A scoping review of caregiver burden during allogeneic HSCT: lessons learned and future directions.

The extant literature documents burden among caregivers of patients undergoing a hematopoietic stem cell transplantation (HSCT), but little is known about the burden of caregivers of patients receiving outpatient and homebound HSCTs. This scoping study sought to evaluate what is known about the burden of the increasing number of adult caregivers of patients receiving outpatient HSCTs and to create practice guidelines for how to best support this vulnerable group. Online databases were searched for studies that evaluated caregiver burden in adult caregivers of HSCT patients since 2010 (the publication date of the most recent systematic review on HSCT caregiver burden). Of the 1271 articles retrieved, 12 met the inclusion criteria, though none specifically examined outpatient or homebound caregivers. Overall, studies corroborated existing literature on the experience of significant burden among HSCT caregivers across the HSCT trajectory, and highlighted the emotional costs of outpatient transplants on caregivers and the need to identify caregivers at high risk for burden early in the transplant process. Future studies of outpatient caregivers should include a comprehensive assessment of burden and seek to identify points along the transplant trajectory at which caregivers are at particular risk for negative outcomes and when intervention is most appropriate.

Barriers to mental health service use among hematopoietic SCT survivors.

This study examined barriers to mental health service use and the demographic, medical and psychosocial correlates of these barriers among hematopoietic SCT (HSCT) survivors. A sample of 253 HSCT survivors who were 1 to 3 years posttransplant completed measures of demographic, physical, psychological and social characteristics as well as a newly modified measure of barriers to mental health service use. Only 50% of distressed HSCT survivors had received mental health services. An exploratory factor analysis of the barriers to mental health service use scale yielded four factors: scheduling barriers, knowledge barriers, emotional barriers and illness-related barriers. Patients with higher social constraints (perceived problems discussing the illness experience with significant others) reported higher levels of all four types of barriers. General distress and transplant-related posttraumatic stress symptoms were positively associated with emotional, knowledge and illness-related barriers to mental health service use, whereas physical and functional well-being were inversely associated with these barriers. Having more knowledge barriers and more emotional barriers predicted a lower likelihood of receiving mental health services, as did lower levels of education and general distress. Results suggest that a significant number of HSCT survivors may benefit from education about mental health services that is tailored to individual barriers.

Social support, intrusive thoughts, and quality of life in breast cancer survivors.

This study explores the moderating effect of social support on the relationship between cancer-related intrusive thoughts and quality of life. Sixty-four breast cancer survivors completed self-report measures of appraisal social support (the disclosure of thoughts and feelings to significant others), cancer-related intrusive thoughts, and quality of life. Controlling for demographic and treatment variables, the negative impact of cancer-related intrusive thoughts on both physical and mental quality of life measures was moderated by appraisal social support. For women with high levels of appraisal support, cancer-related intrusive thoughts had no significant relationship with quality of life. However, for women with low levels of appraisal support, the relationship between cancer-related intrusive thoughts and quality of life was significant and negative. These results suggest that appraisal social support can mitigate the impact of traumatic life events.

Behavioral intervention for cancer treatment side effects.

The use of increasingly aggressive methods of cancer treatment during the last 20 years has brought clinical attention to the need for more effective management of pain, nausea, and other aversive side effects of state-of-the-art cancer therapy. One of the most promising approaches to effective management is nonpharmacologic intervention based on behavioral research and theory. The purpose of this review is to examine the effectiveness of behavioral intervention methods in the control of aversive side effects of cancer treatments. Fifty-four published studies using a variety of research designs were identified for review. Results indicated the following: 1) Behavioral intervention can effectively control anticipatory nausea and vomiting in adult and pediatric cancer patients undergoing chemotherapy; however, the evidence for the efficacy of behavioral intervention to control post-chemotherapy nausea and vomiting is less clear. 2) Behavioral intervention integrating several behavioral methods can ameliorate anxiety and distress associated with invasive medical treatments. 3) Although a variety of behavioral methods have been shown to reduce acute treatment-related pain, there is increasing evidence that these methods are not equally effective. Hypnotic-like methods, involving relaxation, suggestion, and distracting imagery, hold the greatest promise for pain management. Unfortunately, research is scant on the use of behavioral intervention to control prolonged pain associated with invasive medical procedures. It is clear that the application of behavioral theory and methods has an important place in the care of patients undergoing invasive cancer treatments.

Global meaning and psychological adjustment among survivors of bone marrow transplant.

The purpose of the present study was to examine global meaning (i.e. the belief that life has purpose and coherence) and psychological adjustment in survivors of bone marrow transplantation (BMT). Eighty-five survivors of BMT participated in a telephone interview. Regression analyses demonstrated that after controlling for physical functioning, stressor severity, and gender, global meaning was inversely related to global psychological distress and BMT-related psychological distress (i.e. posttraumatic stress disorder-like symptoms related to the cancer treatment). Global meaning was also positively related to mental health aspects of quality of life (e.g. emotional functioning and social functioning). These findings suggest that global meaning may be an important factor in the psychological adjustment of BMT survivors.

Anxiety and depression in mothers of children undergoing bone marrow transplant: symptom prevalence and use of the Beck depression and Beck anxiety inventories as screening instruments.

This study examined anxiety and depressive symptoms among 115 mothers of children undergoing bone marrow transplant and evaluated the ability of the Beck Anxiety Inventory (BAI; A. T. Beck, N. Epstein, et al., 1988) and the Beck Depression Inventory (BDI; A. T. Beck, 1978) to serve as screening tools for assessing generalized anxiety disorder (GAD), panic disorder (PD), and major depressive disorder (MDD). Mothers with BAI or BDI scores greater than or equal to 14 were administered a structured clinical interview. An additional 20% was randomly selected for interview to determine whether the scale cutoff was an accurate screening method. Among the 64 mothers interviewed, 20% received at least I of the 3 diagnoses. Although the BAI did not demonstrate predictive accuracy in assessing GAD and PD, the BDI did in assessing MDD. The results suggest that a subset of mothers may have an anxiety or depressive disorder and that investigators should use caution before using the BAI as a screening instrument for anxiety disorder.

Association of psychological vulnerability factors to post-traumatic stress symptomatology in mothers of pediatric cancer survivors.

The current study investigated whether individual differences in coping style, lifetime experience of traumatic events, perceived social support, and perceived social constraints were associated with symptoms of post-traumatic stress among 72 mothers of children who had successfully completed cancer treatment. Results suggested that more perceived social constraints and less perceived belonging support were associated with significantly more post-traumatic stress symptomatology, and this association was present after controlling for the effects of child age. Monitoring coping style and lifetime traumatic events were not significantly predictive of post-traumatic stress symptoms. The results of this study indicate that a sense of belonging to a social network as well as comfort expressing cancer-related thoughts and feelings to friends and family may play a key role in mothers' long-term adjustment to this extremely difficult life experience.

Intrusive thoughts and psychological distress among breast cancer survivors: global meaning as a possible protective factor.

Previous research has consistently demonstrated a positive association between intrusive thoughts about stressful experiences and psychological distress. The strength of this relation, however, has varied considerably across studies. To examine the possibility that an individual's sense of global meaning (i.e., the existential belief that one's life has purpose and order) may moderate the relation between intrusive thoughts and psychological distress, the authors conducted telephone assessments of 61 women who had survived breast cancer. Results confirmed that the frequency of intrusive thoughts was positively related to psychological distress. Global meaning, moreover, moderated the relation between intrusive thoughts and psychological distress consistent with the authors' hypotheses. Among women with lower global meaning, more frequent intrusive thoughts were associated with higher psychological distress. No association was found between intrusive thoughts and psychological distress among those participants with higher global meaning.

A meta-analysis of hypnotically induced analgesia: how effective is hypnosis?

Over the past two decades, hypnoanalgesia has been widely studied; however, no systematic attempts have been made to determine the average size of hypnoanalgesic effects or establish the generalizability of these effects from the laboratory to the clinic. This study examines the effectiveness of hypnosis in pain management, compares studies that evaluated hypnotic pain reduction in healthy volunteers vs. those using patient samples, compares hypnoanalgesic effects and participants' hypnotic suggestibility, and determines the effectiveness of hypnotic suggestion for pain relief relative to other nonhypnotic psychological interventions. Meta-analysis of 18 studies revealed a moderate to large hypnoanalgesic effect, supporting the efficacy of hypnotic techniques for pain management. The results also indicated that hypnotic suggestion was equally effective in reducing both clinical and experimental pain. The overall results suggest broader application of hypnoanalgesic techniques with pain patients.

Behavioral interventions in the diagnosis, treatment and rehabilitation of children with cancer.

Behavioral interventions used to reduce distress and increase cooperation in children undergoing cancer treatment incorporate: contingency management, cognitive/attentional distraction, hypnosis, systematic desensitization, modeling and behavioral rehearsal. In most cases clinical interventions integrate these procedures into a multimodal intervention package. Although in most behavioral interventions the 'therapist' is a nurse, social worker or child psychologist; parents often take an active role in behavioral intervention. Early return to school can 'normalize' the child's life in the midst of coping with cancer and can promote optimal rehabilitation. More research is needed on the integration of behavioral methods with other therapeutic methods (e.g., pharmacologic). Indeed, research in this area of pediatric oncology must be continuously updated as advances in other areas may affect clinical decisions regarding preferred psychosocial intervention methods.

Validation of the PTSD Checklist-Civilian Version in survivors of bone marrow transplantation.

Life-threatening illness now qualifies as a precipitating stessor for posttraumatic stress disorder (PTSD). We examined the validity of the PTSD Checklist-Civilian Version (PCL-C; Weathers, Litz, Herman, Juska, & Keane, 1993), a brief 17-item inventory of PTSD-like symptoms, in a sample of 111 adults who had undergone bone marrow transplantation an average of 4.04 years previously. Exploratory factor analysis of the PCL-C identified four distinct patterns of symptom responses: Numbing-Hyperarousal, Dreams-Memories of the Cancer Treatment, General Hyperarousal, Responses to Cancer-Related Reminders and Avoidance-Numbing. Respondents meeting PTSD symptom criteria on the PCL-C had significantly lower physical, role, and social functioning, greater distress and anxiety, and significantly more intrusive and avoidant responses than individuals who did not meet PTSD symptom criteria.

Activity and mood temperament as predictors of adolescent substance use: test of a self-regulation mediational model.

The authors tested a mediational model of temperament dimensions and substance use with a sample of 1,826 urban adolescents, M age 12.3 years. Five scales from the Revised Dimensions of Temperament Survey (DOTS-R) were administered together with measures of substance (tobacco, alcohol, marijuana) use and measures of related variables derived from a self-regulation model. Unique contributions to substance use were found for DOTS-R dimensions of high activity level (positively related) and positive mood (inversely related). High activity level and low positive mood were also related to lower levels of parental support. Analyses, including multiple regression and structural modeling, identified generalized self-control, maladaptive coping (anger and helplessness), novelty seeking, and affiliation with peer substance users as mediating the effect of temperament on substance use, with control for effects of parental support. Parental support was inversely related to substance use through several pathways. Implications for the theory of vulnerability are discussed.

Hypnotizability and recovery from cardiac surgery.

We studied 32 coronary bypass patients to examine the effect of hypnosis on recovery from surgery. The patients were assessed for hypnotizability with the Hypnotic Induction Profile (HIP) and assigned to experimental groups with a random stratification procedure to equate for differences in hypnotizability, age, and severity of illness. We taught patients in groups one and two formal hypnosis with different treatment strategies; patients in group three were not taught formal hypnosis or a treatment strategy. Scores on the HIP were significant predictors of recovery, independent of experimental treatment with formal hypnosis. Patients who scored "Midrange" stabilized more quickly in the intensive care unit (ICU) than those who scored "High" or "Low" (p = < .05). Patients who scored "High" had more labile blood pressure in the ICU compared to the "Midrange" and "Lows" (p = < .05). Measured hypnotizability was associated with the recovery sequence from surgery.