Our Rating

Article

    Abstract

Caring for the Whole Patient: The Science of Psychosocial Care. Paul B. Jacobsen, Jimmie C. Holland, and David P. Steensma. JCO published online on March 12, 2012

This Journal of Clinical Oncology Special Series relates to the science of psychosocial care. This series is designed to provide oncology professionals with the most recent information about the psychological, psychiatric, and social aspects of cancer care. The emergence of the field of psychosocial care reflects growing public and professional awareness of the potential for cancer and its treatment to have profound effects on many aspects of life. A principal goal of psychosocial care is to recognize and address the effects that cancer and its treatment have on the mental status and emotional well-being of patients, their family members, and their professional caregivers. In addition to improving emotional well-being and mental health,1 provision of psychosocial care has been shown to yield better management of common disease-related symptoms and adverse effects of treatment, such as pain2 and fatigue.3 Given the centrality of psychosocial issues in cancer, it is surprising that the formal history of this field in the United States dates only to the 1970s.4 This relatively late development becomes more understandable when one realizes that only then had the stigma attached to cancer diminished to the extent that most patients were told their diagnosis, thus making it possible to openly study psychosocial issues.4 A second factor contributing to the field’s late development is the stigma attached to mental illness and psychological problems, even in the context of medical illness.4 During the last 40 years, a subspecialty devoted to cancer-related psychosocial care (ie, psycho-oncology) has become firmly established, with its own journals, scientific meetings, and professional societies. Psychosocial care in oncology received increased attention after the publication in 2008 of an Institute of Medicine (IOM) report entitled, “Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs.”5 This report reflects the work of a multidisciplinary panel that sought to evaluate how best to translate research findings about psychosocial care into practical applications for the purpose of improving the quality of cancer care. The panel found evidence for the effectiveness of an array of formal psychosocial services including counseling and psychotherapy, pharmacologic management of mental symptoms, illness self-management and self-care programs, family and caregiver education, and health promotion interventions. The panel also found that, despite this evidence, many individuals who could benefit from these services do not receive them. The editors of this JCO Special Series on psychosocial care have chosen a number of topics that illustrate recent advances....continues

William Breitbart and Yesne Alici. Evidence-Based Treatment of Delirium in Patients With Cancer. JCO published online on March 12, 2012; 

Delirium is the most common neuropsychiatric complication seen in patients with cancer, and it is associated with significant morbidity and mortality. Increased health care costs, prolonged hospital stays, and long-term cognitive decline are other well-recognized adverse outcomes of delirium. Improved recognition of delirium and early treatment are important in diminishing such morbidity. There has been an increasing number of studies published in the literature over the last 10 years regarding delirium treatment as well as prevention. Antipsychotics, cholinesterase inhibitors, and alpha-2 agonists are the three groups of medications that have been studied in randomized controlled trials in different patient populations. In patients with cancer, the evidence is most clearly supportive of short-term, low-dose use of antipsychotics for controlling the symptoms of delirium, with close monitoring for possible adverse effects, especially in older patients with multiple medical comorbidities. Nonpharmacologic interventions also appear to have a beneficial role in the treatment of patients with cancer who have or are at risk for delirium. This article presents evidence-based recommendations based on the results of pharmacologic and nonpharmacologic studies of the treatment and prevention of delirium.

Marco Maltoni, Emanuela Scarpi, Marta Rosati, Stefania Derni, Laura Fabbri, Francesca Martini, Dino Amadori, and Oriana Nanni. Palliative Sedation in End-of-Life Care and Survival: A Systematic Review. JCO March 12, 2012;

Purpose: Palliative sedation is a clinical procedure aimed at relieving refractory symptoms in patients with advanced cancer. It has been suggested that sedative drugs may shorten life, but few studies exist comparing the survival of sedated and nonsedated patients. We present a systematic review of literature on the clinical practice of palliative sedation to assess the effect, if any, on survival.

Methods A systematic review of literature published between January 1980 and December 2010 was performed using MEDLINE and EMBASE databases. Search terms included palliative sedation, terminal sedation, refractory symptoms, cancer, neoplasm, palliative care, terminally ill, end-of-life care, and survival. A manual search of the bibliographies of electronically identified articles was also performed.

Results: Eleven published articles were identified describing 1,807 consecutive patients in 10 retrospective or prospective nonrandomized studies, 621 (34.4%) of whom were sedated. One case-control study was excluded from prevalence analysis. The most frequent reason for sedation was delirium in the terminal stages of illness (median, 57.1%; range, 13.8% to 91.3%). Benzodiazepines were the most common drug category prescribed. Comparing survival of sedated and nonsedated patients, the sedation approach was not shown to be associated with worse survival. Conclusion Even if there is no direct evidence from randomized clinical trials, palliative sedation, when appropriately indicated and correctly used to relieve unbearable suffering, does not seem to have any detrimental effect on survival of patients with terminal cancer. In this setting, palliative sedation is a medical intervention that must be considered as part of a continuum of palliative care.

Annette L. Stanton. What Happens Now? Psychosocial Care for Cancer Survivors After Medical Treatment Completion.  JCO March 12, 2012; 

The growing population of adults living with a history of cancer in the United States mandates attention to quality of life and health in this group, as well as to the implementation of evidence-based interventions to address psychosocial and physical concerns at completion of medical treatments and beyond. The goals of this article are to document the need for attention to psychosocial domains during the re-entry and later phases of the cancer survivor trajectory, offer an overview of current evidence on efficacy of psychosocial interventions during those phases, and offer suggestions for application and research regarding post-treatment psychosocial care.

[Hot] Paul B. Jacobsen and Lynne I. Wagner. A New Quality Standard: The Integration of Psychosocial Care Into Routine Cancer Care. JCO  March 12, 2012

There is a growing consensus that psychosocial care should be integrated into the routine care of patients with cancer. This consensus is consistent with the considerable body of evidence about the deleterious effects of allowing psychosocial needs to remain unmet and the growing body of evidence about the beneficial effects of providing psychosocial services to address unmet needs. Despite this evidence, available data suggest that a considerable portion of the population of patients with cancer does not receive needed psychosocial care. Three lines of professional activity initiated in recent years have the potential to address this issue in fundamental ways: the formulation of standards of cancer care that address the psychosocial component of care, the issuance of clinical practice guidelines for psychosocial care of patients with cancer, and the development and implementation of measurable indicators of the quality of psychosocial care in oncology settings. This article provides an overview of accomplishments in each of these areas; it is designed to ensure that oncologists and other cancer treatment providers are knowledgeable about current standards for psychosocial care, existing consensus- and evidenced-based recommendations for clinical practice in this area, and resources and tools for evaluating and, if indicated, improving the quality of the psychosocial care their patients are receiving. The article concludes with a critical appraisal of these activities and a consideration of how current efforts might be enhanced.

Lara Traeger, Joseph A. Greer, Carlos Fernandez-Robles, Jennifer S. Temel, and William F. Pirl. Evidence-Based Treatment of Anxiety in Patients With Cancer.  JCO published online on March 12, 2012; DOI:10.1200/JCO.2011.39.5632

Anxiety is a dynamic response to perceived threat that is common among patients with cancer and fluctuates at critical points in the disease trajectory. A substantial minority of patients may experience clinically significant anxiety resulting from a range of potential etiologic factors. This review summarizes evidence-based recommendations for treatment of anxiety in oncology settings. Recommendations are based on the nature and time course of anxiety and the results of meta-analyses, systematic reviews, and individual trials in cancer populations. The evidence-based literature supports the use of psychosocial and psychopharmacologic treatments to prevent or alleviate anxiety symptoms. Conclusions are tempered by study heterogeneity and methodologic limitations and a lack of trials that included patients with clinically significant anxiety. In oncology settings, accessibility and acceptability of evidence-based treatments vary, and patients may seek a variety of resources to manage cancer concerns. Treatment planning should incorporate contributing factors to anxiety and patient preferences for psychiatric care.

Jesse R. Fann, Kathleen Ell, and Michael Sharpe.  Integrating Psychosocial Care Into Cancer Services.  JCO published online on March 12, 2012; DOI:10.1200/JCO.2011.39.7398

Despite substantial evidence that patients with cancer commonly have significant psychosocial problems, for which we have evidence-based treatments, many patients still do not receive adequate psychosocial care. This means that we risk prolonging life without adequately addressing the quality of that life. There are many challenges to improving the current situation, the major one of which is organizational. Many cancer centers lack a system of psychosocial care that is integrated with the cancer care of the patient. Psychosocial care encompasses a range of problems (emotional, social, palliative, and logistical). The integration must occur with the cancer care of the patient at all stages (from screening to palliative care) and across all clinical sites of care (inpatient and outpatient cancer services as well as primary care). In this article, we consider the challenges we face if we are to provide such integrated psychosocial services. We focus on the collaborative care service model. This model comprises systematic identification of need, integrated delivery of care by care managers, appropriate specialist supervision, and the stepping of care based on systematic measurement of outcomes. Several trials of this approach to the management of depression in patients with cancer have found it to be both feasible to deliver and effective. It provides a model for services to meet other psychosocial needs. We conclude by proposing the key components of an integrated psychosocial service that could be implemented now and by considering what we need to do next if we are to succeed in providing better and more comprehensive care to our patients.

Madeline Li, Peter Fitzgerald, and Gary Rodin.  Evidence-Based Treatment of Depression in Patients With Cancer.  JCO published online on March 12, 2012; 

Purpose Depression is a common condition in patients with cancer, although there has been a relative paucity of research on the effectiveness of treatment in this population. This review summarizes the psychosocial and pharmacologic treatment of depression in patients with cancer based on a consideration of evidence regarding etiologic factors and treatment outcomes.

Methods A review of the evidence base for psychosocial and pharmacologic interventions for depression in patients with cancer was performed, including original studies, systematic reviews, and meta-analytic studies in the literature.

Results Recent evidence from randomized controlled trials has demonstrated the efficacy of psychosocial and pharmacologic treatments to alleviate depression in patients with cancer. Further research is needed to establish their relative and combined efficacy and their role in the treatment of depression that is less severe and occurs in association with more advanced disease. First-line recommendations for the treatment of depression in patients with cancer are difficult to derive based on current evidence, because comparative studies have not been conducted to support the superiority of one treatment modality over another in this population.

Conclusion Both psychosocial and pharmacologic interventions have been shown to be efficacious in treating depression in cancer, but further research is needed to establish their relative and combined benefit. Future research directions include the development and evaluation of novel interventions targeted to specific biologic and psychosocial risk factors.

Linda E. Carlson, Amy Waller, and Alex J. Mitchell. Screening for Distress and Unmet Needs in Patients With Cancer: Review and Recommendations.   JCO published online on March 12, 2012; DOI:10.1200/JCO.2011.39.5509 

Purpose This review summarizes the need for and process of screening for distress and assessing unmet needs of patients with cancer as well as the possible benefits of implementing screening.

Methods Three areas of the relevant literature were reviewed and summarized using structured literature searches: psychometric properties of commonly used distress screening tools, psychometric properties of relevant unmet needs assessment tools, and implementation of distress screening programs that assessed patient-reported outcomes (PROs).

Results Distress and unmet needs are common problems in cancer settings, and programs that routinely screen for and treat distress are feasible, particularly when staff are supported and links with specialist psychosocial services exist. Many distress screening and unmet need tools have been subject to preliminary validation, but few have been compared head to head in independent centers and in different stages of cancer. Research investigating the overall effectiveness of screening for distress in terms of improved recognition and treatment of distress and associated problems is not yet conclusive, but screening seems to improve communication between patients and clinicians and may enhance psychosocial referrals. Direct effects on quality of life are uncertain, but screening may help improve discussion of quality-of-life issues.

Conclusion Involving all stakeholders and frontline clinicians when planning screening for distress programs is recommended. Training frontline staff to deliver screening programs is crucial, and continuing to rigorously evaluate outcomes, including PROs, process of care, referrals, and economic costs and benefits is essential.

Stenberg U et al. Review of the literature on the effects of caring for a patient with cancer.    Psycho-Oncology, Volume 19, Issue 1, Date: October 2010, Pages: 1013-1025. 

Objective: To adequately help family caregivers (FCs) of cancer patients, clinicians need to understand the complexity of the problems and responsibilities associated with cancer patients illness that FCs experience.

Methods: This systematic review identified the types of problems and burdens that FCs of cancer patients experience during the patient's illness. We also analyzed the language caregivers use to communicate their problems and responsibilities related to caregiving for the cancer patient.

Results: Of 2845 titles identified, 192 articles met the inclusion criteria and are included in this review. Of these, 164 were research-based. In addition to FC responsibilities and the impact of being a caregiver on daily life, a number of other physical, social, and emotional problems related to caregiving for these FCs were identified.

Conclusion: A substantial evidence base supports the conclusion that FCs experience many difficult problems and increased responsibilities during and after the patient is undergoing treatment and rehabilitation for cancer. The insights gained from this review will help researchers and clinicians to understand the complexity of problems and responsibilities FCs experience. This understanding may encourage them to include support for FCs as part of total or holistic patient care. However, more research is needed to better understand the variations in caregiving experiences over time; how the caregiving perspective is influenced by different cultural, ethnic, or socioeconomic backgrounds as well as gender and age; and how problems and responsibilities related to caregiving interfere with daily life.

Goebel S et al. Distress in patients with newly diagnosed brain tumours. Psycho-Oncology, Volume 20, Issue 6, Date: June 2011, Pages: 260-230

Objective: Patients with intracranial tumours often suffer from clinically relevant psychological distress. However, levels of distress and contributing factors have not been systematically evaluated for the early course of the disease. Using the National Comprehensive Cancer Network's Distress Thermometer (DT), we evaluated the extent and sources of distress within a population of patients with intracranial neoplasms.

Methods: One hundred and fifty-nine patients were included who underwent craniotomy for newly diagnosed intracranial tumours at our department. All patients completed the DT questionnaire, a single-item 11-point visual analogue scale measuring psychological distress. The appendant problem list (PL) consists of 40 items representing problems commonly experienced by cancer patients. Patients were asked to mark any experienced sources of distress.

Results: Percentage of patients suffering from relevant distress was 48.4% (cut-off ⩾6). DT-scores were significantly associated with depression and anxiety as well as reported number of concerns. On average, patients reported 6.9 sources of cancer-related distress. Objective medical data (e.g. tumour stage) as well as sociodemographic data (e.g. gender, IQ) were not associated with psychological distress at this early phase.

Conclusions: Prevalence of elevated distress is high shortly after primary neurosurgical treatment in patients with intracranial tumours and cannot be predicted by objective data. As a consequence, sources of distress can and should be routinely assessed and targeted in these individuals in this particular period. Further studies are needed to help to identify patients who are at risk of suffering from long-term emotional distress in order to enable targeted psychosocial intervention.

Lengacher, CA et al  Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psycho-Oncology, Volume 18, Issue 12, Date: December 2009, Pages: 1261-1272.

Objectives: Considerable morbidity persists among survivors of breast cancer (BC) including high levels of psychological stress, anxiety, depression, fear of recurrence, and physical symptoms including pain, fatigue, and sleep disturbances, and impaired quality of life. Effective interventions are needed during this difficult transitional period.

Methods: We conducted a randomized controlled trial of 84 female BC survivors (Stages 0–III) recruited from the H. Lee Moffitt Cancer and Research Institute. All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and/or chemotherapy. Subjects were randomly assigned to a 6-week Mindfulness-Based Stress Reduction (MBSR) program designed to self-regulate arousal to stressful circumstances or symptoms (n=41) or to usual care (n=43). Outcome measures compared at 6 weeks by random assignment included validated measures of psychological status (depression, anxiety, perceived stress, fear of recurrence, optimism, social support) and psychological and physical subscales of quality of life (SF-36).

Results: Compared with usual care, subjects assigned to MBSR(BC) had significantly lower (two-sided p<0.05) adjusted mean levels of depression (6.3 vs 9.6), anxiety (28.3 vs 33.0), and fear of recurrence (9.3 vs 11.6) at 6 weeks, along with higher energy (53.5 vs 49.2), physical functioning (50.1 vs 47.0), and physical role functioning (49.1 vs 42.8). In stratified analyses, subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning. Conclusions: Among BC survivors within 18 months of treatment completion, a 6-week MBSR(BC) program resulted in significant improvements in psychological status and quality of life compared with usual care.

Wood, MJM et al. What research evidence is there for the use of art therapy in the management of symptoms in adults with cancer? A systematic review. Psycho-Oncology, Volume 20, Issue 2, Date: February 2011, Pages: 135-145

Objective: Common psychosocial difficulties experienced by cancer patients are fatigue, depression, anxiety, and existential and relational concerns. Art therapy is one intervention being developed to address these difficulties. The purpose of this research was to assess and synthesize the available research evidence for the use of art therapy in the management of symptoms in adults with cancer.

Methods: A literature search of electronic databases, ‘grey’ literature, hand searching of key journals, and personal contacts was undertaken. Keywords searched were ‘art therapy’ and ‘cancer’ or ‘neoplasm’. The inclusion criteria were: research studies of any design; adult cancer population; and art therapy intervention. There were no language or date restrictions. Data extraction occurred and quality appraisal was undertaken. Data were analyzed using narrative synthesis. Results: Fourteen papers reporting 12 studies met the inclusion criteria. Symptoms investigated spanned emotional, physical, social and global functioning, and existential/spiritual concerns. Measures used were questionnaires, in-depth interviews, patients' artwork, therapists' narratives of sessions, and stress markers in salivary samples. No overall effect size was determined owing to heterogeneity of studies. Narrative synthesis of the studies shows art therapy is used at all stages of the cancer trajectory, most frequently by women, the most common cancer site in participants being breast. Conclusion: Art therapy is a psychotherapeutic approach that is being used by adults with cancer to manage a spectrum of treatment-related symptoms and facilitate the process of psychological readjustment to the loss, change, and uncertainty characteristic of cancer survivorship. Research in this area is still in its infancy.

Duijts, SFA; et al Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors—a meta-analysis.  Psycho-Oncology, Volume 20, Issue 2, Date: February 2011, Pages: 115-126

Objective: To evaluate the effect of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life (HRQoL) outcomes in breast cancer patients and survivors.

Methods: A meta-analysis was carried out to quantify the effects of behavioral and exercise interventions on fatigue, depression, anxiety, body-image, stress and HRQoL. Summary effect sizes and standard errors were calculated. The presence of publication bias was explored and sensitivity analyses were performed to identify possible sources of heterogeneity.

Results: In total, 56 studies were included. Statistically significant results were found for the effect of behavioral techniques on fatigue (ES −0.158; 95% CI −0.233 to −0.082, p<0.001), depression (ES −0.336; 95% CI −0.482 to −0.190, p<0.001), anxiety (ES −0.346; 95% CI −0.538 to −0.154, p<0.001) and stress (ES −0.159; 95% CI −0.310 to −0.009, p=0.038). For the effect of physical exercise interventions, statistically significant results were found on fatigue (ES −0.315; 95% CI −0.532 to −0.098, p=0.004), depression (ES −0.262; 95% CI −0.476 to −0.049, p=0.016), body-image (ES 0.280; 95% CI 0.077 to 0.482, p=0.007) and HRQoL (ES 0.298; 95% CI 0.117 to 0.479, p=0.001). Conclusions: The results indicate that behavioral techniques and physical exercise improve psychosocial functioning and HRQoL in breast cancer patients and survivors. Future research is needed on the effect of physical exercise on stress and the effect of the combined intervention in breast cancer patients.

Molassiotis, A et al. Unmet supportive care needs, psychological well-being and quality of life in patients living with multiple myeloma and their partners. Psycho-Oncology, Volume 20, Issue 1, Date: Jan 2011, Pages: 88-97.

Purpose: The aim of this project was to identify the nature and range of needs, as well as levels of quality of life (QOL), of both patients living with myeloma and their partners.

Methods: A cross-sectional survey was used, recruiting patients and their partners from 4 hospitals in the United Kingdom at a mean time post-diagnosis of 5 years. Patients completed a scale exploring their Supportive Care Needs, the Hospital Anxiety and Depression Scale (HADS) and the EORTC QOL scale with its Myeloma module. The partners completed the partners' version of the Supportive Care Needs scale and HADS.

Results: A total of 132 patients and 93 of their partners participated. One-quarter of the patients and one-third of the partners reported unmet supportive care needs. About 27.4% of patients reported signs of anxiety and 25.2% reported signs of depression. Almost half the partners (48.8%) reported signs of anxiety and 13.6% signs of depression. Anxious/depressed patients had more than double unmet needs than non-anxious/depressed patients (P<0.05). QOL was moderate, with key areas of impairment being physical, emotional, social and cognitive functioning, and patients complained of several symptoms, including tiredness (40.7%), pain (35.9%), insomnia (32.3%), peripheral neuropathies (28.3%) and memory problems (22.3%). About 40.8% were worried about their health in the future.

Conclusion: Long-term supportive care services should provide support to both patients and their partners in relation to their unmet needs, screening them for psychological disorders, referring them appropriately and timely, and optimising symptom management in order to improve the patients' QOL.

Rivers, BM et al Psychosocial issues related to sexual functioning among African-American prostate cancer survivors and their spouses. Psycho-Oncology, Volume 20, Issue 1, Date: Jan 2011, Pages: 106-110.

Objective: Focus on cancer survivorship and quality of life (QOL) is a growing priority. The aim of this study was to identify and describe the most salient psychosocial concerns related to sexual functioning among African-American (AA) prostate cancer survivors and their spouses.

Methods: Twelve AA prostate cancer survivors and their spouses participated in semi-structured individual interviews. The interviews assessed couples' experiences with psychosocial adjustment and sexual functioning posttreatment for localized prostate cancer. The data were analyzed using the constant comparison method and content analysis.

Results: In this qualitative study of couples surviving prostate cancer, there were divergent views between the male prostate cancer survivors and their female partners, particularly regarding sexual functioning. For the males, QOL issues emerged as the primary area of concern, whereas survival of their husbands was considered most important among the female spouses. The male respondents expressed unease with the sexual side effects of their cancer treatment, such as erectile dysfunction and decreased sexual desire and satisfaction. Female spouses recognized decreased sexual desire in their partners following treatment, but this was not considered a primary concern. Conclusions: Patients and their spouses may have differing perceptions regarding QOL and the impact of sexual functioning on survivorship. This study points to the need for further research and intervention development to address these domains with a goal to improve QOL.

Akechi, T et al Patient's perceived need and psychological distress and/or quality of life in ambulatory breast cancer patients in Japan.  Psycho-Oncology, Volume 20, Issue 5, Date: May 2011, Pages: 497-505. 

Objective: A needs assessment can be used as a direct index of what patients perceive they need help with. The purposes of this study were to investigate the association between patients' perceived needs and psychological distress and/or quality of life (QOL) and to clarify the characteristics of patients with a high degree of unmet needs. Methods: Randomly selected ambulatory female patients with breast cancer participated in this study. The patients were asked to complete the Short-form Supportive Care Needs Survey questionnaire, which covers five domains of need (health system and information, psychological, physical, care and support, and sexuality needs); the Hospital Anxiety and Depression Scale; and the European Organization for Research and Treatment of Cancer QLQ-C 30. Results: Complete data were available for 408 patients. The patients' needs were significantly associated with both psychological distress (r=0.63, p<0.001) and QOL (r=−0.52, p<0.001). A multiple regression analysis revealed that employment status (without full-time /part-time job), duration since diagnosis (less than 6 months), advanced stage, and a lower performance status were significantly associated with higher total needs. Only sexuality needs were significantly associated with a younger age, while the other domains were significantly associated with duration since diagnosis, advanced stage, and a lower performance status. Conclusions: Moderate to strong associations exist between patients' needs and psychological distress and/or QOL. The characteristics associated with patients' needs are multi-factorial, and interventions to respond to patients' needs may be one possible strategy for ameliorating psychological distress and enhancing QOL.

Holland JC. et al. Why Psychosocial Care is Difficult to Integrate into Routine Cancer Care: Stigma is the Elephant in the Room. JNCCN 2010

This issue of JNCCN reviews the NCCN Clinical Practice Guidelines in Oncology: Distress Management for 2010, updated by the NCCN Distress Management Panel. The NCCN appointed this multidisciplinary panel, which met first in 1997, to address the barriers to psychosocial care and to develop clinical practice guidelines.1 The panel members felt that the major barrier, for both physicians and patients, was the negative meaning and stigma attached to words implying the psychological domain, such as psychiatric, psychological, and psychosocial. The panel considered descriptive words that could encompass the range of fears, worries, and concerns of patients with cancer, and proposed the word distress because it could vary in severity from a normal response to a more significant level, consistent with a psychiatric disorder requiring intervention. The word distress also encompasses the range of fears, anxieties, and sadness that patients with cancer experience. The panel then developed guidelines for the management of distress, recommending that patients be first screened for distress with a short, initial, rapid screening question, followed by a second phase during which the doctor or nurse asks about specific problems. This process should be repeated as clinically indicated as part of routine care. Learning from the success of pain management, the panel suggested using a 0 to 10 scale in the form of a Distress Thermometer (DT) to allow patients to indicate their level of distress, either verbally or with pen and paper. Those who scored above a cutoff score for “caseness” (≥ 4) were asked to identify....

[Hot] Vodermaier A et al Screening for Emotional Distress in Cancer Patients: A Systematic Review of Assessment Instruments. J. Natl. Cancer Inst. 2009  

Screening for emotional distress is becoming increasingly common in cancer care. This systematic review examines the psychometric properties of the existing tools used to screen patients for emotional distress, with the goal of encouraging screening programs to use standardized tools that have strong psychometrics. Systematic searches of MEDLINE and PsycINFO databases for English-language studies in cancer patients were performed using a uniform set of key words (eg, depression, anxiety, screening, validation, and scale), and the retrieved studies were independently evaluated by two reviewers. Evaluation criteria included the number of validation studies, the number of participants, generalizability, reliability, the quality of the criterion measure, sensitivity, and specificity. The literature search yielded 106 validation studies that described a total of 33 screening measures. Many generic and cancer-specific scales satisfied a fairly high threshold of quality in terms of their psychometric properties and generalizability. Among the ultrashort measures (ie, those containing one to four items), the Combined Depression Questions performed best in patients receiving palliative care. Among the short measures (ie, those containing five to 20 items), the Center for Epidemiologic Studies–Depression Scale and the Hospital Anxiety and Depression Scale demonstrated adequate psychometric properties. Among the long measures (ie, those containing 21–50 items), the Beck Depression Inventory and the General Health Questionaire–28 met all evaluation criteria. The PsychoSocial Screen for Cancer, the Questionnaire on Stress in Cancer Patients–Revised, and the Rotterdam Symptom Checklist are long measures that can also be recommended for routine screening. In addition, other measures may be considered for specific indications or disease types. Some measures, particularly newly developed cancer-specific scales, require further validation against structured clinical interviews (the criterion standard for validation measures) before they can be recommended.

Kuriyama S et al Factors associated with psychological distress in a community-dwelling Japanese population: the Ohsaki Cohort 2006 Study. J Epidemiol. 2009;19(6):294-302. Epub 2009 Sep 12.

BACKGROUND: In Asia, there has been no population-based epidemiological study using the K6, a 6-item instrument that assesses nonspecific psychological distress. METHODS: Using cross-sectional data from 2006, we studied 43,716 (20,168 men and 23,548 women) community-dwelling people aged 40 years or older living in Japan. We examined the association between psychological distress and demographic, medical, lifestyle, and social factors by using the K6, with psychological distress defined as 13 or more points out of a total of 24 points. RESULTS: The following variables were significantly associated with psychological distress among the population: female sex, young and old age, a history of serious disease (hypertension, diabetes mellitus, stroke, myocardial infarction, or cancer), current smoking, former alcohol drinking, low body mass index, shorter daily walking time, lack of social support (4 of 5 components), and lack of participation in community activities (4 of 5 components). Among men aged 40 to 64 years, only "lack of social support for consultation when in trouble" and a history of diabetes mellitus remained significant on multivariate analysis. Among men aged 65 years or older, age was not significantly associated with psychological distress, and the significant association with current smoking disappeared on multivariate analysis. Among women aged 40 to 64 years, a history of stroke was not associated with psychological distress. Among women aged 65 years or older, the significant association with current smoking disappeared on multivariate analysis. CONCLUSIONS: A number of factors were significantly associated with psychological distress, as assessed by the K6. These factors differed between men and women, and also between middle-aged and elderly people.

Gigerenzer G et al . Public Knowledge of Benefits of Breast and Prostate Cancer Screening in Europe Journal of the National Cancer Institute Advance Access published on August 11, 2009 J. Natl. Cancer Inst. 2009 101: 1216-1220;

Making informed decisions about breast and prostate cancer screening requires knowledge of its benefits. However, country-specific information on public knowledge of the benefits of screening is lacking. Face-to-face computer-assisted personal interviews were conducted with 10 228 persons selected by a representative quota method in nine European countries (Austria, France, Germany, Italy, the Netherlands, Poland, Russia, Spain, and the United Kingdom) to assess perceptions of cancer-specific mortality reduction associated with mammography and prostate-specific antigen (PSA) screening. Participants were also queried on the extent to which they consulted 14 different sources of health information. Correlation coefficients between frequency of use of particular sources and the accuracy of estimates of screening benefit were calculated. Ninety-two percent of women overestimated the mortality reduction from mammography screening by at least one order of magnitude or reported that they did not know. Eighty-nine percent of men overestimated the benefits of PSA screening by a similar extent or did not know. Women and men aged 50–69 years, and thus targeted by screening programs, were not substantially better informed about the benefits of mammography and PSA screening, respectively, than men and women overall. Frequent consulting of physicians (r = .07, 95% confidence interval [CI] = 0.05 to 0.09) and health pamphlets (r = .06, 95% CI = 0.04 to 0.08) tended to increase rather than reduce overestimation. The vast majority of citizens in nine European countries systematically overestimate the benefits of mammography and PSA screening. In the countries investigated, physicians and other information sources appear to have little impact on improving citizens’ perceptions of these benefits.

 Richardson LA, Jones GW. A review of the reliability and validity of the Edmonton Symptom Assessment System. Curr Oncol. 2009 Jan;16(1):55. 

BACKGROUND: Systematic symptom reporting by patients and the use of questionnaires such as the Edmonton Symptom Assessment System (ESAS) have potential to improve clinical encounters and patient satisfaction. We review findings from published studies of the ESAS to guide use of the system and to focus research. METHODS: A systematic search for articles from 1991 through 2007 found thirty-nine peer-reviewed papers from 25 different institutions, thirty-three of which focused on patients with cancer. Observations, data, and statistics were collated according to relevance, reliability, validity, and responsiveness. RESULTS: Findings apply predominantly to symptomatic palliative patients with advanced cancer who were no longer receiving active oncologic therapies. Uncertainty about summarizing findings arises from frequent modification of the esas (altered items, scales, and time periods). Overall, reliability is established for daily administration. Scores are skewed, with a floor effect, but the relative order of symptoms by mean scores is similar across studies. Emotional symptoms are poorly captured by the depression and anxiety items. An equally weighted summation of scores may estimate a construct of "physical symptom distress," which in turn is related to performance status, palliative goals, quality of life, and well-being. CONCLUSIONS: The esas is reliable, but it has restricted validity, and its use requires a sound clinical process to help interpret scores and to give them an appropriate level of attention. Research priorities are to further develop the esas for assessing a greater number of important physical symptoms (and to target "physical symptom distress"), and to develop a similar instrument for emotional symptoms.

Graves KD,et al.  Distress Screening in a Multidisciplinary Lung Cancer Clinic: Prevalence and Predictors of Clinically-Significant Distress. Lung Cancer. 2007 February; 55(2): 215–224.

Screening for distress in cancer patients is recommended by the National Comprehensive Cancer Network, and a Distress Thermometer has previously been developed and empirically-validated for this purpose. The present study sought to determine the rates and predictors of distress in a sample of patients being seen in a multidisciplinary lung cancer clinic. Consecutive patients (N = 333) were recruited from an outpatient multidisciplinary lung cancer clinic to complete the Distress Thermometer, an associated Problem Symptom List, and two questions about interest in receiving help for symptoms. Over half (61.6%) of patients reported distress at a clinically significant level, and 22.5% of patients indicated interest in receiving help with their distress and/or symptoms. Problems in the areas of family relationships, emotional functioning, lack of information about diagnosis/treatment, physical functioning, and cognitive functioning were associated with higher reports of distress. Specific symptoms of depression, anxiety, pain and fatigue were most predictive of distress. Younger age was also associated with higher levels of distress. Distress was not associated with other clinical variables, including stage of illness or medical treatment approach. Similar results were obtained when individuals who had not yet received a definitive diagnosis of lung cancer (n = 134) were excluded from analyses; however, family problems and anxiety were no longer predictive of distress. Screening for distress in a multidisciplinary lung cancer clinic is feasible and a significant number of patients can be expected to meet clinical criteria for distress. Results also highlight younger age and specific physical and psychosocial symptoms as predictive of clinically-significant distress. Identification of the presence and predictors of distress are the first steps toward appropriate referral and treatment of symptoms and problems that contribute to cancer patients’ distress.

Montazeri A et al Disclosure of cancer diagnosis and quality of life in cancer patients: should it be the same everywhere? BMC Cancer. 2009; 9: 39. Published online 2009 January 29.

PURPOSE Psychological interventions are efficacious in reducing emotional distress for cancer patients. However, it is not clear whether psychological improvements are, in turn, related to improved health. A clinical trial tests whether a psychological intervention for cancer patients can do so, and also tests two routes to achieve better health: a) reducing patients’ emotional distress, and/or b) enhancing their functional immunity. METHODS Post-surgery, 227 breast cancer patients were randomized to Intervention or Assessment only study arms. Conducted in small groups, intervention sessions were offered weekly for 4 months and followed by monthly sessions for 8 months. Measures included psychological (distress), biological (immune), and health outcomes (performance status and evaluations of patient’s symptomatology, including toxicity from cancer treatment, lab values) collected at baseline, 4 months, and 12 months. RESULTS A path model revealed that intervention participation directly improved health (p<.05) at 12 months. These effects remained when statistically controlling for baseline levels of distress, immunity, and health as well as sociodemographic, disease, and cancer treatment variables. Regarding the mechanisms for achieving better health, support was found for an indirect effect of distress reduction. That is, by specifically lowering intervention patients’ distress at 4 months, their health was improved at 12 months (p<.05). Although the intervention simultaneously improved patients’ T-cell blastogenesis in response to phytohemagglutinin (PHA), the latter increases were unrelated to improved health. CONCLUSION A convergence of biobehavioral effects and health improvements were observed. Behavioral change, rather than immunity change, was influential in achieving lower levels of symptomatology and higher functional status. Distress reduction is highlighted as an important mechanism by which health can be improved.

Andersen R et al.  Distress Reduction from a Psychological Intervention Contributes to Improved Health for Cancer Patients Brain Behav Immun. 2007 October; 21(7): 953–961.

Abstract Background Evidence suggests that truth telling and honest disclosure of cancer diagnosis could lead to improved outcomes in cancer patients. To examine such findings in Iran, this trial aimed to study the various dimensions of quality of life in patients with gastrointestinal cancer and to compare these variables among those who knew their diagnosis and those who did not. Methods A consecutive sample of patients with gastrointestinal cancer being treated in Cancer Institute in Tehran, Iran was prospectively evaluated. A psychologist interviewed patients using the Iranian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Patients were categorized into two groups: those who knew their diagnosis and those who did not. Independent sample t-test was used for group comparisons. Results In all 142 patients were interviewed. A significant proportion (52%) of patients did not know their cancer diagnosis and 48% of patients were aware that they had cancer. They were quite similar in most characteristics. The comparison of quality of life between two groups indicated that those knew their diagnosis showed a significant lower degree of physical (P = 0.001), emotional (P = 0.01) and social functioning (P < 0.001), whereas the global quality of life and other functional scales including role functioning and cognitive functioning did not show significant result. There were no statistically significant differences between symptoms scores between two groups, except for fatigue suggesting a higher score in patients who knew their diagnosis (P = 0.01). The financial difficulties were also significantly higher in patients who knew their cancer diagnosis (P = 0.005). Performing analysis of variance while controlling for age, educational status, cancer site, and knowledge of cancer diagnosis, the results showed that the knowledge of cancer diagnosis independently still contributed to the significant differences observed between two groups. Conclusion Contrary to expectation the findings indicated that patients who did not know their cancer diagnosis had a better physical, social and emotional quality of life. It seems that due to cultural differences between countries cancer disclosure guidelines perhaps should be differing.

Jacobsen PB, Jim HS.   Psychosocial Interventions for Anxiety and Depression in Adult Cancer Patients: Achievements and Challenges CA Cancer J Clin 2008 58: 214-230.

Psychosocial care is increasingly recognized as an essential component of the comprehensive care of the individual with cancer. Improving patients' access to psychosocial care is important; however, ensuring that the care made available has been shown to be effective is just as important. Accordingly, the goal of this review is to describe an evidence-based approach to the psychosocial care of adults with cancer. The focus is on anxiety and depression because a considerable body of research has examined the impact of psychosocial interventions on these outcomes. After describing the sources, assessment, and prevalence of anxiety and depression in adults with cancer and presenting existing clinical practice guidelines for their management, previous publications that systematically reviewed evidence of the efficacy of psychosocial interventions are summarized. The use of these publications to derive specific recommendations for the use of psychosocial interventions in the management of anxiety and depression is then illustrated. In addition, examples are provided of interventions that are effective against anxiety and depression and have good potential for dissemination in routine clinical practice. The review concludes with a discussion of future directions for the continued development of an evidence-based approach to the psychosocial care of people with cancer.

Shih CT, Halpern MT. Economic Evaluations of Medical Care Interventions for Cancer Patients: How, Why, and What Does it Mean? CA Cancer J Clin 2008.

While the past decade has seen the development of multiple new interventions to diagnose and treat cancer, as well as to improve the quality of life for cancer patients, many of these interventions have substantial costs. This has resulted in increased scrutiny of the costs of care for cancer, as well as the costs relative to the benefits for cancer treatments. It is important for oncologists and other members of the cancer community to consider and understand how economic evaluations of cancer interventions are performed and to be able to use and critique these evaluations. This review discusses the components, main types, and analytic issues of health economic evaluations using studies of cancer interventions as examples. We also highlight limitations of these economic evaluations and discuss why members of the cancer community should care about economic analyses.

Smith RA et al Cancer Screening in the United States, 2008: A Review of Current American Cancer Society Guidelines and Cancer Screening Issues CA Cancer J Clin 2008 58: 161-179.     

Each year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection and a summary of the most current data on cancer screening rates and trends in US adults. In 2007, the ACS updated its colorectal cancer screening guidelines in a collaborative effort with the US Multi-Society Task Force and the American College of Radiology. In this issue of the journal, we summarize the current ACS guidelines, provide an update of the most recent data pertaining to participation rates in cancer screening from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and the National Health Interview Survey, and address some issues related to access to care.

Coughlin SS. Surviving Cancer or Other Serious Illness: A Review of Individual and Community Resources CA Cancer J Clin 2008 58: 60-64.

 In order to provide appropriate individual and community support for cancer survivors, there is a great need to better understand how people who have survived cancer or other serious illness adapt positively to health challenges and to identify effective approaches for helping people cope with health challenges over their lifetime. Studies have identified a number of personal factors that are associated with resilience, increased quality of life, and positive adaptation to illness. Of particular interest is the ability of individuals to survive or even thrive despite an adverse event, as influenced by both individual factors such as resiliency and external factors like social support. The experience of having a potentially life-threatening illness can lead to positive adaptation and increased ability to thrive despite difficult circumstances. The cancer survivorship movement and the cancer community in general provide important resources for improving quality of life and alleviating human suffering and distress among patients and survivors and for adding personal meaning and hope to people's lives

Falagas ME et al.The effect of psychosocial factors on breast cancer outcome: a systematic review Breast Cancer Res. 2007.

Introduction We sought to review the available evidence regarding the effect of psychosocial factors on the survival of breast cancer patients. Methods We systematically searched the PubMed and PsycINFO databases to identify relevant studies. Results We identified 31 studies examining the association of various psychosocial parameters with overall breast cancer survival/disease free survival and 6 studies examining whether psychological intervention influences the disease outcome. Of the 31 studies summarized in this overview, 25 (80.6%) showed a statistically significant association between at least one psychosocial variable and disease outcome. Parameters associated with better breast cancer prognosis are social support, marriage, and minimizing and denial, while depression and constraint of emotions are associated with decreased breast cancer survival; however, the role of these factors has not been verified in all studies. Conclusion Most of the studies show a significant relationship between psychosocial factors and survival, but the actual psychosocial variables related to survival are not consistently measured across studies and the findings for many of the psychosocial variables with survival/recurrence are not consistent across studies. Thus, more research is warranted regarding the role of social support, marriage, minimizing and denial, depression and constraint of emotions on breast cancer survival.

Christ GH and Christ AE.Current Approaches to Helping Children Cope with a Parent’s Terminal Illness CA Cancer J Clin 2006 56: 197-212.

Much has been learned about childhood bereavement in the last few decades as studies have increasingly focused on the direct interviewing of children about their recovery from the tragic loss of a parent. It has been shown that children do indeed mourn, although differently from adults. Important moderating and mediating variables have been identified that impact their recovery from the loss of a parent, which can be the focus of intervention. When death is expected, the terminal phase of an illness has been found to be particularly stressful for children, yet seldom investigated. Similarly, few studies have explored the impact of development on children’s experience and expression of grief. We present research findings that clarify phases in children’s experience during the terminal illness, hospital visits, the death, and its immediate aftermath, as well as how the parent is mourned and issues in longer term reconstitution. Variations in children’s responses in these phases are described as they were experienced by 87 children from 3 different developmental groupings: 3 to 5 years, 6 to 8 years, and 9 to 11 years. Recommendations are suggested for parents and professionals about ways to understand and support children during the terminal illness, at the time of death, and during the phase of reconstitution.

Chochinov HM. Dying, Dignity, and New Horizons in Palliative End-of-Life Care CA Cancer J Clin 2006 56: 84-103.  

Palliative care practitioners are now better able than ever before to ameliorate end-of-life symptom distress. What remains less developed, however, is the knowledgebase and skill set necessary to recognize, assess, and compassionately address the psychosocial, existential, and spiritual aspects of the patient’s dying experience. This review provides an overview of these areas, focusing primarily on empirical data that has examined these issues. A brief overview of psychiatric challenges in end-of-life care is complemented with a list of resources for readers wishing to explore this area more extensively. The experience of spiritual or existential suffering toward the end of life is explored, with an examination of the conceptual correlates of suffering. These correlates include: hopelessness, burden to others, loss of sense of dignity, and desire for death or loss of will to live. An empirically-derived model of dignity is described in some detail, with practical examples of diagnostic questions and therapeutic interventions to preserve dignity. Other interventions to reduce existential or spiritual suffering are described and evidence of their efficacy is presented. The author concludes that palliative care must continue to develop compassionate, individually tailored, and effective responses to the mounting vulnerability and increasingly difficult physical, psychosocial, and spiritual challenges facing persons nearing the end of life.

Deng G, Cassileth BR. Integrative Oncology: Complementary Therapies for Pain, Anxiety, and Mood Disturbance CA Cancer J Clin 2005 55: 109-116.  

The term "complementary and alternative methods" (CAM) refers to products and regimens that individuals may employ either to enhance wellness, relieve symptoms of disease and side effects of conventional treatments, or cure disease. CAM provide evidence-based information on promising complementary and alternative methods, and inform clinicians of methods that may harm patients. Many people with cancer experience pain, anxiety, and mood disturbance. Conventional treatments do not always satisfactorily relieve these symptoms, and some patients may not be able to tolerate their side effects. Complementary therapies such as acupuncture, mind-body techniques, massage, and other methods can help relieve symptoms and improve physical and mental well-being. Self-hypnosis and relaxation techniques help reduce procedural pain. Acupuncture is well documented to relieve chronic cancer pain. Massage and meditation improve anxiety and other symptoms of distress. Many dietary supplements contain biologically active constituents with effects on mood. However, not all complementary therapies are appropriate or useful, and even helpful complementary modalities may not be optimal under some circumstances. Situations when precaution is indicated include acute onset of symptoms and severe symptoms, which require immediate mainstream intervention. Dietary supplements are associated with serious negative consequences under some circumstances. The authors summarize the research on these modalities and discuss the rationale, expectation, and necessary precautions involved with combining complementary therapies and mainstream care. Practical clinical issues are addressed.

[New] History of Psycho-Oncology: Overcoming Attitudinal and Conceptual Barriers Jimmie C. Holland Psychosomatic Medicine March/April 2002 vol. 64 no. 2 206-221  

The formal beginnings of psycho-oncology date to the mid-1970s, when the stigma making the word “cancer” unspeakable was diminished to the point that the diagnosis could be revealed and the feelings of patients about their illness could be explored for the first time. However, a second stigma has contributed to the late development of interest in the psychological dimensions of cancer: negative attitudes attached to mental illness and psychological problems, even in the context of medical illness. It is important to understand these historical underpinnings because they continue to color contemporary attitudes and beliefs about cancer and its psychiatric comorbidity and psychosocial problems. Over the last quarter of the past century, psycho-oncology became a subspecialty of oncology with its own body of knowledge contributing to cancer care. In the new millennium, a significant base of literature, training programs, and a broad research agenda have evolved with applications at all points on the cancer continuum: behavioral research in changing lifestyle and habits to reduce cancer risk; study of behaviors and attitudes to ensure early detection; study of psychological issues related to genetic risk and testing; symptom control (anxiety, depression, delirium, pain, and fatigue) during active treatment; management of psychological sequelae in cancer survivors; and management of the psychological aspects of palliative and end-of-life care. Links between psychological and physiological domains of relevance to cancer risk and survival are being actively explored through psychoneuroimmunology. Research in these areas will occupy the research agenda for the first quarter of the new century. At the start of the third millennium, psycho-oncology has come of age as one of the youngest subspecialties of oncology, as one of the most clearly defined subspecialties of consultation-liaison psychiatry, and as an example of the value of a broad multidisciplinary application of the behavioral and social sciences.

Community Oncology [all in free text!]

Editor-in-Chief Lee S. Schwartzberg, MD, FACP

Miscellaneous articles listed =>  [all PDF links]

Breaking bad news: the S-P-I-K-E-S strategy

Effect of oncologist-based counseling on patient-perceived breast cancer risk and psychological distress

Initiating a community-based cancer supportive care program

Caring for the whole patient: the Institute of Medicine proposes a new standard of care

Modesty and healthcare for women: understanding cultural sensitivities

Recognizing depression in cancer outpatients

Emotional distress in patients with cancer: the sixth vital sign

End of treatment—laugh or cry?

Patients’ and families’ receptivity to discussions about future healthcare

Psychosocial considerations in hematopoietic stem cell transplantation: implications for patient quality of life and post-transplant survival

The explosion of hereditary cancer knowledge: benefiting from a family information service

Putting shared decision making to work in breast and prostate cancers: tools for community oncologists

Developing and implementing a survivorship program in a community cancer center

Better communication with minority patients: seven strategies for achieving cultural competency

Opinion leaders on quality in cancer: views from the field

Quality measurement in oncology practices

Metastatic breast cancer patients: addressing their unmet needs

Journal of Supportive Oncology [all in free text!]

Editor-in-Chief
Jamie H. Von Roenn, MD

Miscellaneous articles listed => [all PDF links]

Physical Activity as a Supportive Care Intervention in Palliative Cancer Patients: A Systematic Review

Communicating a Prognosis in Advanced Cancer

Patients’ and Doctors’ Views of Using the Schedule for Individual Quality of Life in Clinical Practice

Screening for Psychosocial Distress- A National Survey of Oncologists

Symptom Clusters in Patients With Newly-Diagnosed Brain Tumors

Practical Suggestions for Dealing With Distress in the Patient With Head and Neck Cancer

Quality-of-Life Assessment for Routine Oncology Clinical Practice

Visual Analogue Scales and Assessment of Quality of Life in Cancer

Cognitive Rehabilitation and Problem-Solving to Improve Quality of Life of Patients With Primary Brain Tumors

Understanding Depression in the Elderly Cancer Patient

Recognizing and Treating Depression

Psycho-oncology [all in free text!]

Editor-in-Chief
Jimmie Holland and Maggie Watson

Offering its top 10 most cited articles for free!

Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue
Berger AM, Kuhn BR, Farr LA, et al.
Volume 18, Issue 6

No indications of cognitive side-effects in a prospective study of breast cancer patients receiving adjuvant chemotherapy
Mehlsen M, Pedersen AD, Jensen AB, et al.
Volume 18, Issue 3

Cognitive effects of hormonal therapy in early stage breast cancer patients: a prospective study
Collins B, Mackenzie J, Stewart A, et al.
Volume 18, Issue 8

Hopelessness as a predictor of depressive symptoms for breast cancer patients coping with recurrence
Brothers BM, Andersen BL
Volume 18, Issue 3

A couple-based intervention for female breast cancer
Baucom DH, Porter LS, Kirby JS, et al.
Volume 18, Issue 3

Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial
Breitbart W, Rosenfeld B, Gibson C, et al.
Volume 19, Issue 1

Quality of life and sexual functioning after cervical cancer treatment: a long-term follow-up study
Greimel ER, Winter R, Kapp KS, et al.
Volume 18, Issue 5

Antecedents of domain-specific quality of life after colorectal cancer
Steginga SK, Lynch BM, Hawkes A, et al.
Volume 18, Issue 2

Promoting evidence-based psychosocial care for cancer patients
Jacobsen PB
Volume 18, Issue 1