Cognitive Behavioral Treatment for Acute Posttrauma Distress: A Randomized, Controlled Proof-of-Concept Study Among Hospitalized Adults With Burns.

OBJECTIVE: (1) To evaluate the feasibility of conducting a randomized controlled trial (RCT) of the Safety, Meaning, Activation and Resilience Training (SMART) intervention vs nondirective supportive psychotherapy (NDSP) in an acutely hospitalized adult survivor of burn injury sample; and (2) to assess the preliminary effect of SMART on acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) symptom reduction as secondary prevention. DESIGN: Proof-of-concept, parallel group RCT design. SETTING: Regional burn center. PARTICIPANTS: Acutely injured, hospitalized adult survivors of burn injury (N=50) were randomly assigned to SMART (n=28) or nondirective supportive psychotherapy (n=22). Due to dropout and missing data, final sample size was 40, SMART (n=21) and nondirective supportive psychotherapy (n=19). INTERVENTIONS: SMART is a manualized, 4-session cognitive behavioral therapy-based psychological intervention targeting ASD, PTSD, and MDD symptoms. NDSP is a manualized, 4-session protocol. MAIN OUTCOME MEASURES: Davidson Trauma Scale ([DTS]; diagnostic proxy for ASD and PTSD; clinical cutoff=40, with higher score=higher severity) and the Patient Health Questionnaire-9 ([PHQ-9]; diagnostic proxy for MDD; clinical cutoff=10, with higher score=higher severity) at pretreatment, immediate posttreatment, and 1 month posttreatment. RESULTS: At baseline, median DTS scores and PHQ-9 scores were above clinical cutoffs and did not differ across groups. At 1 week and 1 month posttreatment, median DTS and PHQ-9 scores were beneath clinical cutoffs in the SMART group; scores remained above clinical cutoffs in the NDSP group at these time points. CONCLUSIONS: It is feasible to conduct an RCT of SMART in hospitalized adult survivors of burn injury. SMART has the potential to yield clinically significant outcomes. Additional studies are needed to replicate and extend these findings.

Development of the Cancer Survivor Profile-Breast Cancer (CSPro-BC) app: patient and nurse perspectives on a new navigation tool.

PURPOSE: Despite advancements in care, cancer survivors continue to report unmet needs following active cancer treatment. The Cancer Survivor Profile-Breast Cancer (CSPro-BC) application (app) was developed to help address these needs, using breast cancer survivors (BCS) as a pilot group. This paper describes the app development, BCS and nurse perceptions of the app, and changes made based on this feedback. METHODS: The CSPro-BC app was developed for use on an iPad and includes (1) administration of a 15-20-min survey assessing 18 needs, (2) generation of a profile of needs, relative to a reference group of BCS (median 2 years post-treatment), and (3) provision of problem-specific online resources. Perceptions of the app were evaluated using both quantitative and qualitative approaches. Feedback was elicited from nurse navigators and BCS. BCS were recruited until the point of saturation. RESULTS: BCS (N = 11) were middle-aged and a median of 2.4 months post active treatment. Structured questionnaires indicated the following: survey covered meaningful problem areas, profile display was clear, and nurse's involvement was helpful. Follow-up interviews (2 weeks later) revealed that BCS shared their profile with others, but most BCS did not use the resources and those who did thought there were too many. Nurses (N = 3) said the app increased appointment time, but prompted them to discuss areas often not covered in typical BCS follow-up. CONCLUSIONS: Feedback by end users directly informed revision of the app. IMPLICATIONS FOR CANCER SURVIVORS: The CSPro-BC app has been optimized based on BCS feedback.

Cancer, comorbidity and workplace discrimination: The US experience.

Cancer survivors with comorbidities have more work-related challenges than cancer survivors without these other health problems. This study evaluated how these cancer survivors with comorbidities are faring under a newly revised workplace discrimination policy, which better accounts for the episodic nature of chronic illnesses. The sample included 18-64 year olds with a history of cancer who filed allegations of workplace discrimination in 2009-2011 (N = 1.291) in the US. Multivariable logistic regressions were used. Cancer survivors with comorbidities were more likely to file discrimination claims related to the terms of their employment (OR = 1.37, 95% CI = 1.04-1.80) than cancer survivors without comorbidities. Terms of employment-related claims were more likely to be ruled in favour of cancer survivors (versus employers), regardless of comorbidity status (OR = 1.44, 95% CI = 1.06-1.96). Despite this policy reform, alleged discrimination related to terms of employment existed at higher rates in cancer survivors with concurrent health problems. If employment is a goal in this high-risk group, replication of findings in other countries, studies on potential mechanisms and development of innovative interventions in these higher risk cases are warranted. Efforts should be made to mitigate the impact of these comorbid health problems on work-related function.

Challenges Persist Under Americans With Disabilities Act Amendments Act: How Can Oncology Providers Help?

PURPOSE: To determine whether the Amendments to the hallmark Americans with Disabilities Act (ADA; effective January 2009), which provide increased access to the antidiscrimination laws for many with chronic illness, are related to changes in workplace discrimination allegations in individuals with a history of cancer. METHODS: Information collected by the Equal Employment Opportunities Commission was used to compare allegations of discrimination and their merit before (2001 to 2008) and after (2009 to 2011) implementation of the Amendments Act. RESULTS: Allegations related to terms of employment (eg, promotions, wages) were more likely to be filed (odds ratio [OR], 1.34; 95% CI, 1.11 to 1.61) and determined to have merit (OR, 1.35; 95% CI, 1.03 to 1.77) after implementation of the Amendments Act. Allegations related to workplace relations (eg, harassment, discipline, discharge) were also more likely to be filed post Amendments Act (OR, 1.48; 95% CI, 1.23 to 1.78), although the merit of this complaint remained stable. Filing of all other allegations of discrimination (ie, hiring, reasonable accommodation, and termination) and their merit remained unchanged post Amendments Act. CONCLUSION: Despite the implementation of the Amendments Act, discrimination allegations in those with a history of cancer persisted or in certain areas increased. Although prevention of workplace discrimination rests primarily with employers, the oncology care team is uniquely qualified to provide information related to residual symptoms and function that can facilitate more personalized solutions to workplace discrimination, such as successful workplace accommodations. Information is provided that can assist the oncology team in their efforts to improve work outcomes.

Identifying the unmet needs of breast cancer patients post-primary treatment: the Cancer Survivor Profile (CSPro).

PURPOSE: The purpose of this study is to develop a brief measure of problem areas experienced by patients following primary treatment for breast cancer. METHOD: Systematic reviews of the quantitative and qualitative literature were used to inform selection of scale items using (1) valid and reliable items from a national item bank (patient reported outcomes measurement information system [PROMIS]), (2) existing scales from prior breast cancer survivorship research, or (3) items developed by the investigators. RESULTS: Participants (n = 400) were on average 51 years old, highly educated, Caucasian, diagnosed with stage I-III breast cancer, and a median of 1.96 years post-primary treatment. Principal component analysis on a random sample (n = 200) and confirmation on a second random sample (n = 200) indicated that each of the scales under consideration provided a significant measurement model for the symptom burden (CFI = 0.95), health behavior (CFI = 1.00), functional limitation (CFI = 0.99), health care seeking skill (CFI = 0.98), and cancer-related financial strain (CFI = 1.00) broad domains. The median Cronbach's alpha was 0.91. The measure demonstrated convergent, divergent, construct, and clinical validity. Lower levels of fatigue (ß = 0.251. p < 0.000) and pain (ß = 0.221, p < 0.000) and greater health competence (ß = 0.278, p < 0.000) and physical activity (ß = 0.165, p < 0.000) were associated with self-rated global health (F = 60.43, p < 0.000). The final measure consists of 73 items and requires approximately 15 min to complete. DISCUSSION: The Cancer Survivor Profile (CSPro) provides a profile of problem areas supported by epidemiological and qualitative research on unmet needs of breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Breast cancer survivors can use the CSPro to prioritize problem areas following cancer treatment.

Cognitive tasks challenging brain tumor survivors at work.

OBJECTIVE: To identify problematic work tasks involving cognitive function in employed brain tumor survivors. METHODS: Work tasks involving cognitive functions were compared between employed brain tumor survivors (n = 137) and a disease-free group (n = 96). Multivariable logistic regressions were conducted. RESULTS: In the brain tumor survivors, 44% (26/59) of work tasks were more likely to be problematic. Top five problematic work tasks included were as follows: following the flow of events (odds ratio [OR] = 11.72; 95% confidence interval [CI] = 3.19 to 43.07), remembering train of thought while speaking (OR = 11.70; 95% CI = 5.25 to 26.10), putting together materials for a task (OR = 10.90; 95% CI = 2.80 to 42.38), shifting between tasks (OR = 10.71; 95% CI = 3.62 to 31.74), and following written instructions (OR = 9.96; 95% CI = 2.65 to 37.41). CONCLUSION: Findings identified problematic work tasks involving major domains of cognitive function.

Neurocognitive deficits following primary brain tumor treatment: systematic review of a decade of comparative studies.

There has been an increase in the prevalence of adults diagnosed with and treated for primary brain tumors. Cognitive deficits are a common long-term effect in brain tumor survivors. The objective of this paper is to examine whether these deficits are specific to those diagnosed with and treated for a primary brain tumor. A systematic review of the medical literature from 2002 to 2012 was conducted to investigate neurocognitive deficits in brain tumor survivors (post-primary treatment) compared to healthy controls. Four studies were identified that met all inclusion criteria. Gliomas were the most common form of tumor included. Neuropsychological evaluation identified cognitive deficits in brain tumor survivors on tests of working memory, cognitive control and flexibility, cognitive processing speed, visual searching, planning and foresight, and general attention. While age, education, and gender can influence cognitive function, the present review indicates that deficits exist beyond those accounted for by these factors. Many primary brain tumor survivors are involved in roles (e.g., employee, parent, spouse/partner, student) that require optimal performance of these cognitive skills. Future research should evaluate brain tumor survivors on functional challenges resulting from these cognitive sequelae and develop effective ways to mitigate them.

Evaluating functional localizers: the case of the FFA.

Functional localizers are routinely used in neuroimaging studies to test hypotheses about the function of specific brain areas. The specific tasks and stimuli used to localize particular regions vary widely from study to study even when the same cortical region is targeted. Thus, it is important to ask whether task and stimulus changes lead to differences in localization or whether localization procedures are largely immune to differences in tasks and contrasting stimuli. We present two experiments and a literature review that explore whether face localizer tasks yield differential localization in the fusiform gyrus as a function of task and contrasting stimuli. We tested standard localization tasks-passive viewing, 1-back, and 2-back memory tests--and did not find differences in localization based on task. We did, however, find differences in the extent, strength and patterns/reliabilities of the activation in the fusiform gyrus based on comparison stimuli (faces vs. houses compared to faces vs. scrambled stimuli).