Cognitive function in long-term lymphoma survivors: relationship between subjective reports and objective assessments and with quality of life.

Cognitive functioning plays a fundamental role in people's life and quality of life (QoL), and anti-cancer chemotherapy may provoke long-lasting cognitive problems. This study investigated the subjective perception of cognitive functioning in long-term lynfoma survivors and its associations with objectively assessed cognitive functioning and QoL. 198 long-term lynfoma survivors were administered the Cognitive Functioning Self-Assessment Scale (CFSS), the Esame Neuropsicologico Breve 2 (ENB2) and the Short Form 36 Health Survey Questionnaire (SF-36). Subjectively reported cognitive functioning was worse than the norm for the general population (p<0.001). Difficulty in recalling recent information (22%), using of periphrases or generic terms (16.7%) and tip-of-the-tongue phenomena (14.7%) were the cognitive difficulties most frequently reported. CFSS overall score correlated positively with the number of impaired performances (p<0.001) and borderline performances (p=0.014) on the ENB2. Both subjectively and objectively assessed cognitive measures correlated negatively with most assessed QoL domains, indicating that QoL is worse when cognitive functioning is poor. Subjective concerns about one's own cognitive functioning are a reality for long-term lynphoma survivors, who experience these worries more than the general population does. Since improving QoL is a priority in oncology, this study supports the use of interventions to improve cognitive functioning in cancer survivors.

Quality of life and psychological distress during cancer: a prospective observational study involving young breast cancer female patients.

BACKGROUND: Despite the possible traumatic significance of cancer and of the incidence, prevalence, and survival of young women with breast cancer, these patients are underrepresented in multidimensional research. In the present survey, QoL and psychological distress were studied in a sample of young female breast cancer patients during the first year of their disease. More in detail, the study was firstly aimed to assess if QoL of 18-45 years old female breast cancer patients was different from QoL of women from the general population and if it changed over time. Secondly, it described the psychological distress and its change over time. Finally, it assessed if QoL registered 1 year post-surgery may be explained by QoL and/or psychological distress registered during the hospitalization. METHODS: One hundred six, consecutive 18-45 years old, female primary breast cancer patients undergoing anticancer surgery filled out the Short Form 36 Health Survey Questionnaire, the Hospital Anxiety and Depression Scale and a socio-demographic and clinical form during hospitalization to receive surgery (T0), and again at 12 months post-surgery (T1). RESULTS: At T0, participants showed a better physical functioning (p = 0.001) than the female normative sample, whereas their mental functioning was worse (p < 0.001). In this time, mental functioning within our sample was weaker than physical functioning (p < 0.001). Over time, physical functioning decreased (p < 0.001), whereas mental functioning increased (p < 0.001). Both at T0 and T1, anxiety was higher than depression (p < 0.05). Both distress dimensions decreased over time (p < 0.001). Nevertheless, at T0 the 25.5 and 26.4% of the sample were respectively possible and probable cases of anxiety, whereas the 17.9 and 9.4% were possible and probable cases of depression. At T1, the percentages were 17.9 and 18.9% for anxiety, and 8.5 and 6.6% for depression. In both considered times, a better QoL corresponded to less psychological distress. However, QoL and psychological distress assessed at T0 did not predict the QoL at T1. CONCLUSIONS: This study documented as QoL and psychological distress may change during the first year after surgery for a primary breast cancer in young women; therefore, they should be monitored over time to detect and treat women with alarming levels on them.

Hospital Anxiety and Depression Scale (HADS) accuracy in cancer patients.

PURPOSE: The Hospital Anxiety and Depression Scale (HADS) is a self-report questionnaire designed to screen anxious and depressive states in patients in non-psychiatric settings. In spite of its large use, no agreement exists in literature on HADS accuracy in case finding. The present research addresses the issue of HADS accuracy in cancer patients, comparing its two subscales (HADS-A and HADS-D) against tools not in use in psychiatry, which are able to detect prolonged negative emotional states. METHODS: 2121 consecutive adult cancer inpatients were administered the HADS together with the State Anxiety subscale of State-Trait Anxiety Inventory and the Center for Epidemiologic Studies Scale on Depression. Receiver operating characteristic (ROC) curves were computed to identify a cut-off for anxious and depressive states in cancer patients. All indicators were computed together with their corresponding 95% confidence interval (95% CI). RESULTS: Data of 1628 and 1035 participants were used to assess the accuracy in case finding of HADS-A and HADS-D, respectively. According to the ROC analysis, the optimal cut-off was > 9 units for the HADS-A and > 7 units for the HADS-D. The area under the ROC curve was 0.90 for HADS-A (95% CI 0.88-0.91) and 0.84 for HADS-D (95% CI 0.81-0.86). CONCLUSIONS: This study suggested that risk scores of anxious and depressive states above specific HADS cut-offs are useful in identifying anxious and depressive states in cancer patients, and they may thus be applicable in clinical practice.

The impact of cancer: An Italian descriptive study involving 500 long-term cancer survivors.

INTRODUCTION: The well-being and quality of life (QoL) of long-term cancer survivors may be affected, both positively and negatively, by psychosocial factors related to the experience of being a cancer patient. We investigated whether, in long-term cancer survivors, the psychosocial impacts of cancer associate with socio-demographic-clinical variables; whether, within the positive and negative dimensions taken separately, some impacts are more intense than others; and whether these impacts explain QoL. METHODS: Italian long-term cancer survivors (n = 500) completed the Impact of Cancer (IOC-V2) and Short Form 36 Health Survey (SF-36) questionnaires. RESULTS: The IOC-V2 negative impact score associated with gender, education, occupational status and health issues, whereas no association was found between the positive impact score and socio-demographic-clinical variables. Of the positive impacts, Altruism/Empathy was the highest (p < 0.001); Positive self-evaluation was higher than Health awareness (p = 0.001); and Meaning of cancer was the lowest (p < 0.001). Among the negative impacts, Worry was the highest (p < 0.001), whereas Body changes concerns was higher than both Appearance concerns (p < 0.001) and Life Interferences (p < 0.001). The assessed impacts explained more than 25% of the variance of both physical and mental functioning scores. CONCLUSIONS: The provided data document psychosocial factors affecting QoL in Italian long-term cancer survivors.

A contribution to the validation of the Italian version of the Body Image Scale (BIS).

BACKGROUND: The Body Image Scale (BIS) is a 10-item mono-factorial scale, designed to capture distress and symptoms related to body image in cancer patients. This paper describes the conversion and psychometric evaluation of an Italian BIS version. METHODS: After the back-translation procedure, the Italian version of the BIS, together with the Hospital Anxiety and Depression Scale and the Short Form 36 Health Survey Questionnaire, have been administered to a sample of Italian adult females, surgically treated for a breast cancer at least one year before. RESULTS: Data on 109 participants were analyzed. The response rate was 92.5%. Response prevalence was adequate for 9 out of 10 items. Principal component analysis showed a one-factor structure. Internal consistency (Cronbach's alpha =0.924) was good. The BIS correlated with the theoretically pertinent subscales of the other administered tools and was able to discriminate participants (discriminant validity) according to the undertaken surgical treatment (p = 0.031). CONCLUSIONS: This study supports the valid and reliable use also of the Italian version of the BIS.

Long-term quality of life profile in oncology: a comparison between cancer survivors and the general population.

PURPOSE: Understanding the quality of life (QoL) of cancer survivors is relevant to both clinical practice and health care policy. The current study compared the QoL profile in this specific population with that of a normative sample for the general population, as well as with those of both healthy and oncological patients normative sub-samples. In addition, associations between the obtained QoL profile and the main socio-demographic and clinical characteristics of the sample were examined. METHODS: Three hundred and ninety-two adult long-term cancer survivors (i.e., people 5 + years from their cancer diagnosis who were free from it and its treatments) were enrolled during follow-up visits and compiled the Short Form 36 Health Survey. RESULTS: In comparison with the normative data for the adult general population, the present sample showed lower scores in Physical functioning, Role-physical limitation, and Role-emotional limitations (all differences were both statistically and clinically significant); the difference in Vitality was only statistically significant. In all eight SF-36 scales, scores of the present sample were clinically and statistically lower than those of the normative healthy subsample, whereas they were statistically and clinically higher than those of normative subsample which had experienced cancer, except for Role-physical limitation. The QoL profile was associated with gender (p = 0.002), age (p = 0.001), education (p < 0.001), occupational status (p < 0.001), and the presence of other health issues (p < 0.001). CONCLUSION: These data support the utility of rehabilitative programs which integrate both healthcare and social interventions. In addition, they encourage the monitoring of the health status of this specific population, within a broad frame which simultaneously takes into consideration health and QoL.

Body image assessment in oncology: an update review.

PURPOSE: Body image is a psychological dimension of the experience of cancer, which varies along the clinical features of the disease itself and in its phases, as well as its effects in terms of functioning and quality of life. In 2012, Supportive Care in Cancer published a review addressing the relevance, application, and instruments of body image assessment for oncological settings. Since then, many research papers have been published on this topic and new questionnaires for assessing body image in oncology are now available. This contribution aims to offer both researchers and clinicians an updated review of body image assessment tools. METHODS: We searched PubMed, Psychology and Behavioral Sciences Collection, and Scopus databases, which allowed us to identify pertinent papers, classified according to the body image tool to which they refer. We then extracted the characteristics and the psychometric properties from each study. RESULTS: From the 657 initial records, 23 papers met the selection criteria referring to 8 body image measurements. Although increasing in number and being the subject of a growing number of studies, these papers are still not exhaustive with respect to the verified psychometric properties. In particular, it is worth noting that their applicability to all types of cancer is limited and that a focus on women with breast cancer prevails. CONCLUSION: A complete validation (including a study of all types of validity and reliability) and an indication of the case results are not currently available for any of the eight instruments described. However, studies designed to apply body image assessment tools to patients other than those experiencing breast cancer as well to cultural contexts other than English-speaking countries, are increasing.

Posttraumatic growth and cancer: a study 5 years after treatment end.

PURPOSE: Cancer survivors often report posttraumatic growth (PTG). The aims of this study were to assess the presence of PTG in Italian long-term disease-free cancer survivors (LCS) and to explore the association between the dimensions of PTG and clinical, demographic variables, various agents of perceived social support and psychological distress. METHODS: Five hundred forty LCS were assessed with Posttraumatic Growth Inventory (PTGI), Multidimensional Scale of Perceived Social Support (MSPSS), Zung Self-Rating Depression Scale, and State-Trait Anxiety Inventory-Y (STAI-Y). RESULTS: Mean age was 57.08 years, mean survival was 11.04 years (range 5-32), and the most common cancer diagnosis was breast cancer (56.9%). The PTGI average total score was higher in more educated LCS, in those employed, in LCS with longer time from diagnosis, and in those with no comorbidities. In this study, PTG was not found correlated with distress, but it correlated with perceived social support, age, education, and employment. CONCLUSIONS: The absence of a correlation between PTG and psychological distress and the low levels of PTG found let us question the importance of talking about PTG when working as psychotherapists with LCS. It may be suggested that the need of finding benefit and PTG in LCS has been overcome by other experiences or worries happened after the cancer, and LCS may not focus anymore on positive changes occurred. The relevance of work and of perceived social support as linked to PTG stresses the need to protect the LCS's relationship with work and to promote and sustain their social network, and this can help them to experience sharing and closeness to others.

Emotional impact on the results of BRCA1 and BRCA2 genetic test: an observational retrospective study.

BACKGROUND: BRCA1 and BRCA2 mutations are associated with a higher risk of breast and ovarian tumors. This study evaluated the emotional states of women 1 month after having received the results of the genetic test and assessed eventual associations with the type of outcome, personal/familiar disease history and major socio-demographic variables. METHODS: The study, an observational retrospective one, involved 91 women, evaluated 1 month after receiving their results. Patients were administered the Hospital Anxiety and Depression Scale, the Profile of Mood States and emotional Thermometers. RESULTS: Anxiety was significantly higher than depression (p < 0.001), and 21.3% and 21.3% of the sample were, respectively, possible and probable cases for anxiety, whereas 13.5% and 10.1% were possible and probable cases for depression. Within the six mood states, Confusion-Bewilderment (M = 48.5) was the lowest, whereas Fatigue-Inertia (M = 52.3) was the highest. Differences were recorded within the ten assessed emotions too. Being a proband/nonproband and being or not a cancer patient were associated with many tested variables. CONCLUSION: The psycho-emotional screening of women undertaking genetic counseling is relevant and should cover a large range of dimensions.

Psychological health in long-term cancer survivorship: an Italian survey on depression and anxiety.

Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their psychological health can inform health care policy as well as help supporting individual patients. This study was aimed to describe depression and anxiety (i.e. two of the most common psychological symptoms reported in oncology) in a sample of Italian long-term cancer survivors (LTCSs) defined as people who have been free from cancer and cancer treatments for at least five years. Four hundred and four Italian adult LTCSs completed a battery of questionnaires including the Zung Self-rating Depression Scale and the State Anxiety sub-scale of the State-Trait Anxiety Inventory respectively for depression and anxiety assessment. 16.5% of the sample displayed mild depression, 11.1% moderate depression, and 7.1% severe depression. depression was negatively associated with education (p = .017), perceived social support as provided by the family (p = .028), and perceived social support provided by friends (p = .008), and it was positively associated with occupational status (p = .023), presence of health issues (p = .010), and anxiety (p < .001). 8.7 and 15.8% of the sample were respectively possible and probable cases of anxiety. Anxiety was negatively associated with occupational status (p = .038) and it was positively associated with depression (p < .001). These data support ongoing assessment and monitoring of depression and anxiety in LTCSs, and stimulate the development and testing of psychological interventions for such individuals. In addition, they encourage further study on the psychological health of this specific population.

Addressing the psychosocial wellbeing of teenage children of cancer patients and survivors.

Thomas is 13 years old. His parents report a sharp decline in his school grades caused, according to his teachers' opinions, by listlessness and lack of concentration. The parents of Julia, 16 years old, describe her as restless, evasive, isolated, and withdrawn from others and from her usual activities. Linda, 18 years old, is described by her parents as indecisive, uncertain, and almost lethargic. Normally resolute and a high academic achiever, she appears locked in herself, unable to make choices. We first learned about them through the accounts of their concerned parents. Claire, 19 years old, lost weight and exercised hard enough to induce amenorrhea after her young mother underwent treatment for breast cancer, including antihormonal treatment. These four teenagers have in common a parent diagnosed with cancer, undergoing or having just completed treatment.

Mood states in long-term cancer survivors: an Italian descriptive survey.

PURPOSE: Since long-term survivorship is now a reality for an increasing number of people with cancer, understanding their mood states (i.e., transient subjective emotional states) can inform health-care policy as well as help support individual patients. This study described the mood states of Italian long-term cancer survivors, compared them with normative data, and tested their association with the main clinical and socio-demographic sample's characteristics. METHODS: One hundred and fifty-eight Italian adults free from cancer and its treatments for at least 5 years were administered the Profile of Mood States (POMS) and two ad hoc 0-10-point visual-analogue scales on personal health-related worry and risk perception for a personal relapse, respectively. RESULTS: In comparison with the Italian normative sample, the current sample displayed a higher score in Vigor-Activity (p = 0.003) and a lower score in Confusion-Bewilderment (p = 0.008). In Tension-Anxiety, Confusion-Bewilderment, Depression-Dejection, Anger-Hostility, Fatigue-Inertia, and Vigor-Activity, 14.6, 15.9, 17.1, 17.8, 19.7, and 13.3 % of the sample, respectively, displayed meaningful scores (i.e., scores above or below 1 standard deviation from the normative mean score). The mood state profile POMS-provided was associated with gender (p = 0.002), occupational status (p = 0.003), reported health issues (p < 0.001), and quality of sleep (p < 0.001). In personal health-related worry and risk perception for a personal relapse, the average scores were 4.8 (SD = 3.0) and 4.1 (SD = 2.9), respectively. CONCLUSIONS: These data encourage a multidimensional assessment of emotional functioning of this specific population.

Feasibility of a quality improvement strategy integrating psychosocial care into 28 medical cancer centers (HuCare project).

PURPOSE: This study examines the development and feasibility of a quality improvement strategy for the translation of evidence-based psychosocial care into clinical practice. METHODS: The project involved all staff (oncologists, psychologists, and nurses) of the participating centers. Recommendations concerned: improvement of clinician communication skills; use of a patient question prompt list; assignment of a specialist nurse to each patient; screening for psychological distress and social needs; opportunity to attend a Point of Information and Support. The implementation strategy hinged on context analysis and problem solving. Four to six visits were held in each center by the project team to assist staff in identifying obstacles, finding solutions, and strengthening motivation. The primary variable was the adherence percentage to the recommendations (proportion of subjects receiving each intervention). The number of centers that failed to reach the objective was also reported (adherence percentage <75%). RESULTS: Twenty-seven of twenty-eight centers completed the study. Lack of resources was the most commonly perceived barrier preimplementation. Five-hundred-forty-five clinicians were actively involved in the project and completed training. The adherence percentage for each recommendation was greater than 85% except for the question prompt list (78%; 95% CI, 73-83%), where seven centers did not reach the objective. CONCLUSIONS: Our findings demonstrate that evidence-based interventions to improve the psychosocial care of people with cancer can be implemented in a diverse range of oncology wards. This requires the involvement and motivation of the entire staff of the ward, support by an expert team, and promotion by policymakers.

Decompressive percutaneous endoscopic gastrostomy in advanced cancer patients with small-bowel obstruction is feasible and effective: a large prospective study.

PURPOSE: The purpose of this study was to evaluate patient-centered outcomes of decompressive percutaneous endoscopic gastrostomy (dPEG) in patients with malignant bowel obstruction due to advanced gynecological and gastroenteric malignancies. METHODS: This is a prospective analysis of 158 consecutive patients with small-bowel obstruction from advanced gynecological and gastroenteric cancer who underwent PEG or percutaneous endoscopic jejunostomy (PEJ) positioning for decompressive purposes from 2002 to 2012. All of them had previous abdominal surgery and were unfit for any other surgical procedures. Symptom relief, procedural complications, and post dPEG palliation were assessed. Global Quality of Life (QoL) was evaluated in the last 2 years (25 consecutive patients) before and 7 days after dPEG placement using the Symptom Distress Scale (SDS). RESULTS: dPEG was successfully performed in 142 out of 158 patients (89.8 %). Failure of tube placement occurred in 16 patients (10.1 %). In 8/142 (5.6 %) patients, dPEG was guided by abdominal ultrasound. In 3/142 patients, dPEG was CT-guided. In 14 (9.8 %) patients, who had previously undergone total or subtotal gastrectomy, decompressive percutaneous endoscopic jejunostomy (dPEJ) was performed. In 1/14 patients, dPEJ was CT-guided. Out of 142 patients, 110 (77.4 %) experienced relief from nausea and vomiting 2 days after PEG. Out of 142 patients, 116 (81.6 %) were discharged. The median postoperative hospital stay was 9 days (range 3-60). Peristomal infection (14 %) and intermittent obstruction (8.4 %) were the most frequent complications associated with PEG. Median survival time was 57 days (range 4-472) after PEG placement. Twenty-five patients had QoL properly evaluated with SDS score before and 7 days after dPEG. Sixteen patients (64 %) out of 25 exhibited an improvement of QoL (p < 0.05), 7 (28 %) patients exhibited a non-significant worsening of QoL (p = 0.18), and in 2 (8 %) patients, it remained unmodified. CONCLUSIONS: dPEG is feasible, effective, relieves nausea and vomiting in patients with unremitting small-bowel obstruction from advanced gynecological and gastroenteric cancer, and improves QoL.

Patient-Centered Cancer Care Programs in Italy: Benchmarking Global Patient Education Initiatives.

In Italy, educational programs for cancer patients are currently provided by the national government, scientific societies, and patient advocate organizations. Several gaps limit their effectiveness, including the lack of coordinated efforts, poor involvement of patient feedback in the planning of programs, as well as a lack of resources on innovative cancer-related topics. This process is parallel to a strong shift in the attitude of patients towards health in general and taking charge of their own health conditions in particular. The National Cancer Institute in the USA and the Organization of European Cancer Institutes encourage comprehensive cancer centers in providing educational programs conceived to overcome these gaps. The goal of this paper is to identify and describe the key elements necessary to develop a global patient education program and provide recommendations for strategies with practical examples for implementation in the daily activities of cancer institutes. A multidisciplinary committee was established for patient education, including patient representatives as equal partners, to define, implement, verify, and evaluate the fundamental steps for establishing a comprehensive education program. Six essential topics were identified for the program: appropriate communication of cancer epidemiology, clinical trial information, new therapeutic technologies, support in the use of medicines, psycho-oncological interventions, age-personalized approaches, and training programs for healthcare providers. Integration of these topics along with patient feedback is the key to a successful model for educational programs. An integrated educational program can transform a comprehensive cancer center to an institution that provides research and care for and with patients.

Is long-term cancer survivors' quality of life comparable to that of the general population? An italian study.

PURPOSE: Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their quality of life (QoL) can inform health care policy as well as help supporting individual patients. This study was aimed to quantify QoL of this specific population in comparison with data provided for both the general population and cancer patients and to assess QoL association with several sociodemographic, clinical, and psychological variables. METHODS: Three hundred fourteen Italian long-term cancer survivors (people who have been free from cancer and cancer treatments for at least 5 years) completed a battery of questionnaires including the SF12 for QoL assessment. RESULTS: Both physical and mental functioning were higher than those among Italian cancer patients but lower than those of the Italian general population (p < .001). Poorer QoL (physical and mental functioning) was associated more often with psychological conditions (as anxiety and depression) than with sociodemographic and cancer-related variables. CONCLUSIONS: These data support an ongoing specific interest in the QoL of long-term cancer survivors and suggest the need for further study of multidimensional functioning in this population.

Quality of life profile in Italian long-term cancer survivors.

PURPOSE: Understanding the quality of life (QoL) of long-term cancer survivors is relevant to daily clinical practice as well as to healthcare policy. This study assessed QoL of Italian survivors and tested the association between QoL and the main clinical and socio-demographic sample's characteristics. METHODS: Two hundred and sixty-five Italian adult long-term cancer survivors (people free from cancer and its treatments for at least 5 years) were administered the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, the Impact of Cancer, and the Short Form 36 questionnaires obtaining three different QoL profiles-cancer-specific, survivorship-specific, and generic. RESULTS: In both cancer-specific and generic QoL profiles, participants reported a lower general health and a higher social functioning than normative samples; in addition, they reported low emotional functioning and vitality, respectively, in the former and latter profile. In the survivorship-specific profile, participants scored higher on personal growth and altruism (p < 0.001) and lower on dissatisfaction and life interferences (p < 0.001). Males reported less dissatisfaction and life interferences (p < 0.001), and less pain (p < 0.001) than females. Employed participants reported higher physical functioning (p = 0.001) and fewer role limitations (p < 0.001) than unemployed participants. Differences according to cancer type were recorded only in survivorship-specific domains (p < 0.004). No association between survivorship length and any of the three QoL profiles was found. Finally, the absence of other reported health issues was associated to higher functioning in the majority of cancer-specific and generic QoL domains. CONCLUSIONS: Our data support the usefulness of multi-disciplinary follow-ups for long-term cancer survivors and the need to pay particular attention to the psycho-emotional long-term and late-presenting sequels of cancer and its treatment.

Screening for distress in cancer patients: a multicenter, nationwide study in Italy.

BACKGROUND: Routine screening for distress is internationally recommended as a necessary standard for good cancer care, given its high prevalence and negative consequences on quality of life. The objective of the current study was to contribute to the Italian validation of the Distress Thermometer (DT) to determine whether the single item DT compared favorably with referent criterion measures. METHODS: In total, 1108 outpatients with cancer were recruited from 38 representative oncology centers in Italy. Each participant completed the DT and a list of 34 possible cancer-related problems (the Problem List), the Hospital Anxiety and Depression Scale (HADS), the 18-item Brief Symptom Inventory (BSI-18), and a short visual analog scale to determine the understandability of the tools. RESULTS: Receiver operating characteristic analysis revealed that DT cutoff scores ≥ 4 and ≥ 5 had optimal sensitivity and specificity relative to both HADS and BSI-18 cutoff scores for general caseness and more severe psychological distress, respectively. Patients with DT scores ≥ 4 (cases) were more likely to be women; to have had psychological problems in the past; to report more stressful events in the last year; and to currently have more family, emotional, and physical problems related to cancer or cancer treatment. Patients indicated that the DT was easier to fill out and to understand than the HADS, but not the BSI-18. CONCLUSIONS: The DT was identified as a simple and effective screening instrument for detecting distress in Italian cancer patients as a first step toward more properly referring those in need to psychosocial intervention.

The Impact of Cancer Scale (IOC) in Italian long-term cancer survivors: adaptation and psychometric evaluation.

PURPOSE: The Impact of Cancer Scale (IOC) is a self-assessment tool designed to capture the unique and multidimensional aspects of the quality of life of long-term cancer survivors. This paper describes the adaptation and psychometric evaluation of its Italian version. METHODS: After the adaptation (i.e., removal of nonpertinent items and back-translation procedure), the Italian version of IOC has been administered to a sample of Italian long-term cancer survivors (people free from cancer and its treatments for at least 5 years) together with the Short Form 36 Health Survey Questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and the Post-Traumatic Growth Inventory. RESULTS: Data on 304 participants were analyzed. Exploratory factor analysis revealed a three-factor structure composed of Uncertainty/Worry about Health & Future (13 items), Personal Growth & Altruism (14 items), and Dissatisfaction & Life Interferences (10 items). Internal consistency (Cronbach's alpha, >0.77) and temporal stability (Spearman's rho, >0.70) were good for all three factors. The obtained three factors correlated with the theoretically pertinent subscales of the other administered tools. To facilitate cross-cultural comparisons, reliability and convergent/divergent validity data for the eight-factor IOC structure already described in literature (Impact of Cancer Version 2) have been also provided. CONCLUSIONS: This study supports the use of the IOC in Italy as a trifactorial instrument that is able to isolate aspects characteristic of the condition of long-term cancer survivorship. However, subsequent studies are needed to confirm these findings as well as shed more light on the validity of the IOC construct and its cultural variability.

Facilitating the integration of emotional states in patients' personal disease experience with cancer: a new brief intervention for managing psychological distress.

PURPOSE: This paper describes an intervention performed at an Italian oncological institute to manage psychological distress related to the oncological experience. Its objectives are to encourage and normalize awareness of the importance of emotional aspects of the cancer experience, to provide psycho-education to patients on the importance of psycho-social care in promoting well-being, and to introduce our psychology service and promote its usage. METHODS: The intervention consists of three consecutive steps: the psychological distress screening; the clinical interview, which is conducted according to Rogers' client-centered model; and the collection of data regarding the appreciation and usefulness of the initiative, performed through a feedback questionnaire and the codification of the interview contents. RESULTS: Between September 2011 and February 2012, the intervention was administered to 484 consecutive new inpatients. Among them, the prevalence of psychological distress and its components of anxiety and depression are comparable to those found in the literature. The low percentage of participants who refuse the screening (15.4 %) as well as of those who do not wish to have the results returned to them (3.1 %), together with the high scores regarding the usefulness and effectiveness given to the intervention (all >80/100), documents the positive reception of this activity. Lastly, the analysis of the contents of the exit interview shows that a wide range of themes, far more varied and heterogeneous than just anxiety and/or depression symptoms, was discussed. CONCLUSIONS: Even though this was a clinical and not a research activity, it still offers important descriptive data.