Quality of life of testicular cancer survivors and the relationship with sociodemographics, cancer-related variables, and life events.

GOALS OF WORK: The aim of this study was to (1) assess the quality of life (QoL) of testicular cancer survivors (TCSs) by comparing them to a reference group; (2) investigate the relationship between the QoL of TCSs and sociodemographics, cancer-related variables, and life events; and (3) identify TCSs at risk for an impaired QoL. PATIENTS AND METHODS: Of the TCSs approached, 50% (n=354) participated and completed a generic QoL questionnaire (RAND-36) once. Time since completion of treatment varied from 3 months to 24 years. MAIN RESULTS: (1) TCSs had significantly higher mean scores on the subscales physical functioning (p=0.02) and pain (p=0.001), but lower mean scores on mental health (p=0.04) and vitality (p<0.001) than a reference group of men. The effect sizes of these differences were small to insignificant. (2) Employment status and chronic disease were the main correlates of the QoL of TCSs. Age, negative life events, type of treatment, and the experience of a second cancer event were moderately associated with some subscales as well. (3) The joint burden of unemployment and a chronic disease was the strongest predictor for an impaired functioning. CONCLUSIONS: On a group level, TCSs experience a good QoL, but a small group appeared to be at risk for an impaired functioning, namely, those who were unemployed and had a chronic disease. The variance explained by the variables studied was low, indicating that more important predictors remain to be identified.

Sprain of the neck: quality of life and psychological functioning. A 4-year retrospective study.

Aim of the study was to analyse quality of life and psychological functioning in patients with sprain of the neck, to analyse the relationship between complaints, quality of life, psychological functioning and personality factors, and to analyse the profile of patients with whiplash associated disorders (WAD), 4 years after trauma. From the University Hospital Groningen 193 patients with the diagnose sprain of the neck filled out a questionnaire. Of this group 100 subjects did not have complaints before the accident and were therefore at risk for the development of complaints as a result of sprain of the neck. Quality of life and psychological functioning were assessed using the RAND-36 and the SCL-90, respectively. Personality was assessed by means of the Dutch Personality Questionnaire. Of the group at risk (56% women and 44% men, mean age: 33.9, SD: 14.6) quality of life was significantly worse in subjects with complaints (mean: 78.4, SD: 15.5) compared to subjects without complaints (mean: 87.5, SD: 8.7). Psychological functioning did not differ significantly between the group with complaints compared to group without complaints. Personality did not differ between the groups. Personality and complaints together were significantly related to quality of life (r: 0.77) and psychological functioning (r: 0.85). No specific profile of WAD patients was found. In conclusion, personality and complaints influence quality of life and psychological functioning to a considerable extent.

The use of actigraphy revised: the value for clinical practice in insomnia.

In the last years, actigraphy has been used more often for clinical research and research evaluation of sleep disorders. Compared to polysomnography, actigraphy is cheap and less time-consuming. Actigraphy provides more objective information about sleep than sleep logs. Although the algorithms to score sleep and wake based on motions measured by actigraphy are still being improved, we believe that the role of actigraphy in the clinical evaluation of sleep in insomnia is limited. Instead of using actigraphy to distinguish a wakeful state from sleep in insomnia, we might better use the activity plots which the actigraph provides to get more insight into the physiological hyperarousal or restfulness of insomnia patients.

Psychological adaptation and social support of parents of pediatric cancer patients: a prospective longitudinal study.

OBJECTIVE: To investigate levels of support and the concurrent and prospective effects of support on the psychological functioning of parents of children with cancer in a prospective longitudinal study. METHODS: Parents' (n = 128) self-perceived level of psychological distress, quantity of support, and dissatisfaction with support were assessed, at diagnosis, at 6, and at 12 months. RESULTS: Parents received most support at diagnosis. Self-perceived quantity decreased with time, but parents indicated they remained equally satisfied. Support significantly predicted concurrent and prospective distress of fathers, but not of mothers. Dissatisfaction with support and negative interactions were consistent risk factors for fathers. Mothers who adjusted well psychologically received more support and were less dissatisfied than mothers who remained clinically distressed. Nevertheless, no persisting effect of support was found. CONCLUSIONS: Findings illustrate that social support varies with the stress situation and with gender. Identification of vulnerable parents at diagnosis on the basis of their perception of received quantity of and dissatisfaction with support seems difficult. Intervention efforts aimed at mobilization of needed support may be efficacious.

Risk factors for psychological maladjustment of parents of children with cancer.

OBJECTIVE: To examine risk variables for future, more immediate, and persistent psychological distress of parents of pediatric cancer patients. METHOD: Parents (n = 128) completed questionnaires at the time of diagnosis (T1) and 12 months later (T2). Multiple regression analyses were performed using the following as predictors: demographics, illness-related variables, other life events, personality, coping styles, and social support. RESULTS: Trait anxiety was the strongest predictor of both fathers' and mothers' future distress. Changes in trait anxiety during the year also accompanied changes in both parents' levels of distress. Additional prospective predictors for fathers were the coping style "social support-seeking" and dissatisfaction with support. Dissatisfaction with support also had short-term effects for fathers. An additional prospective predictor for mothers was the number of pleasant events they had experienced prior to diagnosis, while a short-term effect was found for performance in assertiveness. No predictors for the persistence of distress were found. CONCLUSIONS: These results underscore the importance of personality anxiety in predicting parents' risk for adjustment difficulties associated with the experience of cancer in one's child. An additional risk factor for fathers was social support. For mothers, previously experienced life events and the frequency of assertive behavior were additional risk factors.

Brief report: an intervention program for parents of pediatric cancer patients: a randomized controlled trial.

OBJECTIVE: To evaluate a psychoeducational intervention program for parents of pediatric cancer patients, using cognitive and behavioral techniques. METHODS: Parents were randomly assigned to an intervention (n = 39) and a control condition (n = 42). Baseline assessment took place at diagnosis. Short-term effects were measured immediately after the intervention, long-term effects six months later. Control parents received standard care. Intervention parents received, in addition, a manual-guided program during the first six months following the diagnosis. RESULTS: With time all parents became significantly less psychologically distressed. However, no between-group differences were noted in psychological functioning, satisfaction with support, and intensity of emotions immediately postintervention and six months later. CONCLUSIONS: Although the clinical evaluation of the intervention was positive, it appeared that a structured intervention program as described in this study was not any more effective than standard care.

Gender differences in psychological adaptation and coping in parents of pediatric cancer patients.

This study investigated differences in psychological distress and coping styles between fathers and mothers of pediatric cancer patients, over a 1-year time period. Also examined were (dis)similarities in couples in distress and coping, and the relationship between (dis)similarities in coping and psychological functioning of both members of a couple. Parents (n = 124, 62 couples) were assessed at diagnosis, at 6 and 12 months. Fathers and mothers experienced higher levels of psychiatric symptomatology and psychological distress at diagnosis than men and women of a normgroup. Distress declined significantly with time. Although parents did not report more symptoms than the normgroup 12 months post-diagnosis, they still were psychologically out of balance. Contrary to findings in the general population, no differences were found between fathers and mothers in psychiatric symptoms or psychological distress on any of the measurements. Only a few gender differences in coping were found. Fathers used more active-problem focusing at diagnosis and a less palliative reaction pattern at 12 months than did mothers. Mothers used more social-support seeking on all measurements. A tendency for similarity in the use of the coping styles within couples was found. Discrepancies in coping in couples were positively related to distress in fathers at diagnosis. However, 12 months later, the more discrepant the couples were in their coping preferences the more distress the mothers indicated.

The treatment of insomnia through mass media, the results of a televised behavioral training programme.

An important trend in behavioral medicine is a psycho-educational approach to health problems. A training course aimed at the treatment of sleep disorders has been developed using the following basic principles: (1) a symptomatic approach, (2) emphasis on information on sleep and sleep disorders, (3) self-management, and (4) interventions based on behaviour therapeutic principles that are further developed for the treatment of sleep disorders. Because the results of courses used in primary health care were encouraging, a similar training course of eight programmes was broadcasted by the Dutch educational radio and television station Teleac. About 200,000 people viewed the course, 23,000 of whom ordered the course material. The results of the training course were assessed from a sample (N = 325) by means of a sleep diary in a pre-test, post-test and a follow-up condition. In addition, several questionnaires were used to collect information on personality factors and on physical and psychological complaints. The training produced an estimated decrease in sleep latency of 25 minutes. The duration of sleep increased by nearly 40 minutes. Of the people using hypnotic drugs 40% ceased their use after the course. The training course broadcasted by Teleac is found to be an effective means of improving sleeping behaviour. The results of the course are comparable with interventions that use direct therapist-client contact, suggesting that the presence of a therapist in this approach may not be of crucial importance. The decrease in the use of hypnotics makes the approach cost-effective.

Coping with asthma.

Coping is a dynamic process playing a major role in a person's behaviour to respond in the best possible way to his environment. Behaviour and environment mutually influence one another. Non-compliance appears in all therapies prescribing the patient to administer his own medication. A number of studies shows that approximately 50% of the chronic patients do not take their medication or do not take it in accordance with the prescription. Knowledge and skills are important variables for maintaining desired behaviour of asthma patients. In order to cope adequately with the disease it requires the patient's understanding of the daily use of an often complex medication regimen. With respect to asthma patients health education is particularly aimed at supplying them with knowledge and skills that enable them to cope adequately with the disease in everyday life. Moreover, health education functions to motivate patients. On investigation into the relation between coping and disease it is important that one should not only focus on the disease and the treatment, but particularly on the relation between the patient, his immediate environment and society, which relation should be adapted.

[Sleep in the elderly. Effects of a behavior therapeutic sleeping course]. / De slaap van ouderen. Effecten van een gedragstherapeutische slaapcursus.

Insomnia is a frequently occurring complaint. The role of the educational approach in the behavioral treatment of insomnia is of increasing importance. In this article the results of an in 1987-1988 televised behaviour-therapeutic course, 'Sleeping can be learned', are presented. Special attention is given to the results of older subjects. Data were collected by means of a sleep diary in a precourse, postcourse and a follow-up measurement. In addition a number of questionnaires were used to collect information on personality factors and on physical and psychological complaints. The self-estimated duration of sleep of the group over sixty years of age was significantly less when compared with the younger group. The results of the course were encouraging. Sleep latency decreased on the average with more than 25 minutes per night and the duration of sleep increased with nearly 40 minutes per night. The use of sleep-medication decreased. These changes did not differ between the group over 60 years old and the younger group. No support was found for the idea that insomnia in the elderly is caused by an increasing number of problems. A factor that could influence the prevalence of insomnia in the elderly can be the more irrational beliefs on sleep and sleep disorders the older group of subjects appeared to have. Strategies directed at these cognitions should therefore be a part of the treatment of insomnia.