Caregivers' anxiety and self‐efficacy in palliative care

MYSTAKIDOU K., PARPA E., PANAGIOTOU I., TSILIKA E., GALANOS A. & GOULIAMOS A. (2012) European Journal of Cancer Care 22 , 188–195 Caregivers' anxiety and self‐efficacy in palliative care This study examined the relationship between caregivers' anxiety supporting a patient with advanced cancer and self‐efficacy and their socio‐demographic characteristics, and then whether these variables could influence their self‐efficacy. One hundred and seven caregivers of advanced cancer patients participated in the study and completed the Greek versions of the State–Trait Anxiety Inventory (STAI) and the General Perceived Self‐efficacy Scale (GSE). Significant comparisons were found between State anxiety and female gender (P= 0.009), cohabitation (P= 0.002) and relationship with the patient (P= 0.004); statistically significant associations were found between State, Trait anxiety and self‐efficacy scores of caregivers (P < 0.0005 respectively). A multiple regression model (enter method) showed women (P= 0.005), spouses (P= 0.01) and self‐efficacy (P= 0.02) as the significant predictors of State anxiety. Furthermore, self‐efficacy seemed to be the strongest contributor of trait anxiety (P < 0.0005). Female caregivers and spouses of advanced cancer patients experience more state anxiety levels than men and other caregivers respectively. In addition, caregivers with low self‐efficacy are more likely to have elevated anxiety scores than self‐efficacious caregivers. These findings can help healthcare professionals focus on some problems common to caregivers of cancer patients and plan appropriate interventions.     

Randomized controlled trial of mindfulness‐based stress reduction (MBSR) for survivors of breast cancer

Objectives: Considerable morbidity persists among survivors of breast cancer (BC) including high levels of psychological stress, anxiety, depression, fear of recurrence, and physical symptoms including pain, fatigue, and sleep disturbances, and impaired quality of life. Effective interventions are needed during this difficult transitional period. Methods: We conducted a randomized controlled trial of 84 female BC survivors (Stages 0–III) recruited from the H. Lee Moffitt Cancer and Research Institute. All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and/or chemotherapy. Subjects were randomly assigned to a 6‐week Mindfulness‐Based Stress Reduction (MBSR) program designed to self‐regulate arousal to stressful circumstances or symptoms (n=41) or to usual care (n=43). Outcome measures compared at 6 weeks by random assignment included validated measures of psychological status (depression, anxiety, perceived stress, fear of recurrence, optimism, social support) and psychological and physical subscales of quality of life (SF‐36). Results: Compared with usual care, subjects assigned to MBSR(BC) had significantly lower (two‐sided p<0.05) adjusted mean levels of depression (6.3 vs 9.6), anxiety (28.3 vs 33.0), and fear of recurrence (9.3 vs 11.6) at 6 weeks, along with higher energy (53.5 vs 49.2), physical functioning (50.1 vs 47.0), and physical role functioning (49.1 vs 42.8). In stratified analyses, subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning. Conclusions: Among BC survivors within 18 months of treatment completion, a 6‐week MBSR(BC) program resulted in significant improvements in psychological status and quality of life compared with usual care. Copyright © 2009 John Wiley & Sons, Ltd     

The impact of nasal reconstruction following tumour resection on psychosocial functioning,a clinical‐empirical exploration

Objective: Total or partial nasal amputation following tumour resection is one of the more severe facial disfigurements. Successful nasal reconstruction can therefore be regarded as restoring a patient's psychosocial health. The objective of this study, therefore, was to evaluate different determinants of patient's psychosocial functioning and their effect on patient satisfaction after nasal reconstruction. Methods: A cross‐sectional study with a case–control study design was conducted. Level of satisfaction with nasal appearance and psychosocial functioning were assessed with validated questionnaires. Results: A total of 30 consecutive patients were recruited. They were treated between November 2001 and May 2005 for (sub)total nasal defects following radical tumour resection. For the control group 99 consented to participate. Social anxiety and avoidance were scored significantly higher within the patient group (p=0.01). Patients cope significantly more passive than controls (p=0.04). Self‐esteem levels did not differ significantly between patients and controls (p=0.22). Determinants of satisfaction with nasal reconstruction were self‐esteem (p=0.0001), active coping strategy (p=0.001), and passive coping strategy (p=0.0001). Conclusion: Nasal reconstruction has an impact on psychosocial functioning of nasal reconstruction patients. In addition, self‐esteem and coping strategy are important determinants of satisfaction with nasal reconstruction, and should be held in mind when treating a patient. Copyright © 2008 John Wiley & Sons, Ltd.     

Can telephone counseling post‐treatment improve psychosocial outcomes among early stage breast cancer survivors?

Objective: To determine whether a telephone counseling program can improve psychosocial outcomes among breast cancer patients post‐treatment. Methods: A randomized trial was conducted involving 21 hospitals and medical centers, with assessments (self‐administered questionnaires) at baseline, 12 and 18 months post‐enrollment. Eligibility criteria included early stage diagnosis, enrollment during last treatment visit, and the ability to receive the intervention in English. Endpoints included distress (Impact of Event Scale), depression (Center for Epidemiologic Studies Depression Scale), and two study‐specific measures: sexual dysfunction and personal growth. The control group (n=152) received a resource directory for breast cancer; the intervention group (n=152) also received a one‐year, 16 session telephone counseling program augmented with additional print materials. Results: Significant intervention effects were found for sexual dysfunction at 12 (p=0.03) and 18 months (p=0.04) and personal growth (12 months: p=0.005; 18 months: p=0.03). No differences by group were found in mean scores for distress and depression, with both groups showing significant improvement at 12 and 18 months (all p values for within‐group change from baseline were ?0.003). However, when dichotomized at cutpoints suggestive of the need for a clinical referral, the control group showed virtually no change at 18 months, whereas the intervention group showed about a 50% reduction in both distress (p=0.07) and depression (p=0.06). Conclusions: Telephone counseling may provide a viable method for extending psychosocial services to cancer survivors nationwide. Copyright © 2010 John Wiley & Sons, Ltd.     

Ototoxicity of cisplatin plus standard radiation therapy vs. accelerated radiation therapy in glioblastoma patients

Summary Purpose: To assess the effect of cisplatin (CDDP) plus concurrent radiation therapy on hearing loss. Methods: 451 patients with glioblastoma multiforme (GBM) were randomly assigned after surgery to: Arm A: Carmustine (BCNU) + standard radiation therapy (SRT); Arm B: BCNU + accelerated radiation therapy (ART: 160 cGy twice daily for 15 days); Arm C: CDDP + BCNU + SRT; or Arm D: CDDP + BCNU + ART. Patients on arms C and D received audiograms at baseline, and prior to the start of RT, and prior to cycles 3 and 6. Otologic toxicities were recorded at each visit. Results: 56% of patients had hearing loss at baseline. 13% and 50% of patients experienced worsening ototoxicity after 1 year of treatment in arms A and B vs. C and D, respectively, with 13% of those on arms C and D experiencing significant ototoxicity (≥ grade 3) at 6 months. Increasing age was associated with an increased risk of ototoxicity. Conclusions: Increased exposure to CDDP increases the risk of ototoxicity over time. Older patients are more susceptible to hearing loss with CDDP. The low proportion of patients with clinically significant ototoxicity suggests that baseline screening is unnecessary in GBM patients.     

Social adjustment among Chinese women following breast cancer surgery

Background: How breast cancer surgery affects social adjustment among Chinese women is unknown, as are factors predicting such adjustment. Methods: 405 Chinese women receiving surgery for localized breast cancer completed Social Adjustment Scales (Ch‐SAS) at 1‐, 4‐ and 8‐months post‐operatively. Subscale scores were regressed on baseline (days 3–12 post‐operatively) measures of treatment decision‐making difficulty (TDMD), self‐efficacy (GSeS), consultation satisfaction (C‐MISS‐R), psychological (CHQ‐12) and physical distress (PD), and 1‐month follow‐up optimism (C‐LOT‐R), and disappointment (E‐OI), fully adjusted for demographic and clinical factors. Results: All Ch‐SAS subscales except appearance & sexuality changed significantly over 8‐months follow‐up: Enjoyment of social activities (F=27.38, df 2, p<0.001) and self‐image (F=3.63, df 2, p=0.027) improved slightly. Family interaction (F=26.63, df 2, p<0.001) and interaction with friends (F=3.37, df 2, p=0.035) declined slightly. Family and friends interaction subscales were predominantly predicted by high self‐efficacy and optimism, whereas self‐image and appearance & sexuality subscales were predominantly predicted by low treatment outcome disappointment, TDM difficulties, baseline psychological morbidity and high self‐efficacy. Enjoyment of social activities was predicted by low baseline psychological distress and concurrent physical symptom distress. Conclusion: High self‐efficacy and optimism predicted women who have better social relationships with friends and family. Higher self‐efficacy, low TDM difficulties, less disappointment with treatment outcome and low psychological and physical distress predicted better adjustment to self‐image and body image. Copyright © 2009 John Wiley & Sons, Ltd.     

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

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

Inflammation‐ and angiogenesis‐related biomarkers are correlated with cancer‐related fatigue in colorectal cancer patients: Results from the ColoCare Study

Cancer‐related fatigue is one of the most common side effects of colorectal cancer treatment and is affected by biomedical factors. We investigated the association of inflammation‐ and angiogenesis‐related biomarkers with cancer‐related fatigue. Pre‐surgery (baseline) serum samples were obtained from n = 236 newly diagnosed colorectal cancer patients. Meso Scale Discovery assays were performed to measure levels of biomarkers for inflammation and angiogenesis (CRP, SAA, IL‐6, IL‐8, MCP‐1, sICAM‐1, sVCAM‐1, TNFα, VEGFA and VEGFD). Cancer‐related fatigue was assessed with the EORTC QLQ‐30 questionnaire at baseline and 6 and 12 months post‐surgery. We tested associations using Spearman's partial correlations and logistic regression analyses, adjusting for age, sex and body mass index. sICAM‐1 and VEGFD showed a significant positive correlation with cancer‐related fatigue at baseline and 6‐, and 12‐month follow‐up (sICAM‐1: r = 0.19, p = 0.010; r = 0.24, p = 0.004; r = 0.25, p = 0.006; VEGFD: r = 0.20, p = 0.006; r = 0.15, p = 0.06; r = 0.23, p = 0.01 respectively). Biomarkers of inflammation and angiogenesis measured prior to surgery are associated with cancer‐related fatigue in colorectal cancer patients throughout various time points. Our results suggest the involvement of overexpressed sICAM‐1 and VEGFD in the development of fatigue.     

Evaluation of the Fertility and Cancer Project (FCP) among young breast cancer survivors

Objective: Fertility and childbearing issues are the major quality of life concerns among young breast cancer survivors. Practical approaches are needed to convey reproductive health information. The Fertility and Cancer Project (FCP) is a dedicated research project that provides online reproductive health and fertility education. We report FCP participants' (a) changes in mood and functioning and (b) changes in knowledge of fertility and cancer from baseline to 6‐month follow‐up. Methods: Participants completed five self‐report baseline measures, accessed FCP content and participated in online discussions. At 6 months post FCP study entry, participants were asked to complete follow‐up self‐reports. Results: One hundred and six breast cancer survivors from 8 countries participated in the FCP. Mean age at diagnosis was 34.3 years; mean time since diagnosis was 22 months. Significant change was detected in improved physical functioning (p=0.019) and social functioning (p=0.02). Significant changes were also noted in improved fertility knowledge (p=0.011). Conclusion: Preliminary evidence shows that young breast cancer survivors derive improved mood and knowledge benefit from FCP participation. Internet‐based approach may be a viable format for engaging this population of cancer survivors. Copyright © 2009 John Wiley & Sons, Ltd.     

The role of appearance investment in the adjustment of women with breast cancer

Objective: Appearance investment can be considered an important factor in the explanation of individual differences in adjustment to breast cancer. This study aims to analyze the role of this variable on a set of adjustment outcomes, namely, quality of life (QOL), emotional adjustment (depression and anxiety) and fear of negative evaluations. The differential role of motivational salience facet of appearance investment (MS; the individual's efforts to be or feel attractive), conceptualized as a protective factor, and of self‐evaluative salience facet (SES; the importance an individual places on physical appearance for their definition of self‐worth), conceptualized as a vulnerability factor, is explored. Methods: This cross‐sectional study included 117 Portuguese breast cancer patients (mean age=52.47; SD=8.81), on average 2.32 months (SD=2.17) post‐diagnosis. Appearance investment was measured by the ASI‐R; QOL by the WHOQOL‐bref; emotional adjustment by the HADS; and fear of negative evaluations by the FNE (Portuguese versions). Several hierarchical multiple regressions were conducted for each outcome, using investment facets as a predictor variable. Results: Both facets of investment contributed to the explanation of social (p?0.001) and psychological (p?0.001) QOL and also depression (p?0.001), with SES being associated with poorer results and MS with better outcomes. SES also predicted higher levels of fear of negative evaluations (p?0.001). Conclusions: This study provided significant information about the role of appearance investment in the adjustment of breast cancer patients and added empirical support to SES‐MS distinction. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychological well-being outcomes in disease-free survivors of mid-low rectal cancer following curative surgery

Objective: The aim of this cross‐sectional study was to evaluate psychological well‐being outcomes in disease‐free survivors who previously underwent radical surgery for rectal adenocarcinoma. Methods: All patients with rectal adenocarcinoma who underwent primary surgery at a single institution from 1990 to 2002 were considered for inclusion in the study. We identified and sent questionnaires to 145 patients after excluding those who had died or had recurrent disease. One hundred and seventeen patients (men/women: 74/43; median age: 65 years) returned the questionnaires. Patients' well being was evaluated using the Psychological General Well‐Being Index (PGWBI) questionnaire. The mean PGWBI score was compared with normative data of the general population. The impact of patient‐, tumor‐ and treatment‐related factors on patients' long‐term psychological well‐being status was also evaluated. Results: Compared with the general population, study patients had significantly better anxiety, depressed mood, positive well being, general health, vitality scales and global index scores. On multivariate analysis, positive well being was independently affected by time from diagnosis (36 months; p=0.025) and occurrence of early major complications (p=0.024). Variables that were independently associated with worse self‐control included primary education (p=0.04) and the presence of fecal urgency (p=0.049). General health was negatively affected by time from diagnosis (36 months; p=0.047) and fecal urgency (p=0.009). Conclusions: Patients who have survived cancer are likely to re‐evaluate the importance of everyday events and this may explain why they had better PGWBI scores. This study also identified that a short time from diagnosis, early adverse events and bowel dysfunction had a negative impact on patients' well being. Copyright © 2010 John Wiley & Sons, Ltd.     

Effectiveness of telephone‐based interventions on health‐related quality of life and prognostic outcomes in breast cancer patients and survivors—A meta‐analysis

The aim of this meta‐analysis was to evaluate the effect of telephone‐based interventions on prognostic outcomes and health‐related quality of life (HRQoL) in breast cancer patients and survivors. A systematic search of the Cochrane Library, Web of science, Medline, EMBASE, CNKI and CBM database was carried out. Randomised, controlled trials (RCTs) examining the effects of telephone‐based intervention versus a control group receiving no telephone intervention, on prognostic outcomes and HRQoL with breast cancer were included. A meta‐analysis was conducted to quantify the effects of telephone‐based interventions on anxiety, depression, fatigue, self‐efficiency, physiological function, social‐domestic function and quality of life. In total, 14 studies involving 2002 participants were included. Due to the effect of telephone‐based interventions, statistically significant results were found on anxiety (standard mean difference [SMD] = ?0.16, 95% confidence intervals [CI] [0.01, 0.30], p = .04), self‐efficiency (SMD = 0.22, 95% CI [?0.34, ?0.10], p = .0004), social‐domestic function (SMD = 0.19, 95% CI [?0.35, ?0.03], p = .02) and quality of life (SMD = 0.54, 95% CI [?1.00, ?0.08], p = .02). Although the effects on depression, fatigue and physiological function were in the expected direction, these effects were not statistically significant (p > .05) based on the insufficient evidence.     

Participation in patient support groups among cancer survivors: do psychosocial and medical factors have an impact?

A better understanding of the role of psychosocial resources and factors associated with participating in patient support groups appears to be important for the development and implementation of cancer survivorship care plans. We therefore investigated the frequency of participation in and satisfaction with patient support groups after completion of a rehabilitation programme and aimed to examine differences in demographic, medical and psychosocial characteristics between group participants and non‐participants. We further aimed to identify predictors of participation in patient support groups. A total of 1281 eligible patients (75.5% participation rate) were recruited on average 11 months post diagnosis and assessed at the beginning (t₁), at the end (t₂) and 12 months after rehabilitation (t₃). Study participants completed self‐report measures assessing support‐group participation and satisfaction, psychosocial distress (anxiety, fear of cancer recurrence, depression), social support, coping, quality of life, pain and treatment‐related characteristics. Sixty‐seven patients (7.6%) participated in a patient self‐help group. Being unemployed, undergoing an increased number of overall treatments, and a higher active emotion‐oriented coping style significantly predicted self‐help group participation; the predictive power of the multivariate logistic regression model was rather weak (Nagelkerke's R² = 0.07). Our data provide evidence that self‐help group participation in cancer patients may be largely related to other factors than medical or psychosocial distress.     

Effect of self-selected music on adults' anxiety and subjective experiences during initial radiotherapy treatment: A randomised controlled trial and qualitative research

Introduction: Patients may experience radiotherapy as anxiety provoking, especially during unfamiliar initial treatment. This study examines whether patients' use of self‐selected music while undergoing first radiotherapy treatment reduces anxiety, and how patients describe their first radiotherapy experience with or without self‐selected music. Methods: Using quantitative and qualitative methods, 100 participants preparing to commence radiotherapy were assigned to the initial radiotherapy session either with self‐selected music or without music. In both participant groups, the Spielberger State Anxiety Inventory measured pre‐ and post‐radiotherapy levels, music preference questions examined future music desires during treatment and a semistructured questionnaire examined additional subjective experiences. Results: Overall, participants were not highly anxious pre‐radiotherapy, anxiety decreased in both music and control groups following radiotherapy (P = 0.008) and this change was not different between groups (P = 0.35). However, music group participants were significantly more likely to want music in future radiotherapy sessions (P = 0.007). Some reported a benefit from the music in terms of feeling supported, distracted or that treatment time seemed faster. Participants in both groups often commended helpful staff. Negative reactions were only occasional. Conclusions: Although preferred music does not reduce anxiety, it can support some patients undergoing initial radiotherapy and departmental staff should invite patients to bring music to radiotherapy, provide music libraries and offer to play patient selected music during treatments.     

Fear of cancer progression and cancer‐related intrusive cognitions in breast cancer survivors

Objective: To assess the character and frequency of fear of progression (FoP) and to clarify its relationship with cancer‐related intrusive cognitions in breast cancer survivors. Methods: A sample of 1083 patients was recruited in this cross‐sectional study through a population‐based Cancer Registry an average of 47 month following diagnosis (66% response rate). Participants completed self‐report measures assessing fear of cancer progression (FoP‐Q‐SF), posttraumatic stress‐disorder symptoms (PCL‐C), coping strategies (DWI) and quality of life (QoL) (SF‐8). Results: In total, 23.6% of women were classified as having moderate to high FoP. Being nervous prior to doctors' appointments or examinations and being afraid of relying on strangers for activities of daily living were the most frequent fears. FoP was significantly associated with younger age, having children, disease progress, chemotherapy, perceived amount of impairments, physical and mental QoL, but not with time since initial diagnosis. Intrusive cognitions were screened in 37% of the sample. We found significant correlations between FoP and intrusive thoughts (r=0.63), avoidance (r=0.57), hyperarousal (r=0.54) and posttraumatic stress disorder diagnosis (r=0.42). Factors significantly associated with moderate and high FoP included a depressive coping style as well as an active problem‐oriented coping style, intrusion, avoidance and hyperarousal symptoms (Nagelkerke's R²=0.44). Conclusions: Findings of this study give information regarding the frequency and the character of anxiety in breast cancer survivors and underline the relation of FoP to the reality of living with breast cancer. Results suggest that intrusive cognitions as well as avoidance and hyperarousal symptoms seem to be closely related to future‐oriented fears of cancer recurrence. Copyright © 2009 John Wiley & Sons, Ltd.     

Absence of adverse early quality of life outcomes of radiation therapy in breast conservation therapy for early breast cancer

The New South Wales Breast Radiation Oncology Group has completed a prospective multicentre study of the impact of radiation therapy (RT) on acute toxicity and quality of life (QoL) in women with early breast cancer treated with breast conservation therapy. The patient group received adjuvant breast tangential RT after wide local excision of breast cancer. Acute toxicity and cosmesis was assessed quantitatively and qualitatively. European Organization of Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30) and Perceived Adjustment to Chronic Illness Scale (PACIS) were the QoL instruments used. Of 175 women, 34.3% described lethargy leading to a significant disruption to normal activity during RT. At week 6, this had reduced to 7.5% reporting significant lethargy. No negative effects on QoL were noted over the time period of RT; EORTC demonstrated no difference (P = 0.79). PACIS recorded a significant improvement in functioning (P < 0.001) from baseline to week 6. Univariate analysis on potential predictive patient, tumour and treatment factors demonstrated an association of baseline pre-RT breast discomfort with worse lethargy (P = 0.03), EORTC (P < 0.01) and PACIS (P < 0.01) measures. This study confirms the minimal impact of RT on patient functioning at 6 weeks post-treatment.     

Patient and oncologist estimates of survival in advanced cancer patients

Objective: There is little information about the accuracy of patient perceptions of their life expectancy. Here, we compare patient perceptions of their outlook and their oncologist's estimates of life expectancy to actual survival. Methods: The Unmet Needs Study recruited patients with metastatic cancer. Oncologists were asked to estimate patient survival as: (1) weeks; (2) months; (3) <1 year; (4)<2 years; and (5) >2 years. Patients were asked to estimate their outlook on a numerical scale from 1–7. Patient and oncologist estimates were compared with actual survival. Results: Complete survival data were available for 50 patients: median age 63.5 years; 48% male; tumor types: 32% colorectal, 24% lung, 10% upper gastrointestinal cancer, 12% unknown primary; and median survival 6.8 months. The oncologists were 32% accurate in predicting survival and overestimated survival 42% of the time (weighted kappa=0.34). The correlation between self‐reported patient outlook and survival was modest (Spearman's rho=0.36, p=0.01). The median survival for categories of outlook of 1–3, 4–5, and 6–7 were 4.4, 5.4, and 14.8 months, respectively (p=0.01). Overseas‐born patient was the only independent predictor for the oncologists' accurate estimates (p=0.01). Conclusions: Oncologists were relatively poor at predicting survival and tended to be optimistic in their prognostication. The probability of survival significantly decreased with worse self‐reported patient outlook. Copyright © 2010 John Wiley & Sons, Ltd.     

Factors influencing opioid-taking self-efficacy and analgesic adherence in Taiwanese outpatients with cancer

Aim: Although research has suggested that medication adherence rates are lower than what is needed to achieve optimal pain control, the role of patient beliefs and attitudes in influencing opioid adherence has rarely been examined. Perceived self‐efficacy is reported to be an important construct in predicting and enhancing adherence behaviour. The purpose of this study was to explore the relationship between opioid‐taking self‐efficacy, opioid beliefs, adherence behaviours, and pain experience amongst Taiwanese cancer outpatients. Method: The cross‐sectional study included 92 oncology outpatients in two teaching hospitals in the Taipei area of Taiwan. The research instruments included the Opioid‐Taking Self‐Efficacy Scale‐Cancer (OTSES‐CA), the Pain Opioid Analgesic Beliefs Scale‐Cancer (POABS‐CA), opioid adherence, and the Brief Pain Inventory‐Chinese (BPI‐Chinese). Results: Opioid‐taking self‐efficacy demonstrated a significant positive relationship with patients' opioid adherence (r=0.22, p<0.05) and pain relief (r=0.35, p<0.01), while also demonstrating a significant positive correlation with worst pain (r=0.25, p<0.05). In addition, the more negative beliefs regarding opioids the patient had, the worse their adherence to around the clock analgesic regimen (r=?0.30, p<0.01). Multivariate analysis identified opioid‐taking self‐efficacy continued to have a significant independent influence on opioid adherence and pain relief, after controlling for key demographic variables. Self‐efficacy accounted for 4% (R=0.04, p=0.043) of the variance and opioid beliefs accounted for 8% (R=0.08, p=0.007) of the variance in opioid adherence. Multivariate analysis also identified that opioid‐taking self‐efficacy accounted for 11% (R=0.11, p=0.001) of the variance in pain relief, but opioid beliefs did not continue to have an independent effect for this outcome. Conclusions: The study highlights the potential importance of a patient's self‐efficacy beliefs in adherence to medication and key pain outcomes. Copyright © 2008 John Wiley & Sons, Ltd.     

Clinical outcomes with use of radiation therapy and risk of transformation in early-stage follicular lymphoma

Between 1998 and 2009, a total of 295 patients (median age 58, 53% females) with newly diagnosed early-stage follicular lymphoma (FL) were managed at Memorial Sloan Kettering Cancer Center. Approximately half of patients (137, 46%) underwent initial observation and half (158, 54%) immediate treatment: radiation alone (n = 108), systemic treatment alone (n = 29), or combined modality treatment (n = 21). Median follow-up was 8.4 years (range 0.3–17.2), and 10-year overall survival (OS) was 87.2%. OS was similar between initially-observed and immediately-treated patients (hazard ratio [HR]: 1.25, 95% CI: 0.67–2.36, p = 0.49). For patients receiving radiation alone, 5-year OS was 98.0%. Patients selected for systemic therapy alone had high-risk baseline features and had shorter OS than patients treated with radiation alone (HR 3.38, 95% CI 1.29–8.86, p = 0.01). Combined modality treatment did not yield superior survival compared with radiation alone (P > 0.05) but was associated with better progression-free survival (HR 0.36, 95% CI 0.14–0.90, p = 0.03). The rate of transformation increased steadily over time and was 4.2% at 5 years and 10.8% at 10 years. This modern-era analysis rationalized the role of initial observation in patients with early-stage FL although patients receiving radiation therapy also demonstrate excellent outcome.Subject terms: B-cell lymphoma, Risk factors     

The circadian rest‐activity rhythm,a potential safety pharmacology endpoint of cancer chemotherapy

The robustness of the circadian timing system (CTS) was correlated to quality of life and predicted for improved survival in cancer patients. However, chemotherapy disrupted the CTS according to dose and circadian timing in mice. A continuous and repeated measures longitudinal design was implemented here to characterize CTS dynamics in patients receiving a fixed circadian‐based chemotherapy protocol. The rest‐activity rhythm of 49 patients with advanced cancer was monitored using a wrist actigraph for 13 days split into four consecutive spans of 3–4 days each, i.e., before, during, right after and late after a fixed chronotherapy course. The relative amount of activity in bed vs. out of bed (I<O, main endpoint), the autocorrelation coefficient r24, the relative 24‐hr amplitude (Amp), interdaily stability (IS) and intradaily variability (IV) were compared according to study span. Circadian disruption (I<O ≤ 97.5%) resulted from the administration of the fixed chronotherapy protocols, with all five rest‐activity rhythm parameters being worsened in the whole group of patients (p < 0.05). Mean parameter values subsequently recovered to near baseline values. The occurrence of circadian disruption on chemotherapy was associated with a higher risk of clinically relevant fatigue (p = 0.028) or body weight loss (p = 0.05). Four CTS dynamic patterns characterized treatment response including no change (9.5% of the patients); improvement (14.3%); alteration and complete recovery (31%) or sustained deterioration (45%), possibly due to inadequate chronotherapy dosing and/or timing. Improved clinical tolerability could result from the minimization of circadian disruption through the personalization of chronotherapy delivery.