No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Emotional distress among long-term breast cancer survivors: The role of insomnia and worry
Abstract
Breast cancer constitutes a challenge for survival and wellbeing. Emotional distress may persist many years after cancer being cured. This study aimed to analyse how emotional symptomatology was present in breast cancer survivors. Additionally, it aimed to study the role of sleep difficulty and worry on symptom maintenance. A sample of 206 women (M= 56.07 years, SD= 11.56) was selected to form four groups: healthy controls, breast cancer patients, short-term and long-term survivors. Emotional distress, worry and sleep problems were assessed. Long-term survivors showed significantly higher levels of anxiety (p< .05). Anxiety was predicted by worry for all groups but with higher variance in long-term survivors (R 2 adj= .47). Insomnia and age predicted depression in this group (R 2 adj= .40). To conclude, long-term emotional distress was observed even after the threat of cancer passed. Our findings confirm the need to extend supportive care to meet survivors' needs. KEY WORDS: anxiety, breast cancer, survivor, depression, sleep, pathological worry. Resumen El cáncer de mama constituye un desafío para la supervivencia y el bienestar personal, observándose síntomas emocionales derivados que podrían persistir incluso muchos años después de superar la enfermedad. En este estudio se pretendía evaluar la presencia de sintomatología emocional en supervivientes de cáncer de mama (SCM). Asimismo, se perseguía evaluar el papel de los problemas de sueño y la preocupación en el mantenimiento de dichos síntomas emocionales. La muestra consistió en 206 mujeres (M= 56,07 años; DT= 11,56), pertenecientes a cuatro grupos: controles sanas, pacientes, SCM a corto plazo (SCMC) y SCM a largo plazo (SCML). Como resultados, se observó que los SCML mostraban más sintomatología ansiosa que los otros grupos (p< 0,05). Dicha sintomatología fue predicha en todos los grupos por la preocupación patológica, encontrándose mayor varianza explicada para el grupo de SCML (R 2 aj= 0,47). La edad y el insomnio predijeron la sintomatología depresiva en este grupo (R 2 aj= 0,40). Como conclusión, se debe extender la atención psicooncológica a supervivientes de larga duración dado su impacto emocional duradero.
... It is worth noting here that the strongest correlations were those between general psychological distress (DASS-21 total score) and worries about the future and the SBCS total score. This is consistent with previous research showing that cancer survivors who experience concerns or fears about the future, often referred to as Damocles syndrome, tend to manifest greater psychological distress 7,17 . These worries about the future in breast cancer patients should therefore be a target of intervention by psycho-oncologists, as they seem to be one of the most important concerns affecting these women. ...
... During this period, patients have to cope with major changes in their lives that drastically disrupt personal, family, social, and work routines. The importance of monitoring anxiety and depression during the first five years after a cancer diagnosis and identifying factors associated with these conditions has been highlighted previously 7,62 . ...
... This is important because breast cancer is known to be one of the most stressful life events that a woman may face during www.nature.com/scientificreports/ her lifetime 3,4,7 . Women with high scores on the DASS-21 should be prioritized for psychological intervention to reduce their psychological distress. ...
Breast cancer impacts the psychological well-being of women, leaving them at risk of developing depression, anxiety, and other stress-related disorders. The Depression Anxiety Stress Scales (DASS-21) is a widely used measure, although empirical evidence regarding its psychometric properties in the breast cancer population is limited. The purpose of this study was to conduct an exhaustive analysis of the psychometric properties of the DASS-21 in a sample of Spanish women diagnosed with breast cancer. Participants were 289 breast cancer patients who completed the DASS-21 and other questionnaires measuring life satisfaction, positive and negative affect, flourishing, perceived stress, and breast cancer-specific stressors. In terms of validity evidence based on the internal structure of the DASS-21, adequate fit indices were obtained for the model based on three first-order factors (depression, anxiety, stress) and one second-order factor (general psychological distress). Reliability coefficients (McDonald’s omega) ranged from .84 to .95. Validity evidence based on relationships with other variables was also provided by moderate and strong correlations with well-being indicators and stress measures. The results support the use of the DASS-21 for measuring general psychological distress in the breast cancer context, where it may provide useful information for the design of psychological interventions with patients.
... Concretely, the prevalence rate of anxiety disorder in breast cancer patients is 41.9% and is even higher in Mediterranean countries [13]. These symptoms are associated with other disorders affecting patients' health, such as worries and insomnia [14]. On the bright side of these data, this means that there is a considerable percentage of women who present good psychological adjustment and do not become distressed after a breast cancer diagnosis, or if they do, they manage to recover quickly. ...
... The absence of this set of symptoms, together with the absence of somatic symptoms, social dysfunction, and insomnia is called general health [32]. Apart from their physical health, it is important to pay attention to the general health of breast cancer patients with regard to the impact that the illness and its consequences have on all aspects of their lives [12,14]. ...
... Previous psychological interventions with a positive psychology approach have already demonstrated their efficacy [46][47][48] because they have worked on improving resilience, among other aspects of psychological functioning. Thus, it has been shown that psychological support during the treatment is of great importance in the recovery from the disease, and the researchers insist that it should also be provided to survivors once the treatment is over [14,15]. Both during treatment and after, when patients become survivors, it is important to foster resilience in order to avoid psychological distress and general decline [46]. ...
A considerable percentage of breast cancer patients present adequate psychological adjustment and do not become distressed after a breast cancer diagnosis, or, if they do, they manage to recover quickly, which is reflected in their general health. This study aims to determine the role of some psychological mechanisms that affect psycho-oncological adjustment, specifically, resilience and well-being, in a sample of 109 breast cancer patients. For this purpose, participants completed questionnaires on general health, resilience, and well-being (life satisfaction and affect). Correlation analyses and a multiple mediation model were carried out. The results revealed that Pearson correlations between all variables showed strong associations between general health scores and positive and negative affect scores, and moderate associations with life satisfaction and resilience scores. Furthermore; in the mediation model, the total percentage of variance explained by the overall model was 55% (R2 = 0.55), where resilience was associated with positive and negative affect, and that influenced general health. These results show that affective well-being is especially relevant in breast cancer patients in terms of its mediating role in resilience, making it clear that an appropriate intervention focused on managing patients' affective status can have a favorable impact on their overall health.
... A diagnosis of breast cancer impacts the psychological well-being of women 3,4,5 , leaving them at risk of developing depression, anxiety, and other stress-related disorders 6 , which importantly may persist beyond the end of medical treatment 7 . The disease therefore needs to be addressed from a psycho-oncological perspective 8 . ...
... It is worth noting here that the strongest correlations were those between general psychological distress (DASS-21 total score) and worries about the future and the SBCS total score. This is consistent with previous research showing that cancer survivors who experience concerns or fears about the future, often referred to as Damocles syndrome, tend to manifest greater psychological distress 7,17 . These worries about the future in breast cancer patients should therefore be a target of intervention by psycho-oncologists, as they seem to be one of the most important concerns affecting these women. ...
Breast cancer impacts the psychological well-being of women, leaving them at risk of developing depression, anxiety, and other stress-related disorders. The Depression Anxiety Stress Scales (DASS-21) is a widely used measure, although empirical evidence regarding its psychometric properties in the breast cancer population is limited. The purpose of this study was to conduct an exhaustive analysis of the psychometric properties of the DASS-21 in a sample of Spanish women diagnosed with breast cancer. Participants were 289 breast cancer patients who completed the DASS-21 and other questionnaires measuring life satisfaction, positive and negative affect, flourishing, perceived stress, and breast cancer-specific stressors. In terms of validity evidence based on the internal structure of the DASS-21, adequate fit indices were obtained for the model based on three first-order factors (depression, anxiety, stress) and one second-order factor (general psychological distress). Reliability coefficients (McDonald’s omega) ranged from .84 to .95. Validity evidence based on relationships with other variables was also provided by moderate and strong correlations with well-being indicators and stress measures. The results support the use of the DASS-21 for measuring general psychological distress in the breast cancer context, where it may provide useful information for the design of psychological interventions with patients.
... Breast cancer is no exception in this regard (Dooley et al., 2017;Tschuschke et al., 2017;Borgi et al., 2020). Stress in people with cancer has been linked to high levels of anxiety, depression (Burgess et al., 2005;Mehnert and Koch, 2008;Alagizy et al., 2020;O'Hea et al., 2020), sleep problems (Schell et al., 2019;De la Torre-Luque et al., 2020), lower self-care (Abdollahi et al., 2020), and low levels of satisfaction with life (Cerezo et al., , 2022. Research in this context has also found that emotional distress is associated with poor adherence to treatment (Ochoa and Casellas-Grau, 2017), lower quality of life (Zhao et al., 2020), and even a reduced likelihood of survival (Cardenal et al., 2012). ...
... It is acknowledged that patients continue to have healthcare needs throughout the disease process (Cherif et al., 2020), and also that factors such as long waiting times and difficulties communicating with staff can lead to dissatisfaction with the care provided (Tremblay et al., 2015). The fact that cancer survivors may, at some point, experience mental health problems such as depression, anxiety, and sleeping difficulties underlines the importance of ongoing access to healthcare (Cherif et al., 2020;De la Torre-Luque et al., 2020;Aggeli et al., 2021). ...
Background
A diagnosis of breast cancer generates psychological stress, due not only to treatment and its side effects but also to the impact on different areas of the patient’s daily life. Although there are instruments for measuring psychological stress in the cancer context, there is currently no tool for assessing stressors specific to breast cancer.
Aims
The aim of this study was to develop the Stressors in Breast Cancer Scale (SBCS).
Method
A panel of experts evaluated the clarity and relevance of scale items, providing validity evidence based on test content. Psychometric properties of the scale were then analyzed.
Results
Validity evidence based on the internal structure of the SBCS was obtained through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), following a cross-validation strategy. The CFA supported a second-order factor model with five dimensions: physical appearance and sex strains, health and daily difficulties, interpersonal relationship strains, healthcare strains, and worries and concerns about the future. This structure was invariant across two groups distinguished by time from cancer diagnosis (less than 3 and 3 years or more from diagnosis). Reliability, based on McDonald’s omega and Cronbach’s alpha coefficients, ranged from 0.83 to 0.89 for factor scores, and reached 0.95 for total scores. Validity evidence was also provided by correlations with depression, anxiety, perceived stress, and perceived health and quality of life.
Discussion
The results support the use of the SBCS for measuring stress as a stimulus in the breast cancer context. Implications for clinical practice and research are discussed.
... Empirical evidence suggests that between 35% and 41% of these patients suffer symptoms of emotional distress Fayanju et al., 2021;Ochoa et al., 2017) that affect their mental health and well-being (Alarcón et al., 2020;Cardenal et al., 2012;Cerezo et al., 2020Cerezo et al., , 2022. The emotional impact of breast cancer manifests in the form of anxiety, fear, and depression, which may persist for years after the end of treatment (Borgi et al., 2020;De la Torre-Luque et al., 2020;Li et al., 2021). High levels of stress are also common among these patients (Abuatiq et al., 2020;Dooley et al., 2017;Harris et al., 2017;Li et al., 2021), and consequently, various studies have examined the impact this has on mental health (Abdollahi et al., 2019;Arnaboldi et al., 2017;Voigt et al., 2017). ...
Breast cancer diagnosis is one of the most difficult events that a woman can experience during her life and it usually produces high levels of stress. Global measures of perceived stress are useful for screening and for comparing stress levels between cancer patients and other clinical and nonclinical populations. One such instrument that is widely used is the Perceived Stress Scale, but its psychometric properties have scarcely been analyzed with breast cancer patients. The aim of this study was to provide validity evidence regarding the use of the 10‐item version of the Perceived Stress Scale (PSS‐10) as a tool for measuring perceived stress in this context. Participants were 215 Spanish breast cancer patients who completed the PSS‐10 and the DASS‐21, a measure of affective distress (depression, anxiety, and stress). The internal structure of the PSS‐10 was examined through confirmatory factor analysis (CFA), and the reliability of test scores was estimated using McDonald's omega coefficient. Validity evidence based on relationships with other variables was also obtained using correlation analysis. The CFA supported a correlated two‐factor structure: perceived helplessness (six negatively worded items) and perceived self‐efficacy (four positively worded items). Reliability coefficients for scores on these two factors were .87 and .73, respectively. Scores on affective distress (DASS‐21) were strongly and positively correlated with perceived helplessness and moderately and negatively correlated with perceived self‐efficacy. The PSS‐10 is an adequate tool for measuring perceived stress in the breast cancer context and it may be useful for identifying women at risk of psychological maladjustment. This article is protected by copyright. All rights reserved.
Objective
Approximately 25% of cancer patients suffer from cancer‐related fatigue (CRF) after cancer treatment. CRF is a multi‐factorial condition affected by several interrelated protective and perpetuating factors. As most studies merely assessed bivariate associations, more insight into the complex relationships among these constructs is needed. We applied the multivariate network approach to gain a better understanding of how patients' fatigue, perpetuating and protective factors are dynamically interconnected.
Method
Between February and August 2022, 30 cancer patients filled out a carefully developed ecological momentary assessment questionnaire (EnergyInSight) five times a day for at least 21 days while being on the waitlist for psychological care for CRF. We performed a multi‐level vector autoregression analysis to examine the interconnectedness among fatigue, protective factors (allowing rest, acceptance, and self‐efficacy) and perpetuating factors (worrying, catastrophizing, and feeling guilty).
Results
In the contemporaneous network (concurrent associations), higher acceptance and self‐efficacy were associated with lower fatigue, whereas all other factors were associated with higher fatigue. The strongest relationships were between worrying and feeling guilty and between acceptance and allowing rest. In the temporal network (lagged associations), fatigue was related to two factors: higher self‐efficacy preceded lower fatigue, and higher fatigue preceded increased allowing rest.
Conclusions
Taking all included factors into account, the networks identified self‐efficacy and allowing rest as key protective factors of CRF. Patients may benefit from psychological interventions that cultivate self‐efficacy, as it seems to pave the way to reduced fatigue.
Background
Empirical evidence shows that life satisfaction is positively related to character strengths, and although this association has been observed in different populations, it is scarce in breast cancer patients. This study analyzes the relationship between character strengths and life satisfaction in Spanish women diagnosed with breast cancer.
Methods
A sample of 117 women completed the Satisfaction with Life Scale (SWLS) and the Spanish version of the VIA Inventory of Strengths (VIA-IS). Correlation analysis and regression modeling were performed to determine which strengths predict life satisfaction.
Results
The results of the correlation analysis showed that 15 strengths were positively and significantly associated with life satisfaction, with the highest correlations corresponding to zest, hope, curiosity, social intelligence, love, gratitude, and judgment. Regression modeling indicated that of these, zest and hope were key strengths for predicting life satisfaction.
Conclusions
These findings suggest that intervention programs based on the development of zest and hope could help to improve life satisfaction and, therefore, the psychological well-being of women with breast cancer.
Objectives:
Depression and anxiety are common mental disorders in later life. Few population-based studies have investigated their potential impacts on mortality in low- and middle-income countries (LMICs). The aim of this study is to examine the associations between depression, anxiety, their comorbidity and mortality in later life using a population-based cohort study across eight LMICs.
Methods:
This analysis was based on the 10/66 cohort study including 15991 people aged 65 or above in Cuba, Dominican Republic, Venezuela, Mexico, Peru, Puerto Rico, China and India, with an average follow-up time of 3.9 years. Sub-threshold and clinical levels of depression were determined using EURO-D and ICD-10 criteria and anxiety was based on GMS-AGECAT. Cox proportional hazard modelling was used to estimate how having depression, anxiety or both was associated with mortality adjusting for sociodemographic and health factors.
Results:
Participants with clinical depression (Hazard Ratio (HR): 1.45; 95%CI:1.24-1.70) and sub-threshold anxiety (HR: 1.26; 95%CI:1.15-1.38) had higher risk of mortality than those without the conditions after adjusting for sociodemographic factors and health conditions. Co-morbidity of depression and anxiety was associated with a 30% increased risk of mortality but the effect sizes varied across countries (Higgins I2 =58.8%), with the strongest association in India (HR: 1.99; 95%CI:1.21-3.27).
Conclusions:
Depression and anxiety appear to be associated with mortality in older people living in LMICs. Variation in effect sizes may indicate different barriers to health service access across countries. Future studies may investigate underlying mechanisms and identify potential interventions to reduce the impact of common mental disorders.
Cognitive activity, manifested as trauma-related ruminative thinking, and deficits in emotional processing are believed to perpetuate the symptoms of posttraumatic stress disorder (PTSD). The aim of this study was to determine the mediating role of rumination in the relationship between emotional processing difficulties and PTSD symptoms. Data from 60 women aged from 40 to 67 (mean 58.0; SD 6.97) with breast cancer diagnosis were analyzed. The participants completed three questionnaires: the Impact of Event Scale-Revised to assess PTSD symptoms, the Event Related Rumination Inventory to measure intrusive and deliberate rumination, and the Emotional Processing Scale to assess emotional processing deficits. The results reveal positive associations between emotional processing deficits, cancer-related rumination, and PTSD symptoms. Mediation analysis indicated that intrusive rumination plays a mediating role in the relationship between difficulties in emotional processing and PTSD symptoms. The findings highlight the role played by cognitive and emotional processes in the development and maintenance of posttraumatic stress disorder symptoms.
Purpose:
Despite the prevalence of fear of cancer recurrence (FCR), understanding of factors underlying clinically significant FCR is limited. This study examined factors associated with greater FCR morbidity, according to a cognitive processing model, in cancer survivors who screened positively for clinically significant FCR seeking psychological treatment through the ConquerFear trial.
Methods:
Participants had completed treatment for breast, colorectal or melanoma cancer 2 months to 5 years previously and scored ≥ 13/36 on the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). Hierarchical regression analyses examined associations between demographic, medical and psychological variables, namely metacognitions (MCQ-30), post-traumatic stress symptoms (IES-R) and FCR (FCRI total score).
Results:
Two hundred and ten (95%) of the 222 cancer survivors who consented to the ConquerFear trial completed the baseline questionnaire. Participants were predominantly (89%) breast cancer survivors. The final regression model accounted for 68% of the variance in FCR (demographic and medical variables 13%, metacognitions 26%, post-traumatic stress symptoms 28%). Negative metacognitive beliefs about worry and intrusive post-traumatic stress symptoms were significant individual correlates of FCR, but negative beliefs about worry did not significantly moderate the impact of intrusions on FCR morbidity.
Conclusions:
Results provide partial support for the cognitive processing model of FCR. Psychological factors were found to play an important role in FCR morbidity after controlling for demographic/medical factors. More intrusive thoughts and negative beliefs about worry were strong independent predictors of FCR morbidity. Cancer survivors with clinically significant FCR may benefit from assessment for intrusive thoughts and metacognitions and delivery of trauma- and/or metacognitive-based interventions accordingly.
Background:
Whether the emotional distress around cancer diagnosis is associated with the long-term outcomes and care utilization is unknown. We aimed to examine the association of mental disorders around cancer diagnosis with the hospital admission rates of cancer patients thereafter.
Methods:
We conducted a nationwide cohort study including 218,508 cancer patients diagnosed in Sweden during 2004-2009 and followed them from 90 days after cancer through 2010. We used a clinical diagnosis of stress-related mental disorders from 90 days before to 90 days after cancer diagnosis as the exposure. We studied first all hospital admissions and then separately three common admissions, including external injuries, infections, and cardiovascular diseases. The Cox model was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).
Results:
Four thousand one hundred five patients received a diagnosis of stress-related mental disorders around the cancer diagnosis, and experienced a 35% increased rate of any hospital admission during follow-up (HR: 1.35, 95%CI: 1.28-1.41) as well as hospital admissions for external injuries (HR: 1.89, 95%CI: 1.67-2.14), infections (HR: 1.28, 95%CI: 1.08-1.52), and cardiovascular diseases (HR: 1.16, 95%CI: 1.03-1.30). Similar association was noted for most common cancer types.
Conclusions:
These data suggest that cancer patients diagnosed with a stress-related mental disorder immediately before or after cancer diagnosis are subsequently at increased risk of hospital admissions for major comorbidities of cancer.
Cognitive and behavioral interventions (CBI) have been used for breast cancer patients with various stages of the disease or undergoing different treatments. However, no quantitative review has summarized their efficacy on the side effects of treatment, distress, and quality of life in the acute treatment setting after diagnosis. This meta-analysis synthesizes data from 19 randomized clinical trials in order to: (a) provide an estimation of overall effect of CBI in breast cancer patients during treatment for breast cancer, i.e., neo-adjuvant and adjuvant treatment; (b) provide average effect sizes on side effects of treatment, distress, and quality of life; and (c) test possible moderators of effect size. The results show that CBI yielded a small effect size overall, specifically on general side effects of treatment, nausea, vomiting, distress, and quality of life. Individual and behavioral interventions seem to elicit better results on distress and on general side effects of treatment, respectively. While more studies are needed with regard to specific side effects (i.e., fatigue, pain, and sleep disturbance), the overall results clearly support the use of CBI in breast cancer patients during treatment.
This case study describes the course and content of cognitive behavior therapy (CBT) for clinical fear of cancer recurrence (FCR) in a breast cancer survivor. The CBT for clinical FCR consisted of seven face-to-face therapy sessions and one telephone session. The primary treatment goal was to reduce FCR severity by modifying cognitive processes and dysfunctional behavior. Assessments of FCR and quality of life were completed by the breast cancer survivor pre-therapy, post-therapy, and at 6 and 12 months of post-therapy. In each treatment session, perceived control over FCR was assessed. A clinical nurse specialist participated in evaluation interviews. The patient’s perceived control over FCR increased during the therapy, and FCR severity declined to a non-clinical level. This improvement was still evident at the 6- and 12-month follow-up assessments and was supported by results for secondary and exploratory outcomes measures. FCR offers a great challenge for health care professionals due to the lack of effective treatment options. This case study shows how clinical FCR can be addressed with CBT and can contribute to the improvement of care for cancer survivors.
Purpose:
Unmanaged distress has been shown to adversely affect survival and quality of life in breast cancer survivors. Fortunately, distress can be managed and even prevented with appropriate evidence-based interventions. Therefore, the objective of this systematic review was to synthesize the published literature around predictors of distress in female breast cancer survivors to help guide targeted intervention to prevent distress.
Methods:
Relevant studies were located by searching MEDLINE, Embase, PsycINFO, and CINAHL databases. Significance and directionality of associations for commonly assessed candidate predictors (n ≥ 5) and predictors shown to be significant (p ≤ 0.05) by at least two studies were summarized descriptively. Predictors were evaluated based on the proportion of studies that showed a significant and positive association with the presence of distress.
Results:
Forty-two studies met the target criteria and were included in the review. Breast cancer and treatment-related predictors were more advanced cancer at diagnosis, treatment with chemotherapy, longer primary treatment duration, more recent transition into survivorship, and breast cancer recurrence. Manageable treatment-related symptoms associated with distress included menopausal/vasomotor symptoms, pain, fatigue, and sleep disturbance. Sociodemographic characteristics that increased the risk of distress were younger age, non-Caucasian ethnicity, being unmarried, and lower socioeconomic status. Comorbidities, history of mental health problems, and perceived functioning limitations were also associated. Modifiable predictors of distress were lower physical activity, lower social support, and cigarette smoking.
Conclusions:
This review established a set of evidence-based predictors that can be used to help identify women at higher risk of experiencing distress following completion of primary breast cancer treatment.
Breast cancer survivors continue to experience an array of physical, psychological and cognitive symptoms following the completion of their treatment. However, there is a lack of understanding of symptom burden during an extended and long-term survivorship. The present review attempts to provide an overview of conceptual and contextual understanding of symptom burden that women with breast cancer may experience following treatment completion. We will focus on six commonly reported symptoms or symptom clusters in post-treatment breast cancer survivors, including menopausal symptoms, lymphoedema, fatigue, depression, sleep disturbance and cognitive dysfunction. To identify and manage the symptom burden effectively, further investigation is required into individual symptoms and their relationship to others.
This study aimed to determine the prevalence and identify the risk factors associated with upper extremity impairments (UEIs) in breast cancer patients and to investigate the degree to which these impairments and other characteristics influence quality of life (QoL). A total of 201 women over the age of 18 who underwent breast cancer treatment at least 6 months were included in this cross-sectional study. All of the patients were evaluated for the presence of lymphoedema and any UEIs. UEIs divided into five subgroups: pain, restriction of shoulder range of motion (ROM), numbness and heaviness, loss of strength, and sensory deficit. QoL of the patients was evaluated by SF-36. The prevalence of the upper extremity impairments was as follows: pain 31.8%, restriction of shoulder ROM 23.9%, numbness and heaviness 35.3%, loss of strength 8.5%, and sensory deficit 18.4%. Furthermore, lymphoedema was seen in 41.3% of patients. The multivariate model showed that lymphoedema is the only statistically significant risk factor that affects the development of UEIs (P = 0.001). However, it also revealed that lymphoedema (P = 0.001) and increased age negatively affect QoL, whereas prolongation of the follow-up period has a favourable impact (P = 0.016). Therefore, lymphoedema diminishes QoL via an increased number of UEIs.
How cancer history and distress relate to sleep outcomes of adolescents and young adults (AYAs) is unclear. The current study compares AYA cancer survivors to controls on indicators of sleep and fatigue; examines the concurrent association between psychological status, sleep, and fatigue; and investigates the lagged relationship between sleep and fatigue problems with psychological functioning.
AYA cancer survivors (n = 167) and controls (n = 170), ages 16 to 30, completed measures at a survivorship clinic/primary care visit (time 1) and 2 months later (time 2). Participants completed questions about sleep quality, quantity, sleep medication use, self-reports of sleep problems, and fatigue in addition to measures of depression, anxiety, and posttraumatic stress symptoms (PTSS).
There were no differences in sleep quantity or quality between survivors and controls, but survivors reported significantly more fatigue. Within groups, AYAs with self-reported sleep and fatigue problems reported significantly higher depression, anxiety, and PTS symptoms. Controlling for baseline depression, sleep, and fatigue problems at time 1 significantly predicted depression at time 2 in survivors but not in controls.
This study offers important insight into the psychological functioning of childhood cancer survivors and prospectively describes sleep and fatigue as risk factors for poor psychological functioning in survivors. These findings support screening for sleep problems in AYA survivors as these difficulties are closely related to mental health functioning.
Context:
Little is known about cancer-related worry in thyroid cancer survivors.
Objectives:
We quantified cancer-related worry in Canadian thyroid cancer survivors and explored associated factors.
Design, setting, and participants:
We performed a cross-sectional, self-administered, written survey of thyroid cancer survivor members of the Thyroid Cancer Canada support group. Independent factors associated with cancer-related worry were identified using a multivariable linear regression analysis.
Main outcome measure:
We used the Assessment of Survivor Concerns (ASC) questionnaire, which includes questions on worry about diagnostic tests, second primary malignancy, recurrence, dying, health, and children's health.
Results:
The response rate for eligible members was 60.1% (941 of 1567). Most respondents were women (89.0%; 837 of 940), and the age was < 50 years in 54.0% of participants (508 of 941). Thyroid cancer was diagnosed within ≤ 5 years in 66.1% of participants (622 of 940). The mean overall ASC score was 15.34 (SD, 4.7) (on a scale from 6 [least worry] to 24 [most worry]). Factors associated with increased ASC score included: younger age (P < .001), current suspected or proven recurrent/persistent disease (ie, current proven active disease or abnormal diagnostic tests) (P < .001), partnered marital status (P = .021), having children (P = .029), and ≤5 years since thyroid cancer diagnosis (P = .017).
Conclusions:
In a population of Canadian thyroid cancer survivors, cancer-related worry was greatest in younger survivors and those with either confirmed or suspected disease activity. Family status and time since thyroid cancer diagnosis were also associated with increased worry. More research is needed to confirm these findings and to develop effective preventative and supportive strategies for those at risk.
-This study assessed the effects of a psychological group intervention based on positive psychology in women with breast cancer. 175 women were randomly assigned either to an experimental group, receiving the 14-session intervention (n = 87), or to a waitlist group (n = 88) that did not receive any type of intervention. For treatment, a group intervention was applied, based on improving psychological strengths and enhancing positive psychology-based styles of coping. Strength-related outcomes, self-esteem, well-being, and happiness were assessed before and after the intervention. The experimental group showed higher scores on all of the study variables after the intervention. Participants reported improved self-esteem, emotional intelligence-related abilities, resilience, and optimism, as well as positive affectivity, well-being, and happiness. The results show a beneficial effect of this psychological intervention based on positive psychology on female breast cancer patients' psychological health.
We aimed to analyze the relationship of anxiety and depression with
fibromyalgia pain and severity. The study comprised 127 women aged 51.9±7
years. Anxiety and depression was assessed by means of the Hospital Anxiety and
Depression Scale (HADS) and fibromyalgia severity with the Fibromyalgia Impact
Questionnaire (FIQ). Pain was assessed by four indicators: tenderness (tender
points count [TPC] and algometer score) and the Short-Form-36 Health Survey
(SF36)-pain and FIQ-pain subscales. Perceived pain, as measured by SF36-pain,
was worse in the severe anxiety-group compared with the low and mild anxietygroups
and in the severe compared with the low depression-group. Perceived
pain, as measured by FIQ, was higher for the severe compared to the low anxietygroup.
Tenderness, as measured by algometer score and TPC, did not differ
among anxiety and depression categories. HADS-anxiety scores ≥8 were
associated with an increased odds ratio of severe fibromyalgia. HADS-depression
≥ 8 were associated with severe fibromyalgia. Overall, women with higher levels
of anxiety and depression present increased pain perception and risk of severe
fibromyalgia. Consequently, anxiety and depression should be detected and
treated properly.
Research on worry during the past 15 years has revealed a remarkable amount of knowledge about this pervasive human phenomenon. Worry involves a predominance of verbal thought activity, functions as atype of cognitive avoidance, and inhibits emotional processing. Worry also produces not only anxious experience but depressive affect as well. Recent evidence suggests that the very private experience of worry is developmentally connected to enmeshed childhood relationships with the primary caregiver and is currently associated with significant interpersonal problems, especially those involving tendency to be overly nurturing to others. At the physiological level, worry is characterized peripherally by parasympathetic deficiency and autonomic rigidity and centrally by left-frontal activation.
Chronic sleep deficiency, defined as a state of inadequate or mistimed sleep, is a growing and underappreciated determinant of health status. Sleep deprivation contributes to a number of molecular, immune, and neural changes that play a role in disease development, independent of primary sleep disorders. These changes in biological processes in response to chronic sleep deficiency may serve as etiological factors for the development and exacerbation of cardiovascular and metabolic diseases and, ultimately, a shortened lifespan. Sleep deprivation also results in significant impairments in cognitive and motor performance which increase the risk of motor vehicle crashes and work-related injuries and fatal accidents. The American Academy of Sleep Medicine and the Sleep Research Society have developed this statement to communicate to national health stakeholders the current knowledge which ties sufficient sleep and circadian alignment in adults to health.
This study examined the relationship between emotion regulation deficits and GAD-related outcomes in an analogue sample. Consistent with hypotheses, general emotion dysregulation was associated with reports of chronic worry and with analogue GAD status. Also, specific regulation deficits, including deficits in emotional clarity, acceptance of emotions, ability to engage in goal directed behaviors when distressed,
impulse control, and access to effective regulation strategies, were associated with worry and analogue GAD above and beyond variance contributed by negative affectivity. These findings provide additional preliminary evidence for an emotion regulation deficit model of GAD and are discussed in terms of clinical implications and directions for future research.
To identify symptom clusters in older adult breast cancer survivors (ages 65-97 years) and examine whether symptom clusters are related to demographic, health, and quality-of-life variables.
Factor analysis to identify possible symptom clusters. The resulting clusters then were correlated with quality-of-life measures.
Phone interviews between the participants and a trained research nurse.
192 breast cancer survivors (X age = 70).
This was a secondary data analysis of the baseline measures of demographics, health history, symptom bother, and physical, mental, and existential dimensions of quality of life. Exploratory and confirmatory factor analyses were conducted as well as multiple indicator multiple cause modeling and partial correlation analyses to assess the relationships among clusters and demographic, health history, and quality-of-life measures.
Self-reported symptom bother, demographics such as age and education level, health history, and quality of life.
Seven clinically distinct symptom clusters tapping 36 different symptoms in older adult breast cancer survivors were found. These symptom clusters were significantly related to multiple dimensions of quality of life.
Older adult breast cancer survivors experience multiple concurrent symptoms that appear to cluster. Identifying symptom clusters helps to elucidate possible intersymptom relationships which may lead to the design of more effective symptom management interventions for older adult breast cancer survivors.
Older adult breast cancer survivors should be assessed for a wide variety of symptoms if clinicians hope to identify and understand intersymptom relationships. Such assessment would enable more comprehensive symptom management.
The purpose of this research was to demonstrate that a specific psychosocial intervention changes reactions to cancer and quality of life. This study was carried out on 66 patients with a first breast cancer. Patients were randomly divided into two groups: a specific intervention group (G1, 8 sessions) or a support group (G2, 8 sessions). A control group (G3) was composed of patients who refused to participate in psychological intervention. Social support, perceived control, repression of emotions, coping strategies, emotional distress, and quality of life were assessed one week before (T1) and at the end (T2) of the psychological intervention. Results showed that G1 did not have significantly modified quality of life or psychological scores. Patients of G2 had poorer emotional quality of life, use of internal causal attributions, and minimized their illness at T1 as compared to patients of G3. At Time 2 these differences were not observed.
Worriers avoid upsetting thoughts yet also demonstrate vigilance for aversive emotional information. Potentially, these processes coexist but are separated in time. Individuals scoring high on a measure of chronic uncontrollable worry were compared to low scorers during valence categorization of emotional stimuli with interleaved Stroop color word trials to monitor extended effects of emotional processing. High worriers were especially fast and accurate in judging the valence of emotional words compared to low worriers. Worriers also had smaller pupil diameters following personally relevant negative emotional stimuli compared to low worriers. Correlations with self-report scales indicated associations between the worrier pupil response profile and symptoms of chronic worry and depression. The combined behavioral and physiological data support theories of emotional vigilance followed by avoidance in worriers.
The number of cancer survivors is steadily increasing. Following completion of primary cancer treatment and many years thereafter, specific symptoms continue to negatively affect cancer survivors. The purpose of this article is to review the evidence of symptom burden following primary treatment for cancer in survivors of the most common types of cancer (breast, gynecological, prostate, and colorectal).
A systematic review of literature published between the years 2000-2008 that reported late-effects and/or long-term psychosocial symptoms associated with cancer survivorship post-completion of primary cancer treatment was conducted. The symptoms include physical limitations, cognitive limitations, depression/anxiety, sleep problems, fatigue, pain, and sexual dysfunctions.
Symptom burden associated with cancer survivorship was consistent among the four most common types of cancer (breast, gynecological, prostate, and rectal/colon), despite various types of treatment exposure. Generally, across the cancer groups, depressive symptoms, pain, and fatigue were commonly found in cancer survivors.
Based on longitudinal and cross-sectional evidence, cancer survivors can experience symptoms for more than 10 years following treatment. These symptoms were present in survivors of all four cancer types who underwent a wide variety of treatment. The results indicate that these symptoms should be evaluated and managed to optimize long-term outcomes.
To identify the most prevalent worries and fears of women diagnosed with ovarian cancer.
Online survey design was used to elicit qualitative data. Examination of worry was a single question extracted from a broader investigation.
A "virtual interview" enabled women from 12 countries and 44 states to participate in this study.
360 English-speaking women aged 19-82 years with a diagnosis of ovarian cancer. Ninety-one percent of the women were partnered, were Caucasian, and had received at least some college education. The sample was equally stratified on income, geographic location (rural versus urban), and distance to healthcare services.
A descriptive survey was used to investigate "worry" among women with ovarian cancer. Colaizzi's qualitative method was used to analyze the narrative responses.
Worries and fears of women with ovarian cancer stratified by age and development stage.
Consistent with previously published studies, worry about recurrence and fear of death were expressed by most women, regardless of age, ethnicity, or stage of life. Other worries expressed by study participants varied by age and development and were found to correlate with the last three stages of life as described in Erikson's Theory of Psychosocial Development.
Age and development stage are key determinants of the needs and concerns of women with ovarian cancer.
Age and development stage should be considered when developing an individualized plan of care. Because recurrence is common among this population, the fear of death exists regardless of age and should be explored by nurses, particularly during periods of remission.
Background
This study examined the prevalence, course and risk indicators of subthreshold anxiety disorder to determine the necessity and possible risk indicators for interventions.
Methods
Data were derived from the ‘Netherlands Mental Health Survey and Incidence Study-2’ (NEMESIS-2), a psychiatric epidemiological cohort study among the general population (n = 4528). This study assessed prevalence, characteristics, and three-year course of subthreshold anxiety disorder (n = 521) in adults, and compared them to a no anxiety group (n = 3832) and an anxiety disorder group (n = 175). Risk indicators for persistent and progressive subthreshold anxiety disorder were also explored, including socio-demographics, vulnerability factors, psychopathology, physical health and functioning.
Results
The three-year prevalence of subthreshold anxiety disorder was 11.4%. At three-year follow-up, 57.3% had improved, 29.0% had persistent subthreshold anxiety disorder and 13.8% had progressed to a full-blown anxiety disorder. Prevalence, characteristics and course of subthreshold anxiety disorder were in between both comparison groups. Risk indicators for persistent course partly overlapped with those for progressive course and included vulnerability and psychopathological factors, and diminished functioning.
Limitations
Course analysis were restricted to the development of anxiety disorders, other mental disorders were not assessed. Moreover, due to the naturalistic design of the study the impact of treatment on course cannot be assessed.
Conclusions
Subthreshold anxiety disorder is relatively prevalent and at three-year follow-up a substantial part of respondents experienced persistent symptoms or had progressed into an anxiety disorder. Risk indicators like reduced functioning may help to identify these persons for (preventative) treatment and hence reduce functional limitations and disease burden.
Purpose:
The number of cancer survivors is increasing due to scientific advances. Previous research on unmet care needs of Taiwanese cancer survivors focused on patients with newly or recently diagnosed cancer. Little is known about the needs and symptom experiences of cancer survivors who have completed treatment.
Methods:
This is a cross-sectional survey study. Patients who were over 20 years old; had completed their first-line treatment for their cancer were recruited into the study. The questionnaire included demographic characteristics, a global item of quality of life, the physical effects subscale of the Cancer Survivors' Survey of Needs (CSSN), and Cancer Survivors' Unmet Needs measure (CaSUN).
Results:
One hundred and twenty cancer survivors participated in this study. Body changes, loss of strength, weight change, memory and concentration and fatigue were the top five symptom concerns. Nearly half of the Taiwanese survivors reported needs for up-to-date information, understandable information, and an ongoing case manager were not met. On average, survivors reported 7.68 unmet care needs. Male gender, being under 50 years of age, and having a solid tumor were associated with higher levels of unmet needs.
Conclusions:
This study provides preliminary information about the type and levels of physical symptom concerns and supportive care needs in long-term cancer survivors in Taiwan. Specific groups of cancer survivors whose needs were unmet were identified. The current healthcare system is not sufficiently meeting the needs of cancer survivors and more efforts are required to advance survivorship care and research in Taiwan.
Background:
Worry or fear related to speaking in front of others, or more broadly, communicating and interacting with others, is common. At elevated levels, however, it may contribute to heightened stress reactivity during acute speaking challenges. The purpose of this study was to examine multi-system physiological stress reactivity in the context of high-stakes public speaking while considering the impact of hypothesized individual difference risk factors.
Methods:
University student participants (n = 95) delivering speeches as a heavily-weighted component of their final grade had saliva samples collected immediately prior to speaking, immediately after, and 20 min after speech completion. Saliva samples were assayed for alpha amylase (sAA), cortisol, and interleukin-1 beta (IL-1β). Self-reported communication anxiety, social interaction anxiety, rejection sensitivity, and sex were assessed as risk factors for heightened stress reactivity.
Results:
Salivary sAA, cortisol, and IL-1β significantly changed following speech delivery. Multivariate analyses demonstrated that elevated levels of self-reported communication anxiety and social interaction anxiety were independently associated with increased cortisol and IL-1β responses and combined to enhance HPA axis and inflammatory cytokine activity further (i.e., cortisol and IL-1β AUCI). Sex and rejection sensitivity were unrelated to physiological stress reactivity.
Conclusions:
These findings suggest that individuals with elevated communication and interaction fears may be at increased risk of heightened neuroendocrine and inflammatory responses following exposure to acute social stressors. Both types of anxiety may combine to increase physiological reactivity further, with unknown, though likely insalubrious, health consequences over time.
Background:
Children with non-Hodgkin lymphoma (NHL) undergo treatment with central nervous system-directed therapy, the potentially neurotoxic effects of which have not been reported in NHL survivors.
Methods:
NHL survivors (n = 187) participating in the St. Jude Lifetime Cohort who were 10 or more years from their diagnosis and were 18 years old or older underwent neurocognitive, emotional distress (Brief Symptom Inventory 18), and health-related quality of life (HRQOL) assessments (36-Item Short Form Health Survey). Age-adjusted z scores were compared with community controls (n = 181) and normative data. Treatment exposures were abstracted from medical records. Models adjusted for the age, sex, and time from diagnosis were used to calculate the risk of impairment.
Results:
The mean ages at evaluation were similar for the survivors and the controls (35.7 ± 8.9 vs 35.5 ± 11.0 years; P = .86). Survivors were 25.2 ± 8.8 years from their diagnosis: 43 (23%) received cranial radiation, 70 (37%) received high-dose methotrexate, 40 (21%) received high-dose cytarabine, and 151 (81%) received intrathecal chemotherapy. Survivors' intelligence and attention were within normal limits; however, their memory, executive function, processing speed, and academics were impaired in comparison with both population norms and community controls (P values < .05). Treatment-related exposures were not associated with neurocognitive function; however, neurocognitive impairment was associated with lower educational attainment, unemployment, and occupational status (P values < .03). Slower processing speed and worse self-reported executive function were associated with symptoms of depression (P values ≤ .003) and poorer HRQOL (P values < .05).
Conclusions:
Adult survivors of childhood NHL experience impaired neurocognitive function, which is associated with lower social attainment and poor HRQOL. Early-detection and intervention strategies are recommended. Cancer 2017. © 2017 American Cancer Society.
Purpose/Objectives: To determine (a) if depressive symptoms in partners of long-term breast cancer survivors (BCSs) could be predicted by social cognitive processing theory and (b) if partners of younger and older BCSs were differentially affected by the cancer experience. Design: A cross-sectional, descriptive study using self-report questionnaires. Setting: Indiana University in Bloomington and 97 ECOG-ACRIN Cancer Research Group sites in the United States. Sample: 508 partners of BCSs diagnosed three to eight years prior to the study. Methods: Secondary data mediation analyses were conducted to determine if cognitive processing mediated the relationship between social constraints and depressive symptoms. Age-related differences on all scales were tested. Main Research Variables: Depressive symptoms; secondary variables included social constraints, cognitive processing (avoidance and intrusive thoughts), and potentially confounding variables. Findings: Cognitive processing mediated the relationship between social constraints and depressive symptoms for partners. Partners of younger BCSs reported worse outcomes on all measures than partners of older BCSs. Conclusions: As predicted by the social cognitive processing theory, cognitive processing mediated the relationship between social constraints and depressive symptoms. In addition, partners of younger BCSs fared worse on social constraints, intrusive thoughts, and depressive symptoms than partners of older BCSs. Implications for Nursing: Results provide support for using the social cognitive processing theory in an intervention design with partners of long-term BCSs to decrease depressive symptoms.
Major Depressive Disorder (MDD) is common among cancer patients, with prevalence rates up to four-times higher than the general population. Depression confers worse outcomes, including non-adherence to treatment and increased mortality in the oncology setting. Advances in the understanding of neurobiological underpinnings of depression have revealed shared biobehavioral mechanisms may contribute to cancer progression. Moreover, psychosocial stressors in cancer promote: (1) inflammation and oxidative/nitrosative stress; (2) a decreased immunosurveillance; and (3) a dysfunctional activation of the autonomic nervous system and of the hypothalamic-pituitary-adrenal axis. Consequently, the prompt recognition of depression among patients with cancer who may benefit of treatment strategies targeting depressive symptoms, cognitive dysfunction, fatigue and sleep disturbances, is a public health priority. Moreover, behavioral strategies aiming at reducing psychological distress and depressive symptoms, including addressing unhealthy diet and life-style choices, as well as physical inactivity and sleep dysfunction, may represent important strategies not only to treat depression, but also to improve wider cancer-related outcomes. Herein, we provide a comprehensive review of the intertwined biobehavioural pathways linking depression to cancer progression. In addition, the clinical implications of these findings are critically reviewed.
To explore sleep-related problems reported by patients with cancer prior to undergoing radiotherapy, and to analyse the effect of cancer severity, history of treatment and psychosomatic symptomatology on these problems.
A descriptive cross-sectional study was conducted. One hundred and five patients with cancer were evaluated prior to radiotherapy. The primary endpoint was the sleep problem score measured by a self-rated version of the Oviedo Sleep Questionnaire. Secondary variables were impact of pain on sleep, anxiety and asthenia.
Patients reported important levels of insomnia and hypersomnia. Insomnia-related problems were significantly higher in patients with more-severe disease (P < 0.05), and led to higher levels of hypnotic drug intake. Prior chemotherapy was significantly associated with hypersomnia-related problems (P < 0.05). Anxiety was significantly associated with both sleep-related problems.
Sleep problems are significant among patients with cancer prior to undergoing radiotherapy, and were found to be associated with progression of cancer, prior treatments and other psychosomatic symptoms (e.g. anxiety). Sleep problems within this context must be explored to provide adequate guidelines to palliate their effects on quality of life.
Copyright © 2015 Elsevier Ltd. All rights reserved.
The comparison of regression coefficients across subsamples is relevant to many studies. Often, the same regression model is fitted to several subsamples and the question arises whether the effect of some of the explanatory variables, as expressed by the linear model, is the same for all subsamples. Because there are sometimes misunderstandings as to the statistical procedure which ought to be applied and consequently, wrong formulae are sometimes adopted by researchers. The purpose of this article is to describe in detail the relevant statistical procedures, together with the assumptions underlying the statistical tests. Some examples are quoted, in which wrong formulae were applied. It is demonstrated how the adoption of the wrong formulae might lead to mistaken conclusions.
Background
Cancer survival has improved in the past 20 years, affecting the long-term risk of mood disorders. We assessed whether depression and anxiety are more common in long-term survivors of cancer compared with their spouses and with healthy controls.
Methods
We systematically searched Medline, PsycINFO, Embase, Science Direct, Ingenta Select, Ovid, and Wiley Interscience for reports about the prevalence of mood disorders in patients diagnosed with cancer at least 2 years previously. We also searched the records of the International Psycho-oncology Society and for reports that cited relevant references. Three investigators independently extracted primary data. We did a random-effects meta-analysis of the prevalences of depression and anxiety in cancer patients compared with spouses and healthy controls.
Findings
Our search returned 144 results, 43 were included in the main analysis: for comparisons with healthy controls, 16 assessed depression and ten assessed anxiety; of the comparisons with spouses, 12 assessed depression and five assessed anxiety. The prevalence of depression was 11·6% (95% CI 7·7–16·2) in the pooled sample of 51 381 cancer survivors and 10·2% (8·0–12·6) in 217 630 healthy controls (pooled relative risk [RR] 1·11, 95% CI 0·96–1·27; p=0·17). The prevalence of anxiety was 17·9% (95% CI 12·8–23·6) in 48 964 cancer survivors and 13·9% (9·8–18·5) in 226 467 healthy controls (RR 1·27, 95% CI 1·08–1·50; p=0·0039). Neither the prevalence of depression (26·7% vs 26·3%; RR 1·01, 95% CI 0·86–1·20; p=0·88) nor the prevalence of anxiety (28·0% vs 40·1%; RR 0·71, 95% CI 0·44–1·14; p=0·16) differed significantly between cancer patients and their spouses.
Interpretation
Our findings suggest that anxiety, rather than depression, is most likely to be a problem in long-term cancer survivors and spouses compared with healthy controls. Efforts should be made to improve recognition and treatment of anxiety in long-term cancer survivors and their spouses.
Funding
None.
Purpose of the research:
To compare the psychological health and quality of life (QoL) of women with breast cancer, and to determine the relationship between anxiety, depression and QoL during treatment and one year afterwards.
Methods and sample:
For this secondary analysis, 269 women undergoing adjuvant therapy for breast cancer, and 148 women with breast cancer who had completed all treatment within the last year completed a self-report questionnaire covering the Hospital Anxiety and Depression Scale-Cantonese/Chinese version, Functional Assessment of Cancer Therapy-General, and demographic and clinical characteristics.
Key results:
The ongoing-therapy group showed higher levels of anxiety and depression and lower levels of all QoL dimensions than the post-therapy group. Linear regression results showed that both anxiety and depression were significantly related to physical and functional well-being, while depression was associated with social/family well-being in both groups. In the case of emotional well-being, anxiety had a strong significant association in both groups and depression a significant relationship only in the ongoing-therapy group.
Conclusions:
The psychological health of women with breast cancer is affected during and after treatment. Psychological distress in these patients, including anxiety and depression, has independent associations with impaired emotional, functional, physical and social well-being. The results highlight the importance of timely detection of anxiety and depression, and their proper management, during the treatment and survivorship phases of the breast cancer trajectory.
The public health burden of cardiovascular disease (CVD) is high both in terms of economic and social costs. Key modifiable factors identified for CVD prevention include health behaviors and health risk factors (e.g., cholesterol, blood pressure). However, a substantial body of research has also identified stress, anxiety, and depression as potentially modifiable CVD risk factors. Here we focus on the role of anxiety in the development of CVD and consider its potential as a key target for primordial prevention strategies. First, we highlight important findings and summarize the latest research on anxiety and incident CVD. We also review and summarize the findings to date on subclinical CVD outcomes and briefly consider mechanisms by which anxiety may influence CVD. We identify key issues and consider how these issues may inform our understanding of the anxiety-CVD relationship. Finally, we briefly discuss the clinical implications of this work, with specific recommendations for providers.
The response styles theory (Nolen-Hoeksema, 1991) was proposed to explain the insidious relationship between rumination and depression. We review the aspects of the response styles theory that have been well-supported, including evidence that rumination exacerbates depression, enhances negative thinking, impairs problem solving, interferes with instrumental behavior, and erodes social support. Next, we address contradictory and new findings. Specifically, rumination appears to more consistently predict the onset of depression rather than the duration, but rumination interacts with negative cognitive styles to predict the duration of depressive symptoms. Contrary to original predictions, the use of positive distractions has not consistently been correlated with lower levels of depressive symptoms in correlational studies, although dozens of experimental studies show positive distractions relieve depressed mood. Further, evidence now suggests that rumination is associated with psychopathologies in addition to depression, including anxiety, binge eating, binge drinking, and self-harm. We discuss the relationships between rumination and worry and between rumination and other coping or emotion-regulation strategies. Finally, we highlight recent research on the distinction between rumination and more adaptive forms of self-reflection, on basic cognitive deficits or biases in rumination, on its neural and genetic correlates, and on possible interventions to combat rumination.
© 2008 Association for Psychological Science.
Over two-thirds of the 11.4 million cancer survivors in the United States can expect long-term survival, with many others living with cancer as a chronic disease controlled by ongoing therapy. However, behavioral co-morbidities often arise during treatment and persist long-term to complicate survival and reduce quality of life. In this review, the inter-relationships between cancer, depression, and sleep disturbance are described, with a focus on the role of sleep disturbance as a risk factor for depression. Increasing evidence also links alterations in inflammatory biology dynamics to these long-term effects of cancer diagnosis and treatment, and the hypothesis that sleep disturbance drives inflammation, which together contribute to depression, is discussed. Better understanding of the associations between inflammation and behavioral co-morbidities has the potential to refine prediction of risk and development of strategies for the prevention and treatment of sleep disturbance and depression in cancer survivors.
Worry, the cognitive enumeration and anticipation of potential future negative events, is associated with autonomic dysregulation, which may in turn have implications for the immune system. People endorsing high (n = 7) and normal levels of trait worry (n = 8) were briefly exposed to a phobic stimulus and the autonomic and immune responses and recovery were assessed. A time-matched control group (n = 6) was not exposed to any stimulus. Both worry groups showed increased heart rate and skin conductance in response to phobic fear. However, only the normal worry group showed a concomitant increase in natural killer cells in peripheral blood. Patterns of change during the follow-up period suggested that phobic fear had disrupted a normal circadian increase in natural killer cells. Adrenergic and hypothalamus–pituitary–adrenal mechanisms may be responsible for the differences between high and normal worry groups in their natural killer cell response to and recovery from phobic fear.
Background:
Increasing proportions of patients diagnosed with cancer will become long-term survivors (≥ 5 years post-diagnosis). However, survivors may continue to experience negative effects of cancer and/or treatment, including fear of recurrence (FoR). This review aims to provide an overview of current knowledge on FoR, including determinants and consequences in long-term cancer survivors, and to outline methodological and conceptual challenges that should be addressed in future research.
Methods:
Multiple databases including PUBMED, EMBASE, and PsycINFO were searched to identify relevant articles. Seventeen articles were included. Data were extracted by two reviewers and summarized following a systematic scheme.
Results:
Even years after initial diagnosis, cancer survivors suffer from FoR. Most studies report low or moderate mean FoR scores, suggesting that FoR is experienced in modest intensity by most survivors. Studies including long-term and short-term survivors indicate no significant change of FoR over time. Lower level of education, lower level of optimism, and being Hispanic or White/Caucasian were found to be associated with higher levels of FoR. Significant negative associations were reported between FoR and quality of life as well as psychosocial well-being. All but three studies were conducted in the USA. General cut-offs for severity/clinical significance have not been defined yet.
Conclusions:
FoR at modest intensity is experienced by most long-term cancer survivors. Future studies should address determinants and consequences of FoR in more detail. Validated instruments providing cut-offs for severity/clinical significance of FoR should be developed and utilized. Efficient interventions should be implemented to reduce detrimental effects of FoR.
Objective:
Although many survivors continue to worry about cancer years after completing treatment, little is known about factors associated with cancer worry. This study examined associations between breast cancer worry and demographic and clinical variables, as well as fatigue, symptom burden, and risk perception in a sample of breast cancer survivors 3 years post-adjuvant treatment. We hypothesized that after controlling for demographic and treatment factors, a significant proportion of variance in cancer worry would be explained by greater fatigue severity, more symptom burden, and greater perceived risk of recurrence.
Methods:
Stage 0-II breast cancer patients (N = 202) completed measures of risk perception, cancer worry (modified Lerman's Cancer Worry Scale), symptom burden (Memorial Symptom Assessment Scale), and fatigue severity (Fatigue Symptom Inventory) 3 years after completing adjuvant treatment. Multiple regression analyses were used to determine the proportion of variance in cancer worry accounted for by fatigue, symptom burden, and risk perception after controlling for demographic and clinical variables.
Results:
Age, fatigue, symptom burden, and risk perception each explained a significant proportion of variance in cancer worry (p < 0.05). Fatigue, symptom burden, and risk perception together accounted for 27% of the variance in cancer worry after controlling for demographic and clinical factors (p < 0.01).
Conclusions:
The hypothesis was supported that fatigue, symptom burden, and risk perception are associated with cancer worry among breast cancer survivors. It is possible that lingering fatigue and other symptoms may remind breast cancer survivors of their disease.
Sleep-related complaints are common in cancer survivors. Although daytime sleepiness and sleep duration are associated with poor functional status, quality of life, and mortality in the general population, little is known about these issues in long-term cancer survivors. This study examined differences in daytime sleepiness and sleep duration between long-term cancer survivors and non-cancer controls.
Survey data were analyzed from individuals diagnosed with cancer ≥2 years in the past (n = 1,171, mean age = 64.30, 80.8% white, 22.8% male) and spouse/friends controls (n = 250, mean age = 60.78, 88.0% white, 64.8% male). Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Associations between sleep-related variables and history of cancer were estimated with multivariable logistic regression, adjusting for potential confounders. Stratified analyses were conducted to identify subgroups of survivors most at risk for sleep problems.
Cancer survivors were more likely than controls to report excessive daytime sleepiness (OR = 1.64, 95% CI: 1.07, 2.50). A cancer diagnosis was associated with longer sleep duration among males (OR = 1.25, 95% CI: 1.02, 1.53), but not in females (OR = 0.87, 95% CI: 0.37, 1.05). All other associations were similar regardless of cancer site, histology, time since diagnosis, treatment history, and history of multiple cancers.
Disturbances in daytime sleepiness and sleep duration persist among long-term cancer survivors and should be monitored in routine survivorship care. More research is needed to identify cancer survivors who are at increased risk for daytime sleepiness and disturbed sleep duration, as well as to identify causal mechanisms for, and interventions to mitigate, persistent differences.
Breast cancer is the most commonly diagnosed cancer in women. Insomnia is a significant problem in breast cancer patients, affecting between 20% to 70% of newly diagnosed or recently treated cancer patients. Pain, fatigue, anxiety, and depression are also common conditions in breast cancer and often co-occur with insomnia in symptom clusters, exacerbating one another, and decreasing quality of life (QOL). There have been no clinical trials of drugs for sleep in cancer. Cognitive behavioral psychotherapies on the other hand, have shown some of the most positive results in alleviating the distressing symptoms that often accompany the breast cancer experience, but even these studies have not targeted the symptom cluster. Pharmacological as well as non-pharmacological treatments need to be explored. It might be that a combined pharmacological and behavioral treatment is most efficacious. In short, substantially more research is needed to fully understand and treat the symptom cluster of insomnia, fatigue, pain, depression and anxiety in breast cancer.
Although excessive worry has been linked primarily with Generalized Anxiety Disorder (GAD), recent work suggests worry is dimensional, with potential relevance to a range of psychiatric disorders. The current study examined associations between worry and psychological symptoms across several primary diagnoses and tested worry's hypothesized unique relation to GAD in an acute psychiatric setting. Participants were 568 patients with primary diagnoses of Major Depression, Bipolar Disorder-Depressed, Bipolar Disorder-Manic, and Psychosis. Participants completed a structured diagnostic interview and questionnaires at admission. Partial correlations controlling for GAD diagnosis indicated that worry correlated with higher depression and poorer overall well-being in the Depressed, Bipolar-Depressed, and Psychosis groups and decreased functioning in the Depressed, Bipolar-Manic, and Psychosis groups. Depressed and Bipolar-Depressed groups endorsed the highest level of worry. A comorbid anxiety disorder was associated with higher worry across primary diagnoses, even after controlling for GAD. Of the anxiety disorders, GAD and Panic Disorder diagnoses predicted higher worry scores. Results discussed in terms of conceptual implications for worry as a transdiagnostic concept and clinical interventions.
To present an update of the evidence on psychosocial responses and factors that contribute to psychosocial functioning and quality of life (QOL) in breast cancer survivors.
Research articles/abstracts and literature reviews.
In the nearly 5 years since the original article, research has confirmed that the majority of breast cancer survivors demonstrate a pattern of recovery after treatment. Age, information, social support, degree of symptom distress, and unmet psychological needs remain key factors influencing psychosocial functioning and QOL outcomes. More knowledge has been disseminated about the experience of the transition to survivorship, women's perceived identity, and the potential benefits of survivorship plans to patient outcomes.
Assessment of psychological and social well-being in the transition to survivorship is essential. Interventions should be targeted to meet informational needs, manage uncertainty, control symptoms, address cultural differences, and enhance social and emotional support.
To examine changes in quality of life among patients with breast cancer and factors related to it, during the first three months after diagnosis.
Numerous studies have examined quality of life among cancer survivors or among patients with cancer after aggressive treatment; such research has demonstrated that quality of life in the third month after surgery can significantly predict quality of life in the long run. In contrast, changes in quality of life causes among patients during the acute treatment phase have not been well studied.
Prospective longitudinal study.
Newly diagnosed patients with breast cancer were recruited during 2008-2009. Sixty-one cases completed the four data collections on the day before operation and one, two and three months after surgery. Data were collected using the Functional Living Index-Cancer, Symptom Distress Scale, the Self-Efficacy Scale and a 0-10 Anxiety Numeric Rating Scale. Generalized Estimating Equations were applied for data analysis.
There were significant changes in quality of life over the three months following surgery, and the worst quality of life was observed in the first month after surgery. Less advanced stages of cancer, lower anxiety, less symptom distress and higher perceived self-efficacy in the preoperative interview could significantly predict which patients experienced more positive quality of life trends. Fatigue, limited shoulder function and perceived poor appearance were the most significant factors predicting changes of quality of life.
Preoperative physical and psychological factors, as well as sense of self-efficacy for managing the cancer, are important factors for predicting changes in patients' quality of life.
Healthcare providers should be alert to factors contributing to changes of quality of life among patients receiving chemotherapy. Interventions based on these results should be developed and their effectiveness tested for their impact on breast cancer patients' quality of life. Clinical interventions based on these results should be developed to improve breast cancer patients' quality of life.
Men have higher incidence and mortality rates for nearly all cancers. They are less likely than women to utilise cancer information services and other social support services. The aim of this study was to explore and compare the experience and coping behaviour of men and women after treatment for colorectal cancer (CRC).
A longitudinal qualitative study was conducted involving 38 individuals (24 men and 14 women) with CRC. Data were generated using semi-structured interviews at four time points over an 18-month period, post-diagnosis. Interviews focused on participant's experience of CRC and on how gender affected their coping. This paper reports the findings of interviews 3 and 4 which examined the participant's experience after chemotherapy.
Three themes emerged from the interviews ('new normal', living with uncertainty and support needs). Many men and women reacted similarly; however, there was some variation evident between and within sexes. The main difference was with regard to the long-term physical side effects of the illness. Many women admitted to still experiencing side effects, whereas many men indicated that they had no problems. These men engaged in practices that aligned with their gender identity and view of masculinity. It must be noted that some men and women were still experiencing an impact.
Recovery from the physical and psychological effects of CRC does not occur simultaneously. Healthcare professionals should be aware that not all men (or women) conform to the social stereotypes of masculinity (or femininity).
To describe long-term psychological morbidity, unmet supportive care needs, positive changes, sexual outcomes and relationship satisfaction in partners of gynaecologic cancer survivors, as compared with respective survivors.
Self-report measures were administered to a cross-sectional sample of 68 partners recruited via patient survivors.
Rates of depression and anxiety among partners were 8.8% and 10.3%, respectively. Anxiety was higher among survivors than partners (P=0.003). Partners reported a mean of 3.25 unmet needs and 48.5% had at least one unmet need. At least one positive change was reported by 66.2% of partners. Greater number of unmet needs was the most important predictor of both anxiety (beta=0.39; P=0.001) and depression (beta=0.45; P<0.001). Poor relationship satisfaction independently predicted greater anxiety (beta=-0.28; P=0.01). Perceptions of relationship satisfaction did not differ within couples. Half of couples had been sexually active in the preceding month. Most reported no change in interest in physical contact (76.4%) or sex (70.6%), had excellent sexual function and high levels of satisfaction with sex life. Compared to partners, survivors perceived worse vaginal stenosis and dryness (both P=0.002) and worse satisfaction with (survivors') appearance (P<0.001). Partner outcomes were not associated with demographic variables or survivors' clinical characteristics.
The majority of partners reported excellent sexual outcomes and little perceived change since the survivors' diagnosis. The association between unmet needs and psychological morbidity suggests a useful target for further intervention. Despite methodological limitations, these data are novel and present a starting point for further investigation to improve outcomes for survivors and partners.
Current evidence shows that sleep-wake disturbances are a persistent problem linked to poor quality of life in women surviving breast cancer. Information regarding correlates of sleep-wake disturbances in long-term survivors is sparse.
The objective of this study was to refine knowledge regarding prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors (BCS) compared with age-matched women without breast cancer (WWC).
The cross-sectional convenience sample included 246 BCS and 246 WWC who completed a quality-of-life study and were matched within +/-5 years of age.
BCS were a mean of 5.6 years beyond completion of cancer treatment (range = 5.6-10.0 years). Based on Pittsburgh Sleep Quality Index (PSQI) scores, BCS had significantly more prevalent sleep-wake disturbances (65%) compared with WWC (55%) (P < 0.05). BCS also had significantly higher PSQI global scores indicating poorer sleep quality compared with WWC (P < 0.05). Significant correlates of prevalence of poor sleep for BCS included hot flashes, poor physical functioning, depressive symptoms, and distress, and for WWC, these included hot flashes, poor physical functioning, and depressive symptoms. Significant correlates (P < 0.05) of severity of poor sleep for BCS included presence of noncancer comorbidities, hot flashes, depressive symptoms, and residual effects of cancer treatment. For WWC, these included hot flashes, poor physical functioning, depressive symptoms, and impact of a life event.
Knowledge of prevalence, severity, and correlates of sleep-wake disturbances provides useful information to health care providers during clinical evaluations for treatment of sleep-wake disturbances in BCS.
A model of cancer as a chronic illness is proposed as a new direction for quality of life research. In the cancer survivor adaptation (CSA) model, adjustment to cancer survivorship is a life-long process involving three interacting components. Personal context incorporates cancer survivorship and personal characteristics across biological, psychological, and social domains. The adaptation process involves a specific cognitive mechanism of change, where the ongoing appraisal of goals and world assumptions occur in the context of the cancer survivor's personal memories and sense of self. Finally, quality of life outcomes are viewed as multidimensional and personally weighted for importance, with expectations for both positive and negative physical, emotional, cognitive, and spiritual adjustments over time. Research and clinical implications are explored.
To assess the prevalence and predictors of anxiety and depression among a heterogeneous sample of long-term adult cancer survivors.
Cross-sectional survey of 863 adults diagnosed with a new histologically confirmed cancer (local or metastatic) between 1 April and 30 November 1997 and still alive in 2002, living in NSW, able to read and understand English adequately, physically and mentally capable of participating, and aware of their cancer diagnosis, who were randomly selected from the New South Wales Central Cancer Registry.
Prevalence of anxiety and depression assessed by the Hospital Anxiety and Depression Scale; and factors (patient, disease, and treatment characteristics; coping style; social support) predicting clinical or borderline levels of anxiety and depression.
Levels of anxiety and depression were low; only 9% of participants reported clinically important levels of anxiety and 4% reported depression. The strongest predictive factors of borderline or clinical anxiety were previous treatment for psychological illness, maladaptive coping styles (helplessness-hopelessness, anxious preoccupation) and poor social support. Borderline or clinical depression was most strongly predicted by previous treatment for psychological illness, being an invalid pensioner, maladaptive coping style (helplessness-hopelessness) and poor positive social interaction.
By 5 years after diagnosis, most survivors had adjusted well to their cancer experience, with levels of anxiety and depression similar to those of the general population. Nevertheless, a small and important group of long-term survivors continue to experience adverse psychological effects and need assistance. Monitoring of psychological wellbeing and referring patients when appropriate need to be integrated into routine care for cancer survivors.