Interactive health communication technologies (IHCTs) present a new opportunity and challenge for... more Interactive health communication technologies (IHCTs) present a new opportunity and challenge for cancer control researchers who focus on couple- and family-based psychosocial interventions. In this article, the authors first present findings from a systematic review of 8 studies that used IHCTs in psychosocial interventions with cancer patients and their caregivers. Although this research area is still in its infancy, studies suggest that it is feasible to incorporate IHCTs in such interventions, that IHCTs are generally well accepted by patients and caregivers, and that the choice of technology is largely dependent on intervention target (i.e., patient, caregiver, or both) and outcomes (e.g., decision making, symptom management, lifestyle behaviors). A major research gap has been the lack of integration of Web 2.0 technologies (e.g., social media), despite the fact that social support and communication are frequently targeted components of interventions that involve cancer patient...
Advanced lung cancer (LC) patients and their families have reported low self-efficacy for self-ca... more Advanced lung cancer (LC) patients and their families have reported low self-efficacy for self-care/caregiving and high rates of distress, yet few programs exist to address their supportive care needs during treatment. This pilot study examined the feasibility, acceptability, and preliminary efficacy of a 6-session, telephone-based dyadic psychosocial intervention that was developed for advanced LC patients and their caregivers. The program was grounded in self-determination theory (SDT), which emphasizes the importance of competence (self-efficacy), autonomy (sense of choice/volition), and relatedness (sense of belonging/connection) for psychological functioning. The primary outcomes were patient and caregiver psychological functioning (depression/anxiety) and caregiver burden. The secondary outcomes were the SDT constructs of competence, autonomy, and relatedness. Thirty-nine advanced LC patients who were within 1 month of treatment initiation (baseline) and their caregivers (51% ...
Objective: Head and neck cancer (HNC) patients experience debilitating side effects, including ab... more Objective: Head and neck cancer (HNC) patients experience debilitating side effects, including abnormally reduced salivation and difficulty swallowing. Intensive self-care protocols are prescribed to control side effects and minimise discomfort, but non-adherence rates are high. Although spouses are in a prime position to encourage adherence, studies have yet to examine how spouse social control (i.e. attempts to influence patient behaviour to support adherence) affects HNC patient mood and self-efficacy for engaging in these self-care routines. Methods: One-hundred twenty-five HNC couples, where the patient (86% male) was undergoing radiotherapy, were recorded in the laboratory as they discussed a cancer-related issue that the patient identified as being a topic of concern. Results: Sixty-eight couples discussed side effects and spouses engaged in social control in 61 of these discussions. Although oral complications and pain were frequently identified by patients as being topics o...
Head and neck cancer patients and their caregivers report high rates of psychological distress. H... more Head and neck cancer patients and their caregivers report high rates of psychological distress. High rates of physical symptom burden and the increased need for family members to provide caregiving during treatment may contribute to this distress. This study examined trajectories of patient and caregiver distress over the course of radiotherapy for head and neck cancer as well as how patients and caregivers influence each other's distress. Forty-nine head and neck cancer patient-caregiver dyads completed 6 weekly assessments of physical symptoms (MDASI-HN) and distress (e.g., NCCN distress thermometer) over the course of radiotherapy. Patient and caregiver distress increased steadily over the course of treatment, peaking at week 5; patients (82% male; 69% Stage 4) and caregivers (90% female) reported significant distress in 77% of cases. Linear mixed models with the patient-caregiver dyad as the unit of analysis showed that increases in patient-rated head and neck specific physi...
... Christopher R. Erbes, Ph. ... Melissa Polusny and Paul Arbisi, he coleads the Readiness and R... more ... Christopher R. Erbes, Ph. ... Melissa Polusny and Paul Arbisi, he coleads the Readiness and Resilience in National Guard Soldiers (RINGS) studies that utilize longitudinal methodologies to explore individual and environmental predictors of functioning in National Guard soldiers. ...
Purpose While spouses play a vital role in the care of cancer patients, caregiving exerts a physi... more Purpose While spouses play a vital role in the care of cancer patients, caregiving exerts a physical and psychological toll. Caregiving burden may not only compromise spouses' quality of life but also the quality of care and support they are able to provide. Consequently, spousal caregiving burden may also negatively impact patients' psychological adjustment. However, the effect of caregiving burden on patients' psychological distress is unknown. Thus, this 6-month longitudinal study examined the associations between caregiving burden and distress in both lung cancer patients and their spouses.
Group-based psychosocial programs provide an effective forum for improving mood and social suppor... more Group-based psychosocial programs provide an effective forum for improving mood and social support for cancer patients. Because some studies show more benefit for patients with initially high psychosocial distress, and little or no benefit for patients with initially low distress, support programs may better address patient needs by only including distressed patients. However, distressed patients may benefit particularly from the presence of nondistressed patients who model effective coping, an idea many researchers and extensions of social comparison theory support. We present a theoretical analysis, based on a social comparison perspective, of how group composition (heterogeneous group of distressed and nondistressed patients versus homogeneous group of distressed patients) may affect the efficacy of cancer support programs. We propose that a heterogeneous group allows distressed patients maximal opportunity for the various social comparison activities they are likely to prefer; a homogeneous group does not. Though the presence of nondistressed patients in a heterogeneous group potentially benefits distressed patients, the benefits for nondistressed patients are unclear. For nondistressed patients, heterogeneous groups may provide limited opportunities for preferred social comparison activity and may create the possibility for no benefit or even negative effects on quality of life. We also discuss ethical issues with enrolling nondistressed patients whose presence may help others, but whose likelihood of personal benefit is questionable.
The Social Cognitive Processing Model suggests that talking with others facilitates cognitive and... more The Social Cognitive Processing Model suggests that talking with others facilitates cognitive and emotional processing of experiences such as cancer if the social context in which these discussions take place is supportive and positive. Despite this, patients and spouses may inadvertently constrain each other's attempts to process and cope with the disease. To our knowledge, no previous studies have directly examined the effect of lung cancer on the spousal relationship. We began to examine this effect by identifying the social constraints experienced by couples coping with lung cancer through semi-structured interviews with 13 patients and 12 spouses. Using Grounded Theory methodology, our analyses showed that these couples experienced a wide variety of social constraints, including denial, avoidance, and conflict that can hinder open spousal communication. Specifically, patients and spouses reported trouble discussing continued tobacco use, cancer-related symptoms, prognosis, and the emotional effects of lung cancer on the spouse. Despite these constraints, participants who reported talking with their partners about their relationships reported fewer constraints and better communication about cancer. These findings highlight the importance of a relationship perspective in the study of lung cancer and provide information about how talking together about the spousal relationship may enable couples to minimize social constraints and enhance cognitive and emotional processing of the disease.
Objective: Couples coping with head and neck and lung cancers are at increased risk for psycholog... more Objective: Couples coping with head and neck and lung cancers are at increased risk for psychological and relationship distress given patients' poor prognosis and aggressive and sometimes disfiguring treatments. The relationship intimacy model of couples' psychosocial adaptation proposes that relationship intimacy mediates associations between couples' cancerrelated support communication and psychological distress. Because the components of this model have not yet been evaluated in the same study, we examined associations between three types of cancer-related support communication (self-disclosure, perceived partner disclosure, and protective buffering), intimacy (global and cancer-specific), and global distress among patients coping with either head and neck or lung cancer and their partners.
Objective: To characterize the sexual function of both prostate cancer patients and their partner... more Objective: To characterize the sexual function of both prostate cancer patients and their partners, and to examine whether associations between sexual dysfunction and psychosocial adjustment vary depending on spousal communication patterns.
Background: The treatment of breast cancer tends to result in physical side effects (e.g., vagina... more Background: The treatment of breast cancer tends to result in physical side effects (e.g., vaginal dryness, stomatitis, and atrophy) that can cause sexual problems. Although studies of early-stage breast cancer have demonstrated that sexual problems are associated with increased depressive symptoms for both patients and their partners, comparatively little is known about these associations in metastatic breast cancer (MBC) and how patients and partners cope together with sexual problems. We examined the links between sexual problems, depressive symptoms, and two types of spousal communication patterns (mutual constructive and demand-withdraw) in 191 couples in which the patient was initiating treatment for MBC.
Background Metastatic breast cancer patients experience significance distress. Although talking w... more Background Metastatic breast cancer patients experience significance distress. Although talking with close others about cancer-related concerns may help to alleviate distress, patients often avoid such discussions, and their partners can engage in social constraints that may limit subsequent patient disclosures and exacerbate distress. Purpose We examined how partner constraints unfold, how they influence patient affect, and whether they exacerbate patient avoidance of cancer-related disclosures. Methods Fifty-four patients and 48 of their partners completed electronic diary assessments for 14 days. Results Partners' social constraints carried over from one day to the next, but patients' avoidance of discussing cancer-related concerns did not. When partners engaged in more social constraints one day, patients reported greater negative affect the following day (p<0.05). Conclusion Findings suggest a temporal link between partner constraints and patient momentary affect. Helping partners to become aware of their constraining behaviors and teaching them skills to overcome this may facilitate patient adjustment to metastatic breast cancer.
Women with metastatic breast cancer (MBC) experience high levels of emotional distress and pain. ... more Women with metastatic breast cancer (MBC) experience high levels of emotional distress and pain. Although individuals often rely on their intimate partners to provide physical and emotional support when they are in pain, the daily impact of pain on the spousal relationship in the context of advanced cancer is unclear. To understand how relationships are affected by pain, 57 MBC patients and their partners completed electronic diary assessments 6 times a day for 14 days. Patients and partners rated the patient's pain, their own mood (circumplex adjectives), the provision/receipt of social support, and the degree to which cancer interfered with their relationship. Multilevel mediation models with the couple as the unit of analysis were estimated. Partners and patients reported greater relationship interference when patients experienced more pain and less aroused (i.e., more tired, less peppy, less active) mood. Greater tired mood during the day accounted for 17% and 82% of the association between patients' morning pain and their evening ratings of emotional and physical support from their partners, respectively. Partners did not directly respond to patients' pain by providing emotional or physical support; however, they were more likely to provide support when patients experienced more tired and less active mood as a consequence of their pain. Results suggest that one way that pain may wear on couples' relationships is through its adverse effects on patients' daily mood. They also suggest that partners may base their provision of support on their perception of the adverse effects of pain on patients' aroused mood.
Women with metastatic breast cancer (MBC) rely on their partners for emotional and practical supp... more Women with metastatic breast cancer (MBC) rely on their partners for emotional and practical support. They also experience significant pain and depression, which can trigger maladaptive pain behaviors (eg, distorted ambulation). The biopsychosocial model of pain posits that partner solicitous responses can reinforce pain behaviors, whereas punishing or distracting responses can minimize their occurrence. This study explored how psychosocial variables (ie, depression and partner responses) influence patient pain behaviors and partner responses in 191 couples coping with MBC. Because few studies have examined the biopsychosocial model in cancer, it also examined associations between partner responses and patient pain behaviors. Multilevel models showed that depression partially mediated: (1) associations between patients' and partners' reports of patient pain (MPI) and their ratings of patient pain behaviors (PBCL), accounting for 41% to 71% of the variance; and (2) associations between both partners' reports of patient pain and the partner's distracting and punishing responses (MPI), accounting for 66% to 75% of the variance. Partner punishing responses moderated associations between patient pain severity and pain behaviors. Specifically, punishing responses were associated with more pain behaviors for patients with low levels of pain and fewer pain behaviors for patients with higher levels of pain (effect size r = .18). These findings provide partial support for the biopsychosocial model of pain but also clarify and extend it in the cancer context. Future pain management programs in MBC may benefit from addressing both partners' depression levels and teaching partners to engage in fewer punishing responses when the patient is experiencing low levels of pain.
Keywords: Assessment Head and neck cancer Instruments Measures Quality of Life Questionnaire s u ... more Keywords: Assessment Head and neck cancer Instruments Measures Quality of Life Questionnaire s u m m a r y
Objectives: Although the incidence of oropharyngeal squamous cell carcinoma (OPSCC) attributable ... more Objectives: Although the incidence of oropharyngeal squamous cell carcinoma (OPSCC) attributable to human papillomavirus (HPV) is rapidly increasing, patients' informational and psychosocial needs related to the sexual transmission of HPV remain unexplored. The goal of this exploratory study was to assess informational and psychosocial needs of HPV+ OPSCC patients and identify psychosocial challenges associated with having an HPV+ cancer. Methods: Patients (N = 62; 87% male; mean age = 56 years) with HPV+ OPSCC and in cohabitating relationships completed paper-pencil questionnaires assessing their HPV-related knowledge (e.g., cancer etiology), information needs (e.g., communicability), psychosocial concerns (e.g., relational consequences, self-blame) and measures of distress and health behaviors. Medical information was obtained from patients' electronic medical records. Results: Sixty-six percent of patients correctly identified their HPV status but only 35% of them recognized HPV as their putative cancer cause. The majority of patients disclosed their HPV status to their partner, 41% discussed transmission of the virus, and only 23% felt informed regarding potential transmission risks and precautions. Thirty-nine percent want their oncologist to discuss more about HPV-related issues and 58% sought this from other sources. Over one-third said they would be interested in more HPV-related information. Patients reported moderate levels of distress (mean = 3.52, SD = 2.54, possible range 0-10) and relatively low levels of self-blame (mean = 2.27, SD = 1.23, possible range 1-4) with distress and self-blame being significantly correlated (r = .38, p = .005). Conclusion: Significant knowledge gaps exist regarding patients' understanding of the link between HPV and OPSCC and the implications of infectious etiology. Future research is encouraged to establish best practice guidelines.
Journal of the American Dietetic Association, 2011
Childhood cancer survivors are at increased risk for chronic health conditions that may be influe... more Childhood cancer survivors are at increased risk for chronic health conditions that may be influenced by their cancer treatment and unhealthy lifestyle behaviors. Despite the possibility that interventions targeting the survivor-parent dyad may hold promise for this population, a clearer understanding of the role of family factors and the lifestyle behaviors of both survivors and parents is needed. A mailed cross-sectional survey was conducted in 2009 to assess weight status (body mass index), lifestyle behaviors (eg, diet, physical activity), and the quality of the parent-child relationship among 170 childhood cancer survivors who were treated at MD Anderson Cancer Center and 114 of their parents (80% mothers). Survivors were more physically active and consumed more fruits and vegetables than their parents. However, fewer than half of survivors or parents met national guidelines for diet and physical activity, and their weight status and fat intakes were moderately correlated (rϭ.30Ϫ.57; PϽ0.001). Multilevel models showed that, compared with survivors with better than average relationships, those with poorer than average relationships with their parents were significantly more likely to consume high-fat diets (PϽ0.05). Survivors and their parents may thus benefit from interventions that address common lifestyle behaviors, as well as issues in the family environment that may contribute to an unhealthy lifestyle.
Interactive health communication technologies (IHCTs) present a new opportunity and challenge for... more Interactive health communication technologies (IHCTs) present a new opportunity and challenge for cancer control researchers who focus on couple- and family-based psychosocial interventions. In this article, the authors first present findings from a systematic review of 8 studies that used IHCTs in psychosocial interventions with cancer patients and their caregivers. Although this research area is still in its infancy, studies suggest that it is feasible to incorporate IHCTs in such interventions, that IHCTs are generally well accepted by patients and caregivers, and that the choice of technology is largely dependent on intervention target (i.e., patient, caregiver, or both) and outcomes (e.g., decision making, symptom management, lifestyle behaviors). A major research gap has been the lack of integration of Web 2.0 technologies (e.g., social media), despite the fact that social support and communication are frequently targeted components of interventions that involve cancer patient...
Advanced lung cancer (LC) patients and their families have reported low self-efficacy for self-ca... more Advanced lung cancer (LC) patients and their families have reported low self-efficacy for self-care/caregiving and high rates of distress, yet few programs exist to address their supportive care needs during treatment. This pilot study examined the feasibility, acceptability, and preliminary efficacy of a 6-session, telephone-based dyadic psychosocial intervention that was developed for advanced LC patients and their caregivers. The program was grounded in self-determination theory (SDT), which emphasizes the importance of competence (self-efficacy), autonomy (sense of choice/volition), and relatedness (sense of belonging/connection) for psychological functioning. The primary outcomes were patient and caregiver psychological functioning (depression/anxiety) and caregiver burden. The secondary outcomes were the SDT constructs of competence, autonomy, and relatedness. Thirty-nine advanced LC patients who were within 1 month of treatment initiation (baseline) and their caregivers (51% ...
Objective: Head and neck cancer (HNC) patients experience debilitating side effects, including ab... more Objective: Head and neck cancer (HNC) patients experience debilitating side effects, including abnormally reduced salivation and difficulty swallowing. Intensive self-care protocols are prescribed to control side effects and minimise discomfort, but non-adherence rates are high. Although spouses are in a prime position to encourage adherence, studies have yet to examine how spouse social control (i.e. attempts to influence patient behaviour to support adherence) affects HNC patient mood and self-efficacy for engaging in these self-care routines. Methods: One-hundred twenty-five HNC couples, where the patient (86% male) was undergoing radiotherapy, were recorded in the laboratory as they discussed a cancer-related issue that the patient identified as being a topic of concern. Results: Sixty-eight couples discussed side effects and spouses engaged in social control in 61 of these discussions. Although oral complications and pain were frequently identified by patients as being topics o...
Head and neck cancer patients and their caregivers report high rates of psychological distress. H... more Head and neck cancer patients and their caregivers report high rates of psychological distress. High rates of physical symptom burden and the increased need for family members to provide caregiving during treatment may contribute to this distress. This study examined trajectories of patient and caregiver distress over the course of radiotherapy for head and neck cancer as well as how patients and caregivers influence each other's distress. Forty-nine head and neck cancer patient-caregiver dyads completed 6 weekly assessments of physical symptoms (MDASI-HN) and distress (e.g., NCCN distress thermometer) over the course of radiotherapy. Patient and caregiver distress increased steadily over the course of treatment, peaking at week 5; patients (82% male; 69% Stage 4) and caregivers (90% female) reported significant distress in 77% of cases. Linear mixed models with the patient-caregiver dyad as the unit of analysis showed that increases in patient-rated head and neck specific physi...
... Christopher R. Erbes, Ph. ... Melissa Polusny and Paul Arbisi, he coleads the Readiness and R... more ... Christopher R. Erbes, Ph. ... Melissa Polusny and Paul Arbisi, he coleads the Readiness and Resilience in National Guard Soldiers (RINGS) studies that utilize longitudinal methodologies to explore individual and environmental predictors of functioning in National Guard soldiers. ...
Purpose While spouses play a vital role in the care of cancer patients, caregiving exerts a physi... more Purpose While spouses play a vital role in the care of cancer patients, caregiving exerts a physical and psychological toll. Caregiving burden may not only compromise spouses' quality of life but also the quality of care and support they are able to provide. Consequently, spousal caregiving burden may also negatively impact patients' psychological adjustment. However, the effect of caregiving burden on patients' psychological distress is unknown. Thus, this 6-month longitudinal study examined the associations between caregiving burden and distress in both lung cancer patients and their spouses.
Group-based psychosocial programs provide an effective forum for improving mood and social suppor... more Group-based psychosocial programs provide an effective forum for improving mood and social support for cancer patients. Because some studies show more benefit for patients with initially high psychosocial distress, and little or no benefit for patients with initially low distress, support programs may better address patient needs by only including distressed patients. However, distressed patients may benefit particularly from the presence of nondistressed patients who model effective coping, an idea many researchers and extensions of social comparison theory support. We present a theoretical analysis, based on a social comparison perspective, of how group composition (heterogeneous group of distressed and nondistressed patients versus homogeneous group of distressed patients) may affect the efficacy of cancer support programs. We propose that a heterogeneous group allows distressed patients maximal opportunity for the various social comparison activities they are likely to prefer; a homogeneous group does not. Though the presence of nondistressed patients in a heterogeneous group potentially benefits distressed patients, the benefits for nondistressed patients are unclear. For nondistressed patients, heterogeneous groups may provide limited opportunities for preferred social comparison activity and may create the possibility for no benefit or even negative effects on quality of life. We also discuss ethical issues with enrolling nondistressed patients whose presence may help others, but whose likelihood of personal benefit is questionable.
The Social Cognitive Processing Model suggests that talking with others facilitates cognitive and... more The Social Cognitive Processing Model suggests that talking with others facilitates cognitive and emotional processing of experiences such as cancer if the social context in which these discussions take place is supportive and positive. Despite this, patients and spouses may inadvertently constrain each other's attempts to process and cope with the disease. To our knowledge, no previous studies have directly examined the effect of lung cancer on the spousal relationship. We began to examine this effect by identifying the social constraints experienced by couples coping with lung cancer through semi-structured interviews with 13 patients and 12 spouses. Using Grounded Theory methodology, our analyses showed that these couples experienced a wide variety of social constraints, including denial, avoidance, and conflict that can hinder open spousal communication. Specifically, patients and spouses reported trouble discussing continued tobacco use, cancer-related symptoms, prognosis, and the emotional effects of lung cancer on the spouse. Despite these constraints, participants who reported talking with their partners about their relationships reported fewer constraints and better communication about cancer. These findings highlight the importance of a relationship perspective in the study of lung cancer and provide information about how talking together about the spousal relationship may enable couples to minimize social constraints and enhance cognitive and emotional processing of the disease.
Objective: Couples coping with head and neck and lung cancers are at increased risk for psycholog... more Objective: Couples coping with head and neck and lung cancers are at increased risk for psychological and relationship distress given patients' poor prognosis and aggressive and sometimes disfiguring treatments. The relationship intimacy model of couples' psychosocial adaptation proposes that relationship intimacy mediates associations between couples' cancerrelated support communication and psychological distress. Because the components of this model have not yet been evaluated in the same study, we examined associations between three types of cancer-related support communication (self-disclosure, perceived partner disclosure, and protective buffering), intimacy (global and cancer-specific), and global distress among patients coping with either head and neck or lung cancer and their partners.
Objective: To characterize the sexual function of both prostate cancer patients and their partner... more Objective: To characterize the sexual function of both prostate cancer patients and their partners, and to examine whether associations between sexual dysfunction and psychosocial adjustment vary depending on spousal communication patterns.
Background: The treatment of breast cancer tends to result in physical side effects (e.g., vagina... more Background: The treatment of breast cancer tends to result in physical side effects (e.g., vaginal dryness, stomatitis, and atrophy) that can cause sexual problems. Although studies of early-stage breast cancer have demonstrated that sexual problems are associated with increased depressive symptoms for both patients and their partners, comparatively little is known about these associations in metastatic breast cancer (MBC) and how patients and partners cope together with sexual problems. We examined the links between sexual problems, depressive symptoms, and two types of spousal communication patterns (mutual constructive and demand-withdraw) in 191 couples in which the patient was initiating treatment for MBC.
Background Metastatic breast cancer patients experience significance distress. Although talking w... more Background Metastatic breast cancer patients experience significance distress. Although talking with close others about cancer-related concerns may help to alleviate distress, patients often avoid such discussions, and their partners can engage in social constraints that may limit subsequent patient disclosures and exacerbate distress. Purpose We examined how partner constraints unfold, how they influence patient affect, and whether they exacerbate patient avoidance of cancer-related disclosures. Methods Fifty-four patients and 48 of their partners completed electronic diary assessments for 14 days. Results Partners' social constraints carried over from one day to the next, but patients' avoidance of discussing cancer-related concerns did not. When partners engaged in more social constraints one day, patients reported greater negative affect the following day (p<0.05). Conclusion Findings suggest a temporal link between partner constraints and patient momentary affect. Helping partners to become aware of their constraining behaviors and teaching them skills to overcome this may facilitate patient adjustment to metastatic breast cancer.
Women with metastatic breast cancer (MBC) experience high levels of emotional distress and pain. ... more Women with metastatic breast cancer (MBC) experience high levels of emotional distress and pain. Although individuals often rely on their intimate partners to provide physical and emotional support when they are in pain, the daily impact of pain on the spousal relationship in the context of advanced cancer is unclear. To understand how relationships are affected by pain, 57 MBC patients and their partners completed electronic diary assessments 6 times a day for 14 days. Patients and partners rated the patient's pain, their own mood (circumplex adjectives), the provision/receipt of social support, and the degree to which cancer interfered with their relationship. Multilevel mediation models with the couple as the unit of analysis were estimated. Partners and patients reported greater relationship interference when patients experienced more pain and less aroused (i.e., more tired, less peppy, less active) mood. Greater tired mood during the day accounted for 17% and 82% of the association between patients' morning pain and their evening ratings of emotional and physical support from their partners, respectively. Partners did not directly respond to patients' pain by providing emotional or physical support; however, they were more likely to provide support when patients experienced more tired and less active mood as a consequence of their pain. Results suggest that one way that pain may wear on couples' relationships is through its adverse effects on patients' daily mood. They also suggest that partners may base their provision of support on their perception of the adverse effects of pain on patients' aroused mood.
Women with metastatic breast cancer (MBC) rely on their partners for emotional and practical supp... more Women with metastatic breast cancer (MBC) rely on their partners for emotional and practical support. They also experience significant pain and depression, which can trigger maladaptive pain behaviors (eg, distorted ambulation). The biopsychosocial model of pain posits that partner solicitous responses can reinforce pain behaviors, whereas punishing or distracting responses can minimize their occurrence. This study explored how psychosocial variables (ie, depression and partner responses) influence patient pain behaviors and partner responses in 191 couples coping with MBC. Because few studies have examined the biopsychosocial model in cancer, it also examined associations between partner responses and patient pain behaviors. Multilevel models showed that depression partially mediated: (1) associations between patients' and partners' reports of patient pain (MPI) and their ratings of patient pain behaviors (PBCL), accounting for 41% to 71% of the variance; and (2) associations between both partners' reports of patient pain and the partner's distracting and punishing responses (MPI), accounting for 66% to 75% of the variance. Partner punishing responses moderated associations between patient pain severity and pain behaviors. Specifically, punishing responses were associated with more pain behaviors for patients with low levels of pain and fewer pain behaviors for patients with higher levels of pain (effect size r = .18). These findings provide partial support for the biopsychosocial model of pain but also clarify and extend it in the cancer context. Future pain management programs in MBC may benefit from addressing both partners' depression levels and teaching partners to engage in fewer punishing responses when the patient is experiencing low levels of pain.
Keywords: Assessment Head and neck cancer Instruments Measures Quality of Life Questionnaire s u ... more Keywords: Assessment Head and neck cancer Instruments Measures Quality of Life Questionnaire s u m m a r y
Objectives: Although the incidence of oropharyngeal squamous cell carcinoma (OPSCC) attributable ... more Objectives: Although the incidence of oropharyngeal squamous cell carcinoma (OPSCC) attributable to human papillomavirus (HPV) is rapidly increasing, patients' informational and psychosocial needs related to the sexual transmission of HPV remain unexplored. The goal of this exploratory study was to assess informational and psychosocial needs of HPV+ OPSCC patients and identify psychosocial challenges associated with having an HPV+ cancer. Methods: Patients (N = 62; 87% male; mean age = 56 years) with HPV+ OPSCC and in cohabitating relationships completed paper-pencil questionnaires assessing their HPV-related knowledge (e.g., cancer etiology), information needs (e.g., communicability), psychosocial concerns (e.g., relational consequences, self-blame) and measures of distress and health behaviors. Medical information was obtained from patients' electronic medical records. Results: Sixty-six percent of patients correctly identified their HPV status but only 35% of them recognized HPV as their putative cancer cause. The majority of patients disclosed their HPV status to their partner, 41% discussed transmission of the virus, and only 23% felt informed regarding potential transmission risks and precautions. Thirty-nine percent want their oncologist to discuss more about HPV-related issues and 58% sought this from other sources. Over one-third said they would be interested in more HPV-related information. Patients reported moderate levels of distress (mean = 3.52, SD = 2.54, possible range 0-10) and relatively low levels of self-blame (mean = 2.27, SD = 1.23, possible range 1-4) with distress and self-blame being significantly correlated (r = .38, p = .005). Conclusion: Significant knowledge gaps exist regarding patients' understanding of the link between HPV and OPSCC and the implications of infectious etiology. Future research is encouraged to establish best practice guidelines.
Journal of the American Dietetic Association, 2011
Childhood cancer survivors are at increased risk for chronic health conditions that may be influe... more Childhood cancer survivors are at increased risk for chronic health conditions that may be influenced by their cancer treatment and unhealthy lifestyle behaviors. Despite the possibility that interventions targeting the survivor-parent dyad may hold promise for this population, a clearer understanding of the role of family factors and the lifestyle behaviors of both survivors and parents is needed. A mailed cross-sectional survey was conducted in 2009 to assess weight status (body mass index), lifestyle behaviors (eg, diet, physical activity), and the quality of the parent-child relationship among 170 childhood cancer survivors who were treated at MD Anderson Cancer Center and 114 of their parents (80% mothers). Survivors were more physically active and consumed more fruits and vegetables than their parents. However, fewer than half of survivors or parents met national guidelines for diet and physical activity, and their weight status and fat intakes were moderately correlated (rϭ.30Ϫ.57; PϽ0.001). Multilevel models showed that, compared with survivors with better than average relationships, those with poorer than average relationships with their parents were significantly more likely to consume high-fat diets (PϽ0.05). Survivors and their parents may thus benefit from interventions that address common lifestyle behaviors, as well as issues in the family environment that may contribute to an unhealthy lifestyle.
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