Adjustment to illness of cancer patients treated by complementary therapy along with conventional therapy.

This pilot study compares the adjustment to illness, i.e. psychosocial and psychological distress, of 29 cancer patients being treated by complementary therapy along with conventional therapy, with a control group of 29 patients being treated by conventional therapy only. The findings indicate statistical differences in the brief symptom inventory scale (BSI), namely, the psychological distress of patients who received conventional therapy only was more severe than those being treated by complementary therapy with conventional therapy. No statistical differences, however, were found between the two groups in terms of psychosocial adjustment to the illness (PAIS). The findings lead to a recommendation that complementary therapy should be offered by public medical facilities as part of the standard treatment for cancer patients in order to ease psychological distress.

Coping with breast cancer: patient, spouse, and dyad models.

OBJECTIVE: The objectives of this study were 1) to assess similarities and differences between patients with breast cancer and their spouses in terms of coping strategies and adjustment (psychosocial and psychological) to cancer and 2) to investigate the pattern of relationships between the patients' and spouses' coping strategies and between each of these strategies and the patient's adjustment to the illness using three types of models: patient, spousal, and dyadic coping. METHODS: Seventy-three patients with breast cancer and their spouses completed questionnaires that measured distress (Brief Symptom Inventory), psychosocial adjustment, and coping strategies. RESULTS: The patients' distress was greater than their spouses', but a similar level of psychosocial adjustment was reported. The patients used more strategies involving problem-focused coping than their spouses. The use of emotion-focused coping, which included ventilation and avoidance strategies, was highly related to distress and poor adjustment on the part of the patient. The spouses' emotion-focused coping and distress were related to that of the patients. Dyad emotion-focused coping measures were highly associated with the patients' distress and adjustment. CONCLUSIONS: Spousal and dyad coping are important factors in a patient's adjustment to breast cancer.

Gender as a predictor of burden and psychological distress of elderly husbands and wives of cancer patients.

The aim of the study is to explore whether gender is a cause of differences in the perception of burden on the part of 39 elderly wife caregivers and 21 elderly husband caregivers of cancer patients. The patients were being treated at an oncological medical center in northern Israel. At the time of interview the patients had no evidence of the disease. Stepwise regression analysis indicated that caregiver gender (i.e., husbands) and age, as well as the patient's psychological distress, predicted greater burden, although gender did not predict greater psychological distress.

How daughters of women with breast cancer cope with the threat of the illness.

Coping strategies and attitudes toward medical treatment of 45 daughters of women who had had breast cancer were compared with strategies (sense of coherence) and attitudes on a health opinion survey of 51 women with no such family history who were referred to a breast health clinic in northern Israel. The daughters of women with breast cancer ranked lower on sense of coherence than the women with no such history. They also were more actively involved in the medical setting and requested more medical information than women whose mothers did not have breast cancer. The age of the daughter at the time her mother's cancer was diagnosed predicted her level of coherence and attitudes toward treatment.

Coping with threat. Implications for women with a family history of breast cancer.

The study aims to determine whether there are differences in coping with the threat of breast cancer between women with a family history of such cancer and those with no such history. The sample consisted of 93 women who have a family history of breast cancer and 142 women who do not have such a history (each group divided into four subgroups), all of whom were referred to a breast health clinic in northern Israel. Psychological distress was measured by the Brief Symptom Inventory, personal coping resources were measured by the Sense of Coherence scale, the coping process was measured by the Health Opinion Surgery, and the denial mechanism was measured by denial scales. The results showed that women at high risk for breast cancer who came to the clinic for a regular checkup and who had a symptom showed more symptoms of psychological distress than any of the other groups. The establishment of special clinics for women with a family history of breast cancer is recommended to provide counseling in coping skills in addition to medical examinations.

Gender, primary headache, and psychological distress.

The study compared the psychological symptoms of 26 young men and 65 young women referred to a neurology clinic in northern Israel by their family physicians for medical advice regarding headache. The main findings indicated that the women had more severe psychological symptoms than the men in six subscales, although only in somatization, depression, and additional items did the differences reach statistical significance. The authors recommend, in addition to medical intervention, special psychological intervention for women, which would offer counseling in developing coping skills.

Relationship between burnout and sense of coherence in health social workers.

The aim of this study was to determine whether a strong sense of coherence as a coping strategy affects burnout in health social workers. The research sample consisted of 31 social workers in the field of physical illness, 21 in the field of mental illness, and 29 in the field of the handicapped. The main finding indicates that health social workers who have a strong sense of coherence experience less burnout than those with a weak sense of coherence. More specifically, the findings indicate that the manageability component of sense of coherence predicts emotional exhaustion.

Length of cancer patients' stay at a hospice: does it affect psychological adjustment to the loss of the spouse?

The relationship is examined between the length of stay of 134 cancer patients at a hospice and the subsequent adjustment to loss by their spouses. Regression analysis found no significant correlation between the independent variables of length of hospice stay, gender, duration of time spent bedridden, time elapsed since death, and year of diagnosis and the dependent variables of psychological adjustment by their surviving spouses as assessed by the brief symptom inventory (BSI), the psychosocial adjustment to physical illness scale (PAIS), and the Texas revised inventory of grief (TRIG) scale. An analysis of covariance, however, found that a short hospice stay (1-7 days) had a beneficial effect on the spouse's bereavement compared to a long stay (8+ days).

Living with mastectomy and breast conservation treatment: who suffers more?

Sixty-five patients who underwent modified radical mastectomy were compared with 55 breast conservation patients, all of whom were in stage I, II or III of breast cancer and were under treatment at an oncology clinic in northern Israel. The main findings indicate no differences between the groups in physical, psychosocial, marital or medical interaction, according to the CARE scale. These findings reflect the results of similar comparative studies conducted during the 1980s and 1990s as documented in the literature. Sexual interaction showed statistical differences favoring the women who had undergone mastectomies.

Women with high risk for breast cancer: psychological symptoms.

This pilot study compared the psychological distress of 16 women with family histories of breast cancer (mother, sister, daughter, aunt) and 37 women with no such histories, all of whom were undergoing a regular checkup in a breast health clinic in northern Israel. Analysis indicated that women at high risk for breast cancer with a suspected syndrome experienced greater psychological distress than the women with no such histories.

Family, migration, and psychosocial adjustment to illness.

The present study examines the coping style of new immigrants in Israel from the former Soviet Union who have been diagnosed with cancer. One hundred and six new immigrants, who were being treated at the Linn Clinical Oncological Institute in Haifa during the first six months of 1992, participated in the study. They were assessed regarding family functioning, the stresses of the migratory process, other life stresses, and psychosocial adjustment to the illness. Contrary to expectations about the influence of family adaptability and cohesion on coping with illness, immigrant participants reported that the combination of stressful events related both to the migratory process and to the illness itself is the best predictor of coping with illness.

The connection between the psychological condition of breast cancer patients and survival. A follow-up after eight years.

Forty breast cancer patients (Stage I, II) were interviewed in 1984. Eight years later, in 1992, 8 of the 40 women had died in the intervening period of time, another 7 women had developed bone metastases, and the remaining 25 women had no evidence of disease. The main findings of this study indicate that the psychological distress, anxiety, hostility, paranoid ideation and psychoticism, as well as the Global Severity Index (GSI), of the eight patients who died during the 8 years following diagnosis were more severe at the time of diagnosis than that of the patients who survived. Moreover, the findings indicate that severity of anxiety may predict length of survival.

When death comes: where should patients die?

This study examines demographic, medical, and psychosocial variables in relation to preference regarding place of death on the part of 171 patients and their families treated at the Home Care Unit of the Oncology Department at Linn Clinic in Haifa, Israel, in 1992-93. Women who had breast cancer, and patients aged 50-59 with few mobility problems, preferred to die at home. Families with support from an extended family and those who communicated with the patients about the illness preferred to treat the patients at home. The patient's age, type of cancer, communication about dying, and the number of days hospitalized affected the place of death. Patients with prostate and brain cancer and patients aged 60 and older spent the most time (1-3 weeks) in a nursing home and tended to die there. Patients who were in a hospice tended to speak less about death than other patients.

Oncologists' attitudes to treatment of cancer patients.

This study, based on questionnaire responses of 46 Israeli oncologists, explores the factors influencing these physicians' beliefs and decisions regarding chemo- and radiation therapy. A simple discriminant analysis identified five physician-related variables with a significant impact on the subjects' attitudes to treatment: age, sex, years of oncology experience, pity for the patient, and whether they believed all cancer patients suffer from pain. In the absence of an unambiguous clinical protocol, the major influences on decisions to treat with chemo- or radiation therapy include, in addition to diagnosis, the patient's overall health, the physician's perception of treatment effectiveness, and the stage to which the illness has progressed. The discussion of the findings centers on their implications for practice.

Workers' Sick Fund (Kupat Holim) hot-line therapeutic first intervention: a model developed in the Gulf War.

This paper describes the work of the Workers' Sick Fund (Kupat Holim) of the Labor Organization in Israel in the Gulf War. A model is presented which was developed in real time, in light of existing conditions. The distinctive feature of the model is its effectiveness: the model accomplished its objective although counselling was by telephone and limited to a single session only.

The quality of life of cancer patients who refuse chemotherapy.

The study compared the quality of life of 51 cancer patients who dropped out of chemotherapy, 19 who refused treatment and a further 70 patients who had completed chemotherapy. The patients were treated in five oncological institutes in Israel. The findings of this study indicate that the quality of life of patients who refuse chemotherapy is no different from that of patients who drop out of treatment or patients who complete treatment. The findings also show that the quality of life of the patients who drop out of treatment is worse than that of patients who complete chemotherapy.

The attitude of the doctor to the refusal of the cancer patient to accept chemotherapy.

The research examined the attitude of the doctor to the refusal of 70 cancer patients being treated at five onocological institutes in Israel to accept chemotherapy. A connection was found between the doctor's attitude on the one hand and the diagnosis, level of illness and patient's age on the other. In other words, the doctor will not attempt to persuade every patient who refuses chemotherapy to accept the treatment.

Adjustment to illness and dropout of chemotherapy.

The study compares the adjustment to illness of a group of 53 cancer patients who dropped out of chemotherapy with a matched group of 53 cancer patients who completed their treatment. The patients were treated in five oncological institutes in Israel. We found differences both in the Psychosocial Adjustment to Illness Scale (PAIS) and Brief Symptom Inventory Scale (BSI). In both scales we found significant differences indicating that the degree of adjustment and the psychosocial distress of patients who dropped out of treatment was worse than that of patients who completed treatment.