Self-Image and Sexuality Issues among Young Women with Breast Cancer: Practical Recommendations.

BACKGROUND: Younger breast cancer survivors face a unique set of treatment-related issues that have enormous impact on quality of life and psychological well-being. Although there is often a profound and distressing impact of treatment on self-image and sexual function, women rarely receive any attention for these issues. Unfortunately, most clinicians receive no training on how to inquire about these problems and most clinicians feel unprepared to discuss them. Often this silence is due to a lack of ready resources and uncertainty of appropriate strategies for rehabilitation. Cultural barriers may also contribute to lack of attention to these issues. OBJECTIVE: The aim of this paper is to not only elucidate common problems regarding self-image and sexual dysfunction, but to also offer concrete guidance about inquiry using a simple checklist approach as well as tips for resources and other evidence-based intervention strategies. Samples of a checklist and resource sheet for women written in Spanish are included, and cultural considerations within a Hispanic/Latina framework will be noted. As the great majority of young breast cancer patients are now becoming long-term survivors, it is essential for clinicians to learn how to address distressing treatment-related late effects including diminished self-image and sexual dysfunction.

Sexual functioning in long-term survivors of Hodgkin's lymphoma.

OBJECTIVE: Studies of Hodgkin's lymphoma (HL) survivors have reported long-term adjustment problems including sexual dysfunction, but the prevalence and persistence of sexual problems in HL survivors have not been well characterized. This study aimed to address these questions by comparing sexual health in a large cohort of long-term HL survivors with a noncancer control group. METHODS: A mailed survey including questions about current sexual problems and sexual satisfaction was completed by 465 HL survivors and 205 sibling controls. Survivors ranged from 20 to 82 years (median=44) and were treated ≥7 years prior (median=18). RESULTS: Sexual problems were commonly reported by HL survivors, with 54.2% reporting decreased sexual activity and 41.4% reporting decreased interest. When survivors' current sexual functioning was compared with the control group, however, no differences were found, and overall sexual satisfaction was positive in both groups. Among survivors, age was not associated with sexual problems but had a small significant negative association with satisfaction (ρ=-0.12; p<0.05). No associations between time since diagnosis, disease stage, and chemotherapy treatment and sexual functioning were found. CONCLUSIONS: Consistent with previous studies, HL survivors reported high rates of current sexual problems. However, no differences in sexual problems or sexual satisfaction were found between survivors and controls. Results indicate that over the long term, survivors' sexual functioning does not differ from noncancer controls. Findings underscore the importance of including healthy control groups to determine whether difficulties reported by cancer survivors can be attributed to cancer treatment.

Addressing psychological challenges after cancer: a guide for clinical practice.

While the completion of therapy is an important milestone in the successful treatment of cancer, many survivors find themselves facing a variety of psychological challenges after their treatment ends. This article highlights some of the most common psychological challenges after cancer therapy such as depression, anxiety, fatigue, and sexual dysfunction. Common risk factors for these challenges will be reviewed and methods for assessing survivors' psychosocial functioning in the context of a medical visit will be discussed. This article also will provide guidance on how to access resources and educational information, and how to make an appropriate referral for follow-up when these psychological challenges are identified.

Brief Training on Patient Anger Increases Oncology Providers' Self-Efficacy in Communicating With Angry Patients.

CONTEXT: Anger is a common reaction to pain and life-limiting and life-threatening illness, is linked to higher levels of pain, and may disrupt communication with medical providers. Anger is understudied compared with other emotions in mental health and health care contexts, and many providers have limited formal training in addressing anger. OBJECTIVES: The objective of this study was to assess if a brief provider training program is a feasible method for increasing providers' self-efficacy in responding to patient anger. METHODS: Providers working in stem cell transplant and oncology units attending a brief training session on responding to patient anger. The program was informed by cognitive behavioral models of anger and included didactics, discussion, and experiential training on communication and stress management. RESULTS: Provider-rated self-efficacy was significantly higher for nine of 10 skill outcomes (P < .005) including acknowledging patient anger, discussing anger, considering solutions, and using relaxation to manage their own distress. All skill increases were large in magnitude (Cohen's d = 1.18-2.22). CONCLUSION: Providers found the program to be useful for increasing their confidence in addressing patient anger. Discussion, didactics, and experiential exercises can support provider awareness of anger, shape adaptive communication, and foster stress management skills.

Anger, provider responses, and pain: prospective analysis of stem cell transplant patients.

OBJECTIVE: Patient anger can be challenging for providers, and may hinder the patient-provider relationship. Research on the relationships among patient anger, relationships with health care providers and medical outcomes, however, has been limited to anecdotal accounts and cross-sectional studies. This study examined relationships among patient anger, perceptions of provider positive support and negative interactions, by prospectively studying a sample of stem cell transplant (SCT) patients. METHOD: A prospective design was used to study patient anger, perceived positive support from providers and perceived negative interactions with providers among 88 SCT patients. Data were obtained upon patient's hospitalization before SCT and at 1, 2, and 3 month follow up periods. Repeated-measures mixed models assessed relationships among study variables. RESULTS: Patient anger was associated with a gradual decline in perceived positive support and higher levels of concurrent perceived negative interactions with providers. Further, a significant lagged relationship was found such that patient anger was associated with increased perceived negative interactions with providers 1 month later. Exploratory analyses revealed that perceived negative interactions were also associated with higher levels of physical distress. Perceived positive support buffered the relationship between patient anger and physical distress, such that anger was not associated significantly with physical distress when perceived provider support was high. CONCLUSIONS: Patient anger may contribute to a deterioration of the patient-provider relationship, and contribute to negative medical outcomes including physical distress. The association between patient anger and physical distress may be reduced by supportive providers.

Evaluating the linguistic appropriateness and cultural sensitivity of a self-report system for spanish-speaking patients with cancer.

Spanish speakers in the United States encounter numerous communication barriers during cancer treatment. Communication-focused interventions may help Spanish speakers communicate better with healthcare providers and manage symptoms and quality of life issues (SQOL). For this study, we developed a Spanish version of the electronic self-report assessment for cancer (ESRA-C), a web-based program that helps people with cancer report, track, and manage cancer-related SQOL. Four methods were used to evaluate the Spanish version. Focus groups and cognitive interviews were conducted with 51 Spanish-speaking individuals to elicit feedback. Readability was assessed using the Fry readability formula. The cultural sensitivity assessment tool was applied by three bilingual, bicultural reviewers. Revisions were made to personalize the introduction using a patient story and photos and to simplify language. Focus group participants endorsed changes to the program in a second round of focus groups. Cultural sensitivity of the program was scored unacceptable ([Formula: see text]) for audiovisual material and acceptable ([Formula: see text]) for written material. Fry reading levels ranged from 4th to 10th grade. Findings from this study provide several next steps to refine ESRA-C for Spanish speakers with cancer.