Quality of life and fear of cancer recurrence in patients and survivors of non-Hodgkin lymphoma.

Non-Hodgkin lymphoma (NHL) is a common haematological cancer that is comprised of approximately 30 subtypes, of which Waldenström Macroglobulinemia (WM) is a rare incurable form. It is typically managed using a watch-and-wait strategy that can contribute to illness uncertainty which may result in fear of cancer recurrence (FCR) and poor health-related quality of life (QOL). However, few studies have examined the correlates of FCR and QOL in NHL patients, including WM patients. One-hundred males and 92 females with a mean age of 62.7 years who were an average of 6.8 years from diagnosis completed the online questionnaire which asked about demographics, medical history, QOL, FCR, stress, anxiety and depression. Few NHL patients reported significant stress or affective distress, most had moderate-high QOL and 41% experienced recent FCR, relative to published cut-off scores. Poorer QOL was related to depression symptoms, FCR, higher illness burden (i.e. comorbidity) and fewer personal resources (i.e. unemployed), whereas FCR was related to shorter time since diagnosis and more depressive symptoms. Results suggest that FCR and depressive symptoms may adversely impact QOL, whereas a recent cancer diagnosis and depression-related pessimism may contribute to FCR.

A Comparison of Physical Activity Levels, Sleep Disrupting Behavior, and Stress/Affective Distress as Predictors of Sleep as Indexed by Actigraphy.

BACKGROUND: Several behaviors have been reported to interfere with sleep in otherwise healthy adults, including low physical activity (PA) levels. However, few studies have compared low PA with the other behavioral risk factors of objective sleep impairment, despite the behavior tending to cooccur in highly stressed and affectively distressed individuals. Thus, the authors compared objective and subjective measures of PA and other potential sleep disrupting behaviors as predictors of objective sleep (sleep onset latency, actual sleep time, total sleep duration, awake time, and sleep efficacy) at baseline (T1) and 3 months later (T2). METHODS: A community-derived sample of 161 people aged 18-65 years were asked about PA, other behavior (ie, night eating, electronic device use, watching television, caffeine and alcohol use), stress, affective distress (ie, anxiety, depression), and demographics including shift work and parenting young children in an online questionnaire at T1 and T2. PA and sleep were also monitored for 24 hours each at T1 and T2 using actigraphy. RESULTS: Multiple regression analyses indicated that sleep at T1 was associated with PA (ie, total number of steps, metabolic equivalents/time, time spent travelling) after controlling mean ambient temperature and relevant demographics. At T2, longer sleep onset latency was predicted by parenting young children and night time television viewing; shorter sleep duration was predicted by female gender; and awake time and sleep efficacy were predicted by alcohol intake after controlling T1 sleep measures, demographics, and mean ambient temperature. CONCLUSION: The risk factors for objective sleep impairment included parenting young children and watching television at night, whereas better sleep outcomes were associated with greater engagement with PA.

The 'grass ceiling': limitations in the literature hinder our understanding of cannabis use and its consequences.

AIM: To illustrate how limitations in the cannabis literature undermine our ability to understand cannabis-related harms and problems experienced by users and identify users at increased risk of experiencing adverse outcomes of use. METHOD AND RESULTS: Limitations have been organized into three overarching themes. The first relates to the classification systems employed by researchers to categorize cannabis users, their cannabis use and the assumptions on which these systems are based. The second theme encompasses methodological and reporting issues, including differences between studies, inadequate statistical control of potential confounders, the under-reporting of effect sizes and the lack of consideration of clinical significance. The final theme covers differing approaches to studying cannabis use, including recruitment methods. Limitations related to the nature of the data collected by researchers are discussed throughout, with a focus on how they affect our understanding of cannabis use and users. CONCLUSIONS: These limitations must be addressed to facilitate the development of effective and appropriately targeted evidence-based public health campaigns, treatment programmes and preventative, early intervention and harm minimization strategies, and to inform cannabis-related policy and legislation.

Efficacy of an emotion-focused treatment for prolonged fatigue.

Previous research findings have suggested a relationship between less adaptive emotional functioning and fatigue. The present study used a research design involving multiple baselines across participants to evaluate the efficacy of a new emotion-focused treatment for prolonged fatigue delivered in a cognitive behavioral therapy framework. The 13 adults participating in the study met the criteria for prolonged fatigue and provided fatigue baselines of 2, 5, or 8 weeks. The results indicated that the treatment was effective, with fatigue severity levels after the initiation of treatment significantly lower than that predicted by baseline patterns, as determined by the split median method of trend estimation. At 3-4 months after treatment, 8 of 11 clients who completed the treatment no longer met the criteria for prolonged fatigue.

Immunological disturbance and infectious disease in anorexia nervosa: a review.

OBJECTIVE: Severely malnourished patients with anorexia nervosa (AN) are reported to show fewer symptomatic viral infections and a poorer response to bacterial infection than controls. They are also reported to show mild immune system changes, although the relevance of these to altered infection disease presentation in AN and AN pathophysiology is unknown. Thus, in this paper, we suggest a range of immune system changes that might underpin these altered responses to common pathogens, and review a number of recent infectious disease findings for their utility in explaining the pathophysiology of AN. METHODS: A systematic review of the literature pertaining to immunity and infectious disease in AN was performed. RESULTS: AN is associated with leucopenia, and the increased spontaneous and stimulated levels of proinflammatory cytokines [i.e. interleukin (IL)-1ß, IL-6 and tumour necrosis factor α). A range of less consistent findings are also reviewed. Most of these data were not controlled for length of illness, degree of malnutrition, micronutrient or vitamin deficiencies or recent refeeding and starvation. CONCLUSION: Cytokine disturbances have been suggested to be causally related to AN symptomatology and pathophysiology of AN, although the evidence supporting this assertion is lacking. Immune and cytokine changes in AN do, however, occur in association with a decreased incidence of symptomatic viral infection, decreased clinical response to bacterial infection leading to delayed diagnosis and increased morbidity and mortality associated with the infections.

Education and role modelling for clinical decisions with female cancer patients.

BACKGROUND: Patients vary widely in their preferences and capacity for participating in treatment decision-making. There are few interventions targeting patient understanding of how doctors make decisions and shared decision-making. This randomized trial investigates the effects of providing cancer patients with a package designed to facilitate shared decision-making prior to seeing their oncologist. PATIENTS AND METHODS: Sixty-five female cancer patients were randomized to receive either the package (booklet and 15-min video) or a booklet on living with cancer, before their initial consultation. Participants completed questionnaires prior to the intervention, immediately after the oncology consultation, and 2 weeks and 6 months later. The first consultation with the oncologist was audio-taped and transcribed. RESULTS: Patients receiving the package were more likely than controls to declare their information and treatment preferences in the consultation, and their perspectives on the costs, side-effects and benefits of treatment. Doctors introduced considerably more new themes in the consultations with intervention subjects than they did with controls; no other differences in doctor behaviour were noted. CONCLUSIONS: This short intervention successfully shifted patient and doctor behaviour closer to the shared decision-making model, although it did not alter patients' preferences for information or involvement.

Responding to the active and passive patient: flexibility is the key.

BACKGROUND: Patients vary widely in their preferences and capacity for participation in medical decision-making. This study aimed to document oncologist responses to more extreme presentations and identify helpful and unhelpful strategies for clinicians. PATIENTS AND METHODS: A trained actor played the role of a patient with early stage breast cancer who was attending her first consultation with a medical oncologist. She adopted in random order two different consultation participation styles: that of a very anxious, active patient, and that of a depressed, passive patient. Medical consultations between the actor and 16 medical oncologists were videotaped and then analysed qualitatively by two trained raters. RESULTS: Strategies that facilitated shared decision-making with both patient types and were positively endorsed by the actor/patient included explicit agenda-setting, active listening, checking understanding, endorsing question-asking, offering decisional delay, and non-verbal behaviours conveying empathy and warmth. Oncologists successfully negotiated with the active patient to share control of the consultation, and responded to emotional cues from the passive patient. Unhelpful strategies were also identified. CONCLUSIONS: Few clinicians receive training in responding to differing communication styles in their patients that could potentially cause conflict and hinder optimal treatment decision-making. This study suggests some useful strategies for oncologists to consider, to widen their behavioural repertoire in the cancer consultation.