Psychosocial benefits of a novel mindfulness intervention versus standard support in distressed women with breast cancer.

OBJECTIVE: It is well documented that stress is associated with negative health outcomes in cancer patients. The purpose of this study was to assess the effects of a novel mindfulness intervention called mindfulness-based art therapy (MBAT) versus standard educational support, on indices of stress and quality of life in breast cancer patients with high stress levels. METHODS: A total of 191 women were enrolled, stratified by age and stress level, and randomized to receive either an 8-week MBAT intervention or a breast cancer educational support program of equal time and duration. Psychosocial stress was measured using the Symptoms Checklist-90-Revised, and quality of life was measured using the Medical Outcomes Study Short-Form Health Survey at baseline, immediately post-intervention, and at 6 months. RESULTS: Results showed overall significant improvements in psychosocial stress and quality of life in both the MBAT and educational support groups immediately post-intervention; however, participants with high stress levels at baseline had significantly improved overall outcomes only in the MBAT group, both immediately post-intervention and at 6 months. In addition, at 6 months follow-up, participants attending five or more sessions trended toward retaining treatment effects better in the MBAT than in the control group. Finally, black women and white women were similar in terms of how they benefited from the MBAT intervention, even though white participants tended to have higher educational level and marital status. CONCLUSIONS: In conclusion, MBAT is associated with significant, sustained benefits across a diverse range of breast cancer patients, particularly those with high stress levels.

Changes in cerebral blood flow and anxiety associated with an 8-week mindfulness programme in women with breast cancer.

This study employed functional magnetic resonance imaging to evaluate changes in cerebral blood flow (CBF) associated with the Mindfulness-based Art Therapy (MBAT) programme and correlate such changes to stress and anxiety in women with breast cancer. Eighteen breast cancer patients were randomized to the MBAT or education control group. The patients received the diagnosis of breast cancer between 6 months and 3 years prior to enrollment and were not in active treatment. The age of participants ranged from 52 to 77 years. A voxel-based analysis was performed to assess differences at rest, during meditation and during a stress task. The anxiety sub-scale of the Symptoms Checklist-90-Revised was compared with changes in resting CBF before and after the programmes. Subjects in the MBAT arm demonstrated significant increases in CBF at rest and during meditation in multiple limbic regions, including the left insula, right amygdala, right hippocampus and bilateral caudate. Patients in the MBAT programme also had a significant correlation between increased CBF in the left caudate and decreased anxiety scores. In the MBAT group, responses to a stressful cue resulted in reduced activation of the posterior cingulate. The results demonstrate that the MBAT programme was associated with significant changes in CBF, which correlated with decreased anxiety over an 8-week period.

Measuring informed decision making about prostate cancer screening in primary care.

PURPOSE: To measure the extent of informed decision making (IDM) about prostate cancer screening in physician-patient encounters, describe the coding process, and assess the reliability of the IDM measure. METHODS: Audiorecoded encounters of 146 older adult men and their primary care physicians were obtained in a randomized controlled trial of mediated decision support related to prostate cancer screening. Each encounter was dual coded for the presence or absence of 9 elements that reflect several important dimensions of IDM, such as information sharing, patient empowerment, and engaging patients in preference clarification. An IDM-9 score (range = 0-9) was determined for each encounter by summing the number of elements that were coded as present. Estimates of coding reliability and internal consistency were calculated. RESULTS: Male patients tended to be white (59%), married (70%), and between the ages of 50 and 59 (70%). Physicians tended to be white (90%), male (74%), and have more than 10 years of practice experience (74%). IDM-9 scores ranged from 0 to 7.5 (mean [SD], 2.7 [2.1]). Reliability (0.90) and internal consistency (0.81) of the IDM-9 were both high. The IDM dimension observed most frequently was information sharing (74%), whereas the dimension least frequently observed was engagement in preference clarification (3.4%). CONCLUSIONS: In physician-patient encounters, the level of IDM concerning prostate cancer screening was low. The use of a dual-coding approach with audiorecorded encounters produced a measure of IDM that was reliable and internally consistent.

Mediated decision support in prostate cancer screening: a randomized controlled trial of decision counseling.

OBJECTIVE: This randomized trial was conducted to assess the impact of a mediated decision support intervention on primary care patient prostate cancer screening knowledge, decisional conflict, informed decision making (IDM), and screening. METHODS: Before a routine office visit, 313 male patients eligible for prostate cancer screening completed a baseline telephone survey and received a mailed brochure on prostate cancer screening. At the visit, participants were randomized to either an enhanced intervention (EI) or a standard intervention (SI) group. Before meeting with their physician, EI Group men had a nurse-led "decision counseling" session, while SI Group men completed a practice satisfaction survey. An endpoint survey was administered. Survey data, encounter audio-recordings, and chart audit data were used to assess study outcomes. RESULTS: Knowledge increased in the EI Group (mean difference of +0.8 on a 10-point scale, p=0.001), but decisional conflict did not change (mean difference of -0.02 on a 4-point scale, p=0.620). The EI Group had higher IDM (rate ratio=1.30, p=0.029) and lower screening (odds ratio=0.67, p=0.102). CONCLUSION: Nurse-mediated decision counseling increased participant prostate cancer screening knowledge, and influenced informed decision making and screening. PRACTICE IMPLICATIONS: Nurses trained in decision counseling can facilitate shared decision making about screening.

Women at a dangerous intersection: diagnosis and treatment of depression and related disorders in patients with breast cancer.

Breast cancer is a relatively common diagnosis for American women and depressive symptoms occur in many women with breast cancer. Identification of women with breast cancer and concomitant depressive symptoms and mood disorders requires particular attention by heath care providers, and may be aided by the administration of a variety of diagnostic and/or screening tools. Insomnia is also a significant problem for women with breast cancer at various stages of diagnosis and treatment, including after remission. Although many studies on the treatment of depression in women with breast cancer have been done, and the data do point to the efficacy of several antidepressants in this population, there are no data to support the widely held hypothesis that treatment of depression in patients with breast cancer may positively affect morbidity and mortality. Breast cancer treatments may give rise to depressive symptoms and this should be considered in the approach to pharmacotherapy. Several psychotherapeutic modalities offer relief of the symptoms and syndromes of depression in breast cancer. Future research can answer the question of which approach is most appropriate for which patients, and whether therapy can improve a variety of health outcomes and survival for women with breast cancer.

Prostate cancer: issues in psychosomatic medicine.

Prostate cancer is now a chronic condition. Screening, diagnosis, and treatment pose specific psychosocial challenges for men diagnosed and surviving with prostate cancer. Depression, anxiety, and cognitive impairment lead to emotional distress and difficulty coping. Treatments for psychosocial distress are targeted at couples and individuals. Lifestyle modification may improve coping and quality-of-life indicators.

Interaction between HP1alpha and replication proteins in mammalian cells.

HP1 is an essential heterochromatin-associated protein known to play an important role in the organization of heterochromatin as well as in the transcriptional regulation of heterochromatic and euchromatic genes both in repression and activation. Using the yeast two-hybrid system and immunoprecipitation, we report here that murine HP1alpha interacts with the preRC proteins ORC1, ORC2 and CDC6. Immunofluorescence staining and EGFP/DsRed fusion proteins revealed a colocalization of HP1alpha with ORC1, ORC2 and CDC6 in heterochromatin, supporting the notion that ORC and probably CDC6 play an important role in murine HP1alpha function. Besides that, we also observed a colocalization of HP1alpha with gamma-tubulin suggesting a centrosomal localization of HP1alpha in murine cells. To gain insight into HP1alpha function, we applied the RNAi technique. Depletion of HP1alpha leads to a slow down of cell proliferation, an aberrant cell cycle progression as well as to multinucleated cells with insufficiently organized microtubule. These results together indicate that HP1alpha exerts functions in mitosis and cytokinesis.

A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer.

The purpose of this study was to gather data on the efficacy of a newly developed psychosocial group intervention for cancer patients, called mindfulness-based art therapy (MBAT). One hundred and eleven women with a variety of cancer diagnoses were paired by age and randomized to either an eight-week MBAT intervention group or a wait-list control group. Ninety-three participants (84%) completed both the pre- and post-study measurements. As compared to the control group, the MBAT group demonstrated a significant decrease in symptoms of distress (as measured by the Symptoms Checklist-90-Revised) and significant improvements in key aspects of health-related quality of life (as measured by the Medical Outcomes Study Short-Form Health Survey). This investigation of MBAT provides initial encouraging data that support a possible future role for the intervention as a psychosocial treatment option for cancer patients.

Psycho-oncology: review and update.

The field of psycho-oncology is moving forward rapidly, especially for a relatively new field. Cancer patients and survivors are willing to discuss their needs and interests relating to diagnosis and treatment. There are guidelines and algorithms for determining levels of distress in cancer patients in both inpatient and outpatient settings. The pharmacologic treatment of distress, particularly depression, has vastly improved. Randomized controlled trials are becoming available for patients in order to determine the efficacy of psychotropic drugs. Numerous interventions are available to help cancer patients move forward with their lives. Some of these interventions began in the 1980s and have progressed to the use of complementary and alternative medicine techniques as coping strategies for cancer. With the rapid expansion of the Internet, cancer survivors' thirst for information also has grown. Many resources are available to help guide cancer patients through the maze of the diagnosis and treatment of cancer.

Preparing African-American men in community primary care practices to decide whether or not to have prostate cancer screening.

BACKGROUND: This study was a randomized trial to test the impact of an informed decision-making intervention on prostate cancer screening use. METHODS: The study population included 242 African-American men from three primary care practices who were 40-69 years of age and had no history of prostate cancer. Participants completed a baseline survey questionnaire and were randomly assigned either to a Standard Intervention (SI) group (N=121) or an Enhanced Intervention (EI) group (N=121). An informational booklet was mailed to both groups. EI group men were also offered a screening decision education session. Two outcomes were considered: (1) complete screening (i.e., having a digital rectal exam (DRE) and prostate specific antigen (PSA) testing), and (2) complete or partial screening (i.e., having a PSA test with or without DRE). An endpoint chart audit was performed six months after initial intervention contact. The data were analyzed via exact logistic regression. RESULTS: Overall, screening use was low among study participants. EI group men had a screening frequency two times greater than that of SI group men, but the difference was not statistically significant: 8% vs. 4 % (OR = 1.94) fo rcomplete screening, and 19% vs. 10% (OR = 2.08) for complete or partial screening. Multivariable analyses showed that being in the EI group and primary care practice were significant predictors of complete or partial screening (OR = 3.9 and OR = 5.64, respectively). CONCLUSION: Prostate cancer screening use may be influenced by exposure to decision education and the influence of screening-related primary care practice factors.

Psychosocial oncology: supportive care for the cancer patient.

Increasing attention is being paid to the emotional and psychosocial needs of cancer patients. As a result of huge advances in early detection and in treatment modalities, there now are millions of cancer survivors in the United States. There has been a realization that cancer survivors have distinct psychosocial needs. As cancer survivors live longer, reduction of psychological distress has been recognized as being an important part of having an improved quality of life. There have been numerous changes in the field of psychosocial oncology since it first began 25 years ago. Guidelines now exist for the definition of distress and decision trees are available for making the appropriate referrals. Advances in pharmacologic treatment for depression and anxiety have made it possible to decrease distress and increase coping in cancer patients undergoing treatment as well as in cancer survivors. Numerous individual and group therapies have demonstrated effectiveness in improving mood and quality of life in cancer patients and those at high risk for developing cancer. Due to the forthright efforts of cancer patients, there are now many organizations and list serves (e-mailing lists) that cancer survivors can turn to for help before, during, and after cancer treatment. Finally, with the rapid expansion of the internet not only are there websites available as resources, but also the creation of interactive online support is becoming a reality. One of the most important issues in providing supportive care to cancer patients in the future is to meet the individual needs of patients and provide the type of psychological therapy that will work best for them.

Behaviors used by men to protect themselves against prostate cancer.

This paper reports on behaviors men use to protect themselves against prostate cancer. Data were collected via a telephone or mailed survey from 353 men enrolled in two studies of prostate cancer screening. Respondents reported behaviors they used to protect themselves against prostate cancer, and responses were coded as conventional care, self-care, or nothing. Men who reported using both conventional care and self-care were categorized as conventional care users. Polytomous logistic regression was conducted to evaluate the association between sociodemographic background, prior prostate screening, and cognitive, affective, and social support and influence factors with protective behavior type. The distribution of protective behaviors was as follows: conventional care, 63%; self-care only, 19%; and nothing, 18%. In multivariable analyses, higher education level was found to be positively associated with conventional care use. Perceived salience and coherence of prostate cancer screening was positively associated with conventional care use among men in one of the two studies. Low concern about screening was positively associated with self-care use, as was mailed survey completion. This study presents self-report data regarding prostate cancer protection behaviors. Most men in the study reported using some type of prostate cancer protective behavior. Decision-making about whether or not to take protective action and what type of behavior to use may be influenced by socioeconomic background, cognitive perceptions related to behavioral options, and concern about risk.

Psychiatric aspects of women with breast cancer.

Women with breast cancer face not only cancer-related taboos but also issues related to changes in sexuality, femininity, and fertility. Although increased emphasis on the woman's participation in the medical decision-making process has afforded her more treatment options, it also gives her more responsibility in determining her course of treatment through the continuum of cancer care. Patients must deal with a variety of issues related to social reintegration, long-term effects of cancer treatment, employment, disability, sexuality, family, and social networks. Screening for distress related to psychological, spiritual/religious, or social concerns can provide guidance for service delivery to those in need.

Ku antigen supports termination of mammalian rDNA replication by transcription termination factor TTF-I.

A replication fork barrier at the 3'-end of mouse ribosomal RNA genes blocks bidirectional fork progression and limits DNA replication to the same direction as transcription. This barrier is an inherent property of a defined DNA-protein complex including transcription termination factor I, and specific protein-protein interactions occur between this factor and protein(s) of the replication machinery. Here we report that a second DNA-binding protein is essential for barrier activity. We have purified and functionally characterised the protein from HeLa cells. The final preparation contained two polypeptides with molecular masses of 70 and 86 kDa, respectively. Both polypeptides interact with a GC-stretch adjacent to the binding site of transcription termination factor I. The specificity of binding to the barrier DNA was demonstrated in an electrophoretic mobility shift assay. The biochemical properties of this protein resemble that of Ku antigen, a human nuclear DNA-binding heterodimer that is the target of autoimmune-antibodies in several autoimmune diseases. Recombinant Ku protein, purified as heterodimer from co-infected insect cells, is able to partially rescue the barrier activity in Ku-depleted HeLa cell extracts. These data demonstrate that transcription termination factor I and Ku act synergistically to prevent head-on collision between the replication and the transcription machinery.