Individual counseling is the preferred treatment for depression in breast cancer survivors.

A substantial number of cancer patients experience depression. This study investigated treatment preferences for depression. Breast cancer survivors (N = 134) completed an anonymous survey asking preference and interest in three treatments for depression: individual counseling (IC), antidepressant medication (MED), or support groups (SG). Participants were recruited from a surgical oncology office and asked to complete the survey as they waited for their appointment. Preference was compared using Wilcoxon Signed Ranks tests. More than 50% ranked IC as first choice of treatment. Preference for IC was significantly higher than preference for MED and SG. Preference between MED and SG did not differ. Survivors prefered counseling for treatment of depression. Cancer centers should be prepared to provide preferred treatment methods, particulary as screening, and therefore management, of psychosocial distress is to be required.

Test of mindfulness and hope components in a psychological intervention for women with cancer recurrence.

OBJECTIVE: Psychological interventions can attenuate distress and enhance coping for those with an initial diagnosis of cancer, but there are few intervention options for individuals with cancer recurrence. To address this gap, we developed and tested a novel treatment combining Mindfulness, Hope Therapy, and biobehavioral components. METHOD: An uncontrolled, repeated measures design was used. Women (N = 32) with recurrent breast or gynecologic cancers were provided 20 treatment sessions in individual (n = 12) or group (n = 20) formats. On average, participants were middle aged (M = 58) and Caucasian (81%). Independent variables (i.e., hope and mindfulness) and psychological outcomes (i.e., depression, negative mood, worry, and symptoms of generalized anxiety disorder) were assessed pre-treatment and 2, 4, and 7 months later. Session-by-session therapy process (positive and negative affect, quality-of-life) and mechanism (use of intervention-specific skills) measures were also included. RESULTS: Distress, anxiety, and negative affect decreased, whereas positive affect and mental-health-related quality-of-life increased over the course of treatment, as demonstrated in mixed-effects models with the intent-to-treat sample. Both hope and mindfulness increased, and use of mindfulness skills was related to decreased anxiety. CONCLUSIONS: This treatment was feasible to deliver and was acceptable to patients. The trial serves as preliminary evidence for a multi-component intervention tailored to treat difficulties specific to recurrent cancer. The blending of the components was novel as well as theoretically and practically consistent. A gap in the literature is addressed, providing directions for testing interventions designed for patients coping with the continuing stressors and challenges of cancer recurrence.

Association of the physiological stress response with depressive symptoms in patients with breast cancer.

OBJECTIVE: The literature on the relationship of depressive symptoms and stress hormones after cancer diagnosis has been mixed, with some studies showing a relationship and other studies showing none. Time since diagnosis may explain these contradictory findings. This study examined the relationship of depressive symptoms to stress hormones in patients with breast cancer using 12-month longitudinal data. METHODS: Patients with Stage II or III breast cancer (n = 227) were assessed every 4 months from diagnosis/surgery to 12 months. They completed the Centers for Epidemiological Studies Depression Scale (CES-D) Iowa Short Form and the Perceived Stress Scale and blood samples were obtained to measure stress hormones (i.e., cortisol, adrenocorticotropin hormone, norepinephrine, and epinephrine). RESULTS: Depressive symptoms were negatively related to cortisol levels (ß= -0.023, p = .002) but were positively related to rate of change in cortisol (ß = 0.003, p = .003). Adrenocorticotropin hormone, epinephrine, and norepinephrine did not covary with depressive symptoms (all p values > .05). When the CES-D and Perceived Stress Scale were both used to predict cortisol, only the CES-D was significantly related (ß = -0.025, p = .017). CONCLUSIONS: Depressive symptoms were negatively related to cortisol, but this relationship changed from the time of diagnosis/surgery through 12 months. Cortisol may initially provide a buffering effect against depression during the stress of initial diagnosis and treatment, but this relationship seems to change over time.

Factor analytic and item response theory evaluation of the Penn State Worry Questionnaire in women with cancer.

PURPOSE: Cancer survivors frequently experience worry about a variety of topics, including fear of recurrence. However, general measures of worry still require examination of reliability for this vulnerable population. This study utilized modern psychometric methods to examine the reliability of a worry measure in women with breast or gynecologic cancer. METHODS: Women with cancer (n = 332) completed the 16-item Penn State Worry Questionnaire (PSWQ), which has an abbreviated 8-item version (PSWQ-A). Categorical confirmatory factor analysis (CCFA) was used to determine the factor structure and item response theory (IRT) was used to examine score reliability. RESULTS: CCFA supported a two-factor structure with 11 positively worded items and the 5 negatively worded items loading on different factors. IRT analysis of the 11 positively worded items showed that each was contributing meaningful information to the overall scores. The 11 positively worded items and the PSWQ-A produced the most reliable scores for levels of worry ranging from one θ below to two θ above the mean. CONCLUSIONS: The 11 positively worded items of the PSWQ and the 8-item PSWQ-A were suitable for use in cancer patients while the full PSWQ was unsuitable due to inclusion of the negatively worded items. Future research should consider measuring worry when examining distress in cancer survivors.

Stress generation over the course of breast cancer survivorship.

Depressive symptoms are frequently elevated following breast cancer diagnosis. The stress generation hypothesis states that people with depression generate stressful events and these stressors lead to subsequent depression. This study tested the stress generation hypothesis over the first 5 years of cancer survivorship. Women with stage II or III breast cancer (N = 113) were accrued. Five mediation models were constructed, one for each year. Each model tested whether stressful events in each year mediated the relationship between depression at the beginning and end of that year. Stress generation was observed in the first 2 years following cancer diagnosis but not from 2 to 5 years after diagnosis. The relationship of depression to future stress in breast cancer patients may be moderated by phase of survivorship. Screening and treatment of depressive symptoms in cancer survivors may need to consider the generation of stressful events.

Helping Her Heal: a pilot study of an educational counseling intervention for spouses of women with breast cancer.

Breast cancer is known to cause substantial anxiety, depressed mood, and diminished marital functioning in the diagnosed woman's spouse. Despite the scope and magnitude of these issues, few intervention studies have included spouses or addressed the causes of their lower functioning. The purpose of this pilot study was to evaluate the short-term impact of a 5-session, clinic-based, educational counseling intervention for spouses whose wife was recently diagnosed with early stage breast cancer. The goals of the intervention were to enhance spouses' skills and confidence to communicate and interpersonally support his wife about the breast cancer as well as improve spouses' self-care, depressed mood, anxiety, and marital adjustment. Pre-post-test results obtained from 20 spouses from valid and reliable standardized questionnaires showed significant improvements in spouses' depressed mood, anxiety, skills, self-confidence, and self-care. Confidential post-intervention interviews with spouses and wives included detailed examples of positive changes in the spouse's communication and support to his wife about the breast cancer, diminished tension in the spouse, and improved quality in the couple's relationship. Further evaluation of the Helping Her Heal Program is warranted within a clinical trial.

Differences in inter-rater reliability and accuracy for a treatment adherence scale.

Inter-rater reliability and accuracy are measures of rater performance. Inter-rater reliability is frequently used as a substitute for accuracy despite conceptual differences and literature suggesting important differences between them. The aims of this study were to compare inter-rater reliability and accuracy among a group of raters, using a treatment adherence scale, and to assess for factors affecting the reliability of these ratings. Paired undergraduate raters assessed therapist behavior by viewing videotapes of 4 therapists' cognitive behavioral therapy sessions. Ratings were compared with expert-generated criterion ratings and between raters using intraclass correlation (2,1). Inter-rater reliability was marginally higher than accuracy (p = 0.09). The specific therapist significantly affected inter-rater reliability and accuracy. The frequency and intensity of the therapists' ratable behaviors of criterion ratings correlated only with rater accuracy. Consensus ratings were more accurate than individual ratings, but composite ratings were not more accurate than consensus ratings. In conclusion, accuracy cannot be assumed to exceed inter-rater reliability or vice versa, and both are influenced by multiple factors. In this study, the subject of the ratings (i.e. the therapist and the intensity and frequency of rated behaviors) was shown to influence inter-rater reliability and accuracy. The additional resources needed for a composite rating, a rating based on the average score of paired raters, may be justified by improved accuracy over individual ratings. The additional time required to arrive at a consensus rating, a rating generated following discussion between 2 raters, may not be warranted. Further research is needed to determine whether these findings hold true with other raters and treatment adherence scales.