Psychological adjustment among African American breast cancer patients: One-year follow-up results of a randomized psychoeducational group intervention.

The effectiveness of support group interventions for cancer patients has been established among White patients but has been virtually unstudied among minority patients. The current study represents the 1st randomized support group intervention targeted to African American women with breast cancer. Participants (N = 73) with nonmetastatic breast cancer were randomly assigned to an 8-week group intervention or an assessment-only control condition At 12 months, the intervention resulted in improved mood as well as improved general and cancer-specific psychological functioning among women with greater baseline distress or lower income. Subsequent research is needed to address effective methods of enrolling and following women with fewer psychosocial and financial resources, as they were the most likely to benefit from this particular intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic effects of methylmercury in rats. I. Biochemical aspects

The effect of a pre-coronary angioplasty education and counselling program on knowledge and psychological status of patients and on knowledge and quality of life/coping status of their spouses was evaluated. Forty patients and their spouses participated in a pre-coronary angioplasty education and counselling program and 40 served as controls. Knowledge, psychological status and quality of life/coping status were assessed prior to coronary angioplasty and at a mean of four and 11 months post-coronary angioplasty. At four months, improved knowledge and reduced anxiety were found for patients in the experimental group. At 11 months, spouses in the experimental group showed continued improvement in quality of life compared to those in the control group. It was concluded that pre-coronary angioplasty education and counselling can impact favourably upon knowledge in patients and quality of life in spouses.     

Tumor risk consultation for predisposed women from high risk cancer families

Germline mutations of the cancer susceptibility genes BRCA1 and BRCA2 seem to lead to a very high risk for breast and/or ovarian cancer. Therefore, genetic counselling and identification of high-risk families may be essential to offer the opportunity to participate in a specific early cancer detection program and to provide individualized psychological support. In a two year period (August 1994-August 1997) 304 consultees present for genetic counselling at the interdisciplinary cancer genetic clinic (Department of Obstetrics & Gynecology and Human Genetics, Heinrich-Heine-Universit?t, Düsseldorf). For genetic testing a BRCA1/2 mutation detection strategy including protein truncation test (PTT), single strand conformation polymorphism (SSCP), and direct DNA sequencing is used. 161 families fulfilled the inclusion criteria; at present, 72 families for whom complete analytical material is available are analyzed. Although genetic testing for BRCA1 and BRCA2 is technically challenging, women with a family history of multiple sporadic breast/ovarian cancers and those with a hereditary BRCA1 and BRCA2 gene defect may be distinguished. For the first group of consultees this may ease their concern, for the second group preventive measures including an early cancer detection or prevention program, psychological support or prophylactic surgery may be discussed.     

Psychological disease adjustment in breast cancer patients

In a prospective follow-up study, attention was focused on adjustment to disease in breast cancer patients one year after diagnosis. Prebioptic data was collected in the original patient group consisting of 95 women with mammary tissue findings that required clarification. Twenty-nine women with histological confirmation of breast cancer and 37 patients of the control group with benign histological findings were recontacted after an interval of one year. Data was collected by means of psychological test questionnaires (STAI, SVF, FPI, CIP-DS), the patients with breast cancer were given an additional problem-oriented questionnaire about coping with disease, compiled by the author. Most denied having disease-related fears-progression of the disease, premature death; instead, marked sleep disturbances, regularly, recurring nightmares, and depressed states of mind characterized the psychosomatic correlate of the mental burden. The psychological consequences of cancer are related to some extent to the stage of tumour growth at the time of diagnosis; the process of social reintegration appears to be facilitated in women whose biopsy operation did not involve removal of a breast. An clear characterization of breast cancer patients could not be established using psychological testing procedures one year after diagnosis of the disease.     

Family history of breast cancer: what do women understand and recall about their genetic risk?

The current study has two aims: (1) to look at people's recall of risk information after genetic counselling and (2) to determine the impact of receiving an audiotape of the genetic consultation on level of recall, cancer related worry, and women's uptake of risk management methods. Using a prospective randomised controlled design, subjects receiving an audiotape were compared with a standard consultation group. Participants were drawn from attenders at the genetic clinics of two London hospitals and included 115 women with a family history of breast cancer. Assessment of perceived genetic risk, mental health, cancer worry, and health behaviour was made before counselling at the clinic (baseline) and by postal follow up. Usefulness of audiotapes and satisfaction with the clinical service was assessed by study specific measures. The data indicate that cancer worry is reduced by provision of an audiotape of the genetic consultation. Recall of the genetic risk figure, however, is not affected by provision of an audiotape and neither is it related to women's overall perception of being more or less at risk of breast cancer than the average woman. Forty-one percent of women accurately recalled their personal risk of breast cancer at one month follow up; however, 25% overestimated, 11% underestimated, and 23% could not remember or did not know their breast cancer risk. Recall of the risk figure is more accurate when the clinical geneticist has given this to the woman as an odds ratio rather than in other formats. Subsequent health behaviour is unaffected by whether women have an audiotape record of their genetic consultation. Results suggest that having a precise risk figure may be less important than women taking away from the consultation an impression that something can be offered to help them manage that risk. Provision of an audiotape of the consultation is of limited usefulness. The need for psychological care to be better integrated into genetic counselling at cancer family clinics was highlighted by the study. The results are discussed in terms of future service development.     

Social-cognitive processes as moderators of a couple-focused group intervention for women with early stage breast cancer.

Objective: The purpose was to examine whether social-cognitive variables would moderate the efficacy of a couple-focused group intervention (CG) for women diagnosed with early stage breast cancer. Design: Participants (N = 238) were randomly assigned to 6 sessions of a couple-focused group versus usual care. Intent to treat growth curve modeling analyses indicated that emotional expression and emotional processing moderated CG effects on depression. Main Outcome Measures: The primary outcome measures for this study were psychological distress and psychological well-being. Results: Treatment attrition analyses separating out participants assigned to but not attending CG indicated that emotional expression, emotional processing, and protective buffering moderated the effects of CG among those who attended CG with the most consistent effects noted for emotional processing on indicators of distress and well-being. Conclusion: The CG intervention may be more effective for patients who begin the group experience using emotional approach coping strategies to deal with cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of preoperative therapy with angiotensin-converting enzyme inhibitors on clinical outcome after cardiovascular surgery

PURPOSE: Quality of life of breast cancer survivors 8 years after diagnosis was compared with that among similarly aged women who had never confronted cancer (controls). METHODS: Survivors of a consecutive series of 227 breast cancer patients first treated in 1984 were approached for this study. Random-digit dialing was used to identify controls with the same age and residential distribution as the survivors. Quality of life was assessed in terms of physical health, functional status, psychologic distress, and social functioning. RESULTS: Participation was obtained from 96% (n = 124) of 129 eligible survivors and 61% (n = 262) of 427 potentially eligible controls. Consistently smaller proportions of survivors reported positive quality-of-life outcomes compared with controls, but these differences were generally small and nonsignificant statistically. When limited to women who remained free of disease over the entire follow-up period (n = 98), survivors' quality of life was similar to that among controls, with the exception of arm problems and sexual satisfaction for those women who lived with a partner. In contrast, survivors who developed recurrence or new primary breast cancer (n = 26) experienced a worse quality of life in all domains except social functioning. CONCLUSION: In most domains and for women without further disease events after diagnosis, quality of life does not seem to be permanently and globally impaired by breast cancer. Consequently, breast cancer survivors who remain free of disease probably do not need organized late psychosocial follow-up to improve quality of life. However, arm problems and sexuality are two areas in which additional effort may be still needed to improve quality of life of long-term survivors.     

Effects of psychotherapy in moderately severe COPD: a pilot study

Anxiety is common in the "pink puffer" syndrome associated with chronic obstructive pulmonary disease (COPD). The degree of anxiety correlates well with perceived dyspnoea. This pilot study examines the effect of group psychotherapy on anxiety, exercise tolerance, dyspnoea and quality of life. Ten patients with moderately severe, stable COPD (mean forced expiratory volume in one second (FEV1)-1.15 L) had six 90 min sessions of cognitive and behavioural psychotherapy at weekly intervals. Patients completed the Hospital Anxiety and Depression Scale (HADS), Medical Research Council Questionnaire (MRCQ) and St George's Respiratory Questionnaires (SGRQ), 1 week before and after therapy. FEV1, forced vital capacity (FVC), slow vital capacity (SVC), blood gas tensions and 6 min walking distance (6MWD) were measured. Eight control patients attended weekly for lung function and 6MWD for 6 weeks, but had no psychotherapy. Mean baseline HADS score was significantly higher in the psychotherapy group (12) than in controls (7), but otherwise there were no differences in lung function, blood gas tensions, 6MWD, or the other questionnaire scores between groups. After treatment, the physiological and psychological parameters where unchanged in both groups with the exception of the mean 6MWD, which had improved in the psychotherapy group only, from 351 to 423 m (p<0.001), an increase of 24%. Three months after treatment, the 6MWD was still 16% above the baseline value (p=0.02). In conclusion, six sessions of cognitive and behavioural psychotherapy produced a sustained improvement in exercise tolerance in a group of 10 anxious patients with severe chronic obstructive pulmonary disease, without any change in anxiety scores on the Hospital Anxiety and Depression Scale. Further studies of more prolonged, intensive psychotherapy would establish whether better symptom and quality of life scores accompany more dramatic increases in exercise tolerance in "pink puffers".     

Identification of DNA binding sites for the V-erbA oncoprotein, the viral homolog to thyroid hormone receptor alpha

It is estimated that 20-25% of cancer patients suffer often unrecognized and untreated long-term depression, a condition that can make life miserable. Symptoms can include: lack of sleep; loss of interest in life; anxiety; irritation; loss of concentration; and, in severe cases, thoughts of suicide; leading to an overall poor quality of life. Given that the majority of patients diagnosed with clinical depression can be effectively treated with one form of treatment or another (psychological, pharmacological or a combination) it is now important that health care professionals routinely assess and offer treatment for depression in cancer patients. Therefore, this article reviews the literature on depression caused by cancer and highlights practical ways in which health care workers can measure and subsequently treat depression using pharmacological and psychological approaches.     

How and for whom are decision aids effective? Long-term psychological outcome of a randomized controlled trial in women with newly diagnosed breast cancer.

Objective: The current study evaluates the long-term psychological impact of a decision aid intervention for surgical and systemic treatment in women with newly diagnosed breast cancer from a previous reported randomized, controlled trial (Vodermaier et al., 2009). Methods: Patients (n = 111) were randomized into usual care, or a 20-min decision aid intervention plus an information brochure prior to consultation planning with the senior physician. The retention rate at 1 year was 88%. Results: Linear mixed model analyses demonstrated that the intervention group experienced less decisional conflict (p = .047; d = .19), which was driven by perceptions of a more effective choice (p = .029; d = .20) over time. Subgroup analyses revealed that patients in the intervention group who participated in chemotherapy decision making showed better long-term body image outcomes (p = .009; d = .44), which were mediated by reduced depressive coping (p = .049). No effects emerged for anxiety and depressive symptoms, or for quality of life. Internal health locus of control moderated group effects on 'uncertainty with the decision' (p = .003). Conclusions: The study results provide novel evidence on the role of individual differences and the mechanisms behind decision aid effectiveness, and demonstrate the long-term impact of decision aid interventions on some indices of well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group support for patients with metastatic cancer. A randomized outcome study

The effects of weekly supportive group meetings for women with metastatic carcinoma of the breast were systematically evaluated in a one-year, randomized, prospective outcome study. The groups focused on the problems of terminal illness, including improving relationships with family, friends, and physicians and living as fully as possible in the face of death. We hypothesized that this invention would lead to improved mood, coping strategies, and self-esteem among those in the treatment group. Eighty-six patients were tested at four-month intervals. The treatment group had significantly lower mood-disturbance scores on the Profile of Mood States scale, had fewer maladaptive coping responses, and were less phobic than the control group. This study provides objective evidence that a supportive group intervention for patients with metastatic cancer results in psychological benefit. Mechanisms underlying the effectiveness of this group intervention are explored.     

The prevalence and detection of psychiatric morbidity in patients with metastatic breast cancer

This study monitored the prevalence and detection of psychiatric morbidity in 80 women newly diagnosed with metastatic breast cancer from diagnosis of metastatic disease over a 16-month period. Patients were interviewed at home every 8 weeks using the Hospital Anxiety and Depression Scale (HADS) and an interview schedule compiled by the author to monitor contact with members of the multidisciplinary team, demographic details, current treatment and sites of metastatic spread. One way analysis of variance (ANOVA) comparing the mean anxiety and depression scores at each interview demonstrated that there were no statistically significant differences in mood across the eight interviews, though there was a trend over the course of the eight interviews for mean anxiety and depression to decrease. Using the cut off scores suggested by the authors of the HADS, the scores were then categorized into case, borderline and normal. These analyses illustrated the relatively large proportion of patients who fell into the borderline and case ranges for anxiety and/or depression with, for example, 39% of women scoring in the case range for anxiety and 31% for depression at diagnosis of metastatic breast cancer. Detection of these mood problems was extremely low with referral to appropriate services not in evidence. The results of this study are consistent with those of other studies monitoring the psychological needs of women with breast cancer and the detection of mood disturbance. The clinical relevance of the results of the present study are discussed and future research avenues suggested.     

Cancer patients with major depressive disorder: Testing a biobehavioral/cognitive behavior intervention.

Objective: In this Phase II trial, we evaluated a novel psychological treatment for depressed patients coping with the stresses of cancer. Effectiveness of a combined biobehavioral intervention (BBI) and cognitive behavior therapy (CBT) was studied. Method: Participants were 36 cancer survivors (mean age = 49 years; 88% Caucasian; 92% female) diagnosed with major depressive disorder. A single group pre–post design was used. Treatment consisted of up to 20 individual 75-min combined BBI/CBT sessions. Outcomes were change in interviewer (Hamilton Rating Scale for Depression; Williams, 1988) and self-rated depressive symptoms (Beck Depression Inventory—Second Edition; Beck, Steer, & Brown, 1996) as well as change in cancer relevant symptoms (Fatigue Symptom Inventory [Hann et al., 1998] and Brief Pain Questionnaire [Daut, Cleeland, & Flanery, 1983]) and quality of life (Medical Outcomes Study Short Form–36; Ware et al., 1995). Mixed-effects modeling, a reliability change index, and generalized linear models were used. All analyses were intent-to-treat. Results: Depressive symptoms significantly improved. In addition, 19 of 21 study completers met criteria for remission. Significant improvements were also noted in fatigue and mental health quality of life. Both concurrent anxiety disorders and high levels of cancer stress (Impact of Events Scale; Horowitz, Wilner, & Alvarez, 1979) were each associated with beginning and concluding treatment with greater depressive symptoms. Conclusions: CBT components were successfully incorporated into a previously efficacious intervention for reducing cancer stress. The BBI/CBT intervention warrants further research in evaluating its efficacy compared with well-established treatments for depression. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychological adjustment in breast cancer: Processes of emotional distress.

The process of psychological adjustment to breast cancer was examined at diagnosis and at 3- and 6-month follow-ups in a sample of 80 women with Stage I–Stage IV breast cancer. At diagnosis, symptoms of anxiety/depression were predicted by low dispositional optimism, and this path was partially mediated by use of emotion-focused disengagement coping. Younger age also was predictive of anxiety/depression symptoms at time of diagnosis and this relationship was fully mediated by magnitude of intrusive thoughts. At 3 months, changes in anxiety/depression symptoms were predicted only by intrusive thoughts. At 6 months, low dispositional optimism reemerged as a significant predictor of changes in anxiety/depression and again was partially mediated by the use of emotion-focused disengagement coping. Independent effects for problem-focused engagement and disengagement and emotion-focused engagement coping were also found at 6 months. Implications of these data for psychosocial interventions with breast cancer patients are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Counseling needs of women with breast cancer: what the women tell us

Research has demonstrated that some women treated for breast cancer are at risk for significant and persistent emotional distress and disrupted quality of life. Factors identified that appear to make women psychologically vulnerable include younger age at diagnosis, a history of high life stress or depression prior to diagnosis, and more advanced disease. Research has quickly moved to develop and implement psychological interventions to help these women, although little is known about the patients' perceptions of their need for, and use of, such services. This article presents research that focuses on the perceptions of the women themselves using a survey technique.     

Long-term effects of educational and peer discussion group interventions on adjustment to breast cancer.

The authors report a 3-year follow-up of the effects of 8-week support group interventions on the quality of life of women with early stage breast cancer. Shortly after diagnosis, women were randomly assigned to 1 of 4 conditions: control, education, peer discussion, and education plus peer discussion. The education group intervention focused on providing information to enhance control over the illness experience, whereas the peer discussion group intervention focused on providing emotional support through the expression of feelings. Consistent with the results that emerged 6 months after the interventions (V. S. Helgeson, S. Cohen, R. Schulz & J. Yasko, 1999), the authors found that the benefits of the education intervention were maintained over a 3-year period N?=?252) although effects dissipated with time. The authors continued to find no benefits of the peer discussion intervention, either alone or in combination with education. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety and depression in adolescent cancer: findings in patients and parents at the time of diagnosis

Adolescent cancer is uncommon and presents an exceptional stress for the young patient and their parents. The emotional needs of adolescents with cancer are a major factor in the recommendation for the establishment of adolescent cancer units in major cancer centres in the U.K. However, there have been no prospective, longitudinal studies assessing the psychological impact of a diagnosis of cancer on the adolescent patient and their family. In 1994 we began a longitudinal study of the emotional impact of the diagnosis of cancer in patients and their families presenting to an adolescent cancer unit and of the coping strategies they employ. This first report presents the results of the study at the time of diagnosis in 42 adolescents, 34 mothers and 27 fathers. The Beck Depression Inventory (BDI) was used to assess depression and anxiety levels were measured using Spielberger's State Trait Anxiety Inventory (STAI). Adolescents and their parents completed the questionnaires on first admission to the adolescent cancer unit. The median time since cancer diagnosis was approximately 3 weeks. To provide normative data for the U.K. adolescent population, control values were obtained from 173 pupils of the same age and background. The results showed that, contrary to expectation, adolescents with cancer were no more anxious or depressed than the control adolescent population. Nevertheless, a substantial minority of patients and controls had elevated anxiety or depression scores. Girls were significantly more anxious (P = 0.011) and depressed (P < 0.0001) than boys. Mothers were the most anxious family members and were significantly more anxious than fathers (P = 0.038). Parental anxiety scores, especially mothers, were much higher than reported norms. There was no significant difference between mothers' and fathers' depression scores. Although at the time of diagnosis adolescent cancer patients are not more anxious or depressed than their healthy peers, many adolescents without cancer are anxious or depressed. Staff on adolescent cancer units should therefore be aware of the frequency of emotional disturbance in this population. Mothers are the most anxious family members. Although the findings are relatively reassuring at the time of diagnosis, follow-up data from this cohort will show whether anxiety and depression change with treatment involving intensive chemotherapy, surgery and radiotherapy and will indicate the coping strategies which patients and their families adopt in dealing with both the disease and its treatment.     

How stress management improves quality of life after treatment for breast cancer.

The range of effects of psychosocial interventions on quality of life among women with breast cancer remains uncertain. Furthermore, it is unclear which components of multimodal interventions account for such effects. To address these issues, the authors tested a 10-week group cognitive-behavioral stress management intervention among 199 women newly treated for nonmetastatic breast cancer, following them for 1 year after recruitment. The intervention reduced reports of social disruption and increased emotional well-being, positive states of mind, benefit finding, positive lifestyle change, and positive affect for up to 12 months (indeed, some effects strengthened over time). With respect to mechanisms tested, the intervention increased confidence in being able to relax at will. There was also evidence that effects of the intervention on the various outcomes examined were mediated by change in confidence about being able to relax. Thus, this intervention had beneficial effects on diverse aspects of quality of life after treatment for breast cancer, which appear linked to a specific stress management skill taught in the intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior Therapy for Depressed Cancer Patients in Primary Care.

Major depression is a common psychiatric disorder among cancer patients and is associated with psychosocial impairment and decreased quality of life. Although some research has explored psychological interventions with cancer patients, outcome studies investigating the benefits of behavior therapy among cancer patients with well diagnosed depression are nonexistent. The present study was a preliminary clinical trial (n=6) used to assess the effectiveness of a Brief Behavioral Activation Treatment for Depression (BATD) among depressed cancer patients in primary care. Results revealed strong treatment integrity, good patient compliance, excellent patient satisfaction with the BATD protocol, and significant pre-post treatment gains across measures assessing depression, quality of life, and medical outcomes. These gains were associated with strong effect sizes and were maintained at 3-month follow up. BATD may represent a practical primary care treatment that may remedy problems associated with traditional psychosocial interventions. Study limitations and future research directions are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)