Psychological distress related to patterns of family functioning among Japanese childhood cancer survivors and their parents.

OBJECTIVE: Family functioning appears to be a predictor of psychological distress among childhood cancer survivors and their family members; however, relatively little is known about patterns in those families that are psychologically at-risk. The purpose of this study was to identify distinct clusters of families that include childhood cancer survivors, and to evaluate differences between the clusters with respect to anxiety, depression, and post-traumatic stress symptoms (PTSS). METHODS: Childhood cancer survivors and their parents (247 individuals: 88 adolescent cancer survivors, 87 mothers, and 72 fathers) completed self-report questionnaires. Perceptions of family functioning were assessed using the Family Relationship Index and its three dimensions (cohesiveness, expressiveness, and conflict), and individuals were classified into groups via a cluster analytic approach. State-trait anxiety, depression, and PTSS were assessed to all of the participants. RESULTS: The individuals were classified into three types: One cluster featured high cohesiveness, high expressiveness, and low conflict ('Supportive-type', n=102); a second cluster featured low cohesiveness, low expressiveness, and high conflict ('Conflictive-type', n=32); and a third cluster had moderate cohesiveness, moderate expressiveness, and moderate conflict ('Intermediate-type', n=113). Among the three types, an analysis of variance revealed that 'Conflictive-type' members had the highest levels of PTSS, depression, and state-trait anxiety. CONCLUSIONS: These findings suggest that perceptions of family functioning are related to psychological distress in family members of childhood cancer survivors. A family-focused intervention might be a useful approach to targeting emotional distress in these families, particularly for families with a 'Conflictive-type' family member.

How Do Hospital Palliative Care Teams Use the WHO Guidelines to Manage Unrelieved Cancer Pain? A 1-Year, Multicenter Audit in Japan.

It has been reported that pain relief for patients with cancer is suboptimal in Japan. This has been mainly attributed to inadequate dissemination of the World Health Organization (WHO) guidelines for cancer pain management. To better understand this problem, we reviewed how 6 hospital palliative care teams (HPCTs) used the WHO guidelines for unrelieved pain in a 1-year audit that included 534 patients. The HPCT interventions were classified according to the contents of the WHO guidelines. In our study, HPCT interventions involved opioid prescriptions in >80% of referred patients, and "For the Individual" and "Attention to Detail" were the 2 most important principles. Our study indicates which parts of the WHO guidelines should be most heavily emphasized, when disseminating them in Japan.

Characteristics of family functioning in patients with endogenous monopolar depression.

The purpose of the study was to investigate dysfunctions in families with a member suffering from endogenous monopolar depression during the acute phase by means of a case-control study, and to consider the possibilities of psychiatric intervention for families with a patient in the course of monopolar depression. Twenty patients with monopolar depression during the acute phase and family members living in the same household (Depressive families) were compared with twenty-seven non-clinical college students and their family members (Control families) with regard to family functioning assessed by the Family Assessment Device (FAD). Depressive families reported significantly worse family functioning than Control families, especially in three areas: Problem Solving, Communication, and General Functioning. Members of Depressive families also perceived their family functioning to be significantly poorer than that of Control families, in the areas of Problem Solving, Communication, Roles, Affective Responsiveness, Affective Involvement and General Functioning, which yielded the same result as a comparison between depressive couples and control couples. The pattern of family dysfunction that was found in the present study, especially in the three areas of family functioning, Problem Solving, Communication, and General Functioning, emphasizes the importance of appropriate family intervention to improve the family's competence in problem solving and to promote better communication in the family during the acute phase of endogenous monopolar depression. Additionally such family dysfunction has been similarly observed in North American studies, indicating that diverse problems emerge beyond differences in the cultural background of families containing a patient with endogenous monopolar depression.

Factors related to anxiety and depression in women with breast cancer and their husbands: role of alexithymia and family functioning.

GOALS OF WORK: The purpose of this study was to explore alexithymia, family functioning, and other factors that might affect anxiety and depression levels in women with breast cancer and in their husbands. PATIENTS AND METHODS: A cross-sectional study was undertaken in 46 postsurgical ambulatory women with breast cancer and their husbands. Documented informed consent for the study was obtained from each subject. All subjects completed the Zung self-rating anxiety scale (SAS), the Zung self-rating depression scale (SDS), the 20-item Toronto alexithymia scale (TAS-20), and the family assessment device (FAD). MAIN RESULTS: Multiple regression analysis revealed that a high degree of alexithymia in patients correlated with a high degree of patient anxiety. Patient perceptions of inappropriate affective responsiveness among family members correlated with a high degree of depression. Among husbands, a high degree of anxiety was correlated with their own high level of alexithymia or low level of education, and with the occurrence of adjuvant therapy in their wives. Husband perceptions of inappropriate sharing of roles among family members, their own low education level, and a large number of family members correlated with high degrees of depression among them. CONCLUSIONS: The present study revealed that alexithymia and family functioning are associated with anxiety and depression, respectively, in both women with breast cancer and in their husbands. Individual traits such as alexithymia and family functioning should be taken into account when we intervene to treat anxiety and depression in breast cancer patients and their husbands.

Factors related to posttraumatic stress in adolescent survivors of childhood cancer and their parents.

GOALS OF WORK: The purpose of this study was to investigate factors related to severe posttraumatic stress symptoms (PTSS) in adolescent survivors of childhood cancer and their parents. MATERIALS AND METHODS: Eighty-nine families (88 adolescent survivors of childhood cancer, 87 mothers, 72 fathers) completed a self-report questionnaire. Multivariate logistic regression analyses were performed using the following risk factors for severe PTSS: trait anxiety, family functioning, demographic and medical variables. MAIN RESULTS: Severe PTSS were reported by 10.9% (n=9) of the survivors, 20.7% (n=18) of the mothers, and 22.2% (n=16) of the fathers. Preliminary analyses found significant correlations of PTSS between mother-survivor (Spearman's gamma=0.377, p<0.01) and mother-father (Spearman's gamma=0.483, p<0.01). The results of multivariate analyses indicated that higher trait anxiety [odds ratio (OR):1.16; 95% confidence interval (CI): 1.03-1.31; p<0.05] and having medical sequelae (OR: 5.85; 95% CI:1.02-33.72; p<0.05) were significant factors related to PTSS for survivors. For mothers, the significant PTSS-related factors were: higher trait anxiety (OR:1.13; 95% CI:1.04-1.23; p<0.01); 5- to 9-year interval from the first diagnosis to the present investigation, compared to more than a 10-year interval (OR: 6.45; 95% CI:1.67-24.89; p<0.01); and a relatively lower rating on "roles" of family functioning (OR: 12.34; 95% CI:1.11-136.97; p<0.05). For fathers, trait anxiety was a significant related factor (OR: 1.07; 95% CI:1.01-1.14; p<0.05). CONCLUSIONS: Survivors and their parents suffered from PTSS after long interval from completion of treatment, and PTSS-related factors varied for each family member. Appropriate allocation of responsibility for family functioning may promote the ability to decrease PTSS, especially for mothers.

Family functioning and psychological distress among Japanese breast cancer patients and families.

GOALS OF WORK: The purpose of this study was to develop a typology of family functioning in the families of breast cancer patients. PATIENTS AND METHODS: Seventy-four families (189 individuals: 74 patients, 54 spouses, 46 offspring, and 15 other relatives) completed self-report questionnaires. Perception of family functioning was assessed using the family relationship index (FRI) and its three dimensions (cohesiveness, expressiveness, and conflict) and was classified into groups by a cluster analytic approach. Psychological distress was assessed using the Zung self-rating depression scale (SDS) and the Zung self-rating anxiety scale (SAS). MAIN RESULTS: Cluster analysis yielded three groups of patients and their family members: one cluster with high cohesiveness, high expressiveness, and low conflict ("supportive" type: n=64); a second group with low cohesiveness, low expressiveness, and high conflict ("conflictive" type: n=65); and a third group with limited cohesiveness, limited expressiveness, and low conflict ("intermediate" type: n=60). Analysis of variance revealed that conflictive families manifested the highest level of depression and anxiety among these clusters. CONCLUSIONS: Typology of family functioning can identify psychologically at-risk families. A family-focused approach can help to reduce psychological distress, especially in conflictive families.

Gastric acidity in patients with follicular gastritis is significantly reduced, but can be normalized after eradication for Helicobacter pylori.

BACKGROUND: Follicular gastritis is thought to be caused by Helicobacter pylori infection. However, the pathophysiology of it remains unclear. MATERIALS AND METHODS: We assessed gastric acidity in 15 patients with follicular gastritis, aged 20-37 years, using a 24-hour intragastric pH-metry, as well as by histologic and serologic evaluations; and compared it with that in other age-matched groups: 18 cases of H. pylori-positive antrum-predominant gastritis, 12 of pangastritis, and 24 H. pylori-negative normals. In eight cases with follicular gastritis, it was re-assessed 6 months after the eradication therapy for H. pylori. RESULTS: During nighttime, the percentage of time with intragastric pH above 3.0 in follicular gastritis was significantly higher than that in normals (p<.0001), and in antrum-predominant gastritis (p<.001), but was comparable with that in pangastritis. In the daytime period, this parameter in follicular gastritis was significantly higher than that in normal (p<.001), in antrum-predominant gastritis (p<.001), and in pangastritis (p<.05). Marked mononuclear cell and neutrophil infiltration but no apparent glandular atrophy were observed in both the antrum and corpus. Serum pepsinogen I/II ratio was significantly lower in follicular gastritis than that in normals (p<.0001) and in antrum-predominant gastritis (p<.001), whereas serum gastrin was significantly higher than that in normals (p<.0001), in antrum-predominant gastritis (p<.01) and in pangastritis (p<.05). After eradication for H. pylori, all of the parameters in follicular gastritis were altered to the same ranges as those in normals. CONCLUSIONS: In follicular gastritis, gastric acidity is significantly reduced, but can be normalized by eradication of H. pylori. It can thus be speculated that inflammatory cytokines or H. pylori-infection-induced prostaglandins might strongly inhibit gastric acid secretion in follicular gastritis.

Prevalence of Helicobacter pylori infection, endoscopic gastric findings and dyspeptic symptoms among a young Japanese population born in the 1970s.

BACKGROUND: With the prevalence of Helicobacter pylori (H. pylori) infection rapidly decreasing in Japan, endoscopic findings and dyspeptic symptoms need to be re-evaluated. METHODS: In a health check-up program, endoscopy was performed on 530 young Japanese subjects (371 men and 159 women) born in the 1970s. Helicobacter pylori infection was evaluated using serology and a rapid urease test. Endoscopic gastritis was classified according to the Sydney classification system, in addition to nodular gastritis. Dyspeptic symptoms were also recorded before endoscopy. RESULTS: Of the 530 subjects, 87 (16.4%) were H. pylori positive. Of the 443 H. pylori-negative subjects, 349 (78.8%) were considered to have endoscopically normal gastric mucosa. However, of the 87 H. pylori-positive subjects, only 19 (21.8%) tested normal (P < 0.001). The prevalence of several types of gastritis was significantly higher in H. pylori-positive subjects compared with H. pylori-negative subjects: atrophic gastritis (37.9% vs 1.1%, P < 0.001), flat erosive gastritis (29.9% vs 7.2%, P < 0.001), rugal hyperplastic gastritis (12.6% vs 0.0%, P < 0.001), and nodular gastritis (13.8% vs 0.0%, P < 0.001). Other types of gastritis were not related to H. pylori status. The prevalence of subjects with dyspeptic symptoms was significantly higher in H. pylori-positive subjects compared with H. pylori-negative ones (28.7% vs 6.5%, P < 0.001). CONCLUSION: It is suggested that in consideration of its recent low prevalence and the slow increase in its infection, the prevalence of H. pylori-related gastritis will gradually decrease in Japan. Further studies will be required to ascertain if there is a need for H. pylori eradication in this young population.

Factors related to patient's mental adjustment to breast cancer: patient characteristics and family functioning.

Previous studies have suggested that patients who adopted a coping response characterized as helplessness or hopelessness reported higher levels of psychological distress than patients who adopted a response characterized as fighting spirit. There are also studies suggesting a relationship between family functioning and psychological well-being of cancer patients and their family members. The aim of this cross-sectional study was to investigate the relationship between breast cancer patients' coping response to the diagnosis of cancer and family functioning. A total of 46 postoperative ambulatory female breast cancer patients and their husbands participated in this study. Patients and husbands completed the Family Assessment Device (FAD), and patients also completed the Mental Adjustment to Cancer (MAC) scale. They filled in these self-report questionnaires at home. The results of multiple regression analysis showed that patients' perception of poor family functioning in the area of Communication measured by the FAD correlated with high Helplessness/Hopelessness score of the MAC, whereas high education in the patients was correlated with low Fighting Spirit score on the MAC. The results suggested a link between a patient's attitude of helplessness or hopelessness in the face of cancer and inappropriate communication among family members. Consequently, health care professionals should devote attention not only to the patient but also to other family members and intervene to promote appropriate communication patterns among the family members.