Loneliness, immunological recovery patterns, and health-related quality of life (HRQOL) outcomes in patients receiving hematopoietic stem cell transplantation.

PURPOSE: Loneliness may compromise health-related quality of life (HRQOL) outcomes and the immunological impacts of loneliness via neuroendocrinological mechanisms likely have consequences for patients who have undergone a hematopoietic stem cell transplantation (HSCT). RESEARCH APPROACH AND MEASURES: Loneliness (pre-transplant), immunological recovery (Day 30, Day 100, 1-year post-transplant), and HRQOL (Day 100, 1 year) were measured in a sample of 205 patients completing a HSCT (127 autologous, 78 allogenic). RESULTS: Greater levels of pre-transplant loneliness predicted poorer HRQOL at Day 100 and 1-year follow-up. Loneliness also was associated with higher absolute neutrophil to absolute lymphocyte (ANC/ALC) ratios in the entire sample at Day 30, which in turn was associated with Day 100 HRQOL. CONCLUSIONS: Findings demonstrate that pretransplant loneliness predicts HRQOL outcomes and associates with inflammatory immunological recovery patterns in HSCT patients. The balance of innate neutrophils to adaptive lymphocytes at Day 30 present a distinct profile in lonely individuals, with this immunity recovery profile predicting reduced HRQOL 100 days after the transplant. Addressing perceptions of loneliness before HSCT may be an important factor in improving immunological recovery and HRQOL outcomes.

A prospective study of the relationship between illness perception, depression, anxiety, and quality of life in hematopoietic stem cell transplant patients.

AIM: The aim of study was to investigate whether depression and anxiety symptoms and illness perception prior to hematopoietic stem cell transplantation (HSCT) predict health related quality of life (HRQOL) at Day 100 and 1 year following HSCT. METHODS: A total of 205 patients who underwent HSCT (N = 127 autologous transplants, N = 78 allogeneic transplants) were included in this prospective study. Baseline assessment was assessed prior to transplantation and post HSCT data were collected at Day 100 and 1 year. At baseline we assessed depressive symptoms (Patient Health Questionnaire-9), anxiety symptoms (Generalized Anxiety Disorder-7), illness perception (Brief Illness Perception Questionnaire), and HRQOL (Functional Assessment of Cancer Therapy-BMT). RESULTS: Patients who expressed a greater level of concern about the severity, course, and ability to exert control over one's illness (i.e., illness perception) and who reported a greater level of depression and anxiety symptoms prior to HSCT reported lower HRQOL at both Day 100 and 1 year posttransplant, with a similar degree of association observed at the two follow-up time points. CONCLUSIONS: Our findings suggest that pretransplant perceptions about their illness and negative mood are significant predictors of HRQOL following HSCT. Illness perception, depression, and anxiety are potentially modifiable risk factors for less than optimal outcome after HCSCT and intervention strategies should be explored.

Baseline and follow-up association of the MAX-PC in Men with newly diagnosed prostate cancer.

OBJECTIVE: The objective of this paper is to conduct a prospective, longitudinal study employing the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) to examine the baseline and follow-up association of prostate cancer (PCa)-specific anxiety, health-related quality of life (HRQOL), and PCa aggressiveness in men with newly-diagnosed PCa undergoing prostatectomy at our institution. METHODS: From our prospective PCa registry, we identified a total of 350 men with newly-diagnosed PCa who completed the MAX-PC and the Expanded Prostate Cancer Index Composite (EPIC) at baseline and one-year following surgery. Scores on both measures were compared with clinical measure and demographics using the Wilcoxon Rank Sum, Fisher's exact, and Cochran-Armitage Trend tests. Spearman test was used to assess correlation at between the MAX-PC and EPIC at baseline and one-year. RESULTS: Baseline overall MAX-PC measures were correlated with measures at one-year (r=0.5479, p<0.001). Those reporting high anxiety at one-year were more likely to have Gleason score>6 (p=0.004), T-Stage ≥ 2C disease (p=0.004), and a postoperative prostate-specific antigen (PSA)>0.1 (p=0.002); however, this did not apply to all anxious patients. Baseline EPIC sexual function scores were predictive of follow-up EPIC sexual function scores as well (r=0.5790, p<0.001). Depression was noted as a problem in 16% of patients at follow-up. CONCLUSIONS: Our data suggests that the MAX-PC could be used at baseline as a tool to determine who may benefit from psychological intervention pre-PCa and post-PCa treatment. In terms of individualized medicine, behavioral therapy may be the most beneficial in improving HRQOL for younger patients, those with advanced stage disease, and more specifically those whose anxiety outweighs their actual prognosis.

Integrated smoking cessation and binge drinking intervention for young adults: a pilot efficacy trial.

Alcohol consumption is strongly associated with cigarette smoking in young adults. The primary aim of this investigation was to complete a pilot evaluation of the efficacy of an integrated intervention that targets both cigarette smoking and binge drinking on the cigarette smoking and binge behavior of young adults at 6-month follow-up. Participants were 95 young adult (M=24.3; SD=3.5 years) smokers (≥1 cigarettes per day) who binge drink (≥1 time per month) and who were randomly assigned to standard treatment (n=47) involving six individual treatment visits plus eight weeks of nicotine patch therapy or the identical smoking cessation treatment integrated with a binge drinking intervention (integrated intervention; n=48). Using an intent-to-treat analysis for tobacco abstinence, at both 3 month end of treatment and 6 month follow-up, more participants who received integrated intervention were biochemically confirmed abstinent from tobacco than those who received standard treatment at 3 months (19% vs. 9%, p=0.06) and 6 months (21% vs. 9%, p=0.05). At 6 months, participants who completed the study and who received integrated intervention consumed fewer drinks per month (p<0.05) and number of binge drinking episodes per month (p<0.05) than those who received standard treatment. Preliminary data supports that integrated intervention enhances smoking cessation and reduces binge drinking compared to standard treatment.

Evaluation of the association of prostate cancer-specific anxiety with sexual function, depression and cancer aggressiveness in men 1 year following surgical treatment for localized prostate cancer.

BACKGROUND: Cancer-specific anxiety (CSA) can affect treatment decisions and is common in men following surgery for prostate cancer (PCa). We hypothesized that CSA is also associated with factors affecting quality of life. Herein, we examine the association of CSA with psychosocial factors and PCa aggressiveness in a cohort of men 1 year after prostatectomy for localized PCa. METHODS: From our prospective PCa Registry, we identified 365 men who underwent prostatectomy for localized PCa who completed the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) and Expanded Prostate Cancer Index Composite at 1-year follow-up. We evaluated the association of scores on the MAX-PC with demographics, clinicopathologic features, sexual function, and depression scores using Wilcoxon Rank Sum and Kendall's tau correlation tests. RESULTS: Higher scores on the MAX-PC (i.e., higher anxiety) are associated with younger age (p < 0.01) and non-Caucasian race (p < 0.01). Men with higher MAX-PC scores also reported poor sexual satisfaction/function (p < 0.01) and increasing depressive symptoms (p < 0.01). Finally, although higher anxiety is associated with several pathologic features of aggressiveness (stage, positive margins, PSA at 1 year; all p-values < 0.01), we noted several men with clinically indolent disease who reported significant anxiety. CONCLUSIONS: Our data suggest that higher levels of CSA are associated with poor sexual function and increased depressive symptoms 1 year after prostatectomy. Moreover, we noted demographic and pathologic features associated with higher CSA as well. If confirmed, our data support development of models to predict men at high risk of CSA following PCa surgery and targeted referral for additional counseling.

Quality of life of patients undergoing surgical treatment for newly-diagnosed, clinically localized renal cell carcinoma.

This investigation sought to evaluate the psychological needs of individuals (N = 28) undergoing nephrectomy for newly diagnosed, localized renal cell carcinoma (RCC) using a mixed qualitative-quantitative approach. The qualitative component consisted of individual semi-structured interviews ≥4 weeks postnephrectomy. The quantitative component involved standardized measures assessing anxiety, depressive symptoms, psychological distress, and general and disease specific quality of life (QOL) prior to nephrectomy and at 4, 12, and 24 weeks postnephrectomy. This investigation provides a unique view of the experiences and needs of persons undergoing surgery for newly diagnosed, localized RCC and reveals that these individuals experience fatigue, anxiety, and depressive symptoms.

A pilot investigation of a multidisciplinary quality of life intervention for men with biochemical recurrence of prostate cancer.

OBJECTIVE: This pilot project evaluated the acceptability and estimated the effect size of a tailored multidisciplinary quality of life (MQOL) intervention for men who have biochemical recurrence of prostate cancer. METHODS: Participants included 57 men with localized prostate cancer with biochemical recurrence (Median=76 years; 89% White). Participants were randomized to wait list control which offered the intervention upon conclusion of the study (n=27) or to an eight-session group-based, MQOL (n=30) intervention. Assessments were completed at baseline, end of treatment, and 6 months post-treatment. RESULTS: MQOL was acceptable as indicated by favorable participant retention (100% retained), treatment compliance (97% attended > 6 treatment sessions), and high ratings of helpfulness (80% rated helpfulness > 4 on 5-point scale). MQOL had a favorable impact on the mental health composite score of the Short Form-36 at the end of treatment but not at 6 months (effect size=0.52 and -0.04); health-related QOL as measured by the Functional Assessment of Cancer Therapy-Prostate at the end of treatment and 6 months (effect size=0.14 and 0.10); and prostate cancer specific anxiety as measured by the Memorial Anxiety Scale for Prostate Cancer at the end of treatment and 6 months (effect size=0.45 and 0.23). CONCLUSIONS: This pilot project provides preliminary data supporting the premise that a tailored behaviorally based MQOL intervention for men with biochemical recurrence of prostate cancer is acceptable to men and might reduce prostate cancer specific anxiety and enhance QOL. Further research examining the efficacy of this intervention in a larger randomized trial is warranted.

Brief integrative multiple behavior intervention effects and mediators for adolescents.

This study evaluated the efficacy of a brief integrative multiple behavior intervention and assessed risk factors as mediators of behavioral outcomes among older adolescents. A randomized controlled trial was conducted with participants randomly assigned to either a brief intervention or standard care control with 3-month follow-up. A total of 479 students attending two public high schools participated. Participants receiving the intervention showed a significant reduction in quantity × frequency of alcohol use, and increases in fruit and vegetable consumption and frequency of relaxation activities, compared to those receiving the control, P's = .01. No effects were found on cigarette and marijuana use, exercise and sleep. Effect sizes were small with alcohol use cessation effects reaching medium size. Intervention effects were mediated by changes in peer influenceability for alcohol use, and self-efficacy and self-image for health promoting behaviors. Findings suggest that the brief intervention resulted in health risk and promoting behavior improvements for adolescents, with outcomes mediated by several risk factors.

Integrated smoking cessation and binge drinking intervention for young adults: a pilot investigation.

BACKGROUND: Alcohol consumption is strongly associated with cigarette smoking in young adults. PURPOSE: The aim of this study was to evaluate the acceptability and estimate the magnitude of the effect of a novel-integrated smoking cessation and binge-drinking intervention for young adults compared with standard treatment control. METHODS: Participants were 41 young adult smokers (≥ 10 cigarettes per day) who regularly (≥ 2 times per month) binge drank who were randomly assigned to standard treatment (n = 19) involving eight individual treatment visits plus 8 weeks of nicotine patch therapy or the identical smoking cessation treatment integrated with a binge-drinking intervention (integrated intervention; n = 22). RESULTS: Participants rated integrated intervention as highly acceptable as indicated by 100% of participants rating helpfulness as 5 on 5-point scale. Using an intent-to-treat analysis for tobacco abstinence, at both week 12 end of treatment and week 24 follow-up, more participants who received integrated intervention were biochemically confirmed abstinent from tobacco than those who received standard treatment (36% vs. 21% at week 12; 23% vs. 11% at week 24). At week 24, change from baseline in binge-drinking episodes, drinks consumed, and drinking days between treatment groups were similar (intent-to-treat analysis was not used for alcohol data). CONCLUSIONS: Preliminary data support the intriguing possibility that integrated intervention may enhance smoking cessation and reduce binge drinking.

The association of alcohol consumption with tobacco use in Black and White college students.

This study explored the association of alcohol and tobacco use among college students. A survey was administered in 2004 to 2,189 Black and White students from the southeastern United States. The prevalence of alcohol and tobacco use, tobacco use characteristics according to level of alcohol consumed, and percentage of students using tobacco according to type of alcoholic beverages consumed were evaluated. The interaction of race and gender with alcohol and tobacco use was explored. Our findings extend prior investigations that have found alcohol use associated with smoking and suggest attention be paid to the relation of alcohol to other forms of tobacco. Racial and gender differences are highlighted. This study was funded by Mayo Clinic. The study's limitations were noted.

A brief image-based prevention intervention for adolescents.

The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects. In a clinical trial, 416 high school-age adolescents were randomized to either the brief intervention or usual care control, with data collected at baseline and 3-month follow-up. The brief intervention consisted of a tailored in-person communication and a series of parent/guardian print materials based on the behavior-image model. Health behavior goal setting increased for participants receiving the brief intervention, with an effect size in the small range (d = 0.33). Overall effect sizes for cigarette smoking frequency and quantity and alcohol use frequency and quantity were small (ds = 0.16-0.21) and in favor of the brief intervention. However, adolescents reporting current substance use who received the brief intervention reduced their frequency and heavy use of alcohol, frequency and quantity of cigarette smoking, and reported fewer alcohol/drug problems, with larger effects ranging from small to approaching medium in size (ds = 0.32-0.43, ps < .01). This study suggests that brief image-based messages may increase health behavior goal setting and reduce substance use, particularly among drug-using older adolescents.

Are effects from a brief multiple behavior intervention for college students sustained over time?

OBJECTIVE: This study examined whether 3-month outcomes of a brief image-based multiple behavior intervention on health habits and health-related quality of life of college students were sustained at 12-month follow-up without further intervention. METHODS: A randomized control trial was conducted with 303 undergraduates attending a public university in southeastern US. Participants were randomized to receive either a brief intervention or usual care control, with baseline, 3-month, and 12-month data collected during fall of 2007. RESULTS: A significant omnibus MANOVA interaction effect was found for health-related quality of life, p=0.01, with univariate interaction effects showing fewer days of poor spiritual health, social health, and restricted recent activity, p's<0.05, for those receiving the brief intervention. Significant group by time interaction effects were found for driving after drinking, p=0.04, and moderate exercise, p=0.04, in favor of the brief intervention. Effect sizes typically increased over time and were small except for moderate size effects for social health-related quality of life. CONCLUSION: This study found that 3-month outcomes from a brief image-based multiple behavior intervention for college students were partially sustained at 12-month follow-up.

Brief multiple behavior health interventions for older adolescents.

PURPOSE: This study examined whether brief intervention strategies founded on the Behavior-Image Model and addressing positive images of college and career success could be potentially efficacious in impacting multiple health habits of high-risk adolescents transitioning into adulthood. DESIGN: Participants were stratified by grade level and drug use and individually randomized to one of the three Plan for Success interventions, with baseline and 1 month postintervention data collections. SETTING: A large, relatively diverse suburban school in northeast Florida. SUBJECTS: A total of 375 11th and 12th grade students participated during the spring semester 2006. INTERVENTION: Three interventions studied included: (1) Goal Survey, (2) Goal Survey plus Contract, or (3) Goal Survey plus Consult. MEASURES: Outcome measures included multiple health risk, health promotion, and personal development behaviors, as well as image and belief measures. ANALYSIS: Repeated-measures MANOVAs and ANOVAs were used to examine intervention effects. RESULTS: MANOVAs were significant for alcohol use, F(4,328) = 6.33, p = .001; marijuana use, F(4,317) = 3.72, p = .01; exercise, F(3,299 = 4.28, p = .01; college preparation, F(2,327) = 6.26, p = .001; and career preparation, F(2,329) = 6.17, p = .001, with most behaviors improving over time, whereas group-by-time interaction effects were found for nutrition habits, F(6,652) = 2.60, p = .02; and career preparation, F(4,658) = 3.26, p = .01, favoring the consultation. CONCLUSION: Brief interventions founded on the Behavior-Image Model may have potential to improve selected health and personal development habits among older adolescents.

Efficacy of a brief image-based multiple-behavior intervention for college students.

BACKGROUND: Epidemiologic data indicate most adolescents and adults experience multiple, simultaneous risk behaviors. PURPOSE: The purpose of this study is to examine the efficacy of a brief image-based multiple-behavior intervention (MBI) for college students. METHODS: A total of 303 college students were randomly assigned to: (1) a brief MBI or (2) a standard care control, with a 3-month postintervention follow-up. RESULTS: Omnibus treatment by time multivariate analysis of variance interactions were significant for three of six behavior groupings, with improvements for college students receiving the brief MBI on alcohol consumption behaviors, F(6, 261) = 2.73, p = 0.01, marijuana-use behaviors, F(4, 278) = 3.18, p = 0.01, and health-related quality of life, F(5, 277) = 2.80, p = 0.02, but not cigarette use, exercise, and nutrition behaviors. Participants receiving the brief MBI also got more sleep, F(1, 281) = 9.49, p = 0.00, than those in the standard care control. CONCLUSIONS: A brief image-based multiple-behavior intervention may be useful in influencing a number of critical health habits and health-related quality-of-life indicators of college students.

Effect of expressive writing as a treatment adjunct for reducing smoking cessation related weight gain in young adult smokers.

This investigation evaluated the effect of expressive writing on weight gain in young adults being treated for smoking cessation. This study was conducted between July 2001 and June 2005. Participants (N = 196) ages 18-24 years (M = 20.8, SD = 2.0 years), who were recruited from a large city in the southeastern United States were randomized to brief office intervention or expressive writing plus brief office intervention. The sample was 56% female, 93% Caucasian, smoked a mean of 18.1 cigarettes per day (SD = 6.1), and had a mean body mass index of 24.9 (SD = 5.6). Participants who received the expressive writing plus brief office intervention gained significantly less weight than those receiving the brief office interventions from week 3 to 24, but did not significantly differ at week 52. A limitation of this investigation relates to the fact that the impact of expressive writing on weight was an unanticipated treatment effect that was evaluated in post-hoc analyses. Although the findings suggest that expressive writing holds promise as a treatment adjunct to decrease weight gain associated with smoking cessation, further research is warranted.

Change in perceived stress, partner support, decisional balance, and self-efficacy following residential nicotine dependence treatment.

The primary aim was to examine the effect of an eight day residential treatment for nicotine dependence on perceived stress, partner support, decisional balance, and self-efficacy for stopping smoking. Whether these variables predicted six months post treatment abstinence following residential treatment was also examined. Participants included 170 adult cigarette smokers. Perceived stress, partner support, decisional balance, and self-efficacy for stopping smoking were assessed on the first and last day of treatment. In addition, six month continuous tobacco abstinence was evaluated. Residential treatment was found to produce significant (p < 0.001) treatment changes in all psychosocial factors except one aspect of decisional balance (i.e., cons of smoking). Psychosocial factors did not predict six month tobacco abstinence. Only age (p = 0.014) and history of mental illness (p = 0.012) were found to predict six month continuous abstinence following residential treatment. This study provides new information about how residential treatment impacts psychosocial factors considered to be important predictors of tobacco abstinence in outpatient settings.

Development and feasibility of a parental support intervention for adolescent smokers.

The aim of this investigation was to develop and evaluate the feasibility and acceptability of a parental support intervention. A new measure of perceived parental support for stopping smoking was also developed. The sample included 59 adolescent-parent pairs recruited from a mid-sized Midwestern town during 2000-2003. The mean +/- SD age of the participants (32 males, 27 females) was 16.3 +/- 0.9 (range 14-18) years and 86% were Caucasian, 7% American Indian, 5% African American, and 2% Hispanic. Participants were randomized to parental support or minimum behavioral intervention. Severity of nicotine dependence was evaluated using the Fagerström Tolerance Questionnaire, and perceived social support was evaluated using the Family Environment Scale and the new measure of perceived parent support for stopping smoking that was developed as part of this investigation. Treatment attendance, adherence, and acceptability were also evaluated. The parental support intervention was feasible but not superior to the minimum behavioral intervention with respect to attendance, retention, or change in support. This study expands on the knowledge of treating adolescent smokers and presents a new assessment measure. The study's limitations are noted. This investigation was funded by NICHHD.

Quality of life of men with biochemical recurrence of prostate cancer.

This investigation evaluated the psychological needs of men (n = 28) with biochemical recurrence of prostate cancer. A mixed qualitative-quantitative approach was employed. The qualitative component consisted of focus groups and the quantitative component included administration of standardized measures assessing quality of life (QOL), anxiety, and mood. Participants reported substantial anxiety and other negative moods secondary to prostate cancer. Responses form the quantitative instruments suggest participants experience significant health problems specific to prostate cancer, while their general QOL is superior to other chronically ill medical populations. In contrast to the qualitative data, participants rated their mood as favorable on the quantitative measures. Data were used to guide development of a novel QOL intervention.

Differences among Black and White young adults on prior attempts and motivation to help a smoker quit.

This study assessed differences between Black and White young adults on prior attempts and motivation to help a smoker quit. A total of 1,621 undergraduates (912 Black, 709 White; 63% female) ages 18-24 years completed a cross-sectional survey. Overall, 54% reported they had previously tried to help someone else stop smoking (52% among Blacks vs. 58% among Whites, p=0.016). Among nonsmokers who indicated they were close to a smoker whom they thought should quit, Blacks were most often concerned about a family member whereas Whites endorsed concern most often for a friend (p<0.001). Blacks were more likely than Whites to indicate interest in learning ways to help this smoker to quit (p<0.001) but there was no significant differences on motivation level (46% of Blacks and 42% of Whites reported they were "very" or "extremely" motivated to help this person quit). After adjusting for gender, the results remained unchanged. Tobacco control efforts could focus on optimizing these supportive behaviors as well as expressed motivation and interest in helping a smoker to quit among young adult nonsmokers.

Expressive writing as a smoking cessation treatment adjunct for young adult smokers.

This investigation evaluated the efficacy of expressive writing as a treatment adjunct to a brief office smoking cessation intervention plus nicotine patch therapy in young adults. Participants aged 18-24 years were randomized to a brief office intervention (n=99) or to an expressive writing plus brief office intervention (n=97). Both conditions received four individual visits plus 6 weeks of nicotine patch therapy, which began on the quit date following the week 2 visit. Participants in the expressive writing plus brief intervention condition wrote for 2 consecutive days before and 3 consecutive days after the quit date. The brief office intervention group completed a control writing assignment. At end of treatment (week 8), biochemically confirmed 7-day point-prevalence abstinence for the expressive writing plus brief office intervention condition was significantly greater than for the brief office condition (33% vs. 20%, p=.043, OR=2.0, 95% CI=1.0-3.7, from a logistic regression adjusting for gender). At 24 and 52 weeks, abstinence rates were similar for the brief office intervention versus expressive writing plus brief office intervention (12% vs. 11% at 24 weeks; 11% vs. 11% at 52 weeks). The results suggest that expressive writing has promise as a smoking cessation treatment adjunct for young adults. Lengthier interventions or the use of boosters should be tested to extend treatment effects. However, participants reported a low level of enthusiasm for the expressive writing, which may be a barrier to implementing it over a longer time frame. Therefore, other modes of delivering expressive writing to young adult cigarette smokers should be explored.