BACKGROUND: Previous studies of cancer patients investigated the effect of psychological treatment on basal endocrine and immune values. Using a randomized experiment, we explored the effect of a 13-week experiential-existential group psychotherapy (EEGP) program on the reactivity to a speech task in breast cancer patients. We explored whether changes in cardiovascular and immune reactivity to a speech task over the 3-month period correlated with changes in psychological distress and emotional expression. METHODS: Patients who had been treated for early-stage breast cancer and who were diagnosed as having either positive axillary lymph nodes or distant metastases were randomly assigned to either EEGP or a waiting list control (WLC) condition. We continuously recorded heart rate (HR), diastolic (DBP) and systolic blood pressure (SBP) in response to the speech task before and after treatment. We also measured lymphocyte proliferation to pokeweed (PWM) and phytohemagglutinin (PHA), and natural killer cell activity (NKCA) as well as peripheral blood lymphocyte distributions in blood samples that were drawn before, during and after the speech task. RESULTS: Patients in EEGP had smaller increases in natural killer (NK) cells induced by the speech task after treatment versus task-induced values observed at study entry and greater than pre-/posttreatment changes seen in patients randomized to the WLC. A similar pattern emerged with respect to NKCA over the intervention period, which was independent of the changes in NK cells. There were no differences between patients assigned to EEGP and WLC in HR, DBP and SBP responses as well as in changes in PWM- and PHA-induced lymphocyte proliferation in response to the speech task measured before and after the 3-month intervention period. Individual differences in pre-/posttreatment increases in emotional expression but not in psychological distress were significantly associated with smaller changes in the number and function of NK cells over the 3-month period. CONCLUSIONS: These findings may indicate that emotional expression during EEGP may render breast cancer patients more comfortable expressing their emotional responses to the speech challenge, which, in turn, results in smaller stress-induced changes in NK cells and function. Copyright © 2001 S. Karger AG, Basel, www.karger.com

http://www.online.karger.com/library/karger/renderer/dataset.exe?jcode=PPS&action=render&rendertype=abstract&uid=PPS.pps70307

Psychiatric morbidity in patients with cancer is high and without appropriate treatment unremitting. We assessed the ability of 143 doctors to establish the psychological status of 2297 patients during outpatient consultations in 34 cancer centres and hospitals in the UK. Prior to seeing the doctor, consenting patients completed a short self-report questionnaire (GHQ12), designed for the psychological screening of large populations. At the end of the consultation, doctors completed visual analogue scales rating patients' distress. 837/2297 (36.4%) patients had GHQ scores suggestive of psychiatric morbidity. The doctors' sensitivity (true positive rate) was 28.87% (SD 25.29), specificity (true negative rate) 84.79% (SD 17.44). The misclassification rate was 34.7% (SD 13.79) meaning that for 797 patients the wrong assessment was probably made. These data show that much of the probable psychiatric morbidity experienced by patients with cancer goes unrecognized and therefore untreated. Doctors need communication skills training to elicit problems during consultations. Appropriate referrals to psychological services are necessary when patients requiring help are identified and ought to be an integral part of cancer care. Copyright © 2001 Nature Publishing Group, www.bjcancer.com

http://www.nature.com/cgi-taf/DynaPage.taf?file=/bjc/journal/v84/n8/abs/6691724ab.html

The purpose of this study is to examine the relationship between psychological factors, regional brain activity and natural killer cell activity (NKA). Eight patients with malignant diseases were studied by FDG-PET under a resting condition. NKA and degree of anxiety and depression were measured using Taylor’s manifest anxiety scale (MAS) and Zung’s self-rating depression scale (SDS). Linear correlation of NKA and psychological measures to the regional brain metabolism in cancer patients was examined using statistical parametric mapping (SPM). Positive linear correlation between NKA and regional metabolic rate ratios was identified in the visual association cortex, anterior cingulate gyrus (CG) and sensorimotor area, and negative correlation was identified in the inferolateral prefrontal cortex (ILPFC), prefrontal cortex (PFC), orbitofrontal cortex (OFC) and anterior temporal cortex. Positive linear correlation to the MAS score was identified in the visual association cortex, anterior CG, primary sensorimotor area and the posterior parietal cortex, and negative correlation was detected in the ILPFC, PFC, OFC and anterior temporal cortex. The NKA and MAS scores positively correlated with each other (p<0.001). The result might serve as supporting data for a hypothesis that psycho-immune interaction is also mediated by the cerebral cortex and limbic system. Copyright © 2001 John Wiley & Sons, Inc. http://www.interscience.wiley.com/jpages/1057-9249/

http://www3.interscience.wiley.com/cgi-bin/abstract/86510548/START

Rawl S, Champion V, Menon U, Loehrer PJ, Vance GH,Skinner CS. Validation of Scales to Measure Benefits of and Barriers to Colorectal Cancer Screening. J Psychosoc Oncol 2001; 19: 47-63

Participating in screening for colorectal cancer can significantly decrease mortality from this disease. Although the health belief model constructs of perceived benefits and barriers have been related to other cancer screening behaviors, benefits and barriers to fecal occult blood testing (FOBT) have not been measured consistently, and little is known about these variables in relation to flexible sigmoidoscopy and colonscopy. The purpose of this study was to establish the psychometric properties of six scales measuring benefits and barriers related to screening for colorectal cancer, including FOBT, flexible sigmoidoscopy, and colonscopy. Reliability coefficients for the scales ranged from .65 to .77. Construct validity was established using exploratory factor analyses with results confirming unidimensionality of constructs. Constructs validity was further assessed by testing theoretical relationships among benefits, barriers, and screening behaviors. Results of analyses of variance were consistent with theoretical predictions: Perceived benefits were higher and perceived barriers were lower for people who had undergone sigmoidoscopy or colonoscopy compared with people who had not had these tests. Copyright © 2001 The Haworth Press, Inc. http://www.HaworthPress.com

This study focused on the validation of measures assessing religiosity by means of three self-report instruments: the System of Belief Inventory (SBI-15R), the Religious Orientation Inventory (ROI), and the Index of Core Spiritual Experiences (INSPIRIT). These instruments were developed and validated previously in the United States. The study measured the extent to which the self-reports maintain their validity when administered in a different country with its own distinct language, culture and religion (e.g. Israel). It was found that all three self-reports have very good external validity and high convergent reliability, with the SBI demonstrating extremely high internal reliability. Copyright © 2001 John Wiley & Sons, Inc. http://www.interscience.wiley.com/jpages/1057-9249/

http://www3.interscience.wiley.com/cgi-bin/abstract/86510546/START

This study examined knowledge and practices regarding screening for colorectal cancer among 312 male and 332 female Chinese Americans in Chicago’s Chinatown. A Chinese translation and cultural adaptation of the Cancer Control Supplement Questionnaire from the National Health Interview Survey was used to interview the respondents, who ranged in age from 40 to 69 years. Approximately 85% of the respondents had never been screened with the fecal occult blood test (FOBT), with compared with 70% of the general population-far below the 50% target set by the Health People 2000 program. The majority of respondents had never heard of the digital rectal examination (DRE), and approximately 20% of respondents had never had one. Fewer than half the respondents knew about the FOBT and thus had never had one, and only a third were able to identify at least one warning sign of cancer. Multiple logistic regression analyses identified educational level and knowledge of the warning signs as the significant factors influencing knowledge about DRE and FOBT. Education alone was associated with use of DRE, and age alone was associated with use of FOBT. The majority of respondents laked a regular source of health care; thus, other sources of health information (e. g., newspapers, magazines, television, community centers) need to be supported and strengthened. Copyright © 2001 The Haworth Press, Inc. http://www.HaworthPress.com

Selective estrogen receptor modulators (SERMs) are anti-estrogens that selectively antagonize the proliferative effects of estrogens on breast cells, thereby inhibiting or reversing neoplastic progression to clinical breast cancer. The goal is to administer these agents to healthy women with an elevated risk for breast cancer. The study reported here assessed the knowledge and attitude of 26 broadly selected women with an elevated risk for breast cancer who participated in three focus groups (eight to ten per group) that discussed the use of SERMs, such as tamoxifen and raloxifen. Data were analyzed by cross-case procedure using variable-oriented strategies. Acceptance of breast cancer chemoprevention treatment with SERMs was found to be influenced by various factors, including a knowledge of breast cancer risk factors, the perception of personal risk for breast cancer, and the perception of barriers and benefits to receiving chemoprevention treatment. The issues involved in making the decision to accept treatment with SERMs are discussed. Most of the participants in the groups indicated they were unlikely to accept breast cancer chemoprevention treatment with SERMs. Copyright © 2001 John Wiley & Sons, Inc. http://www.interscience.wiley.com/jpages/1057-9249/

http://www3.interscience.wiley.com/cgi-bin/abstract/86510545/START

This study investigated attitudes in Italy towards incurable disease, death and dying, and analyses the answers given to questions regarding the end of life and the care of the terminally ill patient. Of 1011 people invited to take part in this study, 829 (82%) agreed to participate. People were interviewed about the images associated with death (47% of those interviewed associated death with cancer); telling the truth to the dying patient (13% were in favour of being made aware of their impending death); the place of death (62% preferred home, 7% hospital); the attitudes of the carers (38% affirmed that pain should be alleviated, without considering the length of life, while 8% stated that they would be prepared to bear physical suffering if it meant prolongation of life) and religious faith (88% of those interviewed declared themselves Christian). Comparing our data with a previous survey, carried out in 1988, we conclude that only small changes have occurred in attitudes in the intervening 11 years: a slight increase in those who said that they think ‘often’ or ‘sometimes’ about death (53% in 1999, 44% in 1988) and an increase in the number of people who associate the causes of death with cancer (47% in 1999, 36% in 1988). The fear has diminished of AIDS (5% versus 8%) and war (5% versus 12%) as causes of death. It is concluded that such studies will serve not simply to provide indicators of public tendencies or public interest in the problem, but will constitute a tool whereby those attitudes which merit close observation can be identified and, where necessary, changed. Copyright © 2001 Arnold Publishers, www.palliativemedjournal.com

Though psychosocial group intervention is considered in the West to be an important source of support for reducing psychosocial distress in cancer patients, in Asian countries, there has been no research as yet on the needs for such intervention. This study investigated the level of participation and interest in psychosocial group intervention plus any associated factors in 151 primary breast cancer patients. All were less than 65 years old at 4-18 months post-surgery. Of the 126 subjects who responded (response rate 83%), 53 (42%) participated (participants) and 73 (58%) did not (non-participants). Participation was greater among those with a high level of anxiety measured by the Hospital Anxiety and Depression Scale (HADS) (odds ratio [OR], 3.25; 95% confidence interval [CI], 1.07-10.42), those who had undergone surgery within the last 12 months (OR, 3.10; 95% CI, 1.35-7.55), and those who were 50-65 years old (OR, 3.08; 95% CI, 1.33-7.66). Among the non-participants, 53 (73%) were interested in the intervention while 20 (27%) were not. Non-participants without any interest in the psychosocial group intervention had significantly higher anxiety levels than those with interest (t=-2.08; df=71; p=0.03). These results suggest that most Japanese breast cancer patients who need psychological support can be sought out by asking whether they are willing to participate in a psychosocial group intervention. However, the minority not interested in any psychological group intervention might need other supports such as medication or individual psychotherapy. Copyright © 2001 John Wiley & Sons, Inc. http://www.interscience.wiley.com/jpages/1057-9249/

http://www3.interscience.wiley.com/cgi-bin/abstract/85011597/START

OBJECTIVE: Nucare, a short-term psychoeducational coping skills training intervention was evaluated in a randomized controlled clinical trial (RCT) of 225 newly diagnosed breast and colon cancer patients. METHOD: Measures of psychosocial distress, well being and optimism were evaluated every four months during a one-year period. Patients were randomized to one of four arms: Nucare presented in an individual basis; Nucare presented in a group format; a non-directive supportive group; and a no-intervention control. The interventions were provided in five sessions of ninety minutes each. RESULTS: Patients with breast cancer who received Nucare presented in an individual format showed more significant improvements in well-being over time compared to those in the control and group arms. CONCLUSIONS: We were unable to develop functioning groups within the RCT. Partial explanations for the latter finding include the structural limitations of the RCT: the groups were small, difficult to schedule and patients indicated that they would have preferred to choose whether or not to participate in a group. The positive changes in women with breast cancer who received Nucare persisted at 12 months. Copyright © 2001 Baywood Publishing Co. www.baywood.com

In total, 132 cancer patients in four oncology outpatient clinics in Hamburg completed a questionnaire consisting of a newly designed instrument for measuring psychosocial support. In this questionnaire, patients were asked about their knowledge of institutions offering support, their previous participation in psychosocial support, the reasons for participation and their experience with and attitude towards it. A second section consisted of standardized instruments: the EORTC QLQ-C30 questionnaire (Aaronson), the Brief Symptom Inventory (Derogatis and Melisaratos), the List of Physical Complaints (von Zerssen and Koller) and the Impact of Event Scale (Horowitz). Descriptive and variance-analytical methods were used for the analysis of results. Most respondents were women (88%). The largest group (72%) had a history of breast cancer. A total of 28% of the patients in the sample had participated in psychosocial support, about 4% of these in self-help groups. Participants in psychosocial support did not differ from non-participants in gender, but they were significantly younger. They showed considerably higher scores in emotional and physical distress than non-participants, their attitude towards psychosocial support was more positive, and they had more knowledge about institutions offering support than non-participants. The main reasons listed for their participation in psychosocial support were mental distress, a desire to obtain help, and the wish to cope with the illness. The main reason for not participating was sufficient support from the family, friends or doctors. Copyright © 2001 John Wiley & Sons, Inc. http://www.interscience.wiley.com/jpages/1057-9249/

http://www3.interscience.wiley.com/cgi-bin/abstract/86510544/START

As part of a multi-centred study evaluating a communication skills training model for clinicians, we collected information preferences using an adaptation of Cassileth's Information Needs questionnaire from a heterogeneous sample of 2331 patients. Results showed that 87% (2027) wanted all possible information, both good and bad news and 98% (2203) preferred to know whether or not their illness was cancer. Cross tabulation of responses revealed no significant differences in information preferences for tumour site or treatment aims but did show an effect of age and sex. The few 58/440 (13.2%) patients who stated that in general they preferred to leave disclosure of details up to the doctor, tended to be older patients more than 70 years of age (chi square = 26.01, df = 2, P< 0.0001), although paradoxically they still wanted to know certain specific details. In comparison to men women preferred to know the specific name of the illness (chi square = 4.9, df = 1, P< 0.02) and what were all the possible treatments (chi square = 8.26, df = 1, P< 0.004). The results from this very large sample provide conclusive evidence that the vast majority of patients with cancer want a great deal of specific information concerning their illness and treatment. Failure to disclose such information on the grounds that significant numbers of patients prefer not to know is untenable. Copyright © 2001 Nature Publishing Group, www.bjcancer.com

http://www.nature.com/cgi-taf/DynaPage.taf?file=/bjc/journal/v84/n1/abs/6691573ab.html

Many studies clearly show the increasing trend of patients to obtain more information about their disease. We have conducted a study in order to assess how diagnostic information is important in doctor’s opinion. For this reason, a questionnaire was administered to 91 doctors and 195 patients. Even if 91% of patients refer to have received an explanation about their disease and doctors refer to have informed 64.2% of pts, really only 48% of patients know the nature of their disease. 91% of doctors are in favour of communicating the diagnosis. However, when asked how many times they have given correct information to their patients, the median percentage of patients that they have informed is 64.2%, while only 46% of doctors communicate the diagnosis using a correct terminology. The results of the study show that only half of the sample is really informed about their disease and that doctors still have difficulties in giving correct communication to their patients. Copyright © 2002 Il Pensiero Scientifico, www.pensiero.it (see also www.vapensiero.info)

We investigated if a cancer patient's unrelieved symptoms during the last 3 months of life increase the risk of long-term psychological morbidity of the surviving partner. All women (n=506) living in Sweden under 80 years of age, who lost their husband/partner owing to cancer of the prostate in 1996 or of the urinary bladder in 1995 or 1996 were asked to answer an anonymous postal questionnaire, 2-4 years after their loss. The widows' psychological morbidity was associated with the patient's unrelieved mental symptoms. When the patient was perceived to have been very anxious during last three months of life (compared to no observed symptoms) the relative risks for the widows' psychological morbidity were: 2.5 (1.4-4.3) for depression and 3.4 (1.4-8.2) for anxiety. When comparing reports of the patient's pain (much vs no), the relative risks were 0.8 (0.5-1.2) for widowhood depression, and 0.8 (0.4-1.7) for widowhood anxiety. The patients were found to have had adequate access to physical pain control but poor access to psychological symptom control. Efficiency in diagnosing and treating psychological complications of terminally ill cancer patients may not only improve their quality of life but possibly also prevent long-term psychological morbidity of their surviving partners. Copyright © 2002 Nature Publishing Group, www.bjcancer.com

http://www.nature.com/cgi-taf/DynaPage.taf?file=/bjc/journal/v86/n10/abs/6600271ab.html

Women undergoing breast-conserving surgery and mastectomy for breast cancer show changes in psychological state. This study presents a survey model of psychological needs and psychological intervention in 50 patients affected by breast cancer. The women have undergone immediate reconstruction with prosthesis after mastectomy at the 1^st Department of Plastic Surgery, Borgo Trento Hospital in Verona. Evaluation of patients was made during breast reconstruction iter: a) during the first phase of the expander in 26 women (I phase), b) after application of the definitive prosthesis in 24 women (II phase). Aim of the study was to evaluate: the women’s psychological state with regard to depression, anxiety and quality of life, during breast reconstruction iter, and the risk of psychopathological effects sequelae one year after reconstruction. Preliminary data show that reconstruction has relevant psychological implications: 25% of women present anxiety and 44% depression. The levels of general well-being, vitality, and mental health were low in all patients, each of them showing needs of holding and assistance. The results suggest that the long-lasting treatment in hospital requires systematic psychological intervention. Copyright © 2002 Il Pensiero Scientifico, www.pensiero.it (see also www.vapensiero.info)

Trikas P., Vlachonikolis I., Samonis G., Askoxilakis I., Tsiftsis D., Koutsoubi K., Paritsis N: Low psychopathology scores in the prognosis of breast cancer. A preliminary report. Psychotherapy and Psychosomatics 2002 May-June; 71 (3): 162-167.

BACKGROUND: Research findings regarding the influence of psychopathology on cancer progression are not yet clear. This preliminary report investigates the severity of psychopathology assessed before biopsy in patients with invasive breast carcinoma (IBC) and its association with two follow-up outcomes: disease-free (to first recurrence) and survival periods. METHOD: The psychiatric assessment of 80 patients under 70 years old was established by means of an interview before biopsy. The DSM-IV criteria were used to establish the past and current psychiatric diagnoses. The Present State Examination (PSE)-Index of Definition (ID)-computer program (CATEGO) was used to define total PSE score, clusters of psychiatric symptoms (psychiatric syndromes) and current clinical severity (ID). The independent influence of biological prognostic factors and psychiatric variables on first recurrence or survival period was tested using Cox's proportional hazards regression model. RESULTS: After biopsy, 38 IBC patients were followed up for 3-8¹/₃ years. During this period, 8 patients died from IBC and 7 were alive with metastatic disease. Cox's proportional hazards regression analyses showed that tumor diameter and low ID were independent significant predictors of early recurrence, whereas tumor diameter, negative estrogen receptors and low ID were independent significant predictors of survival. CONCLUSIONS: A low prebiopsy psychopathology score in IBC is a predictor of early recurrence and short survival. Copyright © 2002 S. Karger AG, Basel www.karger.com (http://www.online.karger.com/library/karger/renderer/dataset.exe?jcode=PPS&action=render&rendertype=abstract&uid=PPS.pps71162)