Screening for depression in palliative cancer patients attending a pain and symptom control clinic.

OBJECTIVE: Depression in palliative care patients is often underrecognized. Screening can increase case recognition. The aims of this study were to assess the prevalence of depression in palliative cancer patients attending a pain and symptom control clinic and to investigate the validity and utility of a depression visual analogue scale in detecting depression in the advanced cancer outpatient population. METHOD: One hundred and thirty-two oncology outpatients who came for consultation at a multidisciplinary pain and symptom control clinic were asked and agreed to complete the Brief Zung Self-Rating Depression Scale (BZSDS; Dugan et al., 1998) and depression visual analogue scale (DVAS). RESULTS: The majority of participants (72%) indicated clinically significant depressive symptoms according to the BZSDS (21% in the "mild" depressive symptoms range, 32% in the "moderate" range, and 19% in the "severe" range). Participants indicated low endorsement rates of items related to overt manifestation of depression (e.g., sadness, tearfulness, irritability, and suicide ideation). The DVAS showed high correlation with the BZSDS (r = .82) and is a potentially useful screening instrument for detecting depressive disorder in palliative care cancer patients. SIGNIFICANCE OF RESULTS: The results of the study underline the importance of routine screening to detect depressive disorder in palliative care patients to improve their quality of care. The depression visual analogue scale was found to be an effective simple screening tool, easy to administer and use.

Sleep disturbances in palliative cancer patients attending a pain and symptom control clinic.

OBJECTIVE: The nature of sleep disturbances in palliative cancer patients has not been delineated clearly or fully understood due to limited clinical information. The purpose of this study was to describe sleep disturbance patterns, treatments, and communication in an advanced cancer outpatient population attending a pain and symptom control clinic. METHOD: One hundred oncology outpatients who came for consultation at a multidisciplinary pain and symptom control clinic were asked and agreed to complete a self-report questionnaire that elicited information about their sleeping habits, sleep concerns, sleep enhancement strategies, and related communication with health care providers. RESULTS: The majority of participants (72%) reported a wide variety of sleep disturbances, after cancer diagnosis, with the three most frequent elevated symptoms (> or = 5) being not feeling rested in the morning (72%), difficulty staying asleep (63%), and difficulty falling asleep (40%). Approximately one-fifth of participants (19%) reported having insomnia problems prior to their cancer diagnosis. In a correlational comparison with four other symptoms (i.e., fatigue, pain, anxiety, depression), the three highest correlations were between difficulty falling asleep and fatigue (r = 0.612), early awakening and fatigue (r = 0.596), and difficulty falling asleep and anxiety (r = 0.572). Fifty-three percent of participants reported using a variety of interventions for their sleep problems, the most frequent being sleep medication (37%). Of the 52 participants who reported an elevated level of concern about their sleeping difficulties (> or = 5), 48 (92%) discussed their concerns with a health care provider. However, of the 20 participants with elevated symptoms (> or = 5) and low levels of concern (<5), only 7 (35%) communicated their concerns to a health care provider. SIGNIFICANCE OF RESULTS: The results of this study underline the importance of routine clinical assessments to detect sleep problems and interventions designed specifically to improve the overall sleep quality of cancer patients.

Exercise motivation and adherence in cancer survivors after participation in a randomized controlled trial: an attribution theory perspective.

The purpose of this study was to examine postprogram exercise motivation and adherence in cancer survivors who participated in the Group Psychotherapy and Home-Based Physical Exercise (GROUP-HOPE; Courneya, Friedenreich, Sela, Quinney, & Rhodes, 2002) trial. At the completion of the GROUP-HOPE trial, 46 of 51 (90%) participants in the exercise group completed measures of attribution theory constructs. A 5-week follow-up self-report of exercise was then completed by 30 (65%) participants. Correlational analyses indicated that program exercise, perceived success, expected success, and affective reactions were strong predictors of postprogram exercise. In multivariate stepwise regression analyses, program exercise and perceived success were the strongest predictors of postprogram exercise. Additionally, perceived success was more important than objective success in understanding the attribution process, and it interacted with personal control to influence expected success and negative affect. Finally, postprogram quality of life and changes in physical fitness were correlates of perceived success. We concluded that attribution theory may have utility for understanding postprogram exercise motivation and adherence in cancer survivors.

The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes.

Physical exercise has been shown to enhance quality of life (QOL) in cancer survivors using pretest-posttest designs and compared to usual care (i.e. no intervention). In the present study, we conducted a randomized controlled trial to determine if exercise could improve QOL in cancer survivors beyond the known benefits of group psychotherapy (GP). We matched 22 GP classes (N=108) on content and then randomly assigned 11 (n=48) to GP alone and 11 (n=60) to GP plus home-based, moderate-intensity exercise (GP+EX). Participants completed a physical fitness test and QOL measures (e.g. Functional Assessment of Cancer Therapy scales) at the beginning and end of GP classes (about 10 weeks). We had excellent recruitment (81%), retention (89%), and adherence (84%) rates and a modest contamination (22%) rate. Using intention-to-treat repeated measures analyses of variance, we found significant Time by Condition interactions for functional well-being, fatigue, and sum of skinfolds. We also found borderline significant interactions for physical well-being, satisfaction with life, and flexibility. All interactions favored the GP+EX condition. We conclude that a home-based, moderate intensity exercise program may im-prove QOL in cancer survivors beyond the benefits of GP, particularly in relation to physical and functional well-being.

Correlates of adherence and contamination in a randomized controlled trial of exercise in cancer survivors: an application of the theory of planned behavior and the five factor model of personality.

In this study, we examined correlates of adherence and contamination in a randomized controlled trial (RCT) of exercise in cancer survivors using the theory of planned behavior and the Five Factor Model of personality (FFM). We randomly assigned cancer survivors in group psychotherapy classes to either a waiting-list control group (n = 45) or a home-based, moderate intensity exercise program (n = 51). At baseline, participants completed measures of the theory of planned behavior, the FFM, past exercise, physical fitness, medical variables, and demographics. We then monitored exercise over a 10-week period by weekly self-reports. Hierarchical multiple regression analyses indicated that the independent predictors of overall RCT exercise across both conditions were past exercise (beta = .36, p < .001), assignment to experimental condition (beta = .34, p < .001), sex (beta = .30, p < .001), and intention (beta = .14, p < .10). For exercise adherence in the exercise condition, the independent predictors were sex (beta = .38, p < .01), extraversion (beta = .30, p < .05), normative beliefs (beta = -.27, p < .05), and perceived behavioral control (beta = .23, p < .10). Finally, the independent predictors of exercise contamination in the control condition were past exercise (beta = .70, p < .001), sex (beta = .20, p < .05), and intention (beta = .17, p < .10). We conclude that the correlates of exercise adherence and contamination differ in kind as well as in degree. Explanations for these findings and practical implications for conducting exercise RCTs in this population are offered.

Sensory and affective dimensions of advanced cancer pain.

The present study was designed to explore the extent to which advanced cancer pain is explicable in terms of both physical pain intensity and affect. Most notably, it expanded on previous findings by more clearly elucidating the relationship between several discrete emotional states and the total experience of cancer pain. One hundred and eleven patients with cancer pain attending a Pain and Symptom Control Clinic were studied. Visual Analogue Scales (VASs) were used to quantify overall pain intensity and the accompanying affect. Then, correlations were calculated to evaluate the relationships both between and within these two variables. Overall, the participants rated both the pain intensity and the negative affect associated with that pain as high. Of the examined affective components of pain, frustration and exhaustion were found to be the most significant. In addition, some gender differences were identified in terms of frustration, anger, fear, exhaustion, helplessness, and hopelessness.