Journal of Psychosocial Oncology最新文献

Objectives: While improved survival rates among pediatric cancer patients are a significant success, the intensive treatments required can lead to treatment-related late effects, psychosocial burden, and reduced health-related quality of life (HRQoL). Therefore, this paper examined the HRQoL of survivors with regard to gender-specific differences and explored the associations between health literacy (HL), self-efficacy (SE) and HRQoL using an exploratory approach.

Methods: Quantitative data of n = 58 childhood cancer survivors between 11 and 18 years were analyzed using a mediation model. All participants had completed cancer treatment and were in follow-up care. The mean age at diagnosis was 5 years. The majority of participants had been diagnosed with leukemia (55%), while the remaining participants had lymphomas, brain tumors, or other types of tumors. We assessed survivors HRQoL using the KINDL-R, a validated pediatric quality of life measure. To measure HL and SE, we used self-developed items, with SE defined as confidence in managing one's own health.

Results: No significant gender-specific differences were found between the survivors with regard to their HRQoL (t(55) = 1.65, p = 0.11). The mediation analysis revealed that SE fully mediated the relationship between HL and HRQoL. The direct effect of HL on HRQoL was not significant (β = -0.06, p = 0.715), while the indirect effect through SE was significant (β = -0.26, p = 0.024). According to the squares of multiple correlation coefficients, this model explained 31% of the variation in HRQoL and 18.2% of the variation in SE.

Conclusions: Our findings suggest that SE has a potentially important role, being positively associated with HRQoL and acting as a key mediator in the relationship between HL and HRQoL in childhood cancer survivors. Given the modest sample size and preliminary nature of this study, we recommend that future research further investigate SE's mediating role in larger cohorts. Screening for low SE and the development of SE-targeted interventions may be promising strategies to support survivors' abilities and promote autonomous health care, but these should be considered as exploratory suggestions pending further validation.

Background: There are nearly 500,000 childhood cancer survivors in the United States, and emerging evidence suggests at least 25% of these survivors have lost a peer to cancer. The current study investigated the nature of peer loss in a sample of young adult survivors of childhood cancer.

Methods: Survivors (n = 63) completed an online survey including measures of peer loss, survivor guilt (Interpersonal Guilt Questionnaire) and posttraumatic stress symptoms (PTSS; Posttraumatic Stress Disorder Checklist for DSM-5). Relations between peer loss, survivor guilt, and PTSS were assessed.

Results: Survivor guilt and PTSS were significantly correlated. Survivor guilt accounted for 6% of variance in PTSS beyond variance explained by other risk factors. Peer loss was not significantly correlated with survivor guilt or posttraumatic stress symptoms.

Discussion: Survivor guilt is a significant concern for childhood cancer survivors. Increased screening and intervention are warranted to reduce the impact of survivor guilt and related symptoms. Further research is needed to clarify the impact of peer loss on childhood cancer survivors given its lack of association with survivor guilt or PTSS.

Purpose: Breast cancer patients and caregivers experience anxiety, depression, fatigue, and pain symptoms during treatment. The present study sought to determine which times during the first year of breast cancer treatment have the greatest risk of interpersonal spillover on patient and caregiver symptoms.

Methods: Self-report survey data were collected from 55 estrogen-receptor positive (ER+) stage I-III breast cancer patients and their identified caregivers throughout the first year of primary treatment (e.g., surgery, radiation) to assess symptoms of biobehavioral reactivity (i.e., anxiety, depression, fatigue, and pain). Surveys from patients and caregivers were provided at baseline (before treatment), 6 weeks after surgery, 6 months after surgery, and 12 months after surgery. The present sample comprised primarily white, middle-income individuals with an average age of 63 years old. Data were analyzed using longitudinal Actor-Partner Interdependence Modeling in Mplus.

Results: Intrapersonally, preceding symptoms predicted poor future functioning for both patients and caregivers across the majority of time points. Interpersonally, patients' anxiety at 6 weeks (p = .04) and fatigue at baseline (p = .01) and 6 months (p = .04) predicted greater caregiver symptoms at the subsequent clinically relevant times. However, concurrent spillover occurs for all of the measures of biobehavioral reactivity at one or more times during treatment.

Conclusion: Anxiety and fatigue are vulnerable to longitudinal interpersonal "spillover" of symptoms, particularly for caregivers, starting early in treatment. We also find in this pilot study that concurrent biobehavioral reactivity symptom spillover occurs in some form throughout the first year of breast cancer treatment. It is common for interventions that target symptoms of biobehavioral reactivity to focus on the individual patient. However, given the degree of longitudinal and concurrent spillover observed between breast cancer patients and caregivers, we recommend future research test behavioral interventions that teach dyadic coping skills in addition to replicating findings with a fully powered prospective study.

Purpose: Cancer diagnosis can be distressing, leading to multidimensional care needs which are often not fully met. The experience of diagnosis and treatment may be traumatizing for some patients, leading to a greater demand for support during survivorship. Survivors exposed to trauma may also have a harder time addressing their own needs or require additional support for their needs which have been neglected by the available care.

Method: We examined the degree to which exposure to trauma and posttraumatic stress disorder (PTSD) symptoms influence cancer survivor unmet needs, and the role of unmet needs in survivor life satisfaction. Survivors diagnosed with cancer in the past year or prior (N = 1,138) from a nationally representative population (N = 11,708) reported Adverse Childhood Experiences (ACES-Q-10) and PTSD symptoms (PTSD-8). Unmet needs were reported on the Survivor Unmet Needs Survey (SF-SUNS). Life satisfaction was measured on a single item. Chronic pain, sociodemographic variables, and self-reported cancer stage were self-reported and included as covariates.

Results: In stepwise-hierarchical regression modeling, PTSD symptoms, advanced-stage cancer and younger age were significant predictors of unmet needs in the first year after diagnosis and in the years thereafter (ps < 0.001); but the influence of ACEs on unmet needs was overshadowed by the other variables in the regression model. Chronic pain was associated with unmet needs experienced after one year (p < 0.001) but not in the first year after diagnosis. Having more unmet needs predicted poor life satisfaction when controlling for income, education, and age (p < 0.001).

Conclusions: Findings suggest that cancer survivors with a trauma history and PTSD symptoms are more vulnerable to unmet needs, which contributes to poor life satisfaction. Trauma-informed care and PTSD treatment, especially in younger survivors and those with advanced-stage cancers, may mitigate the potential for unmet needs after cancer diagnosis and thereby improve health outcomes in survivorship.

A diagnosis of pediatric cancer generates emotional distress for patients and parents, particularly during prognostic discussions in the context of upsetting information and uncertainty. Emotional support from pediatric oncologists is cited as a key factor in psychological well-being during these conversations; however, gaps persist in addressing emotional needs. This qualitative study explored perspectives from 25 patients with cancer aged 12-25 years with an estimated survival of ≤50%, 40 parents, and 20 pediatric oncologists on best practices for providing emotional support during prognostic discussions. Using a structured rapid qualitative analysis approach that employed standardized templates and summary matrices, we generated four key approaches for optimizing emotional support: 1) deliver high-quality information with consistent reliability; 2) dedicate time, space, and attention to families; 3) validate emotions; and 4) preserve hope and positivity. These themes offer actionable insights to inform the design of future communication skills training as well as clinical interventions to encourage individualized emotional support for patients and families facing advanced cancer.

Objective: Breast cancer is the most common malignancy among Arab women in the Middle East.

Objectives: This study examined the relationships between marital support, partner participation, body image, and mental distress among Bedouin women diagnosed with breast cancer.

Design: A total of 100 Muslim Bedouin women who were at least a year from their initial breast cancer diagnoses participate in the study.

Results: The findings indicated negative and significant relationships between partner support and mental distress and between body image and mental distress. In addition, a clear positive relationship was found between partner support and partner participation in the home and between education, income, and spousal support. Women who underwent breast reconstruction following mastectomy reported a higher level of support and improved psychological outcomes. Finally, several distinct relationships were found between demographic variables and the research variables.

Conclusion: The provision of culturally appropriate, patient-centered cancer treatments has not been explored for Muslim Arab women in the Middle East in general and in the Bedouin community more specifically, despite their unique cultural characteristics and increases in the rate of breast cancer among these populations. This study highlights the need for further studies in this area.

Background: Breast cancer survivors (BCS) are at risk of developing psychological distress associated with their cancer and are also more likely to experience comorbid diabetes mellitus (DM), which may worsen distress. Effective patient-physician communication is associated with increased psychological well-being, higher quality of life, and may prolong survival. We aimed to examine the association between race/ethnicity, patient-provider communication, and cancer-related distress in BCS with comorbid DM.

Methods: BCS with DM were surveyed using the Impact of Events Scale-Revised (IES-R) to assess for cancer-related post-traumatic stress (PTS) and the Patient Reactions Assessment (PRA) to assess their views of provider communications with their cancer (PRA-C) and DM providers (PRA-D). Bivariate analyses were conducted to examine the relationships between race/ethnicity, cancer-related PTS, and PRA scores. Pearson's correlation coefficients were used to examine the relationship between PRA and IES-R scores by race/ethnicity.

Results: A total of 181 female BCS with DM [mean (SD) age: 66.7 (7.0) years] who self-identified as White (39.8%), Black (32.0%), or Hispanic/Other (28.2%) were included. Non-White groups reported worse communication with their cancer (p = 0.01) but not with their DM providers (p = 0.09). BCS with cancer-related PTS had lower PRA-C scores (p = 0.04) but no difference in PRA-D scores (p = 0.22), versus those without cancer-related PTS. PRA-C and IES-R scores were significantly correlated, such that better communications with cancer (r = -0.23, p = 0.01) but not DM providers (r = -0.13, p = 0.08), were associated with lower IES-R scores. In subgroup analyses, the correlation between cancer-related PTS and PRA-C scores was significant in Hispanic/Other BCS (r = -0.39, p = 0.01), in contrast to Black (r = -0.12, p = 0.42) and White BCS (r = -0.09, p = 0.49); no significant correlation was observed between cancer-related PTS and PRA-D scores by race/ethnicity.

Conclusions: Compared to White BCS, minoritized BCS with comorbid DM report less satisfaction in communications with their cancer providers, which is associated with higher levels of cancer-related distress.

Purpose: This study explored the types of support necessary for building romantic relationships and marriages after a cancer diagnosis among adolescent and young adult (AYA) cancer survivors.

Method: Semi-structured interviews were conducted with 24 AYA cancer survivors who were unmarried at the time of diagnosis, including any form of cancer. Participants were diagnosed between ages 15 and 39 and were aged 20 to 45 at the time of the interviews.

Results: Five core themes were identified: Providing Information, Emotional Support, Engaging with Others' Experiences, Structural Support, and Negative or Unintended Consequences of Support. Peer cancer survivors and healthcare professionals were the primary sources of both utilized and desired support, though the type of support differed across these areas.

Conclusion: The findings highlight the need for integrated support systems that address the interconnected concerns related to relationships through peer and professional guidance tailored to the age-specific needs of AYA cancer survivors.