Health behaviors and needs of melanoma survivors.

PURPOSE: Little is known about melanoma survivors' long-term symptoms, sun protection practices, and support needs from health providers. METHODS: Melanoma survivors treated at Stanford Cancer Center from 1995 through 2011 were invited to complete a heath needs survey. We compared responses of survivors by sex, education, time since diagnosis (long-term vs. short-term survivors), and extent of treatment received (wide local excision (WLE) alone versus WLE plus additional surgical or medical treatment (WLE+)). RESULTS: One hundred sixty melanoma survivors (51 % male; 61 % long-term; 73 % WLE+) provided evaluable data. On average, patients were 62 years of age (SD = 14), highly educated (75 % college degree), and Caucasian (94 %). Overall, participants rated anxiety as the most prevalent symptom (34 %). Seventy percent reported that their health provider did not address their symptoms, and 53 % requested education about melanoma-specific issues. Following treatment, women spent significantly less time seeking a tan compared with men (p = 0.01), had more extremity swelling (p = 0.014), and expressed higher need for additional services (p = 0.03). Long-term survivors decreased their use of tanning beds (p = 0.03) and time spent seeking a tan (p = 0.002) and were less likely to receive skin screening every 3-6 months (p < 0.001) compared with short-term survivors. WLE+ survivors reported greater physical long-term effects than WLE survivors (p ≤ 0.001) following treatment. CONCLUSIONS: Melanoma survivors experience continuing symptoms long after treatment, namely anxiety, and they express a need for information about long-term melanoma effects, psychosocial support, and prevention of further skin cancer.

Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer.

BACKGROUND: Poor sleep, prevalent among cancer survivors, is associated with disrupted hormonal circadian rhythms and poor quality of life. Using a prospective research design, this study aimed to clarify the relationship between objective measures of sleep efficiency and sleep disruption with survival among women with advanced breast cancer. METHOD: We examined sleep quality and duration via wrist-worn actigraphy and sleep diaries for 3 days among 97 women in whom advanced breast cancer was diagnosed (age = 54.6 ± 9.8 years). Sleep efficiency was operationalized using actigraphy as the ratio of total sleep time to total sleep time plus wake after sleep onset. RESULTS: As hypothesized, better sleep efficiency was found to predict a significant reduction in overall mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.94-0.98; P < 0.001) at median 6 y follow-up. This relationship remained significant (HR, 0.94; 95% CI, 0.91-0.97; P < 0.001) even after adjusting for other known prognostic factors (age, estrogen receptor status, cancer treatment, metastatic spread, cortisol levels, and depression). Secondary hypotheses were also supported (after adjusting for baseline prognostic factors) showing that less wake after sleep onset (HR, 0.41; 95% CI, 0.25-0.67; P < 0.001), fewer wake episodes, (HR, 0.93; 95% CI, 0.88-0.98; P = 0.007); and shorter wake episode duration (HR, 0.29; 95% CI, 0.14-0.58; P < 0.001) also contributed to reductions in overall mortality. CONCLUSIONS: These findings show that better sleep efficiency and less sleep disruption are significant independent prognostic factors in women with advanced breast cancer. Further research is needed to determine whether treating sleep disruption with cognitive behavioral and/or pharmacologic therapy could improve survival in women with advanced breast cancer.

Posttraumatic growth and diurnal cortisol slope among women with metastatic breast cancer.

BACKGROUND: A cancer diagnosis leads to increased psychological and emotional distress. However, in the aftermath of a traumatic event, such as being diagnosed with breast cancer, an individual may also experience beneficial changes in life perspective, relationships with others, and more. These changes are collectively known as posttraumatic growth (PTG). Studies have demonstrated that cortisol levels have been linked with cancer survival, yet an investigation of the relationship between PTG and cortisol has yet to be conducted among cancer patients. METHODS: The relationship of PTG to cortisol levels was examined among 99 metastatic breast cancer patients. RESULTS: We found a significant correlation between PTG and diurnal cortisol slope (Spearman's rho=-0.21, p<0.05), indicating a link between positive psychological changes and healthier endocrine functioning in cancer patients. CONCLUSIONS: PTG in response to the stress of cancer was related to more normal (i.e., steeper) diurnal cortisol patterns. Longitudinal studies are recommended to investigate these mechanisms in relationship to cancer survival.

Bedtime misalignment and progression of breast cancer.

Disruption of circadian rhythms, which frequently occurs during night shift work, may be associated with cancer progression. The effect of chronotype (preference for behaviors such as sleep, work, or exercise to occur at particular times of day, with an associated difference in circadian physiology) and alignment of bedtime (preferred vs. habitual), however, have not yet been studied in the context of cancer progression in women with breast cancer. Chronotype and alignment of actual bedtime with preferred chronotype were examined using the Morningness-Eveningness Scale (MEQ) and sleep-wake log among 85 women with metastatic breast cancer. Their association with disease-free interval (DFI) was retrospectively examined using the Cox proportional hazards model. Median DFI was 81.9 months for women with aligned bedtimes ("going to bed at preferred bedtime") (n = 72), and 46.9 months for women with misaligned bedtimes ("going to bed later or earlier than the preferred bedtime") (n = 13) (log rank p = 0.001). In a multivariate Cox proportional hazard model, after controlling for other significant predictors of DFI, including chronotype (morning type/longer DFI; HR = 0.539, 95% CI = 0.320-0.906, p = 0.021), estrogen receptor (ER) status at initial diagnosis (negative/shorter DFI; HR = 2.169, 95% CI = 1.124-4.187, p = 0.028) and level of natural-killer cell count (lower levels/shorter DFI; HR = 1.641, 95% CI = 1.000-2.695, p = 0.050), misaligned bedtimes was associated with shorter DFI, compared to aligned bedtimes (HR = 3.180, 95% CI = 1.327-7.616, p = 0.018). Our data indicate that a misalignment of bedtime on a daily basis, an indication of circadian disruption, is associated with more rapid breast cancer progression as measured by DFI. Considering the limitations of small sample size and study design, a prospective study with a larger sample is necessary to explore their causal relationship and underlying mechanisms.

Sleep disruption in breast cancer patients and survivors.

Sleep disruption is prevalent in patients and survivors of breast cancer. Most patients undergoing chemotherapy will experience transient sleep disruption, and nearly 60% will have chronic sleep problems. Numerous factors contribute to sleep disruption in women diagnosed with breast cancer. Sleep disruption is a consequence of several biological alterations, including circadian disruption and immune and metabolic deregulations. These systems also play significant roles in the control and progression of breast cancer. Sleep disruption is associated with many side effects and psychiatric and medical comorbidities. This article discusses the relationship between stress and posttraumatic stress disorder, depression and fatigue, and how sleep disturbance might be the cause or consequence of these disorders. Current evidence for management of sleep disturbance in breast cancer and high chronic use of hypnotic medication in this population is also discussed. Finally, the differences in management of sleep disturbance during acute cancer care and during the survivorship phase are discussed. More research is needed on accurate and timely assessment of sleep disturbance associated with breast cancer, and additional tailored approaches for the management of sleep problems in breast cancer should be developed.

Psychosocial correlates of sleep quality and architecture in women with metastatic breast cancer.

BACKGROUND: Sleep disturbance is prevalent among women with metastatic breast cancer (MBC). Our study examined the relationship of depression and marital status to sleep assessed over three nights of polysomnography (PSG). METHODS: Women with MBC (N=103) were recruited; they were predominately white (88.2%) and 57.8±7.7 years of age. Linear regression analyses assessed relationships among depression, marital status, and sleep parameters. RESULTS: Women with MBC who reported more depressive symptoms had lighter sleep (e.g., stage 1 sleep; P<.05), less slow-wave sleep (SWS) (P<.05), and less rapid eye movement (REM) sleep (P<.05). Single women had less total sleep time (TST) (P<.01), more wake after sleep onset (WASO) (P<.05), worse sleep efficiency (SE) (P<.05), lighter sleep (e.g., stage 1; P<.05), and less REM sleep (P<.05) than married women. Significant interactions indicated that depressed and single women had worse sleep quality than partnered women or those who were not depressed. CONCLUSION: Women with MBC and greater symptoms of depression had increased light sleep and reduced SWS and REM sleep, and single women had worse sleep quality and greater light sleep than married counterparts. Marriage was related to improved sleep for women with more depressive symptoms.

"Have a drink, you'll feel better." Predictors of daily alcohol consumption among extraverts: the mediational role of coping.

An abundance of information exists pertaining to individual differences in college drinking behaviors with much attention being provided to the role of personality. However, plausible explanations for what prompts engagement in or avoidance of these behaviors have remained largely ambiguous or underexplored, particularly with respect to extraversion (E). Research has since explored how coping behaviors contribute to these associations. The present study built on this research by evaluating differences in daily alcohol consumption as a function of coping choice. The mediational effects of two specific strategies frequently observed in high E individuals (i.e., problem-focused coping and social support) were examined. Using a daily diary approach, 365 undergraduates reported their most stressful experience, how they coped with it, and the number of drinks consumed for five consecutive days. Resulting multilevel-models were consistent with hypotheses indicating the relationship between E and alcohol consumption was partially mediated by problem-focused and support-seeking strategies. The use of problem-focused coping by high E individuals was associated with lower levels of daily alcohol consumption, suggesting this strategy may play a protective role in influencing drinking behaviors. Conversely, the positive effect observed for social support approached significance (p=.054) and was indicative of a potential risk-factor for daily alcohol consumption.

Do normative perceptions of drinking relate to alcohol use in U.S. Military veterans presenting to primary care?

OBJECTIVE: The current cross sectional study sought to examine whether perceived social normative beliefs are associated with indicators of alcohol use in a sample of alcohol misusing veterans. METHOD: A sample of 107 U.S. Military Veterans presenting to primary care that screened positive for alcohol misuse on the alcohol use disorders identification test-consumption items (AUDIT-C) was recruited. Assessment measures were used to examine social normative beliefs and alcohol-related concerns as they relate to indicators of alcohol use at baseline. RESULTS: Our findings indicate mixed support for our two hypotheses in that perceived descriptive norms were associated with alcohol use indicators in the predicted direction; however, this was not the case for alcohol-related concerns. For perceived norms, we found that higher quantity beliefs were significantly related to greater alcohol consumption on a drinking day (p<.01), increased likelihood of dependence (p<.01), and frequency beliefs were significantly related to total number of drinking days (p<.01). Findings for alcohol-related concerns emerged contrary to our hypothesis, with results depicting increased alcohol-related concerns associated with higher alcohol consumption across indicators of use (ps<.01). SUMMARY: Findings of the current study suggest that social normative beliefs, specifically misperceptions about descriptive norms, are significantly associated with alcohol consumption in a sample of alcohol misusing veterans presenting to primary care.

Daily stress and alcohol consumption: modeling between-person and within-person ethnic variation in coping behavior.

OBJECTIVE: Using a daily diary approach, the current study evaluated the relationship between coping and alcohol consumption using a large, multiethnic sample. The primary goals of this study were to (a) identify coping strategies that are either protective or risk factors for alcohol consumption and (b) model between-ethnic and within-ethnic group variation for these relations. METHOD: College students (N = 365, 69.0% female) were recruited via flyers, course/club presentations, and university seminars. Participants completed Internet-based daily diaries over the course of 5 days and reported specifically on a target stressful event, how they coped with the stressful event, and the amount of alcohol consumed on a daily level. RESULTS: Use of more avoidance-oriented coping strategies (minimization of stressor, emotional rumination) and social support were significantly associated with more alcohol consumption. Ethnicity, however, did moderate some coping-alcohol associations. Use of religious coping was associated with less alcohol consumption and minimization of the stressor was associated with more alcohol consumption in African Americans; use of social support was associated with more alcohol consumption in Asian Americans; and use of problem-focused coping was associated with less alcohol consumption in Whites. CONCLUSIONS: Three maladaptive or risky coping strategies with respect to alcohol consumption were identified using an ecologically valid methodology. However, ethnic-specific variation of these risky (and protective) coping factors was identified. The findings highlight the importance of considering both between-ethnic and within-ethnic group variation with respect to the stress/coping and alcohol consumption.