Quality of Life, Sexual Functioning, and Physical Functioning Following Perineal Reconstruction with the Lotus Petal Flap.

BACKGROUND: Lotus petal flaps (LPF) may be used for the reconstruction of extralevator abdominoperineal defects that cannot be closed primarily. Limited data are available on how perineal reconstruction with the LPF impacts on patients' quality of life (QoL), sexual functioning, and physical functioning. METHODS: A cross-sectional study was performed following perineal reconstruction with the LPF. The QoL of patients having undergone LPF reconstruction was compared with a control group in which perineal defects were closed without flaps. Sexual and physical functioning (presence of perineal herniation and range of motion [ROM] of the hip joints) could only be evaluated in the LPF group. Psychometrically sound questionnaires were used. Physical functioning was evaluated subjectively with binary questions and objectively by physical examination. RESULTS: Of the 23 patients asked to participate, 15 (65%) completed the questionnaires and 11 (47%) underwent physical examination. In the control group, 16 patients were included. There were no significant differences in QoL between the LPF and control groups. Within the LPF group, 33% of patients were sexually active postoperatively compared with 87% preoperatively. No perineal herniation was found. The ROM of the hip joints was bilaterally smaller compared with the generally accepted values. CONCLUSIONS: Conclusions should be made with care given the small sample size. Despite a supposedly larger resection area in the LPF group, QoL was comparable in both groups. Nonetheless, reconstruction seemed to affect sexual function and physical function, not hampering overall satisfaction.

Which goal adjustment strategies do cancer patients use? A longitudinal study.

OBJECTIVE: A cancer diagnosis may lead to the need to adjust personal goals. This study longitudinally investigates patients' use of goal adjustment strategies with goal characteristics over time. Whether and which goal adjustment strategies are used after cancer diagnosis may depend on the period studied (treatment period or follow-up period) and illness variables such as illness severity. METHODS: Newly diagnosed colorectal cancer patients (n = 186) were asked about their personal goals during three assessments (within 1 month after diagnosis and 6 and 18 months after the first assessment). Eight goal adjustment strategies were assessed over the first 6 months (treatment period) and between 7 and 18 months (follow-up period) using goal characteristics. Illness variables were obtained from patients' medical records from the national cancer registry. RESULTS: Most patients used one strategy per period, and patients most often shifted their priorities across life domains. During the treatment period, more patients formed shorter-term goals than during the follow-up period, while during the follow-up period, more patients formed longer-term goals than during the treatment period. Illness variables were not related to the use of goal adjustment strategies. CONCLUSIONS: The findings show that cancer patients use different goal adjustment strategies and, interestingly, that the use of specific strategies depended on the period after diagnosis but not on illness variables.

Long-term effects of goal disturbance and adjustment on well-being in cancer patients.

PURPOSE: To investigate the impact of personal goal disturbance after cancer diagnosis on well-being over time, and a possible moderating role of goal adjustment tendencies and actual goal adjustment strategies. METHODS: Participants (n = 186) were interviewed three times: within a month, 7 months (treatment period), and 18 months (follow-up period) after being diagnosed with colorectal cancer. Participants were asked to freely mention three to ten personal goals. Goal disturbance was assessed by the patients' ratings of the amount of hindrance experienced in goal achievement. Goal adjustment tendencies were assessed using the Goal Disengagement and Re-engagement Scale and actual goal adjustment (i.e. goal flexibility) by the number of goal adjustment strategies used. Outcome measures were overall quality of life and emotional functioning, assessed with the cancer-specific EORTC QLQ-C30. RESULTS: Hierarchical regression analyses showed that goal disturbance predicted well-being over both the treatment and the follow-up period. Additionally, the negative effect of goal disturbance on well-being was less for patients who scored higher on goal disengagement and not significant for patients who were more flexible in their use of actual goal adjustment strategies. CONCLUSIONS: The present study is the first to test the theoretical assumption that goal adjustment is beneficial after goal disturbance. Whereas these findings need to be confirmed in future research, the possibly beneficial role of goal disengagement and actual goal adjustment strategies can be used for psychological interventions.

Changes in cancer patients' personal goals in the first 6 months after diagnosis: the role of illness variables.

PURPOSE: Setting and pursuing personal goals is a vital aspect of our identity and purpose in life. Cancer can put pressure on these goals and may be a reason for people to adjust them. Therefore, this paper investigates (1) changes in cancer patients' goals over time and (2) the extent to which illness characteristics relate to goal changes. METHODS: At both assessment points (1 and 7 months post-diagnosis), colorectal cancer patients (n = 198) were asked to list their current goals and rate them on hindrance of illness, attainability, likelihood of success, temporal range and importance. All goals were coded by two independent raters on content (i.e. physical, psychological, social, achievement and leisure). Patients' medical data were obtained from the national cancer registry. RESULTS: Over time, patients reported a decrease in illness-related hindrance, higher attainability and likelihood of success, a decrease in total number of goals, goals with a shorter temporal range, and more physical and fewer social goals. At both assessments, patients with more advanced stages of cancer, rectal cancer, a stoma, and receiving additional chemotherapy and/or radiotherapy reported more illness-related hindrance in goal attainment, but only patients with a stoma additionally reported lower attainability, likelihood of success and more short-term goals. CONCLUSIONS: The results of this study support the assumption that cancer patients adjust their goals to changing circumstances and additionally show how patients adjust their goals to their illness. Moreover, we demonstrate that illness variables impact on goal change.

Reducing discrepancies of personal goals in the context of cancer: A longitudinal study on the relation with well-being, psychological characteristics, and goal progress.

OBJECTIVES: To (1) examine whether reducing discrepancies between goal importance and goal attainability is an adaptive predictor of well-being, (2) investigate intrusion, awareness, optimism, and pessimism as determinants of reducing discrepancies between goal importance and goal attainability, and (3) explore how goal progress is involved in reducing discrepancies between goal importance and goal attainability during two major periods after a colorectal cancer diagnosis. DESIGN: Prospective design. METHODS: Newly diagnosed colorectal cancer patients (n = 120) were interviewed three times: within a month, 7 months (treatment period), and 18 months (follow-up period) post-diagnosis. Data were analysed using multiple regressions. RESULTS: Results showed that (1) reducing discrepancies enhances well-being, (2) optimism and pessimism are predictors of reducing discrepancies during the treatment period but not during the follow-up period, while intrusion and awareness do not predict reducing discrepancies in either period, and (3) goal progress is a predictor of reducing discrepancies during the follow-up period, but no evidence for a moderating or mediating role of goal progress in the relation between psychological characteristics and reducing discrepancies was found. CONCLUSIONS: Reducing discrepancies between goal importance and goal attainability could benefit colorectal cancer patients' well-being. Optimism, pessimism, and goal progress appear to influence cancer patients' ability to reduce discrepancies. Providing assistance in improving goal progress to those who are less optimistic and highly pessimistic may be a suitable training for cancer patients to prevent deterioration in well-being. Statement of contribution What is already known on this subject? More discrepancy between goal importance and goal attainability is associated with lower levels of well-being. People are able to change evaluations of importance and attainability, but it is unknown whether this positively impacts well-being. Underlying causes of differences in the extent to which discrepancies between goal importance and goal attainability are reduced are unknown. What does this study add? This is the first study to show that reducing discrepancies between goal importance and goal attainability is beneficial for well-being. This is the first study to show that optimism and pessimism are determinants of reducing discrepancies between goal importance and goal attainability. Goal progress might be an effective target for interventions that aim to facilitate one's ability to reduce discrepancies between goal importance and goal attainability.

Distinct trajectories of positive and negative affect after colorectal cancer diagnosis.

OBJECTIVE: Insight into trajectories of positive affect (PA) and negative affect (NA) across the cancer continuum may improve understanding of the nature of adjustment problems. The primary aim of this study was to identify subgroups of patients with distinct trajectories of PA and NA following diagnosis of colorectal cancer (CRC). Secondary to this aim, the co-occurrence between trajectories and their association with goal-related processes was explored. METHOD: CRC patients (n = 186) completed questionnaires within 1 month, 7 months, and 18 months after diagnosis. Multilevel models were used to study the trajectory of PA and NA, as measured with the Positive and Negative Affect Schedule (PANAS). RESULTS: Four classes with distinct PA trajectories were identified: low (18.8%), increasing (6.7%), moderate (68.2%), and high (6.3%); 2 trajectories of NA emerged: low (36.3%) and moderate (63.7%). There was no significant association between PA and NA trajectory class probabilities. The average trajectory of PA covaried with levels of goal disturbance and goal reengagement over time, while the average NA trajectory covaried with goal disturbance and goal disengagement. CONCLUSIONS: Compared with the general population, our sample of cancer patients suffered from a lack of positive emotions, but not a high presence of negative emotions. About one fifth of patients reported low PA up to 18 months after diagnosis and may benefit from supportive care. Furthermore, the trajectory of PA was independent of that of NA and related with a distinct goal adjustment process (i.e., goal disengagement vs. goal reengagement). This finding indicates the need to tailor psychological care to the nature of the adjustment problem. (PsycINFO Database Record

Clinically distinct trajectories of fatigue and their longitudinal relationship with the disturbance of personal goals following a cancer diagnosis.

OBJECTIVES: Most studies on fatigue in patients with cancer aggregate its prevalence and severity on a group level, ignoring the possibility that subgroups of patients may differ widely in their development of fatigue. This study aimed to identify subgroups of patients with clinically distinct trajectories of fatigue from diagnosis to 18 months post-diagnosis. As fatigue might trigger goal disturbance, the study also identified trajectories of concrete and abstract goal disturbance and longitudinally examined their co-occurrence with fatigue. DESIGN: Prospective design with quantitative and qualitative method of data collection. METHODS: Patients with colorectal cancer (n = 183) reported on their levels of fatigue and goal disturbance shortly after diagnosis (T1 ) and at 7 months (T2 ) and 18 months (T3 ) post-diagnosis. Growth mixture model analyses were performed to identify trajectories of fatigue and goal disturbance. Guidelines for the clinical relevance of fatigue were applied. RESULTS: Four clinically distinct trajectories of fatigue were identified as follows: (1) persistent severe fatigue (25.4%), (2) moderate fatigue (56.1%), (3) no fatigue (13.8%), and (4) rapidly improving fatigue (4.7%). The majority of patients with cancer reported high disturbance of their concrete goals, while high disturbance of abstract goals was less evident. Fatigue and concrete goal disturbance co-occurred longitudinally. CONCLUSIONS: The fatigue and goal disturbance experienced from diagnosis to 18 months post-diagnosis differ considerably for subgroups of patients with cancer. Fatigue and concrete goal disturbance are persistent burdens in the majority of patients. Investigating symptom burden beyond average trends can guide clinicians to identify patients most in need for treatment. Targeting goal disturbance might benefit the psychological well-being in patients suffering from persistent symptoms. Statement of contribution What is already known on this subject? Fatigue is a common and distressing symptom at all stages of the cancer experience. Earlier studies suggest that many patients recover from fatigue after treatment completion. Patients with cancer experience disturbance in their personal goals, which is related to poor psychological well-being. What does this study add? Developments of fatigue and goal disturbance differ between subgroups of patients with cancer but co-occur within these subgroups. About 30% of the patients experience severe fatigue after diagnosis, of which only few patients recover within 18 months post-diagnosis. Targeting goal disturbance might benefit patients with severe and ongoing symptoms.

People with cancer use goal adjustment strategies in the first 6 months after diagnosis and tell us how.

OBJECTIVES: Theory has offered suggestions on how people may adjust their personal goals after goal disturbance or altered life situations. However, the actual use of these goal adjustment strategies has rarely been studied. This study aimed to investigate whether the goal adjustment strategies identified in the literature are used in the first 6 months following a diagnosis of cancer and whether alternative strategies can be identified. DESIGN: Exploratory design with a qualitative method of data collection. METHODS: Patients were asked to list their current personal goals within a month after being diagnosed with colorectal cancer. Six months later, they were asked what had happened to each of these goals. For each goal, raters scored whether (1) it was achieved or being pursued as planned, (2) a known strategy was used, or (3) an alternative strategy was used. RESULTS: Patients with colorectal cancer (n = 130) reported that more than half of their goals had been achieved or were being pursued as planned. The remaining goals (n = 210) required goal adjustment strategies. Patients used five of six known strategies that involved mostly limited adjustment. Additionally, they used combinations of goal adjustment strategies, and two alternative strategies were identified. CONCLUSIONS: This study found that patients with cancer use goal adjustment strategies, and it provides illustrations on how these strategies are used, thus deepening and extending existing knowledge of and theory on goal adjustment. Future studies should take the newly identified strategies into account as well as the possible use of combinations of strategies. STATEMENT OF CONTRIBUTION: What is already known on this subject? The successful pursuit of personal goals is important for maintaining well-being. However, an unexpected and serious illness such as cancer can lead to the need to adjust goals, either because they have become difficult or impossible to attain due to physical hindrance of the illness and/or its treatment, or because other goals have become important due to the confrontation with the fragility of life. Theories have proposed options of how people may deal with their personal goals, but whether these so-called goal adjustment strategies are actually used by cancer patients, and whether there are alternative strategies we need to take into account, is still unclear. What does this study add? This study employs a qualitative method of data collection to study what actually happens to cancer patients' goals during the first 6 months after diagnosis. This study found that almost all goal adjustment strategies from theory are indeed used by cancer patients and that they mostly use strategies which involve only limited adjustment and a continued focus on the original goal. We found that patients with cancer use combinations of strategies and two alternative strategies, thereby complementing and expanding theories on goal adjustment.

Goal adjustment strategies operationalised and empirically examined in adolescents with cancer.

Adolescents facing cancer may need to adjust their personal life goals. Theories identified several goal adjustment strategies, but their use has not been tested. Therefore, this study operationalises goal adjustment strategies and examines their use. Adolescent cancer patients listed their goals 3 and 12 months post-diagnosis. Goals received scores on five goal characteristics: life domain, level of abstraction, importance, attainability and effort. Results showed that adolescents with cancer (N = 30, mean age: 14.2 years, 60% female) used four of five strategies described in theory, while one additional strategy was found. These findings suggest that adolescents with cancer use goal adjustment strategies as measured by goal characteristics over time.

A longitudinal case-control study on goals in adolescents with cancer.

OBJECTIVE: This study examined whether: (1) the goals of adolescents with cancer at 3 months post-diagnosis (T1) and healthy peers differed in terms of content, valuation, and abstraction level, (2) the content, valuation and abstraction level of the goals of the adolescents with cancer differed between 3 and 12 months post-diagnosis (T2). METHODS: Thirty-three adolescents with cancer and 66 matched controls completed the Personal Project Analysis Inventory. After nine months, the adolescents with cancer completed the measure again. RESULTS: Compared to controls, adolescents with cancer at 3 months post-diagnosis (T1) reported more intrinsic than extrinsic goals, appraised intrinsic goals as more important than extrinsic goals and reported more concrete goals. Within the adolescents with cancer, the content, valuation and abstraction level of the goals did not differ between T1 and T2. CONCLUSIONS: Adolescents recently diagnosed with cancer set different types of goals than healthy peers and continue to set these types of goals until one year post-diagnosis. Future research can help determine how the personal goals of adolescents with cancer develop in the long term and to what extent personal goal setting during cancer influences the attainment of age-graded developmental tasks and well-being.

The Impact of Goal Disturbance after Cancer on Cortisol Levels over Time and the Moderating Role of COMT.

Due to physical hindrance and time spent in hospital, a cancer diagnosis can lead to disturbance of personally important goals. Goal disturbance in cancer patients has been related to poorer psychological well-being. However, the relation with physiological measures is yet unknown. The purpose of the current study is to examine the impact of goal disturbance on cortisol as a measure of response to stress over time, and a possibly moderating role of a DNA genotype associated with HPA-axis functioning, Catechol-O-Methyl transferase (COMT). We examined the predictive value of goal disturbance on Cortisol Awakening Response (CAR) and Diurnal Cortisol Slope (DCS) over two periods: 1-7 and 7-18 months post-diagnosis, and the moderating role of COMT during these periods. Hierarchical regression analyses showed that goal disturbance 7 months post-diagnosis significantly predicted a steeper CAR a year later. During that period, the slow COMT variant moderated the relation, in that patients reporting high goal disturbance and had the Met/Met variant, had a more flattened CAR. No other significant effects were found. As steeper CARs have been related to adverse health outcomes, and COMT genotype may modify this risk, these results indicate that goal disturbance and genotype may be important factors to consider in maintaining better psychological and physical health in the already vulnerable population of cancer patients.