficacy (GSeS), consultation satisfaction (C‐MISS‐R), psychological (CHQ‐12) and physical distress (PD), and 1‐month follow‐up optimism (C‐LOT‐R), and disappointment (E‐OI), fully adjusted for demographic and clinical factors. Results: All Ch‐SAS subscales except appearance & sexuality changed significantly over 8‐months follow‐up: Enjoyment of social activities (F=27.38, df 2, p<0.001) and self‐image (F=3.63, df 2, p=0.027) improved slightly. Family interaction (F=26.63, df 2, p<0.001) and interaction with friends (F=3.37, df 2, p=0.035) declined slightly. Family and friends interaction subscales were predominantly predicted by high self‐efficacy and optimism, whereas self‐image and appearance & sexuality subscales were predominantly predicted by low treatment outcome disappointment, TDM difficulties, baseline psychological morbidity and high self‐efficacy. Enjoyment of social activities was predicted by low baseline psychological distress and concurrent physical symptom distress. Conclusion: High self‐efficacy and optimism predicted women who have better social relationships with friends and family. Higher self‐efficacy, low TDM difficulties, less disappointment with treatment outcome and low psychological and physical distress predicted better adjustment to self‐image and body image. Copyright © 2009 John Wiley & Sons, Ltd.     

On the positive relation between received social support and negative affect: a test of the triage and self-esteem threat models in women with breast cancer

Objective: There is a seemingly paradoxical positive relation between received social support and psychological distress in cancer patients. This study evaluates two models that explain this positive relation: (a) the triage model, which argues that more distressed people receive more support and (b) the self‐esteem threat model, which argues that receiving support increases distress by undermining self‐esteem. Methods: Longitudinal survey data were collected from 71 women treated for breast cancer at 3‐ (T1) and 18‐months (T2) post‐diagnosis Results: Analyses did not disconfirm either model. Consistent with the triage model, there was a marginally significant (p=0.052) positive relation between T1 negative affect and T2 received support, controlling for T1‐received support. Consistent with the self‐esteem threat model, a significant positive relation between T1 received support and T2 negative affect, controlling for T1 negative affect, appeared to be mediated by T2 self‐esteem. Conclusions: These findings suggest that people with cancer who are most distressed may receive the most social support, but the conveyance of support can have negative consequences for self‐esteem and affect. Copyright © 2008 John Wiley & Sons, Ltd.     

Efficacy of a web‐based cognitive rehabilitation intervention for adult cancer survivors: A pilot study

The purpose of this study was to evaluate the efficacy of a web‐based cognitive rehabilitation intervention in survivors of adult‐onset cancer and a sample of non‐cancer community dwelling adults. Fifty‐one participants were recruited and allocated to a cancer intervention group, a non‐cancer intervention group, or a non‐cancer waitlist group. Intervention groups completed a 4‐week online program and all participants were assessed at baseline, post‐intervention and 3‐month follow‐up. The primary outcome measure was subjective cognitive functioning. Secondary outcome measures included objective cognitive functioning, distress, quality of life (QoL), illness perception and program satisfaction. Results from the study found significant improvements on self‐report measures of cognitive functioning in both treatment groups, as well as improvements on objective measures assessing attention and executive functioning. No intervention effects were observed for distress, QoL or illness perception. High participant satisfaction was observed with 75% of participants in the cancer group reporting being either “satisfied” or “very satisfied” with the program compared to 87% in the non‐cancer treatment group. Initial evaluation of the program suggests that the web‐based cognitive rehabilitation intervention shows potential for improving subjective and objective cognitive functioning in cancer survivors and community dwelling adults.     

A couples intervention for patients facing advanced cancer and their spouse caregivers: outcomes of a pilot study

Objective: The primary objective of this study was to evaluate the effectiveness of a couples intervention in improving marital functioning in advanced cancer patients and their spouse caregivers. A secondary objective was to determine its impact on other symptoms of psychosocial distress and its feasibility and acceptability as a clinical intervention. Methods: Using a one‐arm pre‐ and post‐intervention prospective design, 16 couples were provided 8 weekly sessions of Emotionally Focused Couple Therapy, modified and manualized for the cancer population. Subjects' marital functioning (Revised Dyadic Adjustment Scale [RDAS]), symptoms of depression (Beck Depression Inventory‐II [BDI‐II]), and hopelessness (Beck Hopelessness Scale) were assessed through self‐report at T0 (baseline), T1 (after four sessions), T2 (after eight sessions), and T3 (3 months post‐intervention follow‐up). Results: RDAS scores improved from T0 to T2, with 87.5% of the couples showing some improvement (0.5–5 points) or significant improvement (>5 points) in marital functioning and 68.8% scoring in the non‐distressed range (?48 RDAS). At T3, 60% of the couples (n=15) continued to score in the non‐distressed range on the RDAS. BDI‐II scores were significantly higher for patients than for caregivers. There was a significant reduction in the mean BDI‐II score from T0 to T3 in all subjects (n=30). This reduction was more significant for the patients (n=15). Conclusions: Providing support to couples at this challenging time may result in improved marital functioning and an opportunity for relational growth during end‐stage cancer. This study serves as the first step in the development of an empirically validated intervention for couples. Copyright © 2008 John Wiley & Sons, Ltd.     

Effects of a nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers

Objective: Women with gynecological cancers have reported poor health‐related quality of life (QOL), with complex physical and psychological needs post‐surgery and during chemotherapy treatment. There are no studies reporting interventions addressing these needs post‐hospital discharge in this population. Methods: Patients were randomized into two groups. The intervention group received 6 months of specialized care by an Advanced Practice Nurse (APN); in addition, women with high distress were evaluated and monitored by a psychiatric consultation–liaison nurse (PCLN). The attention control group was assisted with symptom management by a research assistant. The effects of the 6‐month intervention were evaluated using self‐report questionnaires at baseline (24–48 h after surgery), 1, 3, and 6 months post‐ surgery. QOL assessments included the Center for Epidemiological Studies–Depression Scale , the ambiguity subscale of the Mishel Uncertainty in Illness Scale , the Symptom Distress Scale, and the Short‐Form Health Survey (SF‐12). The sample for the longitudinal analysis included 123 who completed QOL outcome measures across three occasions post‐surgery. Results: The APN intervention resulted in significantly less uncertainty than the attention control intervention 6 months after surgery. When the sub‐group who received the APN plus PCLN intervention was compared with the total attention control group, the sub‐group had significantly less uncertainty, less symptom distress, and better SF‐12 mental and physical QOL over time. Conclusion: Nurse tailored interventions that target both physical and psychological aspects of QOL in women recovering from cancer surgery and undergoing chemotherapy produce stronger outcomes than interventions that target solely one QOL aspect. Copyright © 2008 John Wiley & Sons, Ltd.     

A mindfulness‐based intervention for caregivers of allogeneic hematopoietic stem cell transplant patients: Pilot results

Despite high levels of stress, there are few empirically supported stress management interventions for caregivers of allogeneic hematopoietic stem cell transplant (HCT) cancer patients. This study examined the feasibility, acceptability, and various stress‐related outcomes from pre‐ to post‐treatment of a pilot, single‐arm trial of a 6‐week mindfulness‐based intervention (FOCUS) for stress management. Caregivers (N = 21; 76% female; mean age = 57.43) were enrolled prior to patient transplant and received FOCUS during the first 90 days post‐transplant. Findings indicated that FOCUS was highly feasible and acceptable (e.g., 71% attended at least four of six sessions; 100% reported using the skills learned at follow‐up; high treatment engagement). Significant increases in mindfulness, post‐traumatic growth, and general mental health were observed, along with significant decreases in negative affect (all ps < .05).     

The ToT study: helping with Touch or Talk (ToT): a pilot randomised controlled trial to examine the clinical effectiveness of aromatherapy massage versus cognitive behaviour therapy for emotional distress in patients in cancer/palliative care

Distress associated with cancer often presents with symptoms of depression and/or anxiety. Cognitive Behaviour Therapy (CBT) is one of the most effective psychological treatments. Complementary therapies, especially aromatherapy massage (AM), are also popular and alleviate anxiety. No studies have directly compared these two treatments. Aims: The aim of this study is to (1) test the feasibility of recruitment into a randomised controlled trial of AM versus CBT in patients with cancer; (2) test and modify the intervention; (3) determine whether changes in outcomes were consistent with published data. Methods: Patients at all stages of cancer, recruited from oncology outpatient clinics and screening eight or more for anxiety and/or depression on the HADS, were randomised to Treatment as Usual (TAU) plus up to eight sessions weekly of either AM or CBT, offered within 3 months. The POMS was collected at baseline and 3 and 6 months post baseline. Results: Of those suitable, over 60% (39/63) participated (AM, n = 20; CBT, n = 19) and over 90% (36/39) were followed up. Both packages were well received. The preference was for AM, with more sessions were taken up; (Mean number sessions AM = 7.2 (SD 2.0) and CBT = 5.4 (SD 3.1); P<0.05). Significant improvements in POMS (Total Mood, depression and anxiety scores) occurred with both interventions. Between‐group comparison showed a non‐significant trend towards greater improvement in depression with CBT. Conclusions: Recruitment was feasible; the interventions acceptable and engagement with treatment was high. Improvements with both interventions were observed. The beneficial effects on depression with CBT appeared to be sustained. Copyright © 2011 John Wiley & Sons, Ltd.     

Discussing sexuality in the clinical setting: The impact of a brief training program for oncology health professionals to enhance communication about sexuality

Aim: Cancer and its treatments can profoundly affect a person's sexuality and self‐image. However, oncology health professionals (OHP) are often reluctant to discuss these issues with patients. Cancer Council Victoria developed a short workshop to increase OHP's discussion of sexuality issues with cancer patients. We examined the immediate and longer term effect of workshop participation on perceived barriers to these discussions, their confidence in initiating the discussions, and changes in the frequency of their discussing sexuality issues with patients. Method: Twenty‐one workshops were conducted involving 155 OHP. The workshops were run by trained facilitators and incorporated cognitive, behavioral and experiential components. A major part of the workshop involved role‐playing with simulated patients (trained actors). Questionnaires assessing 20 perceived barriers, seven confidence items and seven practices concerning sexuality discussion were completed by the participants pre‐workshop, immediately post‐workshop, and 8‐weeks post‐workshop. Results: Overall 89 participants completed all three assessment phases. Data were analysed to assess change in perceived barriers, confidence and behavior across the three assessment points. Mean scores on 16 of the 20 barriers significantly decreased and scores on all seven confidence measures significantly increased between pre‐ and immediate post‐workshop. Most these changes were maintained 8 weeks later. The mean frequency of sexuality issue discussion in the previous 2 months increased significantly from 3.34 times at pre‐workshop to 3.82 times 8 weeks later (P = 0.003). Conclusion: This workshop appeared to reduce perceived barriers, increase confidence and increase actual practices around discussing sexuality issues with cancer patients.     

Clinical 24 month experience of the first MRgFUS Unit for treatment of uterine fibroids in Australia

Aim: To describe and evaluate treatment of uterine fibroids using Magnetic Resonance Guided Focused Ultrasound (MRgFUS) during its first 24 months of use at The Royal Women's Hospital Melbourne. Methods: One hundred Victorian women were treated with MRgFUS using the ExAblate 2000 system. Treatment outcomes based on fibroid volume shrinkage measured at 4 and 12 months post‐treatment and symptom severity score assessment (Symptom Severity Score Quality of Life – SSS‐QOL) pre‐ and post‐ (4–6 weeks, 4, 6 and 12 months) treatment. Results: Mean non‐perfused volume of the treated fibroids were 67% ± 25% (n = 100) immediately post‐treatment. At 4 months post‐treatment, the treated fibroids demonstrated an average volume reduction of 29% ± 32% (n = 74) and at 12 months 38% ± 45% (n = 32). Mean symptom severity scores (SSS‐QOL) improved by 51% from 59 ± 21 (n = 97) at baseline to 29 ± 17 (n = 36) by 12 months. Conclusion: From our experience, we believe there is a role for MRgFUS in the treatment of uterine fibroids in selected women.