RESUMO
BACKGROUND: We conducted a randomized pilot trial to examine the feasibility, acceptability, and preliminary efficacy of a 5 week positive affect skills intervention (LILAC: lessons in linking affect and coping) for women with metastatic breast cancer. Additionally, we examined whether online delivery of the intervention would offer comparable benefits as in-person delivery. METHODS: Women with metastatic breast cancer (N = 39) were randomized to an in-person intervention, online intervention, or in-person attention-matched control. Psychological well-being (depression [Center for Epidemiologic Studies Depression Scale], positive and negative affect [Differential Emotions Scale], cancer-specific quality of life [Multidimensional Quality of Life Scale-Cancer Version]), and positive coping (mindfulness, positive-affect skill use, and self-compassion [Self-Compassion Scale: Short-Form]) were assessed at baseline, 1 week post-intervention, and 1 month post-intervention follow-up. RESULTS: The LILAC intervention showed good feasibility, acceptability, and retention. Although the study was not adequately powered to detect between-group differences in change on preliminary efficacy outcomes, within-group comparisons revealed that LILAC participants (in-person and online combined) showed reductions in depression and negative affect by the 1 month follow-up (d = -0.81). Notably, LILAC participants fell below the clinical threshold for depression (Center for Epidemiologic Studies Depression Scale = 16) by the 1 month follow-up (t[17] = -2.22, P = .04, d = -0.52), whereas control participants did not differ from threshold (t[9] = 0.45, P = .66, d = 0.14). CONCLUSIONS: The LILAC intervention, regardless of delivery method, shows feasibility, acceptability, and preliminary efficacy for promoting psychological well-being in women with metastatic breast cancer. This research provides support for a larger randomized trial to test more definitively the potential benefits of LILAC. A strength of the LILAC intervention includes its innovative focus on positive affect. The efficacy of the online delivery suggests the potential for widespread Internet dissemination.
Assuntos
Adaptação Psicológica , Neoplasias da Mama/complicações , Neoplasias da Mama/psicologia , Atenção Plena , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade de Vida , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Depressão/psicologia , Emoções , Estudos de Viabilidade , Feminino , Humanos , Internet , Pessoa de Meia-Idade , Metástase Neoplásica , Projetos Piloto , Resultado do TratamentoRESUMO
PURPOSE: Although fear of recurrence (FCR) is common among cancer survivors, it remains unclear what factors predict initial levels (e.g., prior to surgery) or changes in FCR in the post-treatment period. Among women treated for breast cancer, this study evaluated the effects of demographic, clinical, symptom, and psychosocial adjustment characteristics on the initial (preoperative) levels of FCR and trajectories of FCR over 6 months following surgery. METHODS: Prior to and for 6 months following breast cancer surgery, 396 women were assessed for demographic and clinical (disease and treatment) characteristics, symptoms, psychological adjustment characteristics, and quality of life (QOL). FCR was assessed using a four-item subscale from the QOL instrument. Hierarchical linear modeling was used to examine changes in FCR scores and to identify predictors of inter-individual differences in preoperative FCR levels and trajectories over 6 months. RESULTS: From before surgery to 6 months post-operatively, women with breast cancer showed a high degree of inter-individual variability in FCR. Preoperatively, women who lived with someone, experienced greater changes in spiritual life, had higher state anxiety, had more difficulty coping, or experienced more distress due to diagnosis or distress to family members reported higher FCR scores. Patients who reported better overall physical health and higher FCR scores at enrollment demonstrated a steeper decrease in FCR scores over time. CONCLUSIONS: These findings highlight inter-individual heterogeneity in initial levels and changes in FCR over time among women undergoing breast cancer surgery. Further work is needed to identify and provide interventions for women experiencing FCR during and after breast cancer treatment.
Assuntos
Neoplasias da Mama/psicologia , Medo/psicologia , Recidiva Local de Neoplasia/psicologia , Sobreviventes/psicologia , Adaptação Psicológica , Transtornos de Ansiedade/etiologia , Transtornos de Ansiedade/psicologia , Neoplasias da Mama/cirurgia , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , Qualidade de VidaRESUMO
OBJECTIVE: To evaluate the prevalence of depression, anxiety and distress among active surveillance (AS) and radical prostatectomy (RP) patients. To evaluate the impact of these symptoms at baseline on urinary and sexual quality of life at follow-up. PATIENTS AND METHODS: Patients managed with AS or RP who completed validated questionnaires assessing levels of depression, anxiety, distress and urinary (UF) and sexual function (SF) and bother comprised the final analytic cohort. These measures were completed at baseline, within 1 year, and between 1 and 3 years from baseline. Mixed model repeated measures analysis was used to examine associations between mental health at baseline and sexual and urinary outcomes in a subset of RP patients with complete follow-up. RESULTS: Among 679 men who comprised the study cohort, baseline prevalence of moderate or higher levels of depression or anxiety were low (<5%), while levels of mild depression or anxiety ranged from 3-16% over time. Baseline levels of elevated distress ranged from 8-20%. Among men who provided data at baseline and follow-up, there were no significant differences between AS and RP patients in the proportion of men with elevated levels of depression, anxiety, or distress. Among 177 men who underwent RP and had complete follow-up moderate or higher levels of depression or anxiety appeared to be associated with post-treatment SF and bother, while elevated levels of distress were associated with post-treatment UF. CONCLUSION: Moderate or higher levels of depression or anxiety were low in men with localised prostate cancer but were associated with sexual outcomes, while elevated distress was associated with urinary outcomes. Greater attention should be paid to mental health symptoms among men with prostate cancer, as these symptoms may be associated with quality of life outcomes.
Assuntos
Ansiedade/etiologia , Depressão/etiologia , Neoplasias da Próstata/complicações , Qualidade de Vida , Estresse Psicológico/etiologia , Ansiedade/epidemiologia , Depressão/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Prostatectomia , Neoplasias da Próstata/fisiopatologia , Neoplasias da Próstata/terapia , Sexualidade , Estresse Psicológico/epidemiologia , Micção , Conduta ExpectanteRESUMO
PURPOSE: Patients with cancer often experience elevated levels of distress. This double-blind, randomized controlled trial compared the impact of an app-based version of cognitive behavioral stress management (CBSM) versus a health education sham app on anxiety and depression symptoms. METHODS: Patients with nonmetastatic (stage I-III) cancer who were receiving or recently completed (≤6 months) systemic treatment were recruited nationwide. The primary outcome of change in anxiety symptoms (PROMIS-Anxiety) over 12 weeks and the top secondary outcome of change in depression symptoms (PROMIS-Depression) over 12 weeks were analyzed using mixed-effects modeling with repeated measures (weeks 0, 4, 8, 12). Patient global impressions of change in anxiety and depression were reported at weeks 4, 8, and 12. In addition, self-reported adverse events were collected throughout the study and adjudicated by the site principal investigator. RESULTS: Four hundred forty-nine patients were enrolled in the trial (age M [standard deviation] = 52.44 [11.46]; 81% female; 76% White; 53% breast cancer). Patients randomly assigned to digitized CBSM showed significantly greater reductions in anxiety (B = -0.03; P = .019) and depression (B = -0.02; P = .042) symptoms over 12 weeks. Patients who received digitized CBSM were also significantly more likely to perceive much or very much improvement (v no/minimal change or much/very much worse) in their symptoms of anxiety (χ2 = 31.76; P < .001) and depression (χ2 = 19.70; P < .001) compared with the control. CONCLUSION: The use of digitized CBSM led to significant improvements in anxiety and depression outcomes compared with the sham app.
Assuntos
Neoplasias da Mama , Terapia Cognitivo-Comportamental , Feminino , Humanos , Masculino , Ansiedade/complicações , Ansiedade/terapia , Neoplasias da Mama/psicologia , Cognição , Depressão/complicações , Depressão/terapia , Adulto , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Too few cancer patients and survivors receive evidence-based interventions for mental health symptoms. This review examines the potential for Internet interventions to help fill treatment gaps in psychosocial oncology and presents evidence regarding the likely utility of Internet interventions for cancer patients. METHODS: The authors examined available literature regarding Internet interventions tailored to cancer patients' mental health needs and reviewed elements of Internet interventions for mental health relevant to advancing psycho-oncology Internet intervention research. RESULTS: Few rigorous studies focusing on mental health of cancer patients have been conducted online. A growing body of evidence supports the efficacy, accessibility, and acceptability of mental health Internet interventions for a variety of general and medical patient populations. The authors present recommendations and guidelines to assist researchers in developing, testing, and disseminating Internet interventions for cancer patients and survivors, to manage and improve their mental health. Issues unique to Internet interventions-including intervention structure, customization, provider interaction, and privacy and confidentiality issues-are discussed. These guidelines are offered as a step toward establishing a set of "best practices" for Internet interventions in psycho-oncology and to generate further discussion regarding the goals of such interventions and their place in cancer care. CONCLUSIONS: Internet interventions have the potential to fill an important gap in quality cancer care by augmenting limited available mental health services. These interventions should be developed in a manner consistent with best practices and must be empirically tested and validated. Copyright © 2011 John Wiley & Sons, Ltd.
Assuntos
Internet , Saúde Mental , Neoplasias/psicologia , Humanos , Oncologia , Serviços de Saúde Mental/organização & administração , Neoplasias/terapia , Educação de Pacientes como Assunto , Psicoterapia/métodos , Qualidade de Vida , Apoio SocialRESUMO
HYPOTHESIS: The incidence of prostate cancer and the prevalence of complementary and alternative medicine (CAM) use among prostate cancer patients have been increasing. An understanding of the underlying motivations for men to turn to CAM is essential to achieve optimal outcomes. The authors hypothesized that CAM users and nonusers differ in their assessment of conventional and CAM treatments and explored perceptions, feelings, ideas, and experiences among prostate cancer patients who made a decision to use or not to use CAM. STUDY DESIGN: This qualitative study is based on in-person interviews with prostate cancer patients selected from a population-based survey. METHODS: The authors conducted semistructured interviews with 27 prostate cancer patients of Asian and Caucasian ethnicity, 18 of whom used CAM and 9 of whom did not. Using qualitative research methods, they examined perceptions of conventional medicine and CAM and contrasted viewpoints of CAM users and nonusers. Based on the patients' statements, the authors developed a model representing the viewpoints and thought patterns of CAM users as contrasted with those patients who did not use CAM. RESULTS: The interviews revealed notable differences in viewpoints between CAM users and nonusers in 4 areas. The following themes that were important to CAM users emerged from the analysis: a view of CAM as safe and holistic coupled with a view of conventional medicine as an aggressive and isolated treatment; concern about side effects, in particular, impotence and incontinence from conventional cancer therapy; a belief in the potential efficacy of CAM despite the lack of evidence; and a need to gain a sense of control. Although nonusers expressed similar concerns about side effects of conventional treatment and considered CAM harmless, they assigned different priorities to these issues in their decision making. CONCLUSIONS: In this study, no single theme was solely responsible for CAM use among prostate cancer patients. Instead, multiple ideas woven together led patients toward CAM use. An understanding of patients' thought processes may aid health care professionals in initiating a dialogue about decision making and potential side effects.
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Terapias Complementares/psicologia , Terapias Complementares/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias da Próstata/psicologia , Neoplasias da Próstata/terapia , Idoso , Havaí , Humanos , Masculino , Pessoa de Meia-Idade , Narração , Satisfação do Paciente/estatística & dados numéricos , Qualidade de Vida , Autocuidado/psicologia , Inquéritos e QuestionáriosRESUMO
This study examined patterns in the use of health information among Caucasian, Japanese, and non-Japanese Asian Pacific Islander cancer patients in Hawaii and explored the relation of ethnicity and educational level to choices of health information sources. Information from 140 cancer patients, most of whom were users of complementary and alternative medicine (CAM), was analyzed using correspondence analysis. Three clusters of health information pertinent to the three ethnic groups emerged from the data. The results of this study revealed that Caucasian patients preferred objective, scientific, and updated information obtained through medical journals or newsletters from research institutions, telephone information services, and the internet. Japanese patients relied on media and commercial sources including television, newspapers, books, magazines and CAM providers. Non-Japanese Asians and Pacific Islanders used information sources involving person-to-person communication with their physicians, social groups, and other cancer patients. A higher educational level was closely related to a cluster of health information stressing objective, scientific and updated information, while a lower educational level was associated with interpersonally communicated information. The three ethnicity-specific patterns of health information use remained relatively stable at different educational levels, implying that the effect of patients' ethnicity overrides their educational level in shaping their choices of health information. The results of this study indicate the importance of recognizing cancer patients' culturally developed world views when understanding their health information-seeking behavior. For medical practice, these findings indicate the need for healthcare providers to assist cancer patients to obtain accurate health information in a culturally sensitive way.
Assuntos
Asiático/psicologia , Terapias Complementares/estatística & dados numéricos , Serviços de Informação/estatística & dados numéricos , Relações Interpessoais , Neoplasias/etnologia , Educação de Pacientes como Assunto/métodos , Satisfação do Paciente/etnologia , Relações Médico-Paciente , População Branca/psicologia , Adulto , Idoso , Asiático/estatística & dados numéricos , Comunicação , Cultura , Escolaridade , Feminino , Havaí , Humanos , Serviços de Informação/classificação , Entrevistas como Assunto , Japão/etnologia , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Ilhas do Pacífico/etnologia , Satisfação do Paciente/estatística & dados numéricos , População Branca/estatística & dados numéricosRESUMO
CONTEXT: In addition to seeking conventional treatment from physicians, cancer patients will often use religious and spiritual resources (RSR) and complementary and alternative medicine (CAM). Patients' beliefs about the relationships among RSR, CAM, and conventional treatments may reflect belief systems not readily apparent to physicians. OBJECTIVE: 1) Identify the RSR used and explore themes in beliefs regarding RSR, CAM, and conventional treatment. 2) Investigate the nature of the relationships among RSR, CAM, and conventional treatment in the lives of cancer patients. DESIGN: Cancer patients in Hawaii were recruited from a group who had previously completed a questionnaire on CAM use. In-depth interviews were conducted with a selected subset of survey participants. PARTICIPANTS: 143 cancer patients were interviewed 2 to 3 years following diagnosis. RESULTS: Participants reported using a variety of RSR, including personal faith, individual (self) prayer, relationship/dialog with God, prayers from fellow church members and others, counseling from pastor/priest or leader of faith, reading the bible, attending religious services, meditation, finding and spending time at locations of spiritual energy (i.e., churches, specific geographical locations, or certain natural settings), and help or counseling by ancestor(s). They also expressed beliefs that RSR, CAM, and conventional treatment have both shared and distinct purposes. RSR themes included providing treatment or cure, supporting treatment or cure, and being part of life. CAM themes included providing treatment or cure, supporting treatment or cure, preventing cancer and recurrence, substitution for conventional treatment, and as a last resort. Participants believed the purposes of conventional treatment were to fight/cure cancer and to improve quality of life. CONCLUSIONS: RSR, CAM, and conventional treatment served both spiritual and physical purposes. When participants perceived a relationship between RSR, CAM, and conventional treatment, it reflected shared spiritual and physical purposes. Such associations were especially strong when RSR, CAM, and conventional treatment shared the common goals of providing treatment or cure and/or supporting treatment or cure. Perceptions of shared purpose were individual to each participant, with religious congruence and life history playing a role in beliefs about the relationship between RSR and CAM. Such beliefs can affect issues of control, spiritual well-being, coping, depression, decision-making, and possibly health outcomes in cancer patients. Therefore, they should be addressed by clinicians in discussions with their patients.
Assuntos
Adaptação Psicológica , Terapias Complementares , Neoplasias/psicologia , Neoplasias/terapia , Qualidade de Vida , Espiritualidade , Adulto , Anedotas como Assunto , Terapias Complementares/psicologia , Terapias Complementares/estatística & dados numéricos , Cura pela Fé/psicologia , Cura pela Fé/estatística & dados numéricos , Feminino , Seguimentos , Havaí , Humanos , Masculino , Pessoa de Meia-Idade , Relações Metafísicas Mente-Corpo , Satisfação do Paciente , Apoio Social , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: This study explored the use of complementary and alternative medicine (CAM) by degree of use (nonuse, light, moderate, and heavy) by patients with cancer as it relates to sociodemographic and disease characteristics, subjective well-being, and dissatisfaction with the health care system. DESIGN AND PARTICIPANTS: One hundred and forty-three (143) patients with cancer of Asian, Caucasian, and Pacific Islander ethnicities originally recruited through the state-wide population-based Hawaii Tumor Registry and interviewed approximately 3 years postdiagnosis. OUTCOME MEASURES: This study introduced a multidimensional measure, degree of CAM use, to rank participants by quantity of CAMs used as well as frequency, intensity, and breadth of use. Predictor variables explored were sociodemographic variables, disease site, quality-of-life measures, satisfaction with conventional treatment and physicians, satisfaction with medical information, and perceived severity of illness. RESULTS: Heavier CAM use was related to being female, Caucasian, having more education, having breast cancer, and having greater symptoms of nausea and vomiting. Heavier use was also associated with lower doctor satisfaction and a greater perception of disease severity. Sociodemographic and clinical variables accounted for the largest proportion of the variance in degree of use, but subjective well-being and health care satisfaction provided incremental increases in the variance explained. CONCLUSIONS: This study is one of few studies exploring predictors for the quantity or degree of use of CAM by patients with cancer. Understanding factors related to these patients' heavier or lighter CAM use has implications for health care offerings and cancer treatment decision-making.
Assuntos
Atitude Frente a Saúde , Terapias Complementares/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Neoplasias/terapia , Adulto , Terapias Complementares/psicologia , Feminino , Havaí , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Satisfação Pessoal , Qualidade de Vida , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: To examine the trends in the prevalence of breast cancer risk factors in relation to breast cancer incidence trends and to explore whether the changes in risk factors differed by ethnicity in Hawaii over a 25-year period. METHODS: We pooled 17 population-based epidemiological studies conducted in Hawaii between 1975 and 2001. The study population of 82,295 women included subjects of Caucasian, Japanese, Native Hawaiian, Chinese, and Filipino ancestry. We computed age-adjusted prevalence estimates by ethnic group for 5-year time periods. Logistic regression was used to evaluate trends over time. RESULTS: The prevalence of an early age at menarche, nulliparity, and parity of fewer than three children, but not that of a late age at first live birth, increased during the study period. Whereas current smoking decreased for all ethnicities over time, the age-adjusted prevalence of overweight, obesity, college education, and alcohol use increased. Trends differed by ethnicity. For Native Hawaiians, the prevalence of overweight, obesity, alcohol use and nulliparity rose over time. For Japanese, the prevalence of overweight, early age at menarche, and having fewer than three children increased. Caucasians showed an increasing prevalence of overweight, obesity, college education, and nulliparity. In Filipina women, we observed changes in reproductive behavior and increasing obesity. CONCLUSIONS: Despite a slowing trend for some breast cancer risk factors, the overall risk profile in this population may lead to further increases in breast cancer incidence. Different ethnic groups may benefit from specific prevention strategies.
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Neoplasias da Mama/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/etiologia , Etnicidade , Feminino , Havaí , Humanos , Incidência , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores de TempoRESUMO
The aim of this paper is to identify barriers to communication between physicians and cancer patients regarding complementary and alternative medicine (CAM) by exploring the perspectives of patients. In face of the recent popularity of CAM use among cancer patients, the lack of communication is a serious problem. A number of CAM therapies may interfere with conventional treatments and thus impact patients' well-being and chances of survival. In addition, lack of communication is problematic in the health care context because the development of openness and trust between health care providers and clients is contingent upon effective interpersonal communication. We conducted semi-structured interviews with 143 cancer patients to explore their experiences with CAM use. Using a qualitative research method, we examined interview data from 93 CAM users who provided sufficient information about communication issues. As a result, three themes emerged describing barriers to unsuccessful communication as perceived from the patient's point of view: physicians' indifference or opposition toward CAM use, physicians' emphasis on scientific evidence, and patients' anticipation of a negative response from their physician. Increasing education about CAM and regular assessment of CAM use may help physicians to be more aware of their patients' CAM use. As a result, physicians may provide patients with information on risks and benefits of CAM use and refer patients to other services that may address unmet needs. Given a difference in epistemiologic beliefs about cancer and its treatment, the challenge is to find a common ground for an open discussion in which physicians consider that scientific evidence is not all that counts in the life of an individual facing a serious disease.
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Comunicação , Terapias Complementares , Neoplasias/psicologia , Neoplasias/terapia , Pacientes/psicologia , Relações Médico-Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Feminino , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Prática Profissional , Estudos de AmostragemRESUMO
This paper reviews the ergonomic and psychosocial factors that affect musculoskeletal disorders at the workstation. First is a model of a physiological assessment protocol that incorporated SEMG monitoring while working at the computer. Next is a study that showed that participants lack awareness of their muscle tension as compared to the actual SEMG levels. The final study illustrated how an intervention program can reduce RSI symptoms, decrease respiration rate, and lower SEMG activity. Recommendations include suggestions that successful safety and prevention programs need multiple components and that participants should to be trained to control physiological responses with respiration and SEMG biofeedback. All participants should master these physiological skills just as they learn how to use the computer.