Worry About Cancer Progression and Low Perceived Social Support: Implications for Quality of Life Among Early-Stage Breast Cancer Patients

Background

Worry about cancer progression and perceived social support can affect cancer survivors’ quality of life (QOL).

Methods

In 480 early-stage breast cancer survivors, we examined how worry about cancer progression and perceived social support 6 months after definitive surgery were associated with QOL (RAND 36-item Health Survey) at 6-, 12-, and 24-month follow-up.

Results

At 6 months post-surgery, higher worry was associated with worse QOL for five of eight subscales. Lower social support was associated with worse QOL for four subscales. The negative effects of worry and limited social support dissipated for four subscales (worry) and two subscales (social support) by 12-month follow-up and for all subscales by 24-month follow-up. Social support at 6 months moderated the relationship between T2 worry and T4 emotional well-being; post hoc tests did not clarify the nature of the interaction.

Conclusion

Early-stage breast cancer survivors who worry about cancer progression and/or have low social support may experience lower levels of QOL that can take several months to resolve.     

Development and Initial Evaluation of a Multifaceted Intervention to Improve Mental Health and Quality of Life Among Prostate Cancer Survivors

Mental health issues affect a third of prostate cancer (PCa) survivors. Here, we describe the development and preliminary evaluation of a unique multifaceted intervention, the Prostate Cancer–Patient Empowerment Program (PC-PEP), designed to improve mental health and quality of life among survivors. The 28-day pilot PC-PEP Intervention was developed following the engagement of patients, survivors, caregivers and health care professionals In identifying survivorship needs and well-being resources for improved mental health. The pilot intervention was implemented with a group of 30 PCa survivors in Halifax, Canada. Measures collected over the 28-day program included psychological distress and physical health indicators, as well as program compliance. Participation in PC-PEP resulted in significant improvement in measures of mental and physical health over the 28-day program. Very good to excellent compliance with all five components of PC-PEP was observed. This evaluation provides strong initial support for a multifaceted program to improve mental health outcomes in prostate cancer survivors.

     

Neurocognitive and Family Functioning and Quality of Life Among Young Adult Survivors of Childhood Brain Tumors

Many childhood brain tumor survivors experience significant neurocognitive late effects across multiple domains that negatively affect quality of life. A theoretical model of survivorship suggests that family functioning and survivor neurocognitive functioning interact to affect survivor and family outcomes. This paper reviews the types of neurocognitive late effects experienced by survivors of pediatric brain tumors. Quantitative and qualitative data from three case reports of young adult survivors and their mothers are analyzed according to the theoretical model and presented in this paper to illustrate the importance of key factors presented in the model. The influence of age at brain tumor diagnosis, family functioning, and family adaptation to illness on survivor quality of life and family outcomes is highlighted. Future directions for research and clinical care for this vulnerable group of survivors are discussed.     

Exercise Interventions for Cancer Survivors: A Meta-Analysis of Quality of Life Outcomes

Background  

Exercise improves quality of life (QOL) in cancer survivors, although characteristics of efficacious exercise interventions for this population have not been identified.     

Direct and Buffering Effects of Social Support Among Gynecologic Cancer Survivors

Background  

There are few studies of QoL among long-term gynecologic cancer survivors; available data suggest significant sequelae of disease and treatment. Research clarifying circumstances that improve difficult survivorship trajectories is lacking.     

Quality of Life of Couples Dealing with Cancer: Dyadic and Individual Adjustment among Breast and Prostate Cancer Survivors and Their Spousal Caregivers

Background and Purpose Although evidence suggests that survivors and spousal caregivers tend to experience somewhat similar levels of distress and that the survivor’s distress affects his/her own quality of life, the degree to which each person’s distress has an independent effect on their partner’s quality of life is unknown. Thus, this study aimed to examine the dyadic effects of psychological distress on the quality of life of couples dealing with cancer. Methods A total of 168 married survivor–caregiver dyads participating in the American Cancer Society’s Study of Cancer Survivors-I and Quality of Life Survey for Caregivers provided complete data for study variables. Participating survivors were diagnosed with either breast or prostate cancer approximately 2 years prior to participating in the study. Results Using the Actor Partner Interdependence Model, results revealed that although each person’s psychological distress is the strongest predictor of their own quality of life, partner’s distress and (dis)similarity in distress of the couple also play significant roles in one’s quality of life. In addition, the adverse effect of having a partner who is less emotionally resourceful was especially pronounced on men’s physical health. Conclusions Our systematic investigation provided valuable evidence for identifying the subgroup of cancer survivors and their spouses who are vulnerable to poor quality of life due to their mutual psychological distress. These findings suggest that couples may benefit from interventions that enhance their ability to manage psychological distress, particularly the wife’s, which may improve the mental and physical health of both partners when they are dealing with cancer.     

Randomized Controlled Trial of a Behavior Change Intervention to Increase Physical Activity and Quality of Life in Prostate Cancer Survivors

Background

Physical activity improves health in prostate cancer survivors; however, participation rates are low.

Purpose

This study aims to determine the effects of an implementation intention intervention on physical activity and quality of life in prostate cancer survivors.

Methods

Prostate cancer survivors (N?=?423) were randomly assigned to a standard physical activity recommendation, a self-administered implementation intention, or a telephone-assisted implementation intention. Physical activity and quality of life were assessed at baseline, 1, and 3 months.

Results

Analyses of covariance using multiple imputation showed that physical activity at 1 month increased by 86 min/week in the standard physical activity recommendation group compared with 168 min/week in the self-administered implementation intention group (P?=?0.023) and 105 min/week in the telephone-assisted implementation intention group (P?=?0.35).

Conclusions

A self-administered implementation intention intervention resulted in a meaningful short-term increase in physical activity. Supplementation with additional intervention strategies and more frequent intervention may improve longer-term exercise. (ClinicalTrials.gov number NCT01410656).     

Seizures Among Long-Term Survivors of Conservatively Treated ICH Patients: Incidence,Risk Factors,and Impact on Functional Outcome

Background

Seizures are a common complication after intracerebral hemorrhage (ICH) but there is a substantial lack of information on the long-term incidence in ICH survivors and whether post-ICH seizures affect functional long-term outcome.

Methods

Over a five-year period 464 consecutive patients with spontaneous ICH were analyzed. Focussing on 1-year ICH survivors, clinical, and radiological parameters were retrieved from institutional prospective databases. The occurrence of seizures was categorized as early (≤7 days) or late (>7 days). Functional outcome was assessed by mailed questionnaires and telephone interviews, and was categorized into good vs. poor (mRS: 0–2 vs. 3–5) and favorable vs. unfavorable (mRS: 0–3 vs. 4–5). Multivariate regression models were calculated to investigate risk factors associated with post-ICH seizures including an a priori defined subgroup analysis of lobar ICH patients.

Results

Among 203 long-term ICH survivors, 19.7 % developed seizures of which 55 % occurred late. Factors associated with seizures were lobar location (OR 8.10; 95 % CI 3.04–21.59; p < 0.001), sepsis (OR 4.59; 95 % CI 1.20–17.53; p = 0.026), and history of alcohol abuse (OR 3.36; 95 % CI 1.25–9.06; p = 0.017). Subgroup analysis of lobar ICH patients revealed history of alcohol abuse as the only independent predictor of post-ICH seizures (OR 5.22; 95 % CI 1.25–21.78; p = 0.024). Functional long-term outcome among survivors was slightly worse in patients with post-ICH seizures (p = 0.059). In multivariate regression modeling for prediction of poor outcome, the parameter “post-ICH seizures” again reached a statistical trend (p = 0.065), and established parameters such as age, GCS, and hemorrhage volume were independently related to poor outcome.

Conclusions

Post-ICH seizures among long-term ICH survivors are common and may contribute to unfavorable functional outcome. Especially lobar ICH patients with a history of alcohol abuse are at risk to develop post-ICH seizures. Therefore, this subgroup may represent a target population for a prophylactic anticonvulsive treatment approach, preferably investigated in a prospective randomized trial.

     

Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults

Background

Discrimination promotes multisystem physiological dysregulation termed allostatic load, which predicts morbidity and mortality. It remains unclear whether weight-related discrimination influences allostatic load.

Purpose

The aim of this study was to prospectively examine 10-year associations between weight discrimination, allostatic load, and its components among adults 25–75 years in the Midlife Development in the US Biomarker Substudy.

Methods

Participants with information on weight discrimination were analyzed (n=986). At both timepoints, participants self-reported the frequency of perceived weight discrimination across nine scenarios as “never/rarely” (scored as 0), “sometimes” (1), or “often” (2). The two scores were averaged and then dichotomized as “experienced” versus “not experienced” discrimination. High allostatic load was defined as having ≥3 out of 7 dysregulated systems (cardiovascular, sympathetic/parasympathetic nervous systems, hypothalamic pituitary axis, inflammatory, lipid/metabolic, and glucose metabolism), which collectively included 24 biomarkers. Relative risks (RR) were estimated from multivariate models adjusted for sociodemographic and health characteristics, other forms of discrimination, and BMI.

Results

Over 41% of the sample had obesity, and 6% reported weight discrimination at follow-up. In multivariable-adjusted analyses, individuals who experienced (versus did not experience) weight discrimination had twice the risk of high allostatic load (RR, 2.07; 95 % CI, 1.21; 3.55 for baseline discrimination; 2.16, 95 % CI, 1.39; 3.36 for long-term discrimination). Weight discrimination was associated with lipid/metabolic dysregulation (1.56; 95 % CI 1.02, 2.40), glucose metabolism (1.99; 95 % CI 1.34, 2.95), and inflammation (1.76; 95 % CI 1.22, 2.54), but no other systems.

Conclusions

Perceived weight discrimination doubles the 10-year risk of high allostatic load. Eliminating weight stigma may reduce physiological dysregulation, improving obesity-related morbidity and mortality.

     

Suicide Risk Among Holocaust Survivors Following Psychiatric Hospitalizations: A Historic Cohort Study

The association between Holocaust experience, suicide, and psychiatric hospitalization has not been unequivocally established. The aim of this study was to determine the risk of suicide among 3 Jewish groups with past or current psychiatric hospitalizations: Holocaust survivors (HS), survivors of pre-Holocaust persecution (early HS), and a comparison group of similar European background who did not experience Holocaust persecution. In a retrospective cohort study based on the Israel National Psychiatric Case Register (NPCR) and the database of causes of death, all suicides in the years 1981–2009 were found for HS (n?=?16,406), early HS (n?=?1,212) and a comparison group (n?=?4,286). Age adjusted suicide rates were calculated for the 3 groups and a logistic regression model was built to assess the suicide risk, controlling for demographic and clinical variables. The number of completed suicides in the study period was: HS—233 (1.4%), early HS—34 (2.8%), and the comparison group—64 (1.5%). Age adjusted rates were 106.7 (95% CI 93.0–120.5) per 100,000 person-years for HS, 231.0 (95% CI 157.0–327.9) for early HS and 150.7 (95% CI 113.2–196.6) for comparisons. The regression models showed significantly higher risk for the early HS versus comparisons (multivariate model adjusted OR?=?1.68, 95% CI 1.09–2.60), but not for the HS versus comparisons. These results may indicate higher resilience among the survivors of maximal adversity compared to others who experienced lesser persecution.     

Perceived Life Expectancy Is Associated with Colorectal Cancer Screening in England

Background

Cancer screening is a behavior that represents investment in future health. Such investment may depend on how much ‘future’ a person expects.

Purpose

The purpose of this study was to investigate the prospective association between perceived personal life expectancy and participation in fecal occult blood test screening for colorectal cancer (CRC) in a national program.

Methods

Data were from interviews with 3975 men and women in the English Longitudinal Study of Ageing (ELSA) within the eligible age range for the national screening program (60 to 74 years). Perceived life expectancy was indexed as the individual’s estimate of their chance of living another 10–15 years (exact time varied by age), assessed in 2008/2009. Participation in CRC screening from 2010 to 2012/2013 was assessed in 2012/2013. Logistic regression was used to estimate the association between perceived life expectancy and screening participation, adjusted for numeracy and known mortality risk factors.

Results

Overall, 71% of respondents (2817/3975) reported completing at least one fecal occult blood test (FOBt) during the follow-up. Screening uptake was 76% (1272/1683) among those who estimated their 10–15-year life expectancy as 75–100%, compared with 52% (126/243) among those who estimated theirs as 0–25% (adjusted OR 1.74, 95% CI 1.29–2.34).

Conclusions

A longer perceived life expectancy is associated with greater likelihood of participating in CRC screening in England. However, half of people with a low perceived life expectancy still participated in screening. Given that CRC screening is recommended for adults with a remaining life expectancy of ≥10 years, future research should investigate how to communicate the aims of screening more effectively.

     

Long-term Survivors of Childhood Brain Tumors: Impact on General Health and Quality of Life

Purpose of Review

We review and summarize the key issues affecting general health and quality of life (QOL) of pediatric long-term survivors of brain tumors.

Recent Findings

Long-term survivors of brain tumors are at risk of considerable late morbidity and mortality. Lengthening survival in brain tumors has highlighted the deep impact of tumor and its treatment on the physical, psychological, functional, and social health and QOL of these survivors. Evolution in tumor therapy including surgery, radiotherapy, and systemic therapies, etc., has the potential to mitigate this impact to some extent.

Summary

Sensitization of health staff, policy makers, and the primary designers of clinical trials towards integration of QOL end points while measuring survival in brain tumor patients is the need of the hour. New developments in tumor therapeutics must not only provide quantitative gain but also improve the quality of survival in these long-term survivors. While majority of the issues presented pertain to survivorship in pediatric brain tumor population, similar challenges are likely to exist in young adults surviving brain tumors as well.

     

疾病健康教育与康复训练对帕金森病生活质量的影响

目的：评价疾病健康教育与功能康复训练对帕金森病（PD）患者健康生活质量（HR—QOL）的影响。方法：采用随机、单盲、对照设计比较40例原发性PD患者在健康教育与功能康复训练前后生活质量的变化。分析健康教育和康复训练8周前后治疗组与对照组PD患者PDQ-39等的变化。结果：健康教育和康复训练进展顺利,评价良好。8周后治疗组患者生活质量改善明显（P〈0．001）,患者及家属心理状态亦明显改善。结论：疾病健康教育与功能康复训练可以明显改善PD患者的生活质量。这种良性干预不仅是对PD患者除药物治疗以外的一项重要辅助治疗措施,也是慢性疾病管理和“长期医（护）老关怀”的一种有效模式。     

Perceived Mental Illness Stigma and HIV Risk Behaviors Among Adult Psychiatric Outpatients in Rio de Janeiro,Brazil

We examined the associations between perceived mental illness stigma and HIV risk and protective behaviors among adults with severe mental illness (SMI) in Rio de Janeiro, Brazil. We measured mental illness stigma across three domains (“Personal Experiences,” “Perceived Attractiveness,” and “Relationship Discrimination”), and examined the relationship between experiences of stigma in each domain and HIV risk and protective behaviors over the past 3 months in 98 outpatients with SMI. Those who reported greater “Relationship Discrimination” stigma were significantly more likely to be sexually active and to have unprotected sex; they were significantly less likely to report deliberately having fewer partners as a way to protect themselves from HIV. The role of stigma in unprotected sexual behavior should be examined further and considered in any HIV prevention intervention for people with SMI.