Copyright © 2002 Academy of Psychosomatic Medicinem, http://psy.psychiatryonline.org/cgi/content/full/43/3/183

Poorly controlled pain is a significant problem for cancer patients. Contributing factors may include concerns about analgesics and fears about the implications of pain, which may hinder open communication. We surveyed the prevalence of these concerns in Australian oncology patients and investigated associations with inadequate pain control. Ninety-three adult patients with cancer, undergoing treatment at a teaching hospital, completed the patient barriers questionnaire (BQ) and a self-report questionnaire to determine pain severity, interference with daily activities, use of analgesics and alternative therapies, and hesitation to report pain. Overall, there was a high prevalence of agreement with the BQ scales assessing concerns about communication and analgesic use. One-third of patients had clinically significant pain, which interfered with daily activities, despite use of analgesics. They were more likely to use alternative therapies for pain control, to hesitate to discuss their pain, and had significantly greater concerns about side effects of analgesics and injections. Our study confirms that patient barriers exist in this Australian population and are associated with inadequate pain control. Oncology staff need to actively screen for pain, particularly targeting patients using alternative therapies and experiencing side effects, develop communication and prescribing skills, and diversify pain management approaches beyond analgesics. Copyright © 2003 John Wiley & Sons, Ltd. http://www3.interscience.wiley.com/cgi-bin/abstract/103519878/START

BACKGROUND: The influence of psychiatric intervention on cancer outcome remains a topic of considerable debate. We previously reported the survival benefits for 68 patients with malignant melanoma 5 to 6 years following their participation in a structured psychiatric group intervention. In this article, we report the effects of the intervention on disease outcome in these same patients at the 10-year follow-up. METHODS: In this univariate analysis, the survival and recurrence distributions for the intervention and control groups were estimated using the Kaplan-Meier method, and were tested for equality by the log-rank test. The multivariate analysis used the Cox proportional hazards regression model with the following prognostic factors: age, sex, Breslow depth, tumor site, and treatment status (ie, intervention group vs control group). RESULTS: When analyzed as single covariates, differences between the intervention and control groups were not significant for outcome at the 10-year follow-up. However, being male and having a greater Breslow depth were predictive of poorer outcome. Analysis of multiple covariates also revealed that sex and Breslow depth were significant for recurrence and survival. In addition, participation in the intervention was significant for survival. After adjusting for sex and Breslow depth, participation in the intervention remained significant for survival. CONCLUSIONS: These findings suggest that the survival benefit of the intervention has weakened since the 5- to 6-year follow-up; however, it has not entirely disappeared. At the 10-year follow-up, participation in the intervention remained predictive of survival when statistically controlling for the effects of other known prognostic indicators. Despite the potential health benefits, we do not propose that psychiatric intervention be used in lieu of standard medical care, but as one of its integral components. Copyright © 2003 American Medical Association, http://archpsyc.ama-assn.org/cgi/content/full/60/1/100

Satisfaction with treatment is an important early indicator of medical outcome for cancer patients. This study examined patient satisfaction with treatment-planning and follow-up appointments among 58 recently diagnosed ENT and GI cancer patients seen at a multidisciplinary cancer clinic. Patients reported which medical specialties they saw, whether adjuvant treatment was planned, and whether they had a chance to discuss their feelings about the diagnosis. Patients also rated the attention paid by staff to several psychosocial issues considered relevant to cancer. These included how the patient was coping, support services available, and the issue of common emotional reactions to cancer. Patients then rated their overall satisfaction with their clinic visits. Overall satisfaction was predicted by younger age, female gender, and greater attention to how patients were coping with their illness. Having a chance to discuss one's feelings about the diagnosis, and staff attention to other psychosocial issues, also predicted patient satisfaction. The relationship of these psychosocial issues to patient satisfaction did not vary by gender. Results suggest that patient satisfaction may be enhanced when hospital staff attend to and provide for the psychosocial needs engendered by a diagnosis of cancer. Copyright © 2003 John Wiley & Sons, Ltd. http://www3.interscience.wiley.com/cgi-bin/abstract/103019993/START

Having a family member with cancer has been associated with symptoms of distress. While studies have reported distress in adolescents with a parent with cancer, few have included control groups of adolescents with healthy parents. Adolescents who had at least one parent diagnosed with cancer (n=27) and controls (n=23) completed questionnaires on PTSD, anxiety, depression, cancer risk perceptions, and family environment. Groups did not differ on anxiety and depression, but adolescents with an ill parent perceived their own risk for developing cancer as significantly higher than controls. Controls reported significantly higher levels of intrusive thoughts and avoidance regarding other stressful life events. A positive family environment was correlated with higher anxiety and depression, and expressiveness mediated the relations between family cohesion and anxiety. These preliminary findings suggest that distress reported in previous studies of adolescents with parents with cancer may be due to this transitional period of life. Copyright © 2003 John Wiley & Sons, Ltd. http://www3.interscience.wiley.com/cgi-bin/abstract/101521345/START

BACKGROUND: There is considerable debate regarding the clinical issues surrounding the wish to hasten death (WTHD) in the terminally ill. The clinical factors contributing to the WTHD need further investigation among the terminally ill in order to enhance understanding of the clinical assessment and treatment needs that underlie this problem. A more detailed understanding may assist with the development of appropriate therapeutic interventions. METHOD: A sample of terminally ill cancer patients (N = 256) recruited from an in-patient hospice unit, home palliative care service and a general hospital palliative care consulting service from Brisbane Australia between 1998-2001 completed a questionnaire assessing psychological (depression and anxiety), social (family relationship, social support, level of burden on others) and the impact of physical symptoms. The association between these factors and the WTHD was investigated. RESULTS: A high WTHD was reported by 14 % of patients. A discriminant function analysis revealed that the following variables were associated with a high WTHD (P < 0.001): higher levels of depressive symptoms, being admitted to an in-patient hospice setting, a greater perception of being a burden on others, lower family cohesion, lower levels of social support, higher levels of anxiety and greater impact of physical symptoms. CONCLUSIONS: Psychological and social factors are related to a WTHD among terminally ill cancer patients. Greater attention needs to be paid to the assessment of psychological and social issues in order to provide appropriate therapeutic interventions for terminally ill patients. Copyright © 2003 Cambridge University Press http://titles.cambridge.org/journals/journal_article.asp?mnemonic=PSM&pii=S0033291702006827

In recent years, there has been increasing emphasis on understanding how the cancer experience affects individuals' quality of life (QOL). The goal of this study was to assess the QOL and to identify psychosocial predictors of QOL among a large sample of patients with a variety of cancers. Specifically, we assessed the unique contribution of demographic variables, medical variables, and social support on patients' QOL and psychological adjustment. Three hundred and fifty-one participants completed measures of social support, depression, anxiety, and QOL at their follow-up medical visits. Analyses indicated that patients who were older and had better social support reported less anxiety (p<0.001), and patients who were older, married or who had more social support reported less depressive symptoms (p<0.01). Men, individuals whose cancer had not recurred, and those not undergoing active treatment reported better QOL in the physical health domain (p<0.05). Patients who were older, married, with more formal education, less advanced disease, and better social support reported better QOL in the mental health domain (p<0.05). Demographic variables (age, gender, marital status, education) were generally associated with measures of adjustment and QOL whereas medical variables (time since diagnosis, recurrence status, treatment variables, stage of disease) were not. Patients with more support reported less anxiety and depression and better QOL in the mental health domain, independent of demographic and medical variables. Assessing patients' level of social support may help to identify patients at risk for distress. Copyright © 2003 John Wiley & Sons, Ltd. http://www3.interscience.wiley.com/cgi-bin/abstract/101521670/START

We recruited 50 cancer patients and their caregivers with the aim of extending our knowledge of emotional, personality and psychosocial variables, and comparing their reciprocal experience of the disease. The patients and caregivers were administered four of the questionnaires included in the Cognitive Behavioral Assessment 2.0, the Family Strain Questionnaire and the Satisfaction with Life Scale. The patients were characterised by significantly greater emotional disturbances than their caregivers, who were emotionally stable and had a relatively low level of perceived strain despite their high level of hostility and state anxiety. The intra-scale correlations highlighted the fact that the perception of distress depends on neuroticism and the presence of anxiety and depression (which are themselves known to be connected with neuroticism).The everyday life of the caregivers seemed to be characterised by restricted social relationships and interests; a relatively large proportion also declared that they had practical problems related to disease management, economics and some embarrassing and stigmatic aspects of the disease itself. Copyright © 2003 John Wiley & Sons, Ltd. http://www3.interscience.wiley.com/cgi-bin/abstract/102521926/START

In light of the Western focus in the breast cancer literature on spouse support, this study attempted to investigate ethnic differences in their perceptions of the support provided by their spouses. Forty-six women who had had breast cancer 6 months to 3 years prior participated in this study. These women were selected from three ethnic groups (13 Euro-American (EA) women, 18 Chinese-American women and 15 Japanese-American women). The study attempted to assess the women's perceptions at two levels of inquiry. One was based on standardized testing and scales and the second was a qualitative semi-structured interview. It was hypothesized that few differences would exist in standardized testing, and that cultural differences would be found at the level of semi-structured interviewing. Results showed that in fact few differences existed among the three groups on standardized instruments. At the level of qualitative evaluation, however, it appeared that Asian-American women were expected to be self-sacrificing and nurturing of husband and family, while EA women were able to be dependent. Another major difference existed around the theme of harmony and intimacy, where Asian-American women had a goal of harmony over intimacy, while EA women had a goal of intimacy over harmony. A final major difference was in the area of communication, with both Asian groups appearing to value non-verbal communication over verbal, while EA women appeared to value verbal communication over non-verbal. Copyright © 2002 John Wiley & Sons, Ltd. http://www3.interscience.wiley.com/cgi-bin/abstract/101520995/START

Research has shown that perceptions of control influence health-related behavior and outcomes. This study explored the influence of the control constructs in the context of the theory of cognitive adaptation to the use of complementary and alternative medicine (CAM) among 551 women diagnosed with breast cancer in Portland, Oregon. The majority of these women had high perceptions of cancer control and used one or more types of CAM therapy. Multinomial logistical regression indicated that higher perceptions of control over the course and cause of cancer significantly predicted CAM use. The model combining sociodemographic variables (age, education and type of health insurance) and control variables explained more variation (R2=0.23) in predicting CAM use than the model with only sociodemographic variables (R2=0.14), indicating that perceptions of control over the cause and the course of cancer had an independent significant influence. It was concluded that the assessment of control constructs from the theory of cognitive adaptation is useful for studying CAM use among women diagnosed with breast cancer and that understanding the meanings that lie behind the decisions to use these therapies are essential for health care providers who are promoting the health and well-being of their patients. Copyright © 2003 John Wiley & Sons, Ltd. http://www3.interscience.wiley.com/cgi-bin/abstract/102521920/START

The aim of the study was to evaluate the effects of the use of progressive muscle relaxation training (PMRT) on anxiety and quality of life in colorectal cancer patients after stoma surgery. A randomised controlled trial was used with repeated measures assessment over 10 weeks post-stoma surgery. Fifty-nine patients participated in the study and were randomised to a control group receiving routine care (n=30) and an experimental group receiving routine care and PMRT through two teaching sessions and practice at home for the first 10 weeks. The State-Trait Anxiety Inventory and two Quality of Life Scales were used to collect the data of interest in three occasions, namely during hospitalisation, at week 5 and at week 10 post-surgery. The use of PMRT significantly decreased state anxiety and improved generic quality of life in the experimental group (P<0.05), especially in the domains of physical health, psychological health, social concerns and environment. Social relationships decreased in both groups. In relation to the disease-specific quality of life measure, differences were observed only in the 10-week assessment, with the experimental group reporting better quality of life at 10 weeks, but not over time as compared to the control group. The use of PMRT should be incorporated in the long-term care of colorectal cancer patients, as it can improve their psychological health and quality of life. This may be a cost-effective intervention that needs minimal training and could easily be offered to those patients that they would like to use it as part of the specialist care provided to stoma patients. Copyright © 2002 John Wiley & Sons, Ltd. http://www3.interscience.wiley.com/cgi-bin/abstract/101525907/START