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Background: After total laryngectomy, surgical voice restoration is used to establish communication via tracheoesophageal voice prosthesis. Once voice is established, there is a paucity of information on what speech and language therapists (SLTs) should do to improve tracheoesophageal voice quality to ensure functional communication. No existing surveys or studies investigate this specific question. There is also a disconnect between guidelines, knowledge and clinical practice, whereby clinical guidelines stipulate the requirement for SLT intervention, but do not detail what this entails in the rehabilitation context. Aims: (1) To advance understanding of current clinical practice beyond voice prosthesis management and care. (2) To explore what approaches are implemented in clinical practice across the UK and Republic of Ireland to rehabilitate tracheoesophageal voice. (3) To investigate the barriers and facilitators to provision of tracheoesophageal voice therapy. Methods & Procedures: A self-administered 10-min online survey was developed using Qualtrics software and piloted before dissemination. Survey development was informed by the Behaviour Change Wheel to identify barriers, facilitators and additional factors contributing to SLTs' provision of voice therapy to tracheoesophageal speakers. The survey was disseminated via social media and professional networks. Eligibility criteria included SLTs with at least one year post-registration experience and with experience of working with laryngectomy in the past 5 years. Descriptive statistics were used to analyse closed answer questions. Open question responses were analysed using content analysis. Outcomes & Results: The survey received 147 responses. Participants were representative of the head and neck cancer SLT workforce. SLTs believe that tracheoesophageal voice therapy is an important aspect of laryngectomy rehabilitation; however, there was a lack of knowledge about therapy approaches and insufficient resources for implementing therapy. SLTs expressed a desire for more training, specific guidelines and a stronger evidence base to inform clinical practice. Some SLTs expressed feelings of frustration and lack of acknowledgement for the specialist skills required to undertake laryngectomy rehabilitation and tracheoesophageal work in general. Conclusions & Implications: The survey identifies the need for a robust training approach and detailed clinical guidelines to promote consistent practice across the profession. The evidence base within this clinical area is emergent, hence there is a need for increased research and clinical audit to inform practice. Under-resourcing was highlighted, which should be considered in service planning to ensure that adequate staff, access to expert practitioners or time ring-fenced for therapy are available for tracheoesophageal speakers to receive the support they require.

Gene therapy has fascinated clinicians, scientists, and patients since decades ago because of its potential to treat a disease at the genetic level. This can be achieved in many ways, including replacing a disease-causing gene with a healthy copy. Gene therapy must overcome complex tissue and cellular barriers to introduce genetic modifications into the nucleus of the target cells to drive a high level of gene expression. Moreover, the genetically corrected cells must be present in significantly large numbers in the body to reverse the diseased condition and yet able to escape immunological recognition and survive in the long term to sustain the benefit. This paper reviews the early work as well as recent developments in gene therapy, including improvements to viral vectors and novel treatment strategies, diseases targeted, approved gene therapies, and current challenges and prospects for future progress.

Meta-analysis allows researchers to combine evidence from multiple studies, making it a powerful tool for synthesizing information on the safety profiles of new medical interventions. There is a critical need to identify subgroups at high risk of experiencing treatment-related toxicities. However, this remains quite challenging from a statistical perspective as there are a variety of clinical risk factors that may be relevant for different types of adverse events, and adverse events of interest may be rare or incompletely reported. We frame this challenge as a variable selection problem and propose a Bayesian hierarchical model which incorporates a horseshoe prior on the interaction terms to identify high-risk groups. Our proposed model is motivated by a meta-analysis of adverse events in cancer immunotherapy, and our results uncover key factors driving the risk of specific types of treatment-related adverse events.

Lung cancer is the second most common cancer diagnosis and is the leading cause of cancer-related death in the United States for both men and women. The etiologies of many different types of lung cancer can be linked to risk factors that can be prevented, such as chronic tobacco smoking. Lung cancer is significantly more prevalent among socioeconomically disadvantaged and minority populations. Due to the significance of lung cancer as a public health issue, the authors have developed a module on the topic of pulmonology--a medical specialty field that deals with disease processes involving the respiratory system--to (1) explain the basics of normal lung physiology; (2) explain the pathological changes associated with lung cancer and other lung diseases; (3) provide preventive education on the importance of tobacco abstinence and the damaging effects of tobacco smoking on the lungs; and (4) introduce students to some pulmonologic interventions. The Cancer Education Initiative Program is targeted toward first- through third-grade students from underrepresented minorities of the Los Angeles Unified School District (LAUSD) and aims to address students' misconceptions and lack of knowledge regarding the pathogenesis, diagnosis, and treatment of cancer; provide preventive health promotion education so that students may make more healthy lifestyle choices, and foster students' interests in STEM and health care fields. In compliance with the "Next Generation Science Standards" (NGSS), a cancer education curriculum was developed and implemented featuring lessons based in science, technology, engineering, and math (STEM) concepts in relation to cancer. The lesson plans and activities align with grades 3-5 NGSS standards; however, they were implemented with students of grades 1-3.

Purpose: Globally, women suffer from a lack of knowledge about breast cancer (BC), its symptoms and treatment. The purpose of this paper is to examine how people living in rural and less developed areas in Pakistan perceive BC. The study investigates the level of knowledge about BC in rural communities and analyses how the prevalent perceptions and beliefs impact women's lives and delay the diagnosis. Design/methodology/approach: This study is based on 42 in-depth interviews with the women who have undergone BC treatment during the past five years. The participants were interviewed were the residents of the northern Sindh, southern Pakistan. Finding: Findings show that BC was perceived as a contagious disease transmitted through touching or being physically close to the patient. Some women were abandoned by their husbands because of this perception. Faith in fatalism and the perception that BC is an incurable disease were common in communities with low socio-economic status. This is likely to affect the prevention and early detection of BC. Originality/value: The study shows a strong co-relation of awareness with the prevalent perceptions regarding BC. Therefore, we recommend promoting health literacy and introducing culturally specific interventions in remote communities to enhance their understanding of the available treatment and help remove misconceptions about BC.

Introduction: For those with certain blood or bone cancers, bone marrow donation can mean the difference between life and death. The National Marrow Donor Program® (NMDP) operates the largest bone marrow registry of potential donors; however, at times when potential matches are identified, many donors opt not to donate. The purpose of this study was to describe perspectives from college-aged students on recruitment to a bone marrow donation registry and retention to the registry/follow-through with the donation process. Methods: Researchers employed a one-time qualitative study using 7 focus groups comprised of 10-11 college students each (n = 76). Results: Results yielded three overarching themes: donor recruitment, donor retention, and factors contributing to the overall donation process. More specifically, this study identified key factors affecting bone marrow donation in an essential population: facilitators, barriers, knowledge, and "goodness". Additionally, marketing and communication were found to be major determinants of potential donors staying with the NMDP. Conclusion: Better explanations and awareness/promotion campaigns are necessary for recruiting potential donors to the NMDP and to increase the likelihood that the donor will follow through with the donation should a potential match be identified. Recommendations from this study may improve recruitment and retention rates among the NMDP campaigns targeting college students.

In recent years there has been increased focus on evaluating the efficacy of psychosocial interventions for cancer patients. Among the several limitations inherent to these programs of research, few studies have targeted patients with well-diagnosed clinical depression and little is known about factors that best predict treatment outcome and attrition in this population. Using a heterogeneous sample of cancer patients, this study was designed to explore the relations of treatment outcome and attrition with selected demographic (age, education, marital status, gender), psychosocial (pretreatment depression and anxiety, number of co-existent disorders, social support) and medical variables (health and functional status, cancer type, and length of cancer diagnosis). Results indicated that positive treatment outcome was associated with fewer coexistent anxiety disorders at pre-treatment and involvement in a marital relationship. Attrition was more likely to occur among cancer patients presenting with higher pre-treatment depression severity and those who were less educated. Implications of these findings and study limitations are discussed. (Contains 2 tables and 1 note.)

Background: Smoking is especially prevalent among Native Hawaiians. The 2002 Behavioral Risk Factor Surveillance System revealed that 33.8% of Hawaiians were current smokers. Native Hawaiians have the highest age-adjusted lung cancer incidence and mortality rates and the highest prevalence of asthma among all ethnicities. Purpose: This study describes the outcomes of a culturally appropriate, integrated smoking cessation program. Methods: Each participant (n=209) was exposed to multiple treatment options--Hawaiian therapies, Western pharmacotherapy, acupuncture, and fitness training--and was permitted to opt for the program of personal preference. Pre-post program evaluation, with three-, six-, and twelve-month follow-up, was performed. Results: Of the 177 participants who attended two or more sessions, 59% (n=105) quit or reduced smoking by one half, and 23% (n=41) quit. The three-, six-, and twelve-month quit rates were 23% (n=40), 15% (n=27), and 15% (n=27), respectively. Discussion: There is limited data available on quit rates for culturally specific, multi-component smoking cessation programs. A variety of methods and treatments, including pharmacological, lifestyle, alternative, and behavioral therapies, have enhanced smoking cessation program outcomes. Translation to Health Education Practice: Through the development of a multi-component program that integrated Western methodologies with traditional healing practices, a void was filled. Similar culturally informed methods may enhance future efforts in designing ethnic-specific smoking cessation programs.

Purpose: We identified studies that described use of any patient-reported outcome scale for hearing loss or tinnitus among children and adolescents and young adults (AYAs) with cancer or hematopoietic stem cell transplantation (HSCT) recipients. Method: In this systematic review, we performed electronic searches of OvidSP MEDLINE, EMBASE, and PsycINFO to August 2015. We included studies if they used any patient-reported scale of hearing loss or tinnitus among children and AYAs with cancer or HSCT recipients. Only English language publications were included. Two reviewers identified studies and abstracted data. Results: There were 953 studies screened; 6 met eligibility criteria. All studies administered hearing patient-reported outcomes only once, after therapy completion. None of the studies described the psychometric properties of the hearing-specific component. Three instruments (among 6 studies) were used: Health Utilities Index (Barr et al., 2000; Fu et al., 2006; Kennedy et al., 2014), Hearing Measurement Scales (Einar-Jon et al., 2011; Einarsson et al., 2011), and the Tinnitus Questionnaire for Auditory Brainstem Implant (Soussi & Otto, 1994). All had limitations, precluding routine use for hearing assessment in this population. Conclusions: We identified few studies that included hearing patient-reported measures for children and AYA cancer and HSCT patients. None are ideal to take forward into future studies. Future work should focus on the creation of a new psychometrically sound instrument for hearing outcomes in this population.

Every year millions of people contract cancer in the world, and according to prediction of the World Health Organization by the year 2030 there will be about 27 million new cases. Because of these figures and the resulting social and economic implications of this disease, radiotherapy, which is one form of treatment that uses ionizing radiation, has a great importance. In the classroom the teacher can introduce the subject of the use of ionizing radiation in medicine and the basic physical principles to calculate the thickness of the walls of the rooms that house ionizing radiation sources.

Practitioners working with children diagnosed with cancer in the school environment must consider several facets in order to effectively work with the child and family. The remission rate for children with cancer is relatively high, so one must consider whether the child is anticipating treatment, actively in treatment, or posttreatment when one thinks about the potential stressors and cognitive impacts of cancer on the child's education. This article focuses on facts associated with childhood cancer that are relevant to school-based practitioners, common stressors for children and adolescents with a personal cancer diagnosis in their lives, research-based interventions, and accommodations and modifications to consider.

Many students treated for cancer experience significant challenges in maintaining their education during and beyond cancer treatment. Late effects of cancer treatment combined with prolonged periods of missed schooling can dramatically impact upon a student's physical, cognitive and social development. This study examined the relationship between cancer type, cancer treatment, time absent from school, school services and academic areas affected by the cancer diagnosis. An online survey was completed by 80 parents, representing 80 children with cancer, and 136 siblings. Twenty-four parents/carers participated in five focus groups held across rural and regional New South Wales (NSW). Additional difficulties for children and adolescents post cancer treatment were reported by 62.3% of parents and included difficulties with attention, mobility, hearing and fine motor skills. Further areas of specific academic need were identified in mathematics, memory, concentration and confidence. Despite the high level of additional need, only 9.3% of students were reported as receiving additional funding support upon their return to school. Emotional descriptions referring to turmoil, lack of understanding and lack of support were contained within the focus group transcriptions. Results indicated a high level of specific educational and psychosocial needs for this group of students who, having overcome a potentially fatal illness, must continue to fight to learn.

Objectives: This study examined the knowledge, attitudes and practices of clinicians in promoting physical activity to prostate cancer survivors. Design: A purposeful sample was used and cross-sectional data were collected using an anonymous, self-reported online questionnaire or an identical paper-based questionnaire. Settings: Health services and online questionnaire. Methods: Clinicians were invited to complete the questionnaire which measured their knowledge, attitudes and practices relating to physical activity for their patients. Results: Thirty-one clinicians completed a questionnaire. Most participants were men (71%), aged 30-40 years (45.2%), and radiation oncologists (35.5%). Although clinicians recognized the benefits of physical activity for their patients, few always gave advice about physical activity. Advice was verbal in nature, very few provided written material and none referred patients to an exercise specialist. Older age, a belief that physical activity reduces side effects of treatment, higher confidence and disagreement that physical activity has risks were associated with higher frequency of providing physical activity advice. Over half of the clinicians (55%) reported that advising patients on physical activity was not part of their role. Conclusions: This study provides preliminary evidence that physical activity advice may not be provided routinely to prostate cancer survivors. It is important for future research to address the involvement of clinicians in physical activity promotion so that holistic care is provided.

Objective: Recently, behavioral scientists have developed greater interest in understanding the relations between religiousness and spirituality (R/S) and health. Our objectives were to (a) provide an overview of the R/S and health literature specific to cardiovascular disease (CVD) and cancer, (b) discuss the importance of religious culture considerations to behavioral medicine research, (c) suggest methodological changes to advance this research toward greater depth of understanding, and (d) begin discussion on clinically appropriate ways to integrate R/S into treatment. Method: Individual studies and meta-analyses on the relations of R/S with CVD and cancer were reviewed along with articles on the importance of culture to understanding R/S phenomena. Results: Trends in the literature suggest that R/S predicts reductions in all-cause and CVD-related but not cancer mortality. R/S also shows relations with cardiovascular morbidity, and various dimensions of R/S show relations with cancer risk factors and well-being in cancer patients. Investigators have progressively studied more specific dimensions of R/S but have largely failed to consider them within religious cultural contexts. This context is essential for a deeper understanding of R/S and health relations and has profound methodological implications for future studies. Conclusions: R/S and health research is expanding; yet, the field needs more programmatic research and greater theoretical organization. We propose that consideration of R/S variables within their religious culture will provide structure for greater integrative understanding to move the field forward. This understanding is imperative if R/S is to be appropriately integrated into culturally sensitive clinical interventions.

Attitudes about sexual intimacy are an important aspect of relationship satisfaction, especially for couples dealing with prostate cancer. Prostate cancer can have profound effects on men and their partners, and more research is needed to better understand potential sexual barriers for these couples. Five major themes identified in the literature related to prostate cancer survivors and their partners are sexual intimacy, self-esteem, sense of masculinity, role change, and communication. These themes can help counselors identify key clinical issues for helping couples recover from prostate cancer. We integrated these themes with narrative therapy questions to help couples deconstruct problematic narratives and move toward preferred narratives about their thoughts, feelings, and experiences as they learn and grow in their recovery process. (Contains 1 table.)

This article describes the author's experiences of working with cancer patients/survivors both individually and in support groups for many years, across several settings. It also documents current best-practice guidelines for the psychosocial treatment of cancer patients/survivors and their families. The author's view of the important qualities that characterize therapists working in oncology settings is then discussed. Finally, the article describes an oncology practicum experience for psychology doctoral students that has been ongoing for several years. The themes of loss and triumph in the face of loss are implicit throughout.

Objective: The use of mindfulness-based therapy (MBT) in oncology settings has become increasingly popular, and research in the field has rapidly expanded. The objective was by means of a systematic review and meta-analysis to evaluate the current evidence for the effect of MBT on symptoms of anxiety and depression in adult cancer patients and survivors. Method: Electronic databases were searched, and researchers were contacted for further relevant studies. Twenty-two independent studies with a total of 1,403 participants were included. Studies were coded for quality (range: 0-4), and overall effect size analyses were performed separately for nonrandomized studies (K = 13, n = 448) and randomized controlled trials (RCTs; K = 9, n = 955). Effect sizes were combined using the random-effects model. Results: In the aggregated sample of nonrandomized studies (average quality score: 0.5), MBT was associated with significantly reduced symptoms of anxiety and depression from pre- to posttreatment corresponding to moderate effect sizes (Hedges\'s g) of 0.60 and 0.42, respectively. The pooled controlled effect sizes (Hedges\'s g) of RCTs (average quality score: 2.9) were 0.37 for anxiety symptoms (p less than 0.001) and 0.44 for symptoms of depression (p less than 0.001). These effect sizes appeared robust. Furthermore, in RCTs, MBT significantly improved mindfulness skills (Hedges\'s g = 0.39). Conclusion: While the overall quality of existing clinical trials varies considerably, there appears to be some positive evidence from relatively high-quality RCTs to support the use of MBT for cancer patients and survivors with symptoms of anxiety and depression. (Contains 2 tables, 1 figure and 3 footnotes.)

Data suggest that individuals dealing with a cancer diagnosis are less likely to suffer from depression, anxiety, and psychological distress when they cope with their condition from a stance of emotional and cognitive acceptance (e.g. Dunkel, et al., 1992; Stanton, et al., 2000). Although traditional CBT often includes some acceptance-oriented elements, recent variants of CBT, such as Acceptance and Commitment Therapy (ACT), have acceptance as a central focus. ACT targets emotional distress directly through acceptance of difficult thoughts and emotions. The current study is a preliminary comparison of ACT and treatment as usual (TAU) in the treatment of emotional distress among women with late-stage ovarian cancer. Forty-seven women diagnosed with Stage III or IV ovarian cancer were randomly assigned to one of two treatment conditions. Treatment consisted of 12 face-to-face meetings with a therapist, each following a TAU or ACT protocol. Results indicate that both groups showed improved mood and quality of life following the intervention. The ACT group showed significantly greater improvements compared to the TAU group. Furthermore, mediation analyses indicate that the effects of treatment were mediated by cognitive avoidance. Although the study is limited by the implementation of treatment in both conditions by a single therapist, the TAU group showed improvements that were consistent with effect sizes available in the literature, suggesting that the intervention was a credible and effective control treatment. These findings provide preliminary support for the use of ACT in ovarian cancer populations. Further work is needed to investigate the effectiveness in other oncology populations as well as investigate potential patient characteristics which may interact with these interventions. (Contains 1 figure and 1 table.)

Objective: The goal was to understand both therapist and patient perspectives on alliance and session progress for women in treatment for gynecological cancer. We used a longitudinal version of the one-with-many design to partition variation in alliance and progress ratings into therapist, patient/dyad, and time-specific components. We also evaluated therapist and patient characteristics that predict alliance and session progress. Method: Two hundred and three women and their therapists completed measures of alliance and session progress across a 6-session course of treatment. Participants also completed preintervention measures of self-esteem, depression, cancer-specific distress, emotional expressivity, and use of protective buffering. Results: Patients reported higher alliance and greater progress than did therapists. When therapists reported particularly strong alliance with particular patients, those patients concurred. More experienced therapists reported higher alliances and more progress but their patients did not agree. Patients who began treatment in more difficult psychosocial circumstances tended to have less positive session outcomes on average but evidenced more improvement across therapy sessions. Conclusions: Patients rated their alliance and progress more positively than did their therapists, although there was substantial relative agreement between therapists and patients. Alliance and progress improved over time, particularly among patients who evidenced higher levels of distress and poorer physical functioning. More experienced therapists were more confident in their abilities but their patients did not share this perception. (Contains 5 tables and 3 footnotes.)

Dealing with violent cancer patients can be particularly challenging. The purpose of this study was to collect data on the frequency, quality, and underlying variables affecting violent behavior as well as to examine the role played by this behavior in the premature interruption of treatment. A total of 388 cancer inpatients were examined by liaison psychiatrists. The data were assessed using the Staff Observation Aggression Scale (SOAS-R) and Psycho-Oncological Basic Documentation (PO-BADO); the quality of psychiatric disturbances was measured with a three-level rating according to "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.) criteria. Nineteen of 388 patients (4.9%) displayed violent behavior. The variable "cognitive limitations" was clearly associated with aggressive behavior. The interaction factor "constantly bedfast, nonterminal phase, and strong feelings of helplessness or subjection," was associated with aggressive behavior as a trend statistically. Eight of 19 inpatients showing aggressive behavior were prematurely released from the treatment facility. In a multivariate model the association of the variable "aggressive behavior" to premature interruption of treatment with unfinished diagnosis and therapy was weighted rather strong. Despite their methodological limitations, these results suggest that members of oncological teams should be able to identify violent behavior and its precursors at an early stage as important factors, which may decrease patient cooperation. (Contains 5 tables and 1 figure.)

Epigenetics is emerging as one of the most dynamic and vibrant biomedical areas. Multiple lines of evidence confirm that inherited genetic changes alone cannot fully explain all phenotypic characteristics of live organisms, and additional factors, which are not encoded in the DNA sequence, are involved. The contribution of non-genetic factors is perhaps best illustrated by monozygotic twins, which, despite sharing nearly identical DNA sequences, are often discordant for diseases they develop. Even when twins develop the same condition, they may experience different clinical manifestations or clinical onset at different ages. Epigenetic mechanisms explain how a zygote can differentiate into greater than 220 different cell types that form an adult organism and, with rare exceptions, share the same DNA. Increasingly, epigenetic factors emerge, in addition to genetic ones, as important contributors to carcinogenesis. Epigenetic modifications also explain the biological impact of environmental factors, including chemical and dietary compounds, physical agents, pathogens linked to cancer, and social-emotional interactions. Unlike genetic changes, epigenetic changes are reversible, a characteristic that opens unprecedented therapeutic avenues, exemplified by the first epigenetic drugs that were recently approved. Understanding the combined contribution of genetic and epigenetic factors to gene expression will be essential to dissect the biological networks shaping development and disease, and to develop a new array of prophylactic, diagnostic, and therapeutic applications.

Objective: Major depression is the most common psychiatric disorder among breast cancer patients and is associated with substantial impairment. Although some research has explored the utility of psychotherapy with breast cancer patients, only 2 small trials have investigated the potential benefits of behavior therapy among patients with well-diagnosed depression. Method: In a primarily Caucasian, well-educated sample of women (age = 55.4 years, SD = 11.9) diagnosed with breast cancer and major depression (n = 80), this study was a randomized clinical trial testing the efficacy of 8 sessions of behavioral activation treatment for depression (BATD) compared to problem-solving therapy. Primary outcome measures assessed depression, environmental reward, anxiety, quality of life, social support, and medical outcomes. Results: Across both treatments, results revealed strong treatment integrity, excellent patient satisfaction with treatment protocols, and low patient attrition (19%). Intent-to-treat analyses suggested both treatments were efficacious, with both evidencing significant pre-post treatment gains across all outcome measures. Across both treatments, gains were associated with strong effect sizes, and based on response and remission criteria, a reliable change index, and numbers-needed-to-treat analyses, approximately 3/4 of patients exhibited clinically significant improvement. No significant group differences were found at posttreatment. Treatment gains were maintained at 12-month follow-up, with some support for stronger maintenance of gains in the BATD group. Conclusions: BATD and problem-solving interventions represent practical interventions that may improve psychological outcomes and quality of life among depressed breast cancer patients. Study limitations and future research directions are discussed. (Contains 4 footnotes, 2 tables, and 3 figures.)

Objective: In this Phase II trial, we evaluated a novel psychological treatment for depressed patients coping with the stresses of cancer. Effectiveness of a combined biobehavioral intervention (BBI) and cognitive behavior therapy (CBT) was studied. Method: Participants were 36 cancer survivors (mean age = 49 years; 88% Caucasian; 92% female) diagnosed with major depressive disorder. A single group pre-post design was used. Treatment consisted of up to 20 individual 75-min combined BBI/CBT sessions. Outcomes were change in interviewer (Hamilton Rating Scale for Depression; Williams, 1988) and self-rated depressive symptoms (Beck Depression Inventory-Second Edition; Beck, Steer, & Brown, 1996) as well as change in cancer relevant symptoms (Fatigue Symptom Inventory [Hann et al., 1998] and Brief Pain Questionnaire [Daut, Cleeland, & Flanery, 1983]) and quality of life (Medical Outcomes Study Short Form-36; Ware et al., 1995). Mixed-effects modeling, a reliability change index, and generalized linear models were used. All analyses were intent-to-treat. Results: Depressive symptoms significantly improved. In addition, 19 of 21 study completers met criteria for remission. Significant improvements were also noted in fatigue and mental health quality of life. Both concurrent anxiety disorders and high levels of cancer stress (Impact of Events Scale; Horowitz, Wilner, & Alvarez, 1979) were each associated with beginning and concluding treatment with greater depressive symptoms. Conclusions: CBT components were successfully incorporated into a previously efficacious intervention for reducing cancer stress. The BBI/CBT intervention warrants further research in evaluating its efficacy compared with well-established treatments for depression. (Contains 2 figures and 4 tables.)

Objective: This study evaluated the effectiveness of mindfulness-based cognitive therapy (MBCT) for individuals with a diagnosis of cancer. Method: Participants (N = 115) diagnosed with cancer, across site and stage, were randomly allocated to either the treatment or the wait-list condition. Treatment was conducted at 1 site, by a single therapist, and involved participation in 8 weekly 2-hr sessions that focused on mindfulness. Participants meditated for up to 1 hr daily and attended an additional full-day session during the course. Participants were assessed before treatment and 10 weeks later; this second assessment occurred immediately after completion of the program for the treatment condition. The treatment condition was also assessed at 3 months postintervention. All postinitial assessments were completed by assessors who were blind to treatment allocation. Results: There were large and significant improvements in mindfulness (effect size [ES] = 0.55), depression (ES = 0.83), anxiety (ES = 0.59), and distress (ES = 0.53) as well as a trend for quality of life (ES = 0.30) for MBCT participants compared to those who had not received the training. The wait-list group was assessed before and after receiving the intervention and demonstrated similar change. Conclusions: These improvements represent clinically meaningful change and provide evidence for the provision of MBCT within oncology settings. (Contains 3 tables and 1 figure.)

The purpose of this study was to perform a cross-cultural adaptation of the Disability of Arm, Shoulder, and Hand (DASH) questionnaire to Spanish for Puerto Rico. Five steps were followed for the cross-cultural adaptation: forward translations into Spanish for Puerto Rico, synthesis of the translations, back translations into English, revision by an expert committee, and field test of the prefinal version. Psychometric characteristics of reliability and construct validity were evaluated for the final version. Internal consistency of the final version was high (Cronbach's [alpha]=0.97) and item-to-total correlations were moderate (range from 0.44 to 0.85). Construct validity was evaluated by correlating the DASH with the scales of the Functional Assessment of Cancer Therapy-Breast. Fair to moderate correlations found in this study between the DASH and most scales of the Functional Assessment of Cancer Therapy-Breast support the construct validity of the Puerto Rico-Spanish DASH. The final version of the questionnaire was revised and approved by the Institute for Work and Health of Canada. Revisions to the original DASH English version are recommended. This version of the DASH is valid and reliable, and it can be used to evaluate outcomes in both clinical and research settings.

Prior studies have supported the efficacy of cognitive behavioral therapy (CBT) for insomnia comorbid with cancer. This article reports secondary analyses that were performed on one of these studies to investigate the predictive role of changes in dysfunctional beliefs about sleep, adherence to behavioral strategies, and some nonspecific factors on sleep changes assessed subjectively and objectively. Fifty-seven women with chronic insomnia comorbid with breast cancer received CBT for insomnia. At posttreatment, subjective sleep improvements were best predicted by higher initial levels of treatment expectancies, but also by decreased dysfunctional beliefs about sleep; the most consistent predictors of polysomnography (PSG) assessed sleep improvements were reduced dysfunctional beliefs about sleep and a higher avoidance of day napping. At 6-month follow-up, subjectively assessed sleep improvements were best predicted by adherence to behavioral strategies, whereas none of the predictors was significantly associated with PSG-assessed sleep improvements. This study gives some support to the importance of targeting erroneous beliefs about sleep and poor sleep habits in the treatment of cancer-related insomnia, but also to the importance of enhancing patients' expectancies for improvement. (Contains 6 tables.)

Family life is altered irrevocably when a young parent is diagnosed with or dies from cancer. This article tracks the genesis and transformation of a comprehensive psychoeducational support and bereavement program for children, adolescents, and parents affected by cancer. From the inception of the program, families with parents in active treatment participated in time-limited support groups. When a parent died, families transitioned out of support and into bereavement groups. As the cancer experience became more chronic, families remained in these respective groups for longer periods of time. This required clinicians to reconsider group structure to avoid the additional losses incurred as newly bereaved families transitioned from one group to another. Restructuring the program allowed participants to remain in familiar environments and to experience greater support and continuity in their care. Children, teens, and parents made clinical gains in communicating their needs and feelings to loved ones. Further, children and teens stayed on track developmentally, academically, and socially. Clinicians structuring these programs must be skilled in working simultaneously in both support and bereavement modalities. Recommendations for self-care and supervision are suggested.

The population of survivors following diagnosis and treatment for medulloblastoma is thankfully on the rise. An increased focus on the quality of that survivorship has expanded the concept of cure to include efforts aimed at improving long-term cognitive outcome. It is well established in the literature that decline in overall intellect and academic performance is experienced by a majority of those undergoing treatment for pediatric medulloblastoma. This decline is believed to be secondary to decline in core cognitive abilities, which in turn are related to underlying damage to neuroanatomical substrates. A review of research on neurodevelopmental impacts following diagnosis and treatment for pediatric medulloblastoma is presented. Particular consideration is given to studies recently published that also reflect critical collaboration among those within the fields of neuropsychology and neuro-imaging. Results from the review are combined within a conceptual model upon which to guide future research and clinical efforts.

Little is known about the therapeutic processes contributing to efficacy of psychological interventions for patients with cancer. Data from a randomized clinical trial yielding robust biobehavioral and health effects (B. L. Andersen et al., 2004, 2007) were used to examine associations between process variables, treatment utilization, and outcomes. Novel findings emerged. Patients were highly satisfied with the treatment, but their higher levels of felt support (group cohesion) covaried with lower distress and fewer symptoms. Also, specific treatment strategies were associated with specific outcomes, including lower distress, improved dietary habits, reduced symptomatology, and higher chemotherapy dose intensity. These data provide a comprehensive test of multiple therapeutic processes and mechanisms for biobehavioral change with an intervention including both intensive and maintenance phases.

The features and the development of various new acids and bases activity sets that combines chemistry with nanotechnology are being described. These sets lead to the generation of many nanotechnology-based pharmaceuticals for the treatment of various diseases.

Most children diagnosed today with acute lymphoblastic leukemia (ALL) will be cured. However, treatment entails risk of neurotoxicity, causing deficits in neurocognitive function that can persist in the years after treatment is completed. Many of the components of leukemia therapy can contribute to adverse neurologic sequelae, including craniospinal irradiation, nucleoside analogs, corticosteroids, and antifolates. In this review, we describe the characteristic radiographic findings and neurocognitivie deficits seen among survivors of childhood ALL. We summarize what is known about the pathophysiology of delayed treatment-related neurotoxicity, with a focus on the toxicity resulting from pharmacologic disruption of folate physiology within the central nervous system. Finally, we suggest testable strategies to ameliorate the symptoms of treatment-related neurotoxicity or decrease its incidence. (Contains 2 tables and 3 figures.)

Adventure programs have recently emerged that are specifically designed for individuals living with cancer, yet few research studies document the outcomes of such programs. The purpose of the current qualitative study was to examine the effects of an adventure program on individual adult cancer survivors. Three central themes emerged from the data: (a) renewed sense of self (b) feeling of support, and (c) sense of control. The data suggest that adventure programming may be useful in increasing a personal sense of self-confidence, providing an avenue for support and communication, and developing coping strategies. Implications for future research and program design with this population are discussed.

More than 94% of cancer patients described the experience as the most traumatic event they have ever faced and 13% have posttraumatic stress disorder (PTSD) in the aftermath. Empirical evidence demonstrates that certain behaviors lead to more positive health outcomes. Although many patients automatically engage in these behaviors, many others do not. Treatments typically focus on short-term, symptom-focused strategies. Narrative-Expressive Therapy is an intervention designed to address the long-term, underlying stress and to prevent PTSD in patients with serious illness.

The development of a videotape for patients considering treatment options for clinically localized prostate cancer is described. The effectiveness of videotape in improving short-term recall of treatment options and outcomes was assessed quantitatively; qualitative analysis was used to assess the likelihood of patient's active participation in the decision-making process. (Author/EMK)

Physicians were surveyed about the appropriateness, content, and criteria for evaluation of decision aids for women with breast cancer. Both physicians' usual information practice and preference for outcomes from decision aids were measured. Conclusions relevant to developing decision aids to meet the needs of clinicians and patients are discussed. (Author/EMK)

Few differences in quality of life results are reported between different primary surgical treatments for breast cancer. Assumptions regarding the role of informed choice in psychosocial morbidity have not been substantiated, and fewer women than expected take an active role in decision making. Rigorous research is needed. (Author/EMK)

A multidisciplinary care protocol was developed to achieve continuity and integration of information. The protocol integrates medical, nursing, and a variety of extramural events and activities into a comprehensive description of 15 "moments" in the care of breast cancer surgery patients. Implementation and evaluation are reported and discussed. (EMK)

Hampton University President William Harvey's initial readings of proton therapy for cancer sparked his interest. Within a few months, Dr. Harvey was assigning widely respected Hampton nuclear physicist Dr. Cynthia Keppel to do more exploration. Today, the new $225 million Hampton University Proton Therapy Institute, one of eight therapy sites in the United States and the only one in the region, is open for business. Working as a team, they have been helping cancer patients learn whether they (cancer patients) can employ proton therapy as an alternative to traditional therapeutic radiation and chemotherapy treatments in fighting the life-threatening disease. It focuses on treating adults with prostate, breast, lung and eye cancers and on children with cancer. Harvey says he sees his school's new venture playing a role in "easing human misery and saving lives." He adds that it shows how a small Black school can do something huge.

Describes CANSEARCH, an intermediary computer system incorporating fundamental features of the expert systems approach. Designed to provide access to information on cancer therapy in the MEDLINE database for doctors with no experience in document retrieval, search strategies are explained and menu selection from a touch terminal is illustrated. (Author/LRW)

Discusses various aspects of radiation damage to biological material, including free radical mechanisms, radiation sensitization and protection, tumor hypoxia, mechanism of hypoxic cell radiosensitization, redox model for radiation modification, sensitizer probes of cellular radiation targets, pulse radiolysis studies of free radical kinetics, clinical radiosensitizers, and problems of drug metabolism. (CS)