Age-related patterns in negative affect and appraisals about colorectal cancer over time.

OBJECTIVE: Age differences in reactions to cancer are established but poorly understood. The purpose of this study was to apply the theoretical model of strength and vulnerability integration (SAVI; Charles, 2010) to understand age-related patterns in emotional experiences and cancer appraisals among people diagnosed with colorectal cancer. METHODS: Individuals recently diagnosed with colorectal cancer (N = 139; 28-89 years-old) completed measures of positive and negative affect, depressive symptoms, and appraisals about cancer at four time points: baseline (prior to colorectal cancer surgery), 6-, 12-, and 18-months postsurgery. Multilevel modeling examined changes in affective experience and appraisals over time, across age, and the interaction of time by age. RESULTS: Negative affect decreased more rapidly over time among older adults than younger adults, p < .05, but positive affect was reasonably stable and unrelated to age. Depressive symptoms were also fairly stable over time, but consistently higher among younger adults, p < .01. Older age was significantly related to lower threat appraisals and greater levels of challenge, p < .01. Threat, but not challenge, mediated the age-by-time interaction predicting negative affect. CONCLUSIONS: Older age was related to lower levels of depressive symptoms and negative affect. Older adults also reported more adaptive appraisals of their cancer, which accounted for their more rapid decline in negative affect compared to younger adults. Overall, SAVI is a useful model for understanding age-related patterns in emotional well-being and appraisals in the context of colorectal cancer.

Impact of depression and anxiety on the quality of life of constipated patients.

Constipation negatively affects quality of life (QOL), however, the specific mechanisms through which this relationship occurs are unclear. The present study examined anxiety and depression as potential mediators of the relationship between constipation severity and QOL in a sample of 142 constipated patients. Results indicated that depression symptom severity mediated the relationship between constipation severity and mental health-related QOL. For patients meeting diagnostic criteria for Major Depressive Disorder, indirect effects were observed in the relationship between constipation severity and both physical and mental health-related QOL. Anxiety did not contribute to this model. Treating depression may be useful in improving QOL in severely constipated patients, which highlights the importance of psychological screening and treatment referrals in primary care settings.

Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer.

BACKGROUND: Cancer patients are at increased risk for depression compared with individuals with no cancer diagnosis, yet few interventions target depressed cancer patients. METHODS: Efficacy of psychotherapeutic and pharmacologic interventions for depression in cancer patients who met an entry threshold for depressive symptoms was examined by meta-analysis. Five electronic databases were systematically reviewed to identify randomized controlled trials meeting the selection criteria. Effect sizes were calculated using Hedges' g and were pooled to compare pre- and postrandomization depressive symptoms with a random effects model. Subgroup analyses tested moderators of effect sizes, such as comparison of different intervention modalities, with a mixed effects model. All statistical tests were two-sided. RESULTS: Ten randomized controlled trials (six psychotherapeutic and four pharmacologic studies) met the selection criteria; 1362 participants with mixed cancer types and stages had been randomly assigned to treatment groups. One outlier trial was removed from analyses. The random effects model showed interventions to be superior to control conditions on reducing depressive symptoms postintervention (Hedges' g = 0.43, 95% confidence interval = 0.30 to 0.56, P < .001). In the four psychotherapeutic trials with follow-up assessment, interventions were more effective than control conditions up to 12-18 months after patients were randomly assigned to treatment groups (P < .001). Although each approach was more effective than the control conditions in improving depressive symptoms (P < .001), subgroup analyses showed that cognitive behavioral therapy appeared more effective than problem-solving therapy (P = .01), but not more effective than pharmacologic intervention (P = .07). CONCLUSIONS: Our findings suggest that psychological and pharmacologic approaches can be targeted productively toward cancer patients with elevated depressive symptoms. Research is needed to maximize effectiveness, accessibility, and integration into clinical care of interventions for depressed cancer patients.

Cancer perceptions: implications from the 2007 Health Information National Trends Survey.

INTRODUCTION: Research has demonstrated associations between sociodemographic characteristics and illness perceptions; however, the impact of cancer exposure through personal or family diagnoses is not well-studied. The purposes of this study were to examine different cancer beliefs and disparities in cancer beliefs across groups of individuals with distinct cancer histories and to identify whether cancer history predicts a set of cancer beliefs. METHODS: Using Leventhal's Common Sense Model and data from the 2007 Health Information National Trends Survey (N = 7,172), we constructed multivariable logistic regression models to evaluate the effect of different stimuli, including cancer experience on cancer perceptions (e.g., prevention, causation, outcome, worry). RESULTS: Findings indicated significant associations between cancer history and cancer perceptions. Individuals with family and personal cancer histories were more likely than individuals without any cancer history to worry about getting cancer (OR = 3.55, 95 %CI = 2.53-4.99), agree they will develop cancer in the future (OR = 8.81, 95 %CI = 6.12-12.67) and disagree that cancer is most often caused by a person's behavior or lifestyle (OR = 1.24, 95 %CI = 1.01-1.52). CONCLUSIONS: Cancer history affects perceptions throughout the cancer continuum. Additionally, cancer history may influence coping behaviors and outcomes. Cancer education and survivorship programs should assess important variables such as cancer history to more effectively tailor services and monitor evolving needs throughout cancer care. IMPLICATIONS FOR CANCER SURVIVORS: Integrating cancer history information into patient education programs tailored to an individual's needs may better empower survivors and their family members to effectively promote informed decision-making about screening and preventive health behaviors, manage cancer worry, and enhance quality of life.

A randomized controlled trial of anorectal biofeedback for constipation.

PURPOSE: The purposes of this study were: (1) to examine the efficacy of anorectal biofeedback (AB) for constipation compared to a biofeedback control (BC) treatment and (2) to examine the extent to which self-reported childhood sexual/physical abuse predicted biofeedback outcome. METHODS: Twenty-one patients with pelvic floor dyssynergia were randomized to either (1) an AB arm, where patients learned to isolate the anal sphincter using an electromyography probe, or (2) a BC arm that controlled for the nonspecific effects of biofeedback, where patients learned to relax trapezius or temporalis muscles with EMG feedback. Both treatments were delivered by registered nurses for six sessions. Prior to randomization and post-treatment, patients completed the validated Constipation Severity Instrument and two measures of quality of life (QOL), the Irritable Bowel Syndrome-QOL, and the SF-36. Generalized estimating equations examined the within-group and between-group differences over time. RESULTS: Pre- and post-treatment data were obtained for six AB and nine BC patients. AB patients' overall constipation severity scores decreased by 35.5% (vs. 15.3%), and their obstructive defecation symptom scores decreased by 37.9% (vs. 19.7%) compared to BC. A similar pattern was shown on the IBS-QOL. On the SF-36 Mental Health Composite (MCS), AB scores improved 28.0% compared to BC scores, which worsened 12.7%. Those without (vs. with) a childhood sexual/physical abuse history showed improvement on the MCS post-biofeedback. CONCLUSIONS: While our sample was statistically underpowered, AB produced clinical improvements in constipation severity and QOL.

Moderators of cancer-related distress and worry after a pancreatic cancer genetic counseling and screening intervention.

OBJECTIVES: Although the hereditary breast and ovarian cancer literature has demonstrated short-term gains in psychological adjustment following genetic counseling, there has been limited research examining long-term outcomes and moderators. Moreover, there has been minimal research into the psychological effects of this intervention in populations at high risk for pancreatic cancer. This study examines the long-term effects of pancreatic cancer screening and genetic counseling on cancer-related distress and cancer worry in a high-risk population at 1-year follow-up. Additionally, this study explores potential moderators of the effectiveness of this intervention. METHODS: One hundred twenty-nine participants with familial pancreatic cancer or with the BRCA2 gene mutation completed a baseline questionnaire prior to their first pancreatic cancer screening and genetic counseling session. Participants also completed questionnaires at 3- and 12-month follow-up. RESULTS: Cancer-related intrusive thoughts decreased significantly over time, whereas cancer-related worry decreased at 3 months and showed a small but significant increase at 1 year. Age and baseline distress exhibited moderator effects. Younger individuals showed a significant decrease in cancer-related intrusive thoughts, cancer-related avoidant thoughts, and cancer worry. Additionally, individuals with greater baseline distress showed a significant decrease in cancer-related intrusive thoughts over time. CONCLUSIONS: Analysis of the long-term effects of pancreatic cancer screening and genetic testing reveal psychological gains that are maintained at 1-year follow-up. This intervention is particularly effective for younger participants and individuals with greater baseline distress.

Improvements in partner support predict sexual satisfaction among individuals with multiple sclerosis.

PURPOSE: Sexual dysfunction and low sexual satisfaction are common among individuals with multiple sclerosis (MS); however, little is known about factors that influence sexual satisfaction within this population. As such, the purpose of this study was to investigate the extent to which changes in negative and positive partner support predict sexual satisfaction levels over time in individuals with MS. DESIGN: Eighty-one individuals with MS completed measures of sexual dysfunction, sexual satisfaction, partner social support, and depression. Data from baseline and posttreatment follow-up were obtained from a larger randomized clinical trial of telephone-administered psychotherapy for depression in a population with MS. Multiple regression analyses were conducted with change in overall sexual satisfaction from baseline to posttreatment as the outcome variable. RESULTS: After controlling for age, gender, sexual dysfunction, years diagnosed with MS, and depression severity, those with increased positive partner support reported significant improvement in sexual satisfaction over time (ß = .50, p < .001), as did individuals with decreased negative partner support (ß = .36, p < .01). CONCLUSIONS: Results provide evidence that both positive and negative partner support have a distinctive role in the outcome of sexual satisfaction for individuals with MS. Understanding the unique role of positive and negative forms of partner support on sexual satisfaction will help lead to future interventions to improve sexual satisfaction among couples.

Gender-specific differences in pelvic organ function after proctectomy for inflammatory bowel disease.

BACKGROUND: Significant concern exists regarding the effect of proctectomy on sexual function in patients with IBD. Little is known about gender-specific differences. OBJECTIVE: This study aimed to examine sexual function and quality of life in men and women with IBD before and after proctectomy. DESIGN: This is a prospective cohort study. SETTING: The study was conducted at a colorectal surgery center. PATIENTS: The patients included in this study have IBD and underwent proctectomy or proctocolectomy. INTERVENTION: The treatment provided was proctectomy or proctocolectomy. MAIN OUTCOME MEASURES: Validated questionnaires were used to assess sexual function, quality of life, bowel habits, and urinary symptoms, and were completed before and 6 months after surgery. RESULTS: Sixty-six participants (41 men and 25 women) were evaluated at baseline and 6 months after proctocolectomy or completion proctectomy. A total of 48 IPAAs (31 men and 17 women) and 18 end ileostomies (10 men and 8 women) were created. Men reported improved scores on the International Index of Erectile Function (P = .003), a modified Sexual Function Questionnaire (P = .001), Inflammatory Bowel Disease Quality of Life (P < .001), and SF-36 (Mental Component Summary, P = .003; Physical Component Summary, P = .001) after surgery. Women had improvement in the desire subscale of the Female Sexual Function Index (P = .03), Inflammatory Bowel Disease Quality of Life scores (P = .04), and SF-36 (Mental Component Summary, P = .02; Physical Component Summary, P = .02). There was no gender difference in the magnitude of change in scores before and after surgery for any of the measures. LIMITATIONS: Small sample size and sexually inactivity in 50% of cohort may have had an impact on our findings. CONCLUSIONS: Both men and women reported improvements in general and IBD-specific quality of life after surgery, but only men demonstrated several areas of improved sexual function. Women reported improved sexual desire but no other sexual function improvement. The postsurgical gender difference in sexual function, despite similar improvements in quality of life, may be accounted for by unexamined aspects of female sexual function.

Family psychiatric history, peritraumatic reactivity, and posttraumatic stress symptoms: a prospective study of police.

BACKGROUND: Family history of psychiatric and substance use disorders has been associated with posttraumatic stress disorder (PTSD) in cross-sectional studies. METHOD: Using a prospective design, we examined the relationships of family history of psychiatric and substance use disorders to posttraumatic stress symptoms in 278 healthy police recruits. During academy training, recruits were interviewed on family and personal psychopathology, prior cumulative civilian trauma exposure, and completed self-report questionnaires on nonspecific symptoms of distress and alcohol use. Twelve months after commencement of active duty, participants completed questionnaires on critical incident exposure over the previous year, peritraumatic distress to the worst critical incident during this time, and posttraumatic stress symptoms. RESULTS: A path model indicated: (1) family loading for mood and anxiety disorders had an indirect effect on posttraumatic stress symptoms at 12 months that was mediated through peritraumatic distress to the officer's self-identified worst critical incident, (2) family loading for substance use disorders also predicted posttraumatic stress symptoms at 12 months and this relationship was mediated through peritraumatic distress. CONCLUSION: These findings support a model in which family histories of psychopathology and substance abuse are pre-existing vulnerability factors for experiencing greater peritraumatic distress to critical incident exposure which, in turn, increases the risk for development of symptoms of posttraumatic stress disorder. Replication in other first responders, military and civilians will be important to determine generalizability of these findings.

A valid and reliable measure of constipation-related quality of life.

PURPOSE: Few existing measures assess constipation-specific quality of life. This study sought to develop a valid and reliable quality-of-life measure for constipation. METHODS: First, we created a preliminary instrument that assessed quality-of-life domains affected by constipation: body image, eating, mood, and relationships with others. We conducted focus groups both with patients with constipation seeking treatment and the health care providers who treat them. Next, a 59-item questionnaire was given to 240 subjects with constipation (83% female) and 103 healthy volunteers (63% female). Test-retest reliability and discriminant, convergent, and divergent validity were assessed. RESULTS: Exploratory factor analysis revealed four domains: Social Impairment (five items), Distress (six items), Eating Habits (three items), and Bathroom Attitudes (four items). Internal consistency and test-retest reliability for all subscales was high (Cronbach's alpha = 0.89; intraclass correlation coefficient = 0.87). All domains discriminated well between subjects with constipation and healthy volunteers (P < 0.001). Convergent validity was excellent: all subscales correlated highly with the Irritable Bowel Syndrome Quality of Life Scale total score (P < 0.001) and the Medical Outcomes Study Short Form-36 physical component and mental component summary scores (P < 0.001). Scores from our Constipation-Related Quality of Life measure were not significantly correlated with the Social Desirability Scale, demonstrating divergent validity. CONCLUSIONS: Our findings support the reliability and validity of the Constipation-Related Quality of Life measure. Future validation of the Constipation-Related Quality of Life measure for assessing changes in quality of life in response to treatments for constipation is needed.

Informing interventions: the importance of contextual factors in the prediction of sexual risk behaviors among transgender women.

This study identifies contextual factors that predict risky sexual behavior among 153 transgender women who participated in a structured survey soliciting information on demographics, substance use, HIV status, risk behaviors, and other health and psychosocial factors. Multivariate logistic regression models were used to determine predictors. Inconsistent condom use was associated with stimulant use, unstable housing, and recruitment site. Substance use during sex was associated with unstable housing and stimulant use. Sex work was associated with hormone use, gender confirming surgeries, and younger age. When developing interventions for transgender women, it may be useful to focus on predictors of risk behavior rather than predictors of current HIV status (i.e., race/ethnicity as "risk factor"), because these behaviors are the target of interventions aimed at sexual risk reduction. Implications include potential benefits of context-specific interventions, structural interventions addressing barriers to housing and health care, and culturally specific substance abuse treatment programs for transgender women.

Sexual orientation and intentions to obtain breast cancer screening.

AIMS: This longitudinal study examined predictors of intentions to obtain breast cancer screening in two samples, one comprising self-identified lesbian/bisexual women (n = 150) and the other comprising heterosexual women (n = 400). We hypothesized that beliefs about mammography, cancer vulnerability, and attitudes toward the medical provider would mediate the relationship between sexual orientation and plans to obtain breast cancer screening. METHODS: Women in this study participated in one of two larger clinical trials of breast cancer risk counseling methods. All participants completed questionnaires about breast cancer screening attitudes at baseline and at a 6-month follow-up. RESULTS: Logistic regression analyses, controlling for age, education, and race, revealed that baseline negative beliefs about mammography, lower levels of provider trust, and less perceived risk of breast cancer significantly mediated the relationship between sexual orientation and 6-month intentions to obtain a clinical breast examination (CBE) and mammography. CONCLUSIONS: These findings suggest that attitudes and beliefs about breast cancer, breast cancer screening, and medical providers impact lesbian/bisexual women's willingness to plan for CBE and mammography.

Sexual rehabilitation after localized prostate cancer: current interventions and future directions.

Many published articles have documented the impact of prostate-cancer treatment on sexual functioning in men treated for localized disease. Surprisingly, the literature on interventions to rehabilitate men's sexual functioning is much more limited. In this article, we review the sexual-rehabilitation interventions for prostate-cancer patients and identify a number of common themes across interventions. We also identify areas where further research is needed and propose a conceptual model based on psychologic and nursing theories and informed by the published research.

Relationships among depressive symptoms, benefit-finding, optimism, and positive affect in multiple sclerosis patients after psychotherapy for depression.

OBJECTIVE: While many patients with multiple sclerosis (MS) experience psychological problems, such as depression, benefit-finding is commonly reported. Using the Broaden-and-Build Model of positive emotions (Fredrickson, 2001) and the Expectancy-Value Model of optimism (Carver & Scheier, 1998) as two related, yet, distinct conceptual frameworks, this study examined positive affect and optimism as mediators of the relationship between improved depression and enhanced benefit-finding. DESIGN: MS patients (N=127), who participated in a larger, randomized clinical trial comparing two types of telephone psychotherapy for depression, were assessed at baseline, midtherapy (8 weeks), end of therapy (16 weeks), and 6- and 12-month posttherapy. MAIN OUTCOME MEASURES: Depression was measured with a telephone administered version of the Hamilton Rating Scale for Depression; Positive Affect was measured with the Positive Affect Subscale from the Positive and Negative Affect Scale; Optimism was measured with the Life Orientation Test-Revised; Benefit-Finding was measured with the revised version of the Stress-Related Growth Scale. RESULTS: Data were analyzed with multilevel random-effects models, controlling for time since MS diagnosis and type of treatment. Improved depression was associated with increased benefit-finding over time. The relationship between improved depression and benefit-finding was significantly mediated by both increased optimism and increased positive affect. CONCLUSION: Findings provide support to both theoretical models. Positivity appears to promote benefit-finding in MS.

Obstructive defecation in middle-aged women.

Obstructive defecation, a significant contributor to constipation, is frequently reported in middle-aged women, yet few population-based studies have established prevalence in this group. We analyzed data from the Reproductive Risks for Incontinence Study at Kaiser, a population-based cohort of racially diverse women, 40-69 years old, to describe the prevalence of obstructive defecation and identify associated risk factors. The Reproductive Risks for Incontinence Study at Kaiser is a randomly selected cohort of 2,109 women in the Kaiser Medical System. Obstructive defecation, determined by self-report, was defined as difficulty in passing stool, hard stool, straining for more than 15 min, or incomplete evacuation, occurring at least weekly. Age, race, income, education, drinking, health status, parity, pelvic organ prolapse, urinary incontinence, number of medications, hysterectomy, surgery for pelvic organ prolapse, colectomy, irritable bowel syndrome, and body mass index were assessed for both their univariate and multivariate association with obstructive defecation. Multivariate logistic regression was used to determine the independent association between associated factors and the primary outcome of obstructive defecation. Obstructive defecation that occurred at least weekly was reported by 12.3% of women. Significant independent risk factors included irritable bowel syndrome [odds ratio 1.78, (95% confidence interval 1.21-2.60)], vaginal or laparoscopic hysterectomy [2.01 (1.15-3.54)], unemployment [2.33 (1.39-3.92)], using three or more medications [1.81 (1.36-2.42)], symptomatic pelvic organ prolapse [2.34 (1.47-3.71)], urinary incontinence surgery [2.52 (1.29-4.90)], and other pelvic surgery [1.35 (1.03-1.78)]. We concluded that obstructive defecation is common in middle-aged women, especially those with a history of treatment for pelvic floor conditions. Women who had undergone laparoscopic/vaginal hysterectomies or surgery for pelvic organ prolapse or urinary incontinence had a nearly two times greater risk of weekly obstructive defecation. Demographic factors, with the exception of employment status, were not significant, indicating that obstructive defecation, although widespread, does not affect any particular group of women.

Fecal incontinence: does age matter? Characteristics of older vs. younger women presenting for treatment of fecal incontinence.

PURPOSE: The etiology of fecal incontinence is multifactorial. We hypothesize that women who seek treatment at different ages differ. We sought to determine which characteristics of women with fecal incontinence patients are associated with younger age at presentation. METHODS: We reviewed a database of 399 women with complete fecal incontinence evaluations from 2001 to 2006, selecting patients who were aged 49 and younger or aged 65 years and older, for a total of 246 patients. Data were obtained from self-report questionnaires on fecal incontinence frequency and associated symptoms, medical history, and results of anorectal physiology tests. Univariate and multivariate analyses were performed. RESULTS: The median ages of the two groups were 42 (range, 23-49) years and 72 (range, 65-89) years. Sphincter defects > 90 degrees and previous sphincteroplasty were associated with the younger age group. Previous hemorrhoid surgery and bilateral pudendal neuropathy were associated with the older age group. Younger women had more frequent incontinence to gas, mucus, and liquid stool. CONCLUSIONS: In our cohort, fecal incontinence-related symptoms and medical conditions differed in older and younger women presenting with this condition. Younger women may be more likely to seek treatment for any degree of symptoms. The differing characteristics of fecal incontinence by age should be considered when developing a treatment strategy.

The constipation severity instrument: a validated measure.

PURPOSE: This study was designed to develop and test the validity and reliability of the Constipation Severity Instrument. METHODS: Scale development was conducted in two stages: 1) 74 items were generated through a literature review and focus groups of constipated patients and medical providers; and 2) a preliminary instrument was administered to 191 constipated patients and 103 healthy volunteers. Test-retest reliability of the constipated group was assessed (N=90). Content, convergent, divergent, and discriminant validity were evaluated by using other validated measures by performing one-way analysis of variance and Pearson correlations. RESULTS: Exploratory and confirmatory factor analysis revealed three subscales: obstructive defecation, colonic inertia, and pain. Internal consistency (alpha=0.88-0.91) and test-retest reliability (intraclass correlation coefficients=0.84-0.91) were high for all subscales. Constipated patients were grouped by Rome II criteria: functional constipation (22 percent), pelvic floor dyssynergia (15 percent), constipation predominant irritable bowel syndrome (23 percent), and no specific criteria (40 percent). Those with constipation predominant irritable bowel syndrome or pelvic floor dyssynergia scored higher on the Obstructive Defecation and Colonic Inertia subscales than those with functional constipation or no specific criteria (P=0.001-0.058). Subjects with functional constipation had much lower scores on the pain subscale than constipation predominant irritable bowel syndrome, functional constipation, or no specific criteria (P<0.009). The Constipation Severity Instrument subscale and total score correlated very highly with the subscales and total score of the Patient Assessment of Constipation Symptom measure. The Constipation Severity Instrument subscales discriminated well between constipated patients and healthy volunteers (P<0.001) and demonstrated excellent divergent validity. Higher Constipation Severity Instrument scores inversely correlated with general quality of life. CONCLUSIONS: The Constipation Severity Instrument is a reliable and valid instrument for assessing constipated patients. Administration of the Constipation Severity Instrument to other constipated patients will further validate its use.

Fear of recurrence, treatment satisfaction, and quality of life after radical prostatectomy for prostate cancer.

GOALS OF WORK: Fear of cancer recurrence (FOR) is common in prostate cancer patients, but little research has examined the impact of FOR on quality of life (QOL) or the mechanism by which these fears become intensified. The objective of this study was to examine treatment satisfaction (TS) as a moderator of the relationship between FOR and QOL. PATIENTS AND METHODS: Data were drawn from the CaPSURE database, a 12,000-man national observational prostate cancer registry. Three hundred and thirty-three patients who underwent radical prostatectomy (RP) to treat their prostate cancer completed self-report measures. TS was measured 0-6 months post-RP with a nine-item scale developed for this study, FOR was measured 6-12 months post-RP with a previously validated five-item scale, and QOL was measured 12-18 months post-RP with the Short Form 36. MAIN RESULTS: After controlling for age, education, number of comorbid medical conditions, and cancer severity, lower FOR (B = -0.12, p < 0.0001), higher TS (B = 0.09, p < 0.001), and the interaction of TS x FOR (B = 0.87, p < 0.05) significantly predicted higher mental health QOL scores. Furthermore, lower FOR (B = -0.08, p < 0.01), and the interaction of TS x FOR (B = -1.11, p < 0.01) significantly predicted higher physical health QOL scores. CONCLUSIONS: TS levels mitigated the impact of high FOR on lower levels of QOL. Specifically, patients who reported lower TS and greater FOR endorsed significantly lower levels of QOL compared to other patients in the sample.

The relationship between anxiety and time to treatment for patients with prostate cancer on surveillance.

PURPOSE: Little is known about psychosocial factors affecting the decision to move from surveillance to active treatment in men with localized prostate cancer. We examined the impact of cancer anxiety on the decision to move from surveillance to treatment. MATERIALS AND METHODS: We analyzed data from CaPSURE, a national observational prostate cancer registry. A total of 105 participants had localized disease, selected surveillance vs treatment and had at least 3 prostate specific antigen values available after baseline. Cancer anxiety was measured with a 3-item scale (alpha = 0.78). We calculated the rate of change in prostate specific antigen with time (prostate specific antigen velocity) and used the same formula to calculate the rate of change in cancer anxiety. We fit a Cox regression model to determine predictors of receiving treatment in the 3-year observation period, controlling for prostate specific antigen velocity, demographics and baseline clinical characteristics. RESULTS: Prostate specific antigen velocity and the cancer anxiety change rate were significant independent predictors of treatment receipt (HR 1.02, 95% CI 1.004, 1.035, each p <0.01). Men with higher prostate specific antigen velocity (1.51 ng/ml per year or greater) were significantly more likely to receive treatment than men with lower prostate specific antigen velocity (HR 3.18, 95% CI 1.122, 9.016). The 2 velocity measures correlated only modestly (r = 0.29, p <0.001). CONCLUSIONS: Rather than being based only on clinical presentation and disease progression, decisions about treatment receipt for some men are influenced by cancer related anxiety. Men should be provided with more psychosocial support to perhaps delay treatment and the ensuing decrements in health related quality of life.

Education predicts quality of life among men with prostate cancer cared for in the Department of Veterans Affairs: a longitudinal quality of life analysis from CaPSURE.

BACKGROUND: Previous findings have suggested that patient educational attainment is related to cancer stage at presentation and treatment for localized prostate cancer, but there is little information on education and quality of life outcomes. Patient education level and quality of life were examined among men diagnosed with prostate cancer and cared for within an equal-access health care system, the Department of Veterans Affairs Veterans Health Administration (VA). METHODS: Participants were 248 men with prostate cancer cared for in the VA and enrolled in CaPSURE. Repeated-measures analysis of variance was used to examine quality of life over time according to education level, controlling for age, ethnicity, income, site of clinical care, and year of diagnosis. RESULTS: Patients with lower levels of education tended to be younger, nonwhite, and have lower incomes. Controlling for age, ethnicity, income, year of diagnosis, and site, men with less formal education, compared with those with more, had worse functioning in the physical (P=.0248), role physical (P=.0048), role emotional (P=.0089), vitality (P=.0034), mental health (P=.0054), social function (P=.0056), and general health (P=.0002) domains and worse urinary (P=.003) and sexual (P=.0467) side effects. CONCLUSIONS: Men with less education experienced worse health-related quality of life across a wide range of domains and greater urinary and sexual symptoms than their peers who had more education. Clinicians should be aware that, even within an equal access to health care system, men with less education are vulnerable, having greater difficulty functioning in their daily lives after their prostate cancer treatment.