Effect of cancer stage on health-related quality of life of patients with epithelial ovarian cancer.

We compared the quality of life (QoL) of women with early versus advanced epithelial ovarian cancer and examined predicting factors for the poor QoL. We classified 157 participants into 108 with early disease (stage I-II) and 49 with advanced disease (stage III-IV). They completed two questionnaires: EORTC QLQ-C30 and Chiang Mai University (CMU) ovarian cancer QoL. For EORTC QLQ-C30, the study groups were comparable regarding global health status/QoL, functional scales, and summary scores. The advanced group had worse scores on symptom scales specifically appetite loss and constipation. For CMU Ovarian Cancer QoL, the advanced group had worse scores only in the gastrointestinal domain but not in urinary, lymphatic, and sexual/hormonal domains. These findings remained mostly unchanged after excluding those with recurrence. In multivariable analysis, currently receiving treatment was consistently associated with worse QoL scores. The advanced stage had more adverse impact only on the gastrointestinal domains of QoL, mainly during periods of receiving chemotherapy.IMPACT STATEMENTWhat is already known on this subject? Survival outcome for women with epithelial ovarian cancer varies depending mainly on stage. Those who survive advanced stage disease could expect long-term disease and treatment-related morbidities that significantly affected QoL. However, there has been very limited information regarding QoL of women who have the early disease in comparison to those with more advanced disease especially in the context of Asian culture.What do the results of this study add? Apart from the higher prevalence of gastrointestinal symptoms reported by the patients with advanced disease, the general well-being and other symptom-specific domains of QoL were comparable between women with early and advanced diseases. Receiving treatment is a consistent predictor for poor QoL.What are the implications of these findings for clinical practice and/or further research? In comparison to early-stage epithelial ovarian cancer, the advanced stage had more adverse impact only on the gastrointestinal domains of QoL, mainly during periods of receiving chemotherapy. This information will be useful for patient counselling. Future research should examine the underlying causes of this finding.

Prioritizing care for women with breast cancer based on survival stage: A study examining the association between physical symptoms, psychological distress and unmet needs.

PURPOSE: 1) To examine the differences in physical symptoms, psychological distress and unmet needs between short-term (2-5 years) and long-term (>5 years) breast cancer survivors (BCSs). 2) To explore how physical symptoms and psychological distress impact unmet needs among women in different survival stages. METHOD: Three hundred forty-nine people with breast cancer completed questionnaires. Short-term (2-5 years) and long-term (>5 years) survival stages were examined. Physical symptoms (number of physical symptoms); psychological distress, including fear of recurrence (FOR) (FOR visual analogue scale (VAS)) and depressive symptoms (Center for Epidemiological Studies-Depression Scale); and unmet needs (Chinese Cancer Survivors' Unmet Needs scale) were measured. Structural equation modelling with multi-group analysis was used to assess differences between short- and long-term survivors in the magnitude of paths. RESULTS: In total, 157 women who had survived <5 years and 192 women who had survived >5 years were recruited. The path coefficients from physical and depressive symptoms to unmet needs were similar between short-term BCSs and long-term BCSs (p > .05). However, the path coefficient from FOR to unmet needs among women who had survived for >5 years was significantly greater than that among those who had survived <5 years (p < .001). CONCLUSION: Based on these results, health care professionals should be aware of the FOR that women experience even 5 years after their initial diagnosis. Providing survivorship care plans with comprehensive side effect-related information soon after treatment is recommended.

The relationship between fear of cancer recurrence and health behaviors: A nationwide longitudinal study of cancer survivors.

OBJECTIVE: The goal of this study was to examine fear of cancer recurrence (FCR) and 2 health behaviors, physical activity and fruit and vegetable intake, from early to long-term survivorship in a large cohort of mixed cancer survivors. METHOD: Group-based trajectory analyses and repeated measures analysis of variance were conducted on data collected in the American Cancer Society's Studies of Cancer Survivorship-I. Two thousand three hundred thirty-seven survivors of 10 cancers completed the survey at 3 time points (M = 1.3, 2.2, and 8.8 years postdiagnosis). RESULTS: The current study found 3 FCR trajectories clustering cancer survivors by FCR severity: low (33.6%), moderate (58.1%), and high (8.3%). FCR significantly decreased over time and remained distinct for each trajectory group. Patient characteristics prevalent in the high FCR group were being female, of younger age, Hispanic ethnicity, having advanced cancer stage (II to III) and non-Hodgkin lymphoma, and low adherence to physical activity and fruit and vegetable intake recommendations. The high FCR group also reported significantly fewer of these health behaviors compared with the other groups, albeit the effect size was small. CONCLUSIONS: Across the survivorship trajectory, FCR severity decreased but remained distinct for the 3 trajectory groups. Future investigations should inquire about the specific needs of each FCR group to subsequently develop targeted interventions. A weak association between FCR and health behaviors was found, with individuals in the high FCR group reporting less health behaviors. Future research should assess the direction of this relationship over time to inform intervention targets within this subgroup. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

[Psychosocial effects in patients with penile cancer : A systematic review]. / Psychosoziale Auswirkungen bei Patienten mit Peniskarzinom : Ein systematischer Überblick.

BACKGROUND: Psychological stress of patients with penile cancer arises from the cancer diagnosis itself and the treatment consequences. In addition, there is cancer-specific distress. There is the chance of cure in localized stages and in those with limited regional lymph node metastases but this requires surgery and often adjuvant chemotherapy. This systematic review gives a summary of the existing literature to date. MATERIALS AND METHODS: A critical database search using Medline was made in Ovid from 1946 to 2017, in the Cochrane Central Register of Controlled Trials (CENTRAL) and in the Web of Science from 1900 to 2017. This was complemented by a search of the World Health Organization's International Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov. The reference lists of the included studies were manually searched for additional references. RESULTS: Selected studies (n = 10) addressed the psychosocial effects of penile cancer treatment on quality of life and sexual function. Due to the heterogeneity of the study designs only a narrative description of the results was possible. Defects or mutilation due to penile cancer cause psychological distress in a significant number of patients. Organ-sparing interventions have a positive impact on quality of life and sexual function. CONCLUSION: The external genitals are a focus of sexual identity. Mutilating treatment causes significant distress but organ-sparing treatment and reconstruction positively influence quality of life.

Pretreatment quality of life in patients with rectal cancer is associated with intrusive thoughts and sense of coherence.

PURPOSE: Quality of life may predict survival. In addition to clinical variables, it may be influenced by psychological factors, some of which may be accessible for intervention. The primary objective of this study was to investigate the association of intrusive thoughts and the patients' sense of coherence with pretreatment quality of life in patients with newly diagnosed rectal cancer. METHODS: Patients were prospectively included in 16 hospitals in Sweden and Denmark. They answered an extensive questionnaire after receiving their treatment plan. Clinical data were retrieved from national quality registries for rectal cancer. RESULTS: Of 1248 included patients, a total of 1085 were evaluable. Pretreatment global health-related and overall quality of life was lower in patients planned for palliative compared with curative treatment (median 53 vs. 80 on the EuroQoL visual analogue scale, p < 0.001 and odds ratio 0.56, 95% confidence interval 0.36-0.88, respectively). Quality of life was associated with intrusive thoughts (odds ratio 0.33, 95% confidence interval 0.24-0.45) and sense of coherence (odds ratio 0.44, 95% confidence interval 0.37-0.52) irrespective of the treatment plan. CONCLUSIONS: Pretreatment quality of life was influenced by the intent of treatment as well as by intrusive thoughts and the patients' sense of coherence. Interventions could modify these psychological factors, and future studies should focus on initiatives to improve quality of life for this group of patients.

Estadiamento e grau de resiliência do sobrevivente ao câncer de mama / Staging and resilience degree in breast cancer survivors / Estadificación y grado de resiliencia del sobreviviente de cáncer de mama

Objective: To assess the resilience and staging degree relating to sociodemographic factors of breast cancer survivors followed up in an oncology service. Method: Quantitative study with 112 breast cancer survivors.The variables selected were: sociodemographic; clinical staging; survival time; and resilience scale. The analysis was performed using the Epi Info 6.04 software and Fisher’s exact test. The research was approved by the Ethics Committee of the Federal University of Pelotas School of Nursing under Opinion Nº 31/2009. Results: The average age was 46.2 years, there was 60.71% of stage IIcases, 81.25% were white, 40.18% had five-to eight-year schooling, 52.68% were married, 73.32% had lived in urban areas, 41.96% exhibited high resilience, and 48.21% were followed up from one to three years. Conclusion: Staging was not associated with the resilience degree, but rather with age and survival time, confirming the findings of other studies.

Objetivo: Investigar o grau de resiliência e de estadiamento frente aos fatores sociodemográficos dos sobreviventes ao câncer de mama em acompanhamento em um serviço de oncologia. Método: Estudo quantitativo com amostra de 112 sobreviventes ao câncer de mama. Foram selecionadas variáveis sociodemográficas, estadiamento clínico, tempo de sobrevida e escala de resiliência. A análise foi realizada utilizando o software Epi Info 6.04 e o teste exato de Fisher. A pesquisa foi aprovada pelo Comitê de Ética da Faculdade de Enfermagem da Universidade Federal de Pelotas sob o Parecer nº 31/2009. Resultados: A média de idade foi de 46,2 anos, houve 60,71% de estadiamento II, 81,25% eram brancos,40,18% tinham escolaridade entre cinco e oito anos, 52,68% eram casados,73,32% havia vivido em zona urbana, 41,96% apresentou alta resiliência e 48,21% mantinha-se em acompanhamento entre um e três anos.Conclusão: O estadiamento não esteve associado ao grau de resiliência,mas sim à idade e tempo de sobrevida, confirmando os achados em outros estudos.

Objetivo: Investigar el grado de resiliencia y estadificación en relación con factores sociodemográficos de sobrevivientes de cáncer de mama en seguimiento en un servicio de oncología. Método: Estudio cuantitativo con 112 sobrevivientes de cáncer de mama. Las variables seleccionadas fueron: sociodemográficas; estadificación clínica; tiempo de sobrevida; y escala de resistencia. El análisis se realizó utilizando el software EpiInfo 6.04 y el test exacto de Fisher. La investigación fue aprobada por el Comité de Ética de la Facultad de Enfermería de la Universidad Federal de Pelotas con el Dictamen Nº 31/2009. Resultados: La edad promedio fue de 46,2 años, 60.71% estaban en estadio II, 81.25% eran blancos, 40.18% tenían escolaridad entre cinco y ocho años, 52.68% eran casados, 73.32% habían vivido en zonas urbanas, 41.96% tuvieron alta resiliencia y el 48,21% estaban en seguimiento entre uno y tres años. Conclusión: La estadificación no estuvo asociada al grado de resiliencia, sino a la edad y tiempo de sobrevida, confirmando los hallazgos de otros estudios.

Patient anxiety on the use of one step nucleic acid amplification (OSNA) during breast cancer surgery.

INTRODUCTION: Assessment of the sentinel lymph node biopsy (SLNB) is used to stage the axilla in patients with breast cancer. There are a variety of methods to assess metastatic disease within the SLN. One-step nucleic acid amplification (OSNA) has a high sensitivity for detecting metastatic disease within the SLN and avoids the use of staged axillary surgery. However there remains a paucity of data within the literature on the psychological effects upon patients with the use of OSNA. METHODS: All patients undergoing breast surgery (breast-conserving surgery or mastectomy) and assessment of the SLNB with OSNA from December 2011 to June 2012 were included in the study. A questionnaire was sent to patient within four weeks of surgery to assess their understanding and satisfaction with the OSNA procedure. RESULTS: 60 patients responded to the questionnaire (83% response rate). All patients were female with a mean age of 63 years (range 38-71 years). 19 patients had positive SLNB as assessed by OSNA and all had ALND. 15 patients expressed pre-operative anxiety about having OSNA although 97% stated that they would be happy to undergo the same procedure again. CONCLUSION: Our study has identified the anxiety points that patients experience with OSNA based management and this will allow improved direct emotional support and provision of information.

Knowledge of Cancer Stage among Women with Nonmetastatic Breast Cancer.

BACKGROUND: Discrepancies may exist between what oncologists communicate and what patients understand about their cancer stage and its implications. OBJECTIVE: We explored patients' ability to identify their stage of breast cancer. METHODS: As part of a study testing a cancer self-management intervention we asked women to identify their stage of disease and compared responses to the electronic medical record (EMR) for validation. The sample included women with recently diagnosed nonmetastatic (stage I-III) disease. We calculated descriptive statistics and used logistic regression to examine relationships between knowledge of stage, demographic and clinical variables, and study outcomes. Measurement instruments were the Control Preferences Scale (CPS), Knowledge of Care Options Test (KOCO), Measurement of Transitions Scale (MOT), Medical Communication Competence Scale (MCCS), Chronic Disease Self-Efficacy Scale (CDSE), Uncertainty in Illness Scale (MUIS-C), and Hospital Anxiety and Depression Scale (HADS). RESULTS: Participants (n = 98) had a mean age of 52.3 years (range 27-72). Per the EMR, 19 participants (19.4%) had stage I breast cancer, 56 (57.1%) had stage II, and 23 (23.5%) had stage III. Of the 28 participants (28.6%) unable to identify their stage of cancer correctly, 11 (39.3%) provided vague responses, 11 (39.3%) reported an incorrect stage, and 6 (21.4%) did not know their stage. Younger age (p = 0.0412) and earlier cancer stage (p = 0.0136) were predictive of correctly identifying stage. Participants who at baseline had a greater knowledge of care options (curative, palliative, and hospice care) were more likely to correctly identify their stage (KOCO, p = 0.0345). CONCLUSIONS: Clinicians should revisit conversations about cancer stage and care options to ensure patients' understanding and support self-management.

Lived experiences of breast cancer survivors after diagnosis, treatment and beyond: qualitative study.

BACKGROUND: The number of breast cancer survivors has increased since 1990 due to advances in biomedical technology that lead to an increase in early diagnosis and treatment. Research on survivorship has focused on the psychological and treatment aspects of the disease. The goal of this study was focused on exploring the lived experiences of breast cancer survivors from diagnosis, treatment and beyond. OBJECTIVE: To understand the lived experiences of women who are breast cancer survivors. DESIGN, SETTING AND PARTICIPANTS: A purposive sampling strategy was used to recruit participants from two Missouri cancer centres. A total of 15 women breast cancer survivors were interviewed. FINDINGS: Three major themes emerged that described the lived experiences of the women. These were factors from the diagnosis and treatment management impacting survivorship, relationship and support system and implication of survivorship. Participants noted that coping with the diagnosis and treatment was a stressful journey and required lots of adjustment and changes. Some developed various techniques such as journaling their activities which provided comfort. In addition, support from family was shared as the key which gave them strength and courage through the different stages of treatment. However, they found it difficult to articulate what survivorship meant. CONCLUSION: Using in-depth interview techniques, this study shed light on the experiences of women who were diagnosed with breast cancer and have completed treatment. They acknowledged frustration with their diagnosis and body changes. Support received from family and friends helped them cope through their treatment. However, they felt abandoned once the treatment phase was over and were uncertain what survivorhood meant to them.

Information preferences regarding cure rates and prognosis of Austrian patients with advanced lung cancer.

INTRODUCTION: Due to concerns about patients' wellbeing, open end-of-life communication is associated with reservation. Furthermore, sociocultural differences must be considered. The objective of this pilot study was therefore to investigate the information preferences of Austrian patients regarding cure rates and prognosis. PATIENTS AND METHODS: The information preferences of 50 advanced lung cancer patients were assessed at their first visit to the Department of Radiation Oncology, Medical University of Vienna. Preferences in terms of content (cure rates and/or prognosis) and depth of the information (additional quantitative estimates) were addressed. After the individually adapted medical consultation, patients' satisfaction with the consultation and the emotional responses to the information were evaluated. RESULTS: The majority of patients (76 %) requested information about cure rates and/or prognosis; nearly half of these (47 %) wanted additional quantitative estimates. Neither sociodemographic variables, disease characteristics, nor time since diagnosis had an impact on the information preferences. The individually adapted medical information showed no overall negative influence on the emotional responses; only patients receiving prognostic information had significantly higher distress scores after the consultation. High satisfaction with the individually adapted medical consultation was reported by 92 % of patients. CONCLUSION: Austrian physicians may offer end-of-life communication and directly ask patients about their information preferences, since patients seem able to decide whether or not prognostic information would overwhelm their emotional capacity and therefore to accept or reject the invitation. The disclosure of cure rates and/or prognosis with or without quantitative estimates-according to the patients' preferences-shows overall no negative impact on emotional reactions. The individually adapted consultation results in high patient satisfaction. Nevertheless, prognostic information may lead to higher distress.

Quality of life by stage of cervical cancer among Malaysian patients.

Stage of cervical cancer may adversely affect the quality of life (QOL) among patients. The objective of this study was to predict the QOL among cervical cancer patients by the stage of their cancer. A cross-sectional study from September 2012 until January 2013 was conducted among cervical cancer patients who completed treatment. All patients completed a interviewer-guided questionnaire comprising four sections: (A) socio- demographic data, (B) medical history, (C) QOL measured by general health status questionnaire (QLQ-30) and (D) cervical cancer specific module CX-24 (EORTC) was used to measured patient's functional, symptom scale and their global health status. Results showed that global health status, emotional functioning and pain score were higher in stage III cervical cancer patients while role functioning was higher in stage I cervical cancer patients. Patients with stage IV cancer have a lower mean score in global health status (adjusted b-22.0, 95 CI% -35.6, -8.49) and emotional functioning (adjusted b -22.5, 95 CI% -38.1, -6.69) while stage III had lower mean score in role functioning (adjusted b -14.3, 95 CI% -25.4, -3.21) but higher mean score in pain (adjusted b 22.1, 95 CI% 8.56, 35.7). In conclusion, stage III and IV cervical cancers mainly affect the QOL of cervical cancer patients. Focus should be given to these subgroups to help in improving the QOL.

Whole-body MRI vs. CT for staging lymphoma: patient experience.

OBJECTIVE: To assess and compare patient experience of whole-body magnetic resonance imaging (MRI) to that of computed tomography (CT) for staging newly diagnosed lymphoma. MATERIALS AND METHODS: A total of 36 patients with newly diagnosed lymphoma prospectively underwent whole-body MRI and CT for staging purposes. Patients were asked to fill in a short questionnaire with regard to the burden and experience of the examination on a Likert scale (range 1-4). Wilcoxon signed rank tests were used to determine statistically significant differences in patient (dis)comfort between the two examinations. RESULTS: Patients reported to be significantly (P=0.007) less worried before undergoing whole-body MRI compared to CT. Patients also experienced whole-body MRI as significantly (P=0.010) less unpleasant and felt significantly (P=0.003) better shortly after the scan. The necessary preparations before CT scanning (i.e. insertion of intravenous line, drinking of contrast fluid), which are not required for whole-body MRI, were reported to be a considerable burden. CONCLUSION: In this study in patients with newly diagnosed lymphoma, whole-body MRI was experienced as a more patient-friendly technique than CT.

Prospective associations of depression with survival: a population-based cohort study in patients with newly diagnosed breast cancer.

Psychological factors may influence survival in breast cancer patients but results of previous research are inconclusive. This prospective population-based study tested whether depression predicts mortality in breast cancer patients. Routinely collected depression screening data were merged with electronically archived provincial cancer registry data and censored data from British Columbia Vital Statistics (extracted in December 2012). Cox proportional-hazards regression analyses were conducted to predict all-cause and breast cancer-specific mortality as a function of depression after controlling for biomedical confounders. Of 1,646 patients, 1,604 had breast cancer stages I-III and 42 had stage IV breast cancer. 176 (11.0 %) versus 28 (66.7 %) were deceased after a median follow-up of 76 months. In patients with curable breast cancer, depression predicted all-cause (HR = 1.54 (95 % CI 1.06-2.25); p = 0.024), but not breast cancer-specific mortality (HR = 1.51 (95 % CI 0.95-2.41); p = 0.084). No association was shown for metastatic disease. Stage-specific analyses demonstrated a 2-2.5-fold increase in breast cancer-specific and all-cause mortality in patients with stage I and II disease, but not in patients with stage III or IV breast cancer. In stage I breast cancer patients, age moderated effects of depression such that depressed younger patients diagnosed at age 45 (i.e., mean age -1SD) showed a ninefold (HR = 9.82 (95 % CI 2.26-42.68); p = 0.002) increase in all-cause mortality and depressed patients at 57 a 3.7-fold (HR = 3.69 (95 % CI 1.44-9.48); p = 0.007) increase, while no association was evident in older patients at age 69 (mean age +1SD). Depression is strongly associated with mortality in younger patients with early stage breast cancer.

Anxiety, depression and related factors in family caregivers of newly diagnosed lung cancer patients before first treatment.

OBJECTIVE: This study aimed to (i) explore the prevalence and levels (severity) of anxiety and depression in family caregivers (FCs) of patients newly diagnosed with advanced lung cancer (stage IIIb or IV) before first treatment, and (ii) identify the factors related to FCs' anxiety and depression. METHODS: For this cross-sectional study, 106 patient-FC dyads were recruited from a medical center in northern Taiwan. FCs' anxiety and depression were measured using the self-report Hospital Anxiety and Depression Scale, and FCs' ability to manage patients' symptoms was assessed using the Self-Efficacy in Symptom Management Scale. FCs' risks for anxiety and depression were separately identified using two multivariate logistic regression models. RESULTS: This study found two major results. First, before patients' first treatment, 50.9% and 32.1% of FCs were at risk for anxiety and depression, respectively. FCs' overall mean anxiety and depression scores were 7.7 (SD = 4.7) and 6.1 (SD = 4.5), respectively. Second, both FCs' anxiety and depression were significantly related to four factors: caring for another sick family member, younger age, having pain problems, and lower self-efficacy in managing symptoms. CONCLUSION: Family caregivers of patients newly diagnosed with advanced lung cancer had anxiety and depression before the patients' first treatment. We strongly suggest developing and testing interventions to reduce FCs' psychological distress and enhance their quality of life, thus ensuring better quality of patient care.

Pain and quality of life in Turkish cancer patients.

This study was designed to examine the relationship between patients' pain severity and their self-reported quality of life, to evaluate factors that may affect pain and quality of life, and to assess patients' opinions and practices on the use of analgesics. The study was conducted with 260 cancer patients. Data were collected using a Quality of Life Scale and Visual Analog Scale questionnaire. It was found that mean scores of pain, all subdomains of quality of life, and overall mean scores of patients were at a moderate level, the lowest score in the subdomains of quality of life was in the psychological subdomain and the highest was in the spiritual subdomain. It was also found that as severity of pain experienced by patients increased, their general activities, mood, activeness, sleep, and nutrition were negatively affected. As severity of pain experienced by patients increased, their quality of life worsened. Patients were observed to have insufficient knowledge and a poor understanding with respect to the use of analgesics. In conclusion, it is very important for nurses to assess factors that can complicate pain management and to establish an effective pain control.

Personality, choice of coping and T stage predict level of distress in head and neck cancer patients during follow-up.

The aim of the present study was to investigate to what extent TNM stage, treatment level, personality, choice of coping, mood and health-related quality of life (HRQoL) scores predicted distress as measured by general health questionnaire (GHQ) in successfully treated head and neck squamous cell carcinoma (HNSCC) patients. All patients younger than 80 years who had been diagnosed with HNSCC in western Norway in the period from 1992 to 1997, and who had survived until 1999, were sampled. Ninety-six patients (90% response rate) were included 48 ± 2 months after diagnosis. We determined personality by the Eysenck personality inventory, coping by the COPE questionnaire; HRQoL by EORTC QLQ questionnaire; and mood by Beck depression inventory (BDI). Fifty-five of 58 eligible patients were interviewed a second time 47 ± 1 months after the first interview where neuroticism and GHQ-30 questionnaires were answered. Both HRQoL [explained variance (EV), 9-40%] and BDI (EV 26-30%) scores predicted the GHQ scores. Numerical T stage was inversely associated with GHQ scores (EV ~10%). High neuroticism generally predicted high GHQ scores (EV 16-28%). Avoidance focused, problem focused, drinking to cope predicted GHQ scores (EV 8-14%) and high alcohol consumption (EV ~8%) predicted GHQ scores. The present association pattern could still be shown when adjusted for gender, age and educational level when studied by multiple regression analyses. In conclusion, lowered HRQoL, low mood, a high T stage, high alcohol consumption, high neuroticism, coping by avoidance and coping by problem solving directly predicted worse distress as measured by high GHQ scores, whereas neuroticism was also associated with GHQ through choice of coping.

[Diagnostic imaging studies: do they create anxiety?]. / Pruebas de diagnóstico por la imagen: ¿generan ansiedad?

UNLABELLED: Cancer is one of the main health problems in western countries. In 2008, it represented the first cause of death in men and the second one in women. When there is a diagnosis or suspicion of cancer, performing diagnostic imaging studies has an important role in the clinical activity and may have an elevated psychological impact. OBJECTIVE: The purpose of this study was to evaluate the level of anxiety in oncology patients during the performance of a nuclear medicine study (PET-CT) in a Nuclear Medicine Service, by means of the State Trait Anxiety Inventory (STAI). MATERIAL AND METHODS: A total of 200 cancer patients who underwent a PET-CT study in a Nuclear Medicine Service were administered the STAI to evaluate the level of anxiety generated during this test. The STAI is a validated questionnaire developed as a research tool on anxiety in healthy adults. RESULTS: Of the 200 patients, two thirds (n=135) (67%) of the patients evaluated had anxiety. Of the 133, 93 (70%) of the patients who underwent PET-CT study for the first time were anxious whereas 42 (62.7%) of the patients who had undergone the study on previous occasions were anxious. Those patients with the greatest anxiety were those in whom the study was performed to initially stage the disease. CONCLUSION: Performing the PET-CT study as an initial staging method and/or to evaluate tumor recurrence is an important and statistically significant generator of anxiety. There is a high emotional and cognitive impact associated to the participation of the diagnostic tests.

Psychometric properties of the Malay Version of the hospital anxiety and depression scale: a study of husbands of breast cancer patients in Kuala Lumpur, Malaysia.

The main objective of this paper is to examine the psychometric properties of the Malay Version of the Hospital Anxiety and Depression Scale (HADS), tested on 67 husbands of the women who were diagnosed with breast cancer. The eligible husbands were retrieved from the Clinical Oncology Clinic at three hospitals in Kuala Lumpur, Malaysia. Data was collected at three weeks and ten weeks following surgery for breast cancer of their wives. The psychometric properties of the HADS were reported based on Cronbach' alpha, Intraclass Correlation Coefficients (ICC), Effect Size Index (ESI), sensitivity and discriminity of the scale. Internal consistency of the scale is excellent, with Cronbach's alpha of 0.88 for Anxiety subscale and 0.79 for Depression subscale. Test-retest Intraclass Correlation Coefficient (ICC) is 0.35 and 0.42 for Anxiety and Depression Subscale, respectively. Small mean differences were observed at test-retest measurement with ESI of 0.21 for Anxiety and 0.19 for Depression. Non-significant result was revealed for the discriminant validity (mastectomy vs lumpectomy). The Malay Version of the HADS is appropriate to measure the anxiety and depression among the husbands of the women with breast cancer in Malaysia.

Psychosocial effects of mastectomy on married African women in Northwestern Nigeria.

OBJECTIVES: Few studies have examined the psychosocial impact of breast cancer and its treatment on African women who come from a poverty-stricken, uneducated background in a developing country. The purpose of this study was to describe the specific psychosocial effects of breast cancer on married African women in order to help physicians educate and counsel future women and their families in Northwestern Nigeria. METHODS: Two semi-structured, self-report questionnaires were given to 81 consenting married African women treated with unilateral total mastectomy secondary to operable breast cancer at the Ahmadu Bello University Teaching Hospital. Questionnaires were answered at the time of the diagnosis and treatment consultation and at 6 months postmastectomy and included questions about demographics, frequency of conjugal relations and how the woman's sense of femininity was affected. Marital status was also tracked up to 3 years. RESULTS: Six months after surgery, the survey responses revealed that 67.9% of women felt inadequate as a woman because of the mastectomy and that 79.0% experienced a decrease in frequency of conjugal relations. Three years after primary breast cancer treatment, 61.7% of the participants were still married while 38.3% reported being divorced/separated from their husbands. CONCLUSIONS: These results indicated that married African women face significant physical, emotional and social changes and difficulties following primary breast cancer treatment. Culturally sensitive therapeutic groups and interventions should be established to help Nigerian women with breast cancer and their spouses and families understand and cope with the disease and its long-term health and quality-of-life implications.

Spirituality and quality of life in low-income men with metastatic prostate cancer.

OBJECTIVE: To determine how spirituality is associated with health-related quality of life (HRQOL) in an ethnically diverse cohort of low-income men with metastatic prostate cancer. METHODS: Eighty-six participants in a state-funded program that provides free prostate cancer treatment to uninsured, low-income men completed written surveys and telephone interviews containing validated measures of spirituality, and general and disease-specific HRQOL. Assessments were made following diagnosis of metastatic disease. We used multivariate analyses to assess the effect of spirituality and its two subscales, faith and meaning/peace, on HRQOL. RESULTS: African American and Latino men, and men with less than a high-school education had the highest spirituality scores. Spirituality was significantly associated with general and disease-specific HRQOL. We also found a significant interaction between faith and meaning/peace in the physical and pain domains. CONCLUSION: Greater spirituality was associated with better HRQOL and psychosocial function. Meaning/peace closely tracks with HRQOL. Higher faith scores, in the absence of high meaning/peace scores, are negatively associated with HRQOL.