Ajuste y adaptación psicosocial de adultos jóvenes supervivientes de un cáncer en etapa pediátrica: Revisión sistemática / Psychosocial adjustment and adaptation in young adults surviving pediatric cancer: A systematic review

Introducción: Los efectos a largo plazo de tumores en la infancia pueden alterar la trayectoria de adaptación y ajuste psicosocial de los supervivientes en etapas de vida posteriores. Objetivo: Esta revisión sistemática se centra en analizar las experiencias de crecimiento postraumático, estrés postraumático, malestar emocional y dificultades psicosociales sufridas por jóvenes adultos supervivientes a un cáncer en etapa pediátrica. Resultados: Los resultados sugieren una trayectoria mayoritaria que podría definirse como adaptativa, en la que se observa tanto crecimiento postraumático (prevalencia superior al 60%), como síntomas de estrés postraumático (prevalencia inferior al 30%). No obstante, en comparación con población control no oncológica, estos supervivientes tienen mayor riesgo de padecer síntomas de ansiedad y depresión, de alcanzar menores logros educativos y profesionales, y de permanecer solteros o vivir solos, lo que se hipotetiza que podría estar relacionado con las secuelas de cada tipo de tumor y tratamiento, y no únicamente con la vivencia de la enfermedad. Conclusiones: La atención a jóvenes adultos supervivientes a un cáncer pediátrico debería centrarse en proporcionar mayor apoyo médico y psicosocial a largo plazo, a través del abordaje interdisciplinar y la atención centrada en la persona, como aproximación que favorezca una trayectoria de ajuste adaptativa.(AU)

Introduction: Long-term effects of childhood tumors can alter the trajectory of adjustment and psychosocial adjustment of survivors later in life. Purpose: This systematic review focuses on analyzing the experiences of posttraumatic growth, posttraumatic stress, emotional distress, and psychosocial difficulties experienced by young adult survivors of pediatric cancer. Results: The results suggest a more prevalent trajectory that could be conceptualize as adaptive, in which both post-traumatic growth (prevalence greater than 50%) and post-traumatic stress symptoms (prevalence less than 30%) are observed. However, compared to the non-oncology control population, these survivors are at higher risk for anxiety and depressive symptoms, lower educational and occupational attainment, and remaining single or living alone, which is hypothesized to be related to the sequelae of each tumor type and treatment, and not just the disease experience. Conclusions: Care for young adult survivors of pediatric cancer should focus on providing enhanced long-term medical and psychosocial support through an interdisciplinary approach and person-centered care as an approach that supports a trajectory of adaptive adjustment.(AU)

Patients' Desire for Psychological Support When Receiving a Cancer Diagnostic.

BACKGROUND: Factors related to the desire of receiving psychological help in cancer patients are not well known. The aim of this study is to assess the prevalence of patients who would ask for psychological assistance in the first weeks following diagnosis, and to identify their psychosocial and disease-related profile. METHOD: This cross-sectional study assessed 229 consecutive cancer outpatients at a visit with their oncologist to be informed about the treatment they will receive. Disease-related and medical characteristics were assessed, and patients were asked about their mood states, levels of self-efficacy, and difficulties coping with the disease. Finally, patients were asked about their desire to receive psychological assistance. RESULTS: Only 20% of patients expressed a desire for psychological help. These patients were lower in age and had previous history of mood disorders and reported higher discouragement and coping difficulties. These variables explained 30.6% of variance. CONCLUSIONS: Although psycho-oncologists can provide helpful interventions, the percentage of patients interested in receiving psychological assistance in this study is low. Although further studies are needed, results from this study suggest methods that could easily be used by oncologists and nurses to identify patients who would like to receive psychological support.

Estrés cotidiano en supervivientes de cáncer / Daily stress in cancer survivors

Introducción: El número de supervivientes de cáncer ha aumentado considerablemente en los últimos años. Estas personas presentan necesidades asistenciales específicas, y se sienten vulnerables ante cualquier tipo de problema de salud, por lo que, contrariamente a lo que sería esperable, la finalización del tratamiento parece dar inicio a una etapa extremadamente estresante para los supervivientes. Objetivo: Describir las características del malestar cotidiano durante situaciones consideradas estresantes para los supervivientes de cáncer. Metodología: Se ha usado una Evaluación Ecológica Momentánea para recoger información sobre las actividades cotidianas de los supervivientes de cáncer al final del día. Muestra: Sesenta supervivientes de varios tipos de cáncer, que han contestado a un cuestionario online durante 15 días consecutivos. Resultados: Los supervivientes han experimentado un evento estresante un 55,12% de los días registrados, de los cuales el 45,41% de ellos fue atribuido al hecho de ser superviviente y generó niveles de malestar más elevados. El evento estresante más frecuente, cuando se atribuye a la supervivencia, ha sido el problema físico (87,60%). Conclusiones: El problema físico es claramente un evento estresante relacionado con la fase de supervivencia y, es un problema que no parece resolverse con el tiempo. En general, los eventos estresantes atribuidos a la supervivencia generan más malestar.Palabras clave: Cáncer, supervivientes, estrés cotidiano, fatiga, bienestar psicológico (AU)

Introduction: The number of cancer survivors has dramatically increased in recent years. These people have specific healthcare needs, and feel vulnerable to any type of health problems. Contrary to what would be expected, when cancer treatment is finished an extremely stressful stage for survivors begins. Objectives: To describe the characteristics of daily distress during everyday situations considered stressful by cancer survivors. Methodology: Using Ecological Momentary Assessment, information about daily activities of cancer survivors was recorded at the end of the day. Sample: Sixty survivors of various types of cancer, who answered an online survey for a total of 15 consecutive days. Results: Survivors experienced a stressful event at 55,12% of the days recorded, and 45,41% of these days the event was related to the fact of being a survivor and generated higher levels of discomfort. Physical problem was the most frequent stressful event attributed to survival (87.60% of them). Conclusions: the physical problem related to the survival stage is clearly a stressful factor that does not seem to resolve itself over time. To a great extent, stressful events linked to the survival experience, give rise to more distress (AU)

Estructura básica de una página web para apoyo psicológico a adolescentes cuyos padres tienen cáncer / Basic structure of a web page for psychological support to adolescents whose parents have cancer

Cuando un padre o una madre enferma de cáncer, a los hijos les afecta el diagnóstico, siendo los adolescentes el grupo más vulnerable a sufrir las consecuencias. Éstos consideran que sus necesidades son poco escuchadas. Por lo tanto se propone crear los elementos de una página web de apoyo psicológico para adolescentes con padres con cáncer. A partir de entrevistas semiestructuradas con adolescentes, padres afectados, y psicooncólogas, y de la comparación de estos datos con los provenientes de la literatura, hemos llegado a la conclusión de que la página web debería incluir tres elementos fundamentales: información, asesoramiento para el uso de estrategias de afrontamiento, y posibilidad de interactuar con otros adolescentes en la misma situación y también con profesionales. Es también muy necesario que la página web no sea iatrogénica por lo que se propone un sistema de filtros que permitan dirigir al adolescente a los contenidos adecuados para su situación, evitando, en la medida de lo posible, que realice interpretaciones y desarrolle expectativas erróneas que puedan generarle confusión o malestar

When a father or a mother gets diagnosed with cancer, children are affected too. Adolescents are the most vulnerable group to suffer the consequences. They consider that their surrounding do not listen to their necessities. That is why we propose an innovative approach to create the elements of a psychological support website for adolescents with parental cancer. The procedure was based on conducting semistructured interviews with adolescents, affected parents and psycho-oncologist. Results been given from the comparison between the interviews that have been done in this research and the results of the scientific literature. We concluded that the website should include three fundamental elements: Information, coping strategies counseling, and the possibility to interact with other adolescents in the same situation as well as with professionals. It is of great importance to avoid that the website should be iatrogenic. That is the reason why we propose a filter’s system that allows to direct the adolescent to the adequate content for his/her situation. These filters avoid, as much as possible, the wrong misinterpretation and expectations that can generate confusion and discomfort

Aspectos psicosociales de la calidad de vida en supervivientes pediátricos de tumores en el sistema nervioso central / Psychosocial aspects of the quality of life in pediatric survivors of tumors in the central nervous system

Introducción: Los supervivientes de tumores del sistema nervioso central (TSNC) presentan peor calidad de vida en relación a la salud (CVRS) que los supervivientes de otras neoplasias y la población normativa. El tipo y gravedad de las secuelas no parecen tener un impacto claro en la CVRS, pero la afectación del cociente intelectual (CI) sí podría modular la CVRS. Además, las estrategias de afrontamiento del paciente y de los progenitores y el malestar emocional parental podrían también actuar sobre la CVRS. Objetivo: Determinar si las estrategias de afrontamiento del adolescente y su CI, y las estrategias de afrontamiento, el estrés general y el malestar emocional parental, modulan las dimensiones psicosociales de la CVRS del superviviente. Método: Estudio transversal descriptivo-correlacional. Se reclutaron 37 adolescentes (12-19 años) que llevaban ≥1 año fuera de tratamiento oncológico y 44 progenitores. Resultados: En la CVRS valorada por los adolescentes, las dimensiones Relación con los Padres y Vida Familiar, Amigos y Apoyo Social, y Entorno Escolar dependen de la estrategia de afrontamiento de resolución del problema usada por el adolescente. La dimensión Aceptación Social depende del estilo de afrontamiento improductivo del adolescente y del estilo de búsqueda de ayuda social de los padres. La CVRS valorada por los padres depende de las secuelas, el CI del adolescente y, el tipo de tratamiento oncológico recibido. Discusión y conclusiones: Las estrategias de afrontamiento centradas en la resolución del problema, deben ser consideradas para valorar e intervenir en la mejora de la CVRS de los supervivientes TSNC

Introduction: Central Nervous System Tumor (CNST) survivors tend to show worse HRQoL than survivors of other types of cancer and general population. There are still many doubts about what variables and to what extend these are related to their HRQoL. Type and severity of late effects have not a clear impact on HRQoL. However, Intelligence Quotient (IQ) changes as a specific late effect of this sample population, could modulate their HRQL. Furthermore, coping from both patients and parents, as well as parental distress could play a significant role modulating HRQoL in these survivors. Aim: To study whether survivors' coping strategies and IQ, as well as coping, general stress and cancer-related distress of parents could modulate some psychosocial dimensions of their children HRQoL. Methodology: Correlational descriptive cross-sectional study. Thirty-seven teenagers (12-19 years old, both included) ≥1 year free of disease and 44 parents were recruited for the study. Results: When HRQoL is assessed by adolescents, the dimensions Parent Relations and Home Life, Social Support and Peer, and School Environment are related with the use of coping with problem style by adolescents. Social Acceptance/Bullying dimension is related with nonproductive coping by the adolescent and helpseeking coping style by parents. HRQoL assessed by parents is related with late effects, adolescents' IQ, and type of oncological treatment received. Discussion/Conclusion: Coping strategies, and specifically problem-solving strategies must be taken into account to assess and to intervene in the improvement of HRQoL of this sample population

Dimensional analysis of personality in adolescents with suicidal behavior.

OBJECTIVES: This study is aimed at validating the dimensional internalizing and externalizing approach to personality in a sample of adolescents with suicidal behavior and analyzing the psychopathological and syndromic differences between adolescents from each dimension. METHOD: It is a descriptive and cross-sectional study of 75 adolescents (75% women) who attended the emergency service of a pediatric hospital due to suicidal behavior. Sociodemographic, clinical and psychopathological data and personality profiles (MACI) were gathered. RESULTS: The factorial analysis found two factors (total variance of 77.65%): an internalizing (28% of the cases) and an externalizing profile (72% of the cases). Statistically significant differences were obtained between the two profiles in the expressed concerns and the clinical syndromes of the MACI. CONCLUSIONS: Two differentiated personality profiles were found in our sample of adolescents with suicidal behavior. The externalizing profile was more prevalent. These profiles should guide clinical decisions and help plan therapeutic interventions to reduce the risk of suicidal behavior relapse.

Adaptación española de la Escala de Control Personal Percibido ("Perceived Personal Control") en Consejo Genético / Spanish adaptation of the Perceived Personal Control (PPC) in genetic counseling

Objetivo: Analizar la validez y la fiabilidad de la adaptación de la escala Perceived Personal Control (PPC) en el contexto español para pacientes portadoras de mutación en los genes BRCA1/2 responsables del cáncer de mama y ovario hereditario (CMOH). Método: Adaptación transcultural y validación de la escala Perceived Personal Control (PPC) desarrollada por Shiloh y colaboraradores mediante traducción, retrotraducción y validación a través de un análisis factorial exploratorio con rotación Oblimin en una muestra de 176 mujeres portadoras de genes BRCA 1/2 para CMOH. Resultados: La versión española de la PPC reduce a seis los nueve ítems de la escala original, dado que esta estructura es la que ofrece una solución factorial más satisfactoria. El análisis factorial mostró un solo factor que explica el 51,07% de la varianza, en el que todos los ítems tenían cargas factoriales por encima de 0,4. El coeficiente α de Cronbach fue de 0,84 para el conjunto de la escala, la cual permite obtener valores que oscilan entre 0 (bajo grado de percepción de control) y 2 (alto grado de percepción de control). Conclusiones: La adaptación española de la Escala de Percepción de Control (PPC6) posee propiedades psicométricas satisfactorias en la versión de 6 ítems con un solo factor, por lo que su utilización en contexto español Consejo Genético para cáncer hereditario parece adecuada (AU)

Purpose: The aim of this study was to analyze the reliability and validity of the spanish adaptation of the Perceived Personal Control (PPC) scale in women who were positive for BRCA1/2 genes, which are related with hereditary ovarian and breast cancer (HOBC). Method: PPC original items developed by Shiloh and co-workers were translated and back-translated in order to develop an spanish version which was analyzed by an exploratory factor analysis with Oblimin rotation. Answers to the spanish version were provided by a sample of 176 women who were positive for BRCA1/2 for HOBC. Results: Spanish version contains only six items of the nine original items, since this structure provided the optimal solution to the exploratory factor analysis. This version is a one-factor scale (51.07% of variance explained) and all items had factor loading values >0.4. The scale has good reliability (Cronbach's Alpha =0.84) and gives a range of values between 0 (low perceived control) and 2 (high perceived control). Conclusions: Spanish adaptation (PPC6) of the original 9-items version has enough reliability and psychometric properties, and it seems to be useful to be applied in Genetic Counseling at spanish cultural settings (AU)

Análisis dimensional de la personalidad del adolescente con conducta suicida / Dimensional analysis of personality in adolescents with suicidal behavior

Objetivos. El presente trabajo tiene por objetivo validar el enfoque bidimensional de personalidad internalizante y externalizante en una muestra de adolescentes con conducta suicida y analizar las diferencias psicopatológicas y sindrómicas entre los adolescentes que tienden a una u otra dimensión. Método. Estudio descriptivo transversal con una muestra de 75 adolescentes (79% chicas) que acudieron a urgencias de un hospital pediátrico por conducta suicida. Se recogieron datos sociodemográficos, clínicos, psicopatológicos y de perfiles de personalidad (MACI). Resultados. El análisis factorial extrajo dos factores (total varianza 77.56%): un perfil internalizante (28% de casos) y otro externalizante (72% de los casos). Se observaron diferencias estadísticamente significativas entre perfiles en preocupaciones expresadas y síndromes clínicos del MACI. Conclusiones. Se obtienen dos perfiles diferenciados de personalidad en la muestra de adolescentes con conducta suicida, siendo el perfil externalizante el más prevalente. Estos perfiles deberían ayudar a tomar decisiones clínicas y planificar intervenciones para reducir el riesgo de repetición de la conducta suicida

Objectives. This study is aimed at validating the dimensional internalizing and externalizing approach to personality in a sample of adolescents with suicidal behavior and analyzing the psychopathological and syndromic differences between adolescents from each dimension. Method. It is a descriptive and cross-sectional study of 75 adolescents (75% women) who attended the emergency service of a pediatric hospital due to suicidal behavior. Sociodemographic, clinical and psychopathological data and personality profiles (MACI) were gathered. Results. The factorial analysis found two factors (total variance of 77.65%): an internalizing (28% of the cases) and an externalizing profile (72% of the cases). Statistically significant differences were obtained between the two profiles in the expressed concerns and the clinical syndromes of the MACI. Conclusions. Two differentiated personality profiles were found in our sample of adolescents with suicidal behavior. The externalizing profile was more prevalent. These profiles should guide clinical decisions and help plan therapeutic interventions to reduce the risk of suicidal behavior relapse

Predictors of Suicide Behavior Relapse in Pediatric Population.

Identifying patients at increased risk of suicide remains a challenge today. It has been reported that 10% of patients committing a suicide attempt end up dying and that both the risk and the severity of clinical symptomatology increase with the number of attempts. Within the framework of selective and indicated prevention, it is essential to identify the group of patients with an increased risk of recurrence. The objective of this study is to identify factors predicting suicide attempt relapse to improve the decision making process in the therapeutic approach to suicidal behavior. The methodology employed was a longitudinal design aimed at identifying factors, in a binary logistic regression model (stepwise), predicting the repetition of suicidal behavior among a sample of 417 participants aged between 8 and 17 years old, at the six months follow-up. A statistically significant model χ2(3, N = 417) = 18.610; p < .001; Nagelkerke R 2 = .096 including the following factors was obtained: current diagnosis of personality disorder/maladaptive personality OR = .806, p = .028, 95% CI [1.091, 4.595], personal history of self-injury OR = .728, p = .043, 95% CI [1.023, 4.192], and family history of psychopathological diagnosis OR = .925, p = .021, 95% CI [1.151, 5.530]. Considering these results, having a diagnosis of personality disorder or maladaptive personality traits, presence or history of self-harm and family history of psychopathology draws a predictive profile of autolytic attempt recurrence during the six months after the initial intervention at the emergency room.

Predictors of suicide behavior relapse in pediatric population

Identifying patients at increased risk of suicide remains a challenge today. It has been reported that 10% of patients committing a suicide attempt end up dying and that both the risk and the severity of clinical symptomatology increase with the number of attempts. Within the framework of selective and indicated prevention, it is essential to identify the group of patients with an increased risk of recurrence. The objective of this study is to identify factors predicting suicide attempt relapse to improve the decision making process in the therapeutic approach to suicidal behavior. The methodology employed was a longitudinal design aimed at identifying factors, in a binary logistic regression model (stepwise), predicting the repetition of suicidal behavior among a sample of 417 participants aged between 8 and 17 years old, at the six months follow-up. A statistically significant model χ2(3, N = 417) = 18.610; p < .001; Nagelkerke R 2 = .096 including the following factors was obtained: current diagnosis of personality disorder/maladaptive personality OR = .806, p = .028, 95% CI [1.091, 4.595], personal history of self-injury OR = .728, p = .043, 95% CI [1.023, 4.192], and family history of psychopathological diagnosis OR = .925, p = .021, 95% CI [1.151, 5.530]. Considering these results, having a diagnosis of personality disorder or maladaptive personality traits, presence or history of self-harm and family history of psychopathology draws a predictive profile of autolytic attempt recurrence during the six months after the initial intervention at the emergency room

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Padres diagnosticados de cáncer: malestar emocional y recursos para comunicarse con sus hijos meno / Parents receiving cancer diagnosis: emotional distress and resources to communicate with their children

Objetivo: Conocer los recursos que poseen los padres afectados por cáncer al comunicar la enfermedad a sus hijos menores y su relación con el malestar emocional de estos pacientes. Método: Se evaluó el estilo de comunicación familiar mediante una subescala del FAD (Mc Master Family Assessment Device). Se elaboró un cuestionario específico para evaluar los recursos de los pacientes, donde cada ítem era valorado con una escala de 0 a 10 (siendo 0 nada en absoluto y 10, la máxima puntuación posible). También se utilizó una escala numérica de valoración del malestar emocional, en forma de un solo ítem (0-10). El conjunto de pruebas se aplicó a 60 pacientes de edades comprendidas entre los 34 y los 60 años todos ellos padres afectados de cáncer con hijos menores a su cargo. Resultados: Los recursos que parecen poseer en mayor medida los padres evaluados son los recursos relacionados con la gestión de la vida doméstica (media = 8,3), seguidos de los que hacen referencia a delegar a terceras personas los cuidados de sus hijos durante momentos difíciles. Al analizar con más profundidad estos dos recursos, detectamos que más del 80% de los padres de la muestra poseen el recurso relacionado con la gestión de la vida doméstica. Por el contrario, el recurso de como informar sobre la situación de enfermedad a los niños, lo tiene poco más de la mitad de los pacientes evaluados (55%). Los datos indican que existe una relación inversa entre la disponibilidad de este recurso y el nivel de malestar emocional, ya que los pacientes que consideran tener recursos para hablar de la enfermedad a sus hijos, presentan un menor malestar emocional. Conclusiones: Los padres recién diagnosticados de cáncer que plantean comunicar la situación de enfermedad a sus hijos menores, poseen más recursos para gestionar la vida doméstica y delegar el cuidado de sus hijos cuando lo precisan a terceras personas, que para informar sobre la enfermedad y sostener emocionalmente a sus hijos. Así mismo, el no disponer de recursos para comunicar el diagnóstico a los hijos se asocia con una mayor presencia de malestar emocional (AU)

Objective: To know which resources to communicate the illness to their children and whether these resources are related with emotional distress in cancer patients at diagnosis. Method: Sixty patients aged 34-60 years, who have been recently diagnosed and had children less of 18 years old reported their resources, emotional distress and family communication style. Family communication was assessed using the specific subscale of the FAD (McMaster Family Assessment Device). Patients resources were assessed with a specific questionnaire whose items were valued in a 0-10 scale (being 0 nothing and 10 the highest punctuation possible). Emotional distress was assessed with a numeric scale ranging 0-10. Results: Resources more available were those related with the management of daily life (mean= 8.3), followed by resources to delegate to others the care of their children. Both resources were available for more than a 80% of patients. However, resources related with telling the children the illness situation, were available to only 55% of patients. Patients with resources to communicate the illness situation to their children reported less emotional distress. Conclusions: Parents who were recently diagnosed with cancer have more resources to manage their daily life and to delegate the care of their children to others, than to inform them about the illness and to help them to cope emotionally. Parents with less resources to communicate with their children show a higher level of emotional distress (AU)

The Hidden Sufferers: Parental Reactions to Childhood Cancer during Treatment and at Survival.

This study was twofold: 1) to assess parental reactions to childhood cancer throughout the oncological experience and 2) to explore associations between parents' reactions during treatment and cancer-related distress at survival. A cross-sectional descriptive study collecting data (at survival) from retrospective (perceived social support, optimism, distress, coping in the worst situation) and current variables (general stress, distress regarding cancer, benefit finding) was carried out. Forty-one parents of childhood cancer survivors were assessed. High levels of distress (M = 9.5, SD = 1.32, range 4-10) and self-reported efforts to overcome difficulties occurring during the hospitalization (M = 7.48, SD = 3.01, range 0-10) were found. However, parents received high social support from very different sources. This could explain the satisfactory levels of optimism found (43.9% of the sample, M ≥ 16, range 9 - 24). Most parents reported to use engagement (M = 2.57, SD = 0.41, range 1-4) and help-seeking (M = 2.52, SD = 0.53, range 1-4) coping strategies to overcome difficulties. Some parents recognized to use psychological defenses when coping with the distress of cancer. However, this disengagement style was less preferred (M = 1.62, SD = 0.37, range 1-4). Finally, 22% of parents reported positive consequences and 60% reported positive and negative consequences too. When exploring how treatment experiences can influence cancer-related distress in survivorship, we observed that those who received less social support used more disengagement coping and referred higher efforts to overcome difficulties during treatment, displayed persistent distress at survival. These same parents showed higher scores on general stress. Besides, these results were not influenced by child's sequelae at survival. These findings support the hypothesis that "the end of treatment is not the end". Consequently, special attention should be placed in screening parents experiences throughout different milestones of cancer to design tailored interventions aimed at reducing persistent distress at survival.

The hidden sufferers: parental reactions to childhood cancer during treatment and at survival

This study was twofold: 1) to assess parental reactions to childhood cancer throughout the oncological experience and 2) to explore associations between parents’ reactions during treatment and cancer-related distress at survival. A cross-sectional descriptive study collecting data (at survival) from retrospective (perceived social support, optimism, distress, coping in the worst situation) and current variables (general stress, distress regarding cancer, benefit finding) was carried out. Forty-one parents of childhood cancer survivors were assessed. High levels of distress (M = 9.5, SD = 1.32, range 4-10) and self-reported efforts to overcome difficulties occurring during the hospitalization (M = 7.48, SD = 3.01, range 0-10) were found. However, parents received high social support from very different sources. This could explain the satisfactory levels of optimism found (43.9% of the sample, M ≥ 16, range 9 - 24). Most parents reported to use engagement (M = 2.57, SD = 0.41, range 1-4) and help-seeking (M = 2.52, SD = 0.53, range 1-4) coping strategies to overcome difficulties. Some parents recognized to use psychological defenses when coping with the distress of cancer. However, this disengagement style was less preferred (M = 1.62, SD = 0.37, range 1-4). Finally, 22% of parents reported positive consequences and 60% reported positive and negative consequences too. When exploring how treatment experiences can influence cancer-related distress in survivorship, we observed that those who received less social support used more disengagement coping and referred higher efforts to overcome difficulties during treatment, displayed persistent distress at survival. These same parents showed higher scores on general stress. Besides, these results were not influenced by child’s sequelae at survival. These findings support the hypothesis that 'the end of treatment is not the end'. Consequently, special attention should be placed in screening parents experiences throughout different milestones of cancer to design tailored interventions aimed at reducing persistent distress at survival (AU)

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Una estrategia simple para potenciar el bienestar de los pacientes de cáncer: el diálogo enfermera-paciente durante la administración de la quimioterapia / Simple strategy to promote well-being in cancer patients: Nurse-patient dialogue during the administration of chemotherapy

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¿Qué referencias espirituales verbalizan los pacientes atendidos por un equipo hospitalario de cuidados paliativos? / Which spiritual sentences are expressed by patients attending a palliative care unit?

OBJETIVO: Registro de las expresiones con contenido espiritual del paciente a través de sus verbalizaciones espontáneas mientras es atendido por un equipo de cuidados paliativos. Material y MÉTODO: Estudio prospectivo de registro textual de comentarios con referencias espirituales que los pacientes verbalizaron y que posteriormente se clasificaron en los diferentes dominios y necesidades espirituales. Pacientes atendidos por el equipo de cuidados paliativos entre noviembre de 2009 y mayo de 2010. Se recogieron datos sociodemográficos y datos clínicos como: ubicación del paciente, contenido del comentario/s, fecha del comentario, profesional al que se le transmite, género, edad y localización tumoral. RESULTADOS: Durante el periodo de estudio el equipo de cuidados paliativos atendió a 276 pacientes nuevos de los cuales 86 (31,2%) verbalizaron 119 comentarios espirituales y 102 necesidades espirituales. La localización tumoral más frecuente fue la de neoplasia de pulmón (16,2%). La edad media de la muestra fue de 68,8 años siendo el 58% hombres. El personal de enfermería fueron las profesionales que más comentarios espirituales identificaron (41,2%) y la interconsulta hospitalaria la ubicación donde más se registraron (48,8%). Con relación a los dominios espirituales, el 67,4% de los 86 pacientes expresaron al menos una verbalización que se incluía en el dominio intrapersonal, el 51,2% expresaron al menos un comentario referente al dominio interpersonal y el 19,8% de los pacientes lo hicieron dentro del dominio transpersonal. Del dominio intrapersonal se destacaba que un 41,8% de los pacientes que expresaron comentarios espirituales se referían a la desesperanza-deseos de morir. Respecto a las necesidades espirituales, los porcentajes más elevados correspondieron a la necesidad de volver a leer su vida (un 22% de los pacientes) y a la necesidad de encontrar sentido a la existencia y el devenir: la búsqueda de sentido (un 25,5% de los pacientes). CONCLUSIONES: En un tercio de los pacientes atendidos se detectaron expresiones con referencia espiritual. El porcentaje de pacientes que expresaron comentarios espirituales podría haber sido mayor si se hubiera diseñado un plan específico de intervención para evaluar y abordar las cuestiones espirituales

AIM: To record spiritual expressions made spontaneously by patients while attending a palliative care unit. MATERIAL AND METHOD: Prospective study registering all sentences made spontaneously by PATIENTS: Sentences were subsequently classified into different domains and spiritual needs by the palliative care professionals. Patients seen by the palliative care team between November 2009 and May 2010. Socio-demographic and clinical data such as: location of the patient, the content of the comment/s, date of the comment, professional that is transmitted, gender, age and tumor location were collected. RESULTS: During the study period the palliative care team attended 276 new patients, of whom 86 (31.2%) expressed 119 comments spiritual and 102 spiritual needs. Nurses were the professionals who identified more spiritual comments (41.2%) and the hospital consultation the location where most were recorded (48.8%). In relation to the spiritual domains, 93.7% of the 86 patients expressed expressions that were included in the domain of intrapersonal, 61.7% made reference to the interpersonal domain and 26.8% to the transpersonal. Within the intrapersonal domain highlighted that a 41.8% of the patients with spiritual comments referred to hopelessness- desire for hastened death. Respect to the spiritual needs the highest percentages corresponded to the need to lifetime re-examination (22% of patients) and the need to look for meaning to existence (25.5% of patients). CONCLUSIONS: Almost one third of patients expressed spiritual features. The percentage of patients who expressed spiritual comments could have been greater if a specific plan of action to assess and address the spiritual issues had been designed

Effects of a positive emotion-based adjuvant psychological therapy in colorectal cancer patients: a pilot study / Efectos de una terapia psicológica adyuvante en pacientes con cáncer colorrectal: un estudio piloto

Objective: To examine the effectiveness of an "Enhancing Positive Emotions Procedure" (EPEP) based on positive psychology and cognitive behavioral therapy in relieving distress at the time of adjuvant chemotherapy treatment in colorectal cancer patients (CRC). It is expected that EPEP will increase quality of life and positive affect in CRC patients during chemotherapy treatment intervention and at 1 month follow-up. Method: A group of 24 CRC patients received the EPEP procedure (intervention group), whereas another group of 20 CRC patients did not receive the EPEP (control group). Quality of life (EORTC-QLQC30), and mood (PANAS) were assessed in three moments: prior to enter the study (T1), at the end of the time required to apply the EPEP (T2, 6 weeks after T1), and, at follow-up (T3, one-month after T2). Patient’s assessments of the EPEP (improving in mood states, and significance of the attention received) were assessed with Lickert scales. Results: Insomnia was reduced in the intervention group. Treatment group had better scores on positive affect although there were no significantly differences between groups and over time. There was a trend to better scores at T2 and T3 for the intervention group on global health status, physical, role, and social functioning scales. Patients stated that positive mood was enhanced and that EPEP was an important resource Conclusions: CRC patients receiving EPEP during chemotherapy believed that this intervention was important. Furthermore, EPEP seems to improve positive affect and quality of life. EPEP has potential benefits, and its implementation to CRC patients should be considered

Objetivo: Examinar la eficacia de un programa basado en la Psicología Positiva y en la terapia cognitivo-conductual (EPEP) para incrementar emociones positivas y reducir malestar en pacientes de cáncer colorrectal (CRC) que reciben quimioterapia adyuvante. Se espera que el EPEP mejore calidad de vida y estados de ánimo durante la quimioterapia y en el seguimiento un mes después. Método: Un grupo de 24 CRC recibió el EPEP (grupo de intervención: GI), y otro grupo de 20 CRC no recibió el EPEP (grupo control: GC). Se evaluaron la calidad de vida (EORTC-QLQC30) y los estados de ánimo (PANAS) en tres momentos: al entrar en el estudio (T1); 6 semanas después, tiempo de aplicación del EPEP (T2), y un mes después del T2 (seguimiento:T3). Las opiniones de los pacientes sobre el EPEP (mejoría del estado de ánimo e importancia de la atención recibida) fueron evaluadas con escalas Lickert. Resultados: El GI mostró mejores puntuaciones en estado de ánimo positivo, aunque sin diferencias significativas con el GC. Las puntuaciones en T2 y T3 tendían a ser mejores en el GI en nivel global de salud, y en las escalas física, social y de rol, El GI redujo el nivel de insomnio. Los pacientes indicaron que el EPEP era importante y mejoraba el estado de ánimo. Conclusiones: Los datos sugieren que el EPEP mejora el estado de ánimo positivo y la calidad de vida, y los pacientes lo consideraron importante y útil. El EPEP es potencialmente beneficioso y debería considerarse la posibilidad de implementarlo en pacientes CRC

Surviving cancer: The psychosocial outcomes of childhood cancer survivors and its correlates.

This study assessed the psychosocial outcomes of adolescent cancer survivors and their relationship with personal and socio-familiar factors. Using a cross-sectional design, 41 survivors answered the four psychosocial dimensions of the KIDSCREEN-52 questionnaire and measures for social support and coping. Similarly, 41 parents answered coping and cancer-related distress measures. All psychosocial scores were within normative values (50 ± 10). Multiple linear regression analyses revealed four models with a range of explained variance between 9.4 percent and 31.9 percent that include the informative and emotional support, parental distress, and coping. This study contributes to the understanding of psychosocial outcomes of childhood cancer survivors and its correlates.

Social support during childhood cancer treatment enhances quality of life at survival / El apoyo social durante el cáncer infantil favorece la calidad de vida en periodo de supervivencia

Introducción: La calidad de vida en relación a la salud (CVRS) en cáncer se ha relacionado con distintos factores de riesgo y protección tales como el apoyo social percibido (ASP) y el afrontamiento. Sin embargo, la investigación acerca de los efectos de dichos factores sobre la CVRS de supervivientes pediátricos sigue siendo no concluyente. Objetivo: Describir y explorar la relación entre CVRS en periodo de supervivencia y factores presentes durante el periodo de hospitalización (ASP y afrontamiento). Métodos: Diseño transversal. 41 supervivientes de cáncer infanto-juvenil respondieron medidas de CVRS en referencia al periodo actual de supervivencia, así como medidas de ASP y afrontamiento en relación al periodo de hospitalización. Resultados: La función discriminante obtenida logró clasificar correctamente al 78% de la muestra. Los supervivientes con mayores puntuaciones en CVRS, fueron aquellos que, en los peores momentos durante su hospitalización, percibieron un apoyo emocional satisfactorio (por parte del personal de enfermería) y no desplegaron un gran número de recursos de afrontamiento para hacer frente al evento estresante (sólo la estrategia de afrontamiento de acción social mostró relación estadísticamente significativa con CVRS). Conclusiones e implicaciones: Considerando estos resultados, parece adecuado el llevar a cabo intervenciones de tipo psicoeducativo destinadas a fortalecer la red de apoyo social, sobre todo por parte del personal sanitario (enfermería). Estos resultados ponen de manifiesto la importancia de considerar todas las oportunidades para abordar las necesidades emocionales de los pacientes durante su hospitalización, ya que se ha observado que esto puede tener un efecto positivo perdurable en periodo de supervivencia

Background: Health-related quality of life (HRQoL) in cancer has been related to several protective and risk factors such as perceived social support (PSS) and coping. However, their effects on HRQoL once patients are in survivorship have not been fully described in pediatric samples. Objective: To describe and explore the relationship between HRQoL in survivorship and some factors (PSS, coping) present while active treatment. Methods: Cross-sectional study. Forty-one pediatric cancer survivors answered HRQoL measures referred to survivorship, as well as PSS and coping measures referred to treatment period. Results: The discriminant function obtained succeeds to correctly classify 78% of the sample. Survivors who showed high HRQoL were those who, in the hardest moment while hospitalization, perceived satisfactory emotional support (from nurses) and did not deploy a wide range of active coping resources to cope with stressful events (only social action coping strategy showed a significant relationship with HRQoL). Conclusions and implications: Considering these outcomes, educational and counseling interventions to strengthen patients’ social networks and supportive relationships are recommended, specially, among health providers (nurses). These results highlight the importance of not overlooking opportunities to address the emotional needs of patients while hospitalization, since a positive and endurable effect has been observed at survivorship

Is there a relationship between positive affect and other dimensions of quality of life in colorectal cancer patients? / ¿Hay una relación entre estado de ánimo positivo y calidad de vida en enfermos con cáncer colorrectal?

It can be stated from the previous research that positive emotions should allow to better health outcomes in sick populations. The aim of the present work is to know the state-of-the-art of how positive affect (PA) relates with quality of life in colorectal cancer (CRC) patients, as well as to give some guidelines to develop more efficacious psychological interventions in CRC patients to enhance positive affect. This review describes a search of published literature from January 2001 to March of 2012 on the Medline, ISI Web of Knowledge, Psycho Inf and Cochrane databases using publications that contain positive emotions, positive affect, health outcomes, quality of life, CRC and cancer. These articles were classified into two groups: a)-descriptive papers- b)-interventional studies-. Results from -descriptive papers- suggest that positive affect (PA) was significantly associated with greater levels of general health, better social functioning, benefit finding, positive changes, low depression, less anxiety and greather psychological well-being. PA also increases when different activities are developed. The overall results from interventional studies suggest that the interventions described can be recommended for improving patient´s levels of positive affect. The present review offers some suggestions which could be useful for CRC patients

La investigación ha evidenciado que las emociones positivas pueden mejorar la salud de pacientes con diferentes enfermedades. El objetivo del presente trabajo es analizar si el estado de ánimo positivo (EAP) está relacionado con la calidad de vida de pacientes con cáncer colorrectal (CRC) y si pueden establecerse directrices para desarrollar intervenciones eficaces que mejoren ese estado de ánimo. Se lleva a cabo una revisión de artículos publicados entre enero de 2001 y Marzo de 2012 a partir de las bases de datos Medline, ISI Web of Knowledge, Psycho Inf y Cochrane y las palabras: emociones positivas, EAP, indicadores de salud, calidad de vida CRC y cáncer. Los artículos se clasificaron en dos grupos: a) Artículos descriptivos; b) Artículos de intervención. Los resultados de los artículos descriptivos indican que el estado de ánimo positivo está relacionado con mejor estado de salud, mejor funcionamiento social, mayor crecimiento personal, mayor bienestar, y menores niveles de ansiedad y depresión. El EAP aumenta cuando se realizan diferentes actividades. Los resultados de los artículos de intervención sugieren que las intervenciones pueden ser adecuadas para mejorar el EAP de los pacientes. Se proporcionan algunas orientaciones que pueden ser útiles para los pacientes con CRC