Promoting adjustment after treatment for cancer

Department of Psychology, University of California, Los Angeles, Los Ángeles, California, United States
Cancer (Impact Factor: 4.89). 12/2005; 104(11 Suppl):2608-13. DOI: 10.1002/cncr.21246
Source: PubMed


The transition from the period of diagnosis and medical treatment of cancer to survivorship (i.e., the reentry phase) is an understudied phase in the cancer trajectory. The objectives of this report were 1) to illustrate several adaptive tasks of the reentry phase, 2) to provide examples of research on factors that predict positive adjustment during this phase, and 3) to discuss interventions that address the adaptive tasks of early cancer survivorship. Although the pertinent empirical literature is scarce, accounts from cancer survivors, healthcare professionals, and qualitative researchers converge to suggest several themes in adaptive tasks during reentry. Drawing from the authors' work and that of others, the authors have described common expectancies held by many individuals approaching reentry (e.g., "I shouldn't need support"), typical concerns during this phase (e.g., concern over cancer recurrence), and personal and contextual factors that can facilitate and hinder adjustment. Promising psychosocial interventions have been developed for individuals in the reentry period. Continued research will be necessary to characterize this important phase of cancer survivorship.

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Available from: Julia Rowland, Oct 03, 2014
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    • "A number of hypotheses have been proposed to explain these results (Hungerbuehler, et al., 2011; Weiss, 2004a). Women, who are more sensitive to stress (Stanton, et al., 2005), are more likely to experience thoughts, images, and feelings that cause them distress, but this in turn would trigger PTG (Kashdan & Kane, 2011). The results could also be explained by the fact that in terms of personal relationships and intimacy, women guide men, with men being more likely to have an intimate relationship with their wife, whereas she will also have intimate relationships with other women (Weiss, 2004a). "

    01/2016; Springuer.
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    • "Previous researchers have established that adjusting to a diagnosis of cancer takes time [26]. It is striking that those within a year of diagnosis were less likely to detect their own recurrent melanoma. "
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    ABSTRACT: Melanoma incidence is growing and more people require follow-up to detect recurrent melanoma quickly. Those detecting their own recurrent melanoma appear to have the best prognosis, so total skin self examination (TSSE) is advocated, but practice is suboptimal. A digital intervention to support TSSE has potential but it is not clear which patient groups could benefit most. The aim of this study was to explore cutaneous melanoma recurrence patterns between 1991 and 2012 in Northeast Scotland. The objectives were to: determine how recurrent melanomas were detected during the period; explore factors potentially predictive of mode of recurrence detection; identify groups least likely to detect their own recurrent melanoma and with most potential to benefit from digital TSSE support. Pathology records were used to identify those with a potential recurrent melanoma of any type (local, regional and distant). Following screening of potential cases available secondary care-held records were subsequently scrutinised. Data was collected on demographics and clinical characteristics of the initial and recurrent melanoma. Data were handled in Microsoft Excel and transported into SPSS 20.0 for statistical analysis. Factors predicting detection at interval or scheduled follow-up were explored using univariate techniques, with potentially influential factors combined in a multivariate binary logistic model to adjust for confounding. 149 potential recurrences were identified from the pathology database held at Aberdeen Royal Infirmary. Reliable data could be obtained on 94 cases of recurrent melanoma of all types. 30 recurrences (31.9%) were found by doctors at follow-up, and 64 (68.1%) in the interval between visits, usually by the patient themselves. Melanoma recurrences of all types occurring within one-year were significantly more likely to be found at follow-up visits, and this remained so following adjustment for other factors that could be used to target digital TSSE support. A digital intervention should be offered to all newly diagnosed patients. This group could benefit most from optimal TSSE practice.
    BMC Dermatology 03/2014; 14(1):4. DOI:10.1186/1471-5945-14-4
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    • "After the end of primary curative breast cancer treatment, patients go through the transition from ‘patient’ to ‘survivor’ [6,7]. This transition or re-entry phase [8] is characterized by multiple adaptive tasks on emotional, physical and social domain and sets stage for adaptive long-term survivorship [9]. Topics encountered during the re-entry phase are in principle universal for all BCS and include among others: physical recovery, emotional processing, fear of recurrence, decreasing social support (losing the “safety net” of treatment), resuming professional activities, but also positive life changes (e.g. "
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    ABSTRACT: Background After completion of curative breast cancer treatment, patients go through a transition from patient to survivor. During this re-entry phase, patients are faced with a broad range of re-entry topics, concerning physical and emotional recovery, returning to work and fear of recurrence. Standard and easy-accessible care to facilitate this transition is lacking. In order to facilitate adjustment for all breast cancer patients after primary treatment, the BREATH intervention is aimed at 1) decreasing psychological distress, and 2) increasing empowerment, defined as patients’ intra- and interpersonal strengths. Methods/design The non-guided Internet-based self-management intervention is based on cognitive behavioural therapy techniques and covers four phases of recovery after breast cancer (Looking back; Emotional processing; Strengthening; Looking ahead). Each phase of the fully automated intervention has a fixed structure that targets consecutively psychoeducation, problems in everyday life, social environment, and empowerment. Working ingredients include Information (25 scripts), Assignment (48 tasks), Assessment (10 tests) and Video (39 clips extracted from recorded interviews). A non-blinded, multicentre randomised controlled, parallel-group, superiority trial will be conducted to evaluate the effectiveness of the BREATH intervention. In six hospitals in the Netherlands, a consecutive sample of 170 will be recruited of women who completed primary curative treatment for breast cancer within 4 months. Participants will be randomly allocated to receive either usual care or usual care plus access to the online BREATH intervention (1:1). Changes in self-report questionnaires from baseline to 4 (post-intervention), 6 and 10 months will be measured. Discussion The BREATH intervention provides a psychological self-management approach to the disease management of breast cancer survivors. Innovative is the use of patients’ own strengths as an explicit intervention target, which is hypothesized to serve as a buffer to prevent psychological distress in long-term survivorship. In case of proven (cost) effectiveness, the BREATH intervention can serve as a low-cost and easy-accessible intervention to facilitate emotional, physical and social recovery of all breast cancer survivors. Trial registration This study is registered at the Netherlands Trial Register (NTR2935)
    BMC Cancer 09/2012; 12(1):394. DOI:10.1186/1471-2407-12-394 · 3.36 Impact Factor
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