Cognitive functioning in long-term cancer survivorship: A survey utilizing both standardized neuropsychological and self-report measures.

Since long-term cancer survivorship is a reality for an increasing number of people, understanding their cognitive functioning is useful for both research and clinical purposes. This study described the cognitive functioning of Italian long-term cancer survivors, using both an objective standardized battery and a self-report questionnaire. A total of 136 Italian adults 5+ years free from cancer and its treatments were administered the Esame Neuropsicologico Breve, the Self-Assessment Scale of Cognitive Functioning, and assessments of other psychological dimensions. A total amount of 15% of the sample showed impaired performance on 2+ of the assessed cognitive functions, and 32% had 1+ impaired function. The subjective perception of their cognitive functioning was worse in the present sample, compared to the normative data (p < 0.001). Cognitive functioning, objectively and subjectively measured were significantly correlated (p = 0.006). The number of tests scored outside the normal range correlated positively with depression (p = 0.042) and negatively with both the estimated total IQ (p < 0.001) and with estimated performance IQ (p = 0.001). Self-perceived cognitive functioning correlated positively (p < 0.001) with depression, anxiety, and fatigue. These data document how cognitive difficulties may remain for a long time in cancer patients, who are likely to continue to subjectively perceive themselves as impaired, although sometimes to a greater extent than objective impairment.

Cognitive Functioning Self-Assessment Scale (CFSS): Further psychometric data.

The "Cognitive Functioning Self-Assessment Scale" (CFSS) is a questionnaire specifically developed for the self-reporting of cognitive functioning in non-neurologic settings. A previous published study had showed its good reading comprehension and face validity, defining it as monofactorial and reliable. This paper provides further psychometric data and norms derived on a larger sample from the general population. Our work is divided into two studies. In Study 1, 194 adult patients in a General Practitioner study (27.8% retested after 2 weeks) have filled-in the CFSS together with the CES-D, the State Anxiety subscale of the STAI, and a clinical and socio-demographic data form. The Cronbach's alpha of the CFSS was 0.878; the temporal stability was 0.794; in addition, CFSS showed substantial and moderate associations respectively with depression and state anxiety measures. In Study 2, CFSS data on 476 participants have been considered. CFSS score was associated to age (p < 0.01) and education (p < 0.01). In addition, CFSS descriptive statistics according to age and education levels were provided. In conclusion, although further research is surely necessary to refine the CFSS, the herein presented data together with the already published results, confirm the validity and reliability of this tool.

Psychological health in long-term cancer survivorship: an Italian survey on depression and anxiety.

Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their psychological health can inform health care policy as well as help supporting individual patients. This study was aimed to describe depression and anxiety (i.e. two of the most common psychological symptoms reported in oncology) in a sample of Italian long-term cancer survivors (LTCSs) defined as people who have been free from cancer and cancer treatments for at least five years. Four hundred and four Italian adult LTCSs completed a battery of questionnaires including the Zung Self-rating Depression Scale and the State Anxiety sub-scale of the State-Trait Anxiety Inventory respectively for depression and anxiety assessment. 16.5% of the sample displayed mild depression, 11.1% moderate depression, and 7.1% severe depression. depression was negatively associated with education (p = .017), perceived social support as provided by the family (p = .028), and perceived social support provided by friends (p = .008), and it was positively associated with occupational status (p = .023), presence of health issues (p = .010), and anxiety (p < .001). 8.7 and 15.8% of the sample were respectively possible and probable cases of anxiety. Anxiety was negatively associated with occupational status (p = .038) and it was positively associated with depression (p < .001). These data support ongoing assessment and monitoring of depression and anxiety in LTCSs, and stimulate the development and testing of psychological interventions for such individuals. In addition, they encourage further study on the psychological health of this specific population.

Mood states in long-term cancer survivors: an Italian descriptive survey.

PURPOSE: Since long-term survivorship is now a reality for an increasing number of people with cancer, understanding their mood states (i.e., transient subjective emotional states) can inform health-care policy as well as help support individual patients. This study described the mood states of Italian long-term cancer survivors, compared them with normative data, and tested their association with the main clinical and socio-demographic sample's characteristics. METHODS: One hundred and fifty-eight Italian adults free from cancer and its treatments for at least 5 years were administered the Profile of Mood States (POMS) and two ad hoc 0-10-point visual-analogue scales on personal health-related worry and risk perception for a personal relapse, respectively. RESULTS: In comparison with the Italian normative sample, the current sample displayed a higher score in Vigor-Activity (p = 0.003) and a lower score in Confusion-Bewilderment (p = 0.008). In Tension-Anxiety, Confusion-Bewilderment, Depression-Dejection, Anger-Hostility, Fatigue-Inertia, and Vigor-Activity, 14.6, 15.9, 17.1, 17.8, 19.7, and 13.3 % of the sample, respectively, displayed meaningful scores (i.e., scores above or below 1 standard deviation from the normative mean score). The mood state profile POMS-provided was associated with gender (p = 0.002), occupational status (p = 0.003), reported health issues (p < 0.001), and quality of sleep (p < 0.001). In personal health-related worry and risk perception for a personal relapse, the average scores were 4.8 (SD = 3.0) and 4.1 (SD = 2.9), respectively. CONCLUSIONS: These data encourage a multidimensional assessment of emotional functioning of this specific population.

Is long-term cancer survivors' quality of life comparable to that of the general population? An italian study.

PURPOSE: Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their quality of life (QoL) can inform health care policy as well as help supporting individual patients. This study was aimed to quantify QoL of this specific population in comparison with data provided for both the general population and cancer patients and to assess QoL association with several sociodemographic, clinical, and psychological variables. METHODS: Three hundred fourteen Italian long-term cancer survivors (people who have been free from cancer and cancer treatments for at least 5 years) completed a battery of questionnaires including the SF12 for QoL assessment. RESULTS: Both physical and mental functioning were higher than those among Italian cancer patients but lower than those of the Italian general population (p < .001). Poorer QoL (physical and mental functioning) was associated more often with psychological conditions (as anxiety and depression) than with sociodemographic and cancer-related variables. CONCLUSIONS: These data support an ongoing specific interest in the QoL of long-term cancer survivors and suggest the need for further study of multidimensional functioning in this population.

Facilitating the integration of emotional states in patients' personal disease experience with cancer: a new brief intervention for managing psychological distress.

PURPOSE: This paper describes an intervention performed at an Italian oncological institute to manage psychological distress related to the oncological experience. Its objectives are to encourage and normalize awareness of the importance of emotional aspects of the cancer experience, to provide psycho-education to patients on the importance of psycho-social care in promoting well-being, and to introduce our psychology service and promote its usage. METHODS: The intervention consists of three consecutive steps: the psychological distress screening; the clinical interview, which is conducted according to Rogers' client-centered model; and the collection of data regarding the appreciation and usefulness of the initiative, performed through a feedback questionnaire and the codification of the interview contents. RESULTS: Between September 2011 and February 2012, the intervention was administered to 484 consecutive new inpatients. Among them, the prevalence of psychological distress and its components of anxiety and depression are comparable to those found in the literature. The low percentage of participants who refuse the screening (15.4 %) as well as of those who do not wish to have the results returned to them (3.1 %), together with the high scores regarding the usefulness and effectiveness given to the intervention (all >80/100), documents the positive reception of this activity. Lastly, the analysis of the contents of the exit interview shows that a wide range of themes, far more varied and heterogeneous than just anxiety and/or depression symptoms, was discussed. CONCLUSIONS: Even though this was a clinical and not a research activity, it still offers important descriptive data.

[Sexuality and intimacy after cancer: an explorative survey at 5 years or more since treatment completion]. / La sessualità e l'intimità di coppia dopo il cancro: un'indagine esplorativa a cinque anni o più dallo fine dei trattamenti.

INTRODUCTION: Long-term cancer survivorship is a reality for a growing number of persons diagnosed with cancer and this fact justifies the great effort made to know and to improve quality of life (QoL) after having experienced a cancer and its treatments. In this paper, the perception of both sexuality and intimacy--that represents a QoL domain--is investigated in a sample of long-term cancer survivors to identify potential problematic areas and to verify its association with the main socio-demographic and clinical variables. METHOD: 96 long-term cancer survivors (i.e. persons free from cancer and its treatments for at least 5 years) filled out a brief questionnaire together with a socio-demographic and clinical form. RESULTS: 17.7% of the sample reported lower interest in sexuality and intimacy; 34.3% more interest in tenderness and cuddles; 12.5% discomfort in intimacy; 30.2% decreased frequency of sexual intercourses; 28.2%, 23.9% and 22.9%, respectively, decreased sexual desire, difficulty with arousal, difficulty with orgasm; finally, 37.5% reported absent or poor satisfaction for their own sexual life. The perception of sexuality and intimacy was associated with gender, age, occupational status, cancer type, other health problems, organic/functional genital damage (p < 0.05), but not with education, marital status, having or not children, length of survivorship. CONCLUSIONS: Although preliminary, these data seem to support World Health Organization statement on the centrality of sexuality of being human.

Assessing the body image: relevance, application and instruments for oncological settings.

PURPOSE: Body image is the sum of physical, cognitive, emotional, and relational elements that, when integrated, allow the development of a whole, healthy self-identity. Even though body image is normally studied in relation to eating disorders, it can also be influenced by other pathologies, including cancer. In oncology, an effective body image assessment is fundamental. The physical effects of cancer and cancer treatments are important and frequently irreversible also on a functional and emotional level; however, only few surveys have investigated body image in this peculiar context. METHODS: An extensive literature review was carried out in PubMed and PsycINFO. We considered articles published from 1990 to 2010. RESULTS: Two hundred sixty-three papers matched the search criteria. Assessment methodologies included clinical interviews, self-report measures, questionnaires, symptom check lists, and graphic tests and projective techniques. After excluding the instruments that referred to eating disorders, validated only for adolescents, and/or projective and graphic tests, we found 81 articles with six questionnaires specifically dedicated to body image assessment in oncology. CONCLUSIONS: From our systematic review, we could identify six instruments specifically designed for assessing body image in the oncological area. In this paper, we discuss their general characteristics, psychometrics properties and the clinical implications, and body image relevance on the quality of life in cancer patients.

Distance perception in autism and typical development.

Children with autism and typically developing children walked blindfolded to a previously seen target (blindwalking task) and matched the frontal to the sagittal extent of a pattern formed by ropes on the ground (L-matching task). All participants were accurate in the blindwalking task. Children with autism were also very accurate in the matching task. By contrast, in the matching task typically developing children made substantial underestimations that were inversely correlated with age. These findings support models that posit independent representations for the egocentric distance to a target location and for the spatial extent to a target object relative to the other spatial extents. These latter representations involve a form of large-scale pattern perception that may mature more slowly than representations of egocentric distance and develop atypically in autism.

Updating and inhibition processes in working memory: a comparison between Alzheimer's type dementia and frontal lobe focal damage.

A large debate has recently focused on the componential nature of the working-memory system (), as evidenced by functional-imaging studies and by using more sophisticated experimental paradigms. The present work aims at further disentangling the role and effects of central executive (CE) and of phonological loop (PL). It is suggested that maintaining active verbal information mostly relates to an intact PL, while the inhibition of interfering information preponderantly involves the CE. To distinguish these effects, two groups of brain damaged patients were administered with an updating task. Frontal lobe patients showed major difficulties in inhibiting interfering information, an ability requiring an involvement of the CE component. In contrast, Alzheimer's dementia patients evidenced a relative impairment in maintaining relevant information, requiring the intervention of the PL.