When peer support may be most beneficial: the relationship between upward comparison and perceived threat

Objective: Currently, the mechanism by which dyadic peer support programs may facilitate positive psychological adjustment for cancer patients is unclear. This study utilized social comparison theory to examine the effects of peer support on the psychological adjustment of women with breast cancer. Methods: A cross‐sectional survey of 251 recently diagnosed breast cancer patients (52% response), who had received a dyadic peer support intervention, was undertaken assessing anxiety, depression, perceived threat, and upward comparison. Results: Perceived cancer threat significantly moderated the relationship between positive upward comparison and depression levels (p = 0.017). Women who engaged in upward comparisons and who perceived their diagnosis to be more threatening had lower depression levels than women who were less threatened. Conclusions: Peer support services that provide support from cancer survivors may be especially beneficial for people who appraise their cancer diagnosis as more threatening. The application of theoretical models to future evaluation designs will further increase understanding of the psychological mechanisms involved in the effects of peer support and inform program development. Copyright © 2010 John Wiley & Sons, Ltd.     

The experience of chemotherapy‐induced alopecia for Australian women with ovarian cancer

This article describes the experience of chemotherapy‐induced alopecia. Data resulted from an ongoing study, which sought to explore the experience of Australian women with a primary diagnosis of ovarian cancer. Phenomenological analysis of written accounts or interviews with 15 Australian women resulted in 13 of these 15 women giving priority to describing their experience of alopecia. The women described alopecia as the most distressing corporeal feature of the ovarian cancer experience. Factors which contributed to women's distress included: loss of sense of self and altered body image; reminder of their illness and potential for an early death; public statement about their private life, practical issues and re‐growth. No literature was located, worldwide, which specifically explores the experience of alopecia for women with ovarian cancer. This article presents the first in‐depth exploration of the experience of alopecia for Australian women with ovarian cancer. Insight gained from this study will inform understanding of the issues associated with alopecia for women with ovarian cancer and may facilitate the provision of optimal supportive care provided by health care professionals for female cancer patients with chemotherapy‐induced alopecia.     

Improving the quality of care for patients with advanced epithelial ovarian cancer: Program components,implementation barriers,and recommendations

The high lethality of ovarian cancer in the United States and associated complexities of the patient journey across the cancer care continuum warrant an assessment of current practices and barriers to quality care in the United States. The objectives of this study were to identify and assess key components in the provision of high-quality care delivery for patients with ovarian cancer, identify challenges in the implementation of best practices, and develop corresponding quality-related recommendations to guide multidisciplinary ovarian cancer programs and practices. This multiphase ovarian cancer quality-care initiative was guided by a multidisciplinary expert steering committee, including gynecologic oncologists, pathologists, a genetic counselor, a nurse navigator, social workers, and cancer center administrators. Key partnerships were also established. A collaborative approach was adopted to develop comprehensive recommendations by identifying ideal quality-of-care program components in advanced epithelial ovarian cancer management. The core program components included: care coordination and patient education, prevention and screening, diagnosis and initial management, treatment planning, disease surveillance, equity in care, and quality of life. Quality-directed recommendations were developed across 7 core program components, with a focus on ensuring high-quality ovarian cancer care delivery for patients through improved patient education and engagement by addressing unmet medical and supportive care needs. Implementation challenges were described, and key recommendations to overcome barriers were provided. The recommendations emerging from this initiative can serve as a comprehensive resource guide for multidisciplinary cancer practices, providers, and other stakeholders working to provide quality-directed cancer care for patients diagnosed with ovarian cancer and their families.     

It's a choice to move forward: women's perceptions about treatment decision making in recurrent ovarian cancer

Objective: This research explores the treatment decision‐making (TDM) experiences of women with recurrent ovarian cancer (ROC) with regard to treatment options; their understanding of risks and benefits of various treatment options; the decision‐making role they want for themselves and for their oncologist; and the social context of the consultation as it pertains to the decision. Methods: We conducted semi‐structured interviews with 26 women at the time of first recurrence. Through inductive data analysis key themes were identified. Results: Many women describe self‐identifying the cancer recurrence fairly quickly due to new symptoms. Many feel that the goal for treating their recurrence is to control versus cure the cancer. They describe the subsequent process of diagnosis and TDM for ROC as quick and straightforward with all women accepting the oncologists' treatment recommendation. They feel that the type and number of treatment options are limited. They have a strong desire for physician continuity in their care. Participants feel that their doctor's recommendations as well as their previous experience with ovarian cancer are strong factors influencing their current TDM process. Conclusions: Shared decision making is based on a simultaneous participation of both the physician and patient in TDM. When faced with ROC, women feel that their doctor's recommendation and their past experience with treatment and TDM are prominent factors influencing the current TDM process. Copyright © 2009 John Wiley & Sons, Ltd.     

Best supportive care in lung cancer trials is inadequately described: a systematic review

JACK B., BOLAND A., DICKSON R., STEVENSON J. & MCLEOD C. (2010) European Journal of Cancer Care 19 , 293–301
Best supportive care in lung cancer trials is inadequately described: a systematic review The objective of the paper was to identify and discuss clinical terms associated with the availability and delivery of best supportive care for patients with lung cancer in randomised controlled clinical trials. Systematic review was carried out of relevant studies without language restrictions identified through Medline, EMBASE, Science Citation Index (Web of Science and ISI Proceedings) and Cochrane Library. Reference lists of retrieved articles were also searched to identify further studies. Articles describing randomised controlled trials or systematic reviews with a comparator arm of best supportive care for patients with lung cancer were studied. Definitions of best supportive care and elements of best supportive care were reported. Included clinical studies (n = 40) did not adequately describe or outline either the components or the delivery of best supportive care for patients in lung cancer trials. None of the identified studies provided a clear definition of a patient pathway in relation to best supportive care, or a clear list of components. Clinical studies are being conducted without a clear definition of the best supportive care provided in the comparator arms of trials. Inadequate definitions mean that all direct and indirect comparisons in trials comparing active treatments with best supportive care must be interpreted with caution.     

Predictors of change in unmet supportive care needs in cancer

Objective: Patient Reported Outcome (PRO) assessments can assist health professionals to tailor their health practices to the individual needs of patients and improve patient care over time. The present study assessed prospective predictors of unmet supportive care needs in cancer patients over a six‐month period. Methods: Participants were recruited from a regional cancer treatment centre in Australia and completed the Supportive Care Needs Survey (SCNS) at recruitment (n=439; 61.4% response rate) and six months follow‐up (n=396). Hierarchical logistic regression was used to identify predictors of change in unmet needs across each supportive care domain. Predictor variables were socio‐demographic, treatment and psychosocial factors including depression, anxiety, social support, and patient satisfaction. Results: Unmet needs were reported by approximately two‐thirds of patients at baseline and half of patients at six months follow‐up. Having unmet needs at baseline was the strongest predictor of unmet needs at six months. Longer time since diagnosis was a consistent predictor of greater unmet needs, associated with change in physical/daily living, psychological and health system and information unmet needs over time. By contrast, a complex relationship was found in that patient satisfaction, psychosocial and treatment characteristics predicted higher needs in some domains and lower needs in others. Conclusions: Unmet supportive care needs persist over time and psychological needs may emerge later in the illness continuum. Interventions to meet the needs of longer term cancer survivors are needed and should closely articulate with reported supportive care needs. Copyright © 2009 John Wiley & Sons, Ltd.     

Going beyond social support: Fear of receiving compassion from others predicts depression symptoms in breast cancer patients

Background: Recent studies have highlighted the importance of being able to receive compassion and affiliative signals from others. The main aim of the present study was to explore whether social support and fear of receiving compassion from others are predictors of depression symptoms in a sample of breast cancer patients. Methods: The sample included 86 female patients with non-metastatic breast cancer. Participants were recruited at a Radiotherapy Service in central Portugal and completed validated self-report instruments. Multiple regression analysis were conducted to examine the predictive effects of clinical (cancer stage, comorbidities) and demographic variables (age, education), social support, and fear of receiving compassion from others on depressive symptoms. Results: Fear of receiving compassion from others was the only significant predictor of the model, with a positive effect on depression symptomatology (β = 0.44; p < 0.001). These results suggest that the amount of supportive social contacts and networks may not be as important as cancer patients' ability to receive compassion from others. Conclusions: This is the first study to focus on fear of receiving compassion from others in cancer patients and seems to be a significant contribution for the study of the social factors that may be associated with depression in breast cancer. Psychological screening interviews in breast cancer, besides assessing patients' level of depression and social support, ought to also evaluate the ability to receive empathy and emotional help and support from other people.     

The process and effect of supportive message expression and reception in online breast cancer support groups

Objective: To better understand the process and effect of social support exchanges within computer‐mediated social support (CMSS) groups for breast cancer patients, this study examines (1) the dynamic interplay between emotional support giving and receiving and (2) the relative effects of emotional support giving and receiving on patients' psychosocial health outcomes. Methods: Data was collected from 177 patients who participated in online cancer support groups within the Comprehensive Health Enhancement Support System (CHESS) during the 4‐month intervention. Data included (1) pretest and/or post‐test survey scores of demographic, disease‐related, and psychosocial factors, (2) automatically collected CHESS usage data, and (3) computer‐aided content analysis of social support messages posts. Results: Hierarchical regression analyses revealed that those who receive higher levels of support from others have fewer breast cancer‐related concerns (β = ? 0.15, p<0.05), while those who give higher levels of support to others reframe their own problems in a positive light and adopt more positive strategies for coping (β = 0.16, p<0.05). In addition to these positive effects, partial correlation analysis indicated that these two supportive behaviors are reciprocal. Conclusions: We concluded that supportive exchanges of receiving and giving play positive, but different, roles in predicting psychosocial health outcomes. Moreover, emotional support giving and receiving tend to reinforce each other. Our findings help practitioners, health‐care providers, and health system designers make sense of diverse social support processes among cancer patients participating within CMSS groups. Copyright © 2011 John Wiley & Sons, Ltd.     

Supportive-expressive group therapy for primary breast cancer patients: a randomized prospective multicenter trial

Objective: The aim is to evaluate the effectiveness of a manualized 12‐week supportive–expressive group therapy program among primary breast cancer patients treated in community settings, to determine whether highly distressed patients were most likely to benefit and whether therapist's training or experience was related to outcome. Method: Three hundred and fifty‐three women within one year of diagnosis with primary breast cancer were randomly assigned to receive supportive–expressive group therapy or to an education control condition. Participants were recruited from two academic centers and nine oncology practices, which were members of NCI's Community Clinical Oncology Program (CCOP) and were followed over 2 years. Results: A 2×2×19 analysis of variance was conducted with main effects of treatment condition, cohort, and baseline distress and their interactions. There was no main effect for treatment condition after removing one subject with an extreme score. Highly distressed women did not derive a greater benefit from treatment. Therapist training and psychotherapy experience were not associated with a treatment effect. Conclusions: This study provides no evidence of reduction in distress as the result of a brief supportive–expressive intervention for women with primary breast cancer. Future studies might productively focus on women with higher initial levels of distress. Copyright © 2007 John Wiley & Sons, Ltd.     

Supportive care needs in patients with lung cancer

Introduction: The goal of this study was to characterize the prevalence and intensity of supportive care needs and interest in specific supportive care services among individuals with lung cancer. Method: Participants (n=109) were recruited from two medical centers in Southern California to complete questionnaires on physical and psychological functioning following diagnosis of lung cancer. Results: Participants reported the greatest need in the physical and daily living domain, followed by psychological needs, health system and informational needs, and patient care support needs. The most common unmet need was a lack of energy and tiredness (75%). Higher levels of supportive care needs were associated with worse physical functioning (β=?0.30, p<0.001), greater symptom bother (β=0.25, p=0.008), lower satisfaction with health care (β=?0.24, p=0.002), and higher levels of intrusive thoughts about cancer (β=0.40, p<0.001). The sample was most interested in receiving additional information about their disease and treatment (61.0%), exercise‐related information and support (54.3%), and assistance dealing with fatigue (46.7%). Over 91% expressed interest in at least one specific supportive care service, and 51.4% were interested in one or more psychological services. Conclusion and implications for cancer survivors: Our findings suggest that lung cancer survivors have many unmet needs. Patients who report higher physical distress and intrusive stress symptoms, or lower satisfaction with their health care, may experience the highest level of supportive care need and intervention. Copyright © 2009 John Wiley & Sons, Ltd.     

Social comparisons and quality of life following a prostate cancer diagnosis

Purpose: The objective was to explore the relationships among cognitive appraisals of prostate cancer (challenge, threat, and harm/loss), social comparisons, and quality of life in men previously diagnosed. Design, Sample, & Methods: Men who had participated in prostate cancer support groups completed a cross-sectional questionnaire (N = 189). Multivariable linear regression was used to evaluate social comparisons as mediators of quality of life while controlling for uncertainty and optimism. Findings: Positive and negative social comparisons were parallel mediators of the relationships between challenge or threat appraisals and quality of life, while only negative social comparisons mediated the relationship between harm/loss appraisals and quality of life. Conclusions: These findings demonstrate the importance of social comparisons in accounting for the effect of cognitive appraisals of prostate cancer on quality of life among men in support groups. Implications for Psychosocial Providers: Interventions to improve quality of life could address reduction of maladaptive comparisons, a strategy that could be tailored based on the patient's appraisal of prostate cancer.     

Supportive versus palliative care: What's in a name?

BACKGROUND:

Palliative care has been progressively adopted by American cancer centers; however, referrals to palliative care continue to occur late in the trajectory of illness. It was hypothesized that the perceived association between the name palliative care and hospice was a barrier to early patients' referral. The objectives of this study were to determine the perception of the impact of the name palliative care compared with supportive care on patient referral and to determine whether there was an association between demographic factors and the perceptions of the 2 names by medical oncologists and their midlevel providers (advance practice nurses and physician assistants) at a comprehensive cancer center.

METHODS:

A survey was conducted among a random sample of 100 medical oncologists and 100 midlevel providers from The University of Texas M. D. Anderson Cancer Center. Information was collected on demographics, previous experience in palliative care, and attitudes and beliefs toward the impact of the name palliative care compared with supportive care on patient referral.

RESULTS:

A total of 140 of 200 (70%) participants responded (74 midlevel providers and 66 medical oncologists). Median age was 43 years (range, 34.5‐50 years), and there were 83 (60%) women. Midlevel providers and medical oncologists generally agreed in their responses to most of the items. More participants preferred the name supportive care (80, 57%) compared with palliative care (27, 19% P < .0001). Medical oncologists and midlevel providers stated increased likelihood to refer patients on active primary (79 vs 45%, P < .0001) and advanced cancer (89 vs 69%, P < .0001) treatments to a service named supportive care. The name palliative care compared with supportive care was perceived more frequently by medical oncologists and midlevel providers as a barrier to referral (23 vs 6% P < .0001), decreasing hope (44 vs 11% P < .0001), and causing distress (33 vs 3% P < .0001) in patients and families. There were no significant associations among the perception of the 2 names and age (P = .82), sex (P = .35), or prior training in palliative care (P > .99).

CONCLUSIONS:

The name palliative care was perceived by medical oncologists and midlevel providers as more distressing and reducing hope to patients and families. Medical oncologists and midlevel providers significantly prefer the name supportive care and stated more likelihood to refer patients on active primary and advanced cancer treatments to a service named supportive care. Cancer 2009. © 2009 American Cancer Society.     

'The greatest thing in the world is the family': the meaning of social support among black Caribbean and white British patients living with advanced cancer

Purpose: Little is known about the perceptions and meanings of social support among black and minority ethnic groups living with advanced cancer in the UK. The aim of this study was to explore social support networks and their meaning among Black Caribbean and White British patients living with advanced cancer. Method: Semi‐structured interviews were conducted with 26 Black Caribbean and 19 White British cancer patients and analysed using the framework approach. Results: In all, 25 of 26 Black Caribbean and 18 of 19 White British participants volunteered views on the presence of social support in their lives. The presence of a spouse or partners was an indispensable feature within the social support networks in both ethnic groups. More Black Caribbean than White British participants referred to the presence of social networks made through their church communities as being a source of practical and emotional support. Conclusions: We recommend that when health and social‐care professionals perform an assessment interview with patients from cultural backgrounds different to their own, opportunities should be made for patients to express information about their social support networks. This will help them to better understand their place alongside statutory services. Spouses and partners should be given greater recognition of their contribution in order to continue with their important role. Copyright © 2011 John Wiley & Sons, Ltd.     

Referral patterns and psychosocial distress in cancer patients accessing a psycho-oncology counseling service

Objective: One in three cancer patients will experience significant psychosocial distress, yet less than 10% will seek formal counseling. Who are the patients accessing counseling and what are their presenting needs? The purpose of this study was to identify referral patterns and psychosocial distress in cancer patients newly referred to a psycho‐oncology counseling service. Methods: Consecutive new referrals were tracked over 1 year (n=361). On initial visit, 145 patients completed a demographic survey, Brief Symptom Inventory‐18 (BSI‐18), Cancer Coping Questionnaire and Medical Outcomes Study Social Support Survey. Results: Approximately one in five newly referred patients never attended counseling, with a significant representation of men (p=0.016) and lung cancer patients (p=0.010). Of 361 referrals, 295 patients attended initial counseling, 259 were approached, and 145/259 (56%) completed the survey. Most were women (79%), urban‐dwelling (73%), diagnosed with non‐advanced cancer (72%), well‐educated (68%) and married (56%); average age of 52 years (SD=12.3). Two most common diagnoses were breast (36%) and genitourinary (14%) cancers. A total of 59% were significantly distressed (BSI‐18 global severity index T‐score?63) with less available social support than non‐distressed patients (p=0.022). Coping strategy use did not differ significantly between distressed and non‐distressed groups. Two of five patients were not significantly distressed. Conclusions: Most cancer patients attending counseling are well‐educated urban residing women, with significant psychosocial distress. Further research is needed to better understand barriers and appropriate screening methods for accessing counseling, as well as the needs of men, advanced cancer patients, rural residents, and less well‐educated people. Copyright © 2010 John Wiley & Sons, Ltd.     

An exploration of the experience of cancer cachexia: what patients and their families want from healthcare professionals

REID J., Mc KENNA H.P., FITZSIMONS D. & Mc CANCE T.V. (2010) European Journal of Cancer Care 19 , 682–689 An exploration of the experience of cancer cachexia: what patients and their families want from healthcare professionals The aim of this paper is to investigate the perceptions of patients and family members with regard to care received for cancer cachexia. A qualitative study recruited 27 participants, of which 15 were patients with advanced cancer who had primary cachexia and 12 were family members. Participants were recruited from a regional cancer centre in the UK. All participants took part in a domiciliary interview, which was transcribed verbatim for analysis. A major finding from analysis was ‘lack of response from health care professionals’ in relation to cancer cachexia management. This finding illuminated that patients and their family members wanted three things from healthcare professionals. They wanted their profound weight loss acknowledged, they wanted information about it and why it was happening and they wanted interventions to deal with it. This paper provides powerful messages for healthcare professionals and highlights the needs of patients and their family regarding cancer cachexia management. Patients and their families want this problem addressed by healthcare professionals. This client group requires supportive healthcare interventions, so that they can understand the nature and impact of this syndrome.     

Husbands' perspective of living with wives' ovarian cancer

Objectives: The purpose of this qualitative study was to describe the experience of ovarian cancer from the husband's perspective. Methods: Participants were recruited through a large Midwestern hospital and a state ovarian cancer advocacy organization. A one‐time telephone interview was conducted with each participant. The interviews were tape‐recorded, transcribed and analyzed for themes. Results: Eleven husbands were interviewed. Themes included the emotional devastation of the initial diagnosis, the ovarian cancer being a whole new focus/priority, changes to the marital relationship, his response influenced by her response, others sharing the burden of providing support and relying on other family members. Conclusion: Ovarian cancer presents unique challenges for husbands. Both positive and negative effects can result and can linger well past the diagnosis and treatment period. Social support, particularly from family members, may be especially helpful to husbands of women with ovarian cancer. Husbands experience multiple emotional, psychological, social effects from their experience with ovarian cancer. Addressing these effects in practice and future research is imperative. Research based on multidimensional frameworks or family theory using standardized instruments may further elucidate consequences of ovarian cancer on spouses and could evaluate predictors or positive and negative effects. Copyright © 2008 John Wiley & Sons, Ltd.     

The Meaning-Making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: a randomized controlled pilot study

Objective: This pilot study aimed to provide supportive evidence for the acceptability and usefulness of the Meaning‐Making intervention (MMi) in patients newly diagnosed with Stage III or IV ovarian cancer, and to provide estimates of parameters needed to design a full‐scale study. Methods: A randomized controlled trial with 24 patients (12 experimental and 12 control) was conducted. Existential well‐being (primary outcome), overall quality of life, distress, anxiety, depression and self‐efficacy were measured. Results: Compared to the control group, patients in the experimental group had a better sense of meaning in life at one and three months post‐intervention. Conclusion: The MMi seems a promising intervention for advanced cancer patients, and a full randomized controlled trial is warranted to further investigate its efficacy. Copyright © 2010 John Wiley & Sons, Ltd.     

Gynaecologic cancer patients' needs and experiences of supportive health services in New Zealand

Background and Objectives: Psychosocial care across the cancer continuum is a core component of quality gynaecologic cancer services. The purpose of this qualitative study was to identify needs for supportive care in a sample of New Zealand women and to understand to what extent they feel their needs are being met by health services. Methods: Purposive sampling was used to recruit women (n=28) diagnosed with a gynaecologic cancer. Unstructured interviews were conducted and a thematic analysis was performed. Results: Interviews revealed a range of shared and unique needs and support experiences. Three themes emerged reflecting participants' sense of control, need for validation of the cancer experience and organisation of their care. Findings suggest issues of continuity and coordination of care result in unmet support needs across the continuum of care, but primarily after treatment finishes. Conclusion: While broadly consistent with previous results, findings highlight the need for a patient‐focused, comprehensive, integrated approach to supportive cancer care encompassing diagnosis, treatment and long‐term recovery. Copyright © 2009 John Wiley & Sons, Ltd.     

Companion participation in cancer consultations

Objective: Companions play an important role in cancer care. This investigation compared the communication of unaccompanied patients, accompanied patients, and companions during lung cancer consultations. Factors affecting the active participation of companions were analyzed. Methods: Participants included unaccompanied patients (N=48), accompanied patients (N=84), and companions (N=84) of newly diagnosed lung cancer patients seen at a large southern VA medical center. The consultations were audiotaped, then transcribed. Coded utterances included patients' and companions' active participation (asking questions, expressing concerns, and making assertions) and physicians' use of facilitative communication. Mixed linear regression was used for comparisons of accompanied patients' participation to that of their companions and to determine the independent predictors of companion participation and patient satisfaction. Results: The combined companion plus patient participation did not differ from the participation of unaccompanied patients. Patterns of companion participation varied greatly as almost half the interactions had a relatively passive companion (contributed to less than 40% of the patient plus companion active participation) but 33% of the consultations had an active companion and passive patient. Companions with less active participation accompanied black patients and received proportionally less facilitative communication from physicians. Patient satisfaction was lower when companion and patient had similar levels of participation. Conclusion: Companions vary greatly in their participation in lung cancer visits. Physicians facilitate companion participation through the use of partnership‐building and supportive communication. The companions of black patients were less active than their white counterparts which parallels other research indicating that black patients are often less active than white patients. Such communicative discrepancies could contribute to racial disparities in cancer care. Copyright © 2007 John Wiley & Sons, Ltd.