Providing psychosocial support for breast cancer patients based on screening for distress within a consultation-liaison service

In a consecutive sample of 100 breast cancer patients undergoing radiotherapy, cancer-related distress was assessed with the Hospital Anxiety and Depression Scale and patients' interest in and acceptance of psychosocial support with the Questionnaire for Psychosocial Support and the European Consultation Liaison Workgroup documentation form. 31% of the patients suffered moderate to severe anxiety and/or depression and 42% expressed interest in supportive counselling. The wish for psychosocial support did not correlate with distress (moderate or severe anxiety and/or depression; Kappa = 0.06; P = 0.560). Patients with elevated levels of distress and/or those expressing a wish for psychosocial support were offered counselling by a psychotherapist and a social worker within the framework of a liaison service; 69% of the 58 patients offered such support accepted it. We conclude that screening instruments are helpful in identifying and consequently offering support to patients in need of counselling.     

Change in need for psychosocial support for women with early stage breast cancer

To simulate the longitudinal needs of patients treated for breast cancer, 2 groups of women were recruited. Patients within 6 months of diagnosis were considered in the early group and those 6-12 months after diagnosis were categorized as the late group. Participants were asked to identify effective and ineffective methods of psychosocial support and how those needs changed. Thirty-one women participated in the focus groups. Women in the early group identified problems related to their surgery and chemotherapy; those in the late group focused on symptoms associated with menopause. An exaggerated fear of disease recurrence and death were common to both groups. Most women found it difficult to strike a balance between wanting emotional support and wanting to be treated as normal. The provision of concrete medical information in the form of pathology and laboratory reports and information from health care professionals provided comfort and control. Spouses and partners were helpful in providing tangible assistance with transportation and childcare while female friends were more likely to share emotions. Organized support groups were helpful to only 13%. Participants acknowledged a need to learn how to identify their psychosocial needs and to ask for support from friends and family. Medical information provided patients with a sense of control and comfort. Women with breast cancer need to identify effective sources of emotional support and should be taught how to communicate those needs to their families and friends.     

Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial

BACKGROUND: Mixed reports exist about the impact of supportive-expressive group therapy (SEGT) on survival. METHODS: From 485 women with advanced breast cancer recruited between 1996-2002, 227 (47%) consented and were randomized within an average 10 months of cancer recurrence in a 2:1 ratio to intervention with 1 year or more of weekly SEGT plus three classes of relaxation therapy (147 women) or to control receiving three classes of relaxation therapy (80 women). The primary outcome was survival; psychosocial well-being was appraised secondarily. Analysis was by intention-to-treat. RESULTS: SEGT did not prolong survival (median survival 24.0 months in SEGT and 18.3 in controls; univariate hazard ratio for death 0.92 [95% CI, 0.69-1.26]; multivariate hazard ratio, 1.06 [95% CI, 0.74-1.51]). Significant predictors of survival were treatment with chemotherapy and hormone therapy (p<0.001), visceral metastases (p<0.001) and advanced disease at first diagnosis (p<0.05). SEGT ameliorated and prevented new DSM-IV depressive disorders (p = 0.002), reduced hopeless-helplessness (p = 0.004), trauma symptoms (p = 0.04) and improved social functioning (p = 0.03). CONCLUSIONS: SEGT did not prolong survival. It improved quality of life, including treatment of and protection against depression.     

Optimism, social support and psychosocial functioning among women with breast cancer

Personality, psychosocial, demographic and medical variables have been identified as correlates of adjustment to breast cancer and quality of life (QoL). Most studies have examined relationships between personality, social support and adjustment to cancer in predominantly middle-class Caucasian samples, thus limiting the generalizability of their findings. Eighty-one female outpatients at a medical oncology breast clinic in a county general hospital serving primarily indigent Hispanic and African-American patients completed measures assessing demographic and medical information, health-related QoL, cancer-specific distress, mood disturbance, dispositional optimism and satisfaction with social support. Older age, receipt of treatment and greater optimism accounted for 41% of the variance in emotional well-being (p<0.01). Absence of family history of breast cancer, receipt of treatment and optimism accounted for 43% of the variance in functional well-being (p<0.01). Optimism and satisfaction with social support accounted for 43% of the variance in social/family well-being (p<0.01). Absence of treatment (not yet treated) and pessimism accounted for 31% of the variance in cancer-specific distress (p<0.01). Finally, family history of breast cancer and pessimism accounted for 48% of the variance in mood disturbance (p<0.001). Family history of breast cancer and pessimism were related to mood disturbance (p<0.001). No between-group differences were found for race/ethnicity for any of the variables. Encouraging positive expectations and facilitating social support may help women in public sector medical settings cope with the stressful demands of diagnosis and treatment of breast cancer regardless of race/ethnicity.     

Evaluation of an internet support group for women with primary breast cancer

BACKGROUND: Women with breast carcinoma commonly experience psychologic distress following their diagnosis. Women who participate in breast cancer support groups have reported significant reduction in their psychologic distress and pain and improvement in the quality of their lives. Web-based breast cancer social support groups are widely used, but little is known of their effectiveness. Preliminary evidence suggests that women benefit from their participation in web-based support groups. METHODS: Seventy-two women with primary breast carcinoma were assigned randomly to a 12-week, web-based, social support group (Bosom Buddies). The group was semistructured, moderated by a health care professional, and delivered in an asynchronous newsgroup format. RESULTS: The results indicate that a web-based support group can be useful in reducing depression and cancer-related trauma, as well as perceived stress, among women with primary breast carcinoma. The effect sizes ranged from 0.38 to 0.54. Participants perceived a variety of benefits and high satisfaction from their participation in the intervention CONCLUSIONS: This study demonstrated that the web-based program, Bosom Buddies, was effective in reducing participants' scores on depression, perceived stress, and cancer-related trauma measures. The effect size of the intervention was in the moderate range. Although web-based social support groups offer many advantages, this delivery mechanism presents a number of ethical issues that need to be addressed.     

An interactive process model of psychosocial support needs for women living with breast cancer

Psychosocial support is acknowledged as an important aspect of the care and recovery process for women diagnosed with breast cancer. To develop an understanding of support needs, a series of focus groups were conducted with a total of 80 Australian women living with breast cancer. The psychosocial needs identified in discussion were summarised into four main categories, Organisation of Care, Sense of Control, Validation of Experience and Feeling of Reassurance. From these themes an interactive model of psychosocial support needs was developed. As a process model it demonstrates that the provision of effective support is, necessarily, an integrated, not a piecemeal, process. The categories of support are broad, and are made more inclusive through interactions with each other, providing room to accommodate individual needs and styles of adjustment. The model is not esoteric or complicated - it is an accessible overview of the process for both client and helper.     

Changes in emotion regulation and psychological adjustment following use of a group psychosocial support program for women recently diagnosed with breast cancer

This study assesses the efficacy of a group intervention in altering emotion regulation processes and promoting adjustment in women with breast cancer. Using a design with 10 alternating phases of availability of the intervention versus standard care, we assessed women participating in one of three conditions: a 12-week group intervention (N = 54); a decliner group who refused the intervention (N = 56), and a standard care group who were not offered the intervention (N = 44). The intervention included training in relaxation, guided imagery, meditation, emotional expression, and exercises promoting control beliefs and benefit-finding. Emotion regulation processes and adjustment were assessed at baseline (following diagnosis), 4 months (corresponding with the end of the intervention), 6 months, and 12 months. At 4 months, intervention participants (compared to decliners and standard care participants) reported greater increases in use of relaxation-oriented techniques, perceived control, emotional well-being, and coping efficacy, and, greater decreases in perceived risk of recurrence, cancer worry, and anxiety. Intervention participants also reported relatively greater decreases in emotional suppression from baseline to 12 months, suggesting that the intervention had a delayed impact on these tendencies. The findings suggest an emotion regulation intervention can beneficially influence emotional experiences and regulation over the first year following diagnosis.     

A psychosocial group intervention for Japanese women with primary breast carcinoma

BACKGROUND: To the authors' knowledge, there had been no evidence for the efficacy of psychosocial intervention among Japanese cancer patients. The objective of this study was to determine the effect of a psychosocial group intervention in reducing psychologic distress and enhancing coping in this population in a randomized controlled trial. METHODS: The patient selection criteria were age younger than 65 years, lymph node metastasis positive and/or histologic or nuclear Grade 2-3, and surgery undergone within the previous 4-18 months as of the start of the study. We conducted a 6-week, structured, psychosocial group intervention. The intervention consisted of health education, coping skills training, stress management, and psychologic support. Subjects were assessed for psychologic distress and coping by administering the Profile of Mood States (POMS), Mental Adjustment to Cancer (MAC) scale, and Hospital Anxiety and Depression (HADS) scale at the baseline, at 6 weeks, and at 6 months. RESULTS: Fifty (33%) of the 151 patients participated and were randomized, and 46 (30%) completed the study. The experimental group had significantly lower scores than the controls for total mood disturbance and significantly higher scores for vigor on the POMS, and significantly higher scores for fighting spirit on the MAC at the end of the 6-week intervention. These improvements were sustained over 6 months of follow-up. CONCLUSIONS: The results of this study suggest that a short term psychosocial group intervention produces significant long term improvement in the quality of life of Japanese patients with primary breast carcinoma.     

Restorative yoga for women with ovarian or breast cancer: findings from a pilot study

Yoga has demonstrated benefit in healthy individuals and those with various health conditions. There are, however, few systematic studies to support the development of yoga interventions for cancer patients. Restorative yoga (RY) is a gentle type of yoga that has been described as "active relaxation." The specific aims of this pilot study were to determine the feasibility of implementing an RY intervention as a supportive therapy for women diagnosed with ovarian or breast cancer and to measure changes in self-reported fatigue, psychological distress and well-being, and quality of life. Fifty-one women with ovarian (n = 37) or breast cancer (n = 14) with a mean age of 58.9 years enrolled in this study; the majority (61%) were actively undergoing cancer treatment at the time of enrollment. All study participants participated in 10 weekly 75-minute RY classes that combined physical postures, breathing, and deep relaxation. Study participants completed questionnaires at baseline, immediately postintervention, and 2 months postintervention. Significant improvements were seen for depression, negative affect, state anxiety, mental health, and overall quality of life. Fatigue decreased between baseline and postintervention follow-up. Health-related quality of life improved between baseline and the 2-month follow-up. Qualitative feedback from participants was predominantly positive; relaxation and shared group experience were two common themes.     

Development and evaluation of a culturally sensitive support group programme for Chinese-Australian women with breast cancer: a pilot study

Cancer support groups are an important vehicle for providing informational and psychosocial support to cancer survivors. Studies suggest that people from minority cultures are underrepresented in cancer support groups. The aims of this study were to report the development and evaluation of a culturally sensitive support group programme for Chinese-Australian women with breast cancer and to evaluate the informational and psychosocial impact of the programme. In collaboration with a Chinese cancer support organisation, 29 women were enrolled in the programme which was evaluated by a combination of quantitative and qualitative approaches. The results indicated that the programme was well received by the participants who suggested that the content was useful and relevant. In addition, the findings indicated that the programme, designed to be culturally sensitive and linguistically appropriate, was effective in providing informational support and psychosocial support for the participants. A methodology for giving breast cancer survivors a sense of interconnectedness and thus minimising their feelings of isolation and helplessness, were also among the chief outcomes of this study. The study provided some insight into the development of supportive cancer survivorship care for women being treated for breast cancer in the Australian-Chinese community.     

Genetic testing in young women with breast cancer: results from a Web-based survey

BackgroundYoung women with breast cancer have an increased risk for harboring a BRCA1 or BRCA2 mutation. Frequency of genetic testing and factors associated with testing have not been well described in this population.Patients and methodsWe evaluated the rate of genetic testing among young breast cancer survivors identified through the Young Survival Coalition (YSC), an advocacy group for young women with breast cancer. Items regarding family history and genetic testing were included in a Web-based cross-sectional survey.ResultsA total of 701 women were eligible based on a history of breast cancer diagnosed ≤40 years. Mean age at diagnosis was 32.9 years and mean age at survey 35.7 years. About 41% reported a first- or second-degree relative with breast or ovarian cancer. About 24% had undergone genetic testing, and 26% of those tested reported that a mutation was found. By multivariate logistic regression, likelihood of having undergone testing was higher in women who were younger at diagnosis, were more educated, had a first- or second-degree relative with breast or ovarian cancer, had a mastectomy rather than breast conservation, and considered themselves at high risk for a cancer-predisposing mutation.ConclusionMost women diagnosed with breast cancer ≤40 years do not undergo genetic testing.     

Family support for native Hawaiian women with breast cancer

BACKGROUND: A cancer diagnosis affects not only the individual but the entire family. Despite the growing body of literature on family support as a resource in cancer care, there is very little research on how cancer affects families in non-Western cultures. A minority population that experiences a disproportionate burden from cancer is Native Hawaiian women. METHODS: In this study, 8 Native Hawaiian women with breast cancer and 17 family members of other Native Hawaiian women with breast cancer participated in focus groups examining family support. Specifically, types of support provided by the family (eg, informational, emotional, and tangible), changing dynamics of family roles, and recommendations for health care providers, with attention paid to the influence of culture on family support, were topics that were examined. RESULTS: Similarly to other populations, Native Hawaiians viewed the family as the most important source of emotional and tangible support for women with cancer, and identified a need for increased informational support for both patients and families in the face of cancer. However, their reference to specific cultural values and practices within the 'ohana (family) [eg, haku (family liaison) and ho'omana (spirituality)] reflects a uniqueness that has implications for clinical work with this population. CONCLUSIONS: Consideration of cultural values and practices may enhance health care services for this population.     

Applicability of a Western-developed psychosocial group intervention for Japanese patients with primary breast cancer

This paper examines the applicability of psychosocial group intervention for Japanese patients with primary breast cancer. The study included two phases. First, we examined the applicability for Japanese patients of an intervention model developed in a Western country. The model, based on the work of Fawzy and Fawzy (1994) on a structured psychosocial group intervention for cancer patients, is a series of six 1.5-h sessions that incorporate health education, coping-skills training, relaxation training and psychological support. Second, we formulated a Japanese version of the intervention model by modifying areas identified as inappropriate by participants in the first-phase study. We then evaluated this by conducting sessions of the modified model with 44 additional breast cancer patients. Of the ten participants in the first-phase pilot study, three (30%) dropped out and several inappropriate areas were reported. The areas requiring significant change were the provision of medical information and communication style with family members and doctors. No participants dropped out of the modified version, and very few found any program areas to be inappropriate. The findings suggests that psychosocial group intervention is applicable for Japanese breast cancer patients when the model accounts for cultural differences.     

Measurement in group interventions for women with breast cancer

Instrumentation is a critical component of intervention research. This article discusses a review of measurement tools used in research on group interventions for women with breast cancer. The wide variety of instruments used in research studies is listed. The criteria for instrument selection are compared with the most commonly used instrument, the Profile of Mood States. The authors summarize directions for future research related to instrumentation use.