Distress in couples approached for genetic counseling and BRCA1/2 testing during adjuvant radiotherapy

Objective: Breast cancer patients mostly rely on their partners for support in dealing with their cancer diagnosis and treatment. Genetic counseling and BRCA1/2 testing during primary treatment may add to demands made on their partners. This study aimed to gain insight into the extent of psychological distress in partners of recently diagnosed patients and to find factors to help identify couples vulnerable to high psychological distress after an active approach for genetic counseling. Methods: Breast cancer patients and their partners (n=110) completed psychological distress measures (HADS and IES) prior to the approach for counseling (T0), after the approach (T1), and after leaving the genetic counseling protocol (T2). Couples not approached for counseling (n=85) completed similar questionnaires. Results: Partners reported an equal or lower level of distress than patients, with a positive correlation between the two, although partners and patients differed in the course of their distress. Couples approached for genetic counseling did not differ in the level or course of either distress measure from not approached couples. A high baseline distress best predicts long‐term high distress in patients and their partners. Younger patients were found to be particularly vulnerable. Conclusions: The approach for genetic counseling during adjuvant radiotherapy was not associated with extra psychological distress in partners or patients in the first year following the breast cancer diagnosis. A partner's long‐term level of distress was significantly associated with that of the patient. Highly distressed patients with highly distressed partners were most likely to experience high distress in the long term. Copyright © 2009 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.     

Psychological distress related to patterns of family functioning among Japanese childhood cancer survivors and their parents

Objective: Family functioning appears to be a predictor of psychological distress among childhood cancer survivors and their family members; however, relatively little is known about patterns in those families that are psychologically at‐risk. The purpose of this study was to identify distinct clusters of families that include childhood cancer survivors, and to evaluate differences between the clusters with respect to anxiety, depression, and post‐traumatic stress symptoms (PTSS). Methods: Childhood cancer survivors and their parents (247 individuals: 88 adolescent cancer survivors, 87 mothers, and 72 fathers) completed self‐report questionnaires. Perceptions of family functioning were assessed using the Family Relationship Index and its three dimensions (cohesiveness, expressiveness, and conflict), and individuals were classified into groups via a cluster analytic approach. State‐trait anxiety, depression, and PTSS were assessed to all of the participants. Results: The individuals were classified into three types: One cluster featured high cohesiveness, high expressiveness, and low conflict (‘Supportive‐type’, n=102); a second cluster featured low cohesiveness, low expressiveness, and high conflict (‘Conflictive‐type’, n=32); and a third cluster had moderate cohesiveness, moderate expressiveness, and moderate conflict (‘Intermediate‐type’, n=113). Among the three types, an analysis of variance revealed that ‘Conflictive‐type’ members had the highest levels of PTSS, depression, and state–trait anxiety. Conclusions: These findings suggest that perceptions of family functioning are related to psychological distress in family members of childhood cancer survivors. A family‐focused intervention might be a useful approach to targeting emotional distress in these families, particularly for families with a ‘Conflictive‐type’ family member. Copyright © 2009 John Wiley & Sons, Ltd.     

A couple-based intervention for female breast cancer

Objective: Although women's breast cancer affects both women and their male partners, as well as their relationships, few interventions have been developed to work with couples confronting breast cancer. The current investigation presents the pilot results from a new couple‐based intervention program for breast cancer that teaches couples how to minimize negative effects and maximize positive functioning during this difficult time. Method: In this pilot study, 14 couples in which the wife had early stage breast cancer were randomly assigned to one of the two treatment conditions: Couple‐based relationship enhancement (RE) or treatment‐as‐usual (TAU). Results: The results from this study suggest that compared with couples receiving treatment‐as‐usual, both women and men in the RE condition experienced improved functioning on individual psychological variables as well as relationship functioning at posttest and 1‐year follow‐up. In addition, women in RE show fewer medical symptoms at both time periods. Conclusions: In this pilot study, the couple‐based intervention, RE, has shown promise in improving individual, medical, and relationship functioning for couples in which the woman is facing breast cancer, and therefore merits further investigation on a larger scale. Copyright © 2008 John Wiley & Sons, Ltd.     

Bereaved females are more likely to suffer from mood problems even if they do not meet the criteria for prolonged grief

Purpose: The goal of this study was to describe the gender difference of grief experience and mood distress among caregivers who cared for terminal cancer patients residing in a hospice ward. Methods: This study recruited 432 caregivers who cared for terminal cancer patients in the hospice ward. Caregivers received telephone interviews 6 months after the patients had died. The Chinese versions of the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Inventory of Complicated Grief (ICG) developed in 1995 by Prigerson et al. were employed to assess the mood distress and grief status. Results: Total scores of BDI, BAI, and ICG were significantly higher in females. Six out of twenty‐one items of BDI, lack of satisfaction, crying spells, sleep disturbance, fatigability, somatic preoccupation, and loss of libido, showed significantly higher scores in females. According to BAI, inability to relax, dizziness, fear of dying, fright, flushed face, and hot/cold sweats were significantly higher in females. After adjustment for potential confounders, the results show that female gender is associated with higher BDI (regression coefficient 3.24, 95% CI: 1.48–4.99), BAI (3.8; 1.11–6.50), and ICG (4.25, 1.09–7.40). Dichotomizing the BDI, BAI, and ICG into severe and nonsevere cases, the results showed that gender only contributes to severe anxiety status (BAI≧36), but not to severe depression (BDI≧29) or to prolonged grief (ICG≧25). Conclusions: Bereaved females had higher scores for depression and anxiety than males. Female gender is associated with severe anxiety; however, it is not associated with severe depression or prolonged grief. Copyright © 2010 John Wiley & Sons, Ltd.     

The psychosocial impact of interrupted childbearing in long-term female cancer survivors

Objective: To understand the influence of cancer‐related infertility on women's long‐term distress and quality of life. Women diagnosed at age 40 or less with invasive cervical cancer, breast cancer, Hodgkin disease, or non‐Hodgkin lymphoma were interviewed an average of 10 years later. We predicted that women whose desire for a child at diagnosis remained unfulfilled would be significantly more distressed. Methods: Participants completed a semi‐structured phone interview, including the SF‐12^®, Brief Symptom Inventory‐18, Impact of Events Scale (IES), Reproductive Concerns Scale (RCS), brief measures of marital satisfaction or comfort with dating, sexual satisfaction, and menopause symptoms. Results: Of 455 women contacted by phone, 240 (53%) participated. Seventy‐seven women had wanted a child at diagnosis but did not conceive subsequently (38 remaining childless and 39 with secondary infertility). Even controlling for other psychosocial and health factors, this group had higher distress about infertility (RCS) (p<0.001), had more intrusive thoughts about infertility, and used more avoidance strategies when reminded of infertility (IES) (p<0.001). Childless women were the most distressed. Women with adopted or stepchildren were intermediate, and those with at least one biological child were least distressed. Infertility‐related distress did not differ significantly by cancer site. Conclusions: Even at long‐term follow‐up, distress about interrupted childbearing persists, particularly in childless women. Social parenthood buffers distress somewhat, but not completely. Not only is it important to offer fertility preservation before cancer treatment, but interventions should be developed for survivors to alleviate unresolved grief about cancer‐related infertility. Copyright © 2010 John Wiley & Sons, Ltd.     

Marital satisfaction of advanced prostate cancer survivors and their spousal caregivers: the dyadic effects of physical and mental health

Objective: Coping with the physical and mental side effects of diagnosis and treatment for advanced prostate cancer (APC) is a challenge for both survivors and their spousal caregivers. There is a gap in our current understanding of the dyadic adjustment process on marital satisfaction in this population. The current study sought to: (1) document levels of physical and mental health, and marital satisfaction, and (2) evaluate the relationship between physical and mental health with marital satisfaction in this understudied population. Methods: APC survivors who had undergone androgen deprivation therapy within the past year and their spousal caregiver participated in the study (N = 29 dyads). Physical and mental health was assessed using the MOS SF‐36 Health Survey and marital satisfaction was evaluated using the Dyadic Adjustment Scale. Results: The Actor‐Partner Interdependence Model revealed strong relations between physical and mental health with marital satisfaction for both survivor and caregiver (actor effects). Furthermore, caregiver physical and mental health was related with the survivor's marital satisfaction (partner effect). Conclusions: Levels of mental health and marital satisfaction were comparable to community‐based and prostate cancer samples, while physical health was higher. Marital satisfaction between APC survivors and their spousal caregivers may be influenced by both physical and mental health functioning. In particular, APC survivor functioning may affect his marital satisfaction as well as his spousal caregiver's. This has implications for psychosocial interventions for APC dyads. Further evaluation of the complex nature of survivor/caregiver dyadic adjustment in dealing with APC is necessary. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychosocial adaptation in female partners of men with prostate cancer

STREET A.F., COUPER J.W., LOVE A.W., BLOCH S., KISSANE D.W. & STREET B.C. (2010) European Journal of Cancer Care 19 , 234–242
Psychosocial adaptation in female partners of men with prostate cancer The objective was to explore the psychosocial adaptation of female partners living with men with a diagnosis of either localized or metastatic prostate cancer. Semi‐structured qualitative interviews were conducted with 50 women at two time points (baseline and 6 months later). The interviews examined emotions, experiences, attitudes to sexual and continence issues and treatment decision making. As part of a larger prospective observational study, demographic data and scores for depression and anxiety were collected. Initial analysis demonstrated that the group of 11 women assessed as distressed on the anxiety and depression measures described reduced coping skills and poorer adaptation after 6 months. In contrast, the 39 women in the non‐distressed group reported emotional adaptation that fitted the Lazarus and Folkman pattern of coping through appraisal of the impact of the diagnosis on their partner and themselves, appraisal of coping strategies and reappraisal of the situation. A surprise finding was the high level of resilience displayed by majority of these women. Results suggest that a psychosocial intervention could strengthen healthy adaptation and provide better coping skills for distressed couples.     

Do concordances of social support and relationship quality predict psychological distress and well‐being of cancer patients and caregivers?

This study examined concordances of cancer patients’ received and caregivers’ provided support and dyadic relationship quality, and their predictive utility in prospective psychological distress and well‐being. A total of 83 Chinese cancer patient–caregiver dyads were recruited in two government‐funded hospitals in Hong Kong. Participants reported received (patient)/provided (caregiver) emotional and instrumental support and dyadic relationship quality within 6 months after diagnosis (T1), and anxiety and depressive symptoms, positive affect and life satisfaction at both T1 and 6‐month follow‐up (T2). We hypothesised that concordances at T1 would predict lower psychological distress and higher psychological well‐being among both patients and caregivers at T2. Concordances were indicated by Gwet's AC₂ scores (possible range = ?1.00 to 1.00) and as follows: emotional support: M = 0.92, SD = 0.12, range = 0.25–1.00; instrumental support: M = 0.92, SD = 0.16, range = 0.08–1.00; and relationship quality: M = 0.63, SD = 0.27, range = ?0.31 to 1.00. Hierarchical multiple regressions revealed that T1 concordances of perceived emotional and instrumental support and dyadic relationship quality positively predicted T2 anxiety symptoms [F(9, 74) = 6.725, ?R² = .031, p < .001)] and state positive affect [F(9, 74) = 3.436, ?R² = .042, p = .001)], whereas inversely predicted T2 depressive symptoms [F(9, 74) = 4.189, ?R² = .042, p < .01)]. Significant associations were found only among caregivers, but not patients.     

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.

     

Depression and socio‐economical burden are more common in primary caregivers of patients who are not aware of their cancer: TURQUOISE Study by the Palliative Care Working Committee of the Turkish Oncology Group (TOG)

In this study, we aimed to determine the personal, social and economic burden and the frequency of depression, as well as in caregivers of cancer patients who are being treated with chemotherapy in Turkey. The study is designed as a cross‐sectional survey study using a 5‐point Likert‐type response scale, and the last part of the questionnaire includes the Beck Depression Inventory. The depression rate was found to be 64% (n = 476) among all subjects (n = 968), with 91% of those with depression demonstrating signs of mild depression. In this study, a significant difference was found between the presence of depression and age (young), sex (female), educational level (high), economic status (low), financial loss during treatment, patient's lack of knowledge about his/her diagnosis, metastatic disease and short survival time. In addition, 64% of all subjects had concerns of getting cancer, and 44% of all subjects had feelings of anger/rage against other people. In a multivariate regression analysis, the patient's lack of knowledge of the diagnosis was the independent risk factor. In conclusion, depression incidence and burden rate increased among cancer caregivers, and care burden was highly associated with depression. Accordingly, approaches to reducing the psycho‐social effects of cancer should focus intensively on both the patients and their caregivers in Turkey.     

The validity of the Distress Thermometer in female partners of men with prostate cancer

Female partners of prostate cancer (PCa) survivors experience heightened psychological distress that may be greater than that expressed by PCa patients. However, optimal approaches to detect distressed, or at risk of distress, partners are unclear. This study applied receiver operating characteristics analysis to evaluate diagnostic accuracy, sensitivity and specificity of the Distress Thermometer (DT) compared to widely used measures of general (Hospital Anxiety and Depression Scale) and cancer‐specific (Impact of Events Scale‐Revised) distress. Participants were partners of men with localised PCa (recruited around diagnosis) about to undergo or had received surgical treatment (N = 189), and partners of men diagnosed with PCa who were 2–4 years post‐treatment (N = 460). In both studies, diagnostic utility of the DT overall was not optimal. Although area under the curve scores were acceptable (ranges: 0.71–0.92 and 0.83–0.94 for general and cancer‐specific distress, respectively), sensitivity, specificity and optimal DT cut‐offs for partner distress varied for general (range: ≥2 to ≥5) and cancer‐specific (range: ≥3 to ≥5) distress both across time and between cohorts. Thus, it is difficult to draw firm conclusions about the diagnostic capabilities of the DT for partners or recommend its use in this population. More comprehensive screening measures may be needed to detect partners needing psychological intervention.     

Feasibility of an expressive-disclosure group intervention for post-treatment colorectal cancer patients: results of the Healthy Expressions study

BACKGROUND:

Adjusting to cancer requires effective cognitive and emotional processing. Written and verbal disclosure facilitate processing and have been studied independently in cancer survivors. Combined written and verbal expression may be more effective than either alone, particularly for patients with difficult to discuss or embarrassing side effects. Thus, the authors developed and tested the efficacy of a 12‐session combined written and verbal expression group program for psychologically distressed colorectal cancer (CRC) patients.

METHODS:

Forty post‐treatment patients with CRC (stages I‐III) identified as psychologically distressed using the Brief Symptom Inventory (BSI) were randomized to an intervention group (Healthy Expressions; n = 25) or standard care (control group; n = 15). Assessments were completed at baseline, Month 2, and Month 4 (postintervention). Primary outcomes were psychological functioning and quality of life (QOL).

RESULTS:

Most participants were women (63%), white (63%), and non‐Hispanic (75%). The Healthy Expressions group demonstrated significantly greater changes in distress compared with the control group at Month 2 on the BSI Global Severity Index (GSI) and the Centers for Epidemiologic Studies Depression scale (CES‐D) scores (P < .05 for each); differences in the European Organization for Research and Treatment of Cancer (EORTC) global QOL scores approached significance (P = .063). The BSI GSI and Positive Symptom Total, CES‐D, and EORTC emotional functioning subscale scores were all significant at Month 4 (P < .05 for each).

CONCLUSIONS:

The Healthy Expressions program improved psychological functioning in CRC patients who reported experiencing distress. Findings demonstrate the program's feasibility and provide strong support for conducting a larger randomized trial. Cancer 2011;. © 2011 American Cancer Society.     

Needs assessment of family caregivers of cancer survivors: three cohorts comparison

Purpose/Background: Caregivers' quality of life (QOL) may be maximized when the caregivers' needs in the context of cancer care are met. Therefore, determining what needs are not being satisfied for family caregivers should be the first step in the development of programs designed to enhance caregivers' QOL. Method: The 28‐item Needs Assessment of Family Caregivers‐Cancer (NAFC‐C) scale was developed and validated with caregivers at three different survivorship phases: at 2 months (n=162), 2 years (n=896), and 5 years (n=608) post‐diagnosis. Results: The NAFC‐C helped to identify caregivers whose needs were less likely to be met, based on their age and ethnicity. Furthermore, the extent to which caregivers' psychosocial needs were not being met was a consistent and strong predictor of poor mental health across all phases of survivorship, beyond the effects of a host of demographic characteristics. Conclusion: Findings suggest that interventions designed to help caregivers manage their own emotional distress as well as the survivors' distress, find meaning in the cancer caregiving experience, and foster supportive familial relationship will benefit caregivers by improving their QOL, not only during the time of diagnosis and treatment but years after. Copyright © 2009 John Wiley & Sons, Ltd.     

Perceived threat and PTSD symptoms in women undergoing surgery for gynecologic cancer or benign conditions

Objective: We sought to examine levels of perceived threat and traumatic stress symptoms both before and in the short‐ and long‐term period after surgery and associated care in women diagnosed with gynecologic cancer or benign conditions. Methods: Women with advanced‐stage cancer (n=22), early‐stage cancer (n=31), benign gynecologic disease (n=33), and no disease (n=25; post‐annual pelvic examination) completed questionnaires (Perceived Threat, Impact of Event Scale (IES), and Post‐Traumatic Stress Disorder (PTSD Checklist (PCL)) on three occasions: 1 week before surgery (Time 1), 7 weeks after surgery or comparable time (Time 2), and 16 months after surgery (Time 3). Results: Perceived threat did not differ across disease groups at Time 1, but there were differences at both later times (F(2, 93.1)=11.83; p<0.001; group×time interaction); women with advanced cancer reported the highest levels. IES scores were consistently higher for the disease groups compared with the no‐disease group (F(3,104.2)=11.19; p<0.001), but were not significantly different from one another. IES scores declined over time, most markedly for the three disease groups (group×time interaction (F(6,163.8)=2.60; p=0.02). Survival analysis indicated significant differences across the groups in risk of estimated PTSD [Wilcoxon χ² (3, N=96)=7.83, p=0.050] with 34% of advanced cancer, 16% of early cancer, and 15% of benign disease groups reaching estimated PTSD criteria. Conclusions: Women with gynecologic cancer, regardless of stage, and women with benign conditions experience heightened traumatic stress at the time of diagnosis, and some continue to be distressed many months afterwards. Broad‐based screening and intervention for traumatic stress symptoms may be warranted. Copyright © 2010 John Wiley & Sons, Ltd.     

Sexual dysfunction and spousal communication in couples coping with prostate cancer

Objective: To characterize the sexual function of both prostate cancer patients and their partners, and to examine whether associations between sexual dysfunction and psychosocial adjustment vary depending on spousal communication patterns. Methods: In this cross‐sectional study, 116 prostate cancer patients and their partners completed psychosocial questionnaires. Results: Patients and partners reported high rates of sexual dysfunction. Within couples, patients' and their partners' sexual function was moderately to highly correlated (r=0.30–0.74). When patients had poor erectile function, their partners were more likely to report that the couple avoided open spousal discussions; this in turn was associated with partners' marital distress (Sobel's Z=12.47, p=0.001). Patients and partners who reported high levels (+1SD) of mutual constructive communication also reported greater marital adjustment, regardless of their own sexual satisfaction. In contrast, greater sexual dissatisfaction was associated with poorer marital adjustment in patients and partners who reported low levels (?1SD) of mutual constructive communication (p<0.05). Conclusion: Our findings underscore the need for psychosocial interventions that facilitate healthy spousal communication and address the sexual rehabilitation needs of patients and their partners after prostate cancer treatment. Although some couples may be reluctant to engage in constructive cancer‐related discussions about sexual problems, such discussions may help alleviate the negative impact that sexual problems have on prostate cancer patients' and their partners' marital adjustment. Copyright © 2008 John Wiley & Sons, Ltd.     

Adolescent's stress responses and psychological functioning when a parent has early breast cancer

Objective: To identify factors associated with psychological functioning in adolescent children of early‐stage breast cancer patients. Method: Adolescents' self‐reported psychological functioning using the Child Behaviour Checklist (YSR), Mental Health subscale of the Child Health Questionnaire (CHQ‐MH) and Child Impact of Events (C‐IES) scale. The Family Assessment Device (FAD) and the Family Environment Scale (FES cohesion subscale) assessed family functioning. Maternal depression was assessed on the Beck Depression Inventory (BDI) and quality of life using the SF8. Using a cross‐sectional within‐groups design, assessments were obtained for 56 adolescents of 11–17 years. Results: High rates of stress were found (C‐IES) in 33% males and 45% females. Thirty percent of adolescents reported psychological problems (YSR) (28% males and 32% females) when compared with published norms. Poor family functioning was linked with YSR internalising and externalising problems; poor family cohesion with higher externalising and total YSR psychological problems. Maternal depression was linked with adolescent‐reported internalising problems. Conclusions: When mothers have breast cancer, a substantial minority of their adolescent children have psychological and stress response‐related problems linked with poor family functioning. These results argue in favour of a family‐oriented approach to psychological support of breast cancer patients. Copyright © 2008 John Wiley & Sons, Ltd.     

Feasibility study of a randomized controlled trial of a telephone‐delivered problem‐solving–occupational therapy intervention to reduce participation restrictions in rural breast cancer survivors undergoing chemotherapy

Objective: Breast cancer patients receiving adjuvant chemotherapy often experience functional effects of treatment that limit participation in life activities. The purpose of this study was to examine the feasibility of conducting a randomized controlled trial (RCT) of a novel intervention for these restrictions, determine acceptability of the intervention, and preliminarily assess its effects. Methods: A pilot RCT of a telephone‐delivered Problem‐solving and Occupational Therapy intervention (PST‐OT) to improve participation restrictions in rural breast cancer patients undergoing chemotherapy. Thirty‐one participants with Stages 1–3 breast cancer were randomized to 6 weekly sessions of PST‐OT (n = 15) and usual care (n = 16). The primary study outcome was the feasibility of conducting the trial. Secondary outcomes were functional, quality of life and emotional status as assessed at baseline, 6 and 12 weeks. Results: Of 46 patients referred 31 were enrolled (67% recruitment rate), of which 6 participants withdrew (81% retention rate). Twenty‐four participants completed all study‐related assessments (77%). Ninety‐two percent of PST‐OT participants were highly satisfied with the intervention, and 92% reported PST‐OT to be helpful/very helpful for overcoming participation restrictions. Ninety‐seven percent of planned PST‐OT treatment sessions were completed. Completion rates for PST‐OT homework tasks were high. Measures of functioning, quality of life, and emotional state favored the PST‐OT condition. Conclusion: This pilot study suggests that an RCT of the PST‐OT intervention is feasible to conduct with rural breast cancer patients undergoing adjuvant chemotherapy and that PST‐OT may have positive effects on function, quality of life, and emotional state. Copyright © 2010 John Wiley & Sons, Ltd.     

Adopting a family approach to theory and practice: measuring distress in cancer patient-partner dyads with the distress thermometer

Objective: Significant others are central to patients' experience and management of their cancer illness. Building on our validation of the Distress Thermometer (DT) for family members, this investigation examines individual and collective distress in a sample of cancer patients and their matched partners, accounting for the aspects of gender and role. Method: Questionnaires including the DT were completed by a heterogeneous sample of 224 couples taking part in a multisite study. Results: Our investigation showed that male patients (34.2%), female patients (31.9%), and male partners (29.1%) exhibited very similar levels of distress, while female partners (50.5%) exhibited much higher levels of distress according to the DT. At the dyad level just over half the total sample contained at least one individual reporting significant levels of distress. Among dyads with at least one distressed person, the proportion of dyads where both individuals reported distress was greatest (23.6%). Gender and role analyses revealed that males and females were not equally distributed among the four categories of dyads (i.e. dyads with no distress; dyads where solely the patient or dyads where solely the partner is distressed; dyads where both are distressed). Conclusion: A remarkable number of dyads reported distress in one or both partners. Diverse patterns of distress within dyads suggest varying risks of psychosocial strain. Screening patients' partners in addition to patients themselves may enable earlier identification of risk settings. The support offered to either member of such dyads should account for their role‐ and gender‐specific needs. Copyright © 2010 John Wiley & Sons, Ltd.     

A pilot investigation of a multidisciplinary quality of life intervention for men with biochemical recurrence of prostate cancer

Objective: This pilot project evaluated the acceptability and estimated the effect size of a tailored multidisciplinary quality of life (MQOL) intervention for men who have biochemical recurrence of prostate cancer. Methods: Participants included 57 men with localized prostate cancer with biochemical recurrence (Median=76 years; 89% White). Participants were randomized to wait list control which offered the intervention upon conclusion of the study (n=27) or to an eight‐session group‐based, MQOL (n=30) intervention. Assessments were completed at baseline, end of treatment, and 6 months post‐treatment. Results: MQOL was acceptable as indicated by favorable participant retention (100% retained), treatment compliance (97% attended > 6 treatment sessions), and high ratings of helpfulness (80% rated helpfulness > 4 on 5‐point scale). MQOL had a favorable impact on the mental health composite score of the Short Form‐36 at the end of treatment but not at 6 months (effect size=0.52 and ?0.04); health‐related QOL as measured by the Functional Assessment of Cancer Therapy—Prostate at the end of treatment and 6 months (effect size=0.14 and 0.10); and prostate cancer specific anxiety as measured by the Memorial Anxiety Scale for Prostate Cancer at the end of treatment and 6 months (effect size=0.45 and 0.23). Conclusions: This pilot project provides preliminary data supporting the premise that a tailored behaviorally based MQOL intervention for men with biochemical recurrence of prostate cancer is acceptable to men and might reduce prostate cancer specific anxiety and enhance QOL. Further research examining the efficacy of this intervention in a larger randomized trial is warranted.Copyright © 2010 John Wiley & Sons, Ltd.