Journal of Psychosocial Oncology最新文献

Psychosocial oncology and supportive care services are essential for addressing the multifaceted needs of patients with cancer and their families. This paper outlines the framework for a model program, Cedars-Sinai Cancer's Patient and Family Support Program, a service line that integrates psychosocial-spiritual care and supportive care services into standard ambulatory oncology practice throughout the geographic footprint of the institution. The program emphasizes a mission-driven, embedded, transdisciplinary, patient-centered approach, evidence-based interventions, and scholarly activity to improve quality of life, treatment tolerance, and overall outcomes. Key components include wellness offerings, palliative medicine, psychiatry, nutrition, social work, psychotherapeutic services, spiritual care, care coordination, oncology physical medicine and rehabilitation, and survivorship services. Approaches for implementation and strategies for overcoming barriers are also discussed, providing a roadmap for institutions aiming to establish or enhance their psychosocial oncology and supportive care services.

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.

Introduction: Sexual health is an important part of emotional and physical functioning. For patients undergoing cancer treatment, sexual health is an often-overlooked aspect of care for a variety of reasons. It is further overlooked for patients who are undergoing extended hospital admissions. There are no current standardized guidelines or recommendations around patients admitted to hospitals for extended periods of time, and as such, is left to the discretion of floor staff or individual hospital units. Often, there are no guidelines at all, which potentially puts patients in unsafe or emotionally taxing situations.

Case study: In this paper, we explore a case of a 21-year-old woman undergoing extended hospital admission due to complications secondary to a bone marrow transplant, and how the omission of sexual health from her care had significant implications for her emotional functioning. The patient and her family gave consent to participate in research.

Treatment implications: We discuss the ethical, legal, psychological, and medical implications of the case, and how certain guidelines and conversations would have potentially improved this patient's emotional state during her hospitalization.

Recommendations and conclusions: We conclude by providing recommendations for mental health providers on discussing healthy sexuality for chronically ill patients who might be subject to extended hospital stays. We strongly recommend that sexual health be an ongoing conversation between providers and their chronically ill patients who are undergoing extensive medical care or extended hospitalizations.

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.

Background: Over the past 25 years, a growing body of literature has shown oncology family caregivers experience as much, if not more, stress than the oncology patient. This research has demonstrated the need to establish programs to support these family caregivers.

Aim: To establish a proactive oncology family caregiver support process to assist family caregivers during the cancer patient's treatment regimen.

Methods: Based on the Iowa Model of Evidence-Based Practice, an evidence-based practice process was established in a large, downtown hospital's oncology infusion center designed to assess the distress and burden level of the family caregivers. Using the Caregiver Quality of Life Index - Cancer questionnaire, family caregivers were assessed for their overall sense of well-being. In the initial pilot process, family caregivers of patients with GI or lung cancer were asked if they wished to participate as they represented two of the largest disease group populations for this oncology clinic. Eighty-three family caregivers (44%) agreed. The sixty-six family caregivers who reported an increased level of distress were referred to the oncology medical social worker to assist with interventions as indicated by their responses.

Results: The efficacy of this proactive approach of assessing family caregiver distress resulted in the implementation of 95 baseline interventions for the 66 participants. The follow-up assessments resulted in 25 interventions, a 26% decrease. Family caregivers reported a 13% increase in their reported quality of life at the time of their third evaluation with the lowest scores improving by 50%.

Conclusion: The need for ongoing support services for oncology family caregivers to help them thrive through the cancer journey was validated. In response to this need, as of September 2024, this process became a permanent feature of the hospital's oncology infusion center services which now supports family caregivers of patients in all oncology disease groups.

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.

Purpose: Young Latino survivors of Acute Lymphoblastic Leukemia (ALL) and Lymphoblastic lymphoma (LL) are at higher risk for adverse psychosocial health-related quality of life (HRQOL). However, past research investigating within-group variation is limited. The current study compared HRQOL among sub-groups of Latino pediatric ALL/LL survivors based on dominant language spoken at home.

Participants: Young Latino ALL/LL survivors and their parent (Spanish-speaking n = 50; English-Speaking n = 56).

Methods: Language groups were compared on child self-reports and parent proxies from the Pediatric Quality of Life Inventory (PedsQL).

Findings: Children from predominantly Spanish-speaking families reported higher social functioning F(1, 105) = [15.21], p < 0.001); however, this difference was not present for older children (ages ≥ 9 years).

Conclusion: Younger Latino survivors from predominantly Spanish-speaking families may experience better social functioning, warranting further investigation on protective factors of traditional Latino culture for social functioning in Latino CCS.