Sexual dysfunction and spousal communication in couples coping with prostate cancer.

OBJECTIVE: To characterize the sexual function of both prostate cancer patients and their partners, and to examine whether associations between sexual dysfunction and psychosocial adjustment vary depending on spousal communication patterns. METHODS: In this cross-sectional study, 116 prostate cancer patients and their partners completed psychosocial questionnaires. RESULTS: Patients and partners reported high rates of sexual dysfunction. Within couples, patients' and their partners' sexual function was moderately to highly correlated (r=0.30-0.74). When patients had poor erectile function, their partners were more likely to report that the couple avoided open spousal discussions; this in turn was associated with partners' marital distress (Sobel's Z=12.47, p=0.001). Patients and partners who reported high levels (+1SD) of mutual constructive communication also reported greater marital adjustment, regardless of their own sexual satisfaction. In contrast, greater sexual dissatisfaction was associated with poorer marital adjustment in patients and partners who reported low levels (-1SD) of mutual constructive communication (p<0.05). CONCLUSION: Our findings underscore the need for psychosocial interventions that facilitate healthy spousal communication and address the sexual rehabilitation needs of patients and their partners after prostate cancer treatment. Although some couples may be reluctant to engage in constructive cancer-related discussions about sexual problems, such discussions may help alleviate the negative impact that sexual problems have on prostate cancer patients' and their partners' marital adjustment.

Effects of treatment factors, comorbidities and health-related quality of life on self-efficacy for physical activity in cancer survivors.

OBJECTIVE: The physical and psychological benefits of exercise for cancer survivors are well documented. Researchers have examined self-efficacy (SE) as a target for promoting exercise; however, the predictors of SE, including treatment factors and comorbidities, have not been examined extensively. The purpose of this cross-sectional analysis was to examine how variables related to cancer and cancer treatment, comorbid health problems, health-related quality of life (QOL), and depression relate to SE for physical activity in cancer survivors. METHODS: This secondary analysis examined treatment factors, comorbidity, and QOL data from 148 breast cancer and 134 prostate cancer survivors who had participated in studies examining exercise and QOL. A predictive regression model was developed by testing each variable individually with SE and including the variables that had a significance of

Associations with worry about dying and hopelessness in ambulatory ovarian cancer patients.

OBJECTIVE: Women with ovarian cancer face a poor prognosis, with prolonged periods of treatment but relatively high levels of physical functioning. Their thoughts and feelings regarding the prospect of dying are complex and have not been adequately studied. Various demographic, medical and psychosocial factors were examined to determine their independent associations with fear of dying and hopelessness in a cross-sectional design. METHOD: Two hundred fifty-four ovarian cancer patients were assessed at the beginning of a new chemotherapy regimen. Separate logistic regressions were performed for worry about dying and loss of hope. For each analysis, psychosocial variables were entered after the demographic and medical variables to determine whether the psychosocial variables had an independent association with the respective outcome. RESULTS: Fifty-five percent of the sample acknowledged fear of dying, and 31.6% acknowledged loss of hope in the fight against their illness. Being younger (p = .001), being of non-Hispanic White ethnicity (p = .026), and having poorer physical well-being (p = .000) were significantly associated with worry about dying after controlling for all other variables in the model. Regarding loss of hope, depressive symptoms (p = .002), lack of social support/well-being (p = .001), and number of treatments (p = .04) were significant. SIGNIFICANCE OF RESULTS: This is one of the largest studies to examine end-of-life concerns in a sample of advanced cancer patients. Our results underscore the importance of demographic and psychosocial variables in the examination of ovarian cancer patients' end-of-life concerns. Their fears and concerns should be openly acknowledged, even when the clinical focus is still on curative treatment.

Effects of relationship maintenance on psychological distress and dyadic adjustment among couples coping with lung cancer.

OBJECTIVE: Relationship maintenance strategies help to ensure the continuation of valued relationships by keeping them at a certain level of intimacy. This study evaluated how lung cancer patients' and spouses' efforts to maintain their relationships affected their psychological and marital adjustment over time. DESIGN: Psychosocial questionnaires were administered within 1 month of lung cancer treatment initiation (baseline) and 3 and 6 months later to 158 lung cancer patients and their spouses. MAIN OUTCOME MEASURES: Study outcomes were global severity index scores on the Brief Symptom Inventory, and total scores on the Dyadic Adjustment Scale. RESULTS: Multilevel modeling analyses using the Actor-Partner Interdependence Model showed that, regardless of gender or social role (i.e., patient or spouse), individuals who engaged in the strategies of positivity, networks, and shared tasks reported less distress at baseline than other participants. Over time, the effects of providing more assurances and experiencing a partner's increased reliance on social networks differed: patient distress was exacerbated, and spouse distress was alleviated. Couples where both partners engaged in more frequent maintenance behaviors reported greater dyadic adjustment at baseline and over time. CONCLUSION: For couples coping with lung cancer, the initial treatment period may be an important time that sets the tone for future spousal interactions. Engaging in relationship maintenance during this stressful time may help mold more resilient relationships and facilitate adjustment as the disease progresses.

Randomized pilot test of a lifestyle physical activity intervention for breast cancer survivors.

OBJECTIVE: This paper will report the results of a pilot test of a 6-month, 21-session intervention to increase breast cancer survivors' physical activity by teaching them to incorporate short periods of moderate activity into their daily routines (lifestyle intervention). The effect of the intervention on physical performance, quality of life, and physical activity are reported. METHODS: Sixty breast cancer survivors were randomized to either a lifestyle intervention or a standard care control group. Physical performance, quality of life (Medical outcomes study short form-36 [SF-36]), and physical activity (7-day recall and motivation readiness), were assessed at baseline and 6 months. RESULTS: The lifestyle group had significantly better performance in the 6-min walk task than the controls (p=0.005) at 6 months. The intervention had positive effects on the bodily pain (p=0.020) and general health (p=0.006) subscales from the SF-36. The lifestyle group had a greater motivational readiness for physical activity at 6-month than standard care, but no significant differences were seen between the two in terms of number of minutes of moderate or more intense physical activity or number of days on which they did > or =30 min of moderate or more intense activity. CONCLUSIONS: Despite the small sample size, the lifestyle intervention showed promise for improving physical functioning and quality of life and increasing physical activity, and should be tested in a larger randomized trial. PRACTICE IMPLICATIONS: If the lifestyle approach is shown to be effective in a larger trial, it represents a highly feasible intervention that it can be delivered to cancer survivors by health care institutions or community organizations without dedicated exercise facilities and equipment.

Congruence of readiness to change, self-efficacy, and decisional balance for physical activity and dietary fat reduction.

PURPOSE: The current study examines the relations between decisional balance and self-efficacy variables on stage of change between the behaviors of avoiding dietary fat and increasing exercise. DESIGN: A cross-sectional design was used. SETTING: The current study took place in public primary care clinics from four sites across Louisiana. Clinics were associated with teaching hospitals and located in urban and rural areas. SUBJECTS: Subjects included 515 adult outpatients, 60% African-American, 81% women, and 43% married. The age ranged from 18 to 87 years old, and the mean age was 45 (SD = 14). Patients were predominantly low-income (mean household income of $490 per month) and uninsured (71%). MEASURES: Standard questionnaires were given to asses stage of change, decisional balance, and self-efficacy for exercise and dietary fat reduction. RESULTS: Although the chi 2 analysis revealed that dietary fat and exercise stage of change were significantly related, Pearson chi 2 (df = 16) = 74.30, p < .001, 35% of the sample was stage incongruent between behaviors (e.g., a significant percentage of exercise maintainers were precontemplators for reducing dietary fat). Only 27% of the sample was in the same stage for both behaviors. Correlations and multivariate analyses of variance (MANOVAs) indicated that relationships between behaviors were similar to those found previously within behaviors; however, the effect sizes were markedly attenuated. CONCLUSIONS: These results have implications for healthcare providers working with weight management. Accurate assessment of readiness for change for both exercise and dietary fat consumption is critical. For many patients, readiness for change differs dramatically between the two behaviors, and interventions may need to be tailored more precisely. Providers may need to use more active, behaviorally focused interventions for the more advanced behavior while simultaneously implementing more cognitively focused interventions for the less advanced one.

Does talking about their relationship affect couples' marital and psychological adjustment to lung cancer?

INTRODUCTION: Relationship talk refers to talking with a partner about the relationship, what one needs from one's partner, and/or the relationship implications of a shared stressor. This prospective study examined the effects of relationship talk on couples' psychosocial adaptation to lung cancer. METHODS: A total of 169 patients (63% male) and 167 of their partners completed a series of questionnaires within 4-weeks of treatment initiation for newly diagnosed lung cancer (baseline). Follow-up questionnaires were administered 3 and 6 months later. RESULTS: Multilevel models using the couple as the unit of analysis showed that patients and partners who reported more frequent relationship talk had less distress (effect size r = 0.16) and greater marital adjustment over time (effect size r = 0.21), regardless of gender. Satisfaction with the frequency of relationship talk was associated with lower baseline distress for patients and partners (effect size r = 0.25). However, over time, greater communication regarding the relationship was related to less distress in the partner (effect size r = 0.15) than in the cancer patient. DISCUSSION: Expanding the study of spousal communication in cancer beyond patient cancer-related disclosures to include the effects of talking about the spousal relationship may help clarify the role of relationship processes in couples' psychosocial adaptation. Patients and partners who begin talking about the relationship implications of lung cancer early on in their cancer experience may be better able to prepare together for the challenges they may face as cancer progresses and the patient moves toward the end-of-life. IMPLICATIONS FOR CANCER SURVIVORS: Results of this study underscore the need for couple-focused interventions in lung cancer that address the communication and relationship needs of both partners. Working with couples during the initial diagnosis and treatment period and emphasizing the benefits of discussing relationship issues during this time of major upheaval may facilitate couples' successful adaptation to lung cancer.

Social constraints and spousal communication in lung cancer.

The Social Cognitive Processing Model suggests that talking with others facilitates cognitive and emotional processing of experiences such as cancer if the social context in which these discussions take place is supportive and positive. Despite this, patients and spouses may inadvertently constrain each other's attempts to process and cope with the disease. To our knowledge, no previous studies have directly examined the effect of lung cancer on the spousal relationship. We began to examine this effect by identifying the social constraints experienced by couples coping with lung cancer through semi-structured interviews with 13 patients and 12 spouses. Using Grounded Theory methodology, our analyses showed that these couples experienced a wide variety of social constraints, including denial, avoidance, and conflict that can hinder open spousal communication. Specifically, patients and spouses reported trouble discussing continued tobacco use, cancer-related symptoms, prognosis, and the emotional effects of lung cancer on the spouse. Despite these constraints, participants who reported talking with their partners about their relationships reported fewer constraints and better communication about cancer. These findings highlight the importance of a relationship perspective in the study of lung cancer and provide information about how talking together about the spousal relationship may enable couples to minimize social constraints and enhance cognitive and emotional processing of the disease.