Randomized controlled trial of supportive-expressive group therapy and body-mind-spirit intervention for Chinese non-metastatic breast cancer patients.

PURPOSE: This study aimed to evaluate the efficacy of supportive-expressive group (SEG) therapy and body-mind-spirit (BMS) intervention on emotional suppression and psychological distress in Chinese breast cancer patients. METHODS: This three-arm randomized controlled trial assigned 157 non-metastatic breast cancer patients to BMS, SEG, or social support control group. SEG focused on emotional expression and group support, whereas BMS emphasized relaxation and self-care. All groups received 2-h weekly sessions for 8 weeks. The participants completed measurements on emotional suppression, perceived stress, anxiety, and depression at baseline and three follow-up assessments in 1 year. RESULTS: Using latent growth modeling, overall group difference was found for emotional suppression (χ 2(2) = 8.88, p = 0.012), marginally for perceived stress (χ 2(2) = 5.70, p = 0.058), but not for anxiety and depression (χ 2(2) = 0.19-0.94, p > 0.05). Post-hoc analyses revealed a significant and moderate reduction (Cohen d = 0.55, p = 0.007) in emotional suppression in SEG compared to control group, whereas BMS resulted in a marginally significant and moderate fall (d = 0.46, p = 0.024) in perceived stress. Neither SEG nor BMS significantly improved anxiety and depression (d < 0.20, p > 0.05). CONCLUSIONS: The present results did not demonstrate overall effectiveness for either BMS or SEG therapy in the present sample of Chinese non-metastatic breast cancer patients. The participants appear to derive only modest benefits in terms of their psychological well-being from either intervention.

Psychological burden of testing positive for high-risk human papillomavirus on women with atypical cervical cytology: a prospective study.

OBJECTIVE: To assess the psychological burden of testing positive for high-risk human papillomavirus (HPV) on Chinese women with atypical squamous cells of undetermined significance (ASCUS). DESIGN: Prospective observational study. SETTING: Five community women's health clinics in Hong Kong. POPULATION: Ethnic Chinese women (n=299) with ASCUS who underwent reflex HPV testing (of whom 142 tested HPV negative and 157 tested HPV positive). METHODS: Women's psychological condition was assessed by self-administered questionnaires at smear result notification and by structured telephone interviews six months after notification. All women who tested positive for HPV were referred for colposcopy. MAIN OUTCOME MEASURES: State anxiety, cervical cancer worry and psychosocial burden. RESULTS: At result notification, the HPV-positive group had significantly higher state anxiety, cervical cancer worry and psychosocial burden than the HPV-negative group (all p<0.001). Irrespective of the HPV results, all outcome scores decreased over time. About 80% of the women who were HPV positive attended colposcopy as recommended. At six months, the two groups did not differ in state anxiety, cervical cancer worry, perceived risk of cervical cancer and satisfaction with intimate relationship, but psychosocial burden remained higher in the HPV-positive group (p=0.001). CONCLUSIONS: A concurrent positive HPV result intensified the distress of women with ASCUS at result notification. With time and after colposcopy, their initial heightened anxiety and cervical cancer worry were significantly lowered. However, HPV positivity may pose a prolonged psychosocial burden on women even after having had the necessary follow-up for their cervical abnormalities.

The epidemiology and natural history of depressive disorders in Hong Kong's primary care.

BACKGROUND: Depressive disorders are commonly managed in primary care and family physicians are ideally placed to serve as central providers to these patients. Around the world, the prevalence of depressive disorders in patients presenting to primary care is between 10-20%, of which around 50% remain undiagnosed. In Hong Kong, many barriers exist preventing the optimal treatment and management of patients with depressive disorders. The pathways of care, the long term outcomes and the factors affecting prognosis of these patients requires closer examination. METHODS/DESIGN: The aim of this study is to examine the prevalence, incidence and natural history of depressive disorders in primary care and the factors influencing diagnosis, management and outcomes using a cross-sectional study followed by a longitudinal cohort study.Doctors working in primary care settings across Hong Kong have been invited to participate in this study. On one day each month over twelve months, patients in the doctor's waiting room are invited to complete a questionnaire containing items on socio-demography, co-morbidity, family history, previous doctor-diagnosed mental illness, recent mental and other health care utilization, symptoms of depression and health-related quality of life. Following the consultation, the doctors provide information regarding presenting problem, whether they think the patient has depression, and if so, whether the diagnosis is new or old, and the duration of the depressive illness if not a new diagnosis. If the doctor detects a depressive disorder, they are asked to provide information regarding patient management. Patients who consent are followed up by telephone at 2, 12, 26 and 52 weeks. DISCUSSION: The study will provide information regarding cross-sectional prevalence, 12 month incidence, remission rate, outcomes and factors affecting outcomes of patients with depressive disorders in primary care. The epidemiology, outcomes, pathways of care, predictors for prognosis and service needs for primary care patients with depressive disorders will be described and recommendations made for policy and service planning.

De-stigmatising human papillomavirus in the context of cervical cancer: a randomised controlled trial.

OBJECTIVE: To identify the components of a human papillomavirus (HPV) message contributing to reducing the stigma of HPV in cervical cancer. METHODS: 294 ethnic Chinese women attending a community-based clinic in Hong Kong were randomly allocated to read one of three written HPV messages: Group 'lr+hrHPV': low-risk and high-risk HPVs facts, Group 'hrHPV': high-risk HPV facts only and Group 'ds+hrHPV': high-risk HPV facts and de-stigmatising components, namely being anti-stereotypical, motivational and low in complexity. Main outcome measures were high-risk HPV-related sexual stigma, knowledge, attitude towards message, and intention to be HPV-tested measured by self-administered questionnaires immediately before and after reading. RESULTS: Message allocation had a significant effect on sexual stigma (F = 5.219, p = 0.006). Participants who read message ds+hrHPV showed the least stigma, and were significantly less likely to believe that high-risk HPV infection implicated promiscuity, non-monogamy or that monogamy offered complete protection against high-risk HPV. The genital HPV-focused message was more stigmatising than cervical cancer-focused messages. Of all participants, 93% (237/254) and 97% (260/269) indicated a positive intention to be HPV-tested before and after reading, respectively. There were no between-group differences noted in terms of knowledge and intention to be HPV-tested before or after reading. CONCLUSIONS: Our findings show that an HPV message containing specific de-stigmatising components may reduce public stigma towards high-risk HPV. Also, focusing solely on high-risk HPV in the context of cervical cancer helps to avoid the stigmatising effect of genital warts from tainting perceptions about high-risk HPV infection.

Brief problem-solving treatment in primary care (PST-PC) was not more effective than placebo for elderly patients screened positive of psychological problems.

OBJECTIVES: To evaluate whether screening followed by brief problem-solving treatment by primary care doctors (PST-PC) could improve health-related quality of life (HRQOL) and reduce consultation rates in the elderly. DESIGN: A single-blind randomized placebo controlled trial (RCT). SETTING: Two government funded primary care clinics in Hong Kong. PARTICIPANTS: Two hundred and ninety nine Chinese patients aged 60 years or over, with positive screening scores for psychological problems by the Hospital Anxiety and Depression Scale (HADS). INTERVENTIONS: One hundred and forty nine subjects were randomized to receive brief PST-PC from primary care doctors (treatment) and 150 to group video-viewing (placebo). All subjects were followed up by telephone at 6, 12, 26 and 52 weeks. MAIN OUTCOME MEASURES: Changes in SF-36 HRQOL scores, HADS scores and monthly consultation rates were compared within and between groups. RESULTS: Study completion rates were 69-71%. There was significant improvement in the SF-36 role-emotional (RE) and mental component summary (MCS) scores at week 6 in the PST-PC group but not in the placebo group. Several SF-36 scores improved significantly in the placebo (video) group at week 6-52. Mixed effects analysis adjusting for baseline values and cofounders did not show any difference in any of the outcomes between the PST-PC and placebo (video) groups. CONCLUSIONS: Screening followed by brief PST-PC was associated with a short-term improvement in HRQOL in Chinese elderly patients screened positive of psychological problems, but the HRQOL benefit was not greater than those found in the placebo group who participated in group-viewings of health education videos.

Late-life body mass index and waist circumference in amnestic mild cognitive impairment and Alzheimer's disease.

We investigated the progressive associations of late-life body mass index (BMI) and waist circumference (WC) with amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD) in Chinese older adults in a case-control study. Late-life BMI and WC were measured. AD was diagnosed by the NINCDS-ADRDA criteria for probable AD and aMCI by the Petersen's criteria. 426 Chinese older adults [125 AD, 125 aMCI and 176 controls with normal cognition (NC)], aged 55 to 93 years old, were recruited. Both BMI and WC decreased significantly across the normal, aMCI, and AD groups (dementia diagnostic group: p for trend < 0.001 and 0.016 respectively, 1-way ANOVA). After adjustment for significant confounders, multivariate general linear model analyses showed that the dementia diagnostic group (AD/aMCI/NC) was a significant independent predictor of both the late-life BMI and late-life WC (p = 0.002 and 0.018 respectively). In conclusion, late-life BMI and WC progressively decrease in older adults with normal cognition, aMCI, and AD. Low late-life BMI and WC represent potentially useful pre-clinical markers of aMCI and AD.

Unrecognised psychological problems impair quality of life and increase consultation rates in Chinese elderly patients.

OBJECTIVE: Studies have shown that psychological problems in elderly patients are often unrecognised in primary care. The aim of this study was to investigate the quality of life and consultation rates of Chinese elderly patients with unrecognised psychological problems in primary care. The prevalence and risk factors of unrecognised psychological problems were also determined. METHODS: A cross-sectional study on consecutive patients aged > or =60 with no known psychological diseases were screened by the Hospital Anxiety and Depression Scale (HADS) when they consulted at two primary care clinics in Hong Kong. Data on socio-demographic characteristics, chronic morbidity, consultation rates, and health-related quality of life (HROQL) were collected. Multivariable regressions were used to determine the effect of a positive HADS score on HRQOL scores and consultation rates, and the risk factors of unrecognised psychological problems. RESULTS: One thousand eight hundred and fifty-four subjects (mean age 72.6 years and 52% male) were screened and the estimated prevalence of unrecognised psychological diseases was 23% (95% CI = 13.1-33.8%). A positive screening result was associated with poorer SF-36 HROQL scores and higher episodic consultation rates. An increased risk of unrecognised psychological problems was associated with the presence of more than two chronic diseases. Other risk factors included female gender, no formal education and having chronic pulmonary disease or heart disease. Living with a spouse increased the risk in elderly women. CONCLUSIONS: Unrecognised psychological problems are common in Chinese elderly patients in primary care. They are clinically important because they impair quality of life and increase the utilization of consultations.

Sociocultural influences on body dissatisfaction and dieting in Hong Kong girls.

We investigated the relationship of sociocultural influences (SI) promoting thinness (parental, peer and media pressures for thinness, and individual value for modernity), age and body mass Index (BMI) to body dissatisfaction (BD) and dieting in 294 Hong Kong community adolescent girls. We proposed that BD mediated SI's relationship with dieting. In bivariate analyses, all variables were significantly (p < or = .05) related to BD (beta's from 0.14 to 0.59), and, except for modernity, to dieting (beta's from 0.17 to 0.51). In multivariate analyses, peer (beta = 0.32, p < .001) and media pressures for thinness (beta = 0.18, p < .01) bypassed BD and were directly associated with dieting. A culture of thinness appears to be associated with weight loss efforts among girls in modernising cultures independent of BD. Our findings call for public policy to restrict promotion of the impossibly thin ideal, and public education regarding the paradoxical effects of dieting.

Bioavailable testosterone is associated with a reduced risk of amnestic mild cognitive impairment in older men.

OBJECTIVE: We investigated the risk of amnestic mild cognitive impairment (aMCI) in relation to serum bioavailable (BT) and total testosterone (TT) levels in older men. DESIGN, SETTING AND SUBJECTS: A cross-sectional study in an ambulatory setting, with older men aged 55-93 years with normal cognition, aMCI and Alzheimer's disease (AD). MEASUREMENTS: Morning serum BT and TT levels were determined. AD was diagnosed by the Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable AD and aMCI by the Petersen criteria. RESULTS: We recruited 203 Chinese older men (48 aMCI, 66 AD and 89 with normal cognition). Mean serum BT, but not TT, levels were significantly lower in the aMCI (mean BT +/- SEM 1.06 +/- 0.10 nmol/l) and AD (0.99 +/- 0.08 nmol/l) groups than in the normal controls (1.82 +/- 0.12 nmol/l) (P < 0.001, one-way anova) with no significant difference between the aMCI and AD groups. After adjustment for education, age and apolipoprotein E (apoE) genotype, logistic regression analyses showed that the serum BT level [adjusted odds ratio (OR) = 0.52, 95% confidence interval (CI) 0.32-0.85] was an independent protective factor for aMCI. For the combined outcome of aMCI and AD, the serum BT level was an independent protective factor but age and apoE epsilon4 were independent risk factors. There was no interaction between BT and age. CONCLUSIONS: In older men, serum BT, but not TT, levels were associated with a lower risk of aMCI and AD.

Repeat suicide attempts in Hong Kong community adolescents.

It has been well documented that a history of suicide attempts confers risk for subsequent attempts; however, efforts to explain how variables may change after a previous attempt and in turn relate to future suicide attempts are rare in the literature. This study presents longitudinal data on adolescent suicide attempts in Hong Kong, and examines whether the data support the "crescendo" model to explain repeat suicide attempts. One thousand and ninety-nine community adolescents aged 12-18 years were evaluated at two assessment points 12 months apart (T1 and T2). The study assessed (1) risk factors at T1 for a suicide attempt between T1 and T2, (2) whether a suicide attempt during the 12 months prior to T1 predicted an attempt between the two assessment points, and (3) whether the indicators of distress worsened from T1 to T2 if an attempt had taken place in the interim. The results indicated that: (1) depressive symptoms, substance use, and suicidal ideation measured at T1 were independent predictors of a suicide attempt between T1 and T2; (2) suicide attempt in the year prior to T1 predicted suicide attempt between T1 and T2 after controlling for other predictors; and (3) suicide attempt between T1 and T2 was a predictive factor for a negative change from T1 to T2 in substance use, suicidal ideation, family relationships, depression, anxiety, and life stress. These findings are consistent with the "crescendo" model proposing that the risk of repeat attempts is enhanced following a previous suicide attempt.

Factor structure of the Center for Epidemiological Studies Depression Scale in Hong Kong adolescents.

We present data from the Center for Epidemiological Studies-Depression Scale (CES-D; Radloff, 1977) for 2 samples of Hong Kong community adolescents (combined N = 1,385). The 4 positive affect items related poorly to the remainder of the scale. Using 16 items, the data were consistent with 2 models with highly correlated factors: (a) a 2-factor model, 1 of which merged somatic and affective items, and (b) a 3-factor model separating somatic, depressed, and interpersonal items. Correlations with related constructs provide preliminary support of validity. Hong Kong adolescents are influenced both by traditional concepts of mind-body holism and Western psychological models separating psychological and somatic symptoms.

Effect of individual psychological intervention in Chinese women with gynecologic malignancy: a randomized controlled trial.

PURPOSE: To evaluate the effectiveness of psychological intervention in the care of cancer patients and to determine whether routine use of individual psychological therapies is indicated. PATIENTS AND METHODS: Patients with newly diagnosed gynecologic malignancies from August 1999 to November 2000 were recruited and randomly assigned to either a control group receiving routine medical care or to an intervention group receiving individual psychotherapy. A set of fixed-choice, self-report questionnaires assessing the patients' psychological status, quality of life, and their perceptions related to the medical consultations was completed at recruitment and then every 3 months for 18 months. Data analysis was performed according to the intention-to-treat principle by fitting the data into a linear mixed-effects model. Multivariable analyses were performed to examine the effects of confounding factors. RESULTS: One hundred fifty-five patients participated in the trial. There were no statistically significant differences between the two groups at baseline. There was a trend toward better quality of life and functional status and also improvement of the symptoms over time for both groups. No differences were found between the groups in the scores measured by any of the instruments at baseline and at any time points after the cancer diagnosis. Psychological intervention had no significant effects on the psychosocial parameters. CONCLUSION: Routine use of psychological therapies as given in our format has no significant effect on the patients' quality of life and psychological status.

Adolescent suicide attempters in Hong Kong and the United States.

Using a nested case-control design drawing from a larger sample of 2272 adolescents, this study examined the characteristics of adolescents from Hong Kong (n = 99) and the United States (US) (n = 60), who indicated that they had made a suicide attempt at least once in the past, compared to their equally depressed sex- and age-matched counterparts who had not attempted suicide. The cross-cultural literature suggested three hypotheses which were tested: (a) depressive symptoms would differentiate between suicide attempters compared to non-attempters less in Hong Kong and more in the US; (b) discord in interpersonal relationships would be a more important distinguishing factor in suicide attempts in Hong Kong than in the US and (c) cognitive variables such as hopelessness would be less associated with suicide attempts in Hong Kong compared to the US. There were strong similarities in the two cultures with regard to characteristics that distinguished between attempters and matched controls. Hypotheses regarding cultural differences between attempters in Hong Kong and the US were not supported. Depression, current and lifetime suicide ideation, hopelessness, poor interpersonal relationships and exposure to suicide attempters and completers distinguished attempters from controls equally in the two cultures and in both genders. These findings do not support the proposition that depression is a less relevant variable in suicide attempts in Chinese versus western groups.

A cross-cultural investigation of cognitions and depressive symptoms in adolescents.

Adolescents (N=2,272) from Hong Kong and the United States provided information regarding their depressive symptoms, cognitions (self-efficacy, negative cognitive errors, and hopelessness), and stressful events between 2 surveys 6 months apart. Depressive symptoms and hopelessness were higher, and self-efficacy and negative cognitive errors were lower in Hong Kong than in the United States. Cognitions were associated with concurrent depressive symptoms and predicted depressive symptoms 6 months later in both cultures. The "reverse" model was also supported with more variance predicted by depressive symptoms to later cognitions than from cognitions to depressive symptoms. There was some support for the hypothesis that self-efficacy is less salient in collective compared with individualistic cultures. These findings extend cognitive theories of depression to a non-Western culture.

Suicidality and cultural values among Hong Kong adolescents.

Scholars have proposed that individualistic values resulting from globalization are associated with increasing behavioral and emotional problems among youth in modernizing cultures. This study examined specific individualistic and traditional values in the context of suicidal ideation and behaviors in Hong Kong among community adolescent youths (N=2427) ages 14-18 years. Participants indicated the extent to which self-direction/independence and obedience/respect for elders were important to them. They also reported on four progressive levels of suicidality: whether in the last year they had experienced suicidal ideation, made plans for a suicide attempt, attempted suicide, and (for attemptors) made a serious attempt requiring medical attention. After controlling for quality of family relationships and depressive symptoms, at least one of the values predicted suicidality at all but the highest level. There were sex-specific associations between values and suicidality. In general, endorsement of self-direction was correlated with reduced risk of suicidality for boys and was irrelevant to girls. In contrast, traditional emphases on obedience and respect for elders were more frequently protective against suicidality for girls and were inconsistent predictors for boys. The relationship between values and suicidality was generally independent of the effect of family relationships and depressive symptoms. Thus, values were associated with adolescent suicidality, but not consistently in the direction predicted by some theorists, and the association depended upon the adolescent's sex.

Effects of cognitive function and depressive mood on the quality of life in Chinese Alzheimer's disease patients in Hong Kong.

AIM: In view of the paucity of data on the quality of life (QOL) in Chinese Alzheimer's disease (AD) patients, we investigated the effects of cognitive function and depressive mood on QOL among our Chinese AD patients in Hong Kong, using the Cantonese Chinese version of Quality of Life in Alzheimer's disease (QOL-AD). METHODS: This was a cross-sectional study. The Cantonese Chinese version of QOL-AD was adapted from the Mandarin Chinese and English versions of QOL-AD, and was administered to 111 AD patients and their caregivers. RESULTS: The Cantonese Chinese version of QOL-AD showed good internal consistency, test-retest and inter-rater reliability. The patients' and caregivers' reports of QOL-AD were moderately correlated (r=0.516, P<0.001). Both QOL-AD scores from patient and caregiver reports varied significantly in relation to the severity of cognitive impairment, being lowest in the subgroup with Mini-Mental State Examination scores of 10 or less. The mean QOL-AD scores from both patient and caregiver reports were also significantly lower in the depressed (Geriatric Depression Scale [GDS] scores≥15) than non-depressed groups (GDS scores≤15) (QOL-AD patient report 23.8 and 34.2, respectively, P<0.001, Student's t-test; QOL-AD caregiver report 28.9 and 31.0, respectively, P<0.05, Student's t-test). General linear model analyses showed that only the MMSE and GDS scores were independent significant factors associated with the patient but not the caregiver reports of the QOL-AD. CONCLUSION: Among Chinese AD patients in Hong Kong, depressive mood and low MMSE score adversely affect the QOL-AD from the patient but not the caregiver perspectives.

The effect of school-based cervical cancer education on perceptions towards human papillomavirus vaccination among Hong Kong Chinese adolescent girls.

OBJECTIVE: To evaluate the effects of school-based cervical cancer education on Hong Kong Chinese adolescent girls. METHODS: Adolescent girls (n=953) in local secondary schools attended a tailored educational program on cervical cancer prevention. Self-administered questionnaires were used before and after the program to measure its effects on participants' knowledge, attitude and perceived social norms towards human papillomavirus (HPV) vaccination and their intention to be HPV vaccinated. RESULTS: Before the program, HPV vaccine acceptance was favorable but relevant knowledge was low. After the program, participants had greater knowledge and a more positive attitude (both p<0.001), with more girls anticipating family (41.6% before vs. 58.9% after) and peer support (32.8% before vs. 56.9% after). There were 11.3% more girls who indicated an intention to accept the vaccine afterward. More knowledge, a more positive attitude and perceived support from significant others predicted a stronger intention to be HPV vaccinated. CONCLUSION: The educational program had a positive impact on participants' perceptions towards HPV vaccination and their intention to be vaccinated. PRACTICE IMPLICATIONS: School-based cervical cancer education is a viable means to meet the substantial educational needs of adolescents. Promotion of HPV vaccination should also include educating and influencing perceptions of families and peers.

Validation of the eating disorder diagnostic scale for use with Hong Kong adolescents.

OBJECTIVE: We examined the psychometric properties of the Eating Disorder Diagnostic Scale (EDDS) in a community sample of Hong Kong school children. METHOD: Participants (359 boys and 387 girls), aged 12 to 19 years, were assessed on the EDDS on two occasions, one month apart. Factor structure, internal consistency, test-retest reliability, and validity against the Eating Disorders Examination-Questionnaire (EDE-Q) and Center for Epidemiological Studies-Depression (CES-D) were investigated. RESULTS: Four groupings emerged on exploratory factor analysis: body dissatisfaction, bingeing behaviors, bingeing frequency, and frequency of compensatory behaviors. Items loaded on the same factors for boys and girls. Internal consistency for these factors was acceptable. Test-retest reliability was high for body dissatisfaction factor but weak to moderate for other factors and for diagnoses. High concurrent validity with the EDE-Q, and correlation with the CES-D was shown. CONCLUSION: We offer preliminary reliability and validity evidence to support the further development of the EDDS as a screening instrument to assess eating disturbances in Hong Kong youth.

A prospective study of the impact of nasopharyngeal cancer and radiotherapy on the psychosocial condition of Chinese patients.

BACKGROUND: Radiotherapy (RT) promises optimistic results in the treatment of nasopharyngeal cancer (NPC). The objective of the current study was to map out prospectively the impact of NPC and RT on patients from diagnosis to 1 year posttreatment. METHODS: For this study, 67 Chinese patients (46 men and 21 women) with newly diagnosed stage I or II NPC who received primary RT were recruited. Physical and psychosocial adjustments were measured by using the Rotterdam Symptom Checklist, Beck Anxiety Inventory, Beck Depression Inventory, Perceived Stress Scale, and the 36-item Short-Form Health Survey (SF-36). Semistructured clinical interviews were conducted at bimonthly intervals from pre-RT to 1 year post-RT. RESULTS: Physical and psychosocial adjustments were poorest from pre-RT to the end of RT. Rapid improvements in all areas were noted in the first 2 months post-RT and reached a plateau at around the 6th month. At 1 year, except for physical symptoms and perceived stress, patient measures recovered to their pre-RT levels. At 1 year, patients had more physical complaints (P < .001) but less perceived stress (P = .002). The percentage of patients who expressed fear of dying dropped from 28% pre-RT to 2% at 1 year. However, patients who expressed "fear of the worst happening" increased from 51% pre-RT to 57% at 1 year. CONCLUSIONS: Different periods in treatment of NPC imposed different psychosocial demands on patients. The current results indicated that the period from diagnosis to 2-month post-RT was a high-risk period both physically and emotionally. After treatment, most patients showed resilience despite persistent side effects of RT and successfully resumed their pretreatment level of functioning by the end of the year. Despite resuming a normal or near-normal living, patients still noted a subdued fear of recurrence.