Trauma and Personality Correlates in Long Term Pediatric Cancer Survivors

To explore the relationship between PTSD and trauma-spectrum symptoms, including personality and functional correlates, in long term pediatric cancer survivors (N = 40), we assessed these constructs with a structured interview for PTSD, a clinical interview, and self-report questionnaires. Thirty-five out of 40 participants (88%) currently met at least one trauma symptom at a functionally significant level. These survivors demonstrate high levels of restraint and low levels of distress, representative of a repressive adaptive style. After more than 5 years since treatment completion, the relatively high levels of current trauma-spectrum symptoms may reflect the long-term deleterious impact of childhood cancer.     

Truth and reconciliation: a psycholegal perspective

The South African Truth and Reconciliation Commission ('TRC') represents one model of dealing with human rights abuses at a national level. Such abuses, and the subsequent attempts to come to terms with them, can cause mental disorders and psychological pain. Consequently, mental health and mental health practitioners ('practitioners') will play an important role in the process of bodies such as the TRC. The aim of this article is to examine the TRC process from a psycholegal perspective and to recommend which aspects thereof can be improved in the future. For example, the use of terminology such as 'victim' and 'perpetrator' during the process may have influenced how participants were perceived and treated. Likewise, the emphasis on collective, rather than individual interests, restricted the role of survivors and amnesty seekers in the TRC process. This reduced the effectiveness of the TRC in bringing about reconciliation at an individual and a national level, and limited the TRC's potential as a therapeutic agent. Nevertheless, there were claims that the TRC process healed people. It is argued that the process in itself usually did not lead to healing. Instead, the TRC process highlighted great mental health needs, which were not adequately met. The article discusses the factors that make it difficult to meet mental health needs in countries where human rights abuses have taken place. The article then considers strategies to meet these needs and emphasizes how important it is that those who render mental health services are competent and seen to be credible by the consumers of such services. Finally, the article addresses the need for research in this field to be co-ordinated and professionally responsible.     

Breast self-examination in long-term breast cancer survivors

Introduction  For many breast cancer survivors, continued surveillance will be necessary to increase the possibility of finding a new diagnosis in an early stage. One such surveillance approach, breast self-examination, has not been studied specifically in breast cancer survivors. The current study was designed to assess the practice of BSE in a sample of long-term breast cancer survivors, and to examine the personal, emotional, cognitive, and health-care provider factors that may contribute to its performance. Methods  Three hundred forty-five breast cancer survivors (34% response rate, 345/1,001) diagnosed with in situ-stage II breast cancer between 1997–2004 at a community hospital provided answers to a mailed, self-report questionnaire. Results  Seventy-six percent of respondents reported that they had performed a BSE in the last 30-days. Forty percent reported performing BSE once/month, 39% more than once/month, and 21% less than once/month since their diagnosis. Most of the women (90%) reported that a doctor or nurse told them to perform a BSE once/month since their diagnosis, although only 69% had actually been shown how to perform a BSE. Consistently, the perception of increased barriers to BSE performance was associated with performance of BSE less than once/month (OR = 1.4, 95% CI 1.2, 1.6; OR = 0.8, 95% CI 0.8, 0.9). In addition, depending on the model, age (OR = 1.1, 95% CI 1.0, 1.2), perceived effectiveness of cancer treatments (OR = 0.7, 95% CI 0.5, 0.9), and perceived benefits of BSE (OR = 0.8, 95% CI 0.7, 0.9) also was associated with differences in BSE performance. Conclusion  The current study suggests that breast cancer survivors between 4 and 11 years from diagnosis practice BSE, although their perception of the barriers to conducting BSE influences the frequency of this behavior. Further examination is needed to understand why some survivors perceive greater barriers to BSE performance than others. Also needed is a prospective examination of BSE performance using behavioral measures in relation to self-report. Implications for cancer survivors  Increased attention should be paid to this particular screening behavior performed by a majority of breast cancer survivors by both researchers and health-care providers alike. Whether survivors perform the behavior correctly and the impact it has on their emotional and cognitive well-being should be further explored. Supported in part by R25T CA87972     

Consistency of near-death experience accounts over two decades: Are reports embellished over time?

AIM: "Near-death experiences," commonly reported after clinical death and resuscitation, may require intervention and, if reliable, may elucidate altered brain functioning under extreme stress. It has been speculated that accounts of near-death experiences are exaggerated over the years. The objective of this study was to test the reliability over two decades of accounts of near-death experiences. METHODS: Seventy-two patients with near-death experience who had completed the NDE scale in the 1980s (63% of the original cohort still alive) completed the scale a second time, without reference to the original scale administration. The primary outcome was differences in NDE scale scores on the two administrations. The secondary outcome was the statistical association between differences in scores and years elapsed between the two administrations. RESULTS: Mean scores did not change significantly on the total NDE scale, its 4 factors, or its 16 items. Correlation coefficients between scores on the two administrations were significant at P<0.001 for the total NDE scale, for its 4 factors, and for its 16 items. Correlation coefficients between score changes and time elapsed between the two administrations were not significant for the total NDE scale, for its 4 factors, or for its 16 items. CONCLUSION: Contrary to expectation, accounts of near-death experiences, and particularly reports of their positive affect, were not embellished over a period of almost two decades. These data support the reliability of near-death experience accounts.     

A population-based study of prevalence of complementary methods use by cancer survivors: a report from the American Cancer Society's studies of cancer survivors

BACKGROUND: The use of complementary methods (CMs) is widespread and increasing in the United States. Most literature on CM use among cancer survivors focuses on the treatment period, whereas only a few studies address use further along the cancer continuum. METHODS: This study analyzed the prevalence and the medical and demographic associations of CM use among cancer survivors surveyed 10 to 24 months after diagnosis. The study's sample-4139 survivors of 1 of 10 adult cancers-was selected from stratified random samples provided by statewide cancer registries and surveyed by mail and telephone. Three logistic regression models examined associations between medical and demographic factors and CM use among survivors of sex-specific and non-sex-specific cancers. RESULTS: Of the 19 CMs included in the survey, the CMs most frequently reported were prayer/spiritual practice (61.4%), relaxation (44.3%), faith/spiritual healing (42.4%), nutritional supplements/vitamins (40.1%), meditation (15%), religious counseling (11.3%), massage (11.2%), and support groups (9.7%). Among these 19 CMs, the least prevalent were hypnosis (0.4%), biofeedback therapy (1.0%), and acupuncture/acupressure (1.2%). Survivors more likely to use CMs were female, younger, white, higher income, and more educated. CONCLUSIONS: This study provides information regarding prevalence and medical-demographic determinants of CM use reported by a large, population-based sample of survivors of 10 cancers surveyed 10 to 24 months after diagnosis. These findings may be used by clinicians and researchers to inform their decisions regarding which CMs to address in practice and research.     

Lay navigation across the cancer continuum for older cancer survivors: Equally beneficial for Black and White survivors?

ObjectivesThe Patient Care Connect Program (PCCP), through lay navigators' distress assessments and assistance, was shown to lower healthcare utilization and costs in older cancer survivors. PCCP benefits and assistance needs for disadvantaged minorities (e.g., Black) vs. Whites are unknown.Materials and MethodsWe examined the PCCP impact with retrospective analyses of Medicare claims (2012–2015). Outcomes were quarterly costs and utilization (emergency room (ER), hospitalizations) for navigated and matched survivors. Repeated measures generalized linear models with normal (costs), and Poisson (utilization) distributions assessed differences in trends overall and separately for Blacks and Whites. With distress data for navigated survivors, we assessed high distress (score > 3), ≥1 distress cause (overall, by domain), and ≥ 1 assistance request by minority group.ResultsBeneficiaries were: 772 Black and 5350 White navigated, and 770 Black and 5348 White matched survivors. Impact was: i) costs: -$557.5 Blacks (p < .001), ?$813.4 Whites (p < .001); ii) ER: Incidence Rate Ratio (IRR) 0.97 Blacks (NS), 0.93 Whites (p < .001); iii) hospitalizations: IRR 0.97 Blacks (NS), 0.91 Whites (p < .001). There was no significant difference in impact across minority groups. No significant differences were found in high distress (29% Black, 25.1% White), ≥1 distress cause (61.6% Black, 57.8% White), or ≥ 1 assistance request (64.5% Black, 59.1% White). Blacks were more likely to have ≥1 distress cause in the Practical domain.ConclusionThe PCCP may benefit both Black and White older cancer survivors. Programs should consider the proportion of older survivors with high distress, and the specific needs of minorities.     

淋巴瘤幸存者随访期支持性需求体验的质性研究

目的：了解淋巴瘤幸存者随访期支持性需求的真实体验。方法：采用质性研究方法,通过方便抽样选取11例在三级甲等肿瘤专科医院淋巴瘤病区治疗结束进入随访期的幸存者为研究对象进行半结构式深入访谈,并采用Colaizzi 7步分析法进行资料整理与分析。结果：淋巴瘤幸存者随访期支持性需求主要包括疾病相关信息需求（淋巴瘤治疗信息需求、疾病症状管理需求、营养信息需求、社区医疗健康服务需求）、心理重建需求（复发恐惧心理管理需求、焦虑抑郁管理需求）、社会支持需求（家人及同伴支持需求、重返学业或工作的需求、社会救助和经济支持需求等）。结论：淋巴瘤幸存者随访期存在多种支持性需求,护理人员应重视患者随访工作,制定随访计划和工作内容,强化淋巴瘤患者的全程管理,为患者提供专业的心理支持,建立有效的社会支持系统,以期为患者提供更优质的护理服务,提高生存质量。