Complementary medicine and recovery from cancer: the importance of post‐traumatic growth

Many users of Complementary and Alternative Medicines (CAMs) claim that participation leads to improved well‐being; however, contradictory evidence exists, with some studies linking CAM use with poorer quality of life (QoL) or increased distress. This study explored whether an individual's experience of post‐traumatic growth (PTG) following cancer may play a role in explaining these disparate outcomes. One hundred and sixty‐one cancer survivors (mean age = 58.96, SD = 12.12) completed measures comprised of PTG (Post‐Traumatic Growth Inventory), CAM use, QoL (Functional Assessment of Cancer Therapy scale + Functional Assessment of Chronic Illness Therapy Spiritual Well‐Being Scale), post‐traumatic stress disorder symptoms (Impact of Event Scale Revised) and depression, anxiety and stress (21‐item short‐form Depression Anxiety Stress Scale). A multiple regression controlling for gender, age, general and cancer‐specific distress indicated support for PTG as a mediator of the relationship between CAM and QoL. An individual's experience of PTG following cancer may be an important determinant of gaining benefit from participation in CAMs. Future research aimed at identifying potential facilitators of PTG may result in increased benefits of interventions aimed at improving adjustment among cancer survivors.     

Mindfulness‐based Cancer Stress Management: impact of a mindfulness‐based programme on psychological distress and quality of life

Within the area of cancer care, mindfulness‐based therapeutic interventions have been found to be efficacious in reducing psychological distress related to a cancer diagnosis; however, the impact of mindfulness‐based interventions on quality of life is unclear. This study explores the impact of a Mindfulness‐Based Cancer Stress Management programme on psychological distress and quality of life. Research methodology included a single‐group quasi‐experimental study of 26 participants experiencing distress related to a cancer diagnosis, including carers, who completed an MBCSM programme and all assessments. Participants completed the Functional Assessment of Cancer Therapy – General version 4 (FACT‐G) and its associated spirituality index (FACIT‐Sp‐Ex), Hospital Anxiety and Depression Scale (HADS), Freiburg Mindfulness Inventory (FMI), and the Distress Thermometer at baseline, post‐intervention, and three months after programme completion. Significant improvements were observed on all measures (ranges: P ≤ 0.001 to 0.008, r = ?0.53 to ?0.79) following the intervention, which were maintained at 3‐month follow‐up. Mindfulness was significantly correlated with all main outcome measures at post‐intervention (range: r = ?0.41 to 0.67) and 3‐month follow‐up (range: r = ?0.49 to 0.73), providing evidence for the internal validity of the study. Our findings indicate that the MBCSM programme is effective in reducing psychological distress and improving quality of life, including spiritual well‐being.     

Spiritual well‐being of Italian advanced cancer patients in the home palliative care setting

This study evaluates the spiritual well‐being (SpWB) in very advanced cancer patients assisted by the home palliative care program of ANT Foundation, a no‐profit Italian organisation. SpWB was assessed by the Functional Assessment of Chronic Illness Therapy–Spiritual Well‐Being Scale (FACIT‐Sp12), including Meaning, Peace, and Faith subscales. The quality‐of‐life (QoL) was evaluated by using the Functional Assessment of Cancer Therapy‐General scale. Questionnaires were distributed to 1,055 patients and 683 were compiled and evaluable for analysis. The mean scores of FACIT‐Sp12 as well as of QoL were notably lower than reference values for cancer survivors. The FACIT‐Sp12 score was higher in patients with less impaired Karnofsky Performance Status, fully participating in religious rituals and living in central Italy. A high Pearson's correlation was found between QoL and FACIT‐Sp12 (r = .60), Peace (r = .71) and Meaning (r = .52), while it was marginal for Faith (r = .27). The hierarchical regression analysis showed that FACIT‐Sp12 is a significant predictor of QoL. The study suggests that Italian patients with advanced cancer assisted by expert multi‐professional teams in the home palliative care setting have a low level of SpWB thereby highlighting the need for the integration of spiritual support as part of comprehensive cancer care.     

Advanced Cancer Patients' Prognostic Awareness and Its Association With Anxiety,Depression and Spiritual Well-Being: A Multi-Country Study in Asia

AimsThe associations between prognostic awareness, acceptance of illness and psychological outcomes (anxiety, depression and spiritual well-being) remain unclear. This study examined the associations between prognostic awareness and various psychological outcomes and how they can be moderated by patient acceptance of illness (cancer).Materials and methodsIn total, 1184 patients with stage IV solid cancer were recruited at major public hospitals across four Asian countries (China, India, Sri Lanka, Vietnam). Prognostic awareness and acceptance of illness were assessed through self-reported understanding of treatment intent and acceptance of illness, respectively. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, whereas spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale. Multivariate regressions were used to estimate the associations while controlling for patient characteristics.ResultsCompared with being unaware of their prognosis (i.e. believing that their cancer is curable), being aware or unsure of their prognosis was associated with higher anxiety and depressive symptoms, and lower spiritual well-being scores. Acceptance of illness moderated these relationships and improved the psychological outcomes.ConclusionsThe results suggest that disclosure of prognostic information should be provided in conjunction with psychological interventions that focus on acceptance of illness.     

Characteristics of cancer patients using homeopathy compared with those in conventional care: a cross-sectional study

Background: There are only few studies on cancer patients who are treated in complementary and alternative medicine clinics and comparing them with patients in conventional care. We will present the comparison of characteristics of two patient cohorts: one was treated in a homeopathic cancer care clinic and one was treated in a conventional oncology care (CC) outpatient clinic.Patients and methods: Six-hundred and forty-seven patients were included in this cross-sectional cohort study and had to fill in questionnaires [health-related quality of life (QoL) (Functional Assessment of Cancer Therapy—General Scale), depression and anxiety (Hospital Anxiety and Depression Scale), fatigue (Multidimensional Fatigue Inventory) and expectancies toward treatment]. Clinical data were extracted from medical records. This study presents the comparison of both cohorts.Results: Patients in the homeopathy cohort are younger, better educated and more often employed than patients in the CC cohort. The most pronounced differences indicate longer disease histories and different diagnostic and clinical pretreatment variables. Despite the clinical differences, QoL as well as anxiety, depression and fatigue was similar in both the groups.Conclusions: Homeopathic treatment is sought by cancer patients at a different phase during the course of the disease, which has particular implications for research. However, expectancies toward the benefit of the treatment as well as QoL data are similar.     

Psychological impairments burden and spirituality in caregivers of terminally ill cancer patients

The role of spirituality on the psychological health was mostly investigated through studies conducted in terminally ill patients. However, there are not studies investigating the role of religious and spiritual beliefs on psychological state and on burden dimensions in caregivers. The purpose of this study was to investigate the association between spirituality, burden, and psychological state in caregivers of terminally ill cancer patients. Two hundred caregivers of terminally ill patients with cancer were interviewed using Prolonged Grief Disorder 12 (PG‐12), Hamilton Anxiety Rating Scale (HAM‐A), Hamilton Depression Scale (HAM‐D), Caregiver Burden Inventory (CBI) and System of Belief Inventory (SBI‐15R). The caregiver burden was positively correlated with anxiety, depression and PG‐12 scores. The intrinsic spirituality was a significant predictor of the time‐dependence burden (positively associated); and of the emotional burden (negatively associated). In caregivers of terminally ill cancer patients, higher levels of intrinsic spirituality predicted a higher amount of time devote to caregiving, and also protected against the emotional distress linked to providing assistance.     

The factors contributing to death anxiety in cancer patients

Suffering comes in many ways for patients confronting cancer. One of these is an unspecifiable fear about death, which is an existential issue. The aim of this study was to investigate the relationship between death anxiety and its correlates in cancer patients. Seventy cancer patients were assessed using SCID-I, Templer's Death Anxiety Scale, the Hospital Anxiety (A) and Depression (D) Scale, the Distress Thermometer, the Visual Analogue Scale for pain (VAS), the Global Assessment of Functioning, and Glock and Stark's Dimensions of Religious Commitment scales, and these assessments were compared between cancer patients with and without death anxiety. Multiple regression analysis was conducted after correlation analysis between death anxiety and sociodemographic and clinical variables. Axis I psychiatric diagnosis, pain scores, and negative believes about what will happen after death were found to be higher in patients having death anxiety than patients not having death anxiety. Also life expectancy was perceived as shortened in patients with death anxiety. Death anxiety was associated with anxiety, depressive symptoms, and beliefs about what will happen after death. In conclusion, death anxiety could not be regarded as a natural consequence of having cancer; it is associated with the unresolved psychological and physical distress.     

Quality of life,self‐esteem,fatigue, and sexual function in young men after cancer

BACKGROUND:

Androgen deficiency is increasingly recognized in young male cancer survivors; however, its impact on quality of life (QOL) is not established. The authors investigated the relationship between androgen levels, QOL, self‐esteem, fatigue, and sexual function in young male cancer survivors compared with control subjects.

METHODS:

A cross‐sectional, observational study of 176 male cancer survivors and 213 male controls aged 25 to 45 years was performed. Subjects completed 3 QOL scales (Medical Outcomes Study 36‐Item Short‐Form Health Survey version 2, the 12‐item General Health Questionnaire [GHQ‐12], and Aging Male Scale), and measures of self‐esteem (Rosenberg Self‐Esteem Scale), fatigue (Functional Assessment of Chronic Illness Therapy‐Fatigue), and sexual function (Derogatis Interview for Sexual Functioning‐II Self‐Report‐Male).

RESULTS:

Cancer survivors had lower scores for all components of the Short‐Form Health Survey, Aging Male Scale, and Functional Assessment of Chronic Illness Therapy‐Fatigue, and for 4 of 5 subsections of the Derogatis Interview for Sexual Functioning than controls. The majority of these differences remained after adjusting by linear regression analysis. Levels of psychiatric disorder or self‐esteem did not differ between the 2 groups. In cancer survivors, those with androgen deficiency (serum testosterone ≤10 nmol/L) had lower scores than those without for all components of the Short‐Form Health Survey, the General Health Questionnaire, Functional Assessment of Chronic Illness Therapy‐Fatigue, and the Derogatis Interview for Sexual Functioning. Serum testosterone only weakly correlated with health measures.

CONCLUSIONS:

Young male cancer survivors self‐report a marked impairment in QOL, energy levels, and quality of sexual functioning, and this was exacerbated in those with androgen deficiency. However, psychological distress was not elevated, self‐esteem was normal, and sexual relationships were not impaired. The relationship with testosterone is complex, and appears dependent on a threshold level rather than direct correlation. Interventional trials are needed to determine whether testosterone replacement would improve QOL in young male cancer survivors. Cancer 2010. © 2010 American Cancer Society.     

The Factors Contributing to Death Anxiety in Cancer Patients

Suffering comes in many ways for patients confronting cancer. One of these is an unspecifiable fear about death, which is an existential issue. The aim of this study was to investigate the relationship between death anxiety and its correlates in cancer patients. Seventy cancer patients were assessed using SCID-I, Templer's Death Anxiety Scale, the Hospital Anxiety (A) and Depression (D) Scale, the Distress Thermometer, the Visual Analogue Scale for pain (VAS), the Global Assessment of Functioning, and Glock and Stark's Dimensions of Religious Commitment scales, and these assessments were compared between cancer patients with and without death anxiety. Multiple regression analysis was conducted after correlation analysis between death anxiety and sociodemographic and clinical variables. Axis I psychiatric diagnosis, pain scores, and negative believes about what will happen after death were found to be higher in patients having death anxiety than patients not having death anxiety. Also life expectancy was perceived as shortened in patients with death anxiety. Death anxiety was associated with anxiety, depressive symptoms, and beliefs about what will happen after death. In conclusion, death anxiety could not be regarded as a natural consequence of having cancer; it is associated with the unresolved psychological and physical distress.     

Quality of life and dyadic adjustment in oral cancer patients and their female partners

The diagnosis of cancer affects not only the lives of patients, but also the lives of their family members. The purpose of this study was to examine the impact of oral cancer on quality of life (QoL), psychological distress and marital satisfaction in a sample of patients and their wives. Thirty-one men treated for oral cancer (mean time since diagnosis 3.7 years) and their female partners ( n  = 31) were assessed by questionnaires with regard to QoL (WHOQOL-BREF), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), quality of relationship (Dyadic Adjustment Scale, DAS) and physical complaints (EORTC QOL-H&N35). Quality of life was remarkably high in patients and their partners. In patients, lower QoL was associated with more physical complaints and higher levels of psychological distress (HADS), whereas in wives, QoL was found to be related to marital quality (DAS) and levels of distress. In couples with highly discrepant ratings of marital satisfaction, wives reported more psychological distress. The findings indicate that overall QoL is considerably high in patients treated for oral cancer and their partners living in stable relationships. Quality of life correlates stronger with the quality of relationship in spouses than in patients. Generally, marital satisfaction appears to be an important moderating factor regarding QoL and psychological distress.     

Prospective evaluation of the reliability, validity, and minimally important difference of the functional assessment of cancer therapy-gastric (FACT-Ga) quality-of-life instrument

BACKGROUND:

Recently, the Functional Assessment of Cancer Therapy‐Gastric (FACT‐Ga) was developed to measure the quality of life (QoL) of patients with gastric cancer. This newly developed instrument has not yet been validated.

METHODS:

Eighty‐two patients with gastric adenocarcinoma completed questionnaires at baseline. The FACT‐Ga scores were measured as a function of disease stage and performance status, and they were correlated with the Medical Outcomes Study 36‐item short‐form health survey (SF‐36), the Beck Depression Inventory‐II, the Marlow‐Crowne Social Desirability Scale, the Paulhus Deception Scale, and the State‐Trait Anxiety Inventory. Patients received a second questionnaire 2 weeks after baseline to evaluate test‐retest reliability and again at 3 months to evaluate the sensitivity of the FACT‐Ga to changes in performance status and to estimate the minimally important differences in scores that represented meaningful change.

RESULTS:

The internal and test‐retest reliability of the FACT‐Ga instrument was adequate. With the exception of the social well being subscale, all FACT‐Ga scores were correlated as hypothesized with other measures. Relevant components of the FACT‐Ga were sensitive to changes in performance status.

CONCLUSIONS:

The current results indicated that the FACT‐Ga provides a valid and reliable measurement of QoL in patients with gastric adenocarcinoma. It is a useful instrument for QoL assessment in clinical trials, and it also may be useful for the detection of significant changes in the QoL of individual patients. Cancer 2011. © 2010 American Cancer Society.     

Effects of symptom clusters and depression on the quality of life in patients with advanced lung cancer

People with advanced lung cancer experience later symptoms after treatment that is related to poorer psychosocial and quality of life (QOL) outcomes. The purpose of this study was to identify the effect of symptom clusters and depression on the QOL of patients with advanced lung cancer. A sample of 178 patients with advanced lung cancer at the National Cancer Center in Korea completed a demographic questionnaire, the M.D. Anderson Symptom Inventory–Lung Cancer, the Center for Epidemiological Studies Depression Scale, and the Functional Assessment of Cancer Therapy–General scale. The most frequently experienced symptom was fatigue, anguish was the most severe symptom‐associated distress, and 28.9% of participants were clinically depressed. Factor analysis was used to identify symptom clusters based on the severity of patients' symptom experiences. Three symptom clusters were identified: treatment‐associated, lung cancer and psychological symptom clusters. The regression model found a significant negative impact on QOL for depression and lung cancer symptom cluster. Age as the control variable was found to be significant impact on QOL. Therefore, psychological screening and appropriate intervention is an essential part of advanced cancer care. Both pharmacological and non‐pharmacological approaches for alleviating depression may help to improve the QOL of lung cancer patients.     

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.     

Eating ability predicts subsequent quality of life in Chinese patients with breast, liver, lung, or nasopharyngeal carcinoma: a longitudinal analysis

Eating dysfunction is a well-recognized consequence of orophagic tract cancers, but also occurs with other cancers. There is a relative absence of data assessing the impact of eating function on QoL in cancer populations other than those with disease of the oro-phagic tract. We assessed longitudinal changes in eating function and quality of life (QoL), and examined whether eating function predicted QoL over time in a sample of Chinese patients with breast, lung, liver, and nasopharyngeal cancers. Overall, 1 079 patients with breast, liver, lung, or nasopharyngeal carcinoma were assessed during their first outpatient visit (baseline) and at two follow-up interviews (FU1 and FU2). Three dimensions of eating function, including ability, appetite, and enjoyment, were assessed using three 11-point self-rated items. QoL was measured by the Chinese version of the Functional Assessment of Cancer Therapy-General Scale (FACT-G (Ch)). Linear mixed effects (LME) models evaluated mean differences on eating function and QoL scores across interviews and across cancer groups, and the effects of eating function on QoL. After adjustment for socio-demographic and medical variables, pain and depression, eating function significantly predicted patient overall (standardized betas ranged from 0.091 to 0.163, ps < 0.05), physical (standardized betas ranged from 0.101 to 0.200, ps < 0.05), and functional (standardized betas ranged from 0.120 to 0.162, ps < 0.05) aspects of QoL scores over time. Eating dysfunction significantly impacts QoL in cancer populations other than those with orophagic disease. Change of eating function appears to be a common problem in cancer patients regardless of cancer site.     

Factors associated with changes in quality of life in patients undergoing allogeneic haematopoietic stem cell transplantation

KISCH A., LENHOFF S., ZDRAVKOVIC S. & BOLMSJÖ I. (2012) European Journal of Cancer Care Factors associated with changes in quality of life in patients undergoing allogeneic haematopoietic stem cell transplantation It is well known that patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) experience changes in quality of life. We investigated factors associated with quality of life changes in adult HSCT patients. The Functional Assessment of Cancer Therapy – Bone Marrow Transplantation (FACT‐BMT) scale, supplemented with the Functional Assessment of Chronic Illness Therapy – Spiritual Well‐being (FACIT‐Sp) subscale, was administered on three occasions, immediately before transplantation, 100 days and 12 months after transplantation. Analyses of nine selected factors were made where changes in quality of life were found. Seventy‐five patients were included and 40 of these completed the study. Emotional well‐being was found to improve between the baseline and 100 days, while all other dimensions deteriorated, including overall quality of life. Physical and social/family well‐being deteriorated between the baseline and the 12‐month follow‐up, while emotional well‐being improved. The main factors associated with deteriorating quality of life over time were found to be significant infections, female gender and transplantation with stem cells from a sibling donor. In our further studies we aim to focus on the relationships between patients and sibling donors in order to improve the care. Careful attention must be paid to continuous adequate information during the transplantation procedure.     

Spirituality and quality of life in low‐income men with metastatic prostate cancer

Objective: To determine how spirituality is associated with health‐related quality of life (HRQOL) in an ethnically diverse cohort of low‐income men with metastatic prostate cancer. Methods: Eighty‐six participants in a state‐funded program that provides free prostate cancer treatment to uninsured, low‐income men completed written surveys and telephone interviews containing validated measures of spirituality, and general and disease‐specific HRQOL. Assessments were made following diagnosis of metastatic disease. We used multivariate analyses to assess the effect of spirituality and its two subscales, faith and meaning/peace, on HRQOL. Results: African American and Latino men, and men with less than a high‐school education had the highest spirituality scores. Spirituality was significantly associated with general and disease‐specific HRQOL. We also found a significant interaction between faith and meaning/peace in the physical and pain domains. Conclusion: Greater spirituality was associated with better HRQOL and psychosocial function. Meaning/peace closely tracks with HRQOL. Higher faith scores, in the absence of high meaning/peace scores, are negatively associated with HRQOL. Copyright © 2008 John Wiley & Sons, Ltd.     

Assessment of health-related quality of life and patient benefit as outcome measures for clinical trials in hepatocellular carcinoma

Aim: The purpose of the study was to determine the feasibility and validity of using health‐related quality of life (HRQL) and patient benefit as outcome measures in a phase II trial of octreotide long acting release (LAR) for hepatocellular carcinoma (HCC); and, to determine aspects of HRQL that were most impaired and aspects that changed. Methods: Sixty‐three patients with advanced HCC were treated with octreotide LAR. HRQL was assessed monthly with the Functional Assessment of Cancer Therapy – Hepatobiliary Questionnaire (FACT‐Hep) and the Patient Disease and Treatment Assessment Form (Patient DATA Form). Benefit was assessed directly by asking subjects at 1 month about change from baseline using the Patient Benefit Form. Convergent, discriminative and predictive validity were assessed by testing a priori hypotheses. Results: Seventy‐three percent completed a baseline assessment of HRQL. Compliance decreased over time. Fatigue, energy, anxiety, pain, insomnia, and emotional well‐being were the most impaired aspects of HRQL on the Patient DATA Form. Convergent validity was supported by 52 of 57 hypothesized correlations. Predictive validity was supported by associations between survival and four aspects of HRQL. Patients' direct assessments of benefit for common symptoms were moderately associated with changes in their scores on the Patient DATA Form. Conclusion: Use of the FACT Hep and Patient DATA Form is feasible in trials of advanced HCC. The validity of the direct measure of patient benefit was questionable, despite its intuitive attraction. Fatigue, anxiety, insomnia, and impaired emotional well‐being were prominent, are probably under‐recognized in practice, and are worthy of future research.     

Spirituality as a core domain in the assessment of quality of life in oncology

Objectives: This study investigated including spiritual wellbeing as a core domain in the assessment of quality of life (QOL) in an Australian oncology population. Methods: Four hundred and ninety consecutive cancer patients with mixed diagnoses completed the Functional Assessment of Chronic Illness Therapy—Spiritual Well‐Being (FACIT‐Sp) and the Mental Adjustment to Cancer (MAC) scale. Results: Overall, 449 patients completed assessments. Spiritual wellbeing demonstrated a significant, positive association with QOL (r=0.59), fighting spirit (r=0.49) and a significant, negative relationship with helplessness/hopelessness (r=?0.47) and anxious preoccupation (r=?0.26). A hierarchical multiple regression showed spiritual wellbeing to be a significant, unique contributor to QOL beyond the core domains of physical, social/family, and emotional wellbeing (R² change=0.08, p=0.000). However, high levels of meaning/peace or faith did not appear to significantly impact patients' ability to enjoy life despite chronic symptoms of pain or fatigue, making the current results inconsistent with other findings. Conclusion: Results lend further support to the biopsychosocialspiritual model. By failing to assess spiritual wellbeing, the ‘true’ burden of cancer is likely to be miscalculated. However, at this stage, the exact clinical utility of spirituality assessment is unclear. Copyright © 2008 John Wiley & Sons, Ltd.