Possible substantive improvements in the structure of the Quality of Life in Adult Cancer Survivors (QLACS) scale? A study based on its Spanish version.

PURPOSE: Quality of Life in Adult Cancer Survivors (QLACS) scale is one of the most commonly used and validated measures to assess the Health-Related Quality of Life (HRQoL) in this population. However, there are some aspects related to its structure that still deserve consideration. The aim of this study was to test the substantive improvement over the original QLACS structure resulting from several proposals reflected in the literature. METHOD: Using a cross-sectional design and Confirmatory Factorial Analysis, we explored those proposals. Reliability, convergent validity, and factor invariance across three cancer survivorships phases (re-entry, early, and long term) were also analyzed. 1.862 post-treatment survivors of diverse cancer types completed the Spanish versions of QLACS, Brief Symptom Inventory-18 (BSI-18), and Subjective Happiness Scale (SHS). RESULTS: The original model with twelve domains, grouped (with the exception of benefits) into a single total score, versus two subtotal (Generic and Cancer-specific) obtained a good fit. The values of Cronbach's alpha, Composite reliability, Average Variance Extracted indexes, and Pearson correlations supported the internal consistency and temporal stability (interval of 2-3 weeks) of the QLACS. Results also showed its adequate convergent validity and an invariant factor structure across survival periods (re-entry survivorship, early survivorship, long-term survivorship). CONCLUSION: In its original structure, albeit the replacement of the scores on the two subscales by a total score, our results support QLACS as a valid and useful tool for the assessment of HRQoL in post-treatment cancer survivors throughout the different survival phases.

Use of the Distress Thermometer in Cancer Survivors: Convergent Validity and Diagnostic Accuracy in a Spanish Sample.

OBJECTIVES: To explore the performance of the National Comprehensive Cancer Network Distress Thermometer (DT) as a distress screening tool in cancer survivors. SAMPLE & SETTING: 236 Spanish adult-onset cancer survivors who visited the Fundación Instituto Valenciano de Oncología in Valencia, Spain, for follow-up appointments. METHODS & VARIABLES: Survivors completed the DT and the Brief Symptom Inventory 18 (BSI-18), which has established a cutoff score for identifying clinically significant distress. RESULTS: Receiver operating characteristic curve analysis of the DT scores relative to the BSI-18 cutoff score showed good overall accuracy. For a score of 5 or greater, sensitivity, specificity, positive predictive value, negative predictive value, and clinical utility indexes indicated that the DT appeared to be satisfactory for screening but had restricted use for case finding. IMPLICATIONS FOR NURSING: Screening for and responding to distress is considered an important part of nursing practice. The DT is suitable for use as a first-stage, quick-detection instrument in a two-step screening process to rule out noncases among Spanish post-treatment cancer survivors.

Psychometric properties of the Brief Symptom Inventory-18 in a heterogeneous sample of adult cancer patients / Propiedades psicométricas del Inventario Breve de Síntomas-18 en una muestra heterogénea de pacientes de cáncer adulto

Abstract The Brief Symptom Inventory-18 (BSI-18) is a self-reporting screening instrument that is widely used to assess global psychological distress and three kinds of symptoms: anxiety, depression, and somatization. The present study tests the factor structure of the BSI-18 using confirmatory factor analysis (CFA), its reliability, convergent validity, and invariance for both sexes. A heterogeneous sample of 1183 cancer patients completed the BSI 18 and the NCCN Problem List. Hierarchical models of three and four subscales with GSI as a main factor provided an adequate and similar model fit. Nonetheless, the hierarchical three-factor model (the theoretical proposal) was selected for methodological and theoretical reasons. Reliability indexes (Cronbach's alpha and Composite Reliability) were satisfactory. The positive significant associations between BSI-18 (GSI and subscales) and emotional and physical categories of the Problem List showed the suitable convergent validity of the instrument. Finally, multigroup CFA revealed an essentially invariant structure of the BSI-18 for both sexes. The BSI-18 is a short instrument that can be used by researchers and health professionals to assess the psychological distress of cancer survivors.

Resumen El Inventario Breve de Síntomas-18 (BSI-18) es un instrumento de cribado ampliamente utilizado para evaluar distrés emocional (GSI) y tres tipos de síntomas: ansiedad, depresión, y somatización. Este trabajo estudia la estructura factorial del BSI-18, utilizando análisis factorial confirmatorio (AFC), su fiabilidad y validez convergente, así como su invarianza factorial a través del sexo. Una muestra de 1183 pacientes de cáncer completó el BSI 18 y la lista de problemas de la NCCN. Los modelos jerárquicos de tres y cuatro factores proporcionaron ajustes adecuados y similares. Sin embargo, el modelo de tres factores (propuesta teórica) fue seleccionado por razones metodológicas y teóricas. Los índices de fiabilidad (alfa de Cronbach y fiabilidad compuesta) fueron satisfactorios y las correlaciones positivas y significativas entre el BSI-18 (GSI y subescalas) y las categorías emocionales y físicas del listado de problemas evidenciaron la adecuada validez convergente del instrumento. Finalmente, el AFC multigrupo reveló una estructura básicamente invariante del BSI-18 a través del sexo. El BSI-18 es un instrumento breve que puede ser utilizado por investigadores y profesionales de la salud para evaluar el malestar psicológico en la población con cáncer.

Supervivencia en cáncer: La necesidad de una atención integral y la importancia de asumir un rol activo / Cancer survivorship: The need for comprehensive care and the importance of assuming an active role

Los avances en la detección temprana y en el tratamiento del cáncer han conllevado un incremento de las personas que han superado esta enfermedad, llegando a constituir en la actualidad el 5% de la población en nuestro país. Tal y como señala la Sociedad Española de Oncología Médica, esta situación plantea nuevos desafíos que requieren, entre otros, la identificación y atención a la calidad de vida y las necesidades psicosociales de esta creciente población. El objetivo de este artículo es reflexionar sobre la importancia de una atención integral, especializada y multidisciplinar y en la que el superviviente tenga una participación más activa; no obstante, previamente, se recoge el debate existente sobre el concepto de superviviente y se describe el impacto físico, psicológico y social del cáncer y su tratamiento

Advances in the early detection and treatment of cancer have led to an increase in the number of people who have overcome the disease, reaching 5% of the current population in our country. As indicated by the Sociedad Española de Oncología Médica [Spanish Society of Medical Oncology], this situation poses new challenges that require, among other things, the identification of and attention to the quality of life and the psychosocial needs of this growing population. The objective of this article is to reflect on the importance of comprehensive, specialized, and multidisciplinary care, in which the survivor has a more active participation; however, prior to this, the debate on the concept of the survivor, and a description of the physical, psychological, and social impact of cancer and its treatment are described

Emotional distress and unmet supportive care needs in survivors of breast cancer beyond the end of primary treatment.

PURPOSE: Cancer patient survival rates are rapidly growing, and further data are needed on the impact of the disease beyond diagnosis and treatment phases. The aims of this study were to analyze the prevalence and sociodemographic and medical risk factors of clinical distress. Additionally, we also explore the relationship between unmet psychosocial needs and both clinical distress and subgroups of survival periods. METHODS: A cross-sectional study of 450 women who at least 1 month before had completed the primary treatment for breast cancer was conducted. The Brief Symptom Inventory 18 and the Cancer Survivors Unmet Needs measure were used. RESULTS: One in four women showed clinical distress related to unmet psychosocial needs. None of the sociodemographic and medical predictors was associated with clinical distress. Needs focused on the possibility of recurrence and its cognitive-emotional impact were the most frequent. Needs tended to decrease through periods of survival; however, there was a considerable level of unmet needs even among long-term survivors. CONCLUSIONS: The findings highlight the relevance of extending psychosocial care beyond the breast cancer primary medical treatment. Early and regular screen for distress and unmet supportive needs permits to identify high-risk groups that likely benefit from targeted preventive interventions.

Mini-Mental Adjustment to Cancer Scale: Construct validation in Spanish breast cancer patients.

OBJECTIVE: The Mini-Mental Adjustment to Cancer Scale (MiniMAC) is widely used to evaluate cancer patients' psychological responses to diagnosis and treatment. Validation studies of the scale have shown inconsistency in the obtained factor structures. The aim of this study was to explore the factor structure, using Confirmatory Factor Analysis (CFA), and other psychometric properties of the MiniMAC in Spanish breast cancer patients. METHODS: A sample of 368 women with breast cancer completed the MiniMAC and the 18 items version of the Brief Symptom Inventory (BSI-18). RESULTS: The original pentafactorial model and three additional models derived from the empirical research -two first-order structures with four and three factors, and a second-order bifactorial structure- were tested. The five-factor model showed the best model fit and largely replicated the original MiniMAC's subscales. Five factors had acceptable reliability and showed modest correlations with emotional distress in the expected direction. CONCLUSIONS: The Spanish version of the MiniMAC has a satisfactory overall performance and serves as a brief, reliable and valid tool measuring cognitive appraisals and ensuing reactions to cancer.

Distrés emocional y problemas asociados en población oncológica adulta / Emotional distress and problems associated with adult oncological population

Objetivo: en este estudio se estima la prevalencia de distrés, se identifican los problemas asociados y se analiza el conocimiento y uso que hacen los pacientes sobre los recursos psicosociales disponibles en el centro hospitalario. Método: se lleva a cabo un estudio transversal en el que participan 203 pacientes oncológicos que están recibiendo tratamiento quimioterápico. En la evaluación se emplean el Inventario de Síntomas Breve-18 (BSI-18), el Listado de Problemas de NCCN y una encuesta sobre el conocimiento y uso de los recursos asistenciales del centro hospitalario. Resultados: la prevalencia de distrés en la muestra total es del 26%. Los problemas físicos son la principal fuente de distrés: fatiga, dolor, sequedad o picor en la piel y problemas de sueño, entre los más prevalentes. El BSI-18 y la Lista de Problemas muestran correlaciones estadísticamente significativas (r = 0,74; Rango: r = 0,69 y r = 0,18). Sólo el 21% de los casos clínicos de distrés utiliza los servicios psicosociales disponibles. El 79% restante indica no hacer uso de los mismos por considerar no necesitarlos o por desconocer su existencia. Conclusiones: aunque la mayor parte de los participantes muestran un buen ajuste a la enfermedad, un porcentaje significativo presenta niveles clínicos de distrés. Es crucial llevar a cabo cribados rutinarios de la respuesta de distrés para su manejo/control temprano, e informar a la población sobre los recursos psicosociales disponibles, concienciándolos de la importancia de su uso en momentos de vulnerabilidad (AU)

Objective: this study estimates the prevalence of emotional distress, identifies the associated problems, and analyses the knowledge and use that patients make of the psychosocial resources available in the Hospital. Method: a cross-sectional study is carried out involving 203 cancer patients receiving chemotherapy. The Brief Inventory of Symptoms -18 (BSI 18), the NCCN Problem List, and a shorter version of the Psychosocial Questionnaire are used. Results: the prevalence of distress in the total sample was 26%. The physical problems are the main source of distress: fatigue, pain, skin dry/itchy, and sleep related problems, are the most prevalent. The BSI-18 and the List of Problems show statistically significant correlations (r = .74, Range: r = .69 and r = .18). Only 21% of the distress clinical cases use the available psychosocial services. The remaining 79% indicate that they do not use them because they not need any help or not know about their existence. Conclusions: although the majority of the participants have a good adjustment to the disease, a significant percentage presents clinical levels of emotional distress. It is crucial to carry out routine screening of the distress response for early management/control, and to inform the population about the availability of psychosocial resources, making them aware of the importance of their use in vulnerability moments (AU)

Confirming the mechanisms behind cognitive-behavioural therapy effectiveness in chronic pain using structural equation modeling in a sample of patients with temporomandibular disorders.

OBJECTIVE: To evaluate whether therapeutic mechanisms assumed to explain the effect of cognitive behavioural therapy (CBT) concerning temporomandibular symptoms are confirmed by structural equation modelling. METHOD: Patients were randomly assigned to either an experimental group receiving CBT (N = 41) or a standard therapy control group (N = 31). Subjects were assessed before and after intervention using mediator variables hypothesized according to the CBT model, as well as outcome variables and other socio-demographic and clinical measures. RESULTS: The results confirm that the effect of treatment on pain intensity was partially mediated by distress, catastrophizing, perceived control, distraction, and mental self-control. The self-medication frequency was partially mediated by distraction. Pain interference was partially mediated by distress, distraction, and mental self-control. Reduction in the number of painful points on palpation was partially explained by distress, although in this case, there was a significant direct effect of treatment not mediated by other variables. CONCLUSIONS: The results could set the principles for the development of more efficient and effective cognitive behavioural interventions for chronic pain.

Precisión diagnóstica del termómetro de distrés en neoplasias hematológicas / Diagnostic accuracy of distress termometer in hematological cancer

Objetivo: El presente trabajo extiende la investigación previa sobre la validez y precisión diagnóstica del Termómetro de Distrés (DT) para detectar distrés psicosocial en pacientes con cáncer españoles. El DT es un instrumento habitual de screening, al que, recientemente y con el objetivo de mejorar su exactitud diagnóstica, se ha propuesto añadir otras herramientas, como el Termómetro de Impacto (IT). Método: En este estudio analizamos la sintomatología emocional que apresa el DT y la exactitud diagnóstica que alcanza sólo o combinado con el IT mediante dos procedimientos diferentes. Un total de 81 pacientes adultos con cáncer hematológico completaron el DT, la Escala de Quejas Coloreada (CCS), el IT y el Inventario Breve de Síntomas-18 (BSI-18). La precisión diagnóstica del DT e IT se exploró a través de medidas globales Área Bajo la Curva ROC (AUC), medidas de ocurrencia (Se y Sp), medidas de discriminación (PPV y NPV) e índices de utilidad clínica (UIs). Resultado: Los resultados obtenidos fueron comparables a los hallados en estudios previos indicando que el DT es adecuado para la tarea de 'screening', si bien su rendimiento en la 'identificación de caso' es limitado. Además, los índices de precisión asociados al uso combinado del DT y el IT sólo mostraron diferencias menores respecto a los obtenidos por el DT. Conclusiones: DT e IT se posicionan como herramientas útiles para su uso rutinario en la práctica clínica diaria, proporcionando información psicosocial relevante sobre el paciente al profesional sanitario sin interferir con su labor asistencial

Objective: The present study extends the previous investigation about validity and diagnostic accuracy of the DT for detecting psychosocial distress among Spanish cancer patients. The Distress Thermometer (DT) is a common screening tool, but other methods such as Impact Thermometer (IT)- have recently been proposed with the aim of improving its diagnostic accuracy. In this paper, we investigated the emotional symptomatology captured by the DT, and the diagnostic accuracy of both the DT alone and combined with the IT, using two possible combination methods. Methods: A sample of 81 adult patients with hematologic cancer completed the DT, the Colored Complaint Scale (CCS), the IT and the Brief Symptom Inventory-18 (BSI- 18). Several indexes were calculated to study the diagnostic accuracy: the area under the receiver operating characteristics (ROC) curve (AUC); measures of occurrence (Se y Sp), measures of discrimination (PPV and NPV) and clinical utility indexes (UIs). Results: The results of the DT were comparable with those found in previous studies, indicating that the DT is adequate for ‘screening’, but has limited value for ‘case finding’. Furthermore, the DT and the IT combined show minor differences in accuracy indexes compared with the DT alone. Conclusiones: DT and IT are useful tools for routine use in clinical practice providing psychosocial relevant patient information to healthcare professional without interfering in their care task

Adaptación española de la “Escala de afrontamiento por aproximación emocional” (EAC) / Spanish adaptation of the Coping through Emotional Approach Scale (EAC)

Investigaciones recientes revelan que el afrontamiento por aproximación emocional puede promover el bienestar y la salud. Recientemente, Stanton, Kirk, Cameron y Danoff-Burg (2000) han creado una escala con este nombre (Coping through Emotional Approach Scale, EAC) para evaluar este tipo de afrontamiento. Este trabajo presenta las propiedades psicométricas de la versión española del instrumento en una muestra de 57 mujeres con cáncer de mama en fase de seguimiento. También se analiza el posible papel modulador de la receptividad social (SR) entre la EAC y el malestar emocional. El análisis factorial exploratorio apoya la estructura bifactorial propuesta por los autores y el estudio de la consistencia interna indica valores altamente satisfactorios. Además, EAC muestra una alta correspondencia con la “Escala de control emocional de Courtauld” (CEC), así como una mejora en la predicción del malestar emocional clínico tras la consideración de la “Escala breve de ajuste mental al cáncer” (MiniMAC). La SR no tuvo un papel modulador. Concluimos que la EAC se perfila como un prometedor instrumento de evaluación del afrontamiento emocional adaptativo en población oncológica

Recent research reveals that coping through emotional approach (EAC) can promote well-being and health. Stanton, Kirk, Cameron y Danoff-Burg (2000) have developed the EAC scale to assess this type of coping. This paper presents data on the psychometric properties of the Spanish version of the EAC scale in a sample of 57 women in follow-up phase for breast cancer. Moreover, the study examines the moderating role of social receptivity (SR) between EAC and distress. The results of the exploratory factor analysis confirmed the two-factor structure proposed by the authors, and the study of internal consistency indicated highly satisfactory values. In addition, the EAC scale shows a high correspondence with the Courtauld Emotional Control Scale (CEC), as well as an improvement in the prediction of clinical distress upon consideration of the Mini Mental Adjustment to Cancer scale (MiniMAC). The SR did not have a modulating effect. We conclude that the Spanish version of the EAC scale emerges as a promising instrument to assess the adaptive emotional coping for cancer patients

[Age, health beliefs, and attendance to a mammography screening program in the community of Valencia]. / Edad, creencias de salud y asistencia a un programa de cribado mamográfico en la comunidad Valenciana.

BACKGROUND: Age has a significant bearing on health beliefs related to participating in breast cancer screening programs. This study is aimed at analyzing the breast cancer-related beliefs and attitudes influencing screening program participation among different age groups. METHODS: In a transversal study, a comparison is drawn between the health-related beliefs of a group of women participating in a screening program and a group of non-participating women, taking into account three age ranges (under age 50 (N = 279), 50-60 age range (N = 463), and over age 60 (N = 271). RESULTS: Some variables significantly differ between the participating and non-participating women solely in certain subgroups: perceived severity (50-60 age group: F = 5.14; p < 0.01); perceived benefits (under age 50: F = 8, 18; p < 0.01; over age 60: F = 4.54; p < .05); mammogram-related attitude (under age 50: F = 56.67; p? .001; over age 60: F = 18.42; p < 0.001); professional health checkups (under age 50: F = 11.30: p < 0.01) and luck or chance (under age 50: F = 3.78; p < 0.05; 50-60 age group: F = 4.29; p < 0.001). More specific beliefs, assessed by items from these scales, are also statistically significant (p < 0.05), although only for certain age groups. CONCLUSIONS: Women's breast cancer prevention program participation related beliefs and/or attitudes differ in terms of their age.

Aplicación de modelos sociocognitivos a la prevención secundaria del cáncer de mama / Use of sociocognitive models in secondary prevention of breast cancer

La detección temprana del cáncer de mama a través del cribado (screening) mamográfico sigue siendo actualmente el medio más eficaz para reducir la mortalidad asociada a esta enfermedad. Sin embargo no hay que olvidar que el éxito de cualquier programa de detección temprana del cáncer de mama depende, en última instancia, de que se consiga un alto nivel de participación de las mujeres en este proceso. El estudio de los factores psicológicos que influyen en el cumplimiento de las pautas recomendadas de controles mamográficos, se convierte así en un objetivo crucial de la investigación de cara a sugerir intervenciones que faciliten el logro de las metas de un programa de cribado mamográfico. En este trabajo se lleva a cabo una revisión de los estudios que han evaluado los factores psicosociales que modulan la utilización de la mamografía, analizando tanto los marcos conceptuales que han guiado la investigación como los principales resultados empíricos obtenidos. Así mismo se revisan los estudios centrados en la práctica de la autoexploración mamaria como técnica que, a pesar de la controversia sobre su eficacia clínica, sigue siendo recomendada como método complementario al cribado mamográfico. Por último se analizan las implicaciones de estas investigaciones a la hora de diseñar intervenciones que intenten fomentar la utilización regular de los controles mamográficos (AU)

Creencias de salud relacionadas con la participación en un programa de cribado mamográfico / Health beliefs associated with participation in a mammography screening program

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