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Background: People from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for the prevention of T2D in South Asians that are cost-effective, generalisable and scalable across settings. Hypothesis: Compared to usual care, the risk of T2D can be reduced amongst South Asians with central obesity or raised HbA1c, through a 12-month lifestyle modification programme delivered by community health workers. Design: Cluster randomised clinical trial (1:1 allocation to intervention or usual care), carried out in India, Pakistan, Sri Lanka and the UK, with 30 sites per country (120 sites total). Target recruitment 3600 (30 participants per site) with annual follow-up for 3 years. Entry criteria: South Asian, men or women, age 40–70 years with (i) central obesity (waist circumference ≥ 100 cm in India and Pakistan; ≥90 cm in Sri Lanka) and/or (ii) prediabetes (HbA1c 6.0–6.4% inclusive). Exclusion criteria: known type 1 or 2 diabetes, normal or underweight (body mass index < 22 kg/m2); pregnant or planning pregnancy; unstable residence or planning to leave the area; and serious illness. Endpoints: The primary endpoint is new-onset T2D at 3 years, defined as (i) HbA1c ≥ 6.5% or (ii) physician diagnosis and on treatment for T2D. Secondary endpoints at 1 and 3 years are the following: (i) physical measures: waist circumference, weight and blood pressure; (ii) lifestyle measures: smoking status, alcohol intake, physical activity and dietary intake; (iii) biochemical measures: fasting glucose, insulin and lipids (total and HDL cholesterol, triglycerides); and (iv) treatment compliance. Intervention: Lifestyle intervention (60 sites) or usual care (60 sites). Lifestyle intervention was delivered by a trained community health worker over 12 months (5 one-one sessions, 4 group sessions, 13 telephone sessions) with the goal of the participants achieving a 7% reduction in body mass index and a 10-cm reduction in waist circu

Introduction: South Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D. Methods: This cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India, Pakistan, Sri Lanka and the UK. We included 3684 South Asian men and women, aged 40–70 years, without T2D but with raised haemoglobin A1c (HbA1c) and/or waist circumference. Participants were randomly allocated either to the family-based lifestyle intervention or control group by location clusters. Participants in the intervention received 9 visits and 13 telephone contacts by community health workers over 1-year period, and the control group received usual care. Reductions in weight (aim >7% reduction), waist circumference (aim ≥5 cm reduction), blood pressure and HbA1C at 12 months of follow-up were assessed. Our linear mixed-effects regression analysis was based on intention-to-treat principle and adjusted for age, sex and baseline values. Results: There were 1846 participants in the control and 1838 in the intervention group. Between baseline and 12 months, mean weight of participants in the intervention group reduced by 1.8 kg compared with 0.4 kg in the control group (adjusted mean difference −1.10 kg (95% CI −1.70 to −1.06), p<0.001). The adjusted mean difference for waist circumference was −1.9 cm (95% CI −2.5; to 1.3), p<0.001). No overall difference was observed for blood pressure or HbA1c. People who attended multiple intervention sessions had a dose-dependent effect on waist circumference, blood pressure and HbA1c, but not on weight. Conclusion: An intensive family-based lifestyle intervention adopting low-resource strategies led to effective reduction in weight and waist circumference at 12 months, which has potential long-term benefits for preventing T2D. A higher number of attended sessi

OBJECTIVES: Psychosocial interventions that mitigate psychosocial distress in cancer patients are important. The primary aim of this study was to examine the feasibility and acceptability of an adaptation of the Mindful Self-Compassion (MSC) program among adult cancer patients. A secondary aim was to examine pre-post-program changes in psychosocial wellbeing. METHOD(S): The research design was a feasibility and acceptability study, with an examination of pre- to post-intervention changes in psychosocial measures. A study information pack was posted to 173 adult cancer patients 6 months-5 years post-diagnosis, with an invitation to attend an eight-week group-based adaptation of the MSC program. RESULT(S): Thirty-two (19%) consented to the program, with 30 commencing. Twenty-seven completed the program (mean age: 62.93 years, SD 14.04; 17 [63%] female), attending a mean 6.93 (SD 1.11) group sessions. There were no significant differences in medico-demographic factors between program-completers and those who did not consent. However, there was a trend toward shorter time since diagnosis in the program-completers group. Program-completers rated the program highly regarding content, relevance to the concerns of cancer patients, and the likelihood of recommending the program to other cancer patients. Sixty-three percent perceived that their mental wellbeing had improved from pre- to post-program; none perceived a deterioration in mental wellbeing. Small-to-medium effects were observed for depressive symptoms, fear of cancer recurrence, stress, loneliness, body image satisfaction, mindfulness, and self-compassion. SIGNIFICANCE OF RESULTS: The MSC program appears feasible and acceptable to adults diagnosed with non-advanced cancer. The preliminary estimates of effect sizes in this sample suggest that participation in the program was associated with improvements in psychosocial wellbeing. Collectively, these findings suggest that there may be value in conducting an adequatel

OBJECTIVE: Meaning and Purpose (MaP) therapy aims to enhance meaning-based coping through a life review that focuses on the value and worth of the person, key relationships, sources of fulfillment, roles, and future priorities in living life out fully. We sought to test the feasibility and acceptability of a six-session model of MaP therapy against a wait-list control cohort in a pilot study seeking effect sizes on measures of adaptation. METHOD(S): We randomized patients with advanced cancer to MaP therapy or wait-list control, with measures administered at baseline and after 6-8 weeks. Wait-list patients could then crossover to receive therapy, with further measures collected postintervention. Adherence to the manualized model was sustained through weekly supervision and fidelity coding of recorded sessions. We used generalized estimating equations to control for baseline and any correlation of data.ResultFrom 134 eligible participants, 57 (43%) consented, and 40 of 45 (89%) offered therapy completed 6 sessions. Key barriers to consenting patients were poor health (15 refusers and 4 withdrawals) and death intervened in 6 participants. MaP therapy generated adequate effect sizes in posttraumatic growth (new possibilities, appreciation of life, and personal strength) and life attitudes (choices and goal seeking) to permit calculation of power for a formal randomized, controlled trial.Significance of resultsDelivery of this model of existentially oriented therapy is feasible and acceptable to patients. A properly powered randomized controlled trial is justified to examine the efficacy of this intervention.

The study examined psychosocial factors (quality of life, depression, anxiety, optimism, coping, and social support) in relation to symptoms of posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) in 108 women diagnosed with ovarian cancer. Canonical correlational analysis showed that both PTSD and PTG were related to poorer quality of life, lack of social supports, and avoidant coping styles. However, higher PTG was also associated with the use of meaning and social support to cope with their experience. The findings highlight both negative and positive posttraumatic outcomes but longitudinal studies are now needed to more fully evaluate these relationships.Copyright © 2018, © 2018 Taylor & Francis Group, LLC.

Context The risk of suicide is elevated in palliative care patients compared with the general population. Various psychological factors, including depression, demoralization, loss of control, and low self-worth, have been associated with a desire to hasten death. Objectives The aim of this study was to investigate whether depression, demoralization, loss of control, and low self-worth mediated the relationship between global quality of life and desire to hasten death. Methods A sample of 162 palliative care patients completed measures of global quality of life, depression, demoralization, perceived control, self-worth, and desire to hasten death. A multiple mediation model with bootstrapping sampling tested the total (combined) indirect effect and individual indirect effects of depression, the two subscales of demoralization (Meaning and Purpose, and Distress and Coping Ability), perceived control, and self-worth. Results Depressive symptoms, loss of meaning and purpose, loss of control, and low self-worth mediated the direct effect of global quality of life on desire to hasten death. The Distress and Coping Ability component of demoralization was not a significant mediator. Conclusion Depression, loss of meaning and purpose, loss of control, and low self-worth are strong clinical markers for desire to hasten death. Targeting these symptoms through existentially oriented therapies, such as meaning-centered therapy, may ameliorate suicidal thinking.Copyright © 2016 American Academy of Hospice and Palliative Medicine

Demoralization has been the subject of discussion in relation to end-of-life care. It is characterized by hopelessness and helplessness due to a loss of purpose and meaning. The purpose of this review was to consolidate the conceptual understanding of demoralization and argue for its existence as a psychiatric syndrome. The history of the construct is explored, including the nature of existential distress and related psychological conditions that precipitate demoralization. Recent definitions of demoralization are described and differentiated from similar constructs. Future directions are highlighted, specifically in relation to the assessment, diagnosis, and treatment of demoralization in palliative care. Overall, demoralization is a clinically useful construct for those facing existential threat, guiding the clinician toward efforts to restore morale, meaning, and purpose. Copyright © The Author(s) 2014.

BACKGROUND: The Demoralization Scale (DS) was initially validated in 2004 to enable the measurement of demoralization in patients with advanced cancer. Subsequent shortcomings indicated the need for psychometric strengthening. Here, the authors report on the refinement and revalidation of the DS to form the DS-II, specifically reporting the scale's internal validity. METHOD(S): Patients with cancer or other progressive diseases who were receiving palliative care (n = 211) completed a revised version of the 24-item DS and a measure of symptom burden (the Memorial Symptom Assessment Scale). Exploratory factor analysis and Rasch modeling were used to evaluate, modify, and revalidate the scale, providing information about dimensionality, suitability of response format, item fit, item bias, and item difficulty. Test-retest reliability was examined for 58 symptomatically stable patients at a 5-day follow-up. RESULT(S): Exploratory factor analysis supported a 22-item, 2-component model. Separate Rasch modeling of each component resulted in collapsing the response option categories and removing 3 items from each component. Both final 8-item subscales met Rasch model expectations and were appropriate to sum as a 16-item total score. The DS-II demonstrated internal consistency and test-retest reliability (Meaning and Purpose subscale: alpha =.84; intraclass correlation [ICC] = 0.68; Distress and Coping Ability subscale: alpha =.82; ICC = 0.82; total DS: alpha =.89; ICC = 0.80). CONCLUSION(S): The DS-II is a 3-point response, self-report scale comprising 16 items and 2 subscales. Given its revalidation, psychometric strengthening, and simplification, the DS-II is an improved and more practical measure of demoralization for research and clinical use. External validation of the DS-II will be reported subsequently. Cancer 2016;122:2251-9. © 2016 American Cancer Society.

BACKGROUND: The recently refined Demoralization Scale-II (DS-II) is a 16-item, self-report measure of demoralization. Its 2 factors-Meaning and Purpose and Distress and Coping Ability-demonstrate sound internal validity, including item fit, unidimensionality, internal consistency, and test-retest reliability. The convergent and discriminant validity of the DS-II with various measures is reported here. METHOD(S): Patients who had cancer or other progressive diseases and were receiving palliative care (n = 211) completed a battery of questionnaires, including the DS-II and measures of symptom burden, quality of life, depression, and attitudes toward the end of life. Spearman rho correlations were determined to assess convergent validity. Mann-Whitney U tests with calculated effect sizes were used to examine discriminant validity and establish the minimal clinically important difference (MCID). Cross-tabulation frequencies with chi-square analyses were used to examine discriminant validity with major depression. RESULT(S): The DS-II demonstrated convergent validity with measures of psychological distress, quality of life, and attitudes toward the end of life. It also demonstrated discriminant validity, as the DS-II differentiated patients who had different functional performance levels and high/low symptoms, with a difference of 2 points between groups on the DS-II considered clinically meaningful. Furthermore, discriminant validity was demonstrated, as comorbidity with depression was not observed at moderate levels of demoralization. CONCLUSION(S): The DS-II has sound psychometric properties and is an appropriate measure of demoralization. Given its structural simplicity and brevity, it is likely to be a useful tool in meaning-centered therapies. Cancer 2016;122:2260-7. © 2016 American Cancer Society.

Context Demoralization can be understood as a condition that results from existential conflict. It presents with symptoms of hopelessness and helplessness caused by a loss of purpose and meaning in life. It is a significant mental health concern given there can be an associated desire for hastened death. Objectives The aim of this systematic review was to synthesize the recent empirical evidence on demoralization in patients with progressive disease or cancer, including prevalence rates; the relationships between demoralization and sociodemographic, disease- and treatment-related, and psychological factors; and the psychometric properties of demoralization measures. Methods A comprehensive literature search using key words and subject headings was performed following PRISMA guidelines with nine electronic bibliographic databases, resulting in 25 studies (33 articles) with a total of 4545 participants reviewed. Full articles underwent methodological quality assessment, and correlational information was synthesized according to the strength of evidence. Results The findings suggest that demoralization is prevalent in patients with progressive disease or cancer and clinically significant in 13%-18%. A range of factors were consistently associated with demoralization: poorly controlled physical symptoms, inadequately treated depression and anxiety, reduced social functioning, unemployment, and single status. The Demoralization Scale has demonstrated good psychometric properties across five studies. Conclusion Overall, this systematic review was limited by the extent of variability in the characteristics of studies. Patients who are single, isolated or jobless, have poorly controlled physical symptoms, or have inadequately treated anxiety and depressive disorders are at increased risk for demoralization. Clinical recognition of demoralization can trigger more focused interventions.Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier

Objective: The aim of the study was to assess the prevalence and nature of symptoms of posttraumatic stress disorder (PTSD) in women with ovarian cancer. A further aim was to examine the demographic, medical and psychosocial factors associated with PTSD symptoms. Method(s): One hundred and eight women with ovarian cancer were assessed for PTSD, quality of life, depression, anxiety, posttraumatic growth, optimism, coping and social support. Result(s): Clinically significant symptoms were experienced by 9.25% of participants for PTSD, 5.6% for depression and 13.9% for anxiety. Poorer quality of life was associated with total PTSD symptoms, and avoidance and intrusive symptoms. Depression was associated with avoidance and intrusive symptoms. Anxiety was associated with total, avoidance, intrusive and hyperarousal symptoms. Finally, coping by substance use/self-blame was associated with total, avoidance and hyperarousal PTSD symptoms. Conclusion(s): Levels of PTSD in women with ovarian cancer were equivalent to that of the general population. Poorer quality of life, depression, anxiety and maladaptive coping, characterised by avoidance, substance use and self-blame, were associated with increased symptoms of PTSD.Copyright © 2014 John Wiley & Sons, Ltd.

BACKGROUND: Active surveillance (AS) is an alternative treatment strategy for prostate cancer (PCa) and involves regular PSA blood testing and repeat rectal biopsies, the aim of which is to monitor cancer progression and inform appropriate treatment decision-making. Anecdotal evidence suggests that some men experience anxiety when undergoing AS.The primary aim of this study is to establish if PSA test related anxiety exists in this population. A range of secondary aims are also investigated. METHOD(S): Two hundred and sixtyfive men with PCa on AS were invited to complete established psychological measures; 104 men (39%, aged 51-90 years, M = 68; SD +/- 7) participated and returned data. RESULT(S): Overall, results indicated that men experienced low general and illness specific anxieties and high HRQoL when compared to published clinical/non-clinical data. Age and trait anxiety emerged as significant predictors of PCa related HRQoL; trait, state anxiety and fear of recurrence were significant predictors of overall HRQoL. While there were significant bivariate relationships between illness perceptions (disease consequences, illness coherence) and HRQoL, these did not contribute significant variance in HRQoL outcomes when analysed in regression models. Finally, 92% and 86% of the sample found the information about PCa and AS (respectively)to be either very or quite helpful and satisfied information needs. CONCLUSION(S): Findings highlight the importance of trait anxiety in relation to HRQoL and the benefits of information provision to men with PCa on AS.

Objectives: To describe a range of anxieties in men on active surveillance (AS) for prostate cancer and determine which of these anxieties predicted health-related quality of life (HRQL). Patients and Methods: In all, 260 men with prostate cancer on AS were invited to complete psychological measures including the Hospital and Anxiety Depression Scale; the State-Trait Anxiety Inventory-Trait Scale; the Memorial Anxiety Scale for Prostate Cancer; and the Functional Assessment of Cancer Therapy Scale-Prostate. Overall, 86 men with a mean (SD, range) age of 65.7 (5.4, 51-75) years returned data, yielding a response rate of 33%. Outcome measures were standardised psychological measures. Pearson's correlations were used to examine bivariate relationships, while regression analyses were used to describe predictors of dependent variables. Result(s): When compared with the findings of prior research, the men in our cohort had normal levels of general anxiety and illness-specific anxiety and high prostate cancer-related HRQL. Age, trait anxiety and fear of recurrence (FoR) were significant predictors of prostate cancer-related HRQL; trait anxiety and FoR were significant predictors of total HRQL. Results should be interpreted in context of sample characteristics and the correlational design of the study. Conclusion(s): Participants reported low levels of anxiety and high HRQL. Trait anxiety and FoR were significant predictors of both prostate cancer-related and total HRQL. The administration of a short trait-anxiety screening tool may help identify men with clinically significant levels of anxiety and those at risk of reduced HRQL.Copyright © 2014 The Authors BJU International © 2014 BJU International.

To describe a range of anxieties in men on active surveillance (AS) for prostate cancer and determine which of these anxieties predicted health-related quality of life (HRQL).

Objectives To evaluate the effects of androgen deprivation therapy (ADT) on depression, anxiety and quality of life (QoL) in patients with prostate cancer (PCa) and to examine the relationship between meeting the National Physical Activity Guidelines of Australia (NPAGA) and the presence and severity of both psychological sequelae and physical side effects associated with ADT. A secondary purpose was to examine the predictors of depression, anxiety and QoL in patients with PCa. Methods A questionnaire was mailed to English-speaking patients aged 40 to 80 years, who had received radiotherapy for PCa during 2010 and 2011, between 9 and 30 months prior to study initiation. Measures included the following: the International Physical Activity Questionnaire; the Hospital Anxiety and Depression Scale; the Functional Assessment of Cancer Therapy - Prostate; and sociodemographic items. Results Long-term use of ADT was associated with poorer QoL and psychosocial well-being. Those meeting NPAGA had significantly lower levels of depression and anxiety and improved QoL compared with those not meeting NPAGA. Logistic regression analyses showed the odds of clinically significant depression and anxiety scores, increased with younger age and comorbid conditions. Not meeting NPAGA increased the likelihood of caseness for depression. Multiple regression analyses revealed that comorbid conditions and treatment category predicted poorer QoL, whereas meeting NPAGA positively predicted QoL. Conclusions The use of ADT in the management of patients with PCa has a measurable effect on QoL. These findings support the utility of physical activity as an intervention for men undergoing ADT. Copyright © 2013 John Wiley & Sons, Ltd.

Introduction and Objectives: P rostate cancer is major cause of mortality and morbidity in Australian men. One treatment for low risk prostate cancer is active surveillance (AS). Anecdotal evidence suggests that some men on AS are vulnerable to anxiety which may have an impact on health related quality of life (HRQOL) and may also impact on the men ' s ability to remain on AS. The objectives of this study were to describe a range of anxieties in men on AS, and which of these anxieties predicted HRQOL. Our final aim was to examine the satisfaction that these men reported in the information provided to them about AS by their treating physician. Methods : 2 65 men with low risk prostate cancer enrolled on an AS database from a single urologist were invited to participate in the study. Socio-demographic information was collected and patients completed the Hospital and Anxiety Depression scale (HADS), State-trait anxiety inventory - trait scale (STAT), memorial anxiety scale for prostate cancer (MAX-PC), Functional assessment of cancer therapy - prostate version 4 (FACT-P), Illness perception questionnaire-revised (IPQ-R) and Likert scale analysis questionnaire regarding information provision. All data was analysed using SPSSS version 19. Results : 1 04 men agreed to participate in the study. 91% of men did not demonstrate anxiety on HADS, 98% demonstrated low levels of PSA anxiety and 87% low levels of prostate cancer anxiety on MAX-PC. However 81% of men demonstrated higher levels of anxiety regarding fear of recurrence on MAX-PC. General (state/ trait) anxieties and younger age were significantly associated with illness specific prostate cancer and fear of recurrence anxieties. 92% of men were satisfied with the information received from their urologist regarding prostate cancer and AS. Conclusions : M en experience low levels of anxiety and high HRQOL on AS, but still experience some fear of recurrence. Younger age and underlying state/trait anxieties emerged as sign

Objective: This study aimed to estimate the proportion of patients with prostate cancer (PCa) meeting the National Physical Activity Guidelines of Australia (NPAGA) and determine sociodemographic and medical factors associated with meeting these guidelines. Secondary aims included examining physical activity (PA) levels by treatment type and domain (leisure, work, transport and domestic) and establishing a predictive model of the likelihood that men with PCa would meet NPAGA. Method(s): A questionnaire was mailed to 638 men with PCa attending for treatment at the Alfred, Cabrini or Latrobe Regional Hospitals during 2010 and 2011, with a response rate of 59%. Measures included International Physical Activity Questionnaire, Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy - Prostate and sociodemographic items. Inclusion criteria were English speaking men aged 40 to 80 years, who had undergone radiotherapy (RT) between 9 and 30 months prior to the survey. Result(s): Of 356 men with PCa, less than half were meeting NPAGA (41.9%). Lower education and quality of life (QoL), a higher number of comorbid conditions and symptoms of depression and anxiety were associated with decreased leisure-time PA. Patients treated with androgen deprivation therapy were significantly less active than patients treated with RT only. Logistic regression analyses indicated that the likelihood of meeting NPAGA was significantly lower with higher levels of depressive symptoms and lower levels of education. Conclusion(s): Meeting NPAGA is associated with higher QoL and psychosocial well-being in men with PCa. These findings contribute important information for targeting PA interventions to PCa survivors. Copyright © 2013 John Wiley & Sons, Ltd.

Breast cancer is the most common cancer in women living in Australia, accounting for 27% of all diagnoses in 2007. It was also the leading cause of burden of disease for females in 2010. Previous research has highlighted the utility of cancer rehabilitation programs for a range of tumour streams including breast cancer. The aim of cancer rehabilitation is to improve physical, social and psychological outcomes during and after treatment. Based on the end of treatment program for early stage breast cancer 'Yesterday, Today and Tomorrow' conducted at Cabrini Health, a private hospital in Melbourne, a pilot breast cancer rehabilitation program has been developed to address the rehabilitation needs of women with early stage breast cancer. The program will function as an adjunct to the existing rehabilitation service and has a physical reconditioning and psycho-education component. In this paper the establishment of the program will be described and data on the outcomes of the first three months presented.

Aim: The primary purpose of this study was to evaluate the effects of androgen deprivation therapy (ADT) on levels of depression, anxiety and quality of life (QoL) in patients with prostate cancer (PCa) and to examine the relationship between meeting the National Physical Activity Guidelines of Australia (NPAGA) and the presence and severity of psychological sequelae associated with ADT. A secondary purpose was to examine the predictors of depression, anxiety and QoL among patients with PCa. Method(s): A questionnaire was administered to patients with PCa attending for treatment at the Alfred, Cabrini and Latrobe Regional Hospitals in Melbourne, Australia, during 2010 and 2011. Measures included: The International Physical Activity Questionnaire (IPAQ); the Hospital Anxiety and Depression Scale (HADS); the Functional Assessment of Cancer Therapy - Prostate (FACT-P); and socio-demographic items. Patients aged between 40 and 80 years and English speaking, who had received radiotherapy treatment for their PCa between 9 and 30 months ago, were mailed the questionnaire. Result(s): Long-term use of ADT was associated with poorer QoL and psycho-social wellbeing. Those meeting NPAGA had significantly lower levels of depression and anxiety and improved QoL compared to those not meeting NPAGA. Logistic regression analyses showed that the odds of reporting depression and anxiety scores of clinical significance, increased with younger age and number of comorbid conditions. Not meeting NPAGA also increased the likelihood of caseness for depression. Multiple regression analyses revealed that comorbid conditions and treatment category predicted poorer QoL, while meeting NPAGA positively predicted QoL. Conclusion(s): These findings support the utility of physical activity in rehabilitation programs for men undergoing ADT. For clinicians to be aware of the effects of ADT treatment on QoL in recommending treatment based on the patient's age and risk of disease progression is highligh