Psycho‐Oncology最新文献

Objective: To test whether a personality feedback intervention improves three domains of cancer self-management: self-awareness, self-efficacy, and positive affect.

Methods: From 11/2020-02/2021, 372 adults diagnosed with cancer participated in a randomized controlled trial (RCT) of an intervention that entailed reading a brief personality-related excerpt during an online survey. Eligibility included self-reported age ≥ 18 years, current or past cancer diagnosis, and ability to read English. The survey included a baseline assessment with a personality questionnaire, then randomized participants to one of two groups. The intervention group (n = 184) received a personality feedback report with tailored self-care tips, whereas the control group (n = 188) received a generic reading on personality theory. At the end of the survey, participants completed outcome measures of self-awareness (primary), self-efficacy for illness management, and positive affect. General linear models tested between-group differences in changes from baseline to post-test on each outcome.

Results: There was no intervention effect on self-awareness (primary outcome) or positive affect. However, compared to controls, intervention participants experienced a greater increase in self-efficacy for illness management (d = 0.33, p = 0.002), including in 2 of 3 constituent domains: self-efficacy for managing symptoms (d = 0.36, p < 0.001) and self-efficacy for managing treatments/medication (d = 0.22, p = 0.035).

Conclusion: Despite the primary outcome's null results, this was the first RCT of a personality feedback intervention to show improvements in self-efficacy for managing chronic illness. Given the important role of self-efficacy in self-management, the intervention has implications for other cancer outcomes. Follow-up studies on longer-term outcomes such as health behaviors and quality of life should be explored.

Trial registration: NCT04625439.

Objective: Breast cancer has a strong impact on the mental state of those affected. Cognitive behavioral therapy (CBT) is one effective approach to reduce disease burden. This randomized controlled pilot trial aimed to assess the effect of the digital CBT-based application Living Well on psychological outcomes in a German female breast cancer population.

Methods: Female breast cancer patients (n = 70) with ongoing or finished oncological treatment that is who were receiving or had received any type of oncological treatment were included in the study and randomized to an intervention group (IG, n = 32) receiving Living Well in addition to care as usual, and a control group (CG, n = 38) receiving care as usual only. Participants completed standardized questionnaires at baseline and after 2, 4, 8, and 12 weeks to assess anxiety and depression (HADS) as primary outcomes, distress (DT), health-related quality of life (HRQoL, AQoL-8D), and illness perception (B-IPQ) as secondary outcomes.

Results: After 12 weeks, significant (p < 0.05) higher improvements in the IG could be observed in anxiety levels, HRQoL, and illness perception, when compared to the CG. Age and time since diagnosis were found to be relevant covariates for anxiety levels. In distress levels, the IG showed a clinically relevant and nearly significant reduction compared to the CG (p = 0.057). No effects could be observed in depression levels.

Conclusions: The results demonstrate the potential of Living Well to improve psychological outcomes of female breast cancer patients and encourage further studies evaluating the effectiveness of the digital application.

Trial registration: The trial has been registered in the German Clinical Trials Register (DRKS00029918).

Objectives: Adolescents and young adults (AYAs, 18-39 years) with cancer identifying as racially/ethnically minoritized or 2SLGBTQIA+ (Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual and "+" referring to other queer identities) have been underrepresented in cancer research. This study explores the aspects of identity that hold significance for these minoritized AYAs and how these facets impact their healthcare experiences.

Methods: Eligible participants comprised English-speaking AYAs who self-identified as racially/ethnically minoritized and/or 2SLGBTQIA+, were diagnosed with cancer between the ages of 15-39, currently aged > 18, and had received or were receiving cancer care within Canadian healthcare system. Additionally, four patient partners meeting the same criteria were recruited as research collaborators. Semi-structured one-on-one virtual interviews guided by an interview script were conducted, and qualitative analysis employed a framework approach.

Results: We recruited 23 participants from 4 Canadian provinces (mean age: 28, Range: 20-44); 17 identified as racially/ethnically minoritized, one as sexual/gender minoritized, and five as racially/ethnically and sexually/gender minoritized. Participants emphasized that their culture/ethnicity, religion/spirituality, sexuality, gender, family, career, and being an immigrant are important aspects of their identity, with only one participant recognizing their identity as a "person with cancer". A cancer diagnosis altered the aspects of identity deemed most significant by participants. Both visible and invisible aspects of identity shaped participants' experiences and influenced their level of trust in the healthcare system.

Conclusion: Racially, ethnically, gender, or sexually minoritized AYAs with cancer place considerable importance on aspects of their identity that are shaped by their respective communities. Recognizing and respecting these identities are paramount for healthcare professionals to deliver safe and inclusive care.

In this commentary, we propose the use of video-reflexive ethnography (VRE) as a means to support integration of patient-reported outcomes (PROs) in cancer care screening. As for any policy or intervention, the optimization of PROs depends on moving beyond their mere formal introduction, and depends on the integration of PROs in the everyday practice contexts of health care professionals (HPEs). The use of VRE allows for video-playback sessions among oncology professionals to support team-based learning and practice-change grounded in "reflexivity." Through a review of previous methods used to support organizational change in healthcare settings (e.g., policies, quality improvement initiatives, simulation sessions), we present some unsung advantages of VRE that can be applied to a complex integrated setting, such as cancer care. As opposed to other methods to create change, VRE does not dictate new measures, but rather supports "bottom-up" provider-initiated changes to health care practices and contexts, grounded in collaborative day-to-day practice. We argue that VRE optimizes PROs in cancer care by facilitating their effective and sustainable integration, to promote improved patient care.

Objective: To translate Cancer Survivors' Unmet Needs scale (CaSUN) into Simplified Chinese, and to assess the validity and reliability of this translated version among Chinese cancer survivors.

Methods: Following the cross-cultural adaptation guidelines, the original CaSUN scale was translated from English into Simplified Chinese. To enhance the readability and comprehension of each item, a pilot study involving 40 cancer patients was carried out. Subsequently, 324 cancer survivors participating in follow-up appointments at a cancer hospital in Beijing, China completed the Simplified Chinese version of the CaSUN. The scale's validity was assessed through factor analysis. Indices including Satorra-Bentler scaled chi-square to degree of freedom ratio (χ²/df), comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean squared residual (SRMR) were employed for construct validity. Average variance extracted (AVE) of each category reflected the convergent validity. Reliability was confirmed with both Cronbach's α and Guttman split-half coefficient.

Results: Factor analysis suggested that a three-level hierarchical structure of the CaSUN with four first-order factors, nine second-order factors and all the 35 items assessing unmet need could fit our data well (χ²/df = 2.833, CFI = 0.902, RMSEA = 0.076, SRMR = 0.066), indicating sufficient construct validity for this model. For convergent validity, AVE of each second-order category were greater than 0.5. Regarding reliability, Cronbach's α of the 35 items was 0.968, and the Guttman split-half coefficient was 0.984. Both of these coefficients were higher than 0.8.

Conclusions: The present Simplified Chinese version of CaSUN had good cultural adaptability, appropriate validity and reliability for assessing unmet needs in different cancer survivor groups in Chinese mainland. This Simplified Chinese version of CaSUN can assist health professionals in addressing individual survivor needs and bridge the gap between patients' experiences and their expectations, thereby improving the quality of cancer survivorship care.

Objective: The empty pelvis syndrome (EPS) is common after pelvic exenteration (PE), causing fluid collections, bowel obstruction, perineal sinuses, and fistulas. The best approach to fill the pelvis to mitigate this remains controversial, and the impact of EPS on health-related quality of life (HrQoL) is unknown. This study is the first to begin to explore lived-experiences of EPS complications.

Methods: Unstructured EPS virtual focus group meetings were conducted with a convenience sample of patients who underwent PE, as an extension of a modified-Delphi study. Interpretative phenomenological analysis was conducted on verbatim transcripts to generate group experiential themes.

Results: Twelve patients (eight UK, one Dutch, and three Belgian) participated in four focus groups. Eight EPS complications were reported, (two pelvic collections, five chronic perineal sinuses, and one bowel obstruction). Group experiential themes were 'Out of Options', depicting patients forced to accept complications or limited survival; 'The New Normal', with EPS potentially delaying adaptation to post-PE HrQoL; 'Information Influencing Adaptation,' emphasising the significance of patients understanding EPS to cope with its effects; and 'Symptoms,' reporting manifestations of EPS, the resultant physical limitations, and an intangible feeling that patients lost part of themselves.

Conclusions: EPS may influence patient decision-making, regret, adaptation, and information-seeking. It can cause a variety of unpleasant symptoms and physical limitations, which may include phantom phenomenon. This work supports ongoing purposeful HrQoL research to better define these themes.

Objective: Adjuvant endocrine therapy (AET) is increasingly being prescribed for up to 10 years to people diagnosed with hormone receptor-positive breast cancer. AET intake is often accompanied by side effects that significantly impact the well-being of people. The way individuals cope with medication-related side effects might play a pivotal role in their emotional adaption.

Methods: This intensive-longitudinal study investigated the association between self-reported coping strategies (Brief COPE) and psychological well-being (Patient Health Questionnaire-4) among women undergoing AET. A multilevel factor analysis resulted in the identification of four coping factors, namely, problem-focused, support-focused, meaning-focused, and avoidance-focused coping. Daily coping efforts and experienced side effects were analyzed as predictors of psychological well-being using multilevel modeling.

Results: A total of 215 women (M_age = 56.5 ± 10.9 years) participated, resulting in a total of n = 2080 daily surveys (M = 9.67 ± 1.08). On average, women reported 3.7 ± 2.2 different side effects per day. Days characterized by an elevated frequency of side effects and increased burden were associated with diminished well-being. Using more problem- and meaning-focused strategies than usual to cope with side effects correlated positively with well-being. Conversely, employing more support- and avoidance-focused coping strategies than usual was linked to reduced psychological well-being. Exploratory analyses focusing on individual coping strategies provided nuanced insights into coping behaviors.

Conclusion: The present findings underscore the relationship between women's coping efforts concerning medication-related side effects during AET and their daily well-being. Psychosocial education (e.g., cognitive behavioral therapy) may offer valuable benefits for patients by helping them develop adaptive coping strategies to manage side effects.

Background: Despite the increasing burden of breast cancer in the developing world, there is a misunderstanding of the complex and multifaceted relationship between culture and cancer, particularly breast cancer. Hence, a dichotomy of illness narratives exists due to differential meaning making concerning breast cancer. While clinicians always recommend biomedical treatment, women with breast cancer often seek alternative treatment pathways.

Aims: To explore the experiences of women with breast cancer and clinicians in Nigeria on the dichotomy in the illness narratives.

Methods: This qualitative study used in-depth interviews and focus group discussion to explore the experiences of 22 women with breast cancer and 7 clinicians in Nigeria on the dichotomy in the illness narratives using grounded theory method analysis.

Results: This study revealed that many women living with breast cancer (WLBC) hold health beliefs that are contradictory to the biomedical norm. They mostly sought treatment based on the perceived aetiology of breast cancer. The treatment pathway follows faith and traditional healing as alternatives or sometimes in combination with biomedicine. WLBC reported a constant fear of biomedical treatment, perceived to be harmful to women's sexuality, fertility and body image. Hence, after perceived treatment failure from alternative care, biomedical care becomes the last resort, usually at an advanced stage of breast cancer, often responsible for poor prognosis.

Conclusion: There is a dichotomy of illness construction between sufferers and health practitioners. To guide women with breast cancer on the path of care, modern care practitioners should consider some cultural norms and practices without compromising professional ethos.

Objective: To improve mechanistic understanding, this randomized controlled trial examined anxiety, mood, emotional support, and pain-related self-efficacy as mediators of music therapy for pain management in people with advanced cancer.

Methods: People with advanced cancer who had chronic pain were randomized (1:1) to 6 weekly individual music therapy or social attention control sessions. We measured mediators and pain outcomes (pain interference and pain intensity) using self-report measures at baseline, session 4, and post-intervention. We included outcome expectancy/treatment credibility, music reward, adult playfulness, and baseline pain interference and pain intensity as moderators.

Results: Participants (n = 92) had a mean age of 56 years. Most were female (71.7%), white (47.8%) or Black (39.1%), and had stage IV cancer (75%). Self-efficacy was found to be a significant mediator of music therapy for pain intensity (indirect effect ab = 0.79, 95% CI 0.01-1.82) and pain interference (indirect effect ab = 1.16, 95% CI 0.02-2.51), while anxiety, mood, and emotional support were not. The mediating effect of pain-related self-efficacy was significantly moderated by baseline pain interference but not by the other moderators.

Conclusions: The findings suggest that the impact of music therapy on chronic pain is mediated by self-efficacy. This knowledge can help optimize music therapy interventions for chronic pain management for people with advanced cancer by capitalizing on teaching music-based self-management strategies.

Trial registration: ClinicalTrials.gov identifier: NCT03432247.

Objectives: Depression and suicide rates are high among cancer sufferers. Women with breast and gynecological cancer show high levels of distress, depressive symptoms, cognitive impairment, and anxiety. Understanding suicide rates and risk factors in this population would represent a viable tool in planning tailored, prevention strategies. The objective of this study was to estimate suicide rate and identify the determinants of suicide risk in women with breast and other gynecologic cancer.

Methods: A systematic research was performed in PubMed and PsycINFO from anytime to September 26, 2023. The following search strategy was used: (Gynaecol* OR Gynecolog*) AND (cancer OR tumor OR tumor OR neoplas* OR malignan*) AND suicid*. In this review, we adhered to PRISMA statement.

Results: Nine papers met inclusion criteria. Women with breast or gynecological cancers showed higher suicide rates compared to the general population. Ovarian cancer was associated with higher suicide risk and suicidal ideation compared to other gynecological cancers. The extent of surgical demolition was positively associated with both. Psychological factors, such as self-perceived burden and alexithymia, might also influence suicidal thinking.

Conclusions: Women with breast and gynecological cancer are at high risk of suicide. Intervention aimed to reduce burden related to psychological factors might help reducing such risk.