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ObjectivePsycho-oncological institutions offer specialized care for cancer patients. Little is known how this care might impact fatigue. This study aimed to identify fatigue trajectories during psychological care, examined factors distinguishing these trajectories and predicted fatigue severity after nine months of psychological care.DesignNaturalistic, longitudinal study of 238 cancer patients receiving psycho-oncological care in the Netherlands. Data were collected before initiation of psychological care (T1) and three (T2) and nine months (T3) afterwards. Latent class growth analysis, repeated measure analyses (RMA) and linear regression analysis were performed.Main Outcome MeasuresFatigue severity: Checklist Individual Strength.ResultsThree fatigue trajectories were identified: high- (30%), moderate- (62%) and low-level fatigue (8%). While statistically significant decreases in fatigue were found, this decrease was not clinically relevant. RMA showed main effects for time for fatigue trajectories on depression, anxiety, personal control and illness cognitions. Fatigue severity and physical symptoms at T1, but not demographic or clinical factors, were predictive of fatigue severity at T3.ConclusionsFatigue is very common during psycho-oncological care, and notably not clinically improving. As symptoms of fatigue, depression, anxiety and physical symptoms often cluster, supplementary fatigue treatment should be considered when it is decided to treat other symptoms first.

AimsSpirituality can be important in adjusting to the experience of cancer and its medical treatment. Since nurses have frequent contact with patients, they seem to have a unique role in providing spiritual care. Nurses consider spiritual care important; however, little is known about how patients in a curative setting experience and value spiritual care. Therefore, this study aimed to give insight into patients’ experiences with and opinions about spiritual care as provided by nurses in curative cancer care.MethodsThis is a national, multicentre mixed‐methods study, combining a quantitative approach using questionnaires (n = 62) and a qualitative analysis of semi‐structured interviews (n = 61). Nonparametric tests were used for quantitative data, and qualitative data were analysed inductively.FindingsMost patients rarely received spiritual care by nurses. If spiritual care was provided, it mainly consisted of noticing problems and referring to other professionals. This appeared to be dependent on certain ‘triggers’, such as age. Structural discussions on spirituality with a nurse were experienced rarely. This was explained by, among other factors, the hospital setting. Yet, the majority (79%) of patients found the attention to spirituality sufficient or very good. Furthermore, a majority (58%) viewed spiritual care as a nursing task: nurses should notice spiritual problems and refer to other professionals, though extensively discussing patients’ spirituality was neither considered nurses’ task nor capability.ConclusionsAttention to spiritual care in a curative setting, though not so much desired by most patients, should be pursued, because of its importance in performing person‐centred nursing care and its positive impact on patients’ health. By training nurses in offering spiritual care in proactive and ‘nonactive’ (accepting) ways, spiritual care could be structurally offered in clinical practice in personalised forms. Since younger and less spiritual patients are not much satisfied with spiritual care by nurses, they need special attention.

The objective of this meta-analysis was to determine the longitudinal positive effect of religion or spirituality (R/S) on mental health. We summarized 48 longitudinal studies (59 independent samples) using a random effects model. Mental health was operationalized as a continuous and a dichotomous distress measure, life satisfaction, well-being, and quality of life. R/S included participation in public and private religious activities, support from church members, importance of religion, intrinsic religiousness, positive religious coping, meaningfulness, and composite measures. The meta-analysis yielded a significant, but small overall effect size of r = .08 (95% CI: 0.06 to 0.10). Of eight R/S predictors that were distinguished, only participation in public religious activities and importance of religion were significantly related to mental health (r = .08 and r = .09, respectively; 95% CI: 0.04 to 0.11 and 0.05 to 0.12, respectively). In conclusion, there is evidence for a positive effect of R/S on mental health, but this effect is small.

Objectives Psychosocial factors have been hypothesized to increase the risk of cancer. This study aims (1) to test whether psychosocial factors (depression, anxiety, recent loss events, subjective social support, relationship status, general distress, and neuroticism) are associated with the incidence of any cancer (any, breast, lung, prostate, colorectal, smoking‐related, and alcohol‐related); (2) to test the interaction between psychosocial factors and factors related to cancer risk (smoking, alcohol use, weight, physical activity, sedentary behavior, sleep, age, sex, education, hormone replacement therapy, and menopausal status) with regard to the incidence of cancer; and (3) to test the mediating role of health behaviors (smoking, alcohol use, weight, physical activity, sedentary behavior, and sleep) in the relationship between psychosocial factors and the incidence of cancer. Methods The psychosocial factors and cancer incidence (PSY‐CA) consortium was established involving experts in the field of (psycho‐)oncology, methodology, and epidemiology. Using data collected in 18 cohorts (N = 617,355), a preplanned two‐stage individual participant data (IPD) meta‐analysis is proposed. Standardized analyses will be conducted on harmonized datasets for each cohort (stage 1), and meta‐analyses will be performed on the risk estimates (stage 2). Conclusion PSY‐CA aims to elucidate the relationship between psychosocial factors and cancer risk by addressing several shortcomings of prior meta‐analyses., Psychosocial factors and cancer incidence (PSY‐CA) consortium endeavor to understand the role of several different psychosocial factors—including depression and anxiety—in the onset of cancer. The study will employ the use of individual participant data meta‐analyses, combining results from several large, international cohorts with longitudinal designs. Furthermore, PSY‐CA aims to elucidate the role of health behaviors in the relationship between psychosocial factors and cancer risk.

We published a meta-analysis to determine the longitudinal positive effect of religion or spirituality (R/S) on mental health. Forty-eight longitudinal studies were summarized (59 independent samples). The meta-analysis yielded a significant, but small overall effect size of r =.08. We concluded that there is evidence for a positive effect of R/S on mental health, but this effect is small. Our meta-analysis was recently criticized in this Journal by Koenig et al. Scientific debate is welcome, but we disagree with most of their comments. Our reply focusses on the following topics: Is the effect of R/S small? Might methodological issues underlie the small overall effect size? Randomized controlled studies, and change course and look elsewhere for more convincing results?

Rationale: When diagnosed with cancer, a patient has to cope with stressors such as pain, fatigue, and the experience of life-threat that can cause great distress. Spirituality may be a resource for coping with these problems, thereby reducing distress.Objective: Two questionnaire studies the first a cross-sectional (Study 1; N = 216) and the second a one-year longitudinal (Study 2; N = 383) investigated among Dutch cancer patients whether spirituality lessens the impact of pain, fatigue, and perceived life-threat on distress.Method: Data for Study 1 were gathered in 2006-2007 and for Study 2 in 2009-2010. Spirituality was measured with the Spiritual Attitude and Involvement List, which assesses six distinct but related aspects of spirituality. Linear regression analysis and marginal effect plots were applied.Results: Limited evidence appeared for the hypothesis that spirituality reduces the impact of pain, fatigue, or perceived life threat on distress. Meaningfulness and acceptance might reduce a negative impact of increases in fatigue during the rust year after the start of cancer treatment. In contrast, spirituality might enhance a negative impact of increases in perceived life threat.Conclusions: Processes of appraisal might explain the findings. Experiences of meaningfulness and acceptance might help to reappraise fatigue in a less threatening way, thereby reducing distress. Conversely, appraising the cancer as life-threatening might conflict with spiritual experiences of meaning, acceptance, and awe about life. Future studies should focus on the processes by which the various aspects of spirituality influence the adjustment of cancer patients and use other outcome variables than non-specific distress. Such studies may provide further clues as to how the spirituality of patients can be harnessed to help them adjust to a serious life event such as the occurrence of cancer.

Various authors in research on coping advise us to study spirituality from a meaning system perspective. In this approach spirituality is viewed as a part of people's global meaning; an overarching framework of beliefs, goals, and sense of meaning. However, little is known about how spirituality is related to other global meanings to form this meaning system. Therefore, we have explored spirituality and its relationship with other possible elements of the meaning system in interviews with 20 persons, one year after their cancer diagnosis. Applying thematic analysis to analyze the interviews, a typology was developed based on two criteria: (a) the prevalence of spiritual meanings in the interview, and (b) the degree of co-occurrence between spiritual and general meanings. Four types of meaning systems were distinguished: (a) spirituality as an overarching theme that seems to infuse all aspects of the person's meaning system, (b) spirituality as a theme in the background of the meaning system portrayed by a supporting God, (c) spirituality as a hidden theme that is expressed by a transcendent image and experience of oneself, or (d) spirituality as separate from other elements of the individual's meaning system, if described at all. A comparison with quantitative measures of religiosity and spirituality supported the qualitative differences between the four types. This typology can be used to further understand individual differences in adjustment to cancer.

Item does not contain fulltext AIM: To gain insight into the quantity and quality of spiritual care provided by nurses in curative cancer care, from the perspectives of both patients and nurses. BACKGROUND: Cancer causes patients to suffer from diverse symptoms related to their illness. Nurses play an important role in the care for people with cancer. Next to paying attention to physical and psychosocial needs, caring for spiritual needs of patients also belongs to good nursing. Most of the research concerning spirituality and spiritual care in relation to cancer has focused on palliative care. DESIGN: A mixed methods design will be used in two sub-phases. First, we will conduct semi-structured interviews with 72-90 patients coming from nine hospitals. Subsequently, approximately the same number of nurses working on oncology wards of these hospitals will be interviewed. METHODS: We meticulously composed both interview guides so that only near the end of the interview explicit terms like spirituality and spiritual care are explicitly mentioned. Until that point, we will use other words to define the concepts. Next to the interviews, demographics, answers to some statements and several questionnaires will be gathered. Content analysis supported by DEDOOSE will be used to answer the research questions. DISCUSSION: The insight we will gain in this study enables us to compare experiences from the perspective of both patients and nurses. This can also provide us with suggestions for the improvement of nursing care for people with cancer who are treated with curative intent, a topic until now hardly addressed.

OBJECTIVE: The primary aim of this study was to determine the characteristics of clients and interventions in routine psycho-oncological care. The secondary aim was to determine the course of symptomatology during and after the psychological interventions.DESIGN: During a period of nine months all clients who sought help in one of the seven psycho-oncological care institutes in the Netherlands were approached to participate in the present study (N=483). Information was gathered with respect to demographic and medical characteristics, and type and duration of the interventions. In addition, depression, anxiety, well-being, quality of life, fatigue and daily function were determined before interventions and three and nine months later.RESULTS AND CONCLUSIONS: Compared to the Dutch cancer population, patients in psycho-oncological care were more often young and female. Compared to the general Dutch population, they were highly educated and were more likely to have a partner. Clinical levels of depression, anxiety and/or fatigue were found among 83% of the patients. After three months only 23% had completed their intervention; this figure was 62% after nine months. Symptoms decreased significantly for all outcome variables. An importance difference with randomized controlled trials is the low session frequency and the long intervention time of patients in clinical care.

Objectives This study aimed to examine (1) subgroups of cancer patients with distinct co-morbidity patterns of depression, anxiety and fatigue; (2) how individuals transitioned between these patterns; and (3) whether socio-demographic, clinical and psychological care characteristics distinguished patients' transitions. Method This naturalistic, longitudinal study focused on 241 cancer patients receiving psycho-oncological care in the Netherlands. Data were collected before initiation of psychological care (T1), 3 months (T2), and 9 months thereafter (T3). Latent transition analysis was performed examining research questions. Results Three distinct co-morbidity patterns were identified: class 1 (‘mood disturbances and fatigue’), class 2 (‘mood disturbances’) and class 3 (‘few symptoms of mood disturbances and fatigue’). Half of those in class 1 remained in this group from T1 to T3, a quarter transitioned to class 2 and another quarter to class 3. Baseline physical symptoms distinguished these transitions: those with more physical symptoms tended to remain stable. Half of patients in class 2 remained stable from T1 to T3, 46% moved into class 3 and 8% into class 1. Baseline physical symptoms and years after cancer diagnosis significantly distinguished these transitions: the 8% moving to class 1 had more physical symptoms and were longer after cancer diagnosis. Most patients in class 3 remained stable from T1 to T3, and predictors of transitions could not be examined. Conclusions Three distinct co-morbidity patterns of depression, anxiety and fatigue were identified and exhibited different symptom courses longitudinally. Those with poor physical health tended to report elevated mood disturbances and fatigue during psychological care. Copyright © 2016 John Wiley & Sons, Ltd.

Spirituality may help people to maintain a high level of well-being despite adversity, but several studies that claim to support this statement have used spirituality scales and outcome measures that have overlapping content. This practice seems to be widespread: In an exploratory survey of 8 well-cited journals we found that 26 of 58 studies used a spirituality scale that contains 25% or more of well-being items to examine whether spirituality predicts well-being or distress. These spirituality questionnaires would be more appropriate for use as indicators of the domain of quality of life called spiritual well-being. We urge researchers to only use spirituality questionnaires of which less than 25% of the items refer to emotional well-being-such as the SWB Questionnaire or the Spiritual Attitude and Involvement List-when investigating the causal relationship between spirituality and emotional well-being.

Objectives: This study aimed to identify predictors of returning to work in a group of cancer patients that sought and received help from mental health care institutes specialized in psycho-oncological therapy. Moreover we identified which psychosocial factors were seen as important for returning to work by these patients and therapists working at these institutes.Method: This naturalistic study focused on cancer patients who applied for help at specialized psycho-oncology institutions in the Netherlands. Data were collected before the start of psychological care (T1), and three (T2) and nine (T3) months thereafter. Predictors of return to work were identified based on the opinion of therapists and patients from psycho-oncology institutions in the Netherlands. Predictor scores at T1 were used to predict return to work at T3. Discrimination between patients with and without return to work at T3 was investigated with receiver operating characteristic (ROC) analysis and expressed as the area under the ROC curve (AUC).Results: At T1, 174 participants (79%) were off work due to sickness and 119 (68%) had returned to work at T3. Therapists and patients identified psychological symptoms, quality of life, comorbidity, helplessness, acceptation, mastery, stressful life-events, well-being, and domestic and social functioning as being important for predicting return to work. Domestic functioning was the strongest predictor of return to work at T3. The prediction model including all identified predictor variables did not discriminate between patients with and without return to work at T3, with AUC = 0.652 (95% CI 0.553–0.751).Conclusions: These results suggest that, although psychological symptoms are important at face validity for return to work after cancer, in patients that received help for psychological symptoms, they do not predict return to work.

Spirituality can support the adjustment process of people with cancer, by forming a meaning system that supports understanding of the cause and implications of the experience and that provides coping strategies. The different ways in which spiritual meaning systems might fulfill these roles were examined among 20 people who were treated for cancer with curative intent. Narrative interviews were held on average 16 months after cancer diagnosis. The interviews were analyzed in a two-stage process, based on a holistic content approach. The first stage led to the identification of various roles and outcomes of the meaning system. The second stage involved a comparison of these roles and outcomes between previously defined types of meaning systems. The roles identified were discrepancy, legitimation and continuation. Legitimation was associated with the outcome of integration, whereas continuation was associated with an outcome of a positive outlook toward the future. Several differences were found between types of meaning systems, regarding the extent to which and ways in which these roles and outcomes occurred. This study underscores recommendations that healthcare professionals should be aware of the different ways in which the patient&rsquo, s previous beliefs and experiences influence their current adaptation to serious life events.

OBJECTIVES: This study aimed to (1) identify benefit finding trajectories in cancer patients receiving psychological care; (2) examine associations of benefit finding trajectories with levels of and changes in psychological symptoms; and (3) examine whether socio-demographic and medical characteristics distinguished trajectories.DESIGN: Naturalistic longitudinal study design.METHODS: Participants were 241 cancer patients receiving psychological care at specialized psycho-oncological institutions in the Netherlands. Data were collected before starting psychological care, and three and 9 months thereafter. Latent class growth analysis was performed to identify benefit finding trajectories.RESULTS: Five benefit finding trajectories were identified: 'high level-stable' (8%), 'very low level-small increase' (16%), 'low level-small increase' (39%), 'low level-large increase' (9%), and 'moderate level-stable' (28%). People in distinct benefit finding trajectories reported significant differential courses of depression but not of anxiety symptoms. Compared with the other four trajectories, people in the 'low level-large increase' trajectory reported the largest decreases in depression over time. Perceptions of cancer prognosis distinguished these trajectories, such that people with a favourable prognosis were more likely to belong to the 'high level-stable' trajectory, while people perceiving an uncertain prognosis were more likely to belong to the 'low level-large increase' trajectory of benefit finding.CONCLUSIONS: Cancer patients showed distinct benefit finding trajectories during psychological care. A small proportion reporting a large increase in benefit finding were also most likely to show decreases in depressive symptoms over time. These findings suggest a relation between perceiving benefits from cancer experience and improved psychological functioning in cancer patients receiving psychological care. Statement of contribution What is already known on this subject? People vary in course of benefit finding (BF) after trauma, with some experiencing enhanced BF and others decreased BF. Empirical studies have identified subgroups of cancer patients with distinct BF trajectories. What does this study add? This is the first study showing that cancer patients followed different BF trajectories during psychological care. Only a small proportion experienced clinically meaningful increases in BF over time. More attention is needed for cancer patients with decreased BF, as they are at a higher risk of remaining depressed.

Item does not contain fulltext Quantitative studies have assessed nurses' attitudes toward and frequency of spiritual care [SC] and which factors are of influence on this attitude and frequency. However, we had doubts about the construct validity of the scales used in these studies. Our objective was to evaluate scales measuring nursing SC. Articles about the development and psychometric evaluation of SC scales have been identified, using, Web of Science, and CINAHL, and evaluated with respect to the psychometric properties and item content of the scales. Item content was evaluated by each of the five authors with respect to the following questions: Does the item (1) reflect a general opinion about SC instead of a personal willingness to offer SC; (2) reflect general psychosocial care instead of specific SC; (3) focus solely on religious care; (4) contain the words 'spiritual' (care/needs/health/strengths, etc.); and (5) contain multiple propositions, or have an unclear meaning? We found eight scales. Psychometric analysis of these scales was often meager and the items of all but one scale suffered from two or more of the five problems described above. This leads us to conclude that many quantitative results in this area are based on findings with questionable scales. Suggestions for improvements are provided.

Objective This study aimed to (1) identify subgroups of cancer patients with distinct personal control trajectories during psychological care, (2) examine whether socio-demographic, clinical, and psychological care characteristics could distinguish trajectories, and (3) examine differential patterns of psychological symptoms between trajectories. Methods This naturalistic study focused on 241 cancer patients receiving psychological care at psycho-oncology institutions. Data were collected before the initiation of psychological care, and 3 and 9 months thereafter. Latent class growth analysis was applied to identify personal control trajectories. Results Three personal control trajectories were identified: enduring improvement (41%), temporary improvement (50%), and deterioration (9%). Education and baseline physical symptoms distinguished these trajectories. In the whole group, improvements in personal control were associated with improvements in psychological symptoms. Patients at distinct trajectories reported different levels of psychological symptoms, but did not differ in their courses of psychological symptoms. Patients in the enduring and temporary control improvement groups experienced significant psychological symptoms reductions over time, whereas patients in the control deterioration group maintained high psychological symptoms. Conclusions Improvements in personal control seem to depend on initial control level: those who start with the highest control levels show subsequent improvements, whereas those with the lowest control levels show subsequent deterioration

PURPOSE: This study aimed to (1) identify subgroups of cancer patients with distinct subtypes of depression before the start of psychological care, (2) examine whether socio-demographic and medical characteristics distinguished these subtypes, and (3) examine whether people with distinct subtypes reported differential courses of depression during psychological care.METHOD: This naturalistic, longitudinal study included cancer patients who sought psychological care at specialized psycho-oncology institutions in the Netherlands. Data were collected before psychological care (T1) and three (T2) and nine (T3) months thereafter. Latent class analysis was performed to identify depression subtypes in 243 patients at T1.RESULTS: Before starting psychological care, three depressive subtypes were identified, differing in severity and type of symptoms. Class 1 (47 %) with mild depression reported mostly concentration and sleep problems and fatigue. Class 2 (41 %), with slightly higher levels of depression, reported similar concentration and sleep problems and fatigue as class 1, and additionally depressed mood. Class 3 (12 %), with severe depression, reported mainly a depressed mood and, to a lesser extent but still elevated, fatigue and concentration problems. None of socio-demographic and medical characteristics significantly distinguished these subtypes. These subtypes significantly predicted the course of depression over time, with class 1 reporting moderate improvements, class 2 large improvements, and class 3 the largest improvements.CONCLUSIONS: Results indicate the presence of three subtypes of depression in cancer patients before starting psychological care. Our findings suggest that psychological interventions could be tailored to respond to the specific subtype of depression experienced by each individual.

OBJECTIVE: This study evaluated the psychological effects of a pre-surgical stress management training (SMT) in cancer patients. METHODS: Stress management training comprised four sessions in total: on 5 days and 1 day pre-surgery and on 2 days and 1 month post-surgery. Patients also received audio CDs with relaxation and coping skills exercises. Patients were randomly assigned to the SMT (N = 34) or a regular care condition (N = 36). Depression, anxiety, quality of life, perception of control, fatigue, pain, sleep problems, and surgery-related somatic symptoms were measured at Day 6 and Day 1 pre-surgery, and Day 2, 5, 30 and 90 post-surgery. RESULTS: Depression and fatigue decreased in the intervention group and increased in the control group, leading to significant group differences at Day 2 (fatigue) and Day 5 post-surgery (fatigue and depression). It also appeared that surgery-related symptoms had increased more in the control group 3 months post-surgery than in the SMT group. No intervention effects were observed for anxiety, pain, and sleep problems. CONCLUSION: The use of a short psychological intervention is effective in reducing depression and fatigue in the post-surgical period, although the effects are of short duration.

Objective When comparing the efficacy of different interventions for cancer patients, there should be certainty that these types are sufficiently different in the way they are actually presented. The aim of the present study is to develop a method for assessing differences between the content of social support groups and experiential–existential therapy groups. Methods Independent and blind raters assessed video fragments of both intervention types, using a self-developed checklist of five questions. This checklist was first evaluated by a group of experts for appropriateness, importance, and rateability. Results Three out of the five questions were selected on the basis of these experts’ evaluation and on inter-rater reliability. The scores on these questions were used to evaluate five social support groups and six experiential–existential therapy groups for breast cancer patients. According to the independent and blind raters the content of the two intervention forms appeared to be significantly different. Conclusion The assessment method we developed appeared reliable and valid. Practice implications Our assessment method is feasible as a check to compare the content of psycho-oncological interventions and can be easily adjusted into a test for other intervention types.

Introduction: About one-third of cancer survivors suffer from severe chronic fatigue. Aim of this study was to evaluate the efficacy of mindfulness-based cognitive group therapy in reducing severe chronic fatigue in cancer survivors with mixed diagnoses. Patients and Methods: Participants (n = 100) were randomly selected from a cohort and allocated to an intervention and a waiting list condition. Analyses were based on 59 participants in the intervention condition and 24 in the waiting-list condition. Fatigue severity (Checklist Individual Strength), functional impairment (Sickness Impact Profile) and well being (Health and Disease-Inventory) were assessed before and after the 9-week intervention. The intervention group had a follow-up 6 months following the intervention. Results: At post-treatment measurement the proportion of clinically improved participants was 30%, versus 4% in the waiting list condition (χ2 (1) = 6.71; p = 0.007). The mean fatigue score at post-measurement was significantly lower in the intervention group than in the waiting list group corrected for pre-treatment level of fatigue. The mean well-being score at post-measurement was significantly higher in the intervention group than in the waiting list group corrected for pre-treatment level of well-being. The treatment effect was maintained at 6-month follow-up. No difference between the two conditions was found in functional impairment. Discussion: Mindfulness-based cognitive therapy is an effective treatment for chronic cancer-related fatigue. Copyright © 2010 John Wiley & Sons, Ltd.

Background and objectives: Surgical procedures can cause tumor cells to disseminate into the circulatory system. Although this spread of metastatic cells will be limited by immune activity, immunosuppression tends to be the main effect resulting from surgery. The objective of this study is to assess hormonal and immunological changes induced by breast cancer surgery. Methods: Endocrine and immune responses to surgery were determined in 27 breast cancer patients. Blood samples were taken at 6 days and 1 day before surgery and 2 hr, 1 day, and 5 days after surgery. Changes in endocrine function, number of leucocytes and their subpopulations, enumerative immune expression, functional activity, and cytokine levels were determined. Results: Breast cancer surgery induces a pro-inflammatory response and leucocytosis. Immunosuppression is indicated by decreased HLA-DR expression, decreased NKCA, and a Th2 response. A delayed Th1 response was also found 5 days after surgery. As no cortisol level change was observed, this hormone can be excluded as the mediator of surgery-related immunomodulation in breast cancer. Conclusion: Although breast cancer surgery is classified as minor surgery the surgical procedure produces substantial immunomodulation. J. Surg. Oncol. 2010 Wiley-Liss, Inc.

Zorgverleners in de oncologie vinden het belangrijk aandacht te schenken aan het psychosociaal functioneren van hun patienten. Door uiteenlopende factoren, met name tijdsdruk, lukt het niet altijd aandacht voor deze dimensie om te zetten in optimale zorg. Daarbij doet zich het probleem voor dat niet altijd inzichtelijk is welke patient extra psychosociale zorg behoeft. Het gebruik van een signaleringslijst kan uitkomst bieden. Er is in verschillende studies aandacht besteed aan de psychometrische kwaliteit van signaleringslijsten, maar nauwelijks aan de wijze waarop ze in de ziekenhuispraktijk functioneren. Dat laatste is in deze studie onderzocht door personen te interviewen die in 2005 direct betrokken waren bij alle implementatieprojecten die destijds in Nederland in de oncologie waren gestart. De aard en het gebruik van de signaleringslijsten worden besproken, en wat de betrokkenen beschouwen als bevorderlijke en belemmerende factoren bij de implementatie. Een van de belangrijkste bevindingen is dat signaleringslijsten niet alleen worden gebruikt als middel tot screening en verwijzing naar gespecialiseerde psychosociale zorgverleners. Een signaleringslijst stimuleert ook de communicatie tussen de primaire zorgverlener en diens patienten en kan zodoende een bijdrage leveren aan de bevordering van systematische zorg.

This study aimed to examine (1) subgroups of cancer patients with distinct co-morbidity patterns of depression, anxiety and fatigue; (2) how individuals transitioned between these patterns; and (3) whether socio-demographic, clinical and psychological care characteristics distinguished patients' transitions.This naturalistic, longitudinal study focused on 241 cancer patients receiving psycho-oncological care in the Netherlands. Data were collected before initiation of psychological care (T1), 3 months (T2), and 9 months thereafter (T3). Latent transition analysis was performed examining research questions.Three distinct co-morbidity patterns were identified: class 1 ('mood disturbances and fatigue'), class 2 ('mood disturbances') and class 3 ('few symptoms of mood disturbances and fatigue'). Half of those in class 1 remained in this group from T1 to T3, a quarter transitioned to class 2 and another quarter to class 3. Baseline physical symptoms distinguished these transitions: those with more physical symptoms tended to remain stable. Half of patients in class 2 remained stable from T1 to T3, 46% moved into class 3 and 8% into class 1. Baseline physical symptoms and years after cancer diagnosis significantly distinguished these transitions: the 8% moving to class 1 had more physical symptoms and were longer after cancer diagnosis. Most patients in class 3 remained stable from T1 to T3, and predictors of transitions could not be examined.Three distinct co-morbidity patterns of depression, anxiety and fatigue were identified and exhibited different symptom courses longitudinally. Those with poor physical health tended to report elevated mood disturbances and fatigue during psychological care. Copyright © 2016 John WileySons, Ltd.

Objective In this summary of literature, we evaluated 16 studies with respect to recognition and screening for psychosocial problems of cancer patients during nursing or medical visits, and with respect to the effects of providing quality of life information during these visits. Methods A review of the literature was conducted. To obtain the relevant literature, a search was made of two databases: Medline and Nursing and Allied Health Literature. The literature from the last 12 years – from 1993 till 2004 – was selected. Results The results show that in a number of studies a gap is demonstrated between the presence of cancer patients’ psychosocial problems and health care providers’ ability to signalise these problems adequately. The outcomes of these studies further show that the use of a psychosocial checklist is helpful in screening and communicating psychosocial problems, and that supplying information about quality of life facilitates provider–patient communication about these issues. Conclusion None of the studies, however, provides extensive insight into the feasibility of a psychosocial checklist in daily oncology practice. Implementation projects have to be conducted focussing on conditions that block or facilitate the use of a psychosocial checklist in daily practice. Practice implications By monitoring blocking and facilitating conditions strictly and, if necessary, by adjusting them, we can create guidelines to make the use of a psychosocial checklist feasible.

Adjusting to cancer: the role of spirituality Spirituality can play an important role in adjusting to a life-threatening disease such as cancer. In this review, research in this area is summarized. Spirituality has been demonstrated to be positively associated with quality of life, coping, and hope. Negative correlations have been found with anxiety, depression, end-of-life despair, and physical symptoms. However, interpretation of these results is somewhat complicated by the conceptual vagueness of the concept of spirituality, its confusing relationship with religiosity, and the limitations of the – mainly American - instruments used. The development of a Dutch spirituality questionnaire and its use among cancer patients is needed to further clarify the role spirituality plays in adjusting to this disease in Dutch society.

Objective . To study the influence of psychosocial factors on the grade of cervical intra-epithelial neoplasia. Methods . The influence of psychosocial factors on the grade of cervical intra-epithelial neoplasia (CIN) was studied in a group of 342 patients with an abnormal cervical smear. Participants completed a set of questionnaires after colposcopy directed biopsy before knowing the biopsy result. Negatively rated life events, social support, and coping style were studied in relation to distress and grade of CIN. Infection with human papillomavirus (HPV) types was controlled for, as well as sick role bias caused by suspicion of having cervical cancer and distress due to the abnormal cervical smear. Results . Negatively rated life events, lack of social support, and emotional coping were significant predictors for level of distress. No significant relationship was found, however, between the psychosocial factors and grade of CIN. Conclusion . No support was found for an influence of negatively rated life events, social support, coping style, and distress on grade of CIN.

Measures of spirituality often contain the dimension existential well-being (EWB). However, EWB has been found to overlap with emotional and psychological well-being. Using the Spiritual Attitude and Involvement List (SAIL), we have further investigated the overlap between aspects of spirituality and of well-being among patients with cancer, by determining a) the divergent validity of the subscales of the SAIL compared with a well-being questionnaire and b) the differences in their associations to changes in pain and fatigue, and the occurrence of negative life events. Our findings suggest that a sense of trust that one is able to cope with difficulties of life belongs to the realm of well-being, instead of spirituality. Other aspects, such as a sense of meaning in life, seem more similar to spirituality than to well-being. These results can bring researchers a step further toward constructing "pure" spirituality and well-being measures, which will allow them to investigate the (causal) relationship between these constructs.

It has been suggested that spirituality is associated with higher well-being, because it offers social support, improves the relationship with the partner, provides meaning, and reduces self-focus and worry. We performed a qualitative study among ten people with cancer, using the Consensual Qualitative Research method for the analysis of semi-structured interviews. Support was found for the mechanisms of meaning provision and of reduction of self-focus and worries. Participants also mentioned emotion-focused roles of spirituality: Feeling supported by a transcendental confidant, the expression of negative emotions (in prayer), acceptance, allowing feelings of misery, and viewing problems from a distance. There was no mention of a contribution of spirituality to adjustment through improved social support per se or a higher quality of the relationship with the partner. The results of the present study indicate that the role of spirituality in emotion regulation deserves attention in understanding how spirituality helps cancer patients to adjust to their disease.

This study aimed to (1) identify subgroups of cancer patients with distinct personal control trajectories during psychological care, (2) examine whether socio-demographic, clinical, and psychological care characteristics could distinguish trajectories, and (3) examine differential patterns of psychological symptoms between trajectories.This naturalistic study focused on 241 cancer patients receiving psychological care at psycho-oncology institutions. Data were collected before the initiation of psychological care, and 3 and 9 months thereafter. Latent class growth analysis was applied to identify personal control trajectories.Three personal control trajectories were identified: enduring improvement (41%), temporary improvement (50%), and deterioration (9%). Education and baseline physical symptoms distinguished these trajectories. In the whole group, improvements in personal control were associated with improvements in psychological symptoms. Patients at distinct trajectories reported different levels of psychological symptoms, but did not differ in their courses of psychological symptoms. Patients in the enduring and temporary control improvement groups experienced significant psychological symptoms reductions over time, whereas patients in the control deterioration group maintained high psychological symptoms.Improvements in personal control seem to depend on initial control level: those who start with the highest control levels show subsequent improvements, whereas those with the lowest control levels show subsequent deterioration.

This study examined the natural course of psychological functioning in recently bereaved middle-aged women. 69 widows were assessed four times (T1–T4) between the period of 4 to 13 mo. after the loss and were compared to a matched nonwidowed group of 57. Of the SCL-90 feelings of depression, agoraphobic behavior, anxiety, hostility, somatization, feelings of insufficiency, and sleep disorders were heightened at 4 mo. after bereavement compared to the norm group. Significantly higher psychological dysfunctioning was found on all SCL-90 subscales than for nonwidows. Over time, a decrease in psychological dysfunction was found for most widows; however, not every widow appeared to recover psychologically, and 17% of the widows showed severe psychological dysfunctioning at 13 mo. postbereavement (T4). With respect to the predictive value of the Total score on the SCL-90, at 13 mo., 27% of these widows had scores indicating severe psychological dysfunctioning; these were comparable to their scores at 4 mo. postbereavement.

De afgelopen jaren heeft er een explosieve groei plaats gevonden van het aantal publicaties over spiritualiteit in relatie tot gezondheid; het aantal artikelen is de laatste tien jaar zes maal zo veel geworden.1 Spiritualiteit lijkt vooral een belangrijke rol te spelen bij het omgaan met stressvolle gebeurtenissen, zoals een chronische of levensbedreigende ziekte.1-3 Het lijkt dan ook voor de hand te liggen dat zorgverleners in de gezondheidszorg aandacht besteden aan dit thema. In dit artikel geven zorgverleners en onderzoekers hun visie over de manier waarop zorgverleners hieraan aandacht zouden kunnen besteden.

This study tests the hypothesis that a discrepancy between resources and demands explains most of the variance in fatigue in cancer patients undergoing radiotherapy. Patients (n=250) were interviewed at pretreatment, posttreatment, and at 9-month follow-up. Resources involved physical condition, neuroticism, optimism, social support, gender, age, and level of education. Demands entailed prognosis, radiotherapy dose, the effort associated with actual activity, and the patient's perception of overall burden. Regression analyses were performed, using interaction terms to operationalize the discrepancy between resources and demands. The hypothesis was not supported. At pretreatment, physical condition explained most of the fatigue, whereas, at posttreatment, both the patients' physical condition and perception of burden contributed to fatigue. At follow-up, demands did not add to the variance already explained by resources, and vice versa. Factors that contribute to the patient's physical condition before starting radiotherapy and to his/her perception of burden need to be addressed to further our understanding of their fatigue.

Little is known regarding the prevalence and course of fatigue in cancer patients after treatment has ended and no recurrence found. The present study examines fatigue in disease-free cancer patients after being treated with radiotherapy (n = 154). The following questions are addressed. First, how do patients describe their fatigue 9 months after radiotherapy and is this different from fatigue in a nonselective sample from the general population (n = 139)? Secondly, to what degree is fatigue in patients associated with sociodemographic, medical, physical and psychological factors? Finally, is it possible to predict which patients will suffer from fatigue 9 months after radiotherapy? Results indicated that fatigue in disease-free cancer patients did not differ significantly from fatigue in the general population. However, for 34% of the patients, fatigue following treatment was worse than anticipated, 39% listed fatigue as one of the three symptoms causing them most distress, 26% of patients worried about their fatigue and patients' overall quality of life was negatively related to fatigue (r = -0.46). Fatigue in disease-free patients was significantly associated with: gender, physical distress, pain rating, sleep quality, functional disability, psychological distress and depression, but not with medical (diagnosis, prognosis, co-morbidity) or treatment-related (target area, total radiation dose, fractionation) variables. The degree of fatigue, functional disability and pain before radiotherapy were the best predictors of fatigue at 9-month follow-up, explaining 30%, 3% and 4% of the variance respectively. These findings are in line with the associations found with fatigue during treatment as reported in the preceding paper in this issue. The significant associations between fatigue and both psychological and physical variables demonstrate the complex aetiology of this symptom in patients and point out the necessity of a multidisciplinary approach for its treatment.

The effectiveness of a continuing pain education program, directed to surgical cancer nurses, was investigated in a pretest posttest controlled intervention study. ANCOVA for repeated measures revealed that the programme resulted in a lower pain intensity of surgical colon and breast cancer patients (p=0.02). However, no effects were found on pain duration, sleepless hours as a result of pain, state anxiety, mood disturbances, and duration of hospitalization. It is assumed that because the pain CE programme had a moderate impact on pain intensity, this had no consequences for the other outcome variables mentioned. (aut.ref.)

The effect of psychosocial counseling on tumor progression was studied in 96 cancer patients, who were no longer amenable to regular medical treatment. Patients were offered 12 session of individual experiential-existential counseling, each sessions lasting 1.5 to 2 hours. In addition patients participated fortnightly in group counseling meetings. In five out of 35 evaluable patients, tumor growth became stationary during or immediately following therapy. In four patients this stationary period last 3-9 months, and in one patient 2 years. Natural Killer cell activity, self-reported loneliness, depression, purpose in life and locus of control showed no change from pre- to post intervention.

The effectiveness of a continuing education programme on pain assessment and management was investigated in 106 surgical cancer nurses. It was found that the programme led to a more positive attitude towards physical and relaxation interventions (such as the use of relaxation, distraction and massage techniques). In addition, an increase in the duration and quality of psychosocial interventions (provision of information, emotional support, and promotion of autonomy) was established. Furthermore, the programme resulted in an increase in the quality of physical and relaxation interventions. However, the programme did not lead to more positive attitudes towards psychosocial interventions, or to increases in the numbers of psychosocial, physical and relaxation interventions.

This review focuses on the effects of psychosocial interventions on psychological and biological functioning of breast cancer patients. Once in their lifetime, one out of eleven women receive a diagnosis of breast cancer. A diagnosis of breast cancer is a severe stressful life event with profound consequences on all aspects of human life. Whether a woman will regain emotional balance and accept the idea of living with a potentially life threatening disease depends on her psychological resiliency. Provision of psychosocial interventions can improve these women's coping abilities and reduce emotional distress and feelings of isolation, and improve psychosexual functioning. Additionally, there exists some evidence that psychotherapy may prolong survival. Prolongation of survival may be related, in part, to an increase in certain aspects of immune function (e.g., natural killer cell activity). This is plausible because the function of the immune system seems to be related to mammary tumor growth. Therefore, future research should examine the degree to which the effects on mammary tumor growth relate to immune system changes.

Hyperventilation has been posed as an important symptom-producing mechanism in panic attacks. Some arguments and experimental findings, such as the possibility of inducing panic symptoms by voluntary hyperventilation in panic disorder patients, seem to favor this suggestion. This study was undertaken to clarify the role of hyperventilation in panic disorder. Long-term ambulatory measurement of transcutaneous arterial CO2 pressure (PCO2) offers an opportunity to test directly the co-occurrence of panic and hyperventilation under natural conditions.Transcutaneous PCO2 was measured during three to four sessions of approximately 7 hours each in 28 panic disorder patients. Patients were instructed to expose themselves to fear-provoking situations and to press a button as soon as they experienced panic. One-half of the patients experienced one or more panic attacks during these sessions.A decrease in PCO2 was observed during only one of the 24 registered panic attacks that lasted at least 3 minutes. Even during this particular attack, the degree of hyperventilation was not impressive.These findings indicate that the hypothesis that hyperventilation is an important symptom-producing mechanism in panic may be dismissed.

Het mitralisklepprolaps–syndroom is een cardiologische diagnose die in de literatuur vaak geassocieerd wordt met angst en paniek. De klinische symptomatologie die bij dit syndroom kan voorkomen toont een overlap met die van de paniekstoornis. In dit artikel wordt eerst een kort overzicht gegeven over het mitralisklepprolaps–syndroom. Vervolgens wordt nader ingegaan op de in de literatuur veronderstelde samenhang tussen het mitralisklepprolaps–syndroom en het optreden van paniekstoornissen.

The Multidimensional Fatigue Inventory (MFI) is a 20-item self-report instrument designed to measure fatigue. It covers the following dimensions: General Fatigue, Physical Fatigue, Mental Fatigue, Reduced Motivation and Reduced Activity. This new instrument was tested for its psychometric properties in cancer patients receiving radiotherapy, patients with the chronic fatigue syndrome, psychology students, medical students, army recruits and junior physicians. We determined the dimensional structure using confirmatory factor analyses (LISREL's unweighted least squares method). The hypothesized five-factor model appeared to fit the data in all samples tested (AGFIs > 0.93). The instrument was found to have good internal consistency, with an average Cronbach's alpha coefficient of 0.84. Construct validity was established after comparisons between and within groups, assuming differences in fatigue based on differences in circumstances and/or activity level. Convergent validity was investigated by correlating the MFI-scales with a Visual Analogue Scale measuring fatigue (0.22 < r < 0.78). Results, by and large, support the validity of the MFI.

This study examined the effect of high and low anxiety provoking instructions in subjects submitted to a Hyperventilation Provocation Test (HVPT). Subjects were 43 out-patients referred to our clinic for a diagnostic examination of Hyperventilation Syndrome (HVS). Results showed that anxiety levels were affected by the instruction manipulation, but the magnitude of this effect was less than expected and the instruction manipulation had no effect on intensity and type of reproduced symptoms, nor on symptom recognition. Subjects who met Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1 987) criteria for Panic Disorder (PD) were not more responsive to the instruction manipulation than non-PD patients. It is argued that the small effect of the manipulation is probably not due to the solidity of the HVPT but to the pervasiveness of pretest cognitions and expectations. In line with this, the report of HVS symptoms appeared highly related to psychological trait measures like anxiety, fear of bodily sensations, and a general tendency to report somatic symptoms.