Quality of life after immune suppressive therapy in aplastic anemia.

Acquired aplastic anemia (AA) is a rare form of immune-mediated bone marrow failure, which can result in life-threatening infections or bleeding if left untreated. Treatment consists of either immune suppressive therapy (IST) or allogeneic stem cell transplantation (alloHSCT). While considerable research has been published regarding survival, response rate and toxicity of both treatments, knowledge on the impact on quality of life (QoL) is scarce. We used the recently developed AA-specific QoL questionnaire (QLQ-AA/PNH-54) to evaluate QoL in a single center cohort of AA patients who were successfully treated with IST. The 54 questions represent 12 different QoL domains. Results were analyzed for all patients and grouped based on hematologic response (complete response (CR) or partial response (PR)). Thirty-six successfully treated adult patients (15 in CR, 21 in PR) completed the questionnaire (median age 54 years, range 21-71; median time since last IST 5 years, range 0-41). Fatigue was experienced by 83% of patients. Even though total QoL scores did not significantly differ between patients with PR and CR (105 vs 92, p-value 0,17) there appeared to be a trend towards higher scores in patients with PR, especially in domains concerning psychological wellbeing. This trend was most clear in the domains fear of progression (2,12 in PR patients vs 1,73 in CR patients; p-value 0,08) and role functioning (2,22 vs 1,88; p-value 0,07). In conclusion, patients with AA continue to experience psychological and physical effects despite successful IST.

Adverse childhood events and mental health problems in cancer survivors: a systematic review.

PURPOSE: The purpose of this study was to systematically review the literature on the association between adverse childhood events (ACEs) and mental health problems in cancer survivors. METHODS: This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Four databases (PubMed, PsychINFO, Web of Science, and Cochrane) were searched on 27-08-2023. RESULTS: Of the 1413 references yielded by the literature search, 25 papers met inclusion criteria and were reviewed. Most studies were performed in the USA, most included breast cancer survivors, and the number of included participants ranged between 20 and 1343. ACEs were relatively prevalent, with self-report rates ranging between 40 and 95%. Having been exposed to ACEs was a risk factor for heightened levels of emotional distress, anxiety, depressive symptoms, and fatigue during cancer treatment. Results varied depending on the variables included, and per subscale, but were consistent across different cultures and heterogenous patient groups. CONCLUSION: The association between ACE and mental health outcomes was significant in most studies. In order to improve treatment for this vulnerable population, it may be necessary to screen for ACEs before cancer treatment and adjust treatment, for example, by means of trauma-informed care (TIC), which recognizes and responds to the impact of trauma on individuals seeking healthcare.

Psychosocial issues of individuals undergoing surveillance for increased risk of melanoma and pancreatic cancer due to a germline CDKN2A variant: A focus group study.

Individuals with a germline CDKN2A pathogenic variant (PV) are at high risk of developing melanoma and pancreatic cancer and are therefore offered surveillance. The potential advantages and disadvantages associated with genetic testing and surveillance are discussed during medical counseling, although little is known about the associated psychosocial factors that are relevant to this population. This study sought to provide a qualitative exploration of psychosocial factors related to genetic testing and participation in skin and pancreatic surveillance in (potential) carriers of a CDKN2A PV. Fifteen individuals-both at-risk individuals and confirmed variant carriers-participated in one of the three online focus groups. Pre-defined discussion topics, including genetic testing, cancer surveillance, influence on lifestyle and family planning, were discussed. Patients reported that important reasons to engage in genetic testing included the possibility to participate in surveillance to gain control over their cancer risk and to get clarification on the potential carrier status of their children. We observed considerable differences in risk perception and experienced burden of surveillance. Knowledge of the PV has had a positive influence on lifestyle factors and altered attitudes toward life in some. Most participants were not aware of preimplantation genetic testing. This focus group study provided insight into a variety of psychosocial themes related to (potential) carriership of a CDKN2A PV. Future efforts should focus on identifying those who may benefit from additional psychosocial support, development of a centralized source of information, and assessing the knowledge, needs, and timing of counseling for family planning.

Attachment style and post-bariatric surgery health behaviours: the mediating role of self-esteem and health self-efficacy.

BACKGROUND: Attachment avoidance and anxiety have been linked to overweight and poor health behaviours, yet the mechanisms that underpin the relationship between attachment and health behaviours are not fully understood. Self-esteem and self-efficacy have been found to differ between attachment styles, rendering these variables potential mediators of the relationship. This longitudinal study investigated the serial mediation between preoperative attachment and 2-year post-operative health behaviours through self-esteem and health self-efficacy. METHODS: Participants were 263 bariatric surgery patients (75.7% females, aged 47.7 ± 10.4 years, BMI 38.9 ± 3.6 kg/m2) assessed before the operation and again one and two years after the surgery. Patients completed the Experiences for Close Relationships Brief Scale, Rosenberg Self-esteem scale, Weight Efficacy Lifestyle Questionnaire, Bariatric Surgery Self-Management Questionnaire, Exercise Self-Efficacy Scale and the Exercise Behaviour Scale. RESULTS: Higher preoperative attachment anxiety and avoidance were associated with lower self-esteem one year after bariatric surgery and poorer health self-efficacy two years after the surgery. Self-esteem and health self-efficacy mediated the relationships between preoperative anxious and avoidant attachment and 2- year post-operative diet adherence and physical activity. CONCLUSIONS: Helping patients to feel more worthy and reinforcing their beliefs about their own competences could lead to higher engagement with healthy lifestyle and adherence to treatment protocols, ultimately helping patients to achieve their goals for bariatric surgery. CLINICAL TRIAL REGISTRATION: BARIA: Netherlands Trial Register: NL5837 (NTR5992) https://www.trialregister.nl/trial/5837 . Diabaria: ClinicalTrials.gov identifier (NCT number): NCT03330756.

Fluctuations in core depressive symptoms in colorectal cancer patients. A prospective, population-based PROFILES-registry study.

PURPOSE: Research investigating depressive symptoms among cancer patients rarely distinguish between core symptoms of depression (motivational and consummatory anhedonia, and negative affect). This distinction is important as these symptoms may show different trajectories during the course of the illness and require different treatment approaches. The aim of the present study is to investigate fluctuations in core depressive symptoms in patients with colorectal cancer (CRC). It is hypothesized that these core depressive symptoms fluctuate differently during the course of the illness and depend on the phase of the illness (diagnostic, treatment, recovery and palliative phase). METHOD: This study is based on data from the PROCORE study. PROCORE is a prospective, population-based study aimed to examine the longitudinal impact of CRC and its treatment on patient-reported outcomes. Eligible patients completed self-report questionnaires (i.e. Multifactorial Fatigue Index, Hospital Anxiety and Depression scale, EORTC-C30) after diagnosis, after surgery and at one and two years after diagnosis. RESULTS: In total, 539 patients participated of whom 68 have died until March 1ste 2021. Core depressive symptoms fluctuated differently during the course of the illness with higher levels of motivational anhedonia during treatment and palliative phase (P<.001), consummatory anhedonia at the palliative phase (p < .001) and negative affect at the diagnostic and palliative phase (P<.001). CONCLUSION: It is important to distinguish between different core depressive symptoms as they fluctuate differently during the course of an illness like CRC. The various depressive symptoms may require a different treatment approach at specific moments during the illness process.

Fibrotic-like abnormalities notably prevalent one year after hospitalization with COVID-19.

BACKGROUND: We investigated whether COVID-19 leads to persistent impaired pulmonary function, fibrotic-like abnormalities or psychological symptoms 12 months after discharge and whether severely ill patients (ICU admission) recover differently than moderately ill patients. METHODS: This single-centre cohort study followed adult COVID-19 survivors for a period of one year after discharge. Patients underwent pulmonary function tests 6 weeks, 3 months and 12 months after discharge and were psychologically evaluated at 6 weeks and 12 months. Computed tomography (CT) was performed after 3 months and 12 months. RESULTS: 66 patients were analysed, their median age was 60.5 (IQR: 54-69) years, 46 (70%) patients were male. 38 (58%) patients had moderate disease and 28 (42%) patients had severe disease. Most patients had spirometric values within normal range after 12 months of follow-up. 12 (23%) patients still had an impaired lung diffusion after 12 months. Impaired pulmonary diffusion capacity was associated with residual CT abnormalities (OR 5.1,CI-95: 1.2-22.2), shortness of breath (OR 7.0, CI-95: 1.6-29.7) and with functional limitations (OR 5.8, CI-95: 1.4-23.8). Ground-glass opacities resolved in most patients during follow-up. Resorption of reticulation, bronchiectasis and curvilinear bands was rare and independent of disease severity. 81% of severely ill patients and 37% of moderately ill patients showed residual abnormalities after 12 months (OR 8.1, CI-95: 2.5-26.4). A minority of patients had symptoms of post-traumatic stress disorder, anxiety, depression and cognitive failure during follow-up. CONCLUSION: Some patients still had impaired lung diffusion 12 months after discharge and fibrotic-like residual abnormalities were notably prevalent, especially in severely ill patients.

Symptoms of anxiety but not depression before start of taxane-based chemotherapy are associated with peripheral neuropathy: a multicenter study in women with breast cancer.

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy, especially after taxane-based therapy. This study aimed to examine the relationship between symptoms of anxiety and depression before the start of taxane-based chemotherapy and the development of CIPN in women with breast cancer. METHODS: In this prospective study, women with breast cancer receiving taxane-based (neo)adjuvant chemotherapy were recruited from four hospitals in the Netherlands. Patients completed questionnaires assessing anxiety and depressive symptoms before treatment and CIPN before treatment (T0), 6 weeks after start of treatment (T1), after the last cycle of chemotherapy (T2), and 6 months after the end of treatment (T3). Mixed model analyses were used to investigate whether medium/high levels of anxiety or depression at baseline are associated with the level of CIPN during and after treatment. RESULTS: Among the 61 participating women, 14 (23%) reported medium/high levels of anxiety and 29 (47.5%) reported medium/high levels of depressive symptoms at baseline. The group of women with medium/high baseline levels of anxiety showed a significantly higher increase in CIPN during and after chemotherapy than women with low baseline levels of anxiety (p < .001). No relationship between depressive symptoms at baseline and the development of CIPN was found. CONCLUSION: This study showed that baseline medium to high levels of anxiety but not depressive symptoms impacted the development of CIPN during and in the 6 months after treatment.

Psychosocial Determinants of Lifestyle Change after a Cancer Diagnosis: A Systematic Review of the Literature.

The aim of this study is to provide a systematic overview of the scientific literature on sociodemographic, psychological and social determinants that may facilitate or hamper lifestyle change after the diagnosis cancer. Four databases (PubMed, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) were searched for relevant papers up to October 2021. Of the 9586 references yielded by the literature search, 123 papers were included: 71 quantitative and 52 qualitative papers. Findings showed a large variety of determinants influencing lifestyle change after cancer diagnosis, with differences between lifestyle behaviors (physical activity, diet, smoking, alcohol, sun protection, and multiple lifestyle behaviors) and findings from quantitative vs. qualitative studies. Findings demonstrate the important role of oncology healthcare professionals in promoting healthy lifestyle changes in cancer survivors. In addition, findings inform researchers involved in the development of health promotion programs about the methods and strategies they can use to promote healthy lifestyle changes in cancer survivors. Favorable lifestyle changes are expected to have beneficial effects on cancer risk and overall health in cancer survivors.

Pre-consultation information about one's physician can affect trust and treatment outcome expectations.

OBJECTIVE: Information about physicians' skills is increasingly available on the internet and consulted by patients. The impact of such information on patient expectations is largely unknown. The aim of the present study was to investigate whether information about the competence and empathic skills of a physician may impact pre-consultation trust and treatment outcome expectations in mild and severe medical conditions. METHODS: In this experimental web-based study, participants (n = 237) read vignettes describing competence and empathic skills (low versus high) of a fictive physician who would surgically remove a mole or melanoma (low versus high severity) following a 2 × 2 × 2 between-subjects design. Participants rated trust in the physician and treatment outcome expectations. RESULTS: High competence and empathy raised trust in the physician, regardless of condition severity. High competence and high empathy both also increased expected surgery success, while only high competence reduced expected side effects. CONCLUSION: Pre-consultation information highlighting a physician's competence and/or empathy may lead to higher trust in that physician, higher expected surgery success, and lower expected side effects. PRACTICE IMPLICATIONS: Physicians and hospital staff should be aware of the effects of written information available and might, for example, provide profiles on hospital websites emphasizing healthcare providers' competence and empathy.

Are Morbid Obesity and Insomnia Related? Investigating Associated Factors in a Clinical Setting.

Disturbed sleep and (morbid) obesity are increasing health problems in industrial societies and play an important role in chronic illnesses. Conclusive evidence about their relationship is lacking. The aim of this study was to investigate the relationship between insomnia and obesity and if common associated factors such as psychological distress, self-control, attachment insecurity, and socioeconomic status are present to the same extent in both patient groups. The sample consisted of 177 patients referred to the Medical Psychology department of a general hospital (92 with morbid obesity and 85 with insomnia). Measures used were PSQI, HADS, BSCS, PSWQ, DERS, and ECR-M16. Results showed that morbid obesity and insomnia are largely unrelated health risks, with little overlap in associated factors and divided mainly by SES. This indicates that condition-oriented interventions rather than transdiagnostic interventions are likely to be more effective and that different population groups (high vs low SES) may benefit from different approaches.

One Size Does Not Fit All: Comparative Diagnostic Accuracy of the Rowland Universal Dementia Assessment Scale and the Mini Mental State Examination in a Memory Clinic Population with Very Low Education.

BACKGROUND: Diagnosing dementia in elderly immigrants is often difficult due to language and cultural barriers, low education, and illiteracy. We compared the diagnostic accuracy of the Rowland Universal Dementia Assessment Scale (RUDAS) to that of the Mini Mental State Examination (MMSE). METHODS: A total of 144 patients (42 with intact cognition, 44 with mild cognitive impairment [MCI], and 58 with dementia) were administered both instruments and were diagnosed by specialists blinded for MMSE and RUDAS results. RESULTS: Areas under the curve for discriminating intact cognition from MCI and dementia were comparable for RUDAS (0.81; 95% confidence interval 0.74-0.88) and MMSE (0.75; 95% confidence interval 0.69-0.85). Education and literacy were not correlated with the RUDAS but had a medium-large correlation with the MMSE (rho = 0.39). CONCLUSIONS: The study provides additional evidence for the usefulness of the RUDAS in a highly illiterate, culturally diverse geriatric outpatient population.

Perceived Postoperative Support Differentiates Responders from Non-Responders 3 Years After Laparoscopic Roux-en-Y Gastric Bypass.

BACKGROUND: Bariatric surgery is an effective intervention for the majority of patients with morbid obesity, but a significant minority fails to achieve substantial weight loss. In the search of possible predictors of weight loss following bariatric surgery, preoperative factors turn out to have limited predictive power. This study will examine the impact of two postoperative factors on weight loss: perceived social support and stressful life events. METHODS: From the entire 2013 cohort that underwent laparoscopic Roux-and-Y gastric bypass (LRYGB) in a general hospital in the Netherlands, a group of 56 non-responders and a matched group of 56 responders were selected, using an alterable weight loss (%AWL)-based percentile chart. Patients from both groups were interviewed by phone to collect data on demographics, medical complications and comorbidities, social support and stressful life events. A total of 61 patients completed the data collection (54% response rate). RESULTS: One-way ANOVA analysis showed that responders and non-responders differed with regard to perceived support (F(1) = 8.60, p = .005). In a model with place of birth, level of education and pre-surgery diabetes mellitus as covariates, perceived social support was able to classify 83.6% of patients correctly as either responder or non-responder (χ 2 = 28.26, p < .001). Stressful life events turned out to be unrelated to weight loss. CONCLUSIONS: Perceived social support differentiates responders from non-responders after LRYGB. When patients present themselves after LRYGB with sub-optimal weight loss, social support should be a focus of attention.

Bariatric surgery in young adults: a multicenter study into weight loss, dietary adherence, and quality of life.

BACKGROUND: Numerous studies have demonstrated that bariatric surgery is an effective intervention for morbid obesity, but study samples are characterized by an underrepresentation of young adult patients. OBJECTIVES: The aim of this study was to evaluate weight loss, dietary adherence, and quality of life (QoL) in a multicenter, young adult sample, in the first 6 years after bariatric surgery. SETTING: Four general hospitals in the Netherlands. METHODS: A total of 184 young adult patients who underwent bariatric surgery between 6 and 74 months previously at the age of 18 to 24 years were included, interviewed by phone, and sent questionnaires assessing postoperative weight, QoL, and lifestyle behaviors including dietary adherence. Complete data were available for those 96 patients who returned the questionnaires. RESULTS: Mean percent weight loss was 30.2 (SD 10.7) for laparoscopic sleeve gastrectomy and 35.6 (SD 6.9) for laparoscopic Roux-en-Y gastric bypass. Adherence to postoperative dietary recommendations declined over the years (r = -.25, P = .02) and explained 8.3% of the variance in weight loss (r = .29, P = .005). QoL scores lagged behind national norms for young adults and were largely unrelated to weight loss. A quarter of patients (25%) turned out to be not in education, employment, or training and 38% had used mental healthcare services since surgery, which occurred independent of weight loss and concurred with poorer QoL. CONCLUSION: Young adult patients achieve weight loss comparable to adult patients after bariatric surgery. However, postoperative adherence to behavioral recommendations and psychosocial functioning clearly demonstrate room for improvement and require adjunctive interventions.

[Extreme obesity due to feelings of inner emptiness: structural-developmental disorder illustrated by the case of a young morbidly obese patient]. / Extreem overgewicht door gevoel van innerlijke leegte: structurele ontwikkelingsstoornis bij jongvolwassene met morbide obesitas.

Structural-developmental disorder, which is characterized by a lack of mentalisation, is explained in this article using the case of a morbidly obese 19-year-old woman. Mentalisation refers to the ability to understand behaviours on the basis of mental states such as thoughts, feelings, and desires. Not being able to mentalise properly has serious consequences, which became apparent during contact with this patient. Although problems with mentalising may not be a contraindication for bariatric surgery, substantial follow-up is necessary to ensure compliance in the long run. Additionally, knowledge about structural-developmental disorder may help to decide which kind of interventions may be most effective.

Gastric bypass may promote weight loss in overweight partners.

INTRODUCTION: Following bariatric surgery, patients are expected to implement diet and lifestyle changes that may be imitated by cohabitating family members. We hypothesize that cohabitating family members will lose weight and improve their eating behavior within 1 year after surgery. METHODS: In this observational prospective study, family members of patients who had gastric bypass surgery (88 partners, 20 children ≥18 years old, and 25 children between 12 and 17 years old) were repeatedly assessed. Family members were asked to assess their weight and height before and 3, 6, and 12 months following bariatric surgery, and they filled out the Dutch Eating Behavior Questionnaire. RESULTS: Between baseline and 1 year following surgery, 49 partners of patients who underwent gastric bypass surgery (66.2%) lost weight, 6 (8.1%) remained stable, and 19 (25.7%) gained weight. Body mass index of partners (P = .002), particularly of overweight partners (P < .001)-but not children-showed a small, significant decrease over time. No significant changes in eating behavior among partners or children were found. CONCLUSION: The study indicates that gastric bypass surgery may have a ripple effect, with body weight in partners of patients decreasing over time. However, there is considerable variation in the postoperative weight loss of partners.

Attachment anxiety predicts poor adherence to dietary recommendations: an indirect effect on weight change 1 year after gastric bypass surgery.

BACKGROUND: Weight loss after gastric bypass surgery depends on the adoption of healthy dietary recommendations, which may be influenced by psychological issues and patients' attachment representations (habitual states of mind with respect to interpersonal relations). The present study tests (1) whether attachment representations are associated with dietary adherence, (2) whether dietary adherence and weight loss are correlated and (3) whether dietary adherence mediates the relation of attachment representations with weight reduction after gastric bypass surgery. Besides attachment representations, psychological problems are examined. METHODS: This longitudinal study included 105 patients who had a laparoscopic Roux-en-Y gastric bypass operation. Current and past psychological problems and attachment representations were assessed before surgery. Dietary adherence was assessed 6 and 12 months postsurgery. Patients' weight and height were collected from medical records. Multiple linear and logistic regression analyses and mediation analyses using bootstrapping resampling procedures were conducted. RESULTS: Of all examined predictor variables, attachment anxiety, i.e., fear of social rejection and abandonment, was most strongly associated with low dietary adherence at both 6 months (p = 0.009) and 12 months (p = 0.006) postsurgery. Dietary adherence 6 months postsurgery was associated with weight loss 1 year after the operation (p = 0.003). Dietary adherence at 6 months (ß = 0.51; 95% confidence interval (CI) = 0.19-1.04) mediated the association between preoperative attachment anxiety and postoperative weight loss. CONCLUSIONS: The results suggest that more anxiously attached patients are less adherent to dietary recommendations 6 months after gastric bypass surgery, influencing weight loss in a negative way during the first year after surgery.

Coping style as a mediator between attachment and mental and physical health in patients suffering from morbid obesity.

OBJECTIVE: The presence of mental health problems and limitations in physical functioning is high in patients suffering from morbid obesity. The purpose of the current study was to examine the mediating role of coping style in the relationship between attachment representations and mental health and physical functioning in a morbidly obese population. METHOD: A total of 299 morbidly obese patients who were referred to the Slotervaart bariatric surgery unit in Amsterdam, the Netherlands, completed self-report questionnaires assessing adult attachment style (Experiences in Close Relationship-Revised Questionnaire), coping style (Utrecht Coping List), and patients physical functioning and mental health (Short Form-36). RESULTS: Attachment anxiety (beta = -.490, p < .001) and attachment avoidance (3 = -.387, p < .001) were both found to be related to mental health. In addition, attachment anxiety was also found to be related to physical functioning (beta = - .188,p < .001). Coping style partly mediated these associations. CONCLUSIONS: Findings suggest that coping mediates the association between attachment anxiety and attachment avoidance on the one hand and mental health and physical functioning in patients with morbid obesity on the other hand.

Lower levels of trust in one's physician is associated with more distress over time in more anxiously attached individuals with cancer.

OBJECTIVE: In the present study, we investigated individual differences in the outcome of patient-physician trust when confronted with cancer from an attachment theoretical perspective. We expected that lower levels of trust are associated with more emotional distress and more physical limitations within the first 15 months after diagnosis, especially in those who score relatively high on attachment anxiety. No such association was expected for more avoidantly attached individuals. METHOD: A group of 119 patients with different types of cancer (breast, cervical, intestinal and prostate) completed questionnaires concerning trust (short version of the Wake Forest Physician Trust Scale) and attachment (Experiences in Close Relationship scale Revised) at 3 months after diagnosis. Emotional distress (Hospital Anxiety and Depression Scale) and physical limitations (physical functioning subscales of the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire-C30) were assessed at 3, 9 and 15 months after diagnosis. To test the hypotheses, multiple hierarchical regression analyses were performed. RESULTS: Lower levels of trust were associated with more emotional distress and more physical limitations at 3, 9 and 15 months after diagnosis in more anxiously attached patients, but not in less anxiously attached patients. DISCUSSION: These results indicate an attachment-dependent effect of trust in one's physician. Explanations and clinical implications are discussed.

Psychologists' evaluation of bariatric surgery candidates influenced by patients' attachment representations and symptoms of depression and anxiety.

This study examines whether patients self-reported attachment representations and levels of depression and anxiety influenced psychologists' evaluations of morbidly obese patients applying for bariatric surgery. A sample of 250 patients (mean age 44, 84 % female) who were referred for bariatric surgery completed questionnaires to measure adult attachment and levels of depression and anxiety. Psychologists rated patients' suitability for bariatric surgery using the Cleveland Clinic Behavioural Rating System (CCBRS), unaware of the results of the completed questionnaires. Attachment anxiety (OR = 2.50, p = .01) and attachment avoidance (OR = 3.13, p = .001) were found to be associated with less positive evaluations on the CCBRS by the psychologists, and symptoms of depression and anxiety mediated this association. This study strongly supports the notion that patients' attachment representations influence a psychologist's evaluation in an indirect way by influencing the symptoms of depression and anxiety patients report during an assessment interview. The clinical implications of these findings are discussed.

Do patients trust their physician? The role of attachment style in the patient-physician relationship within one year after a cancer diagnosis.

BACKGROUND: The degree of trust in and satisfaction with the physician has been shown to have important implications for treatment outcomes. This study aims to examine individual differences in patients' trust, satisfaction and general distress from an attachment theoretical perspective. MATERIAL AND METHODS: One hundred and thirty recently diagnosed cancer patients of three medical hospitals were extensively interviewed by trained psychologists to assess attachment style. Patients completed standardized questionnaires three and nine months after diagnosis to assess trust, satisfaction and distress. t-tests and repeated measures ANOVAs were used to examine differences between securely and insecurely attached patients and changes over time. A mediation model based on a bootstrapping method was used to examine whether trust mediated between attachment and satisfaction, and attachment and distress. RESULTS: Insecurely attached patients (N = 45, 35%) reported less trust in and satisfaction with their physician, and reported more general distress than securely attached patients three and nine months after diagnosis (p < 0.05). Trust and distress levels did not change over time. Trust mediated between attachment and satisfaction, but not between attachment and distress. CONCLUSION: Insecurely attached patients trusted their physician less than securely attached patients, and in turn were less satisfied with their physician. Their higher levels of general distress were not related to their lower levels of trust. Attachment theory provides a framework to interpret differences in patients' trust, satisfaction and distress, and may help physicians respond in such a way that their patients feel secure, which in turn is expected to result in better health outcomes.