Physical health and function trajectories in adults with cancer: psychosocial predictors of class membership.

PURPOSE: To prospectively examine different trajectories of recovery, across different aspects of physical health and function and to examine trajectory class membership. METHODS: This prospective study enrolled 569 recently diagnosed adult cancer patients (Mage = 58.7) between 2019 and 2022 identified through the Rapid Case Ascertainment resource of The Yale Cancer Center. Patients were diagnosed with breast (63.8%), prostate (25.3%), or colorectal cancer (10.9%) within six-months of baseline assessment. Participants completed comprehensive psychosocial and health survey measures (SF-12) through REDCap at five time points. Growth mixture modeling examined unconditional distinct trajectories for four aspects of physical health and function. We fit logistic regression and multinomial logistic regression models to estimate associations between psychosocial predictors of trajectory class membership for each of the four aspects. RESULTS: We identified distinct trajectories of physical health and function. Over one-third (38.4%) of the sample experienced low and declining scores in their ability to accomplish work/regular daily activities due to physical health. Over half (54.9%) demonstrate moderately stable general health with no improvement over time. A small but significant subset of the sample (3%, 5.7%, 5%) was in the moderate and declining groups with sharp decline in physical function, bodily pain, and general health, after treatment. Different predictors of trajectory class membership were also found. CONCLUSIONS: Our results showed heterogeneity in physical health and function trajectories and different patterns of predictors for each aspect of physical health and function. Findings have the potential to inform screening and intervention efforts to help those who may need additional support.

Perceived negative consequences of cancer and psychological distress in survivors: the moderating role of social support.

PURPOSE: Many cancer survivors experience psychological distress at some point during their care. The degree to which individuals perceive negative consequences of cancer has been associated with psychological distress, including anxiety and depression. Identifying psychosocial factors that buffer the effects of illness perceptions on distress may provide a target for intervention to improve the psychological health of cancer survivors. As such, the present study aimed to examine whether social support moderates the relationship between perceived negative consequences of cancer and psychological distress. METHODS: The current longitudinal study of 413 cancer survivors (64% female, 58% breast cancer, Mage = 59.68, SD = 11.41) examined social support as a potential moderator of the relationship, hypothesizing that greater overall perceived social support would buffer the relationship between perceived negative consequences of cancer and subsequent symptoms of anxiety and depression. RESULTS: Perceived negative consequences of cancer predicted anxiety and depression over time (p < .05), but social support had a buffering effect on the perceived negative consequences of cancer-anxiety relationship (ß = - .20, p < .001) as well as the perceived negative consequences of cancer-depression relationship (ß = - .11, p < .05). CONCLUSION: Results suggest that social support is a protective factor over time against the pathway of illness perceptions leading to psychological distress among cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Interventions that improve social support in cancer survivors may attenuate psychological distress and help support these individuals in their survivorship journey.

Development of a novel measure of advanced cancer patients' perceived utility of secondary germline findings from tumor genomic profiling.

Objective: Tumor genomic profiling (TGP) can inform advanced cancer patients' treatment decisions, and also reveal secondary germline findings-information about inherited risks for cancer and other disorders. We sought to develop a measure of patient perceptions of the clinical and personal utility of secondary germline findings. Methods: We developed a draft survey based on literature and patient interview data (n=40). We evaluated and refined the survey through cognitive interviews with advanced cancer patients who received secondary germline findings from TGP (n=10). The survey was psychometrically validated with data from two independent samples of advanced cancer patients undergoing TGP (total n=349). Results: Cognitive interviews offered opportunities for survey refinement and confirmation of its comprehensible nature. Exploratory and confirmatory factor analysis of the survey identified 16 items across three subscales with strong internal consistency (Cronbach's alpha ≥0.79): perceived utility for others, perceived utility for self and health, and confidence in secondary findings. Conclusion: We developed a novel valid scale with promise for measuring advanced cancer patients' perceptions of the utility of secondary germline findings. Innovation: We offer a new patient-derived measure of perceived utility of and confidence in secondary germline findings with potential applications for precision oncology research and clinical communication.

Disruption in Cancer Care During Early Survivorship due to the COVID-19 Pandemic and Patient Satisfaction with Telemedicine.

PURPOSE: The extent to which adults with cancer during early survivorship experienced disruptions in care due to COVID-19 pandemic, as well as their experiences with the transition to telemedicine, remains understudied. METHODS: We examined cancer care disruption and satisfaction with telemedicine due to COVID-19 in 361 adults (Mage = 59.42, SD = 11.3) with breast, prostate or colorectal cancer during early survivorship. The Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) and patient self-report Cancer Care Disruption Index (CCDI) was administered via RedCap survey. RESULTS: The most prevalent areas of patient-reported cancer care disruption included supportive care appointments canceled/postponed (57%), in-person appointments changed to virtual appointments (56%), social work services canceled (32%), palliative care appointments canceled/postponed (24%), elective surgeries related to cancer postponed (23%), and screening tests postponed (19%). Regarding patient satisfaction with telemedicine, 78.0% "agree" or "strongly agree" that they were satisfied with the overall telemedicine system. Most survivors reported satisfaction with their doctor dealing with problems (88.2%), doctors answering patient questions (92.7%), and engaged patients in care (86.1%), However, 49.3% of cancer patients disagreed that virtual visits are as satisfying as in-person visits and 35.6% were dissatisfied with the lack of physical contact during virtual visits. CONCLUSION: The COVID-19 pandemic disrupted cancer survivorship care, with supportive care, social work services, and mode of delivery (in-person vs. virtual) particularly affected. The downstream impact of cancer care disruption in those living with cancer during the pandemic as well as the quality of telehealth modality as part of cancer survivorship care delivery await future investigation.

Resilience across the Transition to Cancer Survivorship.

Resilience is highly relevant in the context of cancer, and understanding how survivors adapt and potentially thrive following their diagnosis and treatment may provide insights into better supports and interventions to promote healthier survivorship. In this paper, we characterize two different ways to conceptualize and study resilience in cancer survivorship, as a trait and as a process. We focus specifically on the transition from active treatment to post-treatment survivorship. We present data from 225 cancer patients transitioning from active treatment (baseline assessment) to early survivorship (6-month follow-up). Results demonstrate that resilience assessed as a trait at baseline was unrelated to changes in survivors' mental or physical wellbeing at follow-up, but did predict a decline in social satisfaction and spiritual wellbeing over time. However, when resilience is conceptualized as a dynamic process, the sample showed substantial resilience on multiple aspects of wellbeing. We suggest that different ways of conceptualizing resilience--as a trait versus as a dynamic process--may lead to very different conclusions and discuss future research directions for cancer survivors and for science of resilience.

Social media use and internalizing symptoms during early adolescence: The role of co-rumination.

BACKGROUND: This study examined the longitudinal associations between social media use, co-rumination (repeatedly discussing personal problems with peers), and internalizing symptoms during early adolescence. METHODS: Self-report measures were administered to a diverse sample of 1,205 early adolescents (51% girls; 51% non-Hispanic White; Mage= 12.75, SD = .71) at three time points (during the fall of 2016, spring of 2017, and fall of 2017). RESULTS: Findings indicated that daily social media use predicted engagement in co-rumination, which in turn predicted increases in internalizing symptoms. Specifically, co-rumination significantly mediated social media use and anxiety symptoms. LIMITATIONS: Study limitations include the use of self-report data and the geographically limited sample (restricted to the Northeastern United States). CONCLUSIONS: Findings from this study highlight an important interpersonal pathway by which social media use may confer risk for internalizing problems. Prevention and intervention programs designed to reduce the negative effects that social media use may have on adolescent internalizing problems should target co-rumination as a modifiable behavior and provide skills training in the use of more positive, adaptive coping strategies.

Placental gross shape differences in a high autism risk cohort and the general population.

A growing body of evidence suggests that prenatal environment is important in Autism Spectrum Disorder (ASD) etiology. In this study, we compare placental shape features in younger siblings of children with ASD, who themselves are at high ASD risk, to a sample of low risk peers. Digital photographs of the fetal placenta surface and of the sliced placental disk from 129 high ASD risk newborns and from 267 newborns in the National Children's Study Vanguard pilot were analysed to extract comparable measures of placental chorionic surface shape, umbilical cord displacement and disk thickness. Placental thickness measures were moderately higher in siblings of ASD cases. The placentas of ASD-case siblings were also rounder and more regular in perimeter than general population placentas. After stratification by sex, these across-group differences persisted for both sexes but were more pronounced in females. No significant differences were observed in cord insertion measures. Variations in placental shape features are generally considered to reflect flexibility in placental growth in response to changes in intrauterine environment as the placenta establishes and matures. Reduced placental shape variability observed in high ASD risk siblings compared to low-risk controls may indicate restricted ability to compensate for intrauterine changes.

Maternal body mass index does not affect neonatal umbilical artery blood gas parameters.

This study was undertaken to assess the impact of obesity on fetal well-being in glucose-tolerant and nonhypertensive women. Medical charts of all patients admitted to the labor and delivery department at our institution between January, 2011 and July, 2011 were retrospectively reviewed. Patients with diabetes/impaired glucose tolerance or hypertension were excluded. A total of 100 women, 50 lean and 50 obese, were included. Umbilical artery blood gas parameters (BGPs) were compared in lean (<25 kg/m(2)) and obese (≥ 30 kg/m(2)) women. Obese and lean women were comparable with respect to all baseline characteristics. There was no difference in any of the BGP or Apgar scores between obese and lean patients. Pearson's correlation coefficient found no significant correlation between BMI and BGP/Apgar scores. Maternal obesity does not seem to affect BGP and fetal well-being in glucose-tolerant and nonhypertensive women.