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

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

Validation of the needs assessment for advanced lung cancer patients (NA-ALCP)

Objective: The Needs Assessment for Advanced Cancer Patients (NA‐ACP) is a 132‐item self‐report questionnaire designed to assess the seven needs domains of patients with advanced, incurable cancer. This study aimed to evaluate the short derivative form of that questionnaire with advanced lung cancer patients. Methods: Item factor loadings, item test–retest data and response distributions were used to retain or reject items from the original NA‐ACP scale. This resulted in 38 items being maintained, preserving the original subscales. The response scale was simplified following feedback from patients. 108 people with advanced lung cancer completed the shortened NA‐ALCP along with measures of psychological distress (HADS, DT) and quality of life (EORTC QLQ‐C30). A‐priori predictions were made for divergent and convergent validity. Results: Internal consistency coefficients were satisfactory for six of seven subscales, range 0.71–0.95. Correlations between NA‐ALCP and HADS, DT and EORTC‐QLQ‐C30 provided support for 11 of the 22 divergent (r = 0.13–0.27) and convergent predictions (r = 0.45–0.71). Conclusions: Subscales of the NA‐ALCP demonstrated internal reliability consistent with the original scale. Results provided supporting evidence for divergent and convergent validity. This study indicates that the NA‐ALCP is psychometrically robust, easily understood and one‐quarter the length of the original version. Copyright © 2011 John Wiley & Sons, Ltd.     

Development and validation of a symptom index for advanced hepatobiliary and pancreatic cancers

BACKGROUND:

The 45‐item Functional Assessment of Cancer Therapy–Hepatobiliary (FACT‐Hep) questionnaire assesses health‐related quality of life in patients with liver, bile duct, and pancreatic cancers. Although the FACT‐Hep was initially derived from patient input, this study's researchers sought to verify adequate coverage of items by soliciting open‐ended input from patients with advanced disease.

METHODS:

As part of a larger study in collaboration with the National Comprehensive Cancer Network (NCCN), 50 people (60% male, 80% caucasian, average age 60.4 years) with stage 3 or 4 hepatobiliary or pancreatic cancer were recruited. Participants generated and ranked up to 10 important symptoms and concerns that physicians should monitor when assessing the value of chemotherapy. Patients were also able to provide open‐ended, qualitative information that was evaluated systematically. Ten expert physicians also provided input on priority symptoms.

RESULTS:

The resulting 18‐item NCCN‐FACT Hepatobiliary‐Pancreatic Symptom Index (NFHSI‐18) demonstrated high internal consistency (α = .89) and moderate to strong correlations with measures of physical well‐being (ρ = .76), emotional well‐being (ρ = 0.52), and functional well‐being (ρ = 0.57). Scores on the NFHSI‐18 were also highly correlated with the original hepatobiliary scale of the FACT‐Hep (ρ = .82; all P < .001). Compared with patients with better performance status, patients with poor performance status had worse NFHSI‐18 symptom scores, F(3,47) = 9.74; P = .0003.

CONCLUSIONS:

The NFHSI–18 assesses symptoms of importance to patients with hepatobiliary and pancreatic cancers and demonstrates promising measurement properties. The scale is a good candidate for brief symptom assessment in clinical trials. Cancer 2012. © 2012 American Cancer Society.     

Cancer Treatment Survey (CaTS): development and validation of a new instrument to measure patients' preparation for chemotherapy and radiotherapy

Objective: Cancer patients experience high levels of pre‐treatment anxiety. Chemotherapy and radiotherapy are threatening medical procedures. Preparation for these procedures should include the provision of sensory and procedural information, and addressing fears. The aim of this study was to develop a cancer treatment survey (CaTS) to assess the preparation for chemotherapy and radiotherapy in cancer patients. Methods: Drawing on evidence for how to prepare patients for threatening procedures, items were generated by psychosocial/clinical experts and pilot tested with cancer patients. The 36‐item draft CaTS was administered to 192 cancer patients commencing chemotherapy for lymphoma, breast or colon cancer. Participants also completed the Hospital Anxiety and Depression Scale (HADS) and basic medical and demographic information was recorded. Results: A systematic process of item selection removed 11 items. Factor analysis indicated a two‐factor solution, with 11 items representing sensory/psychological concerns and 14 items representing procedural concerns. The two subscales demonstrated excellent internal reliability with Cronbach's alpha both over 0.90 and the average inter‐item correlation for each scale exceeded 0.30. Divergent validity was established for both CaTS subscales with the HADS‐A and‐T (all r<0.30). Younger participants (under 65 years of age) had significantly greater procedural concerns (p = 0.001; medium effect). Conclusions: The CaTS is a two factor, 25‐item measure that assesses sensory/psychological concerns and procedural concerns relating to cancer treatment. The instrument provides a reliable and valid outcome measure for interventions to prepare cancer patients for chemotherapy and radiotherapy. Copyright © 2010 John Wiley & Sons, Ltd.     

Validation of an item bank for detecting and assessing psychological distress in cancer patients

Objective: To validate an item bank for assessing and detecting psychological distress in cancer patients by (1) identifying whether additional items are required in the full item bank; (2) identifying any item bias in the existing item bank; (3) linking levels of distress against thresholds derived from gold‐standard psychiatric interviews (PSE/SCAN/SCID). Method: A Rasch analysis was conducted on a heterogeneous sample of cancer patients (n=4919) who had completed a combination of eight psychological distress screening instruments. A subset of patients had completed a psychiatric interview along with the HADS (n=381) or PHQ‐9 (n=440). Item thresholds were plotted along the latent trait. Furthermore, items were assessed for differential item functioning (DIF) by age and gender. Finally, optimum thresholds were derived for the HADS and PHQ‐9 and plotted along the latent trait distribution for the entire item bank. Result: Item thresholds exceeded the range of person measures, although a gap was still present along the latent trait. No DIF was observed for either age or gender. Putative cut‐offs were derived for the item bank detecting moderate to severe levels of psychological distress. Conclusion: The item bank covers the majority of levels of emotional distress reported by cancer patients. Additionally, initial thresholds have been derived on the item bank, which correspond to a formal psychiatric assessment. Further work is required to ascertain the stability of the item bank over time and by diagnosis and stage of disease, as well as to determine additional thresholds for levels of distress. Copyright © 2008 John Wiley & Sons, Ltd.     

Distress screening in oncology—evaluation of the Questionnaire on Distress in Cancer Patients—short form (QSC‐R10) in a German sample

Objective: The aim was to examine the psychometric properties of the Questionnaire on Stress in Cancer Patients (QSC‐R10), a 10‐item screening instrument for self‐assessment of psychosocial distress in cancer patients. Methods: A total of 1850 cancer patients were assessed with the QSC‐R10. Patients were recruited from different inpatient and outpatient settings in Germany between 2007 and 2009. Results: Mean age of the sample was 62.9 (SD=12.4) with breast cancer as the most frequent diagnosis (35.2%). The analysis indicated high reliability (Cronbach's α=0.85) and test–retest reliability (ICC=0.89). Validation scales included the Hospital Anxiety and Depression Scale (HADS), Distress–Thermometer (DT), European Organization for Research and Treatment of Cancer QLQ‐C30 (EORTC QLQ‐C30) and Karnofsky Performance Status (KPS). Convergent validity was highest for the HADS total score (r=0.74) and the lowest correlation for KPS (r=?0.36). The QSC‐R10 significantly distinguished subgroups by their clinical characteristics (metastases, illness duration, previous psychiatric treatment and psycho‐oncological support; p<0.001). A cutoff score of >14 demonstrated good sensitivity (81.0%) and specificity (73.2%) and is suitable to determine the need for psychosocial support. Conclusion: The QSC‐R10 is a valid and reliable questionnaire to detect distress in cancer patients with high acceptance among professionals and patients. Copyright © 2010 John Wiley & Sons, Ltd.     

Rasch analysis of the Hospital Anxiety and Depression Scale among caregivers of cancer survivors: implications for its use in psycho‐oncology

Objective: The Hospital Anxiety and Depression Scale (HADS) is often used to screen for cancer caregivers' anxiety and depression, despite few studies examining the tool's psychometric performance within this population. The purpose of this article is to use Rasch analysis to assess the psychometric properties of the HADS in a sample of cancer caregivers. Methods: HADS was administered to 541 caregivers of a population‐based sample of patients diagnosed with one of the eight most incident cancers in Australia. Rasch analysis was conducted using RUMM2020. Results: More than two‐thirds of caregivers were women and most participants were married (95.9%) and caring for their spouse/partner with cancer (89.8%). The HADS‐Anxiety (HADS‐A) subscale showed good fit to the model, with appropriate internal consistency after removal of item 11. There were no disordered thresholds and no differential item functioning (DIF) for sex or age. To achieve satisfactory model fit for the HADS‐Depression (HADS‐D) subscale item 8 was removed due to DIF for sex and item 14 was rescored to resolve disordered thresholds. Analyses supported the unidimensionality of the individual subscales; however, there was no support for the combination of subscales to form a HADS‐Total. Conclusions: The results of Rasch analysis support the use of a modified version of the HADS‐A and HADS‐D among cancer caregivers. Further research is needed to confirm these findings and identify revised clinical cut‐points. Findings reinforce the need for clinicians and researchers to formally test the psychometric properties of the instruments that they intend to use with different samples. Copyright © 2010 John Wiley & Sons, Ltd.     

Screening for distress in cancer patients

BACKGROUND:

Routine screening for distress is internationally recommended as a necessary standard for good cancer care, given its high prevalence and negative consequences on quality of life. The objective of the current study was to contribute to the Italian validation of the Distress Thermometer (DT) to determine whether the single item DT compared favorably with referent criterion measures.

METHODS:

In total, 1108 outpatients with cancer were recruited from 38 representative oncology centers in Italy. Each participant completed the DT and a list of 34 possible cancer‐related problems (the Problem List), the Hospital Anxiety and Depression Scale (HADS), the 18‐item Brief Symptom Inventory (BSI‐18), and a short visual analog scale to determine the understandability of the tools.

RESULTS:

Receiver operating characteristic analysis revealed that DT cutoff scores ≥4 and ≥5 had optimal sensitivity and specificity relative to both HADS and BSI‐18 cutoff scores for general caseness and more severe psychological distress, respectively. Patients with DT scores ≥4 (cases) were more likely to be women; to have had psychological problems in the past; to report more stressful events in the last year; and to currently have more family, emotional, and physical problems related to cancer or cancer treatment. Patients indicated that the DT was easier to fill out and to understand than the HADS, but not the BSI‐18.

CONCLUSIONS:

The DT was identified as a simple and effective screening instrument for detecting distress in Italian cancer patients as a first step toward more properly referring those in need to psychosocial intervention. Cancer 2013. © 2013 American Cancer Society.     

Screening for mental disorders in laryngeal cancer patients: a comparison of 6 methods

Objectives: The aim of this study was to determine how accurate mental distress screening instruments are in identifying psychological sequelae in ambulatory laryngeal cancer patients who have undergone surgery. Methods: Two‐hundred and fifty subjects were tested for mental disorders according to the guidelines defined in the Diagnostic Statistical Manual of Psychological Illnesses, Version 4. Screening instruments tested were: the ‘Hospital Anxiety and Depression Scale’ (HADS), the subscale ‘Emotional Functioning’ of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ‐C30), the ‘Hornheider Fragebogen’ (HFB), and a single‐item visual analogues scale (VAS). Accuracy was assessed by calculating the sensitivity rates, specificity rates, and areas under the curve from the receiver operating characteristic curves. Results: The relative frequency of mental disorders was 19.8%. All of the screening instruments tested were found to be highly accurate. The best levels of sensitivity and specificity were associated with the total score of the HADS. Conclusions: These results confirm that a significant minority of laryngeal cancer patients suffer from severe mental distress, and that accurate screening for clinically significant mental disorders is possible using any of the instruments evaluated here. Copyright © 2007 John Wiley & Sons, Ltd.     

Fear of movement in cancer survivors: validation of the modified Tampa scale of kinesiophobia-fatigue

Objective: To date, there is no validated questionnaire to assess fear of movement in cancer survivors. We aim to validate the Modified Tampa Scale of Kinesiophobia‐Fatigue (TSK‐F) in Dutch cancer survivors participating in a rehabilitation programme. We first select the optimal model for cancer survivors. Subsequently, stability, internal consistency, and construct validity of the optimal model is tested. Methods: A sample of 658 cancer survivors participating in a rehabilitation programme was included. Out of nine models derived in chronic pain and chronic fatigue patients, the optimal model of the TSK‐F was selected in a calibration sample (n₁ = 329) using confirmatory factor analysis. Stability of the derived optimal model was confirmed in a validation sample (n₂ = 329). Internal consistency and construct validity were assessed in the full sample. Results: The 11‐item two‐factor model of the TSK‐F was the best‐fitting model for cancer survivors and it seemed to be invariant for sex and cancer diagnosis. Internal consistency of the model was acceptable (Cronbach's alpha between 0.62 and 0.74). Construct validity was illustrated by significant associations between TSK‐F total and TSK‐F somatic focus with perceived global health status (EORTC‐QOL‐C30) and fatigue (FACT‐F) (p<0.001). Conclusions: The adjusted 11‐item TSK‐F consisting of two subscales ‘somatic focus’ and ‘activity avoidance’ seems to be a robust and valid tool in measuring fear of movement in cancer survivors with an acceptable internal consistency. Further psychometric testing of the TSK‐F in cancer survivors is recommended. In the future, TSK‐F scores may be used to customise rehabilitation programmes in cancer survivors.Copyright © 2011 John Wiley & Sons, Ltd.     

Validation of the FACT‐Gastric cancer quality of life questionnaire for use in Spanish‐speaking countries

Objectives: The purpose of this study was to validate a universal Spanish translation of the Functional Assessment of Cancer Therapy‐Gastric Cancer (FACT‐Ga; Version 4) questionnaire for use in Spanish‐speaking countries. Methods: Translation of the FACT‐Ga from English to Spanish was accomplished by employing the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology, which utilizes a multinational team of translation experts. A single (universal) Spanish version of the questionnaire was developed for use with gastric cancer patients recruited from Argentina, Chile, Mexico, Peru, and Spain. Pretesting of the questionnaire was conducted using 75 cancer patients (15 from each country), who were also cognitively debriefed. Results: Statistical analysis yielded marginal results for the Peru and Spain samples, although when analyzing pooled data from all five countries, statistics were within expected ranges. Qualitative analysis indicated that there were negligible linguistic concerns that impacted a very small proportion of the items. Conclusion: The universal Spanish FACT‐Ga demonstrates content and linguistic validity, and is conceptually equivalent to its English source. It is a promising tool for use in evaluating the health‐related quality of life for Spanish‐speaking patients with gastrointestinal‐related cancers, given more research regarding universally derived reliability and validity statistics. Copyright © 2010 John Wiley & Sons, Ltd.     

Validation of the Edmonton Symptom Assessment Scale

BACKGROUND: The Edmonton Symptom Assessment Scale (ESAS) is a nine-item patient-rated symptom visual analogue scale developed for use in assessing the symptoms of patients receiving palliative care. The purpose of this study was to validate the ESAS in a different population of patients. METHODS: In this prospective study, 240 patients with a diagnosis of cancer completed the ESAS, the Memorial Symptom Assessment Scale (MSAS), and the Functional Assessment Cancer Therapy (FACT) survey, and also had their Karnofsky performance status (KPS) assessed. An additional 42 patients participated in a test-retest study. RESULTS: The ESAS "distress" score correlated most closely with physical symptom subscales in the FACT and the MSAS and with KPS. The ESAS individual item and summary scores showed good internal consistency and correlated appropriately with corresponding measures from the FACT and MSAS instruments. Individual items between the instruments correlated well. Pain ratings in the ESAS, MSAS, and FACT correlated best with the "worst-pain" item of the Brief Pain Inventory (BPI). Test-retest evaluation showed very good correlation at 2 days and a somewhat smaller but significant correlation at 1 week. A 30-mm visual analogue scale cutoff point did not uniformly distinguish severity of symptoms for different symptoms. CONCLUSIONS: For this population, the ESAS was a valid instrument; test-retest validity was better at 2 days than at 1 week. The ESAS "distress" score tends to reflect physical well-being. The use of a 30-mm cutoff point on visual analogue scales to identify severe symptoms may not always apply to symptoms other than pain.     

Distress screening, rater agreement, and services in pediatric oncology

Objective: Empirically based data support the validity of the distress thermometer recommended by the National Comprehensive Cancer Network as a standard screen for patient distress. However, the feasibility and utility of the distress thermometer has not been studied in the pediatric oncology setting. We conducted a study to: (1) investigate the validity of an adapted distress thermometer with pediatric oncology patients, (2) assess the degree of agreement among different respondents, including physician and psychosocial staff, with respect to (a) the pediatric cancer patient's distress and (b) the caregiver/parent's distress, and (3) to evaluate the relationship between distress levels and the psychosocial services provided to patients and families. Methods: Ninety‐one patients and their English and Spanish‐speaking caregivers were prospectively assessed at 3‐month intervals for 1 year. The quantity of psychosocial services provided to each family was logged for a 12‐month period. Results: Convergent validity was demonstrated by reasonable agreement between the pediatric distress rating tool and standardized measures. Additionally, the demographic and medical predictors of distress were consistent with previously reported findings using more extensive assessment. There was reasonable agreement among multiple raters of the child's distress; however, there was discrepancy between self‐ratings of caregiver distress and psychosocial staff ratings of caregiver distress. This difference in perception impacted the quantity of psychosocial services provided following the baseline assessment. Conclusion: The single‐item distress thermometer is a viable option as a rapid screening tool of patient and caregiver distress to help efficiently identify those who should be evaluated further. Copyright © 2010 John Wiley & Sons, Ltd.     

Structural and reliability analysis of a patient satisfaction with cancer-related care measure: a multisite patient navigation research program study

BACKGROUND:

Patient satisfaction is an important outcome measure of quality of cancer care and 1 of the 4 core study outcomes of the National Cancer Institute (NCI)‐sponsored Patient Navigation Research Program to reduce race/ethnicity‐based disparities in cancer care. There is no existing patient satisfaction measure that spans the spectrum of cancer‐related care. The objective of this study was to develop a Patient Satisfaction With Cancer Care measure that is relevant to patients receiving diagnostic/therapeutic cancer‐related care.

METHODS:

The authors developed a conceptual framework, an operational definition of Patient Satisfaction With Cancer Care, and an item pool based on literature review, expert feedback, group discussion, and consensus. The 35‐item Patient Satisfaction With Cancer Care measure was administered to 891 participants from the multisite NCI‐sponsored Patient Navigation Research Program. Principal components analysis (PCA) was conducted for latent structure analysis. Internal consistency was assessed using Cronbach coefficient alpha (α). Divergent analysis was performed using correlation analyses between the Patient Satisfaction With Cancer Care, the Communication and Attitudinal Self‐Efficacy–Cancer, and demographic variables.

RESULTS:

The PCA revealed a 1‐dimensional measure with items forming a coherent set explaining 62% of the variance in patient satisfaction. Reliability assessment revealed high internal consistency (α ranging from 0.95 to 0.96). The Patient Satisfaction With Cancer Care demonstrated good face validity, convergent validity, and divergent validity, as indicated by moderate correlations with subscales of the Communication and Attitudinal Self‐Efficacy–Cancer (all P < .01) and nonsignificant correlations with age, primary language, marital status, and scores on the Rapid Estimate of Adult Literacy in Medicine Long Form (all P > .05).

CONCLUSIONS:

The Patient Satisfaction With Cancer Care is a valid tool for assessing satisfaction with cancer‐related care for this sample. Cancer 2011. © 2010 American Cancer Society.     

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

BACKGROUND:

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

METHODS:

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

RESULTS:

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

CONCLUSIONS:

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

Assessment of factors that contribute to decreased quality of life in Gynecologic Oncology Group ovarian cancer trials

BACKGROUND:

The objective of this study was to assess which quality‐of‐life (QOL) line items on the Functional Assessment of Cancer Therapy‐Ovarian (FACT‐O) were associated with low QOL in women who were receiving chemotherapy for ovarian cancer.

METHODS:

Patients with stage III or IV ovarian cancer on Gynecologic Oncology Group Protocols 152 and 172 who underwent primary surgery followed by intravenous paclitaxel and cisplatin completed the FACT‐O. The FACT scale includes the 4 domains of physical, functional, social, and emotional well being (PWB, FWB, SWB, EWB, respectively). Women who had overall FACT‐O scores in the lowest quartile (Q1) were compared with women in the upper 3 quartiles (Q2‐Q4). The proportions of women in each group that selected the 2 worst categories for each item were compared. The level of significance was set at P < .005.

RESULTS:

Before Cycle 4, 361 patients (86.4%) provided valid QOL assessments. For PWB, a significantly greater proportion of women in Q1 versus Q2 through Q4 selected the 2 worst categories of several physical symptoms (nausea, pain, feeling ill, and being bothered by the side effects of treatment). For FWB, significant differences included being able to work, being content with the quality of their life, and sleeping well. For EWB, there were significant differences in feeling nervous and worrying about dying. There were virtually no differences between groups in SWB. Low interest in sex was reported by 56% to 88% of all patients (Q1‐Q4).

CONCLUSIONS:

A large proportion of women with FACT‐O scores in the lowest quartile reported problems that potentially were amenable to clinical interventions, such as symptom management and psychosocial support. Cancer 2009. © 2009 American Cancer Society.     

The Queensland Cancer Risk Study: general population norms for the Functional Assessment of Cancer Therapy-General (FACT-G)

Objective: To derive Australian normative scores for the Functional Assessment of Cancer Therapy‐General Population (FACT‐GP) and to confirm its factor structure. Methods: Quality of life (QoL) data (as measured by the FACT‐GP) were collected within the Queensland Cancer Risk Study (QCRS) in 2004. The QCRS explored cancer screening and cancer risk behaviours among 9419 English‐speaking residents of Queensland aged 20–75 years. Information was collected through computer‐assisted telephone interviews and augmented by mailed, Self‐Administered Questionnaires (SAQ). A total of 2727 participants largely comparable to the general population of Queensland self‐completed the FACT‐GP; however, participants were somewhat higher educated, more likely to have had cancer and less likely to be of indigenous heritage. Results: The Queensland population reported a FACT‐GP summary score of 85.9 (SD=15.1), with subscale scores (range: 19.2 for social well‐being to 25.1 for physical well‐being (PWB)). In this study, men and women within different age groups reported similar QoL. QoL was clinically and significantly lower among participants not married, with a body mass index (BMI) deviating from normal weight and with one or more self‐reported morbidities. A four‐factor solution was confirmed with good goodness‐of‐fit indices (RSMEA<0.05 for all three age groups). Conclusions: The reference values from the general population reported here can be used for comparison with the QoL measured in populations of cancer patients, providing a benchmark against which clinicians can evaluate the impact of the disease and/or the treatments on QoL. Copyright © 2008 John Wiley & Sons, Ltd.     

Burden,emotional distress and quality of life among informal caregivers of lung cancer patients: An exploratory study

This study was conducted to explore the interrelationships among caregiver burden, emotional status and quality of life (QoL) in caregivers of lung cancer patients, and to identify whether caregiver burden and health status are associated with patient emotional status and QoL. Forty‐three dyads of lung cancer patients and their caregivers were included for analysis. Caregiver‐reported outcomes were measured by Caregiver Burden Scale (CBS), Caregivers Quality of Life Index‐Cancer (CQOLC) and Hospital Anxiety and Depression Scale (HADS), while patient‐reported outcomes were collected by HADS and Lung Cancer Symptom Scale (LCSS). The majority of the CBS and CQOLC scores were significantly higher in anxious and depressed caregivers than non‐anxious and non‐depressed caregivers (p < .01 or .05). Caregivers of depressed patients experienced significantly greater emotional distress than those of non‐depressed patients (p < .01). Significantly positive associations were identified among most of the CBS, CQOLC and caregiver HADS scores. Patient LCSS scores were positively correlated with the CBS and caregiver HADS scores, and patient HADS scores were also positively related to caregiver HADS scores. The close interrelationships between caregiver and patient health outcomes provide evidence that lung cancer patients and their caregivers should be viewed as a unit in future supportive service models.     

Validation of the Chinese version of the short-form Supportive Care Needs Survey Questionnaire (SCNS-SF34-C)

Background: There is no instrument available in Chinese for assessing psychosocial needs. This study aimed to assess the validity and reliability of the Chinese version of the Supportive Care Needs Survey short form (SCNS‐SF34‐C) in Chinese women with breast cancer (BC). Methods: The Chinese version of the 34‐item SCNS‐SF34‐C, a self‐report measure for assessing psychosocial unmet needs, was administered to 348 Chinese women with BC at the outpatient oncology unit. Exploratory factor analysis (EFA) tested the factor structure. The internal consistency, convergent, divergent, and discriminant validity of the identified factor structure were assessed. Results: In contrast to the five‐factor structure identified in the original 34‐item SCNS‐SF34, our EFA produced a 33‐item solution accounting for 54% of score variance comprising four‐factors: (1) Health system, information, and patient support, (2) Psychological needs, (3) Physical and daily living, and (4) Sexuality needs. Separate dimensions for Health system and information, and the Patient care and support domains were not supported. Cronbach alphas ranged from 0.75 to 0.92. Correlations of psychological and physical symptom distress measures indicated acceptable convergent validity. No correlation with optimism and positive affect measures indicated divergent validity. Discriminant validity was demonstrated by effective differentiation between clinically distinct patient groups (no active treatment versus active treatment; advanced BC versus localized BC). Discussion: The Chinese version of the Supportive Care Needs Survey has suitable factor structure and psychometric properties for use in assessing psychosocial needs among Chinese women with BC. Further validation is needed for other cancer types. Copyright © 2010 John Wiley & Sons, Ltd.