Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs.

OBJECTIVE: This individual patient data (IPD) meta-analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention-related characteristics. METHODS: Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed-effect model analyses were used to study intervention effects on the post-intervention values of QoL, EF, and SF (z-scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention-related characteristics, and conducted subsequent stratified analyses for significant moderator variables. RESULTS: PSI significantly improved QoL (ß = 0.14,95%CI = 0.06;0.21), EF (ß = 0.13,95%CI = 0.05;0.20), and SF (ß = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types. CONCLUSIONS: PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention-related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.

TrueNTH sexual recovery study protocol: a multi-institutional collaborative approach to developing and testing a web-based intervention for couples coping with the side-effects of prostate cancer treatment in a randomized controlled trial.

BACKGROUND: Over half of men who receive treatment for prostate suffer from a range of sexual problems that affect negatively their sexual health, sexual intimacy with their partners and their quality of life. In clinical practice, however, care for the sexual side effects of treatment is often suboptimal or unavailable. The goal of the current study is to test a web-based intervention to support the recovery of sexual intimacy of prostate cancer survivors and their partners after treatment. METHODS: The study team developed an interactive, web-based intervention, tailored to type of treatment received, relationship status (partnered/non-partnered) and sexual orientation. It consists of 10 modules, six follow the trajectory of the illness and four are theme based. They address sexual side effects, rehabilitation, psychological impacts and coaching for self-efficacy. Each includes a video to engage participants, psychoeducation and activities completed by participants on the web. Tailored strategies for identified concerns are sent by email after each module. Six of these modules will be tested in a randomized controlled trial and compared to usual care. Men with localized prostate cancer with partners will be recruited from five academic medical centers. These couples (N = 140) will be assessed prior to treatment, then 3 months and 6 months after treatment. The primary outcome will be the survivors' and partners' Global Satisfaction with Sex Life, assessed by a Patient Reported Outcome Measure Information Systems (PROMIS) measure. Secondary outcomes will include interest in sex, sexual activity, use of sexual aids, dyadic coping, knowledge about sexual recovery, grief about the loss of sexual function, and quality of life. The impact of the intervention on the couple will be assessed using the Actor-Partner Interaction Model, a mixed-effects linear regression model able to estimate both the association of partner characteristics with partner and patient outcomes and the association of patient characteristics with both outcomes. DISCUSSION: The web-based tool represents a novel approach to addressing the sexual health needs of prostate cancer survivors and their partners that-if found efficacious-will improve access to much needed specialty care in prostate cancer survivorship. TRIAL REGISTRATION: Clinicaltrials.gov registration # NCT02702453 , registered on March 3, 2016.

Effects and moderators of coping skills training on symptoms of depression and anxiety in patients with cancer: Aggregate data and individual patient data meta-analyses.

PURPOSE: This study evaluated the effects of coping skills training (CST) on symptoms of depression and anxiety in cancer patients, and investigated moderators of the effects. METHODS: Overall effects and intervention-related moderators were studied in meta-analyses of pooled aggregate data from 38 randomized controlled trials (RCTs). Patient-related moderators were examined using linear mixed-effect models with interaction tests on pooled individual patient data (n = 1953) from 15 of the RCTs. RESULTS: CST had a statistically significant but small effect on depression (g = -0.31,95% confidence interval (CI) = -0.40;-0.22) and anxiety (g = -0.32,95%CI = -0.41;-0.24) symptoms. Effects on depression symptoms were significantly larger for interventions delivered face-to-face (p = .003), led by a psychologist (p = .02) and targeted to patients with psychological distress (p = .002). Significantly larger reductions in anxiety symptoms were found in younger patients (pinteraction < 0.025), with the largest reductions in patients <50 years (ß = -0.31,95%CI = -0.44;-0.18) and no significant effects in patients ≥70 years. Effects of CST on depression (ß = -0.16,95%CI = -0.25;-0.07) and anxiety (ß = -0.24,95%CI = -0.33;-0.14) symptoms were significant in patients who received chemotherapy but not in patients who did not (pinteraction < 0.05). CONCLUSIONS: CST significantly reduced symptoms of depression and anxiety in cancer patients, and particularly when delivered face-to-face, provided by a psychologist, targeted to patients with psychological distress, and given to patients who were younger and received chemotherapy.

Breast cancer in younger women: effects on interpersonal and family relations.

Although breast cancer can have a stressful impact on women of all ages, young women may be particularly vulnerable to the negative effects of the disease. Based on a developmental perspective, this article reviews studies on the emotional impact of breast cancer on young women, their spouses, children, and the marital relationship. Studies indicate that younger women experience more emotional distress than older women, although the inverse relationship between age and emotional distress is not consistent across all studies. Although age does not appear to have a direct relationship to husbands' adjustments, younger husbands reported more problems carrying out domestic roles and a greater number of life stresses than older husbands. Studies on the impact of breast cancer on children are limited in number and scope but indicate that the effects of breast cancer vary according to the developmental level of the child. Directions for further research on young women and their families are suggested.

Factors affecting couples' adjustment to recurrent breast cancer.

The purpose of this study was to identify factors that affect the adjustment of women and their husbands to recurrent breast cancer and to examine the mutual effect that partners have on one another. An exploratory study was designed to determine the relationship between four predictor variables (support, uncertainty, symptom distress, hopelessness) and women's and husbands' adjustments. The sample consisted of 155 subjects; 81 women, who had a first recurrence of breast cancer, and 74 husbands. Multiple standardized instruments with established reliability and validity were used to measure the study variables. The independent variables were measured with the Social Support Questionnaire, the Mishel Uncertainty in Illness Scale, McCorkle Symptom Distress Scale and the Beck Hopelessness Scale. The dependent variable, psychosocial adjustment, was measured with the Brief Symptom Inventory and the Psychosocial Adjustment to Illness Scale. The results indicated that the independent variables accounted for 43% of the variance in women's distress and 32% of the variance in husbands' distress; they also explained 66% of the variance in women's role adjustment problems and 57% of the variance in husbands' role problems. Symptom distress and hopelessness accounted for the most variance in women's and husbands' levels of adjustment. A significant and positive relationship was found between women's and husbands' adjustment scores, indicating that partners have a mutual influence on one another. The findings suggest that there are multiple factors that influence couples' adjustment to recurrent breast cancer, and that these factors need to be taken into consideration when planning care for women and their partners.

Couples' patterns of adjustment to colon cancer.

The objectives for this longitudinal study were to: (a) compare colon cancer patients' and their spouses' appraisal of illness, resources, concurrent stress, and adjustment during the first year following surgery; (b) examine the influence of gender (male vs female) and role (patient vs spouse caregiver) on study variables; (c) assess the degree of correlation between patients' and spouses' adjustments; and (d) identify factors that affect adjustment to the illness. Fifty-six couples were interviewed at one week post diagnosis, and at 60 days and one year post surgery. Based on a cognitive-appraisal model of stress, the Smilkstein Stress Scale was used to measure concurrent stress; the Family APGAR, Social Support Questionnaire, and Dyadic Adjustment Scale were used to measure social resources; the Beck Hopelessness Scale and Mishel Uncertainty in Illness Scales were used to measure appraisal of illness; and the Brief Symptom Inventory and Psychosocial Adjustment to Illness Scale were used to measure psychosocial adjustment. Repeated Measures Analysis of Variance indicated that spouses reported significantly more emotional distress and less social support than patients. Gender differences were found, with women reporting more distress, more role problems, and less marital satisfaction, regardless of whether they were patient or spouse. Both patients and spouses reported decreases in their family functioning and social support, but also decreases in emotional distress over time. Moderately high autocorrelations and modest intercorrelations were found among and between patients' and spouses' adjustment scores over time. The strongest predictors of patients' role adjustment problems were hopelessness and spouses' role problems. The strongest predictors of spouses' role problems were spouses' own baseline role problems and level of marital satisfaction. Interventions need to start early in the course of illness, be family-focused, and identify the couples at risk of poorer adjustment to colon cancer.

Models of helping and coping in cancer care.

This paper provides a theoretical analysis of four models of helping and coping as they relate to cancer care. The four conceptual models focus on the issue of whether or not patients should be viewed as responsible for the cause or the treatment of their cancer. The moral model, characterized by the holistic health movement, holds patients responsible for both causing and resolving health problems. The compensatory model, exemplified by cancer education programs, attributes low responsibility to patients for causing health problems but high responsibility for resolving them. The medical model views patients as neither responsible for causing nor for resolving health problems. The enlightenment model, typified by the healing movement, holds people responsible for causing their health problems, but not for resolving them. An attempt is made to examine existing programs in cancer care in light of these models. The present analysis addresses the following questions. Why is each of these models appealing? Why are they sometimes embraced by patients or health care providers? What are the benefits and disadvantages of using each of these models with cancer patients? What happens when the health care provider and patient hold different models regarding the patient's responsibility or participation in the cause of the disease or its treatment? Further research is needed to determine the conditions under which a particular model results in better health outcomes for patients, and to assess how factors such as extent of disease or type of cancer influence the patient's choice of a model.

The impact of breast cancer on patients and husbands.

The purpose of this descriptive study was fourfold: (a) to assess the adjustment concerns of patients and husbands after a mastectomy, (b) to describe their reactions to seeing the mastectomy incision, (c) to determine which phase of illness was most stressful for them, and (d) to identify factors that helped them cope with the illness. Tape-recorded interviews were conducted with 50 mastectomy patients and their husbands in the hospital just after surgery and 1 month later. Transcripts were content analyzed by two independent raters. Results indicated that survival concerns were the predominant worries reported by patients and husbands in the hospital and 1 month after surgery. Although most of the husbands reacted well to seeing their wives' mastectomy incision, a small group of husbands reported that it was a difficult experience. Patients and husbands indicated that emotional support, information, attitude, and religion were the factors that helped them cope with the illness during this time.

A longitudinal study of the adjustment of patients and husbands to breast cancer.

Although adjustment to breast cancer is an ongoing process, few studies have assessed the psychosocial adjustment of patients and husbands over an extended period of time. The purpose of this descriptive study was to compare the psychosocial adjustment of mastectomy patients and their husbands at three points in time: 3 days, 30 days, and 18 months post-surgery. Data were obtained from 41 mastectomy patients and their husbands (n = 82 subjects) at each time point. Three instruments with established reliability and validity were used to measure three components of psychosocial adjustment: the Affects Balance Scale (mood), the Brief Symptom Inventory (symptom distress), and the Psychosocial Adjustment to Illness Scale (role functioning). Repeated measures Analysis of Variance was used to compare changes in subjects' adjustment levels over time. Results indicated that while subjects' levels of mood and levels of role functioning improved over time, subjects' levels of distress did not improve over time. Distress levels reported by patients and husbands at 18 months were similar to levels reported at 3 days and 30 days post-surgery. The findings suggest that difficulties in psychosocial adjustment are not confined to the early phase of illness but persist over time for both patients and husbands. Nursing implications center on the importance of long-term, ongoing assessment.

Coping with a breast biopsy: how healthcare professionals can help women and their husbands.

PURPOSE/OBJECTIVE: To examine the type of information women received from their physicians prior to breast biopsy, to describe women's and their husbands' levels of concern during this time, and to determine the type of help they want from healthcare professionals. DESIGN: Descriptive. SETTING: Homes of couples in the midwestern United States. SAMPLE: 300 women and 265 of their husbands interviewed approximately one week prior to biopsy. METHODS: Interviews using a semistructured questionnaire. MAIN RESEARCH VARIABLES: The type of information women and their husbands receive prior to biopsy, their levels of concern, and the type of help they want from healthcare professionals. FINDINGS: Most women were told prior to biopsy that their breast problem needed further assessment (56%) or was probably not cancer (36%). Only a small group of women were told prior to biopsy that they definitely had cancer (2%) or that their breast problem was suspicious (5%). The majority of women and their husbands reported high levels of concern awaiting the biopsy. Women identified several ways healthcare professionals could help, including providing educational materials, shortening the time between detection and biopsy, offering support, using a personalized approach, and involving family members. Husbands identified many of these interventions but also wanted information on how to help their wives. CONCLUSIONS: Breast biopsy generated a high degree of concern in women and their husbands. Their concerns remained high even though many women were told that they probably did not have cancer. IMPLICATIONS FOR NURSING PRACTICE: To minimize the adverse effects of a biopsy, healthcare professionals need to provide information and support, involve husbands, and shorten the biopsy waiting period.

Cancer and the family: strategies to assist spouses.

Research that has been conducted with spouses of cancer patients documents the nature of their stress, the duration of their stress, and the concerns that they confront over the course of the illness. A variety of intervention strategies have been used to assist spouses in dealing with the stressful effects of cancer. Two major categories of intervention strategies are providing information and offering support.

Psychologic consequences of breast cancer on partner and family.

Breast cancer can have psychologic consequences not only for patients but also for the entire family system. Research indicates a major impact on the husband, the marital relationship, the children, and family roles and responsibilities. Greater attention needs to be given to the family members to ensure that they get the support they need, and to enable them to maintain their supportive roles with the patient.

The psychosocial aspects of sexual recovery after prostate cancer treatment.

Prostate cancer affects one in six American men. Erectile and sexual dysfunctions are long-term side effects of prostate cancer treatment. PubMed database was searched for papers on prostate cancer-related sexual recovery for men and couples. The search yielded articles on (1) the treatment of erectile dysfunction, (2) men's psychological and culturally diverse adaptation to the sexual side effects; (3) the impact of prostate cancer on couples' relationships; and (4) interventions to promote sexual function. Erectile dysfunction after prostate cancer treatment has been widely studied. Research on the sexual recovery of men and couples or understanding it in a cultural context is scarce. Greater focus on the impact of sexual sequelae of prostate cancer treatment on men as well as couples in diverse groups is needed. Clinical implications for treating sexual dysfunction and promoting sexual recovery for prostate cancer survivors and their partners are discussed. Recommendations for future research are provided.

Social support in patients' and husbands' adjustment to breast cancer.

Data were obtained from 50 mastectomy patients and their husbands at 3 days and 30 days postsurgery to determine the nature of the relationship between social support and the adjustment of mastectomy patients and their husbands over time. Psychosocial adjustment was related to both patients' and husbands' levels of social support. Patients and husbands who reported higher levels of social support reported fewer adjustment difficulties at both 3 days and 30 days postsurgery. Patients and husbands differed significantly in the levels of support they perceived over time; husbands perceived less support from friends, nurses, and physicians. This study underscores the importance of assessing the support resources of both patients and husbands over time.

The impact of cancer in women on the family.

Using a family-stress framework, this paper analyzes the psychosocial impact of a woman's cancer on her family. More specifically, this paper explores the emotional distress that spouses and children of patients with breast cancer experience and discusses the role changes that are reported over time. Factors that put certain women and their family members at high risk of poorer adjustment to the woman's cancer also are identified. Finally, directions for future research and the implications of the research for clinical practice are discussed.

Psychological impact of the diagnosis of breast cancer on the patient and her family.

The diagnosis of breast cancer creates emotional distress for patients as well as family members. This article reviews studies on the psychological adjustment of women and their family members during the diagnosis, hospitalization, and early convalescence from breast surgery. Studies indicate that the diagnostic phase is an extremely stressful time for women, marked by high anxiety, uncertainty, and difficulty making decisions. The hospital phase is especially difficult for spouses, who must juggle work responsibilities with added home responsibilities and also spend time at the hospital supporting their wives. In the convalescent phase, patients and family members need to adjust to changes in family roles, cope with fears about recurrence, and learn to balance the needs of all family members. In order to provide high quality health care to breast cancer patients and their family members, physicians and nurses need to address the emotional as well as the physical aspects of recovery.

The relationship between social support, help-seeking behavior, and psychological distress in psychiatric clients.

A descriptive exploratory design was used to examine the relationship between the level of social support, the level of psychological distress, and the extent of help-seeking behavior in a nonprobability sample of 53 hospitalized adult psychiatric patients. The subjects completed the Norbeck Social Support Questionnaire, the Brief Symptom Inventory, and a researcher-designed Help-Seeking Behavior Questionnaire. The Pearson Product Moment Correlation coefficients and t test were used to analyze the data. No significant correlation was found between the level of psychological distress and either the level of social support or the extent of help seeking. Social support and help seeking were highly correlated. These results have an implication for nursing practice pertaining to the focus of patient treatment both during hospitalization and in postdischarge planning.