Technology-Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men with Advanced Prostate Cancer: Results from a Randomized Controlled Trial.

BACKGROUND: Men with advanced prostate cancer (APC) face multiple challenges including poor prognosis, poor health-related quality of life (HRQOL), and elevated symptom burden. This study sought to establish the efficacy of a tablet-delivered, group-based psychosocial intervention for improving HRQOL and reducing symptom burden in men with APC. We hypothesized that men randomized to cognitive-behavioral stress management (CBSM) would report improved HRQOL and reduced symptom burden relative to men randomized to an active control health promotion (HP) condition. Condition effects on intervention targets and moderators of these effects were explored. METHODS: Men with APC (N = 192) were randomized (1:1) to 10-week tablet-delivered CBSM or HP, and followed for 1 year. Multilevel modeling was used to evaluate condition effects over time. RESULTS: Changes in HRQOL and symptom burden did not differ between groups. Men in both groups improved across several intervention targets; men in the CBSM condition reported greater increases in self-reported ability to relax, and both conditions showed improvements in cancer-related anxiety, cancer-related distress, and feelings of cohesiveness with other patients over time. Moderating factors included baseline interpersonal disruption, fatigue, and sexual functioning. CONCLUSIONS: Tablet-delivered CBSM and HP were well received by men with APC. The hypothesized effects of CBSM on HRQOL and symptom burden were not supported, though improvements in intervention targets were observed across conditions. Participants reported high-baseline HRQOL relative to cancer and general population norms, possibly limiting intervention effects. The identified moderating factors should be considered in the development and implementation of interventions targeting HRQOL and symptom burden. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03149185.

Fatalism, medical mistrust, and pretreatment health-related quality of life in ethnically diverse prostate cancer patients.

OBJECTIVE: Few studies have examined the impact of cultural processes prevalent in minority ethnic groups such as cancer fatalism and medical mistrust on health-related quality of life (HRQoL) following a cancer diagnosis. The present study examined relationships among ethnicity, HRQoL, and two possible cultural vulnerability factors-fatalistic attitudes and medical mistrust-among an ethnically diverse sample of men with prostate cancer (PC) prior to undergoing active treatment. METHODS: A total of 268 men with localized PC (30% African American, 29% Hispanic, and 41% non-Hispanic White) were assessed cross-sectionally prior to active treatment. Path analyses examined relationships among ethnicity, vulnerability factors, and HRQoL. RESULTS: Ethnicity was not related to HRQoL after controlling for relevant covariates. Hispanic men reported greater cancer fatalism compared with non-Hispanic White men (ß = 0.15, p = 0.03), and both Hispanics (ß = 0.19, p < 0.01) and African Americans (ß = 0.20, p < 0.01) reported greater medical mistrust than non-Hispanic Whites. Fatalism demonstrated a trend toward negatively impacting physical well-being (ß = -0.12, p = 0.06), but was not significantly related to emotional well-being (ß = -0.10, p = 0.11). Greater medical mistrust was associated with poorer physical (ß = -0.14, p = 0.03) and emotional well-being (ß = -0.13, p = 0.04). CONCLUSIONS: Results indicate that fatalistic attitudes and medical system mistrust were more prevalent among minority men. Less trust in the medical system was associated with poorer physical and emotional well-being. Attention to perceptions of the healthcare system and its relation to HRQoL may have implications for targeting culturally driven attitudes that may compromise adjustment to a PC diagnosis.Copyright © 2015 John Wiley & Sons, Ltd.

Feasibility, acceptability, and preliminary efficacy of a technology-assisted psychosocial intervention for racially diverse men with advanced prostate cancer.

BACKGROUND: The utility of psychosocial interventions in reducing symptom burden and improving health-related quality of life (HRQOL) for men with localized prostate cancer has been demonstrated. However, studies have yet to demonstrate the efficacy of interventions in advanced prostate cancer (APC). This study examined the feasibility, acceptability, and preliminary efficacy of a technology-assisted, 10-week, group-based psychosocial intervention for diverse men with APC. METHODS: The participants were 74 men (mean age, 68.84 years; non-Hispanic white, 57%; black, 40.5%) who were randomized to a cognitive-behavioral stress management (CBSM) treatment or health promotion (HP) attention-control condition. The participants were assessed at the baseline, weekly throughout the 10-week program, and 6 months after the baseline. Outcomes were assessed with the Patient-Reported Outcomes Measurement Information System along with established measures of HRQOL, CBSM intervention targets (eg, relaxation skills), and patient-reported acceptability. RESULTS: Feasibility was demonstrated through good retention rates (>85%) and acceptable average attendance rates (>70%), and acceptability was demonstrated through very favorable weekly session evaluations (mean score, 4/5) and exit surveys (mean score, 3.6/4). Men randomized to the CBSM condition reported significant reductions (P < .05) in depressive symptoms and improvements in relaxation self-efficacy (P < .05) at the 6-month follow-up. CBSM participants reported trends for improvement in distress and functional well-being (P < .08) in comparison with those in the HP condition. Effect sizes ranged from medium (0.54) to large (1.87) and, in some instances, were clinically meaningful. CONCLUSIONS: Technology-based CBSM interventions among diverse men with APC may be feasible, acceptable, and efficacious.

Validation of the distress thermometer worldwide: state of the science.

BACKGROUND: The distress thermometer (DT) has been used in psycho-oncology research across the globe and has been recommended as a clinical tool to be used routinely in cancer settings to detect clinically significant distress. We sought to characterize the translation and validation of the DT in cancer patients in different countries and cultures and summarize how the translated versions function to detect clinically significant distress. METHODS: An electronic mail survey was sent to the members of the International Psychosocial Oncology Society Federation of Psycho-Oncology Societies and electronic searches of English language databases were conducted to identify translations of the DT and studies designed to validate these translations. RESULTS: Our efforts yielded a total of 21 non-English translations of the DT; 18 of these were validated in studies designed for that purpose. A variety of instruments were used in receiver operating characteristic curve analysis to derive an optimal cut-off score indicative of clinically significant distress. Cut-off scores varied by language, country, and clinical setting and to sample characteristics. In the majority of studies, a score of 4 maximized sensitivity and specificity relative to an established criterion. CONCLUSIONS: These findings provide a broad, international perspective on the current state of psychosocial screening using the DT. Findings also demonstrate widespread awareness of the need for psychological and social support of persons diagnosed with and treated for cancer.

Cognitive functioning in men receiving androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis.

PURPOSE: Prior research examining the impact of androgen deprivation therapy (ADT) for prostate cancer on cognitive performance has found inconsistent relationships. The purpose of this study was to systematically review the existing literature and determine the effect of ADT on performance across seven cognitive domains using meta-analysis. METHODS: A search of PubMed Medline, PsycINFO, Cochrane Library, and Web of Knowledge/Science databases yielded 157 unique abstracts reviewed by independent pairs of raters. Fourteen studies with a total of 417 patients treated with ADT were included in the meta-analysis. Objective neuropsychological tests were categorized into seven cognitive domains: attention/working memory, executive functioning, language, verbal memory, visual memory, visuomotor ability, and visuospatial ability. RESULTS: Separate effect sizes were calculated for each cognitive domain using pairwise comparisons of patients who received ADT with (1) prostate cancer patient controls, (2) noncancer controls, or (3) ADT patients' own pre-ADT baselines. Patients treated with ADT performed worse than controls or their own baseline on visuomotor tasks (g = -0.67, p = .008; n = 193). The magnitude of the deficits was larger in studies with a shorter time to follow-up (p = .04). No significant effect sizes were observed for the other six cognitive domains (p = .08-.98). CONCLUSIONS: Prostate cancer patients who received ADT performed significantly worse on visuomotor tasks compared to noncancer control groups. These findings are consistent with the known effects of testosterone on cognitive functioning in healthy men. Knowledge of the cognitive effects of ADT may help patients and providers better understand the impact of ADT on quality of life.

A systematic review of research using the diagnostic criteria for cancer-related fatigue.

BACKGROUND: Prevalence rates for cancer-related fatigue vary widely depending on how fatigue is defined and assessed. In 1998, formal diagnostic criteria were proposed for a syndrome of cancer-related fatigue. These criteria were intended to facilitate the study of cancer-related fatigue and the development of appropriate interventions to ameliorate fatigue. Although the criteria have been widely cited, to date, there has been no systematic review of research using the criteria that might inform their continued use or revision. METHODS: We conducted a systematic review of the literature reporting results based on use of the diagnostic criteria. Data were analyzed to characterize the reliability and validity of the criteria and to describe the prevalence of cancer-related fatigue. RESULTS: We identified nine eligible studies. The purpose of the majority of the studies was to estimate the prevalence of cancer-related fatigue; there was considerable variability with respect to design and nature of the samples included. Although few studies examined reliability of the criteria, findings reported support their reliability. The validity of the criteria judged relative to established measures of fatigue and related constructs appears to be strong. Prevalence rates for cancer-related fatigue based on the diagnostic criteria vary widely, reflecting a lack of consistency in how the criteria have been applied. CONCLUSIONS: As a comprehensive approach to diagnosing cancer-related fatigue, the diagnostic criteria have received relatively scant attention by the clinical research community. Our findings suggest the need for research aimed at revising the criteria, enhancing their usefulness, and promoting their more widespread use.

Factors associated with breast cancer worry 3 years after completion of adjuvant treatment.

OBJECTIVE: Although many survivors continue to worry about cancer years after completing treatment, little is known about factors associated with cancer worry. This study examined associations between breast cancer worry and demographic and clinical variables, as well as fatigue, symptom burden, and risk perception in a sample of breast cancer survivors 3 years post-adjuvant treatment. We hypothesized that after controlling for demographic and treatment factors, a significant proportion of variance in cancer worry would be explained by greater fatigue severity, more symptom burden, and greater perceived risk of recurrence. METHODS: Stage 0-II breast cancer patients (N = 202) completed measures of risk perception, cancer worry (modified Lerman's Cancer Worry Scale), symptom burden (Memorial Symptom Assessment Scale), and fatigue severity (Fatigue Symptom Inventory) 3 years after completing adjuvant treatment. Multiple regression analyses were used to determine the proportion of variance in cancer worry accounted for by fatigue, symptom burden, and risk perception after controlling for demographic and clinical variables. RESULTS: Age, fatigue, symptom burden, and risk perception each explained a significant proportion of variance in cancer worry (p < 0.05). Fatigue, symptom burden, and risk perception together accounted for 27% of the variance in cancer worry after controlling for demographic and clinical factors (p < 0.01). CONCLUSIONS: The hypothesis was supported that fatigue, symptom burden, and risk perception are associated with cancer worry among breast cancer survivors. It is possible that lingering fatigue and other symptoms may remind breast cancer survivors of their disease.

Relationship of threat appraisal with coping appraisal to fear of cancer recurrence in breast cancer survivors.

OBJECTIVES: Prior research suggests that fear of cancer recurrence (FOR) is very common among cancer survivors. This study examined the extent to which the interaction of threat appraisal and coping appraisal accounted for differences in FOR in cancer patients who recently completed treatment. It was hypothesized that greater FOR would be related to a combination of high threat appraisal and low coping appraisal. METHODS: A sample of 155 early stage breast cancer patients (mean age = 59 years) who completed surgery, chemotherapy, and/or radiotherapy between 6 and 24 months previously (mean = 12 months) completed measures of FOR, threat appraisal (perceived risk and severity of a potential cancer recurrence), and coping appraisal (perceived response efficacy and self-efficacy to perform diet and exercise recommendations to reduce recurrence risk). Basic demographic and clinical information were also collected. RESULTS: Threat appraisal accounted for 30% of the variance in FOR (p<0.001) while coping appraisal accounted for 0% (p = 0.64). After accounting for these variables and relevant covariates, the interaction of threat appraisal and coping appraisal explained 2% of the remaining variance in FOR (p = 0.04). As hypothesized, survivors who reported high threat appraisal and low coping appraisal had the highest FOR. CONCLUSIONS: Future research should focus on examining these relationships longitudinally and further assess coping appraisal and how it impacts cancer recurrence fears.

Integrating PROMIS® computerized adaptive tests into a web-based intervention for prostate cancer.

OBJECTIVE: This study outlined the implementation and feasibility of delivering PROMIS® computer adaptive tests (CATs) using a web-based method to evaluate the impact of a technological adaptation of Cognitive-Behavioral Stress Management (CBSM) on the psychosocial functioning of men with advanced prostate cancer (APC) undergoing hormone therapy. METHOD: Patients were randomized to a CBSM group intervention (n = 95) or a health promotion (HP) attention-matched control condition (n = 97). Participants attended all sessions via video conference using tablets, and completed PROMIS® computer adaptive tests (CATs) assessing anxiety, depression, fatigue, pain interference, and physical function weekly during the 10-week intervention. RESULTS: Assessment completion rates >50% at week 1 and week 10 demonstrated moderate feasibility of repeatedly administering PROMIS® CATs using a web-based method. Multilevel modeling demonstrated no significant group-by-time interactions from week 1 to week 10 for any of the assessed PROMIS® domains adjusting for sociodemographic and medical covariates. However, simple effects demonstrated decreases in PROMIS® anxiety scores from week 1 to 10 for both groups. Results also demonstrated significant relationships of medical variables to psychosocial functioning across time points. CONCLUSIONS: Results highlight the feasibility and benefits of utilizing PROMIS® CATs to repeatedly assess psychosocial functioning using a web-based method and indicate that web-based interventions may be effective for decreasing psychosocial distress and adverse symptoms among men with APC undergoing hormone therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychosocial risk predicts high readmission rates for hematopoietic cell transplant recipients.

Hematopoietic cell transplantation (HCT) is an intensive treatment resulting in disease control however subsequent psychosocial distress is common. Screening for psychosocial risk factors that contribute to morbidity is underutilized; moreover, the value in screening is uncertain. We performed a retrospective study of 395 HCT patients who were screened for psychosocial risk using the Transplant Evaluation Rating Scale (TERS). Patients were classified by psychosocial risk as no-risk (TERS = 26.5, 52%) vs. at-risk (TERS > 26.5, 48%), with at-risk patients stratified by cumulative deficits into mild risk (TERS = 27-35.5, 39%) and moderate risk (TERS > 35.5, 9%). At-risk patients were more likely to be readmitted within 90 days (mild risk HR = 1.62, p = 0.02; moderate risk HR = 2.50, p = 0.002). Prior psychiatric history (HR = 1.81, p = 0.002) and poor coping skills (HR = 1.64, p = 0.04) also influenced readmission. At-risk patients were more likely to be readmitted for infection (no-risk = 12% vs. at-risk = 25%, p = 0.002). Pre-HCT screening with the TERS did not predict survival or length of stay although at-risk patients are at a heighted risk of readmission. Implementing strategies to reduce readmission in higher risk patients is warranted.

Predictors and patterns of fear of cancer recurrence in breast cancer survivors.

OBJECTIVE: This prospective, longitudinal study examined fear of cancer recurrence (FCR) among breast cancer survivors having mammograms. FCR was hypothesized to increase prior to the mammogram, decrease from immediately pre- to immediately post-mammogram with negative results, and then increase following the mammogram. The possible presence of different trajectories of FCR was also examined. Based on the cognitive-behavioral model (CBM) of health anxiety, greater perceived risk of recurrence, worse perceived consequences of recurrence, lower treatment efficacy beliefs, lower coping self-efficacy, and more engagement in reassurance-seeking behaviors were hypothesized to be associated with greater FCR across all study time points. METHODS: Following treatment completion for Stage 0-IIIA breast cancer, 161 women completed the following measures: perceived risk and perceived consequences of recurrence, treatment efficacy beliefs, coping self-efficacy, and reassurance-seeking behaviors. Participants reported FCR at 3 time points before and 3 after the mammogram. Growth curve analysis was used to test for changes in FCR over time and growth mixture modeling examined different trajectories in FCR and the ability of the CBM to predict these trajectories. RESULTS: As hypothesized, FCR significantly changed over time; scores increased prior to the mammogram, decreased immediately following receipt of negative mammography results, and increased during the month following the mammogram. Growth mixture models revealed 2 classes, higher-FCR and lower-FCR, which were predicted by the CBM. CONCLUSIONS: These study findings support the use of the CBM in predicting which cancer survivors experience greater FCR and indicates that CBM-driven interventions may prove beneficial for reducing distressing FCR.

Cancer Outcomes in Hispanics/Latinos in the United States: An Integrative Review and Conceptual Model of Determinants of Health.

Cancer is the leading cause of death among Hispanics. Compared to non-Hispanic Whites, Hispanics are more likely to be diagnosed with advanced stages of disease and experience poor quality of life following a cancer diagnosis. Cancer outcomes are influenced by a confluence of social, cultural, behavioral and biological factors. Yet, much of the behavioral and psychosocial research in oncology has focused on non-Hispanic Whites, thus limiting our understanding of the potential web of factors that can influence cancer-related outcomes among Hispanics. Furthermore, features of Hispanic ethnicity and culture may influence and interact with, social, psychosocial, health care, disease-specific, and medical factors known to influence cancer-related outcomes, yet very few studies have integrated Hispanic cultural processes when addressing cancer-related outcomes for this ethnic group. Guided by the extant literature in oncology, Hispanic culture and health, and previously established models of determinants of minority health, we present a conceptual model that highlights the interplay of social, cultural, psychosocial, disease-specific, health care, and medical factors as determinants of cancer outcomes (morbidity, mortality, quality of life) and review key evidence of how features of Hispanic culture may influence cancer outcomes and contribute to the disparate outcomes observed in Hispanic cancer samples relative to non-Hispanic Whites. Finally, we conclude with a discussion of future research opportunities and existing challenges to researching oncology outcomes among Hispanics.

Health hopes and fears for the future in relation to health behavior and current health status.

We examined the relationships among age, health, beliefs, and possible-selves. Using a new approach based on health-related possible-selves, young-old and older individuals were separated into specific health types: (1) improvement or maintenance health hopes and (2) preventable or unpreventable health fears. The young-old perceived greater capability to achieve health hopes and reported more health activities than older individuals; the older group reported more maintenance than improvement. More unpreventable fears were related to experiencing higher pain and worse physical functioning. Health types provide useful information about individual differences in health behavior and beliefs and are sensitive to current health status.