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Background: While Cognitive Behavioral Therapy (CBT) is recommended as first-line treatment for depression, a significant minority do not show an adequate treatment response. Despite evidence for the efficacy of Mindfulness-Based Therapies (MBT) both in treating current depression and preventing relapse, it remains unknown whether MBT and CBT are equivalent in the treatment of current depression. Methods: Five databases were searched for randomized controlled trials (RCTs) directly comparing MBT with CBT and including depression as primary or secondary outcome. Results: When pooling the results of 30 independent RCTs with a total of 2750 participants, MBT and CBT were statistically significantly equivalent at both post-intervention (Hedges's g = −0.009; p < .001) and follow-up (g = −0.033; p = .001). Supplementary Bayesian analyses provided further support for the alternative hypothesis of no difference between MBT and CBT. When exploring possible sources of heterogeneity, the differences at follow-up were smaller between CBT and mindfulness-based cognitive therapy (MBCT) than between CBT and mindfulness-based stress-reduction (MBSR) (Slope = 0.37;p = .022). Conclusion: The currently available evidence suggests that that MBT and CBT are equally efficacious in treating current adult depression. It remains unclear whether the similar effects of the two intervention types are due to different mechanisms or common factors.

Highlights • Higher radiation doses to the brain may negatively affect quality of life. • Higher radiation doses to the brain may negatively affect patient-reported cognition. • Patients with fatigue had received higher dose to certain areas in the brain., Aim This study aimed to explore associations between radiation dose and patient-reported outcomes in patients with a primary non-glioblastoma brain tumour treated with radiation therapy (RT), with a focus on health-related quality-of-life (HRQoL) and self-reported cognitive function. Methods In this cross-sectional study, 78 patients who had received RT for a non-glioblastoma primary brain tumour, underwent neuropsychological testing and completed questionnaires on HRQoL, cognitive function, fatigue, depression, anxiety and perceived stress. The study explores the association between HRQoL scores, self-reported cognitive function and radiation doses to total brain, brainstem, hippocampus, thalamus, temporal lobes and frontal lobes. In addition, we examined correlations between neuropsychological test scores and self-reported cognitive function. Results The median time between RT and testing was 4.6 years (range 1–9 years). Patients who had received high mean radiation doses to the total brain had low HRQoL scores (Cohen’s d = 0.50, p = 0.04), brainstem (d = 0.65, p = 0.01) and hippocampus (d = 0.66, p = 0.01). High mean doses to the total brain were also associated with low scores on self-reported cognitive functioning (Cohen’s d = 0.64, p = 0.02), brainstem (d = 0.55, p = 0.03), hippocampus (d = 0.76, p

Background: Sleep disturbances are common in women treated for breast cancer. We have previously shown that internet-delivered cognitive-behavioral therapy for insomnia (e-CBT-I) is an efficacious, low-cost treatment approach. Furthermore, research has shown that e-CBT-I can result in sustained improvements at 12 months post-treatment. However, given the complexity and long duration of post-treatment symptomatology in breast cancer patients, as well as the recommended use of antihormonal therapy for up to 10 years, it is relevant to investigate long-term (>12 months) changes in sleep following e-CBT-I in this population. In the present study, we report data from a 3-year long-term follow-up assessment after e-CBT-I. Methods: Women treated for breast cancer with sleep disturbances (Pittsburg Sleep Quality Index [PSQI] global score >5) who had previously been enrolled in a randomized-controlled trial investigating the efficacy of e-CBT-I (n = 255), were invited to participate in a 3-year follow-up study. All women in the initial control group had also been granted access to e-CBT-I. Assessment included self-reported sleep quality (PSQI), insomnia severity (Insomnia Severity Index, ISI), cancer-related fatigue and symptoms of depression. Within-group changes in these outcomes from baseline to the 3-year long-term follow-up assessment were analyzed. Results: A total of 131 women (51%) participated in the 3-year follow-up study of which 77 (59%) were from the initial intervention group and 54 (41%) from the initial control group. For the pooled sample, within-group improvements from baseline to the 3-year follow-up assessment corresponding to large effect sizes were observed in sleep quality (Cohen's d = 1.0 95% CI [0.78, 1.21]) and insomnia severity (Cohen's d = 1.36 CI 95% [1.12, 1.59]). Similar changes were observed in cancer-related fatigue (Cohen's d = 0.48 CI 95% [0.30, 0.66]) and symptoms of depression (Cohen's d = 0.80 CI 95%. [0.60, 0.99]). The proportion of patients with scores above established cut-offs on the PSQI and the ISI were 56.1% and 29.8%, respectively. Within the initial intervention group, 15.6% evidenced relapse at the 3-year assessment. Conclusion: Overall, these results indicate that long-term sleep quality and insomnia severity following the use of e-CBT-in women treated for breast cancer is significantly lower than the pre-treatment levels. However, a substantial proportion of participants still evidence sleep disturbances.

Contains fulltext : 288352.pdf (Publisher’s version ) (Open Access) OBJECTIVE: Care for fear of cancer recurrence (FCR) is considered the most common unmet need among cancer survivors. Yet the prevalence of FCR and predisposing factors remain inconclusive. To support targeted care, we provide a comprehensive overview of the prevalence and severity of FCR among cancer survivors and patients, as measured using the short form of the validated Fear of Cancer Recurrence Inventory (FCRI-SF). We also report on associations between FCR and clinical and demographic characteristics. METHODS: This is a systematic review and individual participant data (IPD) meta-analysis on the prevalence of FCR. In the review, we included all studies that used the FCRI-SF with adult (≥18 years) cancer survivors and patients. Date of search: 7 February 2020. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. RESULTS: IPD were requested from 87 unique studies and provided for 46 studies comprising 11,226 participants from 13 countries. 9311 respondents were included for the main analyses. On the FCRI-SF (range 0-36), 58.8% of respondents scored ≥13, 45.1% scored ≥16 and 19.2% scored ≥22. FCR decreased with age and women reported more FCR than men. FCR was found across cancer types and continents and for all time periods since cancer diagnosis. CONCLUSIONS: FCR affects a considerable number of cancer survivors and patients. It is therefore important that healthcare providers discuss this issue with their patients and provide treatment when needed. Further research is needed to investigate how best to prevent and treat FCR and to identify other factors associated with FCR. The protocol was prospectively registered (PROSPERO CRD42020142185).

OBJECTIVE: Many patients with chronic obstructive pulmonary disease (COPD) experience persistent interrelated psychological and physical symptoms despite optimal treatment. Several studies of psychosocial intervention in COPD have been published in recent years. The present study aimed to conduct a quantitative summary of the efficacy of such interventions on psychological and physical outcomes.METHODS: Two independent raters screened PubMed, PsycINFO, Embase, Web of Science, Cochrane Library, and CINAHL for eligible studies. In all, 35 independent, randomized controlled trials with a total of 3,120 patients with COPD were included, assessed for their methodological quality, and subjected to meta-analytic evaluation.RESULTS: Meta-analyses revealed small, statistically significant effects of psychosocial intervention on combined psychological (Hedges's g = 0.28; 95%CI: 0.16-0.41) and physical outcomes (g = 0.21; 95%CI: 0.07-0.35) with no indications of publication bias. Supplementary Bayesian meta-analyses provided strong evidence for a non-zero overall effect on psychological outcomes (Bayes factor (BF) = 305) and moderate support for physical outcomes (BF = 6.1). Exploring sources of heterogeneity with meta-regression indicated that older age of patients and longer duration of interventions were associated with smaller effects on psychological outcomes.CONCLUSIONS: The results support psychosocial intervention as an additional, useful tool in multidisciplinary respiratory care with the potential to improve both psychological and physical outcomes. Future studies are recommended to monitor adverse effects, apply blinding of active control conditions, and determine sample sizes with a priori power calculations.RegistrationRegistered with Prospero (www.crd.york.ac.uk/prospero/) prior to initiation of the literature search (Reg. ID: CRD42020170083).

A higher incidence of cognitive impairment (CI) has previously been reported among orchiectomized testicular cancer patients (TCPs), but little is known about the underlying pathophysiology. The present study assessed CI in newly orchiectomized TCPs and explored the structural brain networks, endocrine status, and selected genotypes. Forty TCPs and 22 healthy controls (HCs) underwent neuropsychological testing and magnetic resonance imaging, and provided a blood sample. CI was defined as a z-score ≤ -2 on one neuropsychological test or ≤ -1.5 on two neuropsychological tests, and structural brain networks were investigated using graph theory. Associations of cognitive performance with brain networks, endocrine status (including testosterone levels and androgen receptor CAG repeat length), and genotypes (APOE, BDNF, COMT) were explored. Compared with HCs, TCPs performed poorer on 6 out of 15 neuropsychological tests, of which three tests remained statistically significant when adjusted for relevant between-group differences (p < 0.05). TCPs also demonstrated more CI than HCs (65% vs. 36%; p = 0.04). While global brain network analysis revealed no between-group differences, regional analysis indicated differences in node degree and betweenness centrality in several regions (p < 0.05), which was inconsistently associated with cognitive performance. In TCPs, CAG repeat length was positively correlated with delayed memory performance (r = 0.36; p = 0.02). A COMT group × genotype interaction effect was found for overall cognitive performance in TCPs, with risk carriers performing worse (p = 0.01). No effects were found for APOE, BDNF, or testosterone levels. In conclusion, our results support previous findings of a high incidence of CI in newly orchiectomized TCPs and provide novel insights into possible mechanisms.

BACKGROUND: Evidence suggests that prostate cancer (PC) patients undergoing androgen deprivation therapy (ADT) are at risk for cognitive decline (CD), but the underlying mechanisms are less clear. In the present study, changes in cognitive performance and structural brain connectomes in PC patients undergoing ADT were assessed, and associations of cognitive changes with endocrine status and risk genotypes were explored.METHODS: Thirty-seven PC patients underwent cognitive assessment, structural MRI, and provided blood samples prior to ADT and after 6 months of treatment. Twenty-seven age- and education-matched healthy controls (HCs) underwent the same assessments. CD was determined using a standardized regression-based approach and defined as z-scores ≤ -1.64. Changes in brain connectomes were evaluated using graph theory. Associations of CD with testosterone levels and genotypes (APOE, COMT, BDNF) were explored.RESULTS: Compared with HCs, PC patients demonstrated reduced testosterone levels (p CONCLUSIONS: Our results indicate that PC patients undergoing ADT may evidence CD, and that COMT Met homozygotes may be at increased risk of CD. The results did not reveal changes in brain connectomes or testosterone levels as underlying mechanisms. More research evaluating the role of ADT-related disruption of the dynamics of the hypothalamic-pituitary-gonadal axis is needed.

Objective ConquerFear has been found to effectively reduce fear of cancer recurrence (FCR). Group interventions may be particularly effective for the treatment of FCR and could lower overall costs. Our objectives were therefore to adapt ConquerFear into a group format (ConquerFear-Group, CF-G), and to evaluate its feasibility, acceptability, and preliminary efficacy. Methods Eligible patients had completed treatment for breast cancer 3 months to 5 years previously, were ≥18 years, and scored ≥22 on the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). The manual was first evaluated with seven patients (Pilot 1), adjusted in accordance with feedback from the patients, therapists, and the original ConquerFear developers. After further evaluation with eight patients (Pilot 2), and subsequent adjustments, the preliminary efficacy of the final manual was evaluated with 27 patients, randomized in blocks to CF-G (N=13) or active control (AC) (relaxation training) (N=14) (Pilot 3). The primary outcome was the FCRI total score. Secondary outcomes included general distress, quality-of-life, and process outcomes pertaining to metacognitions, decentering, and worry. All measures were completed at baseline, post-treatment, and at 3 and 6 months follow-up. Results Adjustments of the original ConquerFear manual (Pilot 1 and 2) included changes in the order of treatment components, simplified exercises, and shortened homework. Compared with ACs, CF-G participants reported greater reductions in FCRI total scores from baseline to post-treatment (Hedges's g=0.59, p=.004), 3 months (g=0.50, p=.026), and 6 months later (g=0.93, p=.043). Differences corresponding to medium-to-large effect sizes (Pilot 3). Although non-significant, group differences concerning reductions in general distress and maladaptive metacognitions corresponded to small-to-medium effect sizes (g=0.40-0.61; ps=.40-.61). Conclusions CF-G appears feasible and potentially efficacious in treating FCR in a breast cancer population. These preliminary results are promising but need to be confirmed in a larger randomized trial. This article is protected by copyright. All rights reserved.

Background Numerous studies emphasize the positive effects of physical activity on health and well-being in cancer patients. The effects of physical activity on the working lives of cancer patients have received less attention. The aim of the present study was to examine the association between physical activity and work status in employees with cancer, and the mediating role of return to work self-efficacy (RTWSE) in this association. Methods Data from questionnaires (physical activity, RTWSE, performance status, sociodemographic), patient records, and Danish national registries (work status, education) were collected for 217 employees initiating chemotherapy for cancer. The associations of physical activity at baseline with work status at baseline and at twelve months follow-up, respectively, were estimated with logistic regression. The mediating role of RTWSE was investigated using the Sobel Goodmann test. Results Employees with moderate (> 30 min/day) or high (> 150 min/day) levels of current daily activity at baseline had significantly increased odds for working at baseline (OR = 2.83, 95%CI = 0.73–10.96 and OR = 6.13, 95%CI = 1.68–22.40, respectively) and at twelve months (OR = 3.90, 95%CI = 1.19–12.77 and OR = 3.43, 95%CI = 1.12–10.51, respectively), compared to sedentary employees. Likewise, employees, physically active in their leisure time (light or vigorous psychical activity) for 2–4 h/week or > 4 h/week of light activity at baseline, had increased odds for working at twelve months (OR range = 1.20 (95%CI = 0.40–3.61)–5.39(95%CI = 0.78–37.32)), compared to sedentary employees. RTWSE was not found to mediate the observed associations. Conclusions Physical activity appears positively associated with work status in employees undergoing treatment for cancer in the twelve months period after initiating chemotherapy.

BACKGROUND: Variations in symptom development among breast cancer (BC) survivors are understudied. We examined: (Q1) Symptom trajectories of pain, fatigue, insomnia, breast, and arm symptoms in BC survivors, (Q2) possible patterns or cluster-like associations between trajectory classification of different symptoms, and (Q3) characteristics of survivors assigned to high-burden symptom trajectories.MATERIAL AND METHODS: Participants were 968 women (mean age = 59.6 years) treated for early-stage BC and followed across a three-year postoperative period. As part of routine follow-up procedures, patients reported symptom burden and functioning levels at each hospital visit using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and the BC-specific module (QLQ-BR-23). Growth mixture modeling (GMM) analysis was used to differentiate potential subgroups of individuals with similar longitudinal symptom patterns, i.e., symptom trajectories (Q1). With this approach, groups experiencing persistent, highly distressing cancer- and treatment-related late effects (LEs) may be identified. Latent class analysis (LCA) was used for Q2 and logistic regression analysis for Q3.RESULTS: GMM identified two relatively parallel trajectories across the tested symptoms: The majority of the sample exhibited a low-burden symptom trajectory (74.4-89.2%) and a minority by a high-burden symptom trajectory (10.8-25.6%). LCA revealed that approximately one in five women (18.8%) were likely to be members of the high-burden symptom trajectory across all tested symptoms. In addition to a high probability of being burdened over time across multiple symptoms, these women were also characterized by poorer self-reported physical and social functioning.CONCLUSION: A substantial minority followed a high-burden symptom trajectory for several years following BC treatment. Associations were found in trajectory classification across symptoms, indicating that cancer-related LEs appear in clusters of multiple concurrent symptoms.

Objective Previous research has indicated cognitive decline (CD) among testicular cancer patients (TCPs), even in the absence of chemotherapy, but little is known about the underlying pathophysiology. The present study assessed changes in cognitive functions and structural brain connectomes in TCPs and explored the associations between cognitive changes and endocrine status and hypothesized risk genotypes. Methods Thirty‐eight newly orchiectomized TCPs and 21 healthy controls (HCs) comparable to TCPs in terms of age and years of education underwent neuropsychological testing, structural MRI, and a biological assessment at baseline and 6 months later. Cognitive change was assessed with a neuropsychological test battery and determined using a standardized regression‐based approach, with substantial change defined as z‐scores ≤−1.64 or ≥1.64. MRI scans and graph theory were used to evaluate changes in structural brain connectomes. The associations of cognitive changes with testosterone levels, androgen receptor gene (AR) CAG repeat length, and genotypes (APOE, COMT, and BDNF) were explored. Results Compared with HCs, TCPs showed higher rates of substantial decline on processing speed and visuospatial ability and higher rates of substantial improvement on verbal recall and visuospatial learning (p, The present study confirms previous findings of domain‐specific cognitive decline in testicular cancer patients following orchiectomy, but also points to domain‐specific improvements. The results do not indicate changes in brain connectomes or endocrine status to be the main drivers of cognitive changes.

Shared decision making (SDM) is on the international healthcare agenda among patient advocacy groups and decision makers in healthcare worldwide [1–5]. In Denmark, implementation of SDM with all ca...

Insomnia is prevalent and debilitating, comprising sustained difficulties initiating or maintaining sleep. Cognitive-behavioural therapy for insomnia (CBT-I) is a multicomponent intervention recommended as the first-line treatment, but the mediators of change remain unclear. This systematic review and meta-analysis aimed to synthesise and evaluate the evidence for potential mediators of CBT-I. Searches were performed for studies published until February 2021, reporting on mediation analyses with CBT-I. Seventeen unique samples of adults with insomnia (20 studies, N = 3125) were included. Two-stage structural equation modelling was applied to the available data, where 7 studies examined the cognitive mediator, ‘dysfunctional beliefs about sleep’, 5 studies examined a hyperarousal mediator, and 3 studies examined the behavioural mediator, ‘time in bed’. There was evidence in support of changes in dysfunctional beliefs as a cognitive mediator of insomnia symptom improvement following CBT-I. There was more limited evidence in support of changes in hyperarousal-related mediators, and no significant effect of time in bed as a mediator. Numerous studies recorded diary-based measures of potential behavioural mediators, but analyses of these variables were not typically conducted. The most serious limitation of the evidence base is that the temporal precedence of mediator changes cannot be established. Future studies should consider: i) using mid-treatment measurements of mediator changes; ii) reporting on mediator psychometric properties; and iii) explicitly stating analyses as pre-specified or exploratory.

Objective: Several Return To Work Self-Efficacy (RTWSE) questionnaires have been developed and found relevant to understanding the return to work (RTW) process of employees with various health problems, including employees with cancer. The aim of the present study was to examine the reliability and validity of the Danish 19-item RTWSE questionnaire (RTWSE-19DK) in a sample of employees with cancer. Methods: Employees undergoing treatment for cancer completed the RTWSE-19DK at baseline (n = 68) and at 1 week (n = 49). Additional questionnaires measured work ability, cancer-related self-efficacy and psychological distress. Internal consistency, test–retest reliability and construct validity were examined. Results: The total and the three subscales of the RTWSE-19DK showed good internal consistencies with Cronbach's alphas between 0.90 and 0.97 and high test–retest reliability with Intraclass Correlation Coefficients between 0.84 and 0.90. Examining construct validity, the RTWSE-19DK showed medium and large correlations with cancer-related self-efficacy (r = 0.54), mental work ability (r = 0.51), and general work ability (r = 0.35), small correlations with physical work ability (r = 0.26) and anxiety (r = −0.10), and no correlations with depression (r = −0.08) and test date (r = 0.03). Conclusion: The RTWSE-19DK showed good reliability and adequate validity in employees undergoing cancer treatment. In clinical practice, the RTWSE-19 questionnaire may help practitioners identify areas of concern in the RTW process of cancer patients.

Background: Survival rates for breast cancer (BC) are increasing, leading to growing interest in treatment-related late-effects. The aim of the present study was to explore late effects using Patient-Reported Outcome Measures in postmenopausal BC survivors in standard follow-up care. The results were compared to age- and gender-matched data from the general Danish population. Material and methods: Postmenopausal BC survivors in routine follow-up care between April 2016 and February 2018 at the Department of Oncology, Aarhus University Hospital, Denmark were asked to complete the EORTC QLQ-C30 and BR23 questionnaires together with three items on neuropathy, myalgia, and arthralgia from the PRO-CTCAE. Patients were at different time intervals from primary treatment, enabling a cross-sectional study of reported late effects at different time points after primary treatment. The time intervals used in the analysis were year ≤1, 1–2, 2–3, 3–4, 4–5 and 5+. The QLQ-C30 results were compared with reference data from the general Danish female population. Between-group differences are presented as effect sizes (ESs) (Cohen’s d). Results: A total of 1089 BC survivors participated. Compared with the reference group, BC survivors reported better global health status 2–3 and 4–5 years after surgery (d = 0.26) and physical functioning 2–3 years after (0.21). Poorer outcomes in BC survivors compared with the reference group were found for cognitive functioning (0–4 and 5+ years), fatigue (0–2 years), insomnia (1–3 years), emotional functioning (3–4 years), and social functioning (≤1 year after surgery) with ESs ranging from 0.20 to 0.41. For the remaining outcomes, no ESs exceeded 0.20. Conclusion: Only small to medium ESs were found for better global health and physical functioning and poorer outcomes for cognitive functioning, fatigue, insomnia, emotional functioning, and social functioning in postmenopausal BC survivors, who otherwise reported similar overall health-related quality of life compared with the general Danish female population.

BACKGROUND: Cortisol has been used to capture psychophysiological stress during childbirth and postpartum wellbeing. We explored the effect of a brief antenatal training course in self-hypnosis on salivary cortisol during childbirth and 6 weeks postpartum.METHODS: In a randomized, controlled trial conducted at Aarhus University Hospital Skejby Denmark during the period January 2010 until October 2010, a total of 349 healthy nulliparous women were included. They were randomly allocated to a hypnosis group (n = 136) receiving three one-hour lessons in self-hypnosis with additional audio-recordings, a relaxation group (n = 134) receiving three one-hour lessons in various relaxation methods with audio-recordings for additional training, and a usual care group (n = 79) receiving ordinary antenatal care only. Salivary cortisol samples were collected during childbirth (at the beginning of the pushing state, 30 minutes, and 2 hours after childbirth), and 6 weeks postpartum (at wake up, 30 minutes after wake up, and evening). Cortisol concentrations were compared using a linear mixed-effects model. Correlations between cortisol concentrations and length of birth, experienced pain and calmness during birth were examined by a Spearman rank correlation test.FINDINGS: During childbirth, week correlations were found between cortisol concentrations 30 minutes after childbirth and length of birth. In the beginning of the pushing state and 2 hours after childbirth, we found a tendency towards higher cortisol concentrations in the hypnosis group compared to the other two groups (hypnosis versus relaxation p = 0.02 and 0.03, hypnosis versus usual care p = 0.08 and 0.05). No differences were observed in cortisol concentrations between the groups 30 minutes after childbirth (hypnosis versus relaxation p = 0.08, hypnosis versus usual care 0.10) or 6 weeks postpartum (hypnosis versus relaxation: p = 0.85, 0.51, and 0.68, hypnosis versus usual care: p = 0.85, 0.93, and 0.96).CONCLUSION: Antenatal hypnosis training may increase the release of cortisol during childbirth with no long-term consequences. Further research is needed to help interpret these findings.

BackgroundNo age‐appropriate and disease‐specific instrument currently exists to measure health‐related quality of life (HRQOL) in adolescents with psoriasis (12‐17 years).ObjectivesTo develop and provide preliminary validation of the Adolescent Psoriasis Quality of Life instrument (APso‐QOL).MethodsQualitative interviews with adolescents with psoriasis, parents of adolescents with psoriasis, and health care professionals informed the development of an initial item pool for the APso‐QOL, which was subsequently refined through cognitive interviews. Finally, data from an independent sample of adolescents with psoriasis was used for item reduction, scale construction, and initial validation, using a combination of techniques from classical test theory and Rasch modelling.ResultsRich qualitative data concerning HRQOL in adolescents with psoriasis (18 adolescents, 14 parents, and 4 health care professionals) combined with cognitive interview testing (n = 12) resulted in a 41‐item draft version. Item reduction led to the final APso‐QOL; a 17‐item instrument consisting of two subscales showing good fit to their respective Rasch models: Psychosocial Impact (APso‐PI; 12 items) and impact of Physical Symptoms and Treatment (APso‐PST; 5 items) (n=50). All a priori stated hypotheses regarding construct validity were supported. Both subscales and the total scale showed acceptable test‐retest reliabilities (intra‐class correlations 0.97, 0.89, and 0.96) and internal consistencies (Cronbach’s α 0.94, 0.81, and 0.95).ConclusionsThe preliminary form of the instrument APso‐QOL shows promising psychometric properties. It can be used in daily clinical practice and research to support a patient‐centered approach and inform treatment planning. BACKGROUND: No age-appropriate and disease-specific instrument currently exists to measure health-related quality of life (HRQOL) in adolescents with psoriasis (12-17 years).OBJECTIVES: To develop and provide preliminary validation of the Adolescent Psoriasis Quality of Life instrument (APso-QOL).METHODS: Qualitative interviews with adolescents with psoriasis, parents of adolescents with psoriasis, and health care professionals informed the development of an initial item pool for the APso-QOL, which was subsequently refined through cognitive interviews. Finally, data from an independent sample of adolescents with psoriasis was used for item reduction, scale construction, and initial validation, using a combination of techniques from classical test theory and Rasch modelling.RESULTS: Rich qualitative data concerning HRQOL in adolescents with psoriasis (18 adolescents, 14 parents, and 4 health care professionals) combined with cognitive interview testing (n = 12) resulted in a 41-item draft version. Item reduction led to the final APso-QOL; a 17-item instrument consisting of two subscales showing good fit to their respective Rasch models: Psychosocial Impact (APso-PI; 12 items) and impact of Physical Symptoms and Treatment (APso-PST; 5 items) (n=50). All a priori stated hypotheses regarding construct validity were supported. Both subscales and the total scale showed acceptable test-retest reliabilities (intra-class correlations 0.97, 0.89, and 0.96) and internal consistencies (Cronbach's α 0.94, 0.81, and 0.95).CONCLUSIONS: The preliminary form of the instrument APso-QOL shows promising psychometric properties. It can be used in daily clinical practice and research to support a patient-centered approach and inform treatment planning.

Fear of cancer recurrence (FCR) is a pervasive concern for people living with cancer. The rapidly expanding FCR literature has been weakened somewhat by use of miscellaneous FCR measures of varying quality. The Fear of Cancer Recurrence Inventory (FCRI) has been widely used in observational and intervention studies and the FCRI severity subscale, also known as the FCRI-Short Form (FCRI-SF), is often used to identify potential cases of clinically significant FCR. Given the FCRI’s increasing use in research and clinical practice, we aimed to provide an overview, critique, and suggested improvements of the FCRI. Studies citing the original FCRI validation paper were identified and synthesised using narrative and meta-analytic methods. The 42-item FCRI has demonstrated a reasonably robust 7-factor structure across evaluations in multiple languages, although certain subscales (eg, Coping) demonstrate sub-optimal reliability. Confirmation of the cross-cultural equivalence of several FCRI translations is needed. Meta-analysis of FCRI-SF scores revealed a combined weighted mean score of 15.7/36, a little above the lowest proposed cut-off score (≥13) for clinical FCR. Depending on the FCRI-SF cut-off used, between 30.0% and 53.9% of the cancer population (ie, patients and survivors) appear to experience sub-clinical or clinical FCR. Higher FCRI scores were associated with younger age and female gender, pain/physical symptoms and psychological morbidity, consistent with the FCR literature generally. Issues regarding the application and interpretation of the FCRI remain. Whether the FCRI is well suited to assessing fear of progression as well as recurrence is unclear, the meaningfulness of the FCRI total score is debatable, and the use of the FCRI-SF to screen for clinical FCR is problematic, as items do not reflect established characteristics of clinical FCR. Refinement of the FCRI is needed for it to remain a key FCR assessment tool in future research and clinical practice.

Objective Internet‐delivered interventions may alleviate distress in cancer survivors with limited access to psychological face‐to‐face treatment. In collaboration with a group of cancer survivors, we developed and tested the efficacy of a therapist‐assisted internet‐delivered mindfulness‐based cognitive therapy (iMBCT) program for anxiety and depression in cancer survivors. Methods A total of 1282 cancer survivors were screened for anxiety and depression during their routine oncology follow‐up; eligible breast (n = 137) and prostate cancer (n = 13) survivors were randomized to iMBCT or care‐as‐usual (CAU) wait‐list. Primary outcomes of anxiety and depression were assessed at baseline, 5 weeks, 10 weeks (post intervention), and 6 months. Results Significant effects were found for both anxiety (Cohen's d = 0.45; P = .017) and depressive symptoms (d = 0.42; P = .024) post intervention. The effects were maintained at follow‐up for anxiety (d = 0.40; P = .029), but not for depressive symptoms (d = 0.28; P = .131). Conclusions Our preliminary findings suggest iMBCT to be a helpful intervention for cancer survivors suffering from symptoms of anxiety. Further studies on the efficacy for symptoms of depression are needed.

Poor sleep has been linked to a number of adverse health outcomes. Recent studies suggest that late bedtimes, short or long sleep durations, and poor sleep quality may impair semen quality. No study has previously explored all three factors in relation to semen quality.One hundred and four men and their partners treated at three fertility clinics in Denmark between 2010 and 2012 completed an online-version of the Pittsburgh Sleep Quality Index (PSQI). The results of the semen analyses conducted at the fertility clinics were self-reported and categorised as normal or reduced.Early bedtime ( 10:30 PM) was more often associated with normal semen quality compared with both regular (10:30 PM-11:29 PM) and late (≥11:30 PM) bedtime (OR: 2.75, 95%CI: 1.1-7.1,Early bedtimes ( 10:30 PM) and conventional sleep duration (7.5-7.99 h) were associated with self-reported normal semen quality. The role of subjective sleep quality remains uncertain.Un mauvais sommeil a été associé à plusieurs issues néfastes pour la santé. De récentes études suggèrent que les heures de coucher tardives, des durées de sommeil courtes ou longues, et une mauvaise qualité de sommeil altèrent la qualité du sperme. Aucune étude n’a à ce jour exploré les trois facteurs en relation avec la qualité du sperme.Cent quatre hommes et leurs partenaires traités dans trois cliniques de fertilité au Danemark entre 2010 et 2012 ont rempli un questionnaire correspondant à une version en ligne de l’Indice de Qualité du Sommeil de Pittsburg (IQSP). Les résultats des analyses de sperme réalisées dans les cliniques de fertilité ont été autodéclarés et classés comme normaux ou réduits.Une heure de coucher précoce ( 22 h30) était plus souvent associée à une qualité normale du sperme comparativement à la fois à une heure régulière (22 h30-23 h29) et à une heure tardive (≥23 h30) de coucher (OR: 2.75, 95% CI: 1.1–7.1,Des heures de coucher précoces ( 22 h30) et une durée conventionnelle de sommeil (7.5–7.99 heures) ont été associées à une qualité normale autodéclarée du sperme. Un éventuel rôle de la qualité suggestive du sommeil reste incertain.

Background Previous cognitive behavioral therapies for informal caregivers (ICs) have produced negligible effects. The purpose of this study was to evaluate, in a randomized controlled trial, the efficacy of Emotion Regulation Therapy adapted for caregivers (ERT-C) on psychological and inflammatory outcomes in psychologically distressed ICs and the cancer patients cared for. Methods A total of 81 ICs with elevated psychological distress were randomly assigned to ERT-C or a waitlist condition and assessed pre-, mid-, and post-treatment. In 52 cases, the patient cared for by the IC was included. Patients did not receive ERT-C. Both the ERT-C and waitlist groups were followed 3 and 6 months post-treatment. Data were analyzed with multilevel models, and P values were two-sided. Results Compared with ICs in the waitlist condition, ICs in the ERT-C condition experienced medium to large statistically significant reductions in psychological distress (Hedge’s g = 0.86, 95% confidence interval [CI] = 0.40 to 1.32, P < .001), worry (g = 0.96, 95% CI = 0.50 to 1.42, P < .001), and caregiver burden (g = 0.53, 95% CI = 0.10 to 1.99, P = .007) post-treatment. No statistically significant effects were found for rumination (g = 0.24, 95% CI = −0.20 to 0.68, P = .220). Results concerning caregiver burden were maintained through 6 months follow-up. Although the effects on psychological distress and worry diminished, their end-point effects remained medium to large. No statistically significant effects on systemic inflammation were detected (C-reactive protein: g = .17, 95% CI = −0.27 to 0.61, P = .570; interleukin-6: g = .35, 95% CI = −0.09 to 0.79, P = .205; tumor necrosis factor-alpha: g = .11, 95% CI = −0.33 to 0.55, P = .686). Patients whose ICs attended ERT-C experienced a large increase in quality of life post-treatment (g = 0.88, 95% CI = 0.18 to 1.58, P = .017). Conclusions To our knowledge, this is the first randomized controlled trial evaluating the efficacy of ERT-C for ICs. Given the previous disappointing effects of other cognitive behavioral therapies for this population, the present findings are very encouraging. Identifying ICs with elevated psychological distress and providing them with relevant psychotherapy appears an important element of comprehensive cancer care.

Introduction Mindfulness-based cognitive therapy has been shown to reduce psychological distress in chronic obstructive pulmonary disease, but uptake and attendance rates of hospital-based, face-to-face mindfulness-based cognitive therapy are low. The present mixed-methods study evaluates the clinical feasibility of home-based, tele-delivered mindfulness-based cognitive therapy in chronic obstructive pulmonary disease. Methods Eight patients with chronic obstructive pulmonary disease (mean age: 72.6 years; 50% female) received a standardised eight-week mindfulness-based cognitive therapy programme delivered via home-based video-conferences in groups of four. Feasibility in relation to (a) clinical change, (b) attendance and (c) instructor-patient working alliance were evaluated with questionnaires and semi-structured interviews. Results Statistically non-significant reductions in psychological distress (Cohen’s d = 0.504; p = 0.399) and physical health status impairment ( d = 0.743; p = 0.156) were observed from pre- to post-intervention. Participant narratives about clinical outcomes focused on changes in how to relate to unpleasant sensations, i.e. through attentional flexibility, taking a pause and acceptance. The average attendance rate was 7.5 (standard deviation = 0.8) out of eight sessions and no participants dropped out. The tele-based format appeared to accommodate participants’ planning difficulties and promoted their ability and wish to participate. Although participant narratives suggested the tele-based format to be a barrier to developing a trusting and safe therapeutic environment, working alliance questionnaire scores were comparable to those found for face-to-face mindfulness-based cognitive therapy. Discussion The preliminary results indicate that tele-delivered mindfulness-based cognitive therapy is a clinically feasible intervention in chronic obstructive pulmonary disease. Future large-scale, randomised controlled trials testing its efficacy on the outcomes of psychological distress and physical health status should include analyses of potential mediators and moderators of the effect as well as and careful monitoring of attendance and adverse events.

Background: The present meta-analysis evaluates the efficacy of psychological interventions for grief in bereaved adults and explores the possible moderating influence of various study characteristics. Methods: A systematic literature search was conducted by two reviewers who independently searched electronic databases, reviewed and selected eligible studies, and evaluated their methodological quality. Results: A total of 31 randomized controlled trials (RCTs) were included in the meta-analysis. Statistically significant pooled effects of psychological intervention on grief symptoms were found for both post-intervention (Hedges's g = 0.41, p >.001, K = 31) and follow-up (g = 0.45, p >.001, K = 18). While generally robust, the effect was smaller at post-intervention when adjusting for possible publication bias (g = 0.31). Compared with the remaining studies, larger post-intervention effect sizes were found for studies with (1) individually delivered interventions (Beta = 0.49, p