ABSTRACT Although prevalence estimates vary widely, pain is understood to be widespread among tho... more ABSTRACT Although prevalence estimates vary widely, pain is understood to be widespread among those with cancer, and, for many, such pain is undertreated. Cancer-related pain can be associated with a multitude of causes, courses, and treatments. World Health Organization (WHO) guidelines have helped reduce the burden of pain among those with cancer, with the WHO Cancer Pain Ladder providing a simple algorithm for pain treatment. Opioid treatment continues to be a mainstay of cancer-related pain, and modifications of the WHO Cancer Pain Ladder may be required when pain is severe. As with all pain, psychological factors play an important role in cancer-related pain, with emotional distress, cognitive coping strategies like catastrophizing, and pain-related behaviors shown as important predictors of pain severity. Because of this, psychological and behavioral treatments have shown effectiveness in reducing cancer pain burden. Barriers to effective pain management include psychological barriers, such as a fear of opioid addiction, social variables, such as discriminatory patterns of prescribing, or cultural variables, such as a cultural emphasis on stoicism in the face of pain. As cancer develops into its advanced stages, pain management may move to the forefront of patient care. Palliative care programs are among the most effective approaches to reducing the undertreatment of cancer-related pain and are proven to increase patient quality of life while reducing healthcare costs. Unfortunately, inaccurate perceptions among both patients and physicians of palliative care as being for patients without hope continue to persist. Perceptions of palliative care, however, are beginning to change and the future of cancer treatment will likely see a greater multi-disciplinary and multi-specialty focus on the treatment of pain. Innovations such as patient navigation will also likely result in increased pain management and reduced ethnic disparities.
Weight loss is recommended for obese cancer survivors who are at increased risk of recurrence and... more Weight loss is recommended for obese cancer survivors who are at increased risk of recurrence and non-cancer-related mortality. It remains unknown if this vulnerable population benefits from bariatric surgery to the same extent as those without a history of cancer. A retrospective chart review of 1013 patients identified 29 bariatric surgery patients with a history of cancer who were then matched to patients without a history of cancer. At 1-year postsurgical follow-up, individuals with a history of cancer had lost less weight than those without a history of cancer (14.2 versus 14.8); however, this difference was not significant (P = .76). Cancer survivors appear to draw similar benefit from bariatric surgery as those without a history of cancer, although a larger study with greater statistical power to detect differences is needed to confirm these results. These preliminary results are encouraging in light of the increasing focus on weight loss among this population.
Latino subgroups in the US often shoulder a greater burden of some common diseases, including can... more Latino subgroups in the US often shoulder a greater burden of some common diseases, including cancer. The cultural norm of patriarchy in health-related decision-making has been found to be common among Latinos, and thus male members may be important in the adoption of health practices amongst family members. Demographic information was collected from 488 male attendees (20% of the total sample) as part of a larger randomized trial focused on promoting breast and cervical cancer screening among Latinas in which attendance was open to the entire community. The majority of male attendees were over the age of 40 (62%) and originally from Mexico (39%) or Puerto Rico (25%). Approximately half of attendees reported having no health coverage and living less than 5 years in the United States. Male attendees demonstrated significant increases in knowledge relevant to their group attendance. There were few significant differences between the characteristics of male attendees at a female focused cancer program (intervention) versus more general diabetes program (control). The current study describes characteristics of a group that may be influential in guiding health behaviors and decisions. This information extends our understanding of community participation in health interventions and will assist in the development of effective interventions in the Latino community.
Optimal matching theory posits that the effects of social support are enhanced when its provision... more Optimal matching theory posits that the effects of social support are enhanced when its provision is matched with need for support. We hypothesized that matching received social support with the needs of persons with cancer, and cancer survivors would be related to better psychosocial adjustment than a mismatched condition. In a cross-sectional design, sample 1, consisting of 171 cancer patients, and sample 2, consisting of 118 cancer survivors, completed measures of emotional and instrumental received support, physical debilitation, and psychological distress. The optimal matching theory model was confirmed; those needing support (i.e., greater physical debilitation), who did not receive it, experienced more distress than those who needed support and received it. Patients in treatment benefited from the matching of need and provision for both emotional and instrumental support, whereas survivors only benefited from the matching of emotional support. The results suggest that social ...
Objective: Treatment for anal and rectal cancer (ARCa) often results in side effects that directl... more Objective: Treatment for anal and rectal cancer (ARCa) often results in side effects that directly impact sexual functioning; however, ARCa survivors are an understudied group, and factors contributing to the sexual sequelae are not well understood. Body image problems are distressing and may further exacerbate sexual difficulties, particularly for women. This preliminary study sought to (1) describe body image problems, including sociodemographic and disease/treatment correlates, and (2) examine relations between body image and sexual function.
This cross-sectional study was performed to provide a preliminary investigation of the relationsh... more This cross-sectional study was performed to provide a preliminary investigation of the relationship between patient satisfaction with medical care and depression among individuals diagnosed with lupus. A mail-out questionnaire was completed by 154 members of the Lupus Australia Foundation and the Lupus Association of New South Wales. Each questionnaire consisted of the Lupus Medical and Symptoms Questionnaire, Patient Satisfaction Questionnaire-Third Edition, and Cardiac Depression Scale. Participants reported, on average, a moderate level of illness severity and pain associated with lupus. The majority of participants reported moderate to severe depression and a moderate level of satisfaction with medical care. Hierarchical regression analysis revealed that 40% of the variance in depression scores could be explained by negative illness factors and dissatisfaction with medical care. In particular, depression was associated with the technical quality of medical care, pain levels, and...
Cultural diversity & ethnic minority psychology, Jan 4, 2014
In racial disparities research, perceived discrimination is a proposed risk factor for unfavorabl... more In racial disparities research, perceived discrimination is a proposed risk factor for unfavorable health outcomes. In a proposed "threshold-constraint" theory, discrimination intensity may exceed a threshold and require coping strategies, but social constraint limits coping options for African Americans, who may react to perceived racial discrimination with disengagement, because active strategies are not viable under this social constraint. Caucasian Americans may experience less discrimination and lower social constraint, and may use more active coping strategies. There were 213 African Americans and 121 Caucasian Americans with cancer who participated by completing measures of mistreatment, coping, and quality of life. African Americans reported more mistreatment than Caucasian Americans (p < 001) and attributed mistreatment more to race or ethnicity (p < .001). In the mistreatment-quality of life relationship, disengagement was a significant mediator for Caucasi...
Since its introduction in 1998, the VHA National Pain Management Strategy has introduced and impl... more Since its introduction in 1998, the VHA National Pain Management Strategy has introduced and implemented a series of plans for promoting systems improvements in pain care. We present the milestones of VHA efforts in pain management as reflected by the work of the Strategy. This includes the development of the Strategy and its current structure as well as a review of important initiatives such as "pain as the fifth vital sign" and the stepped care model of pain management.
The association between excess body weight and colorectal cancer screening is not well establishe... more The association between excess body weight and colorectal cancer screening is not well established. The purpose of this analysis was to explore, in the context of patients receiving navigation, whether obesity influences receipt of screening colonoscopy among lower-income Latinos and African Americans. This sub-analysis was conducted among Latinos and African American participants who received patient navigation and had complete body mass index (BMI) data (n = 520). Cross-sectional survey data were collected at baseline among individuals 50 years and older who were referred by their primary care providers for a colonoscopy at Mount Sinai's Primary Care Clinic. BMI was based on height and weight data from chart review at baseline, and colonoscopy completion status was collected at 1 year post-baseline. The mean BMI of the sample was 31.17 kg/m(2), with over half (53 %) of the sample categorized as obese. Rates of colonoscopy screening were high (~80 %), regardless of weight statu...
Engagement in physical activity can provide important benefits for cancer patients and survivors,... more Engagement in physical activity can provide important benefits for cancer patients and survivors, including those diagnosed with lung cancer. Despite this, many survivors do not engage in recommended levels of physical activity and little is known about the obstacles encountered by lung cancer survivors. The current study examines the physical activity preferences of early-stage lung cancer survivors. As part of a larger survey study, 175 non-small cell lung cancer survivors who were on average 3.6 years from surgical treatment responded to questions regarding their preferences for physical activity and physical activity advice. Demographic and medical characteristics were also collected. The majority of respondents (62 %) reported a desire to receive advice regarding physical activity, predominantly before treatment (68 %), in face-to-face interactions (95 %) with a physician (80 %), and within the context of a cancer care center (92 %). Approximately half of participants indicated they would be interested in an exercise program tailored to lung cancer survivors and most individuals (73 %) reported feeling capable of engaging in an exercise program. Differences in physical activity preferences emerged based on demographic and disease characteristics. The majority of participants reported a desire for physical activity advice and a willingness to engage in physical activity. Important differences were found based on demographic and medical characteristics, which may warrant consideration in the development and dissemination of physical activity interventions for this cancer survivor population.
Purpose Health-related quality of life (HRQOL) measures typically do not incorporate patients' pr... more Purpose Health-related quality of life (HRQOL) measures typically do not incorporate patients' preferences for domains such as physical, emotional, functional and social/ family well-being, which may compromise precision. Method A forced-choice domain-preference measure was developed to assess the importance of HRQOL domains. About 194 cancer patients completed the domain-preference measure, along with measures of HRQOL, coping, adjustment, and life satisfaction. Results Patients ranked emotional well-being as most important and the loss of social-family well-being as the most difficult to do without. A weighting algorithm revealed no advantage to incorporating individuals' domain preferences in HRQOL assessment; however, preliminary evidence suggested that HRQOL measurement may be more accurate in predicting outcomes for individuals with no distinct domain preferences than those with distinct preference profiles. Conclusion This study provides preliminary evidence for the validity of current measures of HRQOL, which may inherently take into account patients' domain preferences.
"• Many individuals diagnosed with cancer will experience clinically meaningful distress at some ... more "• Many individuals diagnosed with cancer will experience clinically meaningful distress at some point of their disease trajectory, including 53.8% of the sample in the current longitudinal study. This has prompted recommendations for routine distress screening to help guide supportive care services and promote patient well-being.
• Less is known however regarding the trajectory of patient distress over the course of treatment. Percentile curves may provide unique insight into this trajectory and assist health professionals in developing distress management objectives and enhancing supportive care.
• The current study suggests that more stable demographic characteristics are importante predictors of distress at the outset of treatment but are eclipsed by problems related to symptom control and function as treatment progresses.
• Percentile curve plotting of distress suggested that different cutoff scores may be needed at diferente time points of treatment. Further, such curves would enable clinicians to identify patients whose distress is high relative to other patients at the same time point during treatment.
• This preliminary study examines the potential for percentile curve methodology to help guide supportive care in oncology and provide clinicians and researchers with greater insight into the nature of patient distress over the course of the treatment."
Background: Pancreatic cancer is the fourth leading cause of cancer-related death in the United S... more Background: Pancreatic cancer is the fourth leading cause of cancer-related death in the United States, unsuccessful in significantly improving 5-year survival. A diagnosis of pancreatic cancer may be associated with increased psychological distress, yet remarkably little is known about the degree of psychological distress experienced by these patients at the time of diagnosis and treatment.
The purpose of this study was to investigate the role of pain and depression in night time and da... more The purpose of this study was to investigate the role of pain and depression in night time and daytime functioning of individuals with lupus. A cross-sectional research design was used. Participants were recruited via a mail-out to members of the Lupus Australia Foundation and the Lupus Association of New South Wales. One hundred and fifty-four participants completed a questionnaire package consisting of a Lupus Medical and Symptoms Questionnaire designed by the researchers, the Cardiac Depression Scale and the Pittsburgh Sleep Quality Index. Hierarchical regression analyses revealed that pain principally predicted levels of sleep disturbance, whilst depression and pain (to a lesser extent) together predicted daytime dysfunction. The present results suggested the need for more adequate pain management, particularly at night and psychological interventions to decrease levels of depression that interfere with daily functioning in individuals with lupus.
Mindfulness-based interventions and mindfulness techniques have become increasingly popular in ps... more Mindfulness-based interventions and mindfulness techniques have become increasingly popular in psychosocial care. These interventions have also been increasingly used with cancer patients and survivors. However, more attention is due to issues such as how these techniques may be specifically relevant for an oncology population and whether the religious derivation of mindfulness should be considered by frontline psychosocial clinicians. This article provides a history and overview of the use of mindfulness in psychosocial cancer care.
Sexual dysfunction represents a complex and multifactorial construct that can affect both men and... more Sexual dysfunction represents a complex and multifactorial construct that can affect both men and women and has been noted to often deteriorate significantly after treatment for rectal and anal cancer. Despite this, it remains an understudied, underreported, and undertreated issue in the field of cancer survivorship. This study examined the characteristics of women enrolled in an intervention trial to treat sexual dysfunction, and explored the relationship between sexual functioning and psychological well-being. There were 70 female posttreatment anal or rectal cancer survivors assessed as part of the current study. Participants were enrolled in a randomized intervention trial to treat sexual dysfunction and completed outcome measures prior to randomization. The main outcome measures are quality of life (QOL) (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC-QLQ-C30] and Colorectal Cancer-Specific Module [QLQ-CR38]), sexual functioning (Female Sexual Functioning Index), and psychological well-being (Brief Symptom Inventory Depression/Anxiety, Impact of Events Scale-Revised, CR-38 Body Image). Women enrolled in the study intervention were on average 55 years old, predominantly Caucasian (79%), married (57%), and a median of 4 years postprimary treatment. For those reporting sexual activity at baseline (N=41), sexual dysfunction was associated with a range of specific measures of psychological well-being, all in the hypothesized direction. The Sexual/Relationship Satisfaction subscale was associated with all measures of psychological well-being (r=-0.45 to -0.70, all P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Body image, anxiety, and cancer-specific posttraumatic distress were notable in their association with subscales of sexual functioning, while a global QOL measure was largely unrelated. For sexually active female rectal and anal cancer survivors enrolled in a sexual health intervention, sexual dysfunction was significantly and consistently associated with specific measures of psychological well-being, most notably Sexual/Relationship Satisfaction. These results suggest that sexual functioning may require focused assessment by providers, beyond broad QOL assessments, and that attention to Sexual/Relationship Satisfaction may be critical in the development and implementation of interventions for this cohort of patients.
ABSTRACT Although prevalence estimates vary widely, pain is understood to be widespread among tho... more ABSTRACT Although prevalence estimates vary widely, pain is understood to be widespread among those with cancer, and, for many, such pain is undertreated. Cancer-related pain can be associated with a multitude of causes, courses, and treatments. World Health Organization (WHO) guidelines have helped reduce the burden of pain among those with cancer, with the WHO Cancer Pain Ladder providing a simple algorithm for pain treatment. Opioid treatment continues to be a mainstay of cancer-related pain, and modifications of the WHO Cancer Pain Ladder may be required when pain is severe. As with all pain, psychological factors play an important role in cancer-related pain, with emotional distress, cognitive coping strategies like catastrophizing, and pain-related behaviors shown as important predictors of pain severity. Because of this, psychological and behavioral treatments have shown effectiveness in reducing cancer pain burden. Barriers to effective pain management include psychological barriers, such as a fear of opioid addiction, social variables, such as discriminatory patterns of prescribing, or cultural variables, such as a cultural emphasis on stoicism in the face of pain. As cancer develops into its advanced stages, pain management may move to the forefront of patient care. Palliative care programs are among the most effective approaches to reducing the undertreatment of cancer-related pain and are proven to increase patient quality of life while reducing healthcare costs. Unfortunately, inaccurate perceptions among both patients and physicians of palliative care as being for patients without hope continue to persist. Perceptions of palliative care, however, are beginning to change and the future of cancer treatment will likely see a greater multi-disciplinary and multi-specialty focus on the treatment of pain. Innovations such as patient navigation will also likely result in increased pain management and reduced ethnic disparities.
Weight loss is recommended for obese cancer survivors who are at increased risk of recurrence and... more Weight loss is recommended for obese cancer survivors who are at increased risk of recurrence and non-cancer-related mortality. It remains unknown if this vulnerable population benefits from bariatric surgery to the same extent as those without a history of cancer. A retrospective chart review of 1013 patients identified 29 bariatric surgery patients with a history of cancer who were then matched to patients without a history of cancer. At 1-year postsurgical follow-up, individuals with a history of cancer had lost less weight than those without a history of cancer (14.2 versus 14.8); however, this difference was not significant (P = .76). Cancer survivors appear to draw similar benefit from bariatric surgery as those without a history of cancer, although a larger study with greater statistical power to detect differences is needed to confirm these results. These preliminary results are encouraging in light of the increasing focus on weight loss among this population.
Latino subgroups in the US often shoulder a greater burden of some common diseases, including can... more Latino subgroups in the US often shoulder a greater burden of some common diseases, including cancer. The cultural norm of patriarchy in health-related decision-making has been found to be common among Latinos, and thus male members may be important in the adoption of health practices amongst family members. Demographic information was collected from 488 male attendees (20% of the total sample) as part of a larger randomized trial focused on promoting breast and cervical cancer screening among Latinas in which attendance was open to the entire community. The majority of male attendees were over the age of 40 (62%) and originally from Mexico (39%) or Puerto Rico (25%). Approximately half of attendees reported having no health coverage and living less than 5 years in the United States. Male attendees demonstrated significant increases in knowledge relevant to their group attendance. There were few significant differences between the characteristics of male attendees at a female focused cancer program (intervention) versus more general diabetes program (control). The current study describes characteristics of a group that may be influential in guiding health behaviors and decisions. This information extends our understanding of community participation in health interventions and will assist in the development of effective interventions in the Latino community.
Optimal matching theory posits that the effects of social support are enhanced when its provision... more Optimal matching theory posits that the effects of social support are enhanced when its provision is matched with need for support. We hypothesized that matching received social support with the needs of persons with cancer, and cancer survivors would be related to better psychosocial adjustment than a mismatched condition. In a cross-sectional design, sample 1, consisting of 171 cancer patients, and sample 2, consisting of 118 cancer survivors, completed measures of emotional and instrumental received support, physical debilitation, and psychological distress. The optimal matching theory model was confirmed; those needing support (i.e., greater physical debilitation), who did not receive it, experienced more distress than those who needed support and received it. Patients in treatment benefited from the matching of need and provision for both emotional and instrumental support, whereas survivors only benefited from the matching of emotional support. The results suggest that social ...
Objective: Treatment for anal and rectal cancer (ARCa) often results in side effects that directl... more Objective: Treatment for anal and rectal cancer (ARCa) often results in side effects that directly impact sexual functioning; however, ARCa survivors are an understudied group, and factors contributing to the sexual sequelae are not well understood. Body image problems are distressing and may further exacerbate sexual difficulties, particularly for women. This preliminary study sought to (1) describe body image problems, including sociodemographic and disease/treatment correlates, and (2) examine relations between body image and sexual function.
This cross-sectional study was performed to provide a preliminary investigation of the relationsh... more This cross-sectional study was performed to provide a preliminary investigation of the relationship between patient satisfaction with medical care and depression among individuals diagnosed with lupus. A mail-out questionnaire was completed by 154 members of the Lupus Australia Foundation and the Lupus Association of New South Wales. Each questionnaire consisted of the Lupus Medical and Symptoms Questionnaire, Patient Satisfaction Questionnaire-Third Edition, and Cardiac Depression Scale. Participants reported, on average, a moderate level of illness severity and pain associated with lupus. The majority of participants reported moderate to severe depression and a moderate level of satisfaction with medical care. Hierarchical regression analysis revealed that 40% of the variance in depression scores could be explained by negative illness factors and dissatisfaction with medical care. In particular, depression was associated with the technical quality of medical care, pain levels, and...
Cultural diversity & ethnic minority psychology, Jan 4, 2014
In racial disparities research, perceived discrimination is a proposed risk factor for unfavorabl... more In racial disparities research, perceived discrimination is a proposed risk factor for unfavorable health outcomes. In a proposed "threshold-constraint" theory, discrimination intensity may exceed a threshold and require coping strategies, but social constraint limits coping options for African Americans, who may react to perceived racial discrimination with disengagement, because active strategies are not viable under this social constraint. Caucasian Americans may experience less discrimination and lower social constraint, and may use more active coping strategies. There were 213 African Americans and 121 Caucasian Americans with cancer who participated by completing measures of mistreatment, coping, and quality of life. African Americans reported more mistreatment than Caucasian Americans (p < 001) and attributed mistreatment more to race or ethnicity (p < .001). In the mistreatment-quality of life relationship, disengagement was a significant mediator for Caucasi...
Since its introduction in 1998, the VHA National Pain Management Strategy has introduced and impl... more Since its introduction in 1998, the VHA National Pain Management Strategy has introduced and implemented a series of plans for promoting systems improvements in pain care. We present the milestones of VHA efforts in pain management as reflected by the work of the Strategy. This includes the development of the Strategy and its current structure as well as a review of important initiatives such as "pain as the fifth vital sign" and the stepped care model of pain management.
The association between excess body weight and colorectal cancer screening is not well establishe... more The association between excess body weight and colorectal cancer screening is not well established. The purpose of this analysis was to explore, in the context of patients receiving navigation, whether obesity influences receipt of screening colonoscopy among lower-income Latinos and African Americans. This sub-analysis was conducted among Latinos and African American participants who received patient navigation and had complete body mass index (BMI) data (n = 520). Cross-sectional survey data were collected at baseline among individuals 50 years and older who were referred by their primary care providers for a colonoscopy at Mount Sinai's Primary Care Clinic. BMI was based on height and weight data from chart review at baseline, and colonoscopy completion status was collected at 1 year post-baseline. The mean BMI of the sample was 31.17 kg/m(2), with over half (53 %) of the sample categorized as obese. Rates of colonoscopy screening were high (~80 %), regardless of weight statu...
Engagement in physical activity can provide important benefits for cancer patients and survivors,... more Engagement in physical activity can provide important benefits for cancer patients and survivors, including those diagnosed with lung cancer. Despite this, many survivors do not engage in recommended levels of physical activity and little is known about the obstacles encountered by lung cancer survivors. The current study examines the physical activity preferences of early-stage lung cancer survivors. As part of a larger survey study, 175 non-small cell lung cancer survivors who were on average 3.6 years from surgical treatment responded to questions regarding their preferences for physical activity and physical activity advice. Demographic and medical characteristics were also collected. The majority of respondents (62 %) reported a desire to receive advice regarding physical activity, predominantly before treatment (68 %), in face-to-face interactions (95 %) with a physician (80 %), and within the context of a cancer care center (92 %). Approximately half of participants indicated they would be interested in an exercise program tailored to lung cancer survivors and most individuals (73 %) reported feeling capable of engaging in an exercise program. Differences in physical activity preferences emerged based on demographic and disease characteristics. The majority of participants reported a desire for physical activity advice and a willingness to engage in physical activity. Important differences were found based on demographic and medical characteristics, which may warrant consideration in the development and dissemination of physical activity interventions for this cancer survivor population.
Purpose Health-related quality of life (HRQOL) measures typically do not incorporate patients' pr... more Purpose Health-related quality of life (HRQOL) measures typically do not incorporate patients' preferences for domains such as physical, emotional, functional and social/ family well-being, which may compromise precision. Method A forced-choice domain-preference measure was developed to assess the importance of HRQOL domains. About 194 cancer patients completed the domain-preference measure, along with measures of HRQOL, coping, adjustment, and life satisfaction. Results Patients ranked emotional well-being as most important and the loss of social-family well-being as the most difficult to do without. A weighting algorithm revealed no advantage to incorporating individuals' domain preferences in HRQOL assessment; however, preliminary evidence suggested that HRQOL measurement may be more accurate in predicting outcomes for individuals with no distinct domain preferences than those with distinct preference profiles. Conclusion This study provides preliminary evidence for the validity of current measures of HRQOL, which may inherently take into account patients' domain preferences.
"• Many individuals diagnosed with cancer will experience clinically meaningful distress at some ... more "• Many individuals diagnosed with cancer will experience clinically meaningful distress at some point of their disease trajectory, including 53.8% of the sample in the current longitudinal study. This has prompted recommendations for routine distress screening to help guide supportive care services and promote patient well-being.
• Less is known however regarding the trajectory of patient distress over the course of treatment. Percentile curves may provide unique insight into this trajectory and assist health professionals in developing distress management objectives and enhancing supportive care.
• The current study suggests that more stable demographic characteristics are importante predictors of distress at the outset of treatment but are eclipsed by problems related to symptom control and function as treatment progresses.
• Percentile curve plotting of distress suggested that different cutoff scores may be needed at diferente time points of treatment. Further, such curves would enable clinicians to identify patients whose distress is high relative to other patients at the same time point during treatment.
• This preliminary study examines the potential for percentile curve methodology to help guide supportive care in oncology and provide clinicians and researchers with greater insight into the nature of patient distress over the course of the treatment."
Background: Pancreatic cancer is the fourth leading cause of cancer-related death in the United S... more Background: Pancreatic cancer is the fourth leading cause of cancer-related death in the United States, unsuccessful in significantly improving 5-year survival. A diagnosis of pancreatic cancer may be associated with increased psychological distress, yet remarkably little is known about the degree of psychological distress experienced by these patients at the time of diagnosis and treatment.
The purpose of this study was to investigate the role of pain and depression in night time and da... more The purpose of this study was to investigate the role of pain and depression in night time and daytime functioning of individuals with lupus. A cross-sectional research design was used. Participants were recruited via a mail-out to members of the Lupus Australia Foundation and the Lupus Association of New South Wales. One hundred and fifty-four participants completed a questionnaire package consisting of a Lupus Medical and Symptoms Questionnaire designed by the researchers, the Cardiac Depression Scale and the Pittsburgh Sleep Quality Index. Hierarchical regression analyses revealed that pain principally predicted levels of sleep disturbance, whilst depression and pain (to a lesser extent) together predicted daytime dysfunction. The present results suggested the need for more adequate pain management, particularly at night and psychological interventions to decrease levels of depression that interfere with daily functioning in individuals with lupus.
Mindfulness-based interventions and mindfulness techniques have become increasingly popular in ps... more Mindfulness-based interventions and mindfulness techniques have become increasingly popular in psychosocial care. These interventions have also been increasingly used with cancer patients and survivors. However, more attention is due to issues such as how these techniques may be specifically relevant for an oncology population and whether the religious derivation of mindfulness should be considered by frontline psychosocial clinicians. This article provides a history and overview of the use of mindfulness in psychosocial cancer care.
Sexual dysfunction represents a complex and multifactorial construct that can affect both men and... more Sexual dysfunction represents a complex and multifactorial construct that can affect both men and women and has been noted to often deteriorate significantly after treatment for rectal and anal cancer. Despite this, it remains an understudied, underreported, and undertreated issue in the field of cancer survivorship. This study examined the characteristics of women enrolled in an intervention trial to treat sexual dysfunction, and explored the relationship between sexual functioning and psychological well-being. There were 70 female posttreatment anal or rectal cancer survivors assessed as part of the current study. Participants were enrolled in a randomized intervention trial to treat sexual dysfunction and completed outcome measures prior to randomization. The main outcome measures are quality of life (QOL) (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC-QLQ-C30] and Colorectal Cancer-Specific Module [QLQ-CR38]), sexual functioning (Female Sexual Functioning Index), and psychological well-being (Brief Symptom Inventory Depression/Anxiety, Impact of Events Scale-Revised, CR-38 Body Image). Women enrolled in the study intervention were on average 55 years old, predominantly Caucasian (79%), married (57%), and a median of 4 years postprimary treatment. For those reporting sexual activity at baseline (N=41), sexual dysfunction was associated with a range of specific measures of psychological well-being, all in the hypothesized direction. The Sexual/Relationship Satisfaction subscale was associated with all measures of psychological well-being (r=-0.45 to -0.70, all P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Body image, anxiety, and cancer-specific posttraumatic distress were notable in their association with subscales of sexual functioning, while a global QOL measure was largely unrelated. For sexually active female rectal and anal cancer survivors enrolled in a sexual health intervention, sexual dysfunction was significantly and consistently associated with specific measures of psychological well-being, most notably Sexual/Relationship Satisfaction. These results suggest that sexual functioning may require focused assessment by providers, beyond broad QOL assessments, and that attention to Sexual/Relationship Satisfaction may be critical in the development and implementation of interventions for this cohort of patients.
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Papers by Errol Philip
• Less is known however regarding the trajectory of patient distress over the course of treatment. Percentile curves may provide unique insight into this trajectory and assist health professionals in developing distress management objectives and enhancing supportive care.
• The current study suggests that more stable demographic characteristics are importante predictors of distress at the outset of treatment but are eclipsed by problems related to symptom control and function as treatment progresses.
• Percentile curve plotting of distress suggested that different cutoff scores may be needed at diferente time points of treatment. Further, such curves would enable clinicians to identify patients whose distress is high relative to other patients at the same time point during treatment.
• This preliminary study examines the potential for percentile curve methodology to help guide supportive care in oncology and provide clinicians and researchers with greater insight into the nature of patient distress over the course of the treatment."
• Less is known however regarding the trajectory of patient distress over the course of treatment. Percentile curves may provide unique insight into this trajectory and assist health professionals in developing distress management objectives and enhancing supportive care.
• The current study suggests that more stable demographic characteristics are importante predictors of distress at the outset of treatment but are eclipsed by problems related to symptom control and function as treatment progresses.
• Percentile curve plotting of distress suggested that different cutoff scores may be needed at diferente time points of treatment. Further, such curves would enable clinicians to identify patients whose distress is high relative to other patients at the same time point during treatment.
• This preliminary study examines the potential for percentile curve methodology to help guide supportive care in oncology and provide clinicians and researchers with greater insight into the nature of patient distress over the course of the treatment."