pinecone/core-2020-05-10-deduplication huggingface dataset:
Improving communication in cancer care : A quasi-experimental study testing the effects of an interactive tailored patient assessment on communication between cancer patients and physicians and nurses

List of papers. The papers are removed from the thesis due to copyright restrictions.<br><br>

Paper 1: 
Heyn, L., Finset, A., Eide, H., Ruland, C.M. 
Effects of an interactive tailored patient assessment on patient-clinician communication in cancer care. 
Psychooncology. 2013 Jan;22(1):89-96
<a href="http://dx.doi.org/10.1002/pon.2064">doi:10.1002/pon.2064</a><br><br>

Paper 2: 
Heyn, L., Ruland, C.M., Finset, A. 
Effects of an interactive tailored patient assessment tool on eliciting and responding to cancer patients’ cues and concerns in clinical consultations with physicians and nurses. 
Patient Educ Couns. 2012 Feb;86(2):158-65.
<a href="http://dx.doi.org/10.1016/j.pec.2011.04.024">doi:10.1016/j.pec.2011.04.024</a><br><br>

Paper 3: 
Heyn, L., Finset, A., Ruland, C.M. 
Talking about worries and feelings in cancer consultations. The effects of an interactive tailored symptom assessment on sources, explicitness, and timing of emotional cues and concerns. 
Cancer Nurs. 2013 Mar;36(2):E20-30. <a href="http://dx.doi.org/10.1097/NCC.0b013e318254af66">doi:10.1097/NCC.0b013e318254af66</a><br><br>
Paper 4: 
Finset, A., Heyn, L., Ruland, C.M. 
Responses of physicians and nurses to patients’ emotional cues and concerns in cancer care consultations. 
J Gen Intern Med (submitted)<br><br>

Paper 5: 
Heyn, L., Finset, A., Eide, H., Ruland, C.M. 
Patient-clinician communication assisted by an interactive tailored symptom assessment: differences and similarities in nurses’ and physicians’ communication patterns. 
Supportive Care in Cancer (short communication, submitted
Depression is associated with some patient-perceived cosmetic changes, but not with radiotherapy-induced late toxicity, in long-term breast cancer survivors.
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Depression-associated factors in long-term breast cancer survivors

International audienceOBJECTIVE: Although depression is prevalent in long-term breast cancer survivors (LTBCS; ≥5 years since diagnosis), it is underdiagnosed and undertreated. A better understanding of factors associated with depression could improve depression screening, treatment, and prevention in this population. Our study aimed to assess the link between patient and doctor ratings of breast cosmetic outcomes, late radiotherapy toxicity, and depression in LTBCS. METHODS: In all, 214 patients recruited from the ARCOSEIN study were assessed for late radiotherapy toxicity (by using the LENT-SOMA scale) and patient and doctor ratings of breast cosmetic outcomes (mean = 6.7 years since the end of treatment). We reassessed 120 of these patients for depression (HAD) during a second wave of long-term assessment (mean = 8.1 years since the end of treatment). We used univariate analyses and polytomous logistic regression analyses to predict the HAD depression, which was defined as follows: normal, 0-7 points; and significant depression, ≥8 points (8-10 points, possible depression; ≥11 points, probable depression). RESULTS: The mean HAD depression score was 4.5 ± 3.6. 19. 2% of our population had significant depression, 6.7% with probable depression, and 12.5% with possible depression. Significant depression was not associated with late radiotherapy toxicity or initial cancer-related variables. Patients with probable depression reported worse cosmetic outcomes than nondepressed patients in terms of perceived breast largeness (p = 0.04), breast deformation (p = 0.02), and changes in skin pigmentation (p = 0.03). CONCLUSIONS: In LTBCS, depression seems to be more strongly associated with changes in some patients' perceived breast cosmetic outcome than late treatment toxicity or initial cancer-related variables. Copyright © 2012 John Wiley & Sons, Ltd
The counselees' self-reported request for psychological help in genetic counseling for hereditary breast/ovarian cancer: Not only psychopathology matters

Background Several studies have shown that counselees do not experience psychopathological levels of distress after DNA test result disclosure. However, it has not systematically been studied whether the absence of psychopathology also means that counselees do not want to receive help. Their self-reported request for help may be related not only with psychopathology/distress but also with other psychological needs (e.g., surgery decisions), genetics-specific needs (e.g., feeling vulnerable/stigmatized), and existential concerns (e.g., meaning in life). Methods Questionnaires were filled in by Dutch cancer patients, before and after disclosure of BRCA1/2 test results for hereditary breast/ovarian cancer: pathogenic mutation results (n = 30), uninformative results (n = 202), or unclassified variants (n = 16). Newly developed questions measured request for help, psychopathology was estimated with factor analyses on distress/psychopathology instruments, and several validated questionnaires measured other needs/concerns. Results One-third of all counselees who reported a request for psychological help had actually received help. The level of psychopathology correlated between 0.34 and 0.44 with this self-reported need-for-help. Other needs, genetics-specific distress, and existential concerns correlated strongly/moderately with the counselees' self-reported need-for-help. Examples of other needs were intention to undergo surgery, inaccuracy of their interpretation, the impact of cancer, and family communication difficulties. Genetics-specific distress was for instance feeling vulnerable to develop cancer, stigma, and lack of mastery. Existential concerns were, among others, lack of purpose in life, low self-acceptance, and an unfulfilled wish for certainty. Conclusions The request for help is related to multiple factors. Referral to psychosocial professionals may be improved by not only discussing psychopathology during genetic-counseling sessions but also by other needs and existential concerns. Questions about other needs and existential issues may be added to psychological screening instruments. Copyrigh
A feasibility study of group cognitive rehabilitation for cancer survivors: enhancing cognitive function and quality of life

Objective: This research aimed to address the gap in evidence-based treatment available for cancer survivors who are experiencing cognitive dysfunction through piloting a novel treatment intervention. The overall research question was whether a group cognitive rehabilitation intervention would be feasible for improving cognitive function and quality of life for people who have completed cancer treatment. Methods: Three groups of adults were recruited: an intervention group of 23 cancer survivors who completed a 4-week group cognitive rehabilitation treatment, a comparison group of 9 cancer survivors, and a community sample of 23 adults who had never experienced cancer. Measures of objective and subjective cognitive function, quality of life, psychosocial distress and illness perceptions were used. The research design was non-randomised. Results: The results indicated that the intervention was effective in improving overall cognitive function, visuospatial/constructional performance, immediate memory, and delayed memory beyond practice effects alone. It was helpful in reducing participants' perceptions of cognitive impairment and psychosocial distress, as well as promoting social functioning and understanding of cognition. The improvements were maintained at three months after the intervention. Participants reported a high level of satisfaction with the treatment.  Conclusions: The results provided evidence for the feasibility of a brief group-based cognitive rehabilitation intervention to treat cognitive problems experienced by cancer survivors.Griffith Health, School of Applied PsychologyFull Tex
Individual and family characteristics associated with  BRCA1/2  genetic testing in high‐risk families

Background  Little is known about family members' interrelated decisions to seek genetic testing for breast cancer susceptibility.    Methods  The specific aims of this cross‐sectional, descriptive, cohort study were (i) to examine whether individual and family characteristics have a direct effect on women's decisions to use genetic testing for hereditary susceptibility to breast cancer and (ii) to explore whether family characteristics moderate the relationships between individual characteristics and the decision to use genetic testing. Participants were women (>18 years old) who (i) received genetic testing for hereditary breast cancer and who agreed to invite one of their female relatives into the study and (ii) female relatives who had NOT obtained genetic testing and were identified by pedigree analysis as having >10% chances of hereditary susceptibility to breast cancer.    Results  The final sample consisted of 168 English‐speaking, family dyads who completed self‐administered, mailed surveys with validated instruments. Multivariate conditional logistic regression analyses showed that the proposed model explained 62% of the variance in genetic testing. The factors most significantly associated with genetic testing were having a personal history of cancer; perceiving genetic testing to have more benefits than barriers; having greater family hardiness; and perceiving fewer negative consequences associated with a breast cancer diagnosis. No significant interaction effects were observed.    Conclusions  Findings suggest that both individual and family characteristics are associated with the decision to obtain genetic testing for hereditary breast cancer; hence, there is a need for interventions that foster a supportive family environment for patients and their high‐risk relatives. Copyright © 2012 John Wiley & Sons, Ltd
‘It’s all bad news’: the first 3 months following a diagnosis of malignant pleural mesothelioma

Objective: This study explores patient’s experience during the first three months following a diagnosis of malignant pleural mesothelioma. Methods: This study uses a grounded theory approach with semi-structured, face-to- face interviews with ten patients during the first 3 months following diagnosis. Results: The key concept that emerged from the data was this: Uncertainty and lack of control, leading to emotional, physical and psychosocial distress. Three themes informed the key concept: ‘ it’s all bad news’, ‘good and bad days’ and strategies of amelioration. Patients worked with a short-term perspective on their illness but worried about the long-term outcome and the speed of their deterioration. Conclusion: Patients receive insufficient psychosocial support during the first three months following diagnosis. An early palliative care referral would improve support and referral strategies during the first three months of the disease
Effectiveness of an integrated adventure-based training and health education program in promoting regular physical activity among childhood cancer survivors

Background: There is growing concern about declining levels of physical activity in childhood cancer survivors. This study aimed to examine the effectiveness of an integrated adventure-based training and health education program in promoting changes in exercise behavior and enhancing the physical activity levels, self-efficacy, and quality of life of Hong Kong Chinese childhood cancer survivors. Methods: A randomized controlled trial, two-group pretest and repeated post-test, between-subjects design was conducted to 71 childhood cancer survivors (9- to 16-year-olds). Participants in the experimental group joined a 4-day integrated adventure-based training and health education program. Control group participants received the same amount of time and attention as the experimental group but not in such a way as to have any specific effect on the outcome measures. Participants' exercise behavior changes, levels of physical activity, self-efficacy, and quality of life were assessed at the time of recruitment, 3, 6, and 9 months after starting the intervention. Results: Participants in the experimental group reported statistically significant differences in physical activity stages of change (p < 0.001), higher levels of physical activity (p < 0.001) and self-efficacy (p = 0.04) than those in the control group. Besides, there were statistically significant mean differences (p < 0.001) in physical activity levels (-2.6), self-efficacy (-2.0), and quality of life (-4.3) of participants in the experimental group from baseline to 9 months after starting the intervention. Conclusions: The integrated adventure-based training and health education program was found to be effective in promoting regular physical activity among childhood cancer survivors. Copyright Â© 2013 John Wiley & Sons, Ltd.postprin
Procarbazine and antidepressants: a retrospective review of the risk of serotonin toxicity

Background  Procarbazine is an anticancer agent that also inhibits monoamine oxidase, an enzyme responsible for the metabolism of various catecholamines, including serotonin.    Methods  A retrospective chart review of lymphoma patients who were treated with both procarbazine and an antidepressant, as well as procarbazine alone, was performed to determine if signs and symptoms of serotonin toxicity were present.    Results  A total of 65 patients received procarbazine between 2004 and 2010 and were eligible to be included in the study. Twenty‐six of these patients received an antidepressant in combination with procarbazine, with selective serotonin reuptake inhibitors being the most common type of antidepressant. No patients in the study were diagnosed with serotonin toxicity, nor did any meet Hunter's diagnostic criteria for serotonin toxicity. Diarrhea, tremor, and shivering were the symptoms from Sternbach's criteria that were further analyzed, with diarrhea occurring 8.54% of the time, tremor occurring 5.53% of the time, and shivering occurring 2.51% of the time in patients who received an antidepressant with their procarbazine. Despite these symptoms, the diagnosis of serotonin toxicity according to Sternbach's criteria was determined to be unlikely.    Conclusions  In this small sample of patients treated with procarbazine plus an antidepressant (most typically SSRIs), there were no reports of serotonin toxicity, nor did any patients demonstrate symptoms consistent with serotonin toxicity. The authors urge clinicians to ensure depression is adequately managed in cancer patients who are undergoing procarbazine therapy, starting with typical first‐line antidepressant agents. Copyright © 2013 John Wiley & Sons, Ltd
Does cognitive behaviour therapy for insomnia reduce clinical levels of fatigue, anxiety and depression in cancer patients?

Objectives This secondary analysis of data from a randomised controlled trial explores associations between common symptom clusters and evaluates pre-treatment to post-treatment changes in clinical levels of these symptoms following cognitive behaviour therapy for insomnia (CBT-I). Methods Baseline data from 113 participants with insomnia were explored to establish rates of and associations between clinical levels of fatigue, anxiety and depression across the sample. Effects of CBT-I on this symptom cluster were also explored by examining changes in pre-treatment to post-treatment levels of fatigue, anxiety and depression. Results At baseline, the most common symptom presentation was insomnia+fatigue, and 30% of the sample reported at least three co-morbid symptoms. Post-CBT, the number of those experiencing clinical insomnia and clinical fatigue decreased. There were no changes in anxiety rates from baseline to post-treatment in the CBT group and modest reductions in rates of those with clinical depression. Seven individuals (9.6%) from the CBT group were completely symptom free at post-treatment compared with 0% from the treatment as usual condition. Chi-square analysis revealed a significant relationship between group allocation and changes in symptoms of insomnia and fatigue. No such relationship was found between group allocation and mood variables. Conclusions These findings confirm the high rate of symptom co-morbidities among cancer patients and highlight strong associations between sleep and fatigue. CBT-I appears to offer generalised benefit to the symptom cluster as a whole and, specifically, is effective in reducing fatigue, which exceeded clinical cut-offs prior to implementation of the intervention. This has implications for the diagnosis/management of common symptoms in cancer patients
Barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients

OBJECTIVE:

This study examined barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients (N=165) at two medical centers in the Midwestern United States.

METHODS:

Lung cancer patients completed an assessment of anxiety and depressive symptoms, mental health service use, barriers to using these services, and preferences for addressing emotional concerns.

RESULTS:

Only 45% of distressed patients received mental health care since their lung cancer diagnosis. The most prevalent patient-reported barriers to mental health service use among non-users of these services (n=110) included the desire to independently manage emotional concerns (58%) and inadequate knowledge of services (19%). In addition, 57% of distressed patients who did not access mental health services did not perceive the need for help. Seventy-five percent of respondents (123/164) preferred to talk to a primary care physician if they were to have an emotional concern. Preferences for counseling, psychiatric medication, peer support, spiritual care, or independently managing emotional concerns also were endorsed by many patients (range=40-50%). Older age was associated with a lower likelihood of preferring to see a counselor.

CONCLUSIONS:

Findings suggest that many distressed lung cancer patients underuse mental health services and do not perceive the need for such services. Efforts to increase appropriate use of services should address patients' desire for autonomy and lack of awareness of services
Orientations can avert psychosocial risks to palliative staff

Key points\ud
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1.	Personnel in palliative care wards and hospices are at risk of chronic stress, burnout, anxiety, depression and substance/alcohol abuse because working in end-of-life care involves frequent grief, death anxiety and feelings of professional helplessness. \ud
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2.	This commentary discusses the reported labour shortage in palliative care, and why some occupations are particularly at risk of quitting (e.g., care workers).\ud
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3.	Most healthcare organizations are not providing palliative staff with training or orientations (inductions) about how to cope with the psychosocial risks of the profession.\ud
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4.	This commentary discusses evidence that training interventions trialled on palliative staff are effective solutions.\ud
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5.	The conclusion is a call on healthcare organizations to implement orientation or training programmes that help palliative personnel cope.\ud
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Keywords: cancer; oncology; psychosocial risks; staff inductions; workplace coping
Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: the impact of APOE and smoking

PURPOSE: This study examined the association of post-treatment changes in cognitive performance, apolipoprotein E (APOE), and smoking in breast cancer patients treated with adjuvant therapy.
PARTICIPANTS AND METHODS: Breast cancer patients treated with chemotherapy (N = 55, age = 51.9 ± 7.1, education = 15.7 ± 2.6) were evaluated with a battery of neuropsychological tests prior to chemotherapy and at 1, 6, and 18 months post-chemotherapy. Matched groups of breast cancer patients not exposed to chemotherapy (N = 68, age = 56.8 ± 8.3, education = 14.8 ± 2.2) and healthy controls (N = 43, age = 53.0 ± 10.1, education = 15.2 ± 2.6) were evaluated at similar intervals. APOE epsilon 4 carrier status (APOE4+) and smoking history were also evaluated.
RESULTS: The detrimental effect of APOE4+ genotype on post-treatment cognitive functioning was moderated by smoking history, that is, patients without a smoking history had significantly lower performance on measures of processing speed and working memory compared with those with a smoking history and healthy controls. Exploratory analyses revealed that APOE4+ patients without a smoking history who were exposed to chemotherapy showed a decline in performance in processing speed, compared with patients with a smoking history. A similar but less pronounced pattern was seen in the no chemotherapy group (primarily endocrine treatment). For working memory, the APOE4+ by smoking interaction was observed in the no chemotherapy group only.
CONCLUSIONS: The association between APOE status, breast cancer treatment, and cognitive functioning was moderated by smoking history suggesting that both chemotherapy and endocrine therapy interact with APOE status and smoking to influence cognition. A putative mechanism is that smoking corrects a deficit in nicotinic receptor functioning and dopamine levels in APOE4+ individuals
Caregiving experiences predict changes in spiritual well-being among family caregivers of cancer patients

OBJECTIVE:

Although enhanced spiritual well-being has been linked to positive mental health outcomes among family caregivers of cancer patients, little is known regarding predictors of spiritual well-being in this population. The current study aimed to examine caregiving experiences as predictors of change in family caregivers' spiritual well-being during the initial months following the patient's cancer diagnosis.
METHODS:

Seventy family caregivers of newly diagnosed cancer patients (74% female, mean age = 59 years) participated in this longitudinal survey. Caregivers completed baseline questionnaires shortly before staying with the patient at an American Cancer Society Hope Lodge. Baseline questionnaires assessed caregiving experiences (i.e., self-esteem related to caregiving, family support for providing care, impact of caregiving on finances, and impact of caregiving on one's schedule). In addition, caregivers' spiritual well-being (i.e., meaning in life, peace, and faith) was assessed at baseline and 4-month follow-up.
RESULTS:

In univariate analyses, all caregiving experiences studied were associated with one or more aspects of spiritual well-being at 4-month follow-up. However, in the multivariate analysis, the only caregiving experience associated with aspects of spiritual well-being at 4-month follow-up was caregivers' perceptions of family support. Specifically, lack of family support was associated with lower levels of meaning and peace.
CONCLUSIONS:

Findings point to the importance of family support in facilitating the search for meaning and peace shortly after a loved one's cancer diagnosis and suggest that interventions targeting caregivers' support system may enhance their spiritual well-being