Symptom cluster of emotional distress, fatigue and cognitive difficulties among young and older breast cancer survivors: The mediating role of subjective stress.

OBJECTIVES: To examine the nature of the symptom cluster of emotional distress, fatigue, and cognitive difficulties in young and older breast cancer survivors (BCS); To assess the mediating role of subjective stress and coping strategies (emotional control and meaning-focused coping) in the association between age and symptom cluster. MATERIALS AND METHODS: Participants were 170 BCS, stages I-III, 1-12 months post-chemotherapy, filled-out the Fatigue, Emotional Control, Meaning-focused Coping, Emotional Distress and the Cognitive Difficulties Questionnaires. Statistical analyses included tests for difference between-groups Pearson correlations and Structural Equation Modeling for the assessment of the study model. RESULTS: Older BCS (aged 60-82) reported lower levels of emotional distress (M = 0.87, SD = 0.87), fatigue (M = 3.85, SD = 2.38), and cognitive difficulties (M = 1.17, SD = 1.07) compared to the younger BCS (aged 24-59) (emotional distress M = 1.17, SD = 0.85, fatigue M = 5.02, SD = 2.32, and cognitive difficulties M = 1.66, SD = 1.23, p < .01-,05). The older survivors reported lower levels of subjective stress and used more emotional control strategies compared to the younger BCS. The empirical model had good fit indices (χ2 = 27.60, p = 0.20, χ2/df = 1.26; CFI = 0.98; TLI = 0.98; NFI = 0.95; RMSEA = 0.04 (90% CI = 0.00, 10) and showed that subjective stress, but not coping strategies, mediated the effect of age on symptom cluster severity. CONCLUSIONS: Lower levels of subjective stress, but not coping strategies, mediated the association of age with the symptom cluster of emotional distress, fatigue and cognitive difficulties. Further research is needed to explore differences in subjective stress by age.

Perceived threat and depression among patients with cancer: the moderating role of health locus of control.

Illness perception was found to be a better predictor of psychological outcome among cancer patients than the objective characteristics of illness. The current study explored the association between the perceived threat of illness (a major aspect of illness perception) and depression among cancer patients. We examined the hypothesis that this association will be higher for persons with low External (others) or internal (self) Health Locus of Control (HLC) than for those with high HLC. The study took an exploratory approach regarding the role that different sources of control (external and internal) may assume. Fifty-seven cancer patients completed self-report measures of Perceived Life Threat (PLT), HLC and Depression. The possible moderating role of HLC on the relationship between PLT and Depression was examined. A significant relationship between perceived threat and depression was found only among participants reporting low levels of internal locus of control. The results support the hypothesis that perception of cancer as life threatening is important factor in determining the level of depression among cancer patients. The results also support the differentiation between internal and external HLC and suggest that internal HLC may be more relevant than external HLC in managing perceived threat. Internal locus of control can be interpreted as having a sense of agency and mastery which is important in managing the cognitive perception of the threat of illness. Further research is needed in order to determine the role of external HLC in managing perceived or actual threats.

Ethnic differentials in mental health needs and service utilization among persons with cancer.

PURPOSE: Improving the assessment of and access to appropriate care for mental health problems among persons with cancer is essential, particularly for population groups that are at high risk for psychopathology. This study characterized ethnic differentials regarding needs and service utilization by Jewish (n = 1,430) and Arab-Israeli (n = 141) persons with cancer. METHODS: We reviewed 284 randomly selected active medical charts in an oncology clinic in a large public hospital (November 2010-April 2011). RESULTS: While 12% of the charts of the Jewish-Israeli sample included a record of psychiatric disorders or symptoms, only 5% of the charts of the Arab-Israeli sample had a similar record (χ² = 4.4, p < .05). Similarly, in a higher percentage of the charts of the Jewish-Israeli sample, the current utilization of psychotropics (18.2 and 5.6%, respectively; χ² = 6.7; p < .01) and/or psychotherapy (7.8 and 1.4%, respectively; χ² = 3.6; p < .05) was noted compared with the Arab-Israeli sample. Also, in a higher percentage of the charts of the Jewish-Israeli patients, a referral for psychotherapy was recorded compared with their Arab counterparts (9.1 and 4.3% respectively; χ² = 6.3; p < .05). In contrast, 19.1% of the Arab-Israelis were recommended with welfare assistance compared to their Jewish-Israeli counterparts, 10.5% (χ² = 5.35; p < .05). CONCLUSIONS: Despite methodological limitations, findings confirm past research showing that disadvantaged ethnic minorities may receive differential recommendations for mental health problems among persons with cancer. This may contribute to the differential treatment gap in mental health care among persons with cancer of contrasting ethnic groups.

Psychosocial challenges of elderly patients coping with cancer.

The objective of discussion is to stimulate healthcare professionals to deepen knowledge and understanding of the difficulties, challenges, and developmental tasks of elderly patients coping with cancer. Current research suggests that the psychological impact of cancer is less negative among the elderly, compared with younger patients (such as easier adjustment process). However, the specific psychosocial themes and needs of the elderly patients are not well enough adapted. Evidence-based data may offer clinicians and researchers a better understanding of the coping mechanisms defining elderly people, which may play a role in protecting them from severe emotional distress. Clinical implications would be improved screening, evaluation and intervention skills, which are suitable and adequate to the needs of the elderly population.

Researching the meaning of life: finding new sources of hope.

The purpose of the paper is to discuss means of assisting terminally ill patients in seeking for sources of meaning and hope, alongside the acknowledgment that their lifespan is short.Psycho-spiritual aspects make a substantial component patients suffering from incurable illness have to deal with. Evaluating and mapping the causes and expressions of psychological--spiritual suffering may assist in tailoring appropriate strategies of distress relief. Therefore, interventions should be given in accordance with their specific focus of difficulties, as well as with wishes and needs. Appropriate interventions in palliative psychotherapeutic rapport are inspired by identifying new sources for meaning in current life (sometimes, aided by past experiences or future visions). Reinforcing sources for meaning may attempt in providing patients amongst:--equilibrium, between suffering and sorrow (which sometimes take over the patient's world), and on the other hand, new experiences, sense of satisfaction and fulfillment. Individual's acknowledgment that he is not completely withdrawn from the circle of life, and yet significance and fulfillment in life still exists. For a holistic meaning ? centered intervention it is advisable to simultaneously integrate two central axes: the existential analysis, inspired by concepts driven from Frenkl's Logotherapy, such as freedom of choice, personal responsibility, inner truth, hope and transcendentalism; the operative axis, enhancing meaning and hope by assisting patient's wishes come true. Patients are aware, many times, that those wishes may be their last one, therefore perceive their fulfillment as crucial for their sense of meaning. Moreover, those wishes may elevate patient and family's spirit and reduce risk of demoralization. Whereas existential--spiritual interventions are recommended to be given by qualified professional therapists, the operation of fulfilling wishes is feasible by everyone, from family members to multi-disciplinary staff. Case illustrations for meaning--centered interventions will be discussed in the course of the paper. Cultural and traditional differences within the Israeli society, expressed in themes of work with patients, will lead to the conclusion, that there are many creative ways for researching meaning of life and sources for hope.

Autobiographical memory and depression in the later age: the bump is a turning point.

This preliminary study integrated previous findings of the distribution of autobiographical memories in the later age according to their age of occurrence, with the overgeneral memory bias predictive of depression. Twenty-five non-demented, Israeli participants between 65-89 years of age provided autobiographical memories to 4 groups of word cues reflecting events from childhood, adolescence, adulthood and late age. Their autobiographical responses were coded for degree of specificity of mentioning people, place and time. They additionally completed the Geriatric Depression Scale (Sheikh & Yesavage, 1986). We found that specificity of memories for adolescence cue-words ("the reminiscence bump") was significantly and inversely correlated with depression (r = -0.61), and this remained significant after controlling for gender and education. The study's limitations and the possibility that puberty hormones may be involved in memory and later age depression are discussed.