Validation of the FACT-BRM with interferon-alpha treated melanoma patients.

The somatic, neurocognitive, and psychiatric side effects of biological response modifiers (BRMs) have been documented in specific patient samples. Although these side effects likely have a predictable impact on patients quality of life (QOL), no instrument currently measures the cumulative effect of the various complaints patients' report. The current study investigated the reliability and validity of the Functional Assessment of Cancer Treatment-Biological Response Modifier (FACT-BRM) scale for measuring QOL in a sample of melanoma patients receiving interferon. Measures of distress, depression, and fatigue were also obtained using standardized, well-validated instruments. Results indicate increased symptom burden, depression, and fatigue, and decreased quality of life over 4 months of IFN therapy. The FACT-BRM demonstrated good psychometrics and sensitivity to change, and thus appears to be a good instrument for measuring QOL in patients receiving BRMs.

Longitudinal course of depression, fatigue, and quality of life in patients with high risk melanoma receiving adjuvant interferon.

PURPOSE: Treatment of malignant melanoma with interferon-alpha has been associated with a variety of side effects ranging from fatigue to depression, and a concomitant impact on quality of life (QOL), in a variety of case reports and cross-sectional clinical trials. Few, if any, studies have been conducted with the express purpose of assessing the longitudinal course of depression, fatigue, and QOL before and during interferon therapy. DESCRIPTION OF STUDY: The current study reports on 16 patients who were assessed at 6 points in time: baseline, post high dose, and 1, 2, 3, and 6 months post high dose treatment with interferon-alpha with the Brief Symptom Inventory, Beck Depression Inventory, Revised Piper Fatigue Scale, and Functional Assessment of Cancer Therapy-Biological Response Modifiers. RESULTS: Results revealed consistent changes from baseline through 6 month assessment. Specifically, increased somatic complaints, depression, and fatigue were observed on the BSI, BDI, and RPFS, respectively. Additional reductions in QOL on the FACT-BRM were also identified. CLINICAL IMPLICATIONS: The findings suggest that IFN has a significant effect on QOL, but that it may be the somatic symptoms of fatigue that contribute to changes on measures of mood. Limiting the amount of fatigue and depression would appear to be significant if individuals are to successfully complete IFN therapy.

Course of distress and quality of life in testicular cancer patients before, during, and after chemotherapy: results of a pilot study.

Testicular cancer is the most common cancer in white males between the ages of 15 and 45 years. Treatment may include the administration of chemotherapy which has been associated with changes in emotional distress, quality of life, and symptom distress in other cancers. The current study was designed to evaluate the course of these constructs in a sample of testicular cancer patients undergoing chemotherapy. Patients completed measures of emotional distress and quality of life prior to, during, and after chemotherapy, with symptom distress measured during chemotherapy. Thirty percent of patients reported moderate to high levels of distress at pre-treatment baseline that was associated with worse quality of life. Initial anxiety and distress decreased and stayed low through chemotherapy and post-treatment follow-up. There were no significant changes in fatigue, nausea or change in appearance during chemotherapy. The results suggest that some patients evidence pre-treatment anxiety and distress that appears to be primarily anticipatory, decreases over the course of chemotherapy, and occurs in the context of improved quality of life and reduced symptom severity. Deleterious changes in emotional distress, quality of life, and symptom distress seen in other cancer populations were not apparent in our sample of testicular cancer patients.

Cognitive-behavioral intervention for distress in patients with melanoma: comparison with standard medical care and impact on quality of life.

BACKGROUND: Melanoma accounts for > 79% of skin cancer-related deaths, although it accounts for only 4% of skin cancer incidence. Given the potential for lethality, it is likely that patients with melanoma may experience significant emotional distress. The current study was designed to determine the effect of a cognitive-behavioral intervention on distress and health-related quality of life (HRQOL) in patients with melanoma who had medium-to-high distress. METHODS: Forty-eight patients who had Global Severity Index scores >or= 60 2 months after their initial visit to the multidisciplinary melanoma clinic were randomized to receive either standard care or 4 sessions of a cognitive-behavioral intervention (CBI). Repeated assessments using the Brief Symptom Inventory, the Medical Outcomes Survey Short Form-36, and the State-Trait Anxiety Inventory occurred at baseline, at 2 months, and at 6 months after intervention for both groups. RESULTS: An intent-to-treat analysis did not reveal significantly lower distress in the CBI group at 2 months or 6 months of follow-up, although differences were noted in anxiety and HRQOL. An effect-of-intervention analysis did reveal lower levels of distress in the CBI group at 2 months, with differences approaching significance at 6 months. CONCLUSIONS: The four-session CBI significantly reduced distress and improved HRQOL for a period of 2 months in patients with melanoma who had medium-to-high distress, with improved general health evident 6 months after the intervention. Some variation in results was revealed in an intent-to-treat analysis. The initial evidence from the current study showed that a brief intervention may be effective for creating change in individuals with cancer who have increased distress, although further research is needed to identify the most optimal approach for delivering the intervention.

Parent and adolescent adjustment to pediatric cancer: associations with coping, social support, and family function.

This article presents preliminary results investigating the relationship between parental and adolescent adjustment and coping and their relationship to social support and family functioning in a sample of adolescents (ages 11-18) with cancer and one of their parents. Parents and adolescents from two pediatric oncology clinics completed measures of distress, coping, social support, and family cohesion/adaptability. Low levels of distress were reported by both children and their parents with positive correlations noted between parent and child adjustment. Adolescents reported that their parents and a close friend were the greatest sources of social support and described their families as having a high degree of cohesion and adaptability. Both adolescents and parents used more adaptive than maladaptive coping strategies, although distress was associated with reduced use of adaptive coping. Adolescents are able to adapt to cancer in the context of strong family and social supports. In addition, there is a relationship between parental and adolescents adjustment, and between greater use of adaptive coping styles and lower distress.