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2.
Health Psychol ; 38(5): 403-409, 2019 May.
Article in English | MEDLINE | ID: mdl-31045423

ABSTRACT

OBJECTIVE: This study outlined the implementation and feasibility of delivering PROMIS® computer adaptive tests (CATs) using a web-based method to evaluate the impact of a technological adaptation of Cognitive-Behavioral Stress Management (CBSM) on the psychosocial functioning of men with advanced prostate cancer (APC) undergoing hormone therapy. METHOD: Patients were randomized to a CBSM group intervention (n = 95) or a health promotion (HP) attention-matched control condition (n = 97). Participants attended all sessions via video conference using tablets, and completed PROMIS® computer adaptive tests (CATs) assessing anxiety, depression, fatigue, pain interference, and physical function weekly during the 10-week intervention. RESULTS: Assessment completion rates >50% at week 1 and week 10 demonstrated moderate feasibility of repeatedly administering PROMIS® CATs using a web-based method. Multilevel modeling demonstrated no significant group-by-time interactions from week 1 to week 10 for any of the assessed PROMIS® domains adjusting for sociodemographic and medical covariates. However, simple effects demonstrated decreases in PROMIS® anxiety scores from week 1 to 10 for both groups. Results also demonstrated significant relationships of medical variables to psychosocial functioning across time points. CONCLUSIONS: Results highlight the feasibility and benefits of utilizing PROMIS® CATs to repeatedly assess psychosocial functioning using a web-based method and indicate that web-based interventions may be effective for decreasing psychosocial distress and adverse symptoms among men with APC undergoing hormone therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Subject(s)
Patient Reported Outcome Measures , Prostatic Neoplasms/diagnosis , Aged , Humans , Internet , Male , Prostatic Neoplasms/pathology
5.
Transl Behav Med ; 9(4): 629-637, 2019 07 16.
Article in English | MEDLINE | ID: mdl-30285186

ABSTRACT

Relative to non-Hispanic whites (NHW), black men are disproportionately affected by prostate cancer (PC) incidence, have poorer PC outcomes, and report greater compromises in health-related quality of life. Despite these challenges, black men are underrepresented in psychosocial cancer research, possibly due to limited access to supportive oncology programs. The purpose of this article is to examine the acceptability and efficacy for reducing disease-specific distress of a tablet-delivered psychosocial intervention for older men with advanced PC (APC) and explore differences by race. Men with APC (N = 192, 37.5% black, age M = 68.84 years) were randomized to 10-week Cognitive Behavioral Stress Management (CBSM) or attention-control Health Promotion (HP), both delivered via tablets. Assessments occurred at baseline in person, weekly during the 10-week program via tablets, and at 6 and 12 months in person. Weekly session evaluations and postprogram exit surveys assessed acceptability. Efficacy was assessed with a measure of PC-anxiety validated with racially diverse PC patients using linear mixed effects modeling. Study retention and group attendance did not differ by race. CBSM and HP were both acceptable among older APC patients. Black men rated both conditions more favorably than NHW men. Men in CBSM (vs. HP) reported greater reductions in PC-anxiety at 6 months (not sustained at 12 months). Black men in CBSM reported greater decreases in PC-anxiety over time compared with all other groups. Tablet-delivered CBSM and HP were acceptable for black and NHW APC patients, although black men rated both conditions more favorably. Black men reported a unique intervention benefit related to reduced disease-specific distress.


Subject(s)
Anxiety/therapy , Black or African American/psychology , Computers, Handheld/statistics & numerical data , Prostatic Neoplasms/psychology , Black or African American/statistics & numerical data , Aged , Anxiety/ethnology , Anxiety/psychology , Case-Control Studies , Cognitive Behavioral Therapy/instrumentation , Counseling/trends , Efficiency, Organizational/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/ethnology , Psychosocial Support Systems , Quality of Life/psychology , Surveys and Questionnaires , Telemedicine/instrumentation
6.
Transl Behav Med ; 9(4): 638-645, 2019 07 16.
Article in English | MEDLINE | ID: mdl-29986120

ABSTRACT

Hispanic breast cancer survivors (BCS) are at high risk for experiencing poor health-related quality of life (HRQoL) after completion of active breast cancer treatment. Therefore, there is a need to develop culturally tailored interventions for Hispanic BCS. To date, there have been limited interventions that have demonstrated that increasing cancer-related knowledge, self-efficacy in communication, and self-management skills can improve HRQoL among Hispanic BCS. These interventions have been delivered in person or by phone, which may be burdensome for Hispanic BCS. To facilitate intervention delivery, we developed My Guide, a Smartphone application aimed at improving HRQoL among Hispanic BCS. The purpose of the current study is to describe the feasibility results of a 4-week pilot trial testing My Guide among Hispanic BCS. Twenty-five women enrolled in the study (75% recruitment rate) and 22 women were retained (91.6% retention rate). Mean time spent using My Guide across the 4 weeks was 9.25 hr, and mean score on the satisfaction survey was 65.91 (range 42-70), in which higher scores reflect greater satisfaction. Participants' scores on the Breast Cancer Knowledge Questionnaire significantly improved from study baseline (M = 9.50, SD = 2.92) to the postintervention assessment (M = 11.14, SD = 2.66), d = 0.59. Participants' HRQoL scores improved over the course of 4 weeks, but these improvements were not statistically significant. Overall, My Guide was feasible and acceptable. Future studies will assess the preliminary efficacy of My Guide in improving HRQoL in a larger, randomized trial of Hispanic BCS.


Subject(s)
Breast Neoplasms/ethnology , Breast Neoplasms/therapy , Cancer Survivors/psychology , Hispanic or Latino/psychology , Smartphone/instrumentation , Breast Neoplasms/mortality , Feasibility Studies , Female , Humans , Middle Aged , Mobile Applications/supply & distribution , Pilot Projects , Quality of Life , Self Efficacy , Self-Management/education , Self-Management/psychology , Surveys and Questionnaires , Telephone/instrumentation , Telephone/statistics & numerical data
7.
Psychooncology ; 28(2): 386-393, 2019 02.
Article in English | MEDLINE | ID: mdl-30501015

ABSTRACT

BACKGROUND: Social comparisons (SCs) are common among cancer patients, but their prospective associations are not well understood. This study examined concurrent and prospective relationships of SCs with health-related quality of life (HRQOL) and depressive symptoms during the first year of breast cancer treatment. METHODS: Nonmetastatic breast cancer patients (N = 240) enrolled in a larger intervention trial reported on the frequencies of SCs postsurgery (T1) and 6 months later (T2). HRQOL and depressive symptoms were assessed at T1, T2, and 12 months after T1 (T3). Path analysis via structural equation modeling was used to assess three models relating SCs to HRQOL and depressive symptoms from T1-T2, T1-T3, and T2-T3, controlling for stage of disease, intervention condition, and dispositional optimism. RESULTS: Upward contrast SCs were associated with poorer concurrent HRQOL at T1 and T2, and with more concurrent depressive symptoms at T2. However, upward contrast SC at T1 predicted better T2 and T3 HRQOL. Upward identification SC at T1 predicted more T2 depressive symptoms, and at T2 was associated with poorer concurrent HRQOL and more concurrent depressive symptoms. Downward identification SCs at T1 were associated with poorer concurrent HRQOL. Downward identification SCs at T2 predicted poorer T3 HRQOL. CONCLUSIONS: Upward SCs were related to compromised concurrent psychosocial well-being, but prospective effects varied by the interpretation of the comparison (ie, contrast vs identification). Findings have implications for the development and deployment of group-based psychosocial interventions during the early phases of survivorship, during which opportunities for SC are prevalent.


Subject(s)
Breast Neoplasms/psychology , Depression/psychology , Optimism/psychology , Quality of Life/psychology , Social Perception , Adult , Female , Humans , Male , Middle Aged , Prospective Studies
8.
J Psychosom Res ; 113: 52-57, 2018 10.
Article in English | MEDLINE | ID: mdl-30190048

ABSTRACT

OBJECTIVE: Cognitive-behavioral stress management (CBSM) improves adaptation to primary treatment for breast cancer (BCa), evidenced as reductions in distress and increases in positive affect. Because not all BCa patients may need psychosocial intervention, identifying those most likely to benefit is important. A secondary analysis of a previous randomized trial tested whether baseline level of cancer-specific distress moderated CBSM effects on adaptation over 12 months. We hypothesized that patients experiencing the greatest cancer-specific distress in the weeks after surgery would show the greatest CBSM-related effects on distress and affect. METHODS: Stages 0-III BCa patients (N = 240) were enrolled 2-8 weeks after surgery and randomized to either a 10-week group CBSM intervention or a 1-day psychoeducational (PE) control group. They completed the Impact of Event Scale (IES) and Affect Balance Scale (ABS) at study entry, and at 6- and 12- month follow-ups. RESULTS: Latent Growth Curve Modeling across the 12-month interval showed that CBSM interacted with initial cancer-related distress to influence distress and affect. Follow-up analyses showed that those with higher initial distress were significantly improved by CBSM compared to control treatment. No differential improvement in affect or intrusive thoughts occurred among low-distress women. CONCLUSION: CBSM decreased negative affect and intrusive thoughts and increases positive affect among post-surgical BCa patients presenting with elevated cancer-specific distress after surgery, but did not show similar effects in women with low levels of cancer-specific distress. Identifying patients most in need of intervention in the period after surgery may optimize cost-effective cancer care.


Subject(s)
Breast Neoplasms/psychology , Cognitive Behavioral Therapy/methods , Psychotherapy/methods , Stress, Psychological/psychology , Adolescent , Adult , Aged , Female , Humans , Middle Aged , Young Adult
9.
Can Fam Physician ; 64(2): 88-89, 2018 02.
Article in French | MEDLINE | ID: mdl-29449228
10.
Can Fam Physician ; 64(2): 91-92, 2018 02.
Article in English | MEDLINE | ID: mdl-29449229
11.
Am J Hosp Palliat Care ; 35(5): 788-793, 2018 May.
Article in English | MEDLINE | ID: mdl-29084448

ABSTRACT

BACKGROUND: Sleep disturbance is a common complaint of patients with cancer and is well established in both pain conditions and post-traumatic stress disorder (PTSD). An estimated one-third of patients with cancer develop symptoms of PTSD at some point in their treatment. However, few studies have evaluated the contributions of PTSD and sleep disturbance to pain processes in cancer populations. The current study used mediation models to test the hypothesis that sleep disturbance would mediate the relationships between PTSD symptoms and pain intensity and PTSD symptoms and pain interference in a sample of patients with cancer. METHODS: A cross-sectional, retrospective chart review was conducted of the electronic medical records of 85 adult patients with cancer (89.4% female; 59% white; 42% metastatic) who sought individual psychosocial support services at our institution. RESULTS: Post-traumatic stress disorder symptoms, sleep disturbance, pain intensity, and pain interference were all positively correlated ( P < .01). Clinical levels of PTSD symptoms were reported by 30% to 60% of the sample. Even after controlling for metastatic disease, race, and cancer type, sleep disturbance mediated the relationships between PTSD symptoms and pain intensity ( B = 0.27; 95% CI: 0.10-0.44) and PTSD symptoms and pain-related interference ( B = 0.58; 95% CI: 0.28-0.87). CONCLUSIONS: The relationships among PTSD symptoms, pain intensity, and pain interference could be explained by co-occurring sleep disturbance. Given the high frequency of PTSD symptoms among patients with cancer and PTSD's known links to sleep problems and pain, clinicians should be attentive to the role that traumatogenic processes may play in eliciting sleep and pain-related complaints among patients with cancer.


Subject(s)
Neoplasms/epidemiology , Neoplasms/psychology , Pain/epidemiology , Sleep Wake Disorders/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Adult , Age Factors , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , Sex Factors , Socioeconomic Factors
12.
Expert Rev Qual Life Cancer Care ; 3(2-3): 35-46, 2018.
Article in English | MEDLINE | ID: mdl-31020045

ABSTRACT

INTRODUCTION: A critical challenge in oncology is interpreting clinical trial results to inform clinical decision making. Clinical trials typically focus on overall survival (OS) and progression-free survival (PFS) as primary endpoints, which do not reflect early signs of meaningful patient benefit or harm. Cancer symptom response (CSR) can provide information about early treatment response, and studies show that CSR predicts long-term health outcomes. AREAS COVERED: CSR requires careful consideration of its measurement and interpretation to facilitate integration into clinical practice. We describe considerations for the evaluation, analysis, and interpretation of CSR in clinical trials. To illustrate the potential clinical value of CSR, we performed a retrospective analysis of a three-arm randomized cooperative-group clinical trial. EXPERT COMMENTARY: Evaluation of CSR provides a meaningful assessment of early cancer treatment effects. It can act as an early signal of disease progression and death and thus can identify which patients with stable disease will have a more favorable prognosis. Future research will include development of methods for more accurate assessment of CSR, reduction of the number of symptoms used as signals for disease progression or survival by tumor type, and statistical methods that effectively correct for missing data and informative censoring.

13.
Breast Cancer Res Treat ; 165(1): 169-180, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28560656

ABSTRACT

PURPOSE: Satisfaction with social resources, or "social well-being," relates to better adaptation and longer survival after breast cancer diagnosis. Biobehavioral mechanisms linking social well-being (SWB) to mental and physical health may involve inflammatory signaling. We tested whether reports of greater SWB were associated with lower levels of pro-inflammatory and pro-metastatic leukocyte gene expression after surgery for non-metastatic breast cancer. METHODS: Women (N = 50) diagnosed with non-metastatic (0-III) breast cancer were enrolled 2-8 weeks after surgery. SWB was assessed with the social/family well-being subscale of the FACT-B. Leukocyte gene expression for specific pro-inflammatory (cytokines, chemokines, and COX-2) and pro-metastatic genes (e.g., MMP9) was derived from microarray analysis. RESULTS: Multiple regression analyses controlling for age, stage of disease, days since surgery, education, and body mass index (BMI) found higher levels of SWB related to less leukocyte pro-inflammatory and pro-metastatic gene expression (p < 0.05). Emotional well-being, physical well-being, and functional well-being did not relate to leukocyte gene expression (p > 0.05). Greater SWB remained significantly associated with less leukocyte pro-inflammatory and pro-metastatic gene expression after controlling for depressive symptoms. CONCLUSIONS: Results have implications for understanding mechanisms linking social resources to health-relevant biological processes in breast cancer patients undergoing primary treatment. CLINICAL TRIAL REGISTRATION NUMBER: NCT01422551.


Subject(s)
Breast Neoplasms/surgery , Inflammation Mediators/immunology , Leukocytes/immunology , Mastectomy , Quality of Life , Social Support , Adult , Aged , Breast Neoplasms/genetics , Breast Neoplasms/immunology , Breast Neoplasms/psychology , Chemokines/genetics , Cross-Sectional Studies , Cyclooxygenase 2/genetics , Cytokines/genetics , Female , Florida , Gene Expression Profiling/methods , Humans , Mastectomy/adverse effects , Matrix Metalloproteinase 9/genetics , Middle Aged , Neoplasm Metastasis , Neoplasm Staging , Oligonucleotide Array Sequence Analysis , Risk Factors , Surveys and Questionnaires , Time Factors , Treatment Outcome
14.
Int Wound J ; 14(6): 955-959, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28326673

ABSTRACT

Calciphylaxis (CPX) is a rare calcifying thrombotic vasculopathy responsible for painful necrotic ulcers, with a high mortality rate, and its management is often difficult. Recently, intravenous infusions of sodium thiosulfate (STS) have shown efficacy. The aim of this study was to assess the efficacy of intralesional STS (IL STS) in four patients. Our aim was to assess the efficacy of IL STS in a prospective mono-centric open study that included four patients with a biopsy-proven cutaneous CPX. Four women (55-84 years old, mean age: 71·2 years) with a uremic (n = 1) or non-uremic CPX (n = 3) and primary hyperparathyroidism induced by teriparatide or after the initiation of oral anti-vitamin K were treated by IL STS (250 mg/ml). The injections were performed around the ulcers, on the active borders, once or twice a week and then at 1-2 weeks intervals. The injected quantity varied from 1·5 to 15 ml. Pain usually improved after two series of injections. Clinical response was visible after 2 weeks. Three patients (75%) healed completely or almost completely. A failure was observed in the last patient who also had lower limb arteriopathy. The main side effect was the pain during injections. IL STS is an interesting alternative therapeutic option in the management of CPX necrotic ulcers with limited side effects. Larger studies are warranted to precisely define its place, its administration procedure and the patients who could benefit from it.


Subject(s)
Antidotes/therapeutic use , Calciphylaxis/drug therapy , Leg Ulcer/drug therapy , Thiosulfates/therapeutic use , Aged , Aged, 80 and over , Female , Humans , Injections, Intralesional , Middle Aged , Prospective Studies
15.
Gen Hosp Psychiatry ; 44: 16-21, 2017.
Article in English | MEDLINE | ID: mdl-28041571

ABSTRACT

BACKGROUND: Mild to moderate depressive symptoms are common during treatment for non-metastatic breast cancer. The goal of this secondary analysis was to determine if depressive symptoms predict clinical outcomes at long-term follow-up. METHODS: From 1998 to 2005, we interviewed 231 women with the Hamilton Rating Scale for Depression who were participating in a psychosocial study 2-10weeks post-surgery for non-metastatic breast cancer (Stage 0-IIIb). We conducted Kaplan Meier (K-M) curves and Cox proportional hazards (PH) models to examine associations between depressive symptoms, overall survival, and disease-free survival at 8-15-year follow-up. RESULTS: A total of 95 women (41.1%) scored in the mild-moderately depressed range. Non-depressed women had longer overall survival (M=13.56years; SE=0.26) than those in the mild/moderate depressed group (M=11.45years; SE=0.40), Log-rank χ2(1)=4.41, p=0.036. Cox PH models, adjusting for covariates, showed comparable results: mild/moderate depressive symptoms hazard ratio=2.56, [95% CI, 1.11 to 5.91], p=0.027. Similar results were observed in a subsample with invasive disease (n=191). Depression category did not predict disease-free survival in the overall or invasive sample. CONCLUSIONS: Screening and referrals for treatment of depressive symptoms, even at subclinical levels, is important early in treatment. A randomized trial is warranted to determine effects of depressive symptoms on clinical outcomes.


Subject(s)
Breast Neoplasms , Depression/psychology , Outcome Assessment, Health Care , Postoperative Period , Adult , Aged , Breast Neoplasms/mortality , Breast Neoplasms/psychology , Breast Neoplasms/surgery , Disease-Free Survival , Female , Follow-Up Studies , Humans , Middle Aged
16.
Psychoneuroendocrinology ; 74: 269-277, 2016 12.
Article in English | MEDLINE | ID: mdl-27689900

ABSTRACT

PURPOSE: Cognitive behavioral stress management (CBSM) is an empirically-validated group-based psychosocial intervention. CBSM is related to decreased self-reported indicators of psychological adversity during breast cancer treatment and greater disease-free survival (DFS) vs. a control condition. This study examined relationships between CBSM, DFS, and a potential biobehavioral pathway linking these variables in breast cancer patients through a gene expression composite representing the leukocyte conserved transcriptional response to adversity (CTRA). DESIGN: Women with stage 0-IIIb breast cancer completed questionnaires and provided blood samples post-surgery. Participants were randomized to 10-week group-based CBSM or a psychoeducation control group and followed at 6 months, 12 months, and median 11 years. In total, 51 participants provided blood data for longitudinal analyses (CBSM n=28; Control n=23). Mixed model analyses examined CBSM effects on 6-12 month changes in CTRA expression (53 indicator genes representing pro-inflammatory, anti-viral and antibody production signaling). Cox regression models assessed the relationship between 6 and 12 month changes in CTRA expression and 11-year DFS. RESULTS: Patients randomized to CBSM showed attenuated 6-12 month change in CTRA gene expression, whereas patients randomized to control showed increased CTRA expression (p=0.014). Average DFS was 5.92 years (SD=3.90). Greater 6-12 month CTRA increases predicted shorter 11-year DFS controlling for covariates (p=0.007). CONCLUSIONS: CBSM attenuated CTRA gene expression during the initial year of breast cancer treatment. In turn, greater increases in CTRA gene expression predicted shorter long-term DFS. These findings identify a biobehavioral oncology pathway to examine in future work.


Subject(s)
Breast Neoplasms/psychology , Cognitive Behavioral Therapy/methods , Leukocytes/metabolism , Neoplasm Recurrence, Local/psychology , Stress, Psychological/therapy , Transcription, Genetic/physiology , Adult , Breast Neoplasms/mortality , Disease-Free Survival , Female , Follow-Up Studies , Humans , Middle Aged , Neoplasm Recurrence, Local/prevention & control , Neoplasm Staging
17.
Psychosom Med ; 78(1): 26-37, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26569533

ABSTRACT

OBJECTIVE: Depression and inflammation may independently promote breast cancer (BCa) disease progression and poorer clinical outcomes. Depression has been associated with increased levels of inflammatory markers in medically healthy individuals and patients with cancer. However, inconsistencies in study time frames complicate interpretation of results within specific cancer types. This study examined relationships between depressive symptoms and inflammation in women with early-stage BCa before beginning adjuvant treatment. METHODS: Women with Stage 0-III BCa were recruited approximately 4 to 8 weeks after surgery. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression, and blood samples were collected to quantify circulating levels of interleukin (IL)-1ß, IL-6, and tumor necrosis factor α (TNF-α) by enzyme-linked immunosorbent assay. Analyses of covariance were used to test for group differences (elevated versus low depressive symptoms) in levels of cytokines. Multiple regression analyses were used to examine relationships between continuous severity of depressive symptoms and levels of cytokines adjusting for relevant biobehavioral covariates. RESULTS: Thirty-six (40%) of 89 patients showed elevated levels of depressive symptoms and, in adjusted models, had marginally higher levels of IL-1ß (mean [M] = 14.49 [95% confidence interval {CI} = 6.11-32.65] versus M = 4.68 [95% CI = 1.96-9.86] and IL-6 [M = 88.74 {95% CI = 33.28-233.96} versus M = 61.52 {95% CI = 27.44-136.40}]) significantly higher levels of TNF-α (M = 17.07 [95% CI = 8.27-34.32] versus M = 6.94 [95% CI = 3.58-12.80]) than did women with low depressive symptoms. Across the spectrum of depressive symptoms, greater magnitude of depressive symptoms was related to greater levels of IL-1ß (ß = 0.06, p = .006, R = 0.25) and TNF-α (ß = 0.06, p = .003, R = 0.27). CONCLUSIONS: Postsurgery and preadjuvant treatment for early-stage BCa, depressive symptoms covary with elevated levels of multiple proinflammatory cytokines. Findings have implications for psychosocial and biological interventions concurrently focusing on depression and inflammation. TRIAL REGISTRATION: NCT01422551.


Subject(s)
Breast Neoplasms/psychology , Depression/epidemiology , Interleukin-1beta/blood , Interleukin-6/blood , Mastectomy , Postoperative Complications/epidemiology , Tumor Necrosis Factor-alpha/blood , Adult , Body Mass Index , Breast Neoplasms/blood , Breast Neoplasms/ethnology , Breast Neoplasms/surgery , Comorbidity , Depression/blood , Depression/ethnology , Depression/etiology , Ethnicity , Fatigue/blood , Fatigue/epidemiology , Fatigue/etiology , Female , Humans , Inflammation/blood , Lymphocyte Count , Mastectomy/psychology , Middle Aged , Postoperative Complications/blood , Postoperative Complications/ethnology , Postoperative Complications/etiology , Socioeconomic Factors
18.
Ethn Health ; 21(5): 411-25, 2016 10.
Article in English | MEDLINE | ID: mdl-26218189

ABSTRACT

OBJECTIVES: Diagnosis of and treatment for breast cancer (BCa) may require psychological adaptation and often involve heightened distress. Several types of social support positively relate to psychological adaptation to BCa, and negative support is associated with poorer adaptation. Although Hispanic women report greater distress than non-Hispanic White (NHW) women after diagnosis of BCa, no studies have examined ethnic differences in types of social support received from varying sources after surgery for BCa. DESIGN: Hispanic (N = 61) and NHW (N = 150) women diagnosed with early-stage BCa self-reported emotional, informational, instrumental, and negative support from five sources. Ethnic differences in levels of social support were compared using multiple regression analysis. RESULTS: When controlling for age, income, days since surgery, and stage of disease in multivariable models there were no ethnic differences in levels of emotional support from any source. Hispanic women reported greater informational support from adult women family members and children and male adult family members than did NHW women. Instrumental support from adult women family members was also greater among Hispanic than NHW women. Hispanic women reported higher negative support from husbands/partners and from children and male adult family members. When the number of years in the USA was controlled, Hispanic women showed greater informational support from adult women family members, children and male adult family members, and friends. Instrumental support from adult women family members remained greater in Hispanic women, but negative support no longer differed. CONCLUSION: Family is a greater source of informational and instrumental support for Hispanic than NHW women. Hispanic women reported higher negative support from male sources than did NHW women. Level of support from different sources may also depend on time spent in the USA. Longitudinal studies are needed to determine whether patterns and sources of social support shift over the course of BCa treatment.


Subject(s)
Breast Neoplasms/psychology , Hispanic or Latino/psychology , Social Support , White People/psychology , Adult , Aged , Breast Neoplasms/surgery , Cancer Care Facilities , Family Health/ethnology , Female , Florida , Friends/ethnology , Friends/psychology , Humans , Male , Middle Aged , Neoplasm Staging , Regression Analysis , Spouses/ethnology , Spouses/psychology
19.
Breast Cancer Res Treat ; 154(2): 319-28, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26518021

ABSTRACT

Non-metastatic breast cancer patients often experience psychological distress which may influence disease progression and survival. Cognitive-behavioral stress management (CBSM) improves psychological adaptation and lowers distress during breast cancer treatment and long-term follow-ups. We examined whether breast cancer patients randomized to CBSM had improved survival and recurrence 8-15 years post-enrollment. From 1998 to 2005, women (N = 240) 2-10 weeks post-surgery for non-metastatic Stage 0-IIIb breast cancer were randomized to a 10-week, group-based CBSM intervention (n = 120) or a 1-day psychoeducational seminar control (n = 120). In 2013, 8-15 years post-study enrollment (11-year median), recurrence and survival data were collected. Cox Proportional Hazards Models and Weibull Accelerated Failure Time tests were used to assess group differences in all-cause mortality, breast cancer-specific mortality, and disease-free interval, controlling for biomedical confounders. Relative to the control, the CBSM group was found to have a reduced risk of all-cause mortality (HR = 0.21; 95 % CI [0.05, 0.93]; p = .040). Restricting analyses to women with invasive disease revealed significant effects of CBSM on breast cancer-related mortality (p = .006) and disease-free interval (p = .011). CBSM intervention delivered post-surgery may provide long-term clinical benefit for non-metastatic breast cancer patients in addition to previously established psychological benefits. Results should be interpreted with caution; however, the findings contribute to the limited evidence regarding physical benefits of psychosocial intervention post-surgery for non-metastatic breast cancer. Additional research is necessary to confirm these results and investigate potential explanatory mechanisms, including physiological pathways, health behaviors, and treatment adherence changes.


Subject(s)
Breast Neoplasms/epidemiology , Breast Neoplasms/psychology , Cognitive Behavioral Therapy , Stress, Psychological/therapy , Adaptation, Psychological , Adult , Biomarkers, Tumor , Breast Neoplasms/diagnosis , Breast Neoplasms/mortality , Breast Neoplasms/therapy , Cause of Death , Cognition , Combined Modality Therapy , Disease Management , Female , Follow-Up Studies , Humans , Middle Aged , Neoplasm Recurrence, Local , Neoplasm Staging , Proportional Hazards Models , Risk Factors
20.
Fatigue ; 3(3): 142-155, 2015.
Article in English | MEDLINE | ID: mdl-26180660

ABSTRACT

OBJECTIVE: Persistent fatigue and depressive symptoms are both highly prevalent among patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) as well as breast cancer survivors. This study aimed to assess and directly compare perceptions of fatigue as highly interfering in one's daily functioning in both patient populations to better understand their relationships with depressed mood. METHODS: Participants were 95 female CFS/ME patients and 67 females who were approximately 5 years post-treatment for stage 0-III breast cancer presenting with clinically elevated fatigue severity. Self-report measures were obtained on participants' fatigue-related interference in daily functioning and fatigue severity as well as depressed mood. Hierarchical regression was used to test effects controlling for relevant demographic, psychosocial, and medical covariates. RESULTS: CFS/ME patients endorsed greater depressed mood and fatigue interference than did fatigued breast cancer survivors, p's<.001. These factors were significantly positively correlated among CFS/ME patients (ß=.36, p<.001), but not the fatigued breast cancer survivors (ß=.18, p=.19). CONCLUSIONS: CFS/ME patients reported elevated fatigue symptoms and depression relative to fatigued breast cancer survivors. In the former group, greater depressed mood was highly and significantly associated with greater fatigue-related inference in daily activities. Potential targets for cognitive behavioral interventions are discussed.

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