Psycho‐Oncology最新文献

Objective: Black/African American women with breast cancer have disproportionately higher mortality rates and report experiencing a lower quality of life during survivorship compared to non-Hispanic white women. Despite support for the integration of peer navigation in cancer care and survivorship to address these inequities, Black/African American women often have limited access to culturally tailored peer navigation programs. We aimed to investigate the unique needs and strengths of Black/African American women with breast cancer and survivors to inform the development of a culturally tailored peer navigation program for Black/African American women.

Methods: We developed a community-university partnership based on best practices of community-based participatory research. The partnership conducted storytelling sessions with Black/African American survivors of breast cancer and their caregivers and key informant interviews with community partners and applied thematic analysis.

Results: A total of 14 survivors and 4 caretakers took part in storytelling sessions and 6 community partners took part in key informant interviews. Themes from the storytelling sessions included spirituality, social support, information seeking, and relationship with care team. These themes were then incorporated into developing the theoretical basis, structure, and content of the BLACC peer navigation program. The key informant interviews were instrumental in building new partnerships to support the implementation of the peer navigation program.

Conclusions: The community-university partnership successfully identified the unique needs and strengths of Black/African American women who either had breast cancer or were survivors of breast cancer, identified valuable resources, and secured buy-in from community leaders to develop a comprehensive peer navigation program.

Objectives: Individuals living with advanced cancer commonly experience death anxiety, which refers to the distressing thoughts or feelings associated with awareness of one's mortality. Deriving an overview of existing literature on the psychological and social factors linked to death anxiety may inform conceptual models, clinical screening, and intervention strategies in oncology and palliative care. Therefore, the present scoping review was conducted to summarize the current literature on the psychosocial correlates of death anxiety among individuals with advanced cancer.

Methods: A comprehensive scoping review methodology was used following the Arksey and O'Malley framework. A literature search was conducted using four electronic databases: CINAHL, Embase, PsycInfo, and MEDLINE. Abstracts and full-text articles were screened, and relevant data were extracted and summarized.

Results: Sixteen studies met the inclusion criteria. Seventeen psychosocial correlates of death anxiety were identified, with depression, spiritual well-being, and attachment security representing the most frequently investigated. Four previously tested death anxiety models were also identified, two of which were designed longitudinally.

Conclusions: This review provides a current summary of psychosocial factors and established models related to death anxiety in advanced cancer. Multiple psychosocial correlates should be targeted concurrently in research and clinical practice to address death anxiety. Longitudinal studies designed to test new models are especially needed to identify unique pathways contributing to death anxiety across the disease trajectory of advanced cancer.

Background: Black women generally report high levels of spirituality. Less is known about Black women's spiritual coping with a cancer diagnosis. Persisting health disparities between Black breast cancer survivors and other racial groups necessitate examining whether spirituality can be a contextual and personal resource for Black women with breast cancer.

Aims: This qualitative study's goals were to: (1) characterize positive and negative dimensions of spirituality in a sample of Black women diagnosed with breast cancer; and (2) examine whether and how women used spirituality during their cancer experience.

Methods: Three Gatherings (i.e., culturally curated focus groups) were conducted as part of Project SOAR (Speaking Our African American Realities), a community-academic partnership. In these all-Black women Gatherings, participants (N = 37) discussed their breast cancer experience, including how spirituality played a role.

Results: Through reflexive thematic analysis, six themes were identified: (1) faith is central to my identity even through challenging times; (2) meaningful, ineffective, or non-existent support from my spiritual community; (3) grappling with spiritual discontent during breast cancer; (4) God is omnipotent; (5) spiritual anchors helped me persevere through the breast cancer journey; (6) breast cancer reflections enhanced my spiritual gratitude and growth.

Conclusions: Participants' experiences highlight the complexities of spirituality when confronting breast cancer. Many Black women reflected on the centrality of spirituality to their lives and cited spirituality as a resource and effective coping process during their cancer experience. Findings have important implications for understanding how spirituality can be incorporated to support Black women with breast cancer.

Objective: Individuals with low socioeconomic status (SES) exhibit higher rates of mental disorders; however, data in oncological populations are insufficient. This study investigated the course of DSM-5 mental disorders in cancer patients, stratified by SES, over a period of 1.5 years following initial cancer diagnosis.

Methods: This multi-center prospective longitudinal study assessed cancer patients within two months of cancer diagnosis (t1), and at 6-, 12-, and 18-month follow-up (t2-t4) using the SCID-5 interview for mental disorders based on DSM-5 criteria. Chi-square-tests were tested for frequency changes over time. A generalized linear mixed model (GLMM) was applied with fixed effects for SES and time on mental disorders.

Results: Out of 1030 patients with a SCID-5 at baseline (53.2% men, 60 years), 821, 719 and 654 participated at respective follow-ups. The most common diagnoses were skin and prostate cancer. Point prevalence of mental disorders was 20.9% at baseline, decreasing to 18.2%, 14.6%, and 15.0% (t2-t4; χ² (3) = 15.3, p = 0.002). Patients with low SES consistently showed highest prevalence rates, whereas patients with high SES showed decreasing rates of mental disorders over time, with a main effect of time (χ² (3) = 19.9, p < 0.001) and SES (χ² (2) = 8.8, p = 0.01) in the GLMM. Two thirds never met diagnostic criteria for a mental disorder. Sensitivity analysis among study completers (n = 592) revealed a similar pattern to the main analysis.

Conclusions: Cancer patients with low SES exhibit impaired coping with cancer-related stressors, increasing their risk for mental disorders. Social disparities affect physical and mental health, possibly via health behavior or health literacy, and need to be addressed by tailored survivorship care planning.

Background: Family members can be required to take on the role of "caregiver" at any stage of life, causing disruption and psychological distress. This review sought to describe the traumatic impact (i.e., posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) of cancer caregiving across the lifespan.

Aims: This systematic review characterizes the current literature on cancer caregiver PTSS and PTG through a developmental lens with respect to caregiver age and their relationship to the patient.

Methods: Three electronic databases (PubMed/MEDLINE, Embase, and PsycInfo) were searched for relevant studies using a combination of controlled vocabulary and text words. Studies were limited to English-language only articles, but not limited by geography or publication date. A literature review management tool, Covidence, was used to screen for article eligibility as well as for data extraction and article quality assessment.

Results: A final total of 275 studies underwent data extraction and quality assessment. Studies indicated that at all ages, caregivers experience PTSS. A gap in the literature was identified for child (< 18) and older adult (65+) caregivers. At other ages, most studies found elevated PTG in caregivers. Small variations of number of studies finding PTSS and PTG were found across age ranges.

Conclusions: Posttraumatic stress and growth appear to be experienced across the lifespan. However certain age groups are under-researched. Few studies focus on younger or older caregivers, especially in respect to PTG. There is a crucial need for studies in caregivers, particularly in these groups to fully address and support their unique caregiving needs and current population-based research does not attempt to depict the proportion of cancer caregivers at different developmental stages.

Objective: Novel behavioral interventions are needed for patients with cancer who smoke cigarettes. Standard tobacco treatment may not effectively address the psychological distress and/or emotion dysregulation that makes quitting smoking difficult for many patients. Dialectical Behavior Therapy-Skills Training (DBT-ST) has demonstrated efficacy as a brief intervention for managing emotions and stress across varied populations but has not been adapted for patients with cancer who smoke. To determine its suitability for this population, we conducted a scoping review of brief DBT-ST with similar populations: people with substance use, breast cancer, or emotion dysregulation.

Methods: We followed PRISMA-ScR (preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews) guidelines. Studies were restricted to English-language publications of DBT-ST as a brief intervention of 20 or fewer sessions. We found 26 publications representing 23 research studies, extracted study details, and narratively synthesized the results.

Results: The 23 studies included 12 quasi-experimental designs, seven pilot randomized controlled trials (RCTs), and four RCTs. All studies found at least one improvement in a main outcome following DBT-ST intervention, with results maintained at follow-up. Qualitative outcomes indicated high satisfaction with DBT-ST and good retention. Studies recruited diverse participants, with some far exceeding population averages. Over half of the studies included only females or males. We found considerable heterogeneity across studies in intervention design, testing, and measurement.

Conclusion: DBT-ST as a brief intervention for people with substance use, cancer, or emotion dysregulation demonstrates sufficient positive outcomes to adapt this approach for patients with cancer who smoke cigarettes.

Objective: Studies have found that cancer patients with dependent children exhibit high symptoms of anxiety, depression, and worry. Patients' parenting concerns can negatively impact their own and their family's adjustment to the cancer experience. However, relatively little is known about parenting concerns of partners of cancer patients, or associations between parenting concerns and couples' relationship adjustment. This longitudinal study investigated parenting concerns among both patients and partners, and their associations with psychological and relationship adjustment.

Methods: One hundred thirty-four patients with cancer and their partners (67 couples) completed the Parenting Concerns Questionnaire at baseline and measures of psychological distress, communication, and relationship adjustment at four time points (baseline, 4-, 8-, and 12-month follow up).

Results: Baseline parenting concerns did not differ by role, gender, cancer site or cancer stage (p > 0.05). Patients and partners who reported higher levels of parenting concerns at baseline reported significantly greater psychological distress and poorer communication concurrently and at each subsequent assessment. There were no significant associations between parenting concerns and relationship satisfaction either concurrently or over time.

Conclusions: These findings reinforce the need for a dyadic perspective to assessing both patients' and partners' parenting concerns and a focus on processes such as communication as an avenue for managing and processing parenting concerns.

Background: The evidence-based Managing Cancer and Living Meaningfully (CALM) psychotherapeutic intervention was designed to address the complex needs of those with advanced cancer. Ample evidence supports the efficacy of CALM therapy; less is known about the patient-specific factors that influence initiation and continuation of CALM sessions.

Aims: To gain understanding of patient-specific factors and referral routes that influence initiation and continuation of CALM.

Methods: An Interpretive Description framework and concurrent triangulation mixed-methods design was used to analyse baseline patient-specific variables for prediction of engagement (number of sessions) in CALM following recruitment from cancer centres, palliative care services, and community cancer care organisations across Southern Alberta, Canada. Patient input (n = 10) occurred through semi-structured interviews exploring experiences with advanced cancer, CALM referral and engagement.

Results: Among consented individuals (n = 69), those directly referred by healthcare providers (HCPs) and self-referred (total n = 32), engaged in more CALM sessions (M = 4.97, SD = 3.51) than those referred indirectly (M = 3.19, SD = 2.26, p < 0.05), particularly younger participants (< 65 years) and those with longer life expectancy (> 10 months). Participants chose CALM based on experiences of distress, wanting to talk openly, and expecting benefit.

Conclusions: Greater patient engagement in the CALM intervention following HCPs' direct referrals may be based on trust in the HCP-patient relationship, and accurately prognosticating sufficient physical well-being for participation and benefit. Future health systems research may evaluate systematic programing with offering CALM referrals following an advanced cancer diagnosis.

Background: Self-directed interventions are cost-effective for patients with cancer and their family caregivers, but barriers to use can compromise adherence and efficacy.

Aim: Pilot a Sequential Multiple Assignment Randomized Trial (SMART) to develop a time-varying dyadic self-management intervention that follows a stepped-care approach in providing different types of guidance to optimize the delivery of Coping-Together, a dyadic self-directed self-management intervention.

Methods: 48 patients with cancer and their caregivers were randomized in Stage 1 to: (a) Coping-Together (included a workbook and 6 booklets) or (b) Coping-Together + lay telephone guidance. At 6 weeks, change in distress level was assessed, and non-responding dyads were re-randomized in Stage 2 to (a) continue with their Stage 1 intervention or (b) be stepped-up. Benchmarks for acceptability, feasibility, and clinical significance (anxiety and quality of life (QOL)) were assessed via surveys and study logs.

Results: Feasibility was supported by a low refusal rate at ≤ 30% and < 10% missing data. Men and women were enrolled in at least a 40:60 ratio for caregivers, but less for patients. Recruitment was slow at 1 dyad/week. Acceptability was supported by a low attrition rate (12.5%) and with 87% of participants finding the booklets helpful. Telephone guidance in Stage 1 increased adherence to Coping-Together; however, in Stage 1, participants benefited more from the self-directed format than the guidance. All patients who were stepped-up in Stage 2 benefited from their new assignment; this trend was less clear for caregivers.

Significance: Findings suggest a 3-step approach to dyadic self-management support that warrants further testing.

Trial registration: Clinical Trials Registration #: NCT04255030.

Background: Insomnia is the most common sleep disturbance among cancer patients undergoing active treatment. If untreated, it is associated with significant physical and psychological health consequences. Prior efforts to determine insomnia prevalence and correlates have primarily assessed patients in clinical trials, in limited disease groups, and excluding important patient subgroups. These findings are likely to be influenced by research participation effects, which could bias outcomes. We sought to address these limitations in a large, real-world sample.

Methods: Between 2018 and 2021, all patients seen at our institution were offered an electronic patient-reported outcomes (PRO) questionnaire where they could self-report on a range of symptoms based on the National Cancer Institute's PRO-CTCAE. Medical records were abstracted for demographics and cancer diagnosis/treatment. We evaluated N = 9350 patients for whom there was complete data.

Results: During cancer treatment, 21% of patients reported insomnia symptoms. Demographically, prevalence was higher in patients who were female (22% vs. 19%), younger than 60 years of age (22% vs. 20%), non-White (24% vs. 20%), and on public insurance (22% vs. 20%). Medically, patients undergoing palliative treatment were more likely to report insomnia symptoms, irrespective of cancer site (23% vs. 19%). The prevalence of insomnia symptoms ranged from 18% (genitourinary) to 23% (gastrointestinal).

Conclusion: More than 1 in 5 cancer patients suffer from symptoms of insomnia. It is important that oncologists and cancer centers routinely assess insomnia severity in their patients. Leveraging the use of existing patient-reported outcomes at an institution may be important to help with the identification of insomnia symptoms.