Cancer patients' desire for psychological support: prevalence and implications for screening patients' psychological needs

Objectives: To investigate cancer patients' desire for psychological support and to identify patients' sociodemographic, disease‐related and psychological factors associated with this desire. Methods: The study is part of a multicenter, cross‐sectional study assessing cancer patients' needs and desire for psychological support. Patients completed the Hospital Anxiety and Depression Scale, the Ways of Coping Checklist, the Cancer Rehabilitation Evaluation System and reported their desire for psychological support. Results: Among the 381 included patients, women (26%) desired psychological support significantly more often than men (11%) (p<0.001). Patients' desire for psychological support was associated with being younger (OR=0.94; p<0.001 for women and OR=0.93; p=0.007 for men) and having a support‐seeking coping (OR=1.10; p=0.010 for women and OR=1.36; p=0.003 for men). Other contextual factors such as difficulties encountered and treatment modalities were diversely associated with women and men's desire for psychological support. Neither women's, nor men's psychological distress was associated with their desire for psychological support. Conclusions: One female cancer patient out of four and one male cancer patient out of ten desire psychological support. Results emphasize the need to screen not only for cancer patients' distress but also for their desire for psychological support. This will allow implementing psychological interventions according to patients' needs and desire. Copyright © 2009 John Wiley & Sons, Ltd.     

Efficacy of a global supportive skin care programme with hydrotherapy after non‐metastatic breast cancer treatment: A randomised,controlled study

This study investigated the efficacy of post‐treatment hydrotherapy as supportive care for management of persistent/long‐lasting dermatologic adverse events (dAEs) induced in breast cancer survivors by adjuvant therapy, and its impact on quality of life (QoL). Patients in complete remission after standardised (neo)adjuvant chemotherapy, surgery and radiotherapy combination treatment for infiltrating HR+/HER2‐breast carcinoma were enrolled in this randomised, multicentre controlled study 1–5 weeks after completing radiotherapy. The control group (CG, n = 33) received best supportive care and the treatment group (HG, n = 35) received 3‐weeks of specific hydrotherapy. The primary criterion was change in QoL (QLQ‐BR23) after hydrotherapy. Clinical grading of dAEs, cancer‐related QoL (QLQ‐C30), dermatologic QoL (DLQI) and general psychological well‐being (PGWBI) were assessed. Significant dAEs were found at inclusion in both groups (n = 261). Most items showed significantly greater improvement in the HG versus CG group: QLQ‐BR23 (breast [p = .0001] and arm symptoms [p = .0015], systemic therapy side effects [p = .0044], body image [p = .0139]), some dAE grading, DLQI (p = .0002) and PGWBI (p = .0028). Xerosis (88% of patients at inclusion) completely healed in all HG patients. Specific hydrotherapy is an effective supportive care for highly prevalent and long‐lasting dAEs occurring after early breast cancer treatment, including chemotherapy, and leads to improved QoL and dermatologic toxicities.     

Sexual dysfunction and spousal communication in couples coping with prostate cancer

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

A prospective study of posttraumatic growth as assessed by self-report and family caregiver in the context of advanced cancer

Objective: The study of posttraumatic growth (PTG) has burgeoned over the last decade, particularly in the area of oncology. The aims of the study were to: (1) describe PTG in patients with hepatobiliary carcinoma, (2) examine agreement between the patient and caregiver measures of patient PTG, and (3) test the associations between PTG and other psychological factors and clinically relevant outcomes. Methods: Two hundred and two patients with hepatobiliary carcinoma completed a battery of standardized questionnaires that measured PTG, depressive symptoms, optimism, expressed emotion, and quality of life (QOL). A subsample of family caregivers also completed ratings of patient PTG, using the Posttraumatic Growth Inventory (PTGI), as well as their own PTG. Results: No significant increase in the patients' PTG was observed between diagnosis and 6‐month follow‐up with the exception of the Relating to Others subscale of the PTGI. PTG was not found to be associated with QOL or depressive symptoms. At diagnosis, the agreement between the patients' PTG and family caregivers' rating of patient PTG was found to be high (ICC=0.34–0.74, p=0.001–0.05). PTG was found to be significantly associated with optimism (r=0.20 p=0.02–0.05) and traumatic life events reported in the past 3 years, including recent losses (F(1, 52)=6.0, p=0.02) and severe physical injury (F(1, 52)=5.5, p=0.02). Caregivers reported PTG as a result of their loved one's diagnosis of cancer. Conclusion: Preliminary results suggest that PTG is relatively stable over the first 6 months after diagnosis and changes as a result of a diagnosis of cancer were reported, and possibly observed, by others. Family caregivers also experience PTG as a result of their loved one's diagnosis of advanced cancer. Copyright © 2010 John Wiley & Sons, Ltd.     

Facing haematopoietic stem‐cell transplantation: do patients and their physicians agree regarding the prognosis?

Objective: To evaluate the correlation and concordance between patients' and physicians' estimations of prognoses before initiation of the conditioning regimen for allogeneic haematopoietic stem‐cell transplantation. Methods: A total of 123 patients and their attending physicians were asked to estimate a prognosis on a six‐point scale. The patients were also asked to fill out questionnaires addressing their psychological state and coping. Results: The mean prognostic estimations differed by 1.17 points (p<0.001), with the patients being more optimistic than the physicians. With respect to concordance: Pearson correlation r=0.024 (ns); unweighted kappa and kappa with linear weighting are 0.115 and 0.068, respectively. The prognostic estimates of the patients correlated with their psychological state, but not with the objective disease‐ or treatment‐related variables, whereas the physicians' estimates were partially based on such objective factors. Conclusions: A clear significant association between actual survival and the physicians' estimates, but not the patients' estimates, was observed. If agreement regarding the prognosis exists, the relationship between physicians' and patients' estimates is probably non‐linear. Assessing one's chances of being cured is a highly emotional task, and psychological processes such as denial or repression most likely play a decisive role. Moreover, collusion between the patient and physician may be inevitable in this situation. Whether it is desirable to gain concordance and who will benefit from such efforts must be discussed and empirically studied. Copyright © 2009 John Wiley & Sons, Ltd.     

Information satisfaction in breast and prostate cancer patients: implications for quality of life

Objectives: This study aimed to assess information needs and levels of information satisfaction in breast and prostate cancer patients. It further examined relationships between information satisfaction and multi‐dimensional quality of life (QoL). Methods: An adapted Information Satisfaction Questionnaire (ISQ, 2004) and the Functional Assessment of Cancer Therapy QoL questionnaire (FACT‐G, 1993) were randomly distributed to cancer patients during oncology clinic visits (breast cancer, n=102; prostate cancer, n=112). Hierarchal regression analyses examined information satisfaction as a predictor of global QoL and its four dimensions (i.e. physical, social, emotional, and functional well‐being). Results: High levels of information needs and desire for decision involvement were identified, with patients expressing a considerable degree of information satisfaction. After controlling for demographic and illness factors, information satisfaction explained 21% of the variance in global QoL, 12% in physical well‐being, 13% in social well‐being, 8% in emotional well‐being, and 10% in functional well‐being (all p<0.001). Conclusions: This study highlights the importance of information satisfaction for perceived QoL in individuals with cancer. It is clearly important to identify specific information requirements during the diagnosis and treatment process in order to provide information that is congruent with patients' needs. Copyright © 2007 John Wiley & Sons, Ltd.     

No improvement in distress and quality of life following psychosocial cancer rehabilitation. A randomised trial

Objective: Rehabilitation programmes are intended to help cancer patients achieve optimal functioning and live independently. We evaluated whether a psychosocial rehabilitation course was effective in relieving cancer patients' distress and improving their well‐being. Methods: Patients with breast, prostate or colorectal cancer diagnosed within 2 years who had finished primary treatment were randomised to usual care or a 6‐day residential course of lectures, discussions and peer groups on issues related to treatment and living with cancer. Changes in self‐reported distress (POMS‐Sf) and quality of life (EORTC QLQ‐C30) from baseline to 1 and 6 months' follow‐up were measured. Analyses were adjusted for baseline scores of outcome, cancer site, time since diagnosis, gender, age and education. Results: Of 507 patients, 452 were included in the analyses, 404 completed the 1‐month and 394 the 6‐month assessment. Patients in the control group showed greater decreases in total mood disturbance and subscales of the POMS‐Sf and showed more improvement in emotional, cognitive and social functioning at both 1 and 6 months and in role functioning at 6 months than the intervention group. A similar pattern was observed in analyses of breast cancer patients only. Conclusion: A 6‐day residential rehabilitation course did not relieve cancer patients' distress or improve their well‐being. Copyright © 2011 John Wiley & Sons, Ltd.     

Patient's perceived need and psychological distress and/or quality of life in ambulatory breast cancer patients in Japan

Objective: A needs assessment can be used as a direct index of what patients perceive they need help with. The purposes of this study were to investigate the association between patients' perceived needs and psychological distress and/or quality of life (QOL) and to clarify the characteristics of patients with a high degree of unmet needs. Methods: Randomly selected ambulatory female patients with breast cancer participated in this study. The patients were asked to complete the Short‐form Supportive Care Needs Survey questionnaire, which covers five domains of need (health system and information, psychological, physical, care and support, and sexuality needs); the Hospital Anxiety and Depression Scale; and the European Organization for Research and Treatment of Cancer QLQ‐C 30. Results: Complete data were available for 408 patients. The patients' needs were significantly associated with both psychological distress (r=0.63, p<0.001) and QOL (r=?0.52, p<0.001). A multiple regression analysis revealed that employment status (without full‐time /part‐time job), duration since diagnosis (less than 6 months), advanced stage, and a lower performance status were significantly associated with higher total needs. Only sexuality needs were significantly associated with a younger age, while the other domains were significantly associated with duration since diagnosis, advanced stage, and a lower performance status. Conclusions: Moderate to strong associations exist between patients' needs and psychological distress and/or QOL. The characteristics associated with patients' needs are multi‐factorial, and interventions to respond to patients' needs may be one possible strategy for ameliorating psychological distress and enhancing QOL. Copyright © 2010 John Wiley & Sons, Ltd.     

Quality‐of‐life and surgical treatments for rectal cancer—a longitudinal analysis using the California Cancer Registry

Background: Heterogeneous results for research investigating health‐related quality of life (HRQL) in patients undergoing sphincter‐ablating procedures for rectal cancer are likely due to single institution experiences and measurement of HRQL. To address this heterogeneity, we evaluated HRQL in patients with rectal cancer by type of surgery, location of tumor, and receipt of adjuvant therapy using an HRQL instrument that has not been used to address rectal cancer patients in a population‐based sample over time. Methods: The Functional Assessment of Cancer Therapy‐Colorectal instrument was administered at 9 and 19 months after diagnosis to a consecutive sample of 160 patients in Northern California identified by the California Cancer Registry. A broad multidimensional interpretation of HRQL was used to examine the impact of tumor location and treatment status, stage of disease, age, and gender. Results: In general, men had lower social well‐being scores, and younger patients had lower physical and emotional well‐being scores and colorectal concerns scores. We found no differences in HRQL by either tumor location or type of surgery, at either 9 or 19 months after diagnosis. Lower physical well‐being and greater adverse colorectal concerns were reported at 9 months among patients who received adjuvant therapy; however, only adverse colorectal concerns persisted over time. Conclusions: This study provides additional evidence that sphincter‐ablating procedures do not necessarily reduce quality of life in patients with rectal cancer. Distinctive features of this study include a broad multidimensional interpretation of HRQL, the 19 months of longitudinal follow‐up, and a prospective population‐based study design. Copyright © 2009 John Wiley & Sons, Ltd.     

Social support buffers the impact of functional impairments on caregiver psychological well‐being in the context of brain tumor and other cancers

Objective: This study investigated the association between functional impairments of individuals with cancer and caregiver psychological well‐being, and examined the moderating effect of social support. Methods: Sixty‐three caregivers (71% female) of individuals with brain tumor (n=27) and other cancers (n=36) were recruited from community services. Caregivers rated their psychological well‐being on the World Health Organisation Quality of Life measure Brief version, social support on a brief version of the Social Support Questionnaire, and the individuals' functional impairments on the Patient Competency Rating Scale. Results: For caregivers of individuals with brain tumor, better psychological well‐being was associated with lower functional impairment in all domains (r_s=0.33–38, p<0.05), except for cognitive difficulties. For caregivers of individuals with other cancers, better psychological well‐being was associated with lower functional impairment in all domains (r_s=0.30–0.49, p<0.05), with the exception of activities of daily living. For the total caregiver sample, better psychological well‐being was significantly correlated with overall functional impairment (r=0.34, p<0.005) and satisfaction with support (r=0.40, p<0.005). Caregivers supporting individuals with greater functional impairment had better psychological well‐being if they were highly satisfied with their social support. Conclusions: Effective social support is particularly important for caregivers who support individuals with poorer functional status, and this study highlights the need to evaluate caregiver social support interventions in the context of cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

Comparison of patient and family assessments of quality of life of terminally ill cancer patients in Japan

Objective: This study examined the extent and the nature of agreement on health‐related quality of life (QOL) assessments between terminally ill cancer patients and their primary family caregivers in Japan, using a multidimensional QOL instrument including psychosocial and spiritual domains. Methods: The Functional Assessment of Chronic Illness Therapy‐Spiritual well‐being questionnaire was used to assess patients' QOL. Study subjects were inpatients of a palliative care unit (PCU), outpatients who applied for admission to the PCU, and their primary family caregivers. Results: QOL ratings were obtained from 102 of 197 eligible patient–caregiver dyads. A moderate level of patient–family concordance on patients' overall QOL as well as families' underestimation of patients' QOL were observed. Families reported on observable domains of patients' QOL more reliably and assessed subjective aspects, such as psychospiritual concerns less accurately. Families tended to underrate the patients' social aspect of QOL, whereas most patients gave the highest rating on support from their families. The spiritual domain, particularly regarding faith, showed the least agreement. The size of the systematic bias between patient and family assessments on the patients' QOL was moderate (>0.50). Conclusions: Families' limited ability to assess psychosocial and spiritual aspects of patients' QOL may suggest the need for better approaches or measures to assess these aspects of a patient's life. The systematic bias was larger than in earlier studies. Further investigation is needed to identify factors affecting patient–family discord on QOL assessments to guide effective interventions to enhance patient–caregiver agreement. Copyright © 2010 John Wiley & Sons, Ltd.     

Cancer patients' reluctance to disclose their emotional distress to their physicians: a study of Japanese patients with lung cancer

Purpose: To explore cancer patients' concerns about emotional disclosure (ED) to their physicians, and to investigate the factors associated with them. Subjects and Methods: Randomly selected ambulatory patients with lung cancer participated in this study. An 18‐item questionnaire to assess patients' beliefs regarding ED to their physicians was developed for this study. Factor analysis was used to extract the underlying factors of this scale. Patients were asked to answer this questionnaire along with other self‐administered questionnaires. Results: Complete data were available from 104 patients. Four factors were extracted by factor analysis: ‘Hesitation to disturb the physicians by ED’, ‘No perceived need for ED’, ‘Negative attitude towards ED’, and ‘Fear of a negative impact of ED’. All factors reached standards of internal consistency. The prevalence of the above concerns, in that order, among the patients was 68, 67, 46, and 20%. Patients with high distress levels were significantly more likely to endorse ‘Negative impact’ (p=0.02). Older patients were more likely to report ‘Negative attitude’ (p=0.06), whereas male patients were more likely than females to report ‘Hesitation’ (p=0.05). Conclusion: Knowledge of such patient‐related barriers should better prepare physicians to build good communication channels with their cancer patients. Copyright © 2007 John Wiley & Sons, Ltd.     

The impact of perceived stage of cancer on carers' anxiety and depression during the patients' final year of life

Objective: This paper explores the effects of perceived stage of cancer (PSOC) on carers' anxiety and depression during the patients' final year. Methods: A consecutive sample of patients and carers (N=98) were surveyed at regular intervals regarding PSOC, and anxiety and depression using the Hospital Anxiety and Depression Scale. Means were compared by gender using the Mann–Whitney U‐test. The chi‐square was used to analyse categorical data. Agreement between carers' and patients' PSOC was estimated using kappa statistics. Correlations between carers' PSOC and their anxiety and depression were calculated using the Spearman's rank correlation. Results: Over time, an increasing proportion of carers reported that the cancer was advanced, culminating at 43% near death. Agreement regarding PSOC was fair (kappa=0.29–0.34) until near death (kappa=0.21). Carers' anxiety increased over the year; depression increased in the final 6 months. Females were more anxious (p=0.049, 6 months; p=0.009, 3 months) than males, and more depressed until 1 month to death. The proportion of carers reporting moderate–severe anxiety almost doubled over the year to 27%, with more females in this category at 6 months (p=0.05). Carers with moderate–severe depression increased from 6 to 15% over the year. Increased PSOC was weakly correlated with increased anxiety and depression. Conclusions: Carers' anxiety exceeded depression in severity during advanced cancer. Females generally experienced greater anxiety and depression. Carers were more realistic than patients regarding the ultimate outcome, which was reflected in their declining mental health, particularly near the end. Copyright © 2008 John Wiley & Sons, Ltd.     

Meaning‐centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial

Objectives: An increasingly important concern for clinicians who care for patients at the end of life is their spiritual well‐being and sense of meaning and purpose in life. In response to the need for short‐term interventions to address spiritual well‐being, we developed Meaning Centered Group Psychotherapy (MCGP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace and purpose in their lives, even as they approach the end of life. Methods: Patients with advanced (stage III or IV) solid tumor cancers (N=90) were randomly assigned to either MCGP or a supportive group psychotherapy (SGP). Patients were assessed before and after completing the 8‐week intervention, and again 2 months after completion. Outcome assessment included measures of spiritual well‐being, meaning, hopelessness, desire for death, optimism/pessimism, anxiety, depression and overall quality of life. Results: MCGP resulted in significantly greater improvements in spiritual well‐being and a sense of meaning. Treatment gains were even more substantial (based on effect size estimates) at the second follow‐up assessment. Improvements in anxiety and desire for death were also significant (and increased over time). There was no significant improvement on any of these variables for patients participating in SGP. Conclusions: MCGP appears to be a potentially beneficial intervention for patients' emotional and spiritual suffering at the end of life. Further research, with larger samples, is clearly needed to better understand the potential benefits of this novel intervention. Copyright © 2009 John Wiley & Sons, Ltd.     

Effectiveness of communication skills training of nurses on the quality of life and satisfaction with healthcare professionals among newly diagnosed cancer patients: a preliminary study

Introduction: The importance of effective communication skills to sustain the cancer patient quality of life (QOL) and their satisfaction with healthcare professionals is well documented. This study aims to assess the effectiveness of communication skills training (CST) of nurses for patient QOL and their satisfaction with healthcare professionals just after being diagnosed with cancer. Methods: This is a secondary analysis of a randomized controlled trial. Eight nurses, who mainly provide psychological and informational support for patients soon after they were informed of their cancer diagnosis by physicians at a cancer screening center, were randomly assigned to an experimental group attending a CST program (four nurses) or to a control group (four nurses). Eighty‐nine patients with gastric, colorectal, or breast cancer were supported and assessed by either group of nurses during the study period. The effectiveness for patient QOL and their satisfaction with healthcare professionals was assessed by administering the Short Form‐8 Health Survey (SF‐8) and a single‐item VAS three times (1 week after diagnosis: T1; 1 month after diagnosis: T2; and 3 months after diagnosis: T3). Results: Repeated measures analysis of variance showed a group‐by‐time significant increase of the mental aspects of SF‐8 (F=3.48; P=0.03) and satisfaction with the nurse (F=3.18; p=0.04) Conclusions: Our findings underscore the importance of CST for healthcare professionals to improve the QOL of patients as well as their satisfaction with these professionals. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychological benefits for cancer patients and their partners participating in mindfulness‐based stress reduction (MBSR)

Objective: Cancer patients experience many negative psychological symptoms including stress, anxiety, and depression. This distress is not limited to the patient, as their partners also experience many psychological challenges. Mindfulness‐based stress reduction (MBSR) programs have demonstrated clinical benefit for a variety of chronic illnesses, including cancer. This is the first study to report MBSR participation with partners of cancer patients. Methods: This study examined the impact of an 8‐week MBSR program for 21 couples who attended the program together on outcomes of mood disturbance, symptoms of stress, and mindfulness. Results: Significant reductions for both patients and partners in mood disturbance (p<0.05) and the Calgary Symptoms of Stress Inventory (C‐SOSI) subscales of muscle tension (p<0.01), neurological/GI (p<0.05), and upper respiratory (p<0.01) symptoms were observed after program participation. Significant increases in mindfulness (p<0.05) were also reported in both groups. No significant correlations were observed between patient and partner scores on any measures at baseline or on change scores pre‐ to post‐intervention; however, after MBSR participation couple's scores on the Profile of Mood States and C‐SOSI were more highly correlated with one‐another. Post‐intervention, partners' mood disturbance scores were significantly positively correlated with patients' symptoms of stress and negatively correlated with patients' levels of mindfulness. Conclusions: Overall, the MBSR program was helpful for improving psychological functioning and mindfulness for both members of the couple. Several avenues of future research are suggested to further explore potential benefits of joint couple attendance in the MBSR program. Copyright © 2010 John Wiley & Sons, Ltd.     

The trajectory of religious coping across time in response to the diagnosis of breast cancer

Objectives: This study investigates the mobilization of religious coping in women's response to breast cancer. Methods: Ninety‐three breast cancer patients and 160 women with a benign diagnosis participated. Breast cancer patients were assessed on their use of religious coping strategies and their level of emotional distress and well‐being at pre‐diagnosis, 1 week pre‐surgery, and 1 month, 6 months, 1 year, and 2 years post‐surgery. Results: In general, breast cancer patients used religious strategies more frequently than women with a benign diagnosis; however, the patterns of use were similar across time for the majority of strategies. Results showed that religious coping strategies are mobilized early on in the process of adjustment to breast cancer. Breast cancer patients' use of support or comfort‐related strategies peaked around surgery and then declined, while the use of strategies that reflected more a process of meaning‐making remained elevated or increased into the long‐term. Positive and negative forms of religious coping were predictive of concurrent distress and emotional well‐being. As well, there was evidence that the mobilization of religious coping was predictive of changes in distress and well‐being across time. For example, women's increased use of active surrender coping from 1 to 6 months post‐surgery was related to a concomitant decrease in emotional distress and increase in emotional well‐being. Conclusions: Notably the nature of the relationship between religious coping and emotional adjustment depended on the type of religious coping strategy as well as the specific time of assessment. Specificity of information in the use of religious coping can allow health‐care professionals to better identify resources and address potential points of difficulty during the process of women's adjustment to breast cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

Factors that influence cancer patients' and relatives' anxiety following a three-person medical consultation: impact of a communication skills training program for physicians

Background: No study has yet assessed the impact of physicians' skills acquisition after a communication skills training program on changes in patients' and relatives' anxiety following a three‐person medical consultation. This study aimed at comparing, in a randomized study, the impact, on patients' and relatives' anxiety, of a basic communication skills training program and the same program consolidated by consolidation workshops and at investigating physicians' communication variables associated with patients' and relatives' anxiety. Methods: Consultations with a cancer patient and a relative were recorded and analyzed by the Cancer Research Campaign Workshop Evaluation Manual. Patients' and relatives' anxiety were assessed with the State‐Trait Anxiety Inventory—State. Results: No statistically significant change over time and between groups was observed. Mixed‐effects modeling of changes in patients' and relatives' anxiety showed that decreases in both patients' and relatives' anxiety were linked with patients' and relatives' self‐reported distress (p = 0.031 and 0.005), and that increases in both patients' and relatives' anxiety were linked with physicians' breaking bad news (p = 0.028 and 0.005). Conclusion: No impact of the training program was observed. Results indicate the need to further study communication skills which may help reduce patients' and relatives' anxiety especially when breaking bad news. Copyright © 2007 John Wiley & Sons, Ltd.     

Burden of focal cryoablation versus brachytherapy versus active surveillance in the treatment of very low‐risk prostate cancer: a preliminary head‐to‐head comprehensive assessment

Focal cryoablation (FC), brachytherapy (B) and active surveillance (AS) were offered to patients diagnosed with very low‐risk prostate cancer (VLRPC) in an equal access protocol. Comprehensive validated self‐report questionnaires accessed patients' erectile (IIEF‐5) and voiding (IPSS) functions, Beck scales measured anxiety (BAI), hopelessness (BHS) and depression (BDI), SF‐36 reflected patients' quality of life added to the emotional thermometers including five visual analogue scales (distress, anxiety, depression, anger and need for help). Kruskal–Wallis or ANOVA tests and Spearman's correlations were obtained among groups and studied variables. Thirty patients were included, median follow‐up 18 months (15–21). Those on AS (n = 11) were older, presented higher hopelessness (BHS) and lower general health perceptions (SF‐36) scores than patients opting for FC (n = 10) and B (n = 9), P = 0.0014, P = 0.0268 and P = 0.0168 respectively. Patients on B had higher IPSS scores compared to those under FC and AC, P = 0.0223. For all 30 included patients, Spearman's correlation (r_s) was very strong between BHS and general health perceptions (r_s = ?0.800, P < 0.0001), and weak/moderate between age and BHS (r_s = 0.405, P = 0.026) and age and general health perceptions (r_s = ?0.564, P = 0.001). The sample power was >60%. To be considered in patients' counselling and care, current study supports the hypothesis that even VLRPC when untreated undermines psychosocial domains.