The relationship between meaning discrepancy and emotional distress among patients with cancer: the role of posttraumatic growth in a collectivistic culture

The aim of this study was to examine the relationship between meaning discrepancy and emotional distress (i.e. anxiety and depression) among patients with cancer in a collectivistic culture, and to explore the stress‐buffering effect of posttraumatic growth on this relationship. We collected data from 198 patients with cancer who completed questionnaires measuring meaning discrepancy, posttraumatic growth, anxiety and depression. Correlation analyses indicated that meaning discrepancy positively correlated with anxiety (r = 0.477, P < 0.01) and depression (r = 0.452, P < 0.01). Three structural equation models were built to compare competing hypotheses. Results showed that the moderation model fits the data better than the mediation and independence models (χ²/df = 1.31, RMSEA = 0.040, CFI = 0.98, GFI = 0.92). The present study demonstrated a positive association between meaning discrepancy and anxiety/depression, and a protective effect of posttraumatic growth on mental health by buffering traumatic stress. The study has clinical implications for the medical practice of oncology; doctors, nurses, relatives and counsellors should attend to the psychological care of patients with cancer by exploring their meaning discrepancy, and promoting the use of posttraumatic growth as a psychological resource to buffer the anxiety and depression of patients with cancer.     

Depression,anxiety, post‐traumatic stress disorder and health‐related quality of life and its association with social support in ambulatory prostate cancer patients

MEHNERT A., LEHMANN C., GRAEFEN M., HULAND H. & KOCH U. (2010) European Journal of Cancer Care 19 , 736–745
Depression, anxiety, post‐traumatic stress disorder and health‐related quality of life and its association with social support in ambulatory prostate cancer patients The aim of this study is to identify anxiety, depression and post‐traumatic stress disorder in prostate cancer patients and to investigate the association with social support and health‐related quality of life. A total of 511 men who had undergone prostatectomy were surveyed during ambulatory follow‐up care for an average of 27 months after surgery using standardised self‐report measures (e.g. Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist – Civilian Version, Illness‐Specific Social Support Scale, Short‐Form Health Survey). Seventy‐six per cent of patients evaluated their disease as ‘not’ or a ‘little threatening’. The cancer diagnosis and uncertainty were most frequently reported as ‘distressing’, while medical treatment and doctor–patient interaction were most frequently evaluated as ‘most helpful’. The number of patients reporting increased levels of psychological distress was 16%, with 6% demonstrating signs of having severe mental health problems'. No higher levels of anxiety and depression were observed in cancer patients compared with age‐adjusted normative comparison groups. Lack of positive support, detrimental interactions and perceived threat of cancer were found to be predictors of psychological co‐morbidity (P < 0.001). Lack of positive support, detrimental interactions, threat of cancer, disease stage and age significantly predicted mental health (P < 0.001), whereas the impact of social support on physical health was rather weak. Findings emphasise the need for routine psychosocial screening.     

Anxiety,helplessness/hopelessness and ‘desire for hastened death’ in Korean cancer patients

SHIM E.‐J. & HAHM B.‐J. (2011) European Journal of Cancer Care 20 , 395–402
Anxiety, helplessness/hopelessness and ‘desire for hastened death’ in Korean cancer patients Despite a relatively high rate of suicide associated with cancer, this issue has not been explored in Korean patients. This study investigates the prevalence and factors related to ‘the desire for hastened death’ (DHD) in Korean cancer patients. A cross‐sectional survey using standardised measures, including the Schedule of Attitudes toward Hastened Death and the Hospital Anxiety and Depression Scale, was performed with 131 patients with different types of cancer. 13.7% of the participants experienced moderate DHD (Schedule of Attitudes toward Hastened Death scores 5–9) and 1.7% experienced high DHD (≥10). Socio‐demographic and disease‐associated factors of the DHD included age, overall health and shortness of breath. The majority of psychosocial variables such as sadness, distress, ‘helplessness/hopelessness’ and ‘anxious preoccupation’ had a moderate association with DHD. Patients with a clinically significant level of anxiety or depression reported higher levels of DHD. Other significant correlates included ‘meaning/peace’, a sense of burdening family, dignity impairment and suicidal thoughts after diagnosis. Helplessness/hopelessness and anxiety were the strongest predictors of DHD in multivariate analysis. In view of significant role of helplessness/hopelessness and anxiety in the DHD of cancer patients, careful monitoring and management of these factors should be an integral part of cancer care to reduce the occurrence of DHD.     

Exploring global meaning in Greek breast cancer patients: validation of the Life Attitude Profile--Revised (LAP-R)

Objective: The aim of this study was to examine the factor structure and the psychometric properties of the Life Attitude Profile—Revised (LAP‐R) among a sample of Greek breast cancer patients, and to test the fit of a structural equation model with one latent factor underlying the measured LAP‐R dimensions. Methods: A total of 153 patients with breast cancer completed the LAP‐R. Convergent validity was assessed by examining the correlations between the LAP‐R subscales and measures of perceived stress, intrusiveness, mental health, and coping styles. Known‐groups validity was also assessed. Results: Principal axis factor analysis with promax rotation yielded four factors: purpose–coherence–vacuum, choice, death acceptance, and goal seeking. Internal consistency reliability of the subscales and convergent validity of LAP‐R were satisfactory. LAP‐R was able to detect differences in meaning between different age groups. Confirmatory factor analysis provided support for a single‐factor model including a latent meaning‐variable indicated by the observed subscales. Conclusions: The LAP‐R is a reliable and valid measure of global meaning in life, when administered to breast cancer patients. The use of LAP‐R in evaluating meaning‐centered psychotherapy interventions for patients with cancer is emphasized. Copyright © 2010 John Wiley & Sons, Ltd.     

Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients

Objective: This longitudinal study examines the extent to which global meaning, existential distress in terms of demoralization, and depression are predicted by tumor stage (UICC stages 0–II vs III/IV), palliative treatment, and physical problems in cancer patients. Methods: N = 270 cancer patients were studied at baseline (T1, response rate: 41%) and after 3 months (T2) (N = 178, 72%). The following standardized self‐report measures were used: Demoralization Scale, Life Attitude Profile—Revised, Hospital Anxiety and Depression Scale, NCCN DT (physical problems list). Results: Multivariate regression analyses controlling for sociodemographic variables showed the number of physical problems significantly predicting higher demoralization (β = 0.42, p<0.001) and depression (β = 0.34, p<0.001), but not global meaning. While palliative treatment intention was related to higher depression (β = 0.21, p = 0.03) and higher demoralization (ns), there was no effect of tumor stage on dependent variables. The hypothesized moderating effect of global meaning on the relation between physical problems and depression or demoralization, respectively, was not found. Conclusions: Results indicate a risk of existential distress in cancer patients across all disease stages, possibly due to confrontation with, albeit different, existential stressors throughout the illness. The general protective effect of global meaning against distress, independent of the number of physical problems, underscores the notion of existential concerns being relevant to cancer patients more generally, rather than just to a subgroup. However, physical problems might play a central role in the process of becoming demoralized through impairing the sense of mastery and competence. Findings finally strengthen the difference between the concepts of demoralization and global meaning. Copyright © 2010 John Wiley & Sons, Ltd.     

Screening for distress in patients with brain cancer using the NCCN's rapid screening measure

Goals of work: Patients with brain cancer are at a risk of experiencing elevated levels of distress due to the severe functional, neurocognitive, and neuropsychological sequelae of the disease. Using the National Comprehensive Cancer Network's Distress Thermometer, we evaluated the extent and sources of distress within a population of patients with brain cancer. Patients and methods: Participants were asked to complete the Distress Thermometer, a single‐item rapid screening tool for distress. The Distress Thermometer is a visual analog scale on which participants rate their level of distress from ‘0’ (none) to ‘10’ (extreme). Participants were also asked to designate which items from a 34‐item list constitute sources of distress. Main results: Fifty‐two percent of participants met the ?4 cut‐off score for distress. The scores were positively correlated with patient‐reported emotional sources of distress (r=0.444, p<0.001), physical sources of stress (r=0.231, p<0.05), and total number of concerns (r=0.368, p<0.001). On average, brain tumor patients reported 5.8 cancer‐related items of concern. Conclusion: Brain cancer patients are likely to experience distress at some point during their disease trajectory. Patient‐reported emotional sources of distress should be targeted and interventions should be designed to address sources of distress such as worry, sadness, and depression. Copyright © 2007 John Wiley & Sons, Ltd.     

Prevalence of distress in cancer patients undergoing chemotherapy

Aim: Feeling distressed is often a normal reaction to the diagnosis of cancer and cancer treatment. However, if excessive, distress may lead to more disabling conditions such as depression and anxiety. The aims of the study were to determine the prevalence and level of distress in patients with cancer who were undergoing chemotherapy and to examine the associated factors related to psychological distress in these patients. Methods: Adult patients with confirmed cancer who were undergoing out‐patient chemotherapy at the Clinical Oncology Unit, Universiti Malaya Medical Centre were invited to participate in the study. They were assessed on their sociodemographic profiles, clinical history, distress level as measured using the ‘Distress Thermometer’, and problems checklist on practical, family, emotional and physical symptoms. The Hospital Anxiety Depression Scale (HADS) was used by patients to report anxiety and depression. Results: One hundred and sixty‐eight patients with mean age of 50 years participated in the study. The prevalence of psychological distress determined by the ‘Distress Thermometer’ was 51%. HADS found the prevalence of depression/anxiety to be 32%. There was no significant association between distress and the primary site of cancer, the phase of chemotherapy and the sociodemographic profiles except for age (r = ?0.21, P = 0.007). Distress was significantly associated with practical, family and emotional problems. Some of the physical problems such as appearance, breathing, changes in urination, constipation, eating, fatigue, getting around, memory/concentration, nausea, pain and sleep were also significantly associated with distress. Conclusion: Cancer patients undergoing chemotherapy experienced high level of distress. This finding should alert oncologists that some patients exhibiting these signs of distress may need referral to the mental health team.     

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.     

Effects of psychosocial interventions on meaning and purpose in adults with cancer: A systematic review and meta-analysis

Meaning and purpose in life are associated with the mental and physical health of patients with cancer and survivors and also constitute highly valued outcomes in themselves. Because meaning and purpose are often threatened by a cancer diagnosis and treatment, interventions have been developed to promote meaning and purpose. The present meta-analysis of randomized controlled trials (RCTs) evaluated effects of psychosocial interventions on meaning/purpose in adults with cancer and tested potential moderators of intervention effects. Six literature databases were systematically searched to identify RCTs of psychosocial interventions in which meaning or purpose was an outcome. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, rater pairs extracted and evaluated data for quality. Findings were synthesized across studies with standard meta-analytic methods, including meta-regression with robust variance estimation and risk-of-bias sensitivity analysis. Twenty-nine RCTs were identified, and they encompassed 82 treatment effects among 2305 patients/survivors. Psychosocial interventions were associated with significant improvements in meaning/purpose (g = 0.37; 95% CI, 0.22-0.52; P < .0001). Interventions designed to enhance meaning/purpose (g = 0.42; 95% CI, 0.24-0.60) demonstrated significantly higher effect sizes than those targeting other primary outcomes (g = 0.18; 95% CI, 0.09-0.27; P = .009). Few other intervention, clinical, or demographic characteristics tested were significant moderators. In conclusion, the results suggest that psychosocial interventions are associated with small to medium effects in enhancing meaning/purpose among patients with cancer, and the benefits are comparable to those of interventions designed to reduce depression, pain, and fatigue in patients with cancer. Methodological concerns include small samples and ambiguity regarding allocation concealment. Future research should focus on explicitly meaning-centered interventions and identify optimal treatment or survivorship phases for implementation.     

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.     

Development of guidelines for distress management in Korean cancer patients

Objectives: Psychological distress is common in cancer patients, and the need to develop a system for assessing and managing distress is widely recognized. This project developed recommendations that are feasible for Korean cancer patients and the Korean healthcare system. Methods: Based on the findings from a series of studies in the context of this project, we developed guidelines following the steps and parameters recommended by the Scottish Intercollegiate Guidelines Network (SIGN). The Development Group consisted of individuals from several professions, including psychiatrists, psychologists, nurses, social workers, a health policy expert, and a methodologist. Opinions from various healthcare providers, patients, and related societies were also reflected in the guidelines. Results: The main recommendations for distress management in cancer patients were the following: (1) a concept of distress in Korean cancer patients, screening tools, management algorithms, and triage approaches was developed and (2) four symptom‐specific guidelines with management algorithms were proposed for depression, anxiety, insomnia, and delirium. Conclusion: This is the first effort to develop recommendations for distress management in psycho‐oncology in Korea. These guidelines offer standards for psychosocial care for cancer patients in Korea. We have made a significant step toward integrated cancer care that incorporates the psychosocial care of patients as an essential component of patient care in a Korean oncology context. This version will be updated constantly to keep up with emerging evidence from empirical research and clinical experience. Copyright © 2011 John Wiley & Sons, Ltd.     

The concept and measurement of meaning in life in Dutch cancer patients

We investigated the psychometric properties of a Dutch translation of the Personal Meaning Profile in a heterogeneous group of cancer patients. Our study resulted in a relatively short scale consisting of 39 of the 57 original items, divided into 5 factors, labeled 'relation with God'; 'dedication to life'; 'fairness of life'; 'goal-orientedness' and 'relations with other people', which can be summed to a total score of the experience of meaning in life. The internal consistency of the total scale as well as of its sub dimensions was high. The experience of meaning in life was positively related to feelings of psychological well-being and negatively to feelings of distress. Furthermore, the experience of meaning in life was also related to trait-like characteristics as personality. Future research can investigate its appropriateness for other populations than cancer patients, and if and how the experience of meaning in life eventually changes as a result of existential threats.     

Patient versus clinician symptom reporting: how accurate is the detection of distress in the oncologic after‐care?

Objective: The high prevalence of psychosocial distress in cancer patients is well known. The objective of this study was to investigate the agreement between the self‐report of patients and the detection of distress by the treating physicians. Methods: The participating patients were all enrolled in a structured 5‐year after‐care program in Palatinate, Germany. All tumor‐free patients with a scheduled follow‐up exam in a 3‐month time frame were asked to fill in a questionnaire regarding their psychosocial distress. The treating physicians participating in the program are family doctors or specialized physicians working in general practices. Their assessment of the patients' distress is part of the program. Agreement was evaluated using the kappa statistic. Results: The levels of psychosocial distress were very high in the self‐rating of 2642 patients. Low concordance was observed between the ratings of the patients and the physicians, with all kappa values below 0.1. Only about every 10th patient reporting weak to severe problems with depression or anxiety was identified as such. Detection of problems by physicians was somewhat better for female than male patients and highest among breast cancer patients. Conclusions: Overall the results of our study show that the need for psychosocial support extends past the acute treatment phase. The recognition of psychosocial distress in their patients seems to be extremely low in the outpatient, follow‐on care phase. The application of an efficient rating method should become a routine part of the follow‐up exams with physicians being trained to improve their abilities to detect the distress in the patient. Copyright © 2011 John Wiley & Sons, Ltd.     

Distress,anxiety, depression,and emotional well‐being in African‐American men with prostate cancer

Objective: African‐American men have an incidence rate of prostate cancer 60% higher than Caucasian men. Over one‐quarter of men with prostate cancer experience significant distress, yet psychosocial research has rarely focused on African‐American men. This study presents novel data on emotional well‐being, distress, anxiety, and depression in African‐American men with prostate cancer. Methods: This archival research combined two databases (N=385 and N=367) comprised of 55 African‐American men with prostate cancer. Quality of life was assessed with the Functional Assessment of Cancer Therapy, distress was measured with the Distress Thermometer, and anxiety and depression were measured with the Hospital Anxiety and Depression Scale. African‐American and Caucasian men were matched on age, education, and stage of disease, and compared on emotional well‐being, distress, anxiety, and depression. Results: The mean age of the 55 African‐American was 63 years old. In non‐matched comparison, African‐American men had elevated levels of distress, anxiety, and depression similar to Caucasian men. African‐American men reported high levels of clinically significant distress (>31%) and anxiety (>23%). However, after matching the African‐American and Caucasian men, African‐American men reported higher mean scores on emotional well‐being (p<0.05) and a lower percentage of African‐American men displayed clinically significant depressive symptoms (p<0.05) compared with Caucasian men. Conclusions: After matching the sample, African‐American men seem to display a sense of resilience, demonstrating greater emotional well‐being and a lower incidence of clinically significant depressive symptoms, compared with Caucasian men. This is consistent with cross‐cultural research outside of prostate cancer. Continued research is needed to further elucidate the concept of resiliency in African‐American men with prostate cancer. Copyright © 2010 John Wiley & Sons, Ltd.     

Cancer‐related trauma,stigma and growth: the ‘lived’ experience of head and neck cancer

Head and neck cancer is associated with multiple layers of distress including stigma. Stigma attraction or devalued social identity is twofold: (1) it is a cancer associated with lifestyle risk factors and (2) treatment often results in confronting facial disfigurement. Subjective interpretations from nine head and neck cancer patients were analysed using Interpretative Phenomenological Analysis. An overarching superordinate theme – Distress, Stigma and Psychological Growth – encompassed four subordinate themes. Two themes captured the expressed trauma and terror as a result of diagnosis and treatment, and two the redefining of self despite stigma through meaning making. Distress was interpreted as a catalyst for awakening new life interpretations and combined with social support to facilitate two distinct pathways of growth: (1) psychological growth without support; (2) psychological and relational growth with support. Previously unfelt empathetic understanding and altruism for others with cancer emerged from the impact of stigma on ‘self’. Acceptance allowed a new sense of identity that recognised cancer‐related traumatic distress as integral to growth for these participants. The present study offers a unique insight into cancer‐related trauma and stigma and the potential to redefine a more accepting, empathic and altruistic ‘self’ for psychological growth. Implications are discussed.     

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.     

Relationship of stress management skill to psychological distress and quality of life in adults with cancer

Background: Distress is common among cancer patients, especially those undergoing chemotherapy. Although skill in stress management is often the target of intervention efforts, its relationship to distress and quality of life in patients about to begin cancer treatment has not been examined. Objective: To examine the relationship of pre‐treatment skill in stress management to patient distress and quality of life. Methods: One hundred and ten adults diagnosed with stage I–IV cancer and ECOG?2 provided data on perceived stress management skill, anxiety, depression, and health‐related quality of life prior to their initial chemotherapy infusion. Results: As predicted, greater skill in stress management was associated with lower levels of anxiety and depression and better overall mental quality of life. These relationships were generally independent of demographic and clinical variables also found to be associated with distress and quality of life. Conclusions: Findings confirm that skill in stress management is related to pre‐chemotherapy distress and quality of life and suggest the importance of assessing this variable as part of efforts to link distressed patients to appropriate psychosocial services. Findings also raise the possibility that assessing extant stress management skills could be used to match patients to the type of intervention most likely to benefit them. Copyright © 2009 John Wiley & Sons, Ltd.     

Spirituality,quality of life,psychological adjustment in terminal cancer patients in hospice

The purpose of this study was to show the different components of spirituality in the last few weeks of life for advanced cancer patients admitted to hospice and to evaluate quality of life (QoL), pain, anxiety, depression and psychological adjustment to cancer. One hundred and fifteen patients were interviewed with a series of rating scales: the Functional Assessment of Chronic Illness Therapy – Spiritual Well‐Being Scale, the Hospital Anxiety and Depression Scale, the Visual Analogue Scale for pain, the Brief Coping Orientation to Problem Experienced and the Functional Assessment of Cancer Therapy Scale – General Measure. Workers and single patients with higher education level showed a worse QoL. Moreover, anxiety and pain were negatively associated with QoL, while spirituality and ‘Instrumental Support’ coping style were positively associated with QoL. In the Italian sample, it was observed that when patients are close to death, faith is a more important component of spirituality than meaning/peace. This study confirms that QoL could be related to physical and psychological symptoms, and this reiterates the importance of faith in end‐of‐life care.     

The contribution of self‐esteem and self‐concept in psychological distress in women at risk of hereditary breast cancer

Objective: Clarification of the role of several aspects of self‐concept regarding psychological distress in women at risk of hereditary breast cancer will help to target counselling and psychosocial interventions more appropriately. In this study, we aimed (1) to examine the role of general self‐esteem and specific aspects of self‐concept (i.e. stigma, vulnerability, and mastery) in psychological distress in women at risk of hereditary breast cancer and (2) to compare the relative importance of these self‐concept aspects in psychological distress in women with low versus high self‐esteem. Methods: General and breast‐cancer‐specific distress, self‐esteem, self‐concept, and demographics were assessed in 246 women being at risk of hereditary breast cancer, who opted either for regular breast surveillance or prophylactic surgery. Results: In the total study group, self‐esteem was negatively associated with general distress. Furthermore, feeling stigmatized was strongly associated with more breast‐cancer‐specific distress, and to a lesser degree with general distress. In women with low‐self esteem, feelings of stigmatization were strongly associated with higher levels of both breast–cancer‐specific and general distress, while a sense of mastery was associated with less general distress. For women with high self‐esteem, feelings of both stigmatization and vulnerability were associated with more breast‐cancer‐specific distress, whereas there were no significant associations with general distress. Discussion: Psychosocial interventions or support groups for women at risk of hereditary breast cancer should focus on self‐esteem and feelings of stigmatization and isolation, and consequently tailor the interventions on specific items for respective women. Copyright © 2010 John Wiley & Sons, Ltd.     

Distress levels in patients undergoing chemotherapy in Brazil

Objective: The objective of this study was to measure distress at three points during the course of chemotherapy: beginning, middle, and the last day of therapy in a private cancer center in Brazil. Methods: One hundred patients were assessed at three points during chemotherapy using the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS). The data were analyzed with the support of SPSS 15.0 software. Results: At the beginning of chemotherapy, patients mean scores were distress (82%), anxiety (78%) and depression (55%). In the middle of treatment, the percentages of distress, anxiety and depression decreased to 36.4, 25 and 25.3%, respectively. On the last day, the levels were 18.2% for distress and 14.3% for both anxiety and depression. Conclusion: Distress is highest in these patients at the beginning of chemotherapy, suggesting that evaluation of patients for psychosocial needs is important. Screening with a simple rapid instrument such as the DT is feasible and useful. Copyright © 2010 John Wiley & Sons, Ltd.