Does psychosocial intervention in cancer patients affect survival and psychological well-being?]

We have critically reviewed the scientific literature examining the effect of psychosocial interventions on survival and well-being among adult cancer patients. Only studies using randomization and including a control-group not receiving psychosocial intervention were reviewed. Six studies examined the effect on prognosis. In four of these studies survival increased significantly in the intervention group as compared to the control group. All of these studies, however, have methodological flaws, leaving a possible prognostic effect to be clarified in larger, well-controlled future studies. The effect of psychosocial intervention on various psychosocial variables (such as anxiety and depression) was evaluated in 20 studies. Differences in patient populations, intervention strategies, and outcomes decrease the comparability of the results, and the majority of these studies suffer from methodological flaws as well. A positive effect on anxiety and depression immediately following the intervention is, however, reported in the majority of these studies. It is thus possible that the level of anxiety and depression may be decreased by integrating psychosocial intervention in the overall treatment of cancer.     

Curvilinear associations between benefit finding and psychosocial adjustment to breast cancer.

Two previously studied cohorts of women with nonmetastatic breast cancer (Ns = 230 and 136) were reexamined. Participants were assessed during the year after surgery and 5-8 years later. Associations were examined between benefit finding (BF) and several indicators of psychosocial adjustment (e.g., perceived quality of life, positive affect, negative affect, social disruption, and intrusive thoughts). Significant curvilinear relations between BF and other outcomes were observed cross-sectionally during initial assessment and at long-term follow-up in both samples. Compared with the intermediate BF group, low and high BF groups had better psychosocial adjustment. Further analyses indicated that the high BF group reported higher optimism and more use of positive reframing and religious coping than the other BF groups. Discussion highlights the need to examine nonlinear as well as linear relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The treatment decision-making process: age differences in a sample of women recently diagnosed with nonrecurrent, early-stage breast cancer

This research utilizes retrospective, self-report data collected from a nonprobability sample of women recently diagnosed with nonrecurrent, early-stage breast cancer to better understand how the treatment decision-making process varies with patient age. Three important areas--context, decision-making style, and influencing factors--are examined using bivariate and multivariate analyses. Findings indicate that although patients recalled similar contextual attributes, they reported attitudes, behavior, and considerations that differed by age. Older women were less likely than their younger counterparts to have desired participation in therapy selection, sought out medical information, or considered the possibility of recurrence when making treatment decisions.     

Bidimensional measurement of acculturation in a multiethnic community sample of first-generation immigrants.

Despite the rapid growth of the acculturation research literature in recent years, few studies have examined acculturation among community samples of immigrants in Canada. The present study used a bidimensional approach to examine acculturation among Anglophone Caribbean (n = 109), Vietnamese (n = 97), and Filipino (n = 109) first-generation immigrant adults living in a diverse urban community in Montreal, Quebec, Canada. Heritage and mainstream cultural orientations were independently assessed in 3 domains of acculturation: loyalty, behaviour, and situated identity. Across the 3 domains and the 3 groups, the 2 cultural orientations were largely independent, though in the Vietnamese and Filipino samples heritage group loyalty was positively related to mainstream group loyalty. Overall, results support a bidimensional model of acculturation and suggest the value of separately assessing different acculturation domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability and determinants of psychosocial well-being in multiple sclerosis.

Illness-induced lifestyle disruption was hypothesized to compromise psychosocial well-being (PW) in multiple sclerosis (MS) by (1) interfering with continued involvements in valued activities and interests and (2) decreasing personal control over important life domains. Three categories of illness-related variables (IRVs) were hypothesized to contribute to increased illness intrusiveness (ILI): burden of illness, functional deficits, and physical disabilities. Measures of ILI, personal control, PW, and IRVs were obtained from 94 people with MS on 3 occasions over 18 mo. Regression analyses supported the proposed model and indicated that each of the hypothesized determinants was significantly and uniquely related to the perception of ILI. Approximately two-thirds of the Ss achieved a positive psychosocial adjustment to MS, but the rest reported elevated levels of emotional distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unemployment and the likelihood of detecting early-stage breast cancer

Laparoscopic surgery is one of the treatment modalities available to urologists, who must be familiar with the concepts of the physiology of CO2 and its clinical consequences. CO2 is absorbed during insufflation, leading to hypercapnia, reaching a steady-state from the 20th minute. The insufflation pressure must be between 10 and 14 mmHg. Intraoperative surveillance is based on oxygen saturation (pulse oximeter) and capnography, which measures the CO2 concentration of expired air. The causes of hypercapnia must be prevented: untimely recovery, retroperitoneal dissection, excessive intra-abdominal pressure. If hypercapnia occurs, the patient must be exsufflated and the operation should be resumed after a certain interval. The specific complications of laparoscopy (gas embolism, arrhythmias, pneumothorax) can be avoided by respecting the rules of security and by maintaining surveillance during recovery. The pain due to diaphragmatic peritoneal irritation can also be decreased by complete exsufflation.     

Extending the activity restriction model of depressed affect: Evidence from a sample of breast cancer patients.

Survey data from 95 women with Stage 1 (n?=?36), Stage 2 (n?=?49), or Stage 3 (n?=?10) breast cancer both confirm and extend prior research indicating that restriction of normal activities is an important factor in depressed affect. Illness severity was directly related to more restricted routine activities, and more activity restriction was associated with higher public self-consciousness and less social support. Beyond the effects of age, self-consciousness, illness severity, and social support, activity restriction explained significant additional variance in symptoms of depression. Moreover, activity restriction mediated the impact of pain, public self-consciousness, and social support on depressed affect, which implies that these factors foster symptoms of depression by disrupting normal activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer

OBJECTIVE: To develop a short, patient-based questionnaire for auditing the outcomes of treatment for benign prostatic hyperplasia (BPH) and to evaluate the acceptability, reliability and validity of the measure. PATIENTS AND METHODS: Data from a long research questionnaire used in the Oxford/North West Thames Prostatectomy Study were analysed to identify the subset of items which contained the most scientifically sound indicators of outcome. Items were selected on the basis of standard psychometric analyses to develop a short questionnaire, the Prostate Outcomes Questionnaire (POQ), a 27-item instrument covering urinary symptoms, complications after surgery, quality of life and patient satisfaction with outcome. The POQ was field tested for acceptability, reliability and validity in a postal survey of 125 men undergoing transurethral resection of the prostate for BPH from seven hospitals in south-east England. RESULTS: The POQ was highly acceptable to patients, as indicated by a 95% response rate, the absence of 'floor' and 'ceiling' effects and a low proportion of missing data. It showed excellent internal consistency reliability (Cronbach's alpha of 0.82-0.93 for the five summary scales and a mean item-total correlation of 0.56) and test-retest reliability (test-retest correlations for items were 0.40-1.00, with a mean test-retest correlation of 0.85, and for summary scales of 0.91-0.95). Construct validity was confirmed by: high intercorrelations between the five summary scales and the total score (0.88-0.95), with a pattern of intercorrelations among specific subscales that showed item-convergent and discriminant validity; higher scores for patients who reported an improvement after surgery than in those who were not improved (P < 0.001); the expected gradient of scores for patients reporting different levels of symptom distress (P < 0.001); high correlations with the longer parent questionnaire (0.75-0.88); and low to moderate correlations with the Nottingham Health Profile and Activities of Daily Living scores (0.15-0.67), with the pattern of correlations providing evidence of scale convergent and discriminant validity. Correlations with age and social class were low, suggesting that responses were not biased by sociodemographic factors. CONCLUSION: The POQ is a practical and scientifically sound patient-based measure of outcome after treatment for BPH which can be used for routine audit. It takes < 5 min to complete, is feasible for routine monitoring of large numbers of patients by postal survey, and is accompanied by a Users' Manual which provides practical help in conducting a local patient survey, and a computer program for scoring data. Most importantly, the POQ has been shown scientifically to perform well, having met standard psychometric criteria for reliability and validity.     

Peer victimization and academic achievement in a multiethnic sample: The role of perceived academic self-efficacy.

This study examines the link between perceived peer victimization and academic adjustment in an ethnically diverse sample of 1,895 Grade 6 students nested within 108 school classes. It was hypothesized that students' academic self-efficacy mediates the (negative) link between victimization experiences and academic achievement outcomes. Multilevel analyses were used to test this hypothesis and to explore whether there are differences between ethnic minority and majority group children. Results indicated that peer victimization was negatively associated with both relative class-based, and absolute test-based measures of academic achievement. These associations were similar across different school classes. As expected, the link between victimization and achievement was mediated by perceived academic self-efficacy, suggesting that victimized students did less well academically because they considered themselves to be less competent. The lower perceived self-efficacy of victimized children could be partly attributed to lower global self-esteem and depressed affect. Results were largely similar for ethnic minority and majority group children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The MMPI as a predictor of psychosocial adaptation to cancer.

Examined the utility of the MMPI as a longitudinal predictor of psychosocial adaptation to cancer. A sample of 133 newly diagnosed cancer patients (mean age 50.2 yrs) representing 5 types of neoplastic disease was selected from consecutive hospital admissions. Patients were given the MMPI at the time of diagnosis and were evaluated at 5 follow-ups over a period of 6 mo. Dependent measures of adjustment included a composite emotional distress indicator (Profile of Mood States plus Index of Vulnerability), percentage of problems in 6 psychosocial areas (Inventory of Current Concerns), actual problem resolutions, and reported number of physical symptoms. Semistructured interviews were also completed. A multiple regression analysis showed that significant amounts of variance (p?p?     

Concerns about misinterpretation and placement of blame.

Clarifies remarks made by E. Schopler (see record 1987-32878-001) in response to a comment by T. Smith (1988) on specific vs nonspecific (placebo) effects on treatment outcomes. While the use of electric shock to encourage social behavior in autistic children (O. T. Lovaas et al, 1965) was a mistake based on erroneous beliefs, the lesson to be learned is that punishment (such as belittling colleagues' mistaken efforts) is not a constructive method for inducing change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions, beliefs about control, and adjustment to breast cancer.

Examined attributions for cancer and beliefs about control over cancer for their association with adjustment to breast cancer. 78 29–78 yr old females with breast cancer served as Ss. Ss were administered a battery of tests that included the Profile of Mood States, Rotter's Internal–External Locus of Control Scale, and the Rosenberg Self-Esteem Scale. Although 95% of the Ss made attributions for their cancer, no particular attribution (e.g., stress, diet) was associated with better adjustment. Analyses of attributions of responsibility for the cancer to the self, environment, another person, or chance yielded only a negative relation between adjustment and blaming another person. In contrast, both the belief that one could now control one's cancer and the belief that others (e.g., the physician) could now control the cancer were significantly associated with good adjustment. Of the different types of control, cognitive control was most strongly associated with adjustment, behavior control was less strongly associated with adjustment, and information control and retrospective control were unassociated with adjustment. (56 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High-titer HER-2/neu protein-specific antibody can be detected in patients with early-stage breast cancer

PURPOSE: To evaluate HER-2/neu-specific antibody immunity in patients with breast cancer, to determine the rate of occurrence of serum antibodies to HER-2/neu in patients with breast cancer, and to relate the presence of specific immunity to overexpression of HER-2/neu protein in primary tumor. METHODS: The antibody response to HER-2/neu protein was analyzed in 107 newly diagnosed breast cancer patients. Sera was analyzed for the presence of HER-2/neu-specific antibodies with a capture enzyme-linked immunosorbent assay (ELISA) and verified by Western blot. Sera from 200 volunteer blood donors was used as a control population. RESULTS: The presence of antibodies to HER-2/neu correlated with the presence of breast cancer. HER-2/neu antibodies at titers of > or = 1:100 were detected in 12 of 107 (11%) breast cancer patients versus none of 200 (0%) normal controls (P < .01). The presence of antibodies to HER-2/neu also correlated to overexpression of HER-2/neu protein in the patient's primary tumor. Nine of 44 (20%) patients with HER-2/neu-positive tumors had HER-2/neu-specific antibodies, whereas three of 63 (5%) patients with HER-2/neu-negative tumors had antibodies (P = .03). The antibody responses could be substantial. Titers of greater than 1:5,000 were detected in five of 107 (5%). CONCLUSION: The presence of HER-2/neu antibodies in breast cancer patients and the correlation with HER-2/neu-positive cancer implies that immunity to HER-2/neu develops as a result of exposure of patients to HER-2/neu protein expressed by their own cancer. These findings should stimulate further studies to develop the detection of immunity to oncogenic proteins as tumor markers, as well as the development and testing of vaccine strategies to induce and augment immunity to HER-2/neu for the treatment of breast cancer or prevention of recurrent disease.     

Modeling the cost-effectiveness of granulocyte colony-stimulating factor use in early-stage breast cancer

PURPOSE: To model the cost-effectiveness (CE) of granulocyte colony-stimulating factor (G-CSF) in early-stage breast cancer when its use is directed to those most in need of the medication. METHODS: A conditional CE model was developed for the use of G-CSF based on a ranking of patient need as determined by patient blood counts during the first cycle of chemotherapy. In the base case, no G-CSF was used. In the alternative case, G-CSF was used in the following manner. If the risk of a neutropenic event (as defined by a predictive model based on nadir absolute neutrophil count [ANC] and hemoglobin decrease in cycle 1) was equal to or exceeded a predetermined critical value "T," then patients would receive G-CSF in cycles 2 through 6 of chemotherapy. If the risk of an event was less than T, patients would not use G-CSF unless an event occurred, at which time G-CSF would be administered with every subsequent cycle. RESULTS: A decision rule (T) that would allow the most needy 50% of early-stage breast cancer patients to receive G-CSF after the first cycle of chemotherapy resulted in a CE ratio of $34,297 dollars per life-year saved (LYS). If only the most needy 10% of patients received G-CSF, then the associated CE ratio was $23,748/LYS; if 90% of patients could receive the medication, the CE ratio would be $76,487/LYS. These estimates were relatively insensitive to inpatient hospital cost estimates (inpatient costs for fever and neutropenia of $3,090 to $7,726 per admission produced dollar per LYS figures of $34,297 to $32,415, respectively). However, the model was sensitive to assumptions about the shape of the relationship between dose reduction and disease-free survival (DFS) at 3 years. CONCLUSION: Providing G-CSF to the neediest 50% of early-stage breast cancer patients (as defined by first-cycle blood counts) starting after the first cycle of chemotherapy is associated with a CE ratio of $34,297/LYS, which is well in the range of CE ratios for treatment of other common medical conditions. Furthermore, conditional CE studies, based on predictive models that incorporate individual patient risk, allow one to define populations for which therapy is, or is not, cost-effective. Limitations of our present understanding of the shape of the chemotherapy dose-response curve, especially at low levels of dose reductions, affect these results. Further work is required to define the shape of the dose-response curve in early-stage breast cancer.     

Social relations and depressive symptomatology in a sample of community-dwelling French older adults.

This study examined the association between social relations and mental health, specifically the relative contribution of social networks and social support to depressive symptomatology. The culturally unique representative sample consisted of 3,777 noninstitutionalized older persons living in southwestern France. The findings indicated that French older adults generally had more than 8 people in their networks, their networks consisted mostly of family members, and they felt understood by most of their network members. These older adults reported being satisfied with their social relations. Sociodemographic variables contribute (R–2?=?.143) to depressive symptomatology, as did social network (incremented R–2?=?.033) and social support (incremented R–2?=?.09) variables. Sociodemographic, social network, and social support variables together increased the variance explained still further (incremented R–2?=?.108). Results were consistent with similar analyses in the US and indicated that social support variables account for more variance in depressive symptomatology than social network variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bi-directional relations between anti-smoking parenting practices and adolescent smoking in a Dutch sample.

Objective: Parenting is generally regarded a determinant of adolescent behavior, whereas the reverse is seldom considered. Reported effects of anti-smoking parenting practices on adolescent smoking are inconsistent. Cross-sectional results may have been misinterpreted and child effects have been overlooked. The main goal of this study was to explain previous inconsistent effects of anti-smoking parenting practices, by examining bi-directional relations between parenting and adolescent smoking. Design and Main Outcome Measures: Bi-directional relations were studied using a cross-lagged model where anti-smoking house rules, communication about smoking, and adolescent smoking were assessed at three subsequent years. Results: The most prominent finding was that adolescent smoking behavior was a stronger predictor of parenting than vice versa. Anti-smoking house rules decreased as a result of adolescent smoking behavior, while communication increased. The reduction in house rules was more pronounced if parents smoked, while the increase in communication was greater for non-smoking parents. Results were independent of adolescent sex. Conclusion: Further research is needed to establish which aspects of parenting can be effective in deterring adolescent smoking. This study emphasizes the need for caution in interpreting cross-sectional research findings relating parenting to adolescent smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Specific worry about breast cancer predicts mammography use in women at risk for breast and ovarian cancer.

This longitudinal study examined predictors of mammography use among women with a family history of breast cancer participating in a risk assessment and surveillance program (N?=?213). Assessed were background variables (age, prior mammography utilization), cognitive variables (perceived vulnerability), and affective variables (cancer worry and general distress). Results of logistic regression analyses predicting adherence 1 year after baseline contact, in which variables of prior utilization, feelings of vulnerability, and general distress were controlled for, indicated that and age were significant predictors of mammography adherence. Results suggest that moderate levels of cancer worry facilitate, rather than undermine, adherence. The results have implications for the construction of educational messages that should be designed to acknowledge feelings of cancer-specific worry and to provide guidance in health protective behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

More may not be better in psychosocial interventions for cancer patients.

Comments on the article by M. H. Antoni et al (see record 2000-14051-003) which tested the effects of a 10-week group cognitive-behavioral stress management intervention among female breast cancer patients. The authors express concern that this profession is offering interventions that patients in need cannot access and studying patients who may not be in particular need of intervention and who therefore fail to demonstrate substantial improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical and psychosocial outcomes in cancer patients: a comparison of different age groups

In situ hybridization of a digoxigenin-labeled oligonucleotide probe combined with computer assisted image assessment was used to directly visualize D1 dopamine receptor mRNA-containing neurons in rat striata, and quantify age-related changes in the sizes and relative mRNA content of these neurons. It was found that 1) numbers of D1 mRNA-containing neurons appear to decrease in striata of aged rats; 2) relative amounts of D1 receptor mRNA in individual striatal neurons do not change during aging; and 3) neurons of all sizes appear to be lost, with the greatest absolute decrease in those larger than 150 microns2. These data confirm the age associated loss of D1 dopamine receptors reported for some other rat strains in that species, and further suggest that neuronal loss is responsible for the decrement. The latter finding contrasts with the aging associated loss of D2 dopamine receptors, which additionally involves decreased amounts of mRNA per cell.     

Facets of support related to well-being: Quantitative social isolation and perceived family support in a sample of elderly women.

The purpose of this study was to examine the independent and interactive relationships of measures of network embeddedness and perceived social support with mental and physical health measures from responses of a sample of 271 community-dwelling elderly women. Quantitative social isolation was measured as the co-occurrence of low network embeddedness with family and with friends. There was a threshold effect such that quantitatively isolated participants had poorer psychological well-being and functional health than did nonisolated participants. This effect was independent of perceived support levels. The pattern was different for perceived social support. Elderly women with low perceived family support had poorer psychological well-being regardless of perceived support from friends or network embeddedness. Implications are discussed for several unanswered questions in the social support literature, including possible interventions for the quantitatively isolated and for those with low levels of perceived support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)