Papers by Michael Andrykowski
Psycho-Oncology, 2015
For clinical and research purposes, efficient identification of cases of cancer-related fatigue (... more For clinical and research purposes, efficient identification of cases of cancer-related fatigue (CRF) is important, as CRF can be persistent and interfere with usual functioning. While various fatigue-screening instruments are available, no brief screening indices have been developed using formally diagnosed CRF cases as the criterion. Breast cancer patients (n = 385) completed a fatigue diagnostic interview and self-report fatigue measures (Profile of Mood States-fatigue subscale, Fatigue Symptom Inventory, and SF-36 vitality subscale), after initial adjuvant therapy (post-treatment (post-Tx) 1 assessment), after completion of radiotherapy for women receiving chemotherapy + radiotherapy (post-Tx 2 assessment), and 6 months after completion of all adjuvant therapy (6-month post-Tx assessment). CRF cases were identified using specific diagnostic criteria. ROC analyses identified screening indices, which could accurately identify CRF cases after initial adjuvant therapy. Screening indices were cross-validated using post-Tx 2 and 6-month follow-up assessment data. A total of 104 women (27%) met CRF criteria after initial adjuvant therapy. Six two-item screening indices were identified. For all indices, area under the curve exceeded 0.80, sensitivity exceeded 0.80, and specificity exceeded 0.57. Cross-validation suggested that, except for the index based on SF-36, all the indices continued to accurately identify CRF cases at the post-Tx 2 and 6-month post-Tx assessments. Overall, a two-item composite index based on Fatigue Symptom Inventory 'most severity' and 'work interference' items performed best. Breast cancer patients and survivors meeting CRF diagnostic criteria can be accurately identified using brief screening indices derived from common self-report fatigue measures. Copyright © 2015 John Wiley & Sons, Ltd.
Journal of traumatic stress, 2015
Little research has examined how lung cancer survivors whose cancer experience met the Diagnostic... more Little research has examined how lung cancer survivors whose cancer experience met the Diagnostic and Statistical Manual of Mental Disorders (DSM) traumatic stressor criterion differ with regard to posttreatment mental health status from survivors whose cancer experience did not. No research of which we are aware has examined the impact of the revised DSM-5 traumatic stressor criterion on this question. Non-small-cell (NSC) lung cancer survivors (N = 189) completed a telephone interview and questionnaire assessing distress and growth/benefit-finding. Survivors were categorized into Trauma and No Trauma groups using both the DSM-IV and DSM-5 stressor criterion. Using the DSM-IV criterion, the Trauma group (n = 70) reported poorer status than the No Trauma group (n = 119) on 10 of 10 distress indices (mean ES = 0.57 SD) and better status on all 7 growth/benefit-finding indices (mean ES = 0.30 SD). Using the DSM-5 stressor criterion, differences between the Trauma (n = 108) and No Trau...
Journal of behavioral medicine, 1998
Fatigue is a common and distressing symptom following cancer treatment. Research examining "... more Fatigue is a common and distressing symptom following cancer treatment. Research examining "off-treatment" fatigue has been weakened by limited assessments of fatigue and lack of suitable comparison groups. The extent of off-treatment fatigue following treatment for breast cancer (BC) was examined. Women with BC (n = 88; mean, 28 months posttreatment) and age-matched women (n = 88) with benign breast problems (BBP), completed a set of fatigue questionnaires at an Initial assessment and a 4-month Follow-up assessment. The BC group reported more fatigue, more weakness, and less vitality relative to the BBP group at both assessments. No relationship was found in the BC group between fatigue and extent of treatment or time since treatment completion. While the results document the existence of off-treatment fatigue following BC, elucidation of the psychobiological processes underlying this symptom and development of clinical management strategies remain as challenges for futur...
Preventive medicine
Previous studies have reported high interest in genetic testing for risk for colon or breast-ovar... more Previous studies have reported high interest in genetic testing for risk for colon or breast-ovarian cancer. These studies, however, have used samples which might be atypical with regard to level of interest evident among the general U.S. population. As part of an annual statewide telephone health survey, adults' (n = 649) interest in learning about their personal genetic predisposition for cancer was assessed. High levels of interest in learning about a personal genetic predisposition for cancer in general (87%) and breast cancer in particular (93%) were expressed. Logistic regression analysis indicated that lack of interest was associated with less education, minority status, and less performance of other health-protective behaviors. Only 53% of respondents reported their understanding of genetics was "good" or "excellent." While interest in learning of one's personal genetic predisposition for cancer was high, many individuals requesting testing may ha...
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2012
Data are scarce about whether past history of major depressive disorder in the absence of current... more Data are scarce about whether past history of major depressive disorder in the absence of current depression places breast cancer patients at risk for worse quality of life. The current study prospectively examined quality of life during chemotherapy in breast cancer patients with a history of resolved major depressive disorder (n = 29) and no history of depression (n = 144). Women with Stages 0-II breast cancer were assessed prior to and at the completion of chemotherapy. Major depressive disorder was assessed via structured interview and quality of life with the SF-36. Patients with past major depressive disorder displayed greater declines in physical functioning relative to patients with no history of depression (p ≤ 0.01). Findings suggest that breast cancer patients with a history of resolved major depressive disorder are at increased risk for declines in physical functioning during chemotherapy relative to patients with no history of depression.
Menopause-the Journal of The North American Menopause Society, 2001
Similar to the circadian rhythm of core body temperature, hot flashes have been found to exhibit ... more Similar to the circadian rhythm of core body temperature, hot flashes have been found to exhibit a circadian rhythm in healthy, naturally postmenopausal women, with a peak in frequency at 18:25 h. However, to date, no studies have evaluated whether this same pattern is found among breast cancer survivors reporting hot flashes. Daily hot flash frequencies were measured among 21 postmenopausal breast cancer survivors using validated 24-h sternal skin conductance monitoring. Hot flashes were noted in all women, ranging in frequency from 1 to 30 per 24-h period. A majority of the sample (86%) experienced > or = 1 nighttime hot flash, with 48% exhibiting > or = 3 but < or = 7 nighttime hot flashes. For the total sample, a modest circadian rhythm was noted with a peak in hot flash frequency occurring at 16:10 h. However, significant variability was observed across individual women, and, as a whole, breast cancer survivors demonstrated distorted to obliterated rhythms. Data suggest that hot flashes in postmenopausal breast cancer survivors do not follow the same circadian pattern as previously seen in healthy, naturally postmenopausal women. Findings have implications for (1) understanding the potential for sleep disturbances and fatigue in breast cancer survivors experiencing hot flashes, and (2) future research examining circadian rhythms of core body temperature and hot flashes in breast cancer survivors.
Oncology Nursing Forum, 2002
To compare the hot flash symptom experience and related outcomes between breast cancer survivors ... more To compare the hot flash symptom experience and related outcomes between breast cancer survivors and healthy women. Descriptive, cross-sectional, comparative study. Southeastern university medical center. 69 of 207 breast cancer survivors contacted via a tumor registry and 63 age-matched healthy female volunteers. Survivors were a mean of 57 years and a mean of 39 months postdiagnosis. Mailed survey included a demographic, disease, and treatment information form; a gynecologic history form; a two-day, prospective, hot flash diary; a detailed hot flash questionnaire; mood and affect scales; and the Hot Flash-Related Daily Interference Scale. Hot flashes, mood, affect, interference with daily activities, and overall quality of life. Breast cancer survivors had hot flashes that were significantly more frequent, severe, distressing, and of greater duration. Breast cancer survivors were less likely to be using hormone replacement and more likely to have tried nonhormonal prescription interventions in the past, but reported significantly less effectiveness from hot flash treatments. Breast cancer survivors with severe hot flashes reported significantly greater mood disturbance; higher negative affect; more interference with daily activities, including sleep, concentration, and sexuality; and poorer overall quality of life in comparison to breast cancer survivors with no hot flashes to mild hot flashes. Hot flash quality and triggers were not significantly different between groups. No clear temporal pattern of hot flashes emerged. Hot flashes are a significant problem for breast cancer survivors, even for those who are naturally postmenopausal (i.e., did not undergo menopause as a result of surgery or the effects of chemotherapy). Hot flashes remained fairly stable over time and did not diminish in frequency, severity, or associated distress. The findings guide the assessment of the uniqueness of the problem of hot flashes experienced by breast cancer survivors and help define outcomes to address in clinical practice or include in future hot flash intervention research.
Journal of Psychosomatic Research, 1998
The Pittsburgh Sleep Quality Index (PSQI) measures sleep quality and disturbance retrospectively ... more The Pittsburgh Sleep Quality Index (PSQI) measures sleep quality and disturbance retrospectively over a 1-month period using self-reports. Although the PSQI has been used in a variety of populations, published psychometric data are limited. The goal of this study was to examine psychometric properties of the PSQI among four populations: bone marrow transplant patients (n=155); renal transplant patients (n=56); women
Cancer Practice, 1999
Careful study of risk factors that predispose an individual to developing postmastectomy pain (PM... more Careful study of risk factors that predispose an individual to developing postmastectomy pain (PMP) after breast cancer surgery has not been reported. This study examined potential risk factors for PMP including demographic, disease, and treatment variables, as well as surgical factors, such as surgical technique and number of lymph nodes removed.
Supportive Care in Cancer, 2008
Introduction-Cancer patients experience multiple concurrent symptoms. This exploratory analysis a... more Introduction-Cancer patients experience multiple concurrent symptoms. This exploratory analysis assessed symptom burden among patients undergoing chemotherapy for breast cancer to identify distinct subgroups of patients who experience differential symptom burden and assessed whether the patient subgroups were associated with deleterious quality of life (QOL) outcomes.
Psycho-Oncology, 2005
The common sense model posits that individuals&am... more The common sense model posits that individuals' understanding of illness is based upon somatic symptoms and life experiences and thus may differ significantly from the biomedical view of illness. The current study used the common sense model to understand cancer risk perceptions in 99 individuals testing for BRCA1/2 mutations. Specifically, we examined change from post-counseling to post-result in (1) absolute risk (risk of developing cancer in one's lifetime) and (2) comparative risk (risk relative to the general population). Results indicated that absolute risk showed a trend such that those with a personal history of cancer receiving uninformative negative results reported decreased absolute risk. Further, individuals receiving uninformative negative results reported decreased comparative risk. Those with no personal cancer history receiving informative negative results did not decrease in risk over time nor did their risk differ from those with a personal cancer history, evidencing unrealistic pessimism regarding their risk of cancer. The reasons provided for individuals' risk perceptions could be classified in terms of attributes of the common sense model and included the: (1) causes of cancer (e.g. family history, mutation status); (2) control or cure of cancer through health behaviors and/or surgery; and (3) perceived timeline for developing cancer (e.g. time left in life to develop cancer). We conclude that key to developing interventions to improve understanding of cancer risk and promoting effective cancer control mechanisms is an understanding of the specific reasons underlying individuals' perceptions of cancer risk.
Psycho-Oncology, 2009
Objective: While much research has sought to identify disparities in cancer incidence, survival, ... more Objective: While much research has sought to identify disparities in cancer incidence, survival, and treatment, little research has sought to identify disparities in mental health (MH) outcomes among cancer survivors. The present study aims to identify disparities in MH outcomes between rural and nonrural cancer survivors.
Psycho‐Oncology, 2000
While some recent research has examined the prevalence and severity of posttraumatic stress disor... more While some recent research has examined the prevalence and severity of posttraumatic stress disorder (PTSD)-like symptoms following cancer treatment, no research has examined temporal change or stability in these symptoms in cancer survivors. Female breast cancer survivors (n=46) participated in an initial telephone interview and a follow-up interview 12 months later. PTSD symptoms associated with breast cancer were assessed using the PTSD Checklist-Civilian version (PCLC). In general, PTSD symptoms in this population did not diminish over time. While group analyses indicated that PCLC-total and subscale scores were stable across the two assessments, analyses of PCLC scores indicated that many patients exhibited fairly large ( \ 0.5 S.D.) increases and/or decreases in PCLC-total or subscale scores. Some evidence suggested that decreases in PCLC scores between the two study assessments were associated with greater social support and experience of fewer traumatic stressors prior to breast cancer diagnosis. Most significantly, the research suggested that women with greater PTSD symptoms at the initial interview were less likely to participate in the follow-up interview. Implications of this for research and clinical management of PTSD in this population are discussed.
Psycho-Oncology, 2013
The health status and psychosocial well-being of multiple primary cancer (MPC) survivors are unde... more The health status and psychosocial well-being of multiple primary cancer (MPC) survivors are under-researched. In total, 3615 survivors identified from the Eindhoven Cancer Registry between 2008 and 2009 were assessed. About one in six survivors had survived MPC (n = 556). All survivors completed questionnaires on health status (SF-36/European Organization of Research and Treatment of Cancer quality of life module), mental health (Hospital Anxiety and Depression Scale) and impact of cancer (Impact of Cancer). Compared with single primary cancer survivors, MPC survivors reported significantly poorer scores on general health and higher symptom scores on diarrhoea and fatigue. Significantly more MPC survivors met the subclinical cut-off score of ≥ 8 points on the Hospital Anxiety and Depression Scale depression subscale (27% vs. 19%, p = 0.0001). MPC survivors also reported significantly greater negative impact of cancer (namely body changes and life interferences) and positive impact of health awareness on their lives. All results were adjusted for age at survey, time since last diagnosis, sex, comorbidity, body mass index and marital status. In secondary analyses, MPC survivors with different primary cancer combinations or time interval between primary cancer diagnoses had comparable health status and psychosocial well-being. Multiple primary cancer survivors reported a poorer health status and, in general, experienced a greater negative impact of cancer on their psychosocial well-being than single primary cancer survivors.
Psycho-Oncology, 2013
The goal of this study is to examine the relationship between socioeconomic status (SES) and both... more The goal of this study is to examine the relationship between socioeconomic status (SES) and both positive and negative mental health (MH) outcomes in a population-based sample of colorectal cancer survivors. On the basis of theoretical conceptualizations of trauma and posttraumatic growth, low SES was hypothesized to be positively associated with both greater negative MH outcomes (e.g., distress) and greater positive MH outcomes (e.g., growth). Colorectal cancer survivors (n = 1300; 57% male; mean age 69.4 and 4.0 years post-diagnosis) were recruited using a regional, population-based cancer registry in the Netherlands and completed a questionnaire assessing current negative and positive MH outcomes. Low, medium, and high SES respondents were identified using an area-level indicator of SES based on aggregated individual fiscal data on monetary home value and household income. Analysis of covariance and logistic regression analyses indicated that low SES was a risk factor for greater negative MH outcomes. Relative to high SES survivors, low SES survivors reported poorer status on nine indices of MH, and high SES survivors were about 50% less likely to report clinically important levels of anxiety and depression. Results provided partial support for the hypothesis low SES was a 'risk' factor for greater positive MH outcomes. Relative to high SES survivors, low SES survivors reported greater positive MH outcomes on 2 of 5 positive MH indices examined (Positive Self-Evaluation, Meaning of Cancer). Study findings are the first to suggest that low SES might increase the likelihood of both greater negative as well as positive MH outcomes in cancer survivors.
Psycho-Oncology, 2014
Healthy People 2020 identifies elimination of health disparities as a key aim. Rural residence is... more Healthy People 2020 identifies elimination of health disparities as a key aim. Rural residence is associated with disparities in cancer screening, physical morbidity, and survival. The present study aimed to identify potential disparities in mental health (MH) outcomes (e.g., anxiety and depression symptoms, distress) in lung cancer (LC) survivors associated with ruralness of residence. Lung cancer survivors (LC group; n = 193; mean age = 63.1 years; mean time since diagnosis = 15.6 months) were recruited from the population-based SEER Kentucky Cancer Registry. LC survivors completed a telephone interview and questionnaire assessing MH outcomes. U.S. Department of Agriculture Rural-Urban Continuum Codes were used to identify Rural (n = 117) and Urban (n = 76) LC survivors. A healthy comparison (HC) group was recruited (n = 152) and completed a questionnaire assessing MH outcomes. Across six MH indices, Rural LC survivors reported poorer MH relative to Urban LC survivors with a mean effect size (ES) of 0.43 SD in unadjusted analyses and 0.29 SD in analyses adjusted for education and physical comorbidity. Comparison of the LC and HC groups revealed significant Ruralness × Group interactions for five of six MH indices. The Rural LC group reported poorer MH than the Rural HC group with a mean ES of 0.51 SD. The MH of Urban LC and HC groups did not differ (mean ES = 0.00 SD). Rural residence is a risk factor for poorer MH outcomes for LC survivors. The MH of Rural LC survivors may be more negatively impacted by cancer diagnosis and treatment than the MH of Urban LC survivors.
Psycho-Oncology, 2010
Objective: Previous research has identified rural residence as a risk factor for poorer mental he... more Objective: Previous research has identified rural residence as a risk factor for poorer mental health (MH) outcomes in cancer survivors. This may be due to less use of various MH resources due to poorer access and less favorable attitudes and social norms related to MH resource utilization. The present study sought to examine use of MH resources in rural and nonrural survivors and identify factors associated with MH resource use.
Psycho-Oncology, 2008
Objective: Research suggests individuals possess multifaceted cognitive representations of variou... more Objective: Research suggests individuals possess multifaceted cognitive representations of various diseases. These illness representations consist of various beliefs, including causal attributions for the disease, and are believed to motivate, guide, and shape health-related behavior. As little research has examined factors associated with beliefs about cancer causation, this study examined the relationship between personal and family history of cancer and beliefs about the causes and prevention of malignant disease.
Psycho-Oncology, 2013
BACKGROUND: Reports of &a... more BACKGROUND: Reports of 'growth' following cancer diagnosis and treatment are common and are considered evidence for the transformative potential of the cancer experience. However, reports of growth are also common in the general population. This study sought to identify the unique, 'value-added' with regard to the nature and magnitude of growth represented by the cancer experience. METHODS: Lung cancer (LC) survivors (n = 190; mean 15 months post-diagnosis) completed the Posttraumatic Growth Inventory (PTGI), reporting changes occurring 'as a result of having cancer'. Community-based, healthy controls (HC) (n = 152) completed the PTGI, reporting changes occurring 'in the past year'. RESULTS: Reports of growth were common in both the LC and HC groups. However, the LC group reported greater total PTGI scores (effect size (ES) = 0.39 SD) and greater growth for 3 of 5 subscales (ESs 0.34-0.48 SD). The LC group was more likely to report any degree of change for 11 of 21 PTGI items (mean odds ratio (OR) across 21 items = 1.92) and were more likely to report 'moderate' to 'very great' change for eight of 21 items (mean OR = 1.75). The LC group was more likely to report growth in the areas of social relationships and appreciation for life. CONCLUSIONS: In sum, the growth evidenced by LC survivors after diagnosis quantitatively and qualitatively differs from growth reported by the general population over a similar period. Estimates of the value-added by the cancer experience suggest a magnitude representing at least the lower range of clinical significance. Copyright © 2013 John Wiley & Sons, Ltd.
Psychology & Health, 2005
The role of emotional expression (EE) in the onset and progression of cancer remains equivocal. T... more The role of emotional expression (EE) in the onset and progression of cancer remains equivocal. The purpose of this study was to compare breast cancer patients (n = 25) and matched healthy controls (n = 25) on self-report and behavioral measures of EE and emotional recognition. Based upon Pennebaker's paradigm, participants completed a verbal positive or negative EE behavioral task. Transcripts of participants’ responses
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Papers by Michael Andrykowski