Long-term telephone therapy outcomes for breast cancer patients

We present the results of a breast cancer clinical trial that tested two therapy interventions delivered by telephone. Women (N = 218) with Stages I, II, or III breast cancer were randomly assigned to breast cancer health education or emotional expression interventions, or to a standard care control condition. Outcome and process measures were obtained at baseline, 6-month and 13-month follow-ups. Oncology certified nurses conducted the therapies in six, 30-minute individual phone sessions. Women in the health education condition reported significantly better knowledge and less perceived stress compared to women in the emotional expression and control conditions. No treatment effects, however, were obtained for quality of life or mood, and all women generally improved on these measures over time. Secondary analyses showed that younger women and women with a more advanced stage of breast cancer reported significantly greater avoidant coping. The data show that telephone therapy is a viable delivery modality and that distress improves with time for most women. Overall, this study showed that neither of the two telephone interventions tested had a meaningful effect on quality of life or mood.     

A couples intervention for patients facing advanced cancer and their spouse caregivers: outcomes of a pilot study

Objective: The primary objective of this study was to evaluate the effectiveness of a couples intervention in improving marital functioning in advanced cancer patients and their spouse caregivers. A secondary objective was to determine its impact on other symptoms of psychosocial distress and its feasibility and acceptability as a clinical intervention. Methods: Using a one‐arm pre‐ and post‐intervention prospective design, 16 couples were provided 8 weekly sessions of Emotionally Focused Couple Therapy, modified and manualized for the cancer population. Subjects' marital functioning (Revised Dyadic Adjustment Scale [RDAS]), symptoms of depression (Beck Depression Inventory‐II [BDI‐II]), and hopelessness (Beck Hopelessness Scale) were assessed through self‐report at T0 (baseline), T1 (after four sessions), T2 (after eight sessions), and T3 (3 months post‐intervention follow‐up). Results: RDAS scores improved from T0 to T2, with 87.5% of the couples showing some improvement (0.5–5 points) or significant improvement (>5 points) in marital functioning and 68.8% scoring in the non‐distressed range (?48 RDAS). At T3, 60% of the couples (n=15) continued to score in the non‐distressed range on the RDAS. BDI‐II scores were significantly higher for patients than for caregivers. There was a significant reduction in the mean BDI‐II score from T0 to T3 in all subjects (n=30). This reduction was more significant for the patients (n=15). Conclusions: Providing support to couples at this challenging time may result in improved marital functioning and an opportunity for relational growth during end‐stage cancer. This study serves as the first step in the development of an empirically validated intervention for couples. Copyright © 2008 John Wiley & Sons, Ltd.     

Psychosocial interventions and quality of life in gynaecological cancer patients: a systematic review

Objective: Women with gynaecological cancer are at risk of poor quality of life outcomes. Although various psychosocial interventions have been developed to address these concerns, such interventions have not yet been systematically evaluated in this population. The current review provides an up‐to‐date and comprehensive summary of the evidence regarding the effectiveness of psychosocial interventions in women with gynaecological cancers. Methods: Relevant studies were identified via Medline, CINAHL, and PsycINFO databases (1980 to June 2008), reference lists of articles and reviews, grey literature databases, and consultations with physicians and other experts in the field. Only controlled trials comparing a psychosocial intervention with a control group in a gynaecological cancer population, with at least one quality of life variable as a main outcome, were included in the review. Two authors independently assessed trial quality and extracted data. Results: Twenty‐two studies involving 1926 participants were included. There was substantial variability in study quality and results. Evidence was mixed regarding intervention effects on social and sexual functioning, distress, depression, anxiety, attitude to medical care, self‐esteem and body image. Interventions generally did not improve physical or vocational outcomes. Conclusions: There was limited evidence in support of healing touch, whereas information‐based interventions seemed largely unable to provide meaningful benefits. Cognitive‐behavioural interventions had some positive effects. Counselling appeared to be the most promising intervention strategy for addressing quality of life concerns for women with gynaecological cancers. Copyright © 2008 John Wiley & Sons, Ltd.     

Results of a multi-componential psychosocial intervention programme for women with early-stage breast cancer in Spain: quality of life and mental adjustment

The effectiveness of a structured psychosocial intervention for women with breast cancer was studied in relation to a control group. The study was conducted in a hospital setting in Spain, and the aim of the intervention programme was to foster a higher quality of life and a more positive mental adjustment to the cancer. Three measures were used: baseline, post-treatment and 6-month follow-up for both groups. The dependent variables examined were quality of life and mental adjustment. The independent variable was the psychosocial intervention programme. Subjects were 188 women who had been operated for breast cancer and who satisfied a series of medical criteria, had no history of psychological problems and were between 25 and 65 years old. The results have shown that the psychosocial intervention programme was highly effective in improving the patients' quality of life, as compared with baseline measures, as well as compared with the control group. Additionally, the intervention increased the patients' fighting spirit and hopefulness/optimism, and reduced their anxious preoccupation as coping styles. These changes persevered at the 6-month follow-up.     

Concerns of former breast cancer patients about disease recurrence: a validation and prevalence study

Objective: The present study has three aims: first, to evaluate the psychometric properties of the Dutch version of the CARS (CARS‐DLV). Second, to measure the prevalence of concerns about disease recurrence in former breast cancer patients and identify potential predictors and third, to establish how fear of recurrence was effecting quality of life. Methods: A prospective study was carried out on breast cancer patients (n=136) who had undergone curative treatment. Eligible patients completed an extensive questionnaire consisting of the CARS (fear of recurrence), HADS (anxiety and depression), BPI (pain), RAND (quality of life), LOT (optimism) and the PCS (catastrophzing). Results: This study confirmed the good internal consistency, test–retest stability and construct validity of the CARS (Dutch Language version). Moderate to high levels of fear of disease recurrence were found in 56% of 136 breast cancer survivors. Worries about health and death were the most prominent. Pain was a strong predictor of overall fear and of fear on the four sub domains of the CARS. The prevalence of fear decreased significantly with age. Education level, living arrangements and time since the last treatment did not predict the prevalence of overall fear. Fear of recurrence was negatively correlated with quality of life. Conclusion: The CARS‐DLV proved to be a valuable instrument to measure women's' concerns about breast cancer recurrence. More than half of former breast cancer patients indicated moderate to severe concerns about disease recurrence. Health and death worries were the most prominent. The levels of worry were independent of the time since diagnosis. Copyright © 2008 John Wiley & Sons, Ltd.     

Quality of life in breast cancer patients: a cluster analytic approach

Quality of life (QOL) questionnaires are integrated into clinical trials in order to evaluate different treatments, and rarely used in a diagnostic sense. The aim of this study was to identify clinically meaningful subgroups by means of established QOL tools. Since January 1995, a field study funded by the German Ministry of Health was conducted to evaluate quality of care of breast cancer patients in eastern Thuringia. During the follow-up period, the European Organization of Research and Treatment of Cancer (EORTC), Quality of Life C30 and the breast specific module BR23 were mailed. One-hundred-fifty-eight women answered both questionnaires. A cluster analysis was performed to distinguish subgroups on the basis of QOL-BR23 scores. According to the QOL outcomes, four subgroups could be described. There was a strong relation to operative treatment (p<0.05), while no association with the adjuvant treatment strategy was observed. The subsets identified on the basis of BR23 scores were significantly related to all C30 domains. It was possible to demonstrate the clinical validity in terms of clinical and sociodemographic data. No association was found with the marital status or the highest level of education, while a worsening of the financial situation was associated. It could be shown that a distinction of patient subgroups based on clinically meaningful BR23 data is possible. Subgroups with specific profiles could be identified. In the future, the characterisation of subgroups could provide a possibility to generate indications for specific supportive interventions.     

Positive schemas,psychopathology, and quality of life in children with pediatric cancer: A pilot study

Purpose: Research in the area of pediatric oncology has shown that although some children and youth diagnosed with this disease cope adaptively after their diagnosis, others continue to have long-term psychosocial difficulties. The potential mechanisms that may protect against the experience of psychopathology and poor quality of life within this population are not well known. The purpose of this pilot study was to utilize a new comprehensive measure of positive schemas to better understand the relationship between positive schemas, quality of life, and psychopathology, for children on active treatment for cancer. Methods: Participants were 22 patients, aged 8–18 years, being treated in a pediatric oncology clinic. Patients and parents completed measures of positive schemas, quality of life, and psychopathology. Results: The mean age at time of initial diagnosis of the patient sample was 11.6 years. Child-reported positive schemas were significantly related to child-reported child quality of life (r = 0.46, p = 0.03). Conclusions: This is the first study to examine positive schemas within a pediatric oncology sample. Future research is needed to further explore facets of positive schemas that may be particularly relevant to child psychological functioning in a pediatric oncology population.     

Applying a conceptual model for examining health-related quality of life in long-term breast cancer survivors: CALGB study 79804

Objectives: The Survivor's Health and Reaction study used a quality‐of‐life model adapted for cancer survivors by Dow and colleagues to identify factors related to global health‐related quality of life (HRQL) and to document the prevalence of problems and health‐oriented behaviors in a follow‐up study of breast cancer patients who participated in CALGB 8541. Methods: A total of 245 survivors (78% of those invited) who were 9.4–16.5 years post‐diagnosis completed surveys that inquired about current HRQL, economic, spiritual, physical and psychosocial concerns, and health‐oriented behaviors (e.g. smoking, exercise, and supplement use). A regression model was developed to examine factors related to global HRQL across all domains. Results: The regression model revealed that decreased energy levels (odds ratio (OR)=1.05, 95% confidence interval (CI): 1.03, 1.07), having heart disease (OR=5.01, 95% CI: 1.39, 18.1), having two or more co‐morbidities (OR=2.39, 95% CI: 1.10, 5.19), and lower social support (OR=1.03, 95% CI: 1.02, 1.05) were associated with lower global HRQL. Factors related to psychological, spiritual, and economic domains were not predictive of global HRQL. Regarding lifestyle changes, some women reported engaging in health‐oriented behaviors since their cancer diagnosis, such as improving eating habits (54%), increasing exercise (32%), and reducing/quitting smoking (20%). The most prevalent problems reported by women at follow‐up were menopausal symptoms (64%), such as hot flashes and vaginal dryness, osteoporosis (25%), and lymphedema (23%). Conclusion: Suggestions are provided to target interventions, such as provider‐based strategies, in order to improve HRQL in long‐term breast cancer survivors. Copyright © 2008 John Wiley & Sons, Ltd.     

Patterns,correlates, and prognostic significance of quality of life following breast cancer

Objective: To describe quality of life (QOL) over a 12‐month period among women with breast cancer, consider the association between QOL and overall survival (OS), and explore characteristics associated with QOL declines. Methods: A population‐based sample of Australian women (n=287) with invasive, unilateral breast cancer (Stage I+) was observed prospectively for a median of 6.6 years. QOL was assessed at 6, 12, and 18 months post‐diagnosis, using the Functional Assessment of Cancer Therapy, Breast (FACT‐B+4) questionnaire. Raw scores for the FACT‐B+4 and subscales were computed and individuals were categorized according to whether QOL declined, remained stable or improved between 6 and 18 months. Kaplan–Meier and Cox proportional hazards survival methods were used to estimate OS and its associations with QOL. Logistic regression models identified factors associated with QOL decline. Results: Within FACT‐B+4 subscales, between 10% and 23% of women showed declines in QOL. Following adjustment for established prognostic factors, emotional well‐being and FACT‐B+4 scores at 6 months post‐diagnosis were associated with OS (p<0.05). Declines in physical (p<0.01) or functional (p=0.02) well‐being between 6 and 18 months post‐diagnosis were also associated significantly with OS. Receiving multiple forms of adjuvant treatment, a perception of not handling stress well and reporting one or more other major life events at 6 months post‐diagnosis were factors associated with declines in QOL in multivariable analyses. Conclusions: Interventions targeted at preventing QOL declines may ultimately improve quantity as well as quality of life following breast cancer. Copyright © 2010 John Wiley & Sons, Ltd.     

Application of a stress and coping model to positive and negative adjustment outcomes in colorectal cancer caregiving

This study examined relations between stress and coping predictors and negative (distress) and positive (positive affect, life satisfaction, positive states of mind, health) adjustment outcomes in colorectal cancer caregivers. A total of 622 caregivers and their care‐recipients completed questionnaires and interviews. Predictors included caregiving parameters, social support, appraisal (stress, control, challenge), and coping strategies (problem‐solving, avoidance, substance use, religion, humor, seeking social support). Regression analyses indicated that after controlling for the effects of relevant caregiving parameters (caregiver age, gender and paid employment status, care‐recipient quality of life, cancer stage), better caregiver adjustment was related to higher social support, lower stress and higher challenge appraisals, and less reliance on avoidance and substance use coping, as hypothesized. Stress appraisal emerged as the strongest and most consistent predictor of all adjustment outcomes. Findings support the utility of the stress and coping model of adjustment to caregiving in colorectal cancer. Copyright © 2009 John Wiley & Sons, Ltd.