Advances in quality of life research among head and neck cancer patients.

Head and neck cancer often has a marked impact on multiple spheres of functioning. A rapidly expanding literature has examined the functional and psychosocial sequelae that patients experience over the trajectory of the disease. This review considers some of the salient developments in quality-of-life (QOL) research over the past decade. Selected findings are summarized regarding assessment of QOL in head and neck cancer, acute and long-term sequelae, clinical and psychosocial determinants, and intervention programs. Some of the advances and limitations of the database are examined, and recommendations are offered for further work in this area.

Posttraumatic growth among cancer patients in India.

Cancer patients sometimes report positive life changes in addition to more harrowing ones. Theoretically, several cognitive processes are thought to contribute to posttraumatic growth, but few studies have examined these relationships empirically among cancer patients. Moreover, most research has been conducted in western developed countries. This preliminary study offered a novel examination of posttraumatic growth and its cognitive correlates among cancer patients in western India. As hypothesized, in bivariate analyses perceived growth was significantly associated with greater meaning-focused coping (sense-making, benefit-finding), and with reappraisal of worldviews. Growth was not related to subjective appraisals regarding illness threat or stressfulness. In multivariate analyses, reappraisal of worldviews was the strongest concurrent predictor of posttraumatic growth. Results suggest that deliberative cognitive processes merit further study.

Effects of global meaning and illness-specific meaning on health outcomes among breast cancer patients.

Growing attention has focused on meaning-making processes and their health correlates among cancer patients. However, much of this work is marked by conceptual and methodological limitations. The current study evaluated global meaning and theoretically distinct aspects of illness-specific meaning (i.e., seeking sense, found sense, seeking benefits, found benefits) among breast cancer survivors who had completed primary treatment. Health outcomes (i.e., emotional distress, health-related quality-of-life) were assessed 4 months later. Different facets of meaning had different longitudinal associations with outcomes. Findings underscore the importance of distinguishing among conceptually discrete dimensions of personal meaning.

Religious coping and posttraumatic growth among family caregivers of cancer patients in India.

Growing attention has focused on relationships between religious coping and health outcomes among cancer patients. However, surprisingly little is known about religious coping among family caregivers. Moreover, few studies have been conducted outside of Western developed nations. This investigation evaluated family caregivers in Pune, India. The authors examined discrete dimensions of cancer-specific religious coping, and their associations with posttraumatic growth, among families at a similar phase of treatment. As hypothesized, posttraumatic growth was associated with increased use of positive religious coping strategies and diminished use of negative coping strategies. In multivariate analyses, the strongest predictors were benevolent religious reappraisals and punishing God reappraisals. Findings underscore the importance of meaning-focused religious coping.

Changes in quality-of-life and psychosocial adjustment among multiple myeloma patients treated with high-dose melphalan and autologous stem cell transplantation.

High-dose melphalan and autologous hematopoietic stem cell transplantation (HSCT) is a standard treatment for myeloma, but very little is known about the psychosocial or quality-of-life difficulties that these patients encounter during treatment. Data regarding older patients is particularly scarce. Using a prospective design, this investigation evaluated 94 patients at stem cell collection and again after high-dose therapy and transplantation. Outcomes included quality-of-life (FACT-BMT) and psychosocial adjustment (ie, Brief Symptom Inventory, Impact of Events Scale, and Satisfaction with Life Scale). Findings were compared with age- and sex-adjusted population norms and with transplantation patient norms. At stem cell collection, physical deficits were common, with most patients scoring 1 standard deviation below population norms for physical well-being (70.2%) and functional well-being (57.5%), and many reporting at least moderate fatigue (94.7%) and pain (39.4%). Clinically meaningful levels of anxiety (39.4%), depression (40.4%), and cancer-related distress (37.0%) were evident in a notable proportion of patients. After transplantation, there was a worsening of transplant-related concerns (P < .05), depression (P < .05), and life-satisfaction (P < .001); however, pain improved (P < .01), and social functioning was well preserved. Overall, the declines in functioning after transplantation were less pronounced than anticipated. Older patients were not more compromised than younger ones; in multivariate analyses, they reported better overall quality of life (P < .01) and less depression (P < .05) before transplantation. Our findings emphasize the importance of early screening and intervention.

Determinants of participation in cancer support groups: the role of health beliefs.

BACKGROUND: Although considerable attention has been directed toward cancer support groups, little is known about how often these services are actually used in clinical practice or the factors that influence participation. PURPOSE: Drawing in part on the Health Belief Model, this study examined group participation and its correlates among 425 patients with diverse malignancies treated at a large academic oncology center. METHOD: Patients were surveyed regarding utilization rates, health beliefs, and medical and demographic characteristics. RESULTS: Only a small number of patients reported having participated in groups (8.0%). Consistent with the model, in univariate analyses, participation was significantly related to greater perceptions of illness severity (p < .0001), greater perceived benefits (p < .01), fewer perceived barriers (all p < .01), and greater cues for action (i.e., recommendation by family/friends, p < .000001). In multivariate analyses controlling for disease site and other covariates, the strongest predictors included recommendation by family/friends (OR = 5.04; CI = 1.98-12.81), perceived seriousness of the illness (OR = 4.07; CI = 1.42-11.60), and geographical residence (OR = 2.74; CI = 1.09-6.93). CONCLUSION: Results suggest that participation might be increased by involving the patient's support network, improving access in underserved rural communities, addressing illness appraisals, and increasing outreach to certain diagnostic groups.

Group interventions for patients with cancer and HIV disease: Part II. Effects on immune, endocrine, and disease outcomes at different phases of illness.

There has been great interest in the potential impact of group interventions on medical outcomes. This article reviews the effects of professionally-led groups on immune activity, neuroendocrine function, and survival among patients with cancer or HIV disease. We examine findings concerning different types of group services at different phases of illness. Results are mixed, but the most prominent changes in immune and endocrine activity were associated with structured group interventions for patients with early-stage disease. These findings offer provocative illustrations of relevant mind-body interactions, but their clinical importance has yet to be demonstrated empirically. Group interventions have not been tied consistently to improved survival rates for patients with advanced cancer; few studies as yet have focused on survival outcomes among patients with early-stage cancer or HIV disease.

Group interventions for patients with cancer and HIV disease: Part I: Effects on psychosocial and functional outcomes at different phases of illness.

Group interventions for individuals facing cancer or HIV disease have drawn considerable attention among researchers and clinicians over the past 20 years. There is growing evidence that group services may be helpful, but which interventions are most effective for participants at which phases in the trajectory of disease has been less clear. Moreover, professionals working in different intervention settings (e.g., primary prevention vs. clinical care) and different disease sites (cancer vs. HIV disease) often have little awareness of relevant advances in other fields. Efforts to integrate findings in the literature may accelerate research and advance the standard of clinical care. The current article, the first in a series of four special reports, critically evaluates the efficacy of group interventions led by professional or trained facilitators for individuals confronted by cancer or HIV, across the spectrum of illness from elevated risk through advanced disease. We examine psychosocial and functional outcomes for different interventions directed toward different patient subgroups, trace common themes, highlight limitations, and offer recommendations for further research.

Group interventions for patients with cancer and HIV disease: part IV. Clinical and policy recommendations.

Group interventions have assumed a growing role in primary prevention and supportive care for cancer and HIV disease. Earlier sections of this Special Report examined empirical findings for these interventions and provided recommendations for future research. The current section offers brief recommendations for service providers, policymakers, and stakeholders. Group services now occupy an increasingly prominent place in primary prevention programs and medical settings. In previous sections of this Special Report (Sherman, Leszcz et al., 2004; Sherman, Mosier et al., 2004a, 2004b) we examined the efficacy of different group interventions at different phases of cancer or HIV disease, considered characteristics of the intervention and the participants that might influence outcomes, and discussed mechanisms of action. Methodological challenges and priorities for future research were highlighted. In this, the final section, we offer brief recommendations for service providers, policymakers, and other stakeholders. We consider some of the barriers that constrain use of empirically-based group interventions and note how these programs might be implemented more widely and effectively.

Group interventions for patients with cancer and HIV disease: Part III. Moderating variables and mechanisms of action.

Growing evidence supports the value of group interventions for individuals who are at risk for or have developed cancer or HIV disease. However, information is more limited concerning how these services can be delivered in an optimal manner, and what processes contribute to their benefits. Parts I and II of this review examined the efficacy of different interventions for individuals at different phases of illness, ranging from primary prevention to late-stage disease, in both psychosocial and biological domains. The current paper examines some of the factors other than phase of illness that might influence group treatment effects (e.g., intervention parameters, participant characteristics), and explores mechanisms of action.

Effects of personal meaning among patients in primary and specialized care: associations with psychosocial and physical outcomes.

Personal meaning is thought to serve as an important resource among individuals adapting to the demands of illness. However, some work in this area has been marked by vague conceptualization, or use of assessment instruments that are confounded by well-being. This investigation evaluated relationships between psychosocial and physical outcomes and one theoretically important dimension of attained global meaning - perceptions of life purpose and commitment. Study 1 evaluated 175 patients followed in a primary care gynaecological practice. Study 2 assessed 104 cancer patients in a specialized stem cell transplantation centre. In both samples, personal meaning was concurrently associated with reduced emotional distress, enhanced coping efficacy, and closer intimate relationships, after controlling for social desirability bias and relevant demographic and medical covariates. Associations with lower distress and improved coping efficacy remained significant after additionally controlling for other psychosocial resource variables (i.e. social support, religiousness, emotional control). Personal meaning appears to be independently related to concurrent psychosocial adjustment in a range of medical settings.

Prospective study of religious coping among patients undergoing autologous stem cell transplantation.

Considerable attention has focused on relationships between religious or spiritual coping and health outcomes among cancer patients. However, few studies have differentiated among discrete dimensions of religious coping, and there have been surprisingly few prospective investigations. Negative or conflicted aspects of religious coping, in particular, represent a compelling area for investigation. This prospective study examined negative religious coping, positive religious coping, and general religious orientation among 94 myeloma patients undergoing autologous stem cell transplantation. Participants were assessed during stem cell collection, and again in the immediate aftermath of transplantation, when risks for morbidity are most elevated. Outcomes included Brief Symptom Inventory anxiety and depression and Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMI) scales. Negative religious coping at baseline predicted worse post-transplant anxiety, depression, emotional well-being, and transplant-related concerns, after controlling for outcome scores at baseline and other significant covariates. Post-transplant physical well-being was predicted by an interaction between baseline positive and negative religious coping. Results suggest that religious struggle may contribute to adverse changes in health outcomes for transplant patients, and highlight the importance of negative or strained religious responses to illness.

Patient preferences regarding cancer group psychotherapy interventions: a view from the inside.

Group interventions for cancer patients have commanded notable interest among investigators, but utilization rates are low and little is known about the features that patients themselves deem most important. The authors examined the views of potential participants, among 425 patients with diverse malignancies. A large number (64.6%) expressed interest, although few had attended a group. Preferences were strongest for interventions convened during diagnostic or active treatment periods rather than later, and those focusing on medical education or health-promotion, rather than emotional support or coping. Most were amenable to drop-in formats and to heterogeneous membership. In subgroup analyses, preferences were associated with disease site and not strongly related to psychosocial or demographic predictors. Understanding patient preferences may be critical for successful program development and utilization.

Caregiver stress and burnout in an oncology unit.

PURPOSE: Caring for patients with cancer can be taxing for front-line health care providers. The growing intensity of treatment protocols, in conjunction with staff shortages, reduced hospital stays, and broader pressures on the health care system may exacerbate these challenges, leading to increased risk for burnout. This article reviews the research literature regarding the prevalence of burnout and psychosocial distress among oncology providers, examines multifactorial occupational and personal determinants of risk, and considers intervention strategies to enhance resilience. METHODS: Literature review of empirical peer-reviewed studies focusing on prevalence and correlates of burnout among oncology physicians and nurses. RESULTS: Findings from a number of studies using validated measures and large samples suggest that prevalence rates for burnout and psychosocial distress are high among oncology staff, though not necessarily higher than in non-cancer-practice settings. A growing database has examined occupational (e.g., workload) and demographic (e.g., gender) factors that may contribute to risk, but there is less information about personal (e.g., coping) or organizational (e.g., staffing, physician-nurse relations) determinants or multilevel interactions among these factors. Oncologist burnout may adversely affect anticipated staff turnover. Other important endpoints (biological stress markers, health status, patient satisfaction, quality-of-care indices) have yet to be examined in the oncology setting. Intervention research is at a more rudimentary phase of development. CONCLUSIONS: Burnout and distress affect a significant proportion of oncology staff. There is a need for additional conceptually based, longitudinal, multivariate studies regarding burnout and its associated risk factors and consequences.

Religious struggle and religious comfort in response to illness: health outcomes among stem cell transplant patients.

Growing interest has focused on relationships between health and religious coping among cancer patients. However, little is known about the health correlates of negative or conflicted religious responses. The current study examined general religiousness and two modes of cancer-specific religious coping, drawing closer to faith (positive) and struggling with faith (negative), among 213 multiple myeloma patients evaluated at the same point in treatment, during their initial work-up for autologous stem cell transplantation. The outcomes assessed included standardized measures and clinician ratings of depression, general distress, physical functioning, mental health functioning, pain, and fatigue. Results indicated that, after adjusting for relevant control variables, negative religious coping was associated with significantly poorer functioning on all outcomes but one: depression, distress, mental health, pain, and fatigue. Neither general religiousness nor positive religious coping was significantly related to any of the outcomes measured. Results highlight the role of negative or ambivalent religious responses to illness.

Use of a supportive care team for screening and preemptive intervention among multiple myeloma patients receiving stem cell transplantation.

Although peripheral blood stem-cell transplantation (PBSCT) has assumed a growing role in the treatment of multiple myeloma, very few studies have examined the functional and quality-of-life changes experienced by myeloma patients in the transplant setting. Multiple myeloma is characterized by a range of debilitating physical and psychosocial symptoms. However, supportive care needs for patients with this disease are often overlooked or managed only episodically. The current study pilot-tested an interdisciplinary supportive care program designed to provide screening and identify patients at risk early in the course of care. Participants in this pilot project were 61 patients with hematological disorders, predominantly multiple myeloma (85.3%), evaluated during their initial workup. Mean time since diagnosis was 7.4 months. Participants were interviewed by an advanced-practice nurse and completed standardized measures of heath-related quality of life (SF-12), fatigue (POMS-Fatigue), nutritional risk (PG-SGA), pain (Brief Pain Inventory), emotional functioning (Hospital Anxiety and Depression Scale), and sexual concerns (FACIT). Results indicated that difficulties were prevalent across multiple functional domains; 61.4% of patients displayed significant nutritional deficits. Physical functioning was below age-adjusted national norms for 53.5%. Moderate-to-severe fatigue was reported by 39.0%, and one third experienced clinically significant levels of pain, impaired daily functioning associated with pain, and emotional distress. A similar proportion of respondents (33.9%) reported disrupted sexual functioning and difficulty with body image. Findings suggest that early, systematic screening is feasible in a busy transplant center. The prevalence of symptoms highlights the importance of providing screening and proactive intervention for multiple myeloma patients early in the course of treatment and even prior to beginning protocols for high-dose therapy and transplantation.