The effect of an attachment‐oriented couple intervention for breast cancer patients and partners in the early treatment phase: A randomised controlled trial

Objective

Patients and partners both cope individually and as a dyad with challenges related to a breast cancer diagnosis. The objective of this study was to evaluate the effect of a psychological attachment‐oriented couple intervention for breast cancer patients and partners in the early treatment phase.

Methods

A randomised controlled trial including 198 recently diagnosed breast cancer patients and their partners. Couples were randomised to the Hand in Hand (HiH) intervention in addition to usual care or to usual care only. Self‐report assessments were conducted for both patients and partners at baseline, postintervention (5 months), and follow‐up (10 months), assessing cancer‐related distress, symptoms of anxiety and depression, and dyadic adjustment. Patients' cancer‐related distress was the primary outcome.

Results

Cancer‐related distress decreased over time in both patients and partners, but the intervention did not significantly affect this decrease at postintervention (P = .08) or follow‐up (P = .71). A significant positive effect was found on dyadic adjustment at follow‐up for both patients (P = .04) and partners (P = .02).

Conclusions

There was no significant effect of the HiH intervention cancer‐related distress. The results suggest that most couples can cope with cancer‐related distress in the context of usual care. However, the positive effect on dyadic adjustment implies that the HiH intervention benefitted both patients and partners. Future studies should investigate how to integrate a couple focus in usual cancer care to improve dyadic coping in the early treatment phase.

     

Heads Up: a pilot trial of a psychological intervention to improve nutrition in head and neck cancer patients undergoing radiotherapy

Malnutrition in head and neck cancer (HNC) patients is common and associated with poorer radiotherapy outcomes including increased mortality. This pilot trial investigates the feasibility and effectiveness of a psychological intervention to improve nutritional status, depression and mortality in HNC patients undergoing radiotherapy. Fifty‐nine intervention patients received motivational interviewing and cognitive behavioural therapy compared to 70 historical controls who received treatment as usual. Participants were assessed for nutrition, depression and mortality. There were no significant differences between groups in nutritional status, depression or mortality. Subgroup analyses among patients at greater nutritional risk (cancers of the oral cavity, pharynx, larynx) revealed a potentially clinically important reduction on the PG‐SGA and lower mortality (31% of controls vs. 16% intervention; P = 0.03) in favour of the intervention condition. Potential benefits in nutritional status and in mortality in this pilot trial of a psychological intervention among HNC patients at high nutritional risk suggest that a larger randomised controlled trial is warranted.     

A turning point: Head and neck cancer patients’ exercise preferences and barriers before and after participation in an exercise intervention

This study examined the exercise barriers and preferences of head and neck cancer (HNC) survivors in relation to exercise experience. Participants (n = 22; 46.8% response rate) completed retrospective self‐report questionnaires on demographic and medical information, exercise barriers and preferences. A subset of participants then completed semi‐structured interviews (n = 18). Participants had previously engaged in the ENHANCE trial during, or immediately following, radiation treatment, an average of 22.1 ± 5.8 months before. Retrospective questionnaires revealed that before ENHANCE participation, lack of interest and time were the primary exercise barriers. After participation, there was a significant decrease in typical barriers including lack of interest (p = .008), exercise not a priority (p = .039) and exercise not in routine (p = .004). Number of barriers experienced after ENHANCE participation was negatively correlated with age, quality of life and minutes of resistance exercise training per week. After ENHANCE participation, significant increases were found in preference for exercising at a cancer centre (p = .031) and with other cancer survivors (p = .016). Four higher order themes emerged inductively from interview data analysis pertaining to preferences (i.e., class format) and three higher order themes regarding barriers (physical, psychological and external). By investigating participants’ perspectives after ENHANCE participation, key factors for effective HNC exercise programme design were identified.     

Contextual and stress process factors associated with head and neck cancer caregivers’ physical and psychological well‐being

Head and neck cancer (HNC) caregivers are especially vulnerable to poor outcomes because the HNC patients are at high risk for physical and functional impairments. This study examines contextual and stress process variables potentially associated with HNC caregivers’ physical and psychological well‐being. Patient‐caregiver variables included socio‐demographics, primary stressors (caregiving, patient clinical characteristics, HNC‐related symptoms/dysfunction), secondary stressors (caregiver employment, childcare responsibilities and sleep duration <7 hr), appraisal, and response (physical activity). General linear models modeled caregiver well‐being, along with depression and anxiety. A total of 33 patient‐caregiver dyads were included. Most caregivers were female (81.8%) and patient spouses/partners (72.7%). Factors significantly associated with better caregiver physical well‐being included caregiver older age, <2 comorbidities, ≥7 hr of sleep, ≥3 days/week physical activity, and patient swallowing and speech dysfunction. Factors significantly associated with better caregiver mental health functioning were less patient social dysfunction and less perceived caregiving burden. Short nighttime sleep, higher caregiver burden, and <3 days/week physical activity were also significantly related to caregivers’ depression and anxiety. Results suggested caregiver behaviors and perceived burden, along with patient HNC concerns are linked with caregiver well‐being. These behavioral, cognitive, and patient factors should be incorporated into caregiver screening tools or targeted with behavioral interventions to improve caregiver well‐being.     

The psychological impact of a specialist referral and telephone intervention on male cancer patients: a randomised controlled trial

Objective: To examine the psychological impact of a referral and telephone intervention, involving information and support, among men with colorectal cancer (CRC) and prostate cancer. Methods: 571 newly diagnosed male CRC (N=182) and prostate (N=389) cancer patients were block‐randomised into three arms. In the two intervention arms, the specialist actively referred men to a Cancer Helpline. In Active Referral—4 outcalls, men received calls from the Helpline within 1 week of diagnosis, and at 6 weeks, 3 months and 6 months post‐diagnosis. In Active Referral—1 outcall, men received one call within 1 week of diagnosis. In the control arm, Passive Referral, patients were referred to the Helpline, with contact at their initiative. Participants completed scales measuring cancer‐specific distress, anxiety and depression at study entry, then 4, 7 and 12 months post‐diagnosis. Random effects regression models compared rates of change in these outcomes between study arms. Results: At the first outcall, over 85% of participants in both intervention arms discussed treatment management and psychological/emotional issues. Among the Active Referral—4 outcalls arm, over 80% of participants discussed psychological/emotional issues at each call. Mean changes over time in cancer‐specific distress, anxiety and depression were similar between study arms. Conclusion: Although men were willing to discuss psychosocial issues via the telephone, we found no psychological impact. Further research is required to determine whether the intervention is more effective for patients who do not have psychosocial support or have unmet information needs. Copyright © 2009 John Wiley & Sons, Ltd.     

Mindfulness significantly reduces self-reported levels of anxiety and depression: Results of a randomised controlled trial among 336 Danish women treated for stage I–III breast cancer

IntroductionAs the incidence of and survival from breast cancer continue to raise, interventions to reduce anxiety and depression before, during and after treatment are needed. Previous studies have reported positive effects of a structured 8-week group mindfulness-based stress reduction program (MBSR) among patients with cancer and other conditions.PurposeTo test the effect of such a programme on anxiety and depression among women with breast cancer in a population-based randomised controlled study.MethodsA total of 336 women who had been operated on for breast cancer (stage I–III) were randomised to usual care or MBSR + usual care. Questionnaires including the Symptom Checklist-90r anxiety and depression subscales and the Center for Epidemiological Studies-Depression scale were administered before randomisation and immediately, 6 and 12 months after the intervention.ResultsIntention-to-treat analyses showed differences between groups in levels of anxiety (p = 0.0002) and depression (SCL-90r, p < 0.0001; CES-D, p = 0.0367) after 12 months. Graphical comparisons of participants with higher levels of anxiety and depression at baseline showed a significantly greater decrease in the intervention group throughout follow-up and no differences among least affected participants. Medium-to-large effects were found for all outcomes in the intervention group in analyses of change scores after 12 months’ follow-up.ConclusionThe 8-week group based MBSR intervention had clinically meaningful, statistically significant effects on depression and anxiety after 12 months’ follow-up, and medium-to-large effect sizes. Our findings support the dissemination of MBSR among women with breast cancer. (Clintrials.gov No.: NCT00990977).     

Significance of survivin and Bcl-2 homologous antagonist/killer mRNA in detection of bone metastasis in patients with breast cancer

Aim The relation of anxiety and depression levels with characteristics of coping with the disease and quality of life were evaluated in women under follow-up for breast cancer. Materials and Methods Patients who had presented to the breast cancer polyclinics for follow-up were evaluated. The Beck Depression and the State-Trait Anxiety inventories were used in the evaluation of depression and anxiety levels. In order to evaluate their power to cope with cancer, the patients were questioned for a social support network. EORTC QLQ-C30 and QLQ-BR23 questionnaires were applied for quality of life evaluations. Results There were 23 (19%) patients with depression; 3 (2.5%) with grade I anxiety, 94 (77%) grade II, and 23 (19%) grade III anxiety, respectively. Depression and anxiety levels were affected by the following parameters: being unaccompanied by spouse for hospital follow-ups (P < 0.0001); request to get help by a psychologist (P = 0.02); presence of a person to share their problems (P < 0.0001); and using an alternative treatment (P = 0.04). In the quality of life evaluations, difficulty in sleeping, emotional status, fatigue, and body appearance were related with both depression and anxiety (P < 0.05 for all), whereas physical function (P = 0.002), role performance (P = 0.005), cognitive condition (P < 0.0001), social position (P < 0.0001), pain (P < 0.0001), general health (P < 0.0001), treatment methods (P = 0.001), future anxiety (P < 0.0001), and arm symptoms (P = 0.001) were negatively affected in patients with depression. Conclusion High depression and anxiety levels in patients under follow-up for breast cancer influence the coping with cancer and quality of life adversely.     

Effects of individual and partner factors on anxiety and depression in Taiwanese prostate cancer patients: A longitudinal study

Studies exploring the mediating and predictive factors of anxiety and depression for prostate cancer patients in Eastern countries are scant. Guided by the transactional model of stress and coping, this study determined the predictors and mediators of anxiety and depression in prostate cancer patients. The participants comprised 115 prostate cancer patients and 91 partners. The patients and partners completed questionnaires regarding physical symptoms, disease appraisals, coping behaviours, anxiety and depression in the period before confirmation of treatment decisions and 1, 3, 6 and 12 months after treatment. The results revealed that partner anxiety engendered a stressful situation and aggravated patient anxiety. Patients’ threat appraisals and affective‐oriented coping behaviours mediated the relationships between their anxiety levels and those of their partners. The patients’ most recent prostate‐specific antigen (PSA) levels and hormonal symptoms were key predictors of their anxiety and depression levels. The patients’ harm appraisals mediated the relationships between their most recent PSA levels and hormonal symptoms and depression. Their threat appraisals and affective‐oriented coping behaviours mediated the relationships between their hormonal symptoms and anxiety and depression. To manage those key factors, reframing, appraising disease and improving coping behaviours may reduce anxiety and depression levels in prostate cancer patients.     

Depression,anxiety and disease-related distress in couples affected by advanced lung cancer

Objectives

Lung cancer patients and their partners are prone to high levels of depression and anxiety or severe distress related to the poor prognosis of the illness. However, there remain doubts regarding the extent to which this distress exceeds levels in the general population. This study explored levels of depression and generalized anxiety for comparison with matched data of a representative sample from the general population. Additionally, covariance of distress between the two partners, together with disease-specific components and differences were investigated.

Materials and methods

In a cross-sectional survey, 54 pairs of lung cancer patients and their partners (n = 108) were assessed for depression and anxiety, cancer-related distress, unmet needs and disclosure in communication. Comparisons between distress levels of participating couples and matched community-comparisons (n = 162) were conducted. Additionally, multilevel analysis for estimating intra-dyadic associations of anxiety and depression was computed. Components of distress, needs and aspects of communication were explored via item mean values.

Results

Lung cancer patients as well as their partners exhibited significantly higher levels of depression and anxiety when compared to community-based comparison subjects (patients: mean difference of 1.01 for depression with a relative risk (RR) of 4.5 and 0.84 for anxiety with RR = 6.1; partners: 1.17 for depression with RR = 4.6 and 1.59 for anxiety with RR = 7.6). Partial intraclass correlations between patients and partners were weak (PIC = .29 for depression; PIC = .21 for anxiety). Fear of progression emerged as main component of distress for both patients and partners, although differing stressors were described.

Conclusion

Lung cancer-affected couples exhibit levels of depression and anxiety far exceeding those of the general community. In clinical practice, patients and partners should be assessed separately for distress against the background of weak intra-dyadic associations. In cases of significant depression or anxiety, referral for psychosocial treatment is indicated and has been shown to improve quality of life.     

Improving social network support for partners facing spousal cancer while caring for minors: Four‐month outcomes of a single‐centre randomised controlled trial

Social support is an important predictor of the well‐being of partners of cancer patients. Those who are caring for minors (well parents) may be in special need of such support. The aim of this study was to evaluate the 4‐month impact of a psychoeducational social support intervention, named the Cancer‐PEPSONE programme (CPP), on well parents’ received and perceived social support, as well as on their psychological distress, quality of life (QOL) and parental capacity. The study was an open randomised controlled trial with a parallel‐group design (N = 35; Intervention = 17, Controls = 18). The participants in the intervention group received CPP in their homes. Controls received support as usual. Data were collected in Norway using validated self‐report questionnaires. Questionnaires were sent by post, before randomisation (T1), and at three‐ (T2) and six‐month (T3) follow‐up. Linear mixed models analyses revealed intervention effects on received (p = 0.04, d = 0.6) and perceived (p = 0.01, d = 1.0) social support, as well as on parental capacity (p = 0.02, d = 1.0), but not on psychological distress and QOL. Social support mediated the relationship between receiving CPP and later psychological distress. CPP may help well parents in maintaining social support and enhancing parental capacity. An improvement in social support may alleviate well parents’ psychological distress.     

Intensity and prevalence of depressive states in cancer inpatients: a large sample descriptive study

In cancer patients, depression causes suffering during the whole disease trajectory and it also influences the personal perception of well‐being as well as treatment adherence. Consequently, its better definition is needed for planning more tailored supportive programmes. This study was aimed to provide information on depressive state intensity and prevalence in an heterogeneous sample of cancer inpatients. In addition, associations were studied between depressive state and different socio‐demographic and clinical factors. A total of 1,147 consecutive adult cancer inpatients completed the Center for Epidemiologic Studies Scale on Depression together with a form for collecting socio‐demographic and clinical data. The mean score of depression was 16.9 (SD = 9.3). There were differences in depression intensity associated with gender (p < .001), age (p = .001) and cancer type (p < .001), but not with education level (p = .282) or marital status (p = .436). Of the entire sample 13.9% had depressive states; this percentage raised to 26.2% if a less stringent criterion was used. These data reinforce the importance of a clinical and research focus on depression in oncology. As differences according to gender, age and diagnosis exist in depression prevalence and intensity, tailored supportive intervention should be planned and verified for effectiveness and efficacy.     

Investigating the health disparities in the association between lifestyle behaviors and the risk of head and neck cancer

Many studies have reported a positive association between lower socioeconomic status (SES) and higher head and neck cancer (HNC) risk. Fewer studies have examined the impact of SES on the association between alcohol or cigarette use and HNC risk. The current case‐control study (1104 HNC cases and 1363 controls) investigated the influence of education, a SES indicator, on the association between HNC and the use of alcohol, cigarettes, or betel quids in Taiwan, a country with universal health care. Our results showed a larger increase in HNC risk associated with alcohol among those with lower educational level (odds ratio [OR] = 2.07; 95% confidence interval [CI], 1.53‐2.80) than those with higher educational level (OR = 1.38; 95% CI, 1.04‐1.85) (heterogeneity‐P = .03). Educational level had an influence on the association between alcohol use and HNC risk among those with genetic susceptibility (ALDH2‐deficient) to the carcinogenic effect of alcohol. The association between cigarette or betel quid use and HNC risk was similar between the high and low educational groups. National policies and social interventions have led to the decline in the prevalence of cigarette and betel quid users in Taiwan. In contrast, due to the lack of adequate alcohol control policies, alcohol consumption in Taiwan has continued to rise. A higher impact of alcohol on HNC risk among lower SES individuals even with universal health care could be the result of insufficient alcohol control policies in Taiwan.     

The effects of a cancer diagnosis on the health of a patient's partner: a population‐based registry study of cancer in Sweden

The aim of this population‐based registry study was to explore how cancer influences the health of partners, by examining the onset of new diagnoses for partners, health care use and health care costs among partners living with patients with cancer. The sample consisted of partners of patients with cancer (N = 10 353) and partners of age‐ and sex‐matched controls who did not have cancer (N = 74 592). Diagnoses, health care use and health care costs were studied for a continuous period starting 1 year before the date of cancer diagnosis and continued for 3 years. One year after cancer diagnosis, partners of patients with cancer had significantly more mood disorders, reactions to severe stress and ischaemic heart disease than they exhibited in the year before the diagnosis. Among partners of patients with cancer, the type of cancer was associated with the extent and form of increased health care use and costs; both health care use and costs increased among partners of patients with liver cancer, lung cancer, colon cancer and miscellaneous other cancers. The risk of poorer health varied according to the type of cancer diagnosed, and appeared related to the severity and prognosis of that diagnosis.     

Fear of cancer progression in patients with stage IA malignant melanoma

We aimed to determine the prevalence and importance of fear of cancer progression (FoP) in melanoma patients with stage IA tumours to assess psychosocial and demographic factors associated with severity of FoP and to determine the relationship of FoP and quality of life (QoL). One hundred and thirty‐six patients with stage IA melanoma completed the short version of the Fear of Progression Questionnaire (FoP‐Q‐SF), the Hospital Anxiety and Depression Scale (HADS) and the EORTC‐QLQ‐C30. We found a mean FoP‐Q‐SF sum score of 30.2 points (±8.4 points SD). In this study, 33% of patients reported high FoP at or above the cutoff‐value of 34 points. Higher FoP was found in women (p < 0.01), young (p = 0.03) and employed (p = 0.02) patients. Being confronted with a cancer diagnosis in closely related persons predicted higher FoP (p < 0.01). FoP correlated positively with the HADS anxiety (r = 0.50, p < 0.01) and depression scales (r = 0.26, p < 0.01) and negatively with the EORTC‐QLQ‐C30 global health state (r = −0.32, p < 0.01). FoP is considerably prevalent in low‐risk melanoma patients and associated with reduced QoL, cancer in related persons, women sex and participation in working life. Considerably high levels of FoP, even in patients with low‐risk malignancies, underline the need for psychosocial support and psychotherapeutic interventions for melanoma patients.     

Peer support for physical activity adoption among breast cancer survivors: Do the helped resemble the helpers?

Interventions offering peer mentoring programmes promoting moderate‐to‐vigorous physical activity (MVPA) have shown improvements in MVPA and well‐being from baseline; however, research is limited. The purpose of this study was to compare the physical activity (PA) levels and psychosocial well‐being of coaches and participants at baseline and following a 12‐week intervention. Breast cancer survivors (<5 years) were recruited and randomised into either exercise (Reach‐to‐Recovery (RTR) + PA) or control (RTR Control). Participants in both groups were individually assigned one of the 18 available coaches who delivered either the MVPA intervention or the control condition via telephone. PA (7‐Day PA Recall), psychosocial well‐being, fatigue and mood were assessed at baseline and intervention completion. Seventy‐six breast cancer survivors (average age = 55.62 (±9.55)) were randomised. At baseline, all participants showed significantly lower MVPA (p = .001) and well‐being (p < .05) as compared to coaches. However, post‐intervention showed significant improvement in PA and well‐being in RTR + PA, so that they were no longer significantly different from the coaches. Post‐intervention, MVPA (p < .01), quality of life (p < .05) and fatigue (p < .05) remained significantly lower in RTR Controls compared to coaches. Future interventions should consider the behavioural patterns not only of the participants, but also of those who deliver the interventions.     

Correspondence of physical activity and fruit/vegetable consumption among prostate cancer survivors and their spouses

A healthy diet and physical activity are recommended for prostate cancer survivors. Interdependence theory suggests that the spousal relationship influences those health behaviours and the degree of correspondence may be an indicator of this influence. This study evaluated the correspondence between prostate cancer survivors and spouses regarding physical activity and fruit/vegetable consumption. Baseline data from an ongoing randomised control trial were utilised. Men who had been treated for prostate cancer within the past year and their partners (N = 132 couples) completed self‐report measures of physical activity, fruit/vegetable consumption, relationship satisfaction and support for partner's healthy diet and physical activity. Couples reported similar fruit/vegetable consumption and physical activity as indicated by high levels of correspondence. Greater fruit/vegetable correspondence was related to higher relationship satisfaction (F = 4.14, P = 0.018) and greater patient (F = 13.29, P < 0.001) and spouse‐rated support (F = 7.2, P < 0.001). Greater physical activity correspondence was related to greater patient (F = 3.57, P = 0.028) and spouse‐rated support (F = 4.59, P = 0.031). Prostate cancer survivors and spouses may influence each other's diet and exercise behaviours. Couple‐based interventions may promote healthy behaviours among this population.     

The impact of optimism on anxiety,depression and quality of life in urogenital cancer patients

Objective: The purpose of the present study was to examine the relationship between optimism and anxiety, depression and health‐related quality of life (HRQOL). A further aim was to investigate the predictive value of optimism for anxiety, depression and HRQOL, quantified with and without controlling the corresponding base level. Methods: A total of 427 urogenital cancer patients were asked to complete the Life Orientation Test (LOT), the Hospital Anxiety and Depression Scale (HADS) and the health survey SF‐8 during their stay in the hospital (T1), two weeks later (T2) and three months later. Results: Finally, 275 patients (64.4%) completed all questionnaires. Optimism at T1 was significantly associated with anxiety (r=?0.35), depression (r=?0.41) and HRQOL (physical: r=0.29; mental: r=0.27) and can predict outcome variables three months later. After controlling for the base levels of anxiety, depression and HRQOL, the predictive value of optimism remained significant but small. The incrementally variance explained by the LOT varied between 2.1% in anxiety and 8.2% in physical HRQOL. Conclusion: Especially patients with a low level of optimism and a high level of pessimism are at risk for higher levels of anxiety and depression in addition to lowered HRQOL. Copyright © 2009 John Wiley & Sons, Ltd.     

A brief bedside visual art intervention decreases anxiety and improves pain and mood in patients with haematologic malignancies

Treatment of cancer‐related symptoms represents a major challenge for physicians. The purpose of this pilot study was to determine whether a brief bedside visual art intervention (BVAI) facilitated by art educators improves mood, reduces pain and anxiety in patients with haematological malignancies. Thirty‐one patients (21 women and 10 men) were invited to participate in a BVAI where the goal of the session was to teach art technique for ~30 min. Primary outcome measures included the change in visual analog scale, the State‐Trait Anxiety Inventory and the Positive and Negative Affect Schedule scale, from baseline prior to and immediately post‐BVAI. Total of 21 patients (19 women and two men) participated. A significant improvement in positive mood and pain scores (p = .003 and p = .017 respectively) as well as a decrease in negative mood and anxiety (p = .016 and p = .001 respectively) was observed. Patients perceived BVAI as overall positive (95%) and wished to participate in future art‐based interventions (85%). This accessible experience, provided by artists within the community, may be considered as an adjunct to conventional treatments in patients with cancer‐related mood symptoms and pain, and future studies with balanced gender participation may support the generalisability of these findings.     

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.