Can a tailored telephone intervention delivered by volunteers reduce the supportive care needs, anxiety and depression of people with colorectal cancer? A randomised controlled trial.

OBJECTIVE: The objective was to assess the effectiveness of a volunteer-delivered tailored telephone-based intervention in reducing prevalence of unmet supportive care needs, elevated levels of anxiety and depression among people with colorectal cancer over a 9-month period. METHODS: There were 653 participants who completed the baseline questionnaire and were randomised to usual care (n = 341) or intervention (n = 306). Three follow-up questionnaires were completed at 3-monthly intervals (response rates: 93%, 87%, 82%, respectively). All four questionnaires contained the Supportive Care Needs Survey (SCNS), Hospital Anxiety and Depression Scale (HADS) and checklists for colorectal cancer symptoms and use of support services. The intervention consisted of trained volunteers providing emotional support, service referral and information and was delivered after completion of each of the first three questionnaires. Primary outcomes were prevalence of moderate to high SCNS needs and elevated levels (scores of 8+) of HADS anxiety and depression. RESULTS: Over the study period, SCNS needs decreased similarly for both groups, and prevalence of elevated depression did not change for either group. There was a greater reduction in the prevalence of elevated anxiety in the intervention than usual care group (p < 0.01), with the intervention group decrease mainly occurring between baseline and the first follow-up survey (p < 0.01). However, the prevalence of elevated anxiety was similar between the two groups at each follow-up point. CONCLUSIONS: The intervention had no effect on supportive care needs or depression, although it may be associated with a greater reduction in anxiety. Future research should test the intervention with patients closer to diagnosis.

Predictors of psychosocial distress 12 months after diagnosis with early and advanced prostate cancer.

OBJECTIVE: To assess psychosocial distress in patients with early (localised) and advanced (metastatic) prostate cancer (PCA) at diagnosis (Time 1) and 12 months later (Time 2), and identify psychosocial factors predictive of later distress. DESIGN, PARTICIPANTS AND SETTING: Observational, prospective study of 367 men with early (211) or advanced (156) PCA recruited as consecutive attendees at clinics at seven public hospitals and practices in metropolitan Melbourne between 1 April 2001 and 30 December 2005. Both groups completed questionnaires at Time 1 and Time 2. MAIN OUTCOME MEASURES: Health-related quality of life as assessed by the Short Form 36-item Health Survey; psychological distress, including depression and anxiety as assessed by the Brief Symptom Inventory; and coping patterns as assessed by the Mini-Mental Adjustment to Cancer scale. RESULTS: Over the 12 months, both the early and advanced PCA group showed reduced vitality and increased depression and anxiety; this effect was greater in the advanced PCA group. Mental health, social functioning and role-emotional functioning also deteriorated in the advanced group. Predictors of depression at Time 2 for the early PCA group were depression, vitality and a fatalistic coping pattern at Time 1; anxiety at Time 2 was predicted by anxiety and vitality at Time 1. In the advanced PCA group, depression at Time 2 was predicted by depression and mental health at Time 1; anxiety at Time 2 was predicted by anxiety, mental health, cognitive avoidance and lower anxious preoccupation at Time 1. CONCLUSIONS: Men with early PCA experience decreasing vitality and increasing psychological distress over the 12 months following diagnosis; this trend is accelerated after diagnosis with advanced PCA. A fatalistic coping pattern at diagnosis of early PCA predicts later depression while cognitive avoidance and lower anxious preoccupation at diagnosis of advanced PCA predict later anxiety.

Coping patterns and psychosocial distress in female partners of prostate cancer patients.

BACKGROUND: With medical advances since the 1990s, a growing proportion of patients are living for many years with prostate cancer (PCA) and the consequences of its treatment. OBJECTIVE: The authors investigated the experience of being diagnosed with cancer and the effects of its treatment on patients' partners. METHOD: The authors conducted an observational, longitudinal study of 103 couples facing the diagnosis of either localized (potentially curable) or metastatic (incurable) PCA at Time 1 and then 6 months later (Time 2). RESULTS: At both Time 1 and Time 2, psychological distress, marital satisfaction, and family functioning were measured in patients and partners; coping was measured in partners only. Partner maladaptive coping patterns of avoidance and self-blame at Time 1 predicted greater partner psychological distress at Time 2, as did "wishful thinking" at Time 2. DISCUSSION: Psychosocial interventions designed to promote adaptive coping in couples facing PCA warrant systematic study.

Psychosocial adjustment in newly diagnosed prostate cancer.

OBJECTIVE: To examine the psychological and social adjustment of men with early or advanced stage prostate cancer and to compare them with a matched group of cancer-free community volunteers. METHODS: A longitudinal observational study in which 367 men recently diagnosed with early (n=211) or advanced stage (n=156) prostate cancer were compared to 169 cancer-free men from the community, of similar age and residential area, using self-report measures of psychosocial adjustment. RESULTS: On the mental health subscales of the Short-Form 36-item Health Survey, men with advanced disease had lower vitality and social functioning than the other two groups, and lower mental health scores than the comparison group. Both patient groups had lower role-emotional scores than the comparison group. With regard to the Brief Symptom Inventory, the advanced disease group had higher somatization scores, and lower interpersonal sensitivity and paranoid ideation scores than the early stage group and the community comparison group. In terms of psychiatric morbidity, there were higher rates of anxiety disorders but not depressive disorders in both patient groups although overall diagnosis rates were low. No differences were found in terms of couple or family functioning. CONCLUSIONS: There is impairment in psychosocial function in men with prostate cancer, particularly those with advanced disease, but no increase in the rate of formal psychiatric disorder or adverse effects on the couples and families. This suggests directions for psychosocial interventions with these patient groups.

One-to-one volunteer support programs for people with cancer: a review of the literature.

OBJECTIVE: To conduct a systematic review of literature reporting on the use of volunteers in support programs for people with cancer. METHODS: PsycINFO, Medline and CINAHL were used to identify papers published up to April 2007 reporting one-to-one support programs using volunteers. Program data were extracted from the papers, which were rated on research quality and descriptions of the program, volunteers and support recipients. RESULTS: Twenty-eight papers were reviewed. Nineteen (69%) reported peer-support programs, with four (14%) pertaining to the Reach to Recovery program for women with breast cancer, and eight (28%) describing other peer-support programs for women with breast cancer. Few papers described the programs sufficiently to enable a good understanding of support recipients, volunteers, and what transpired between volunteers and support recipients. Twenty papers (71%) were research studies: 10 (36%) with one group descriptive data, 6 (21%) were non-randomized comparative studies and 4 (14%) were randomized controlled trials. CONCLUSION: While most papers reported that programs were beneficial, few presented data from studies using rigorous research methodologies to support these claims. PRACTICE IMPLICATIONS: Using volunteers in cancer care may have merits; however, papers need to provide more information regarding these programs and further evidence is required to determine their effectiveness.

Psychological adjustment of men with prostate cancer: a review of the literature.

OBJECTIVE: Prostate cancer (PCA) is the most common malignancy and a major cause of death in men but, importantly, a substantial proportion will live for several years following diagnosis. However, they face the prospect of experiencing symptoms, side-effects of treatment and diminished quality of life. The patient's psychological adjustment is particularly complex, given the potential trajectory of the disease, from the point of diagnosis, with its immediate impact, to the phase of palliative care, with its attendant issue of facing mortality. Since a comprehensive review of the literature on psychological adjustment of men with PCA has not yet been done, we have documented relevant research, integrated findings and drawn conclusions, where possible, in order to map out clinical and research implications. METHOD: We searched 5 databases for the period 1994 - July 2006, during which most of the work in the field has been done. RESULTS: We found few studies of substance among the 60 we examined to draw conclusions about psychological adjustment to prostate cancer and its treatment. This is in marked contrast to the picture in breast cancer. While some patterns have emerged, many gaps remain to be filled. DISCUSSION: Aspects of methodology need attention, particularly longitudinal, prospective designs, incorporation of control groups and the use of valid and reliable measures. There is scope for qualitative studies as a complement to quantitative research.

Reducing the unmet needs of patients with colorectal cancer: a feasibility study of The Pathfinder Volunteer Program.

GOALS OF THE WORK: Many cancer patients experience unmet needs and elevated levels of anxiety and depression. This paper describes a volunteer-delivered intervention to reduce the psychosocial needs of cancer patients and presents findings from a feasibility study of this intervention. MATERIALS AND METHODS: The telephone-based intervention, called the Pathfinder Program, involves the assignment of volunteers to patients to assist them in addressing their needs as identified in questionnaires. Fifty-two patients with colorectal cancer were involved in the feasibility study, with 18 in the intervention. Sixty-two percent of the sample was male and the mean age was 64 years. Patients' needs were assessed using The Supportive Care Needs Survey, a colorectal cancer symptom checklist, and the Hospital Anxiety and Depression Scale. All patients completed baseline questionnaires (Time 1) and 47 completed Time 2 questionnaires 3 months later. MAIN RESULTS: The most common needs were fear of the cancer spreading and returning, concerns about the worries of others, gas or wind, changes in weight, and bowel problems such as diarrhea, constipation, and pain. A statistically significant Time 1 to Time 2 decrease in supportive care needs and depression was found for the intervention group. CONCLUSIONS: The Pathfinder Program has been found to be feasible, acceptable for patients, and has the potential to reduce needs and depression. A larger, randomized controlled trial is needed to determine the impact of this program on colorectal symptoms and anxiety.

The psychosocial impact of prostate cancer on patients and their partners.

OBJECTIVE: To assess the psychosocial impact of the diagnosis of either localised or metastatic prostate cancer (PCA) on patients and their female partners. DESIGN: Observational, prospective study at Time 1 and 6 months later at Time 2 of two groups of couples facing PCA. Time 1 was when patients were first diagnosed with histologically confirmed localised (potentially curable) PCA or metastatic (incurable) PCA. MAIN OUTCOME MEASURES: Depression and anxiety disorders according to the Diagnostic and statistical manual of mental disorders 4th edition (DSM-IV); psychological distress; marital satisfaction. RESULTS: At Time 1, partners had rates of DSM-IV major depression and generalised anxiety disorder twice those of women in the Australian community, and considerably higher than the patients' rates. At Time 2, psychological distress in partners had lessened but that in patients had increased. On the other hand, at Time 2, partners' marital satisfaction had deteriorated. CONCLUSIONS: To be fully effective, interventions aimed at reducing the psychosocial morbidity of PCA must involve both patient and partner, rather than the patient alone.

Psychosocial adjustment of female partners of men with prostate cancer: a review of the literature.

Advances in prostate cancer treatments since the 1990s have led to a growing proportion of patients living with the effects of the cancer. Various challenges face the man and his partner from the point of learning of the diagnosis: deciding among numerous diverse treatment options, dealing with side-effects of treatment and possibly facing the terminal phase of the illness. This invariably has an impact on the patient's family and, in view of the older age group of men usually affected, the experience of a partner is particularly relevant. A thorough review of the research literature reporting directly from partners of prostate cancer patients has not been undertaken previously. For this review, five databases were searched for the decade 1994-2005, during which most of the work in this field has been done. Very few evaluations of psychosocial interventions involving the partner were found, but there was a preponderance of qualitative studies involving small numbers of participants and quantitative surveys with little consistency in the measures used. The literature suggests that partners report more distress than patients, yet believe that patients are the more distressed, and the focus of concern of patients on their sexual function is not shared to an equal degree by their partners.