Psychological distress in patients with pancreatic cancer—an understudied group

Background: Pancreatic cancer is the fourth leading cause of cancer‐related death in the United States, unsuccessful in significantly improving 5‐year survival. A diagnosis of pancreatic cancer may be associated with increased psychological distress, yet remarkably little is known about the degree of psychological distress experienced by these patients at the time of diagnosis and treatment. Method: In a cross‐sectional study, 304 patients with pancreatic cancer and 7749 patients with other cancer diagnoses completed the Brief Symptom Inventory (BSI) or the Brief Symptom Inventory‐Shortened Version (BSI‐18) and the Problem Common Checklist (PCL) during outpatient registration. Sociodemographic characteristics were collected from patients' clinical files. Results: A higher percentage of pancreatic cancer patients reported elevated distress across each subscale of the BSI and BSI‐18 when compared with those diagnosed with other cancer diagnoses as a group. The most notable difference was established on the depression subscale, with 28.8% of pancreatic patients reporting elevated depression compared with 18.5% of other cancer diagnoses. In pancreatic patients, a significant difference was also found in the percentage of males endorsing high depression levels when compared with females (34.0 vs 22.6%, p<0.05). Conclusions: Pancreatic cancer patients demonstrate elevated levels of psychological distress. This should alert providers to be vigilant in evaluating patients for distress and to provide appropriate referrals. The endorsement of fatigue and pain, along with the observed gender differences, suggest that early distress management interventions may need to include components targeted to these issues. Copyright © 2010 John Wiley & Sons, Ltd.     

The psychosocial impact of interrupted childbearing in long-term female cancer survivors

Objective: To understand the influence of cancer‐related infertility on women's long‐term distress and quality of life. Women diagnosed at age 40 or less with invasive cervical cancer, breast cancer, Hodgkin disease, or non‐Hodgkin lymphoma were interviewed an average of 10 years later. We predicted that women whose desire for a child at diagnosis remained unfulfilled would be significantly more distressed. Methods: Participants completed a semi‐structured phone interview, including the SF‐12^®, Brief Symptom Inventory‐18, Impact of Events Scale (IES), Reproductive Concerns Scale (RCS), brief measures of marital satisfaction or comfort with dating, sexual satisfaction, and menopause symptoms. Results: Of 455 women contacted by phone, 240 (53%) participated. Seventy‐seven women had wanted a child at diagnosis but did not conceive subsequently (38 remaining childless and 39 with secondary infertility). Even controlling for other psychosocial and health factors, this group had higher distress about infertility (RCS) (p<0.001), had more intrusive thoughts about infertility, and used more avoidance strategies when reminded of infertility (IES) (p<0.001). Childless women were the most distressed. Women with adopted or stepchildren were intermediate, and those with at least one biological child were least distressed. Infertility‐related distress did not differ significantly by cancer site. Conclusions: Even at long‐term follow‐up, distress about interrupted childbearing persists, particularly in childless women. Social parenthood buffers distress somewhat, but not completely. Not only is it important to offer fertility preservation before cancer treatment, but interventions should be developed for survivors to alleviate unresolved grief about cancer‐related infertility. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychological distress and use of psychosocial support in familial adenomatous polyposis

Objective: Familial adenomatous polyposis (FAP) is characterized by multiple adenomas in the colorectum with a high risk to develop colorectal cancer. It is unclear whether individuals at risk of FAP experience distress due to this potentially life‐threatening disease. This nationwide study assessed: (1) the prevalence of psychological distress; and (2) the need for and use of specialized professional psychosocial support. Methods: In this cross‐sectional study, all individuals from families at high risk for FAP registered at the Netherlands Foundation for the Detection of Hereditary Tumours were invited to complete a questionnaire assessing, among other issues, generalized, cancer‐specific and FAP‐specific distress. Results: In total, 525 individuals completed the questionnaire. Approximately 20% of the respondents had moderate to severe levels of FAP‐specific distress. Levels of generalized distress were comparable to the general Dutch population. Significantly more individuals with a FAP diagnosis had frequent cancer worries than those at risk of FAP or non‐carriers (p=0.02). Distress levels were more strongly associated with psychosocial variables (e.g. perceived cancer risk), than with sociodemographic or clinical variables. Up to 43% of the variance in distress could be explained by all variables combined. Of those moderately to severely distressed, 26% had received specialized professional psychosocial support, while 30% of those did not receive the support they wanted. Conclusions: A substantial minority of individuals reported moderate to severe distress levels associated with FAP. However, only one‐third of those received specialized professional psychosocial support. We recommend the use of a screening questionnaire to identify individuals in need of such support. Copyright © 2009 John Wiley & Sons, Ltd.     

Distress in couples approached for genetic counseling and BRCA1/2 testing during adjuvant radiotherapy

Objective: Breast cancer patients mostly rely on their partners for support in dealing with their cancer diagnosis and treatment. Genetic counseling and BRCA1/2 testing during primary treatment may add to demands made on their partners. This study aimed to gain insight into the extent of psychological distress in partners of recently diagnosed patients and to find factors to help identify couples vulnerable to high psychological distress after an active approach for genetic counseling. Methods: Breast cancer patients and their partners (n=110) completed psychological distress measures (HADS and IES) prior to the approach for counseling (T0), after the approach (T1), and after leaving the genetic counseling protocol (T2). Couples not approached for counseling (n=85) completed similar questionnaires. Results: Partners reported an equal or lower level of distress than patients, with a positive correlation between the two, although partners and patients differed in the course of their distress. Couples approached for genetic counseling did not differ in the level or course of either distress measure from not approached couples. A high baseline distress best predicts long‐term high distress in patients and their partners. Younger patients were found to be particularly vulnerable. Conclusions: The approach for genetic counseling during adjuvant radiotherapy was not associated with extra psychological distress in partners or patients in the first year following the breast cancer diagnosis. A partner's long‐term level of distress was significantly associated with that of the patient. Highly distressed patients with highly distressed partners were most likely to experience high distress in the long term. Copyright © 2009 John Wiley & Sons, Ltd.     

Feasibility of an expressive-disclosure group intervention for post-treatment colorectal cancer patients: results of the Healthy Expressions study

BACKGROUND:

Adjusting to cancer requires effective cognitive and emotional processing. Written and verbal disclosure facilitate processing and have been studied independently in cancer survivors. Combined written and verbal expression may be more effective than either alone, particularly for patients with difficult to discuss or embarrassing side effects. Thus, the authors developed and tested the efficacy of a 12‐session combined written and verbal expression group program for psychologically distressed colorectal cancer (CRC) patients.

METHODS:

Forty post‐treatment patients with CRC (stages I‐III) identified as psychologically distressed using the Brief Symptom Inventory (BSI) were randomized to an intervention group (Healthy Expressions; n = 25) or standard care (control group; n = 15). Assessments were completed at baseline, Month 2, and Month 4 (postintervention). Primary outcomes were psychological functioning and quality of life (QOL).

RESULTS:

Most participants were women (63%), white (63%), and non‐Hispanic (75%). The Healthy Expressions group demonstrated significantly greater changes in distress compared with the control group at Month 2 on the BSI Global Severity Index (GSI) and the Centers for Epidemiologic Studies Depression scale (CES‐D) scores (P < .05 for each); differences in the European Organization for Research and Treatment of Cancer (EORTC) global QOL scores approached significance (P = .063). The BSI GSI and Positive Symptom Total, CES‐D, and EORTC emotional functioning subscale scores were all significant at Month 4 (P < .05 for each).

CONCLUSIONS:

The Healthy Expressions program improved psychological functioning in CRC patients who reported experiencing distress. Findings demonstrate the program's feasibility and provide strong support for conducting a larger randomized trial. Cancer 2011;. © 2011 American Cancer Society.     

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.     

Socio-demographic, psychosocial and attitudinal predictors of help seeking after cancer diagnosis

Objective: The objective is to describe cancer patients' patterns of use of psychosocial support services and identify socio‐demographic, psychosocial, and attitudinal predictors of service utilization. Methods: A cross‐sectional survey of 439 cancer patients (61.2% response) at a regional tertiary cancer center assessed patterns of support service utilization, cancer‐specific distress, social support and constraints, and attitudes to help seeking. Results: Patients less frequently received advice about psychosocial support in comparison with treatment‐related information. More than half the respondents were aware of social work support, support groups, and chaplain support; however, most did not utilize these services. For unaware patients, up to 47% would have utilized support services if they had known of their existence. The use of services was significantly related to being female, younger, and having greater cancer‐specific distress, more positive and less negative attitudes to help seeking. Future intention to contact a health professional for psychological support was predicted by more positive subjective norms and outcome expectations, higher cancer‐specific distress, and less negative attitudes to help seeking. Conclusion: Initiatives that encourage distressed patients to use psychosocial care services should highlight positive outcomes. Educational programs for health professionals to support psychosocial care in oncology are needed. Copyright © 2008 John Wiley & Sons, Ltd.     

Use of complementary and alternative therapies by Western Australian cancer patients

Aim: Despite the paucity of controlled trials and possible interference with conventional treatments, complementary and alternative therapy (CAT) use is becoming increasingly popular and many patients do not discuss it with their physicians. Consequently, we examined the incidence and type of CAT use, perceived benefits of use, and the relationship between demographic, clinical or psychological factors and use in Western Australian patients. Methods: Two hundred newly diagnosed cancer patients beginning conventional multi‐modal treatment participated. Health‐related quality of life (HQOL), psychological adjustment and CAT use were assessed longitudinally at pretreatment, in treatment (at 8 weeks) and post‐treatment. Results: Overall, 30% of patients reported CAT use in the course of treatment. CAT users were predominantly younger (P = 0.004), tertiary educated (P = 0.016), possessed comorbid conditions (P = 0.023), and underwent lengthy treatment (P = 0.004). Patients who underwent lengthy treatment (>6 months) were three times more likely to use CAT than those who did not. Overall, 64% of CAT users perceived benefit from their use, primarily citing enhanced physical and emotional well‐being. CAT users, however, did not score significantly better than non‐users on any measure of HQOL, physical health or psychological function. CAT users generally reported greater psychosocial distress than non‐users across treatment, especially at pretreatment (baseline). However, with ongoing/new CAT use they significantly reduced their distress levels to that of non‐users by 8 weeks in treatment (P = 0.042). Conclusion: Complementary and alternative therapies enhanced cancer patients' psychological well‐being during the early stages of conventional treatment only. Use of CAT by cancer patients may be a clinical marker for psychosocial distress, and should trigger clinicians to inquire about physical symptoms, and concomitant anxiety and depression.     

Distress in post-treatment hematological cancer survivors: Prevalence and predictors

Abstract

Objectives: To calculate the prevalence of psychosocial distress, and identify factors that predict distress, in early post-treatment hematological cancer survivors.

Design: Cross-sectional survey containing self-report measures.

Sample/Methods: Post-treatment hematological cancer survivors in remission (>18?years) (n?=?409) completed questionnaires. Distress was measured with the distress thermometer (DT). Logistic regression was used to identify predictors of distress.

Findings: Overall 21.9% (n?=?93) of respondents reported significant distress (DT?≥4). Significant distress was twice as high in those born overseas (OR = 2.09, p?=?.03), 3.5 times higher in those with lower social support (OR = 3.51, p = <.001) and five times higher in those with increased fear of recurrence (OR = 0.17, p = <.001).

Implications for Psychosocial Providers: Early identification of distress may decrease psychosocial issues in the post-treatment period, especially as psychosocial services have been shown to improve wellbeing for those who are distressed.     

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.     

Adopting a family approach to theory and practice: measuring distress in cancer patient-partner dyads with the distress thermometer

Objective: Significant others are central to patients' experience and management of their cancer illness. Building on our validation of the Distress Thermometer (DT) for family members, this investigation examines individual and collective distress in a sample of cancer patients and their matched partners, accounting for the aspects of gender and role. Method: Questionnaires including the DT were completed by a heterogeneous sample of 224 couples taking part in a multisite study. Results: Our investigation showed that male patients (34.2%), female patients (31.9%), and male partners (29.1%) exhibited very similar levels of distress, while female partners (50.5%) exhibited much higher levels of distress according to the DT. At the dyad level just over half the total sample contained at least one individual reporting significant levels of distress. Among dyads with at least one distressed person, the proportion of dyads where both individuals reported distress was greatest (23.6%). Gender and role analyses revealed that males and females were not equally distributed among the four categories of dyads (i.e. dyads with no distress; dyads where solely the patient or dyads where solely the partner is distressed; dyads where both are distressed). Conclusion: A remarkable number of dyads reported distress in one or both partners. Diverse patterns of distress within dyads suggest varying risks of psychosocial strain. Screening patients' partners in addition to patients themselves may enable earlier identification of risk settings. The support offered to either member of such dyads should account for their role‐ and gender‐specific needs. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychological distress and quality of life of partners of individuals with familial adenomatous polyposis

Objective: Familial adenomatous polyposis (FAP) is a genetic condition characterized by the development of multiple adenomas in the colorectum that could lead to colorectal cancer. Our aim was to assess levels and predictors of psychological distress and quality of life (QOL) among partners of FAP‐patients. Methods: A nationwide, cross‐sectional survey using validated self‐report questionnaires assessing psychological distress and QOL. Results: One hundred and twenty‐nine partners completed the questionnaire (84% response rate), 30% of whom reported moderate‐to‐severe levels of distress. The partners' distress was associated significantly with the patients' distress, having children, and feelings of guilt. Fifty‐seven percent of the partners with moderate‐to‐severe distress levels had received professional psychosocial support. Partners did not differ significantly from the general population in QOL. However, 9–21% reported that FAP had affected their work, leisure time activities, and relationships. Conclusions: Clinicians should be particularly alert for heightened distress levels in partners of patients who are themselves distressed, and among those with children. Copyright © 2010 John Wiley & Sons, Ltd.     

The report of coping strategies and psychosocial adjustment in Korean mothers of children with cancer

Objective: Parents of children with cancer must cope with multiple challenges over time. As most research on parental coping has been conducted in Western countries, little information is available on the parental experience of coping in non‐Western countries. Using a new cultural sample of Korean mothers, this study describes their coping strategies. In addition, the association of particular coping patterns with mothers' report of psychosocial adjustment is investigated. Methods: A total of 200 Korean mothers of children with cancer participated in the study. Coping strategies were measured by the Coping Health Inventory for Parents in the following three categories: Maintaining Family Integration and an Optimistic Outlook for the Situation, Seeking Social Support, and Seeking Information. Maternal psychosocial adjustment was measured by psychological distress, family relationship, and social relationship subscales from the Psychosocial Adjustment to Illness Scale. Results: Korean mothers reported coping strategies related to Maintaining Family Integration and an Optimistic Outlook for the Situation as being most helpful. More frequent use of coping pattern, Maintaining Family Integration and an Optimistic Outlook for the Situation, and less frequent use of coping pattern, Information‐Seeking were significantly associated with lower psychological distress and better family relationship after children's medical and maternal characteristics were controlled for. Coping pattern, Seeking Social Support was only predictive of social relationships. Conclusions: This study suggests that culture may play a significant role in the report of coping among Korean mothers. Future studies should consider culturally preferred coping methods and available resources as they relate to different adjustment outcomes. Copyright © 2008 John Wiley & Sons, Ltd.     

Are cancer survivors following the national comprehensive cancer network health behavior guidelines? An assessment of patients attending a cancer survivorship clinic

Purpose: Engaging in positive health behaviors post-treatment is important for cancer survivors' health. However, little is known about whether survivors are practicing health promoting behaviors. We aimed to explore whether survivors are meeting the recent health behavior guidelines set forth by the National Comprehensive Cancer Network (NCCN) and to examine associations between health behaviors and distress. Methods: Sixty-six survivors completed a cross-sectional questionnaire assessing health behaviors prior to an initial appointment at a survivorship care clinic. Information about sociodemographic, clinical, and psychosocial variables and six health behavior recommendations, including physical activity, sunscreen use, tobacco use, alcohol consumption, weight management, and annual primary care provider visits, was collected. Findings: Only 7.6% of survivors met all six NCCN health behavior guidelines. One in ten (10.6%) survivors had smoked a cigarette in the previous 30 days, and half did not use sunscreen regularly (50%), had an unhealthy body mass index (53%), and did not engage in >10 MET-h/week of physical activity (50%). Approximately 1 in 6 (15.1%) survivors reported drinking beyond the recommended limit, and a similar proportion had not seen a PCP in the previous year (27.3%). Clinically significant levels of distress (>5; range 0–10) on the NCCN distress scale were reported by 64.6% of survivors. Participants with clinical levels of distress were less likely to adhere to health behavior guidelines than those who were not distressed (p = .002). Conclusions: Overall, survivors engaged at a survivorship clinic did not meet the NCCN recommended health behavior guidelines. Implications for Psychosocial Providers or Policy: Survivors' health behaviors and distress should be assessed and intervened upon during survivorship care. Survivorship clinics may provide a unique forum in which to provide ongoing behavioral health counseling and psychosocial support for these patients.     

An examination of distress, sleep, and fatigue in metastatic breast cancer patients

Objective: Few studies have used rapid screening instruments to document the prevalence of distress among metastatic breast cancer patients. This study used the one‐item Distress Thermometer (DT) to assess distress in this population. Anxiety and depressive symptoms, sleep problems, fatigue, and mental health service use were assessed for patients who met the cutoff on the DT for probable distress (score ?4). Methods: A total of 173 metastatic breast cancer patients rated their distress on the DT. Respondents who met study eligibility criteria (n = 90), including a score ?4 on the DT, completed a telephone survey 1 week later that assessed anxiety, depressive symptoms, sleep problems, and fatigue. Associations of study outcomes with demographic and medical characteristics were computed. Results: Sixty percent of the 173 patients met the cutoff for probable distress on the DT. Meeting this cutoff was not associated with age, ethnicity, time since diagnosis, or medical treatments. The majority (61%) of respondents who were classified as distressed on the DT reported clinically significant anxiety or depressive symptoms 1 week later. On average, these patients also showed significant fatigue and sleep disturbance, with 70% reporting decrements in sleep quality. Only 29% of patients with significant anxiety or depressive symptoms accessed mental health services. Conclusions: Results point to a high prevalence of distress, sleep problems, and fatigue across demographic and medical subgroups of metastatic breast cancer patients. A rapid one‐item screening tool may be used to identify patients with a potential need for psychosocial assessment and intervention. Copyright © 2010 John Wiley & Sons, Ltd.     

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

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

Evaluating the quality of psychosocial care in outpatient medical oncology settings using performance indicators

Objective: An American Psychosocial Oncology Society workgroup has developed indicators of the quality of psychosocial care that can be measured through review of medical records. The present report describes the first large‐scale use of these indicators to evaluate psychosocial care in outpatient medical oncology settings. Methods: Medical records of 1660 colorectal, breast and non‐small cell cancer patients first seen by a medical oncologist in 2006 at 11 practice sites in Florida were reviewed for performance on indicators of the quality of psychosocial care. Results: Assessment of emotional well‐being was significantly less likely to be documented than assessment of pain (52 vs 87%, p<0.001). A problem with emotional well‐being was documented in 13% of records and evidence of action taken was documented in 58% of these records. Ten of eleven practice sites performed below an 85% threshold on each indicator of psychosocial care. Variability in assessment of emotional‐well being was associated (p<0.02) with practice site and patient gender and age while variability in assessment of pain was associated (p<0.001) with practice site and cancer type. Conclusions: Findings illustrate how use of the psychosocial care indicators permits identification of specific practice sites and processes of care that should be targeted for quality improvement efforts. Additionally, findings demonstrate the extent to which routine assessment of emotional well‐being lags behind routine assessment of pain in cancer patients. Copyright © 2010 John Wiley & Sons, Ltd.     

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.     

A community-based approach to cancer counselling for patients and carers: a preliminary study

Objective: The delivery of psychological care services to people with cancer and their carers is a key clinical priority that has yet to be broadly implemented. The present study aimed to provide guidance for service provision by describing a community‐based intervention approach; outlining the characteristics, psychological concerns, and distress outcomes for people who utilise the service. Methods: Over a 3‐year period 681 patients and 520 significant others referred from a community‐based Cancer Helpline received tele‐based psychosocial interventions. Results: In this case series presenting problems varied between patients and significant others, with significant others reporting higher levels of distress (p<0.001). Both patients and significant others experienced decreases in distress over the period of the intervention (p<0.001). Conclusions: This study provides level IV evidence that the tele‐based intervention for cancer‐related distress is an effective approach to service delivery. A randomised control trial is currently underway to assess the effectiveness of this approach. Copyright © 2010 John Wiley & Sons, Ltd.