Change in cancer-related fatigue over time predicts health-related quality of life in ovarian cancer patients.

OBJECTIVE: There is limited research examining how change in cancer-related fatigue (CRF) over time predicts change in health-related quality of life (HRQOL), and no studies have examined this relationship in ovarian cancer patients, specifically. The purpose of this study was to explore the prevalence and trajectory of CRF over time and examine how change in CRF over time predicts change in HRQOL in ovarian cancer patients. METHODS: Ovarian cancer patients (N = 202) were recruited from Princess Margaret Cancer Centre in Toronto, Canada. Consenting participants completed measures at baseline (beginning of study) and again three months later. Data were analyzed using a longitudinal multilevel mixed model design. RESULTS: Four groups of CRF trajectories emerged. Fifty-four percent reported CRF as always present, 16% reported CRF subsided, 21% reported CRF developed, and 9% reported CRF as never present. As CRF developed, functional and physical wellbeing decreased. As CRF subsided, functional, physical, and emotional wellbeing improved. CRF trajectory was not associated with change in social wellbeing over time. CONCLUSIONS: Our findings suggest CRF negatively impacts all domains of HRQOL except for social wellbeing in ovarian cancer patients. Among patients who reported that CRF improved over time, all HRQOL domains impacted by CRF showed recovery to normal endorsement rates. Among patients who reported development of CRF, impacted HRQOL domains significantly declined over time. Implications from this research indicate that fatigue management should be prioritized during and after cancer treatment to ensure optimal physical, functional, and emotional wellbeing.

Insomnia Symptoms, Subjective Appraisals, and Fatigue: A Multiple Mediation Model.

OBJECTIVE AND BACKGROUND: Fatigue and insomnia are common debilitating symptoms associated with multiple sclerosis (MS). Negative subjective appraisals of symptoms may influence both insomnia and fatigue severity, but this relationship has not been examined among those with MS. The relationship between insomnia symptoms and both physical and cognitive fatigue were examined. Health-related self-efficacy, fatigue catastrophization, and rumination were examined as potential mediators of the relationship between insomnia symptoms and fatigue. PARTICIPANTS: Participants diagnosed with MS (N = 115) were recruited from hospital and community settings in a large metropolitan city. METHODS: Participants completed self-report questionnaires, including: Modified Fatigue Impact, Insomnia Severity Index, MS Quality of Life Questionnaire-54, Fatigue Catastrophizing Scale, Multidimensional Health Locus of Control Scale, and the Rumination-Reflection Questionnaire. Two multiple mediation analyses were performed using bootstrapping techniques, examining the cognitive and physical domains of fatigue as separate outcomes. RESULTS AND CONCLUSIONS: Mediation analyses revealed a significant association between insomnia symptom severity and the cognitive and physical domains of fatigue. Fatigue catastrophizing was the only significant mediator, accounting for 25% of the variance in the relationship between insomnia symptoms and the cognitive fatigue. However, fatigue catastrophizing did not significantly mediate the relationship between insomnia symptoms and physical fatigue, indicating physical and cognitive fatigue may reflect distinct processes in fatigue expression in those with MS.

Examining intrafamilial communication of colorectal cancer risk status to family members and kin responses to colonoscopy: a qualitative study.

BACKGROUND: First-degree relatives (FDRs) of probands with colorectal cancer (CRC) may be at increased risk of CRC and require colonoscopy. Proband disclosure about this risk and need for colonoscopy is essential for FDRs to take appropriate action. Low colonoscopy rates are reported among FDRs and little is known about the proband disclosure process. A better understanding of the barriers surrounding colonoscopy and disclosure is needed. METHODS: CRC probands (n = 16) and FDRs (n = 9), recruited from a Canadian CRC Consortium, completed interviews to determine barriers to disclosure and colonoscopy, respectively. Interviews were analyzed using thematic analysis and participants' motivation to disclose to FDRs or undertake colonoscopy was categorized into Stages of Change (i.e., Precontemplation, Contemplation, Preparation, Action, or Maintenance) using the transtheoretical model. RESULTS: 25% of probands had not disclosed to any first-degree kin and were categorized in the Precontemplation or Contemplation Stage of Change. Barriers to disclosure included lack of information, negative expectations about familial reaction, assuming FDRs were aware of risk or already being screened, dysfunctional family dynamics, and cultural barriers. 75% of FDRs were categorized in the Precontemplation or Contemplation Stage of Change. Barriers included negative perceptions about colonoscopy, health-care provider related factors, practical concerns, and lack of information about CRC, risk, and colonoscopy. CONCLUSIONS: In the absence of barriers such as cost and accessibility, this Canadian sample still reported several challenges to disclosure and colonoscopy adherence. Future research should explore interventions such as motivational interviewing to improve proband disclosure and to increase FDR adherence to colonoscopy.

Patient-physician relationships, health self-efficacy, and gynecologic cancer screening among women with Lynch syndrome.

BACKGROUND: Lynch syndrome, a hereditary cancer syndrome, predisposes women to colorectal, endometrial, and ovarian cancer. Current guidelines recommend that women with Lynch syndrome undergo risk-reducing gynecological surgery to reduce their chances of developing endometrial or ovarian cancer. Little is known about how women with Lynch syndrome perceive gynecological cancer screening, or the psychosocial factors associated with screening attitudes and behaviour. METHODS: This study used a cross-sectional, quantitative design. Using self-report questionnaire data from a sample of women with Lynch syndrome (N = 50) who had not undergone risk-reducing surgery, the current study sought to: 1) describe the gynecological cancer screening behaviours of women with Lynch syndrome, as well participant-reported sources of information about Lynch syndrome; 2) examine the extent to which women believe gynecological cancer screening is effective and provides them with reassurance and; 3) assess to what extent relationships with one's family physician were associated with gynecological cancer screening, perceptions about screening, and health self-efficacy. Data were analyzed using descriptive statistics and Spearman rank-ordered correlations. RESULTS: Data analyses showed that transvaginal ultrasound was the most common screening behaviour (57%) followed by pelvic ultrasound (47%). Only 22% of participants underwent endometrial biopsy. Patient-physician relationships were related to greater health self-efficacy to manage Lynch syndrome and greater perceived effectiveness of gynecological screening. However, health self-efficacy and better patient-physician relationships were not associated with increased engagement in gynecological cancer screening. CONCLUSIONS: The data suggest that feeling efficacious about managing one's Lynch syndrome and screening is related to positive interactions and communication with one's family physician. While this is encouraging, future research should examine educating both family physicians and patients about current guidelines for Lynch syndrome gynecological screening recommendations.

Psychological symptoms and perceived cognitive impairment in multiple sclerosis: The role of rumination.

PURPOSE/OBJECTIVE: Perceived cognitive impairment is a common concern among individuals with multiple sclerosis (MS) and is associated with prevalent psychological symptoms, namely depression and anxiety. The mechanisms by which these psychological symptoms are associated with perceived cognitive impairment among people diagnosed with MS have been unexplored. A possible mechanism is rumination, a maladaptive form of self-reflection that is commonly associated with anxiety and depression. The purpose of this study was to examine the associations of symptoms of anxiety and depression with perceived cognitive impairment, and to examine whether anxiety and depression indirectly affect cognitive impairment through rumination. Research Method/Design: The study utilized a cross-sectional observational design. People diagnosed with MS (N = 111) were recruited from an MS clinic in Toronto, and through the community. Participants completed self-report questionnaires that included the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ), the Hospital Anxiety and Depression Scale (HADS), and the Rumination-Reflection Questionnaire (RRQ). Two indirect effect statistical analyses were conducted using bootstrapping techniques. RESULTS: We found a positive association between both symptoms of depression and anxiety and perceived cognitive impairment. Moreover, psychological symptoms were related to perceived cognitive impairment indirectly through rumination, indicating ruminative thinking style may be implicated in the relationship between anxiety, depression, and perceived cognitive impairment. CONCLUSIONS/IMPLICATIONS: These findings provide additional support for previous research examining the relationship between psychological symptoms (e.g., anxiety and depression) and perceived cognitive impairment, and enrich our understanding of a potential mechanism driving these relationships. (PsycINFO Database Record

Distribution patterns of zoochlorellae and zooxanthellae hosted by two Pacific Northeast anemones, Anthopleura elegantissima and A. xanthogrammica.

This study investigated patterns in the relative abundance of two photosynthetic algal symbionts, zoochlorellae (ZC) and zooxanthellae (ZX), hosted by two temperate anemones, Anthopleura elegantissima and A. xanthogrammica. Previous studies have documented varying proportions of each symbiont along environmental gradients, presumably determined by their respective physiological capabilities. To test for differences in the algal type between the two host species, we sampled anemone tissues (tentacle or tentacle and body column) of similarly sized polyps that were located close together in multiple habitats: tidepools, crevices, underneath rock ledges, and along natural light gradients in caves. The ZC-A. elegantissima symbiosis was rare on the west coast of Vancouver Island, British Columbia, Canada. Even in low-irradiance habitats, ZC were the dominant algae hosted by A. xanthogrammica, while nearby A. elegantissima hosted ZX or was algae-free. As a first step in determining whether symbiont growth rates differed between the two host species, we quantified mitotic index (MI), the percentage of cells with division furrows, under artificial light and in the field by simultaneously sampling tentacles from both species. MI was more stable in A. elegantissima: the MI of ZX isolated from the tentacles of A. xanthogrammica was slightly higher at a light level of 80 micromol quanta m(-2) s(-1) than it was for ZX from A. elegantissima (respectively, 7.3 vs. 6.2) and relatively lower at 40 micromol quanta m(-2) s(-1) (3.9 vs. 5.6). Our data indicate host-specific differences in symbiont distributions and MI when extrinsic physical parameters were similar.