Search

Purpose. To systematically evaluate the literature on quality of life and adjustment to brain tumor from a biopsychosocial perspective. Methods. On the basis of the cancer and brain injury literature, a biopsychosocial organisational framework was initially developed to support an evaluative review of the brain tumor literature. This framework consisted of four themes relating to pre-illness characteristics, neuropathology, personal appraisals and reactions and social support. Electronic searches of Medline, PsycINFO and CINAHL databases identified 48 empirical studies (1980-2007) that investigated factors associated with quality of life or the adjustment of adults with brain tumor. A review of studies within each theme appraised these findings and evaluated the quality of methodology and extent to which biopsychosocial perspectives have guided investigations. Results. Overall, the review identified consistent associations between depression, performance status, fatigue and quality of life. Seven multivariate studies with strong methodology that adopted a biopsychosocial perspective were found. In general, the relationships among pre-illness and brain tumor characteristics, psychosocial variables and quality of life were unclear and various gaps in the literature emerged. Conclusions. Empirical findings within a biopsychosocial perspective may guide the development and delivery of support services for individuals with brain tumor; however, many important areas exist for future research. [ABSTRACT FROM AUTHOR]

Objective: to assess knowledge, attitudes and behaviours about environmental tobacco smoke (ETS) in cars and homes in Queensland.Method: 1,026 randomly selected Queensland residents (84% response) participated in a computer assisted telephone survey to assess knowledge, attitudes and behaviours about ETS in cars and homes; and attitudes towards restrictions on smoking in a range of contexts.Results: Most respondents are aware of the negative health effects of ETS and have smoking bans in their cars (75.8%) and homes (76.8%), however bans are less prevalent for smokers (cars: 37.9%; homes: 51%; p=0.000). For cars/homes, most smokers who did not have smoking bans would not smoke at all around pregnant women (67.7%/53.7%); fewer would refrain for childrenor=2 years (p=0.000) compared to non-parent smokers. Most respondents support car/ home smoking bans for childrenConclusions: There is strong community support for legislation targeting ETS in cars and homes, however this varies by context, smoking and parental status. [ABSTRACT FROM AUTHOR]

Men diagnosed with prostate cancer must make decisions about medical treatment in a context of high uncertainty. However, when making decisions about treatment, many men prefer to defer decisionmaking responsibility to their physician. Because the reason has not been explained well, an exploratory study investigated the effect of varying ambiguity and risk and relevant psychological and sociodemographic variables on men's desire for involvement in decision making in a hypothetical treatment scenario. A self-report questionnaire was administered by mail to a community sample of 705 men who were part of an ongoing study into men's health. Measures included the Multidimensional Health Locus of Control scale, the Revised Scale for Ambiguity Tolerance, and the Desire for Involvement Scale. In addition, the men were randomly allocated to four experimental groups for a 232 manipulation of high and low ambiguity with high and low risk for one of four scenarios for choices of treatment. Varying risk and ambiguity did not affect men's desire for involvement in decision making. Deferral of decision-makingresponsibility to the physician was predicted by high powerful others (p < .0001), low internal locus of control, a preference for blackandwhite thinking, and lower levels of education (p's < .05). The results provided preliminary support for the conceptualization of deferral of decisionmaking responsibility to the physician as a shortcut-the expertopinion heuristic. [ABSTRACT FROM AUTHOR]

The diagnosis and subsequent treatment of prostate cancer is followed by a range of significant disease specific and iatrogenic sequelae. However, the supportive care needs of men with prostate cancer are not well described in the literature. The present study assesses the supportive care needs of men with prostate cancer who are members of prostate cancer self-help groups in Queensland, Australia. In all, 206 men aged between 48 and 85 years (mean=68) completed the Supportive Care Needs Survey (SCNS) (62% response). The SCNS is a validated measure assessing perceived need in the domains of psychological needs, health system and information needs, physical and daily living needs, patient care and support, and sexuality. Items assessing need for access to services and resources were also included. One third of the sample reported a moderate to high need for help for multiple items in the sexuality, psychological and health system and information domains. Younger men reported greater need in the sexuality domain; living in major urban centres was predictive of greater psychological need; being closer to the time of diagnosis was related to greater need for help in the physical and daily living domain; having prostate cancer that is not in remission, having received radiation therapy, and lower levels of education were predictive of greater need for help in patient care and support. Of the total sample, 55% of men had used alternative cancer treatments in the past 12 months, with younger and more educated men more likely to use alternative therapies. Interventions in sexuality, psychological concerns and informational support are priorities for men with prostate cancer. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A recent genome-wide association study found that genetic variants on chromosomes 3, 6, 7, 10, 11, 19 and X were associated with prostate cancer risk. We evaluated the most significant single-nucleotide polymorphisms (SNP) in these loci using a worldwide consortium of 13 groups (PRACTICAL). Blood DNA from 7,370 prostate cancer cases and 5,742 male controls was analyzed by genotyping assays. Odds ratios (OR) associated with each genotype were estimated using unconditional logistic regression. Six of the seven SNPs showed clear evidence of association with prostate cancer (P = 0.0007-P = 10(-17)). For each of these six SNPs, the estimated per-allele OR was similar to those previously reported and ranged from 1.12 to 1.29. One SNP on 3p12 (rs2660753) showed a weaker association than previously reported [per-allele OR, 1.08 (95% confidence interval, 1.00-1.16; P = 0.06) versus 1.18 (95% confidence interval, 1.06-1.31)]. The combined risks associated with each pair of SNPs were consistent with a multiplicative risk model. Under this model, and in combination with previously reported SNPs on 8q and 17q, these loci explain 16% of the familial risk of the disease, and men in the top 10% of the risk distribution have a 2.1-fold increased risk relative to general population rates. This study provides strong confirmation of these susceptibility loci in multiple populations and shows that they make an important contribution to prostate cancer risk prediction.

Objectives: To assess the supportive care needs and interest in related services among brain tumour patients and their carers and to compare the level of unmet needs to other cancer populations., Methods: A cross-sectional survey was posted to 363 households who were subscribed to the Queensland Cancer Fund Brain Tumour Support Service in 2005. Overall, 75 patients and 70 carers (response rate 29.8%) returned completed questionnaires. Measures were the Supportive Care Needs Survey (SCNS-34) and a brain tumour specific subscale for patients and carers, as well as the Hospital Anxiety and Depression Scale (HADS)., Results: Patients most frequently reported requiring support to overcome fatigue, uncertainty about the future and not being able to do the things they used to do. Carers wanted help dealing with fears about the patients mental or physical deterioration, with the impact caring had on their own life, and with reducing stress in the patient's life. Among patients, 30% reported anxious mood and 17% depressed mood on the HADS, while corresponding numbers for carers were 40% and 10%, respectively. Patients and/or carers with higher than average supportive care needs expressed greater interest in support services, such as those to improve physical activity, using community services more effectively and to manage stress. Greater emotional distress predicted higher supportive care needs (e.g. odds ratio depressed patients=2.11; (95% confidence interval 1.10-4.03), while no association was detected between patients' or carers' demographic characteristics, or patients' self-reported medical status and higher than average supportive care needs., Conclusion: The level of unmet supportive care needs observed among patients with a brain tumour and their carers is similar to that observed among cancer populations with metastatic disease., Practice Implications: Interventions for this group should integrate lifestyle, coping support, and neuropsychological rehabilitation.

After treatment completion, gynaecological cancer survivors may face long-term challenges and late effects, specific to this disease. Available research on supportive care needs of women with gynaecological cancer is limited. This study aimed to determine the prevalence and correlates of unmet needs within a population of gynaecological cancer survivors. Eight hundred and two women participated in a population-based mail survey in 2004 (56% response rate). The questionnaire included a validated instrument to assess 45 need items across multiple supportive care domains, and a range of measures to evaluate related correlates consistent with a social-ecological perspective. Forty-three per cent of respondents reported having at least one moderate- or high-level unmet need. The five highest included needing help with fear about the cancer spreading (17%), concerns about the worries of those close to them (15%), uncertainty about the future (14%), lack of energy/tiredness (14%), and not being able to do things they used to do (14%). Subgroups of women with higher odds of reporting 'some' unmet needs across multiple supportive care domains include those who, are not in remission, live with lymphoedema or are unable to work due to illness. Odds were also higher for women who had undergone more recent treatment, and who lived in rural or remote locations. Further assistance with the top specific concerns of gynaecological cancer survivors is recommended. Identified subgroups with higher needs are important targets for support., (Copyright 2007 John Wiley & Sons, Ltd.)

Objective: This study assessed the quality of life and psychosocial well-being of brain tumor patients and their carers., Methods: A cross-sectional postal survey was completed by 75 patients and 70 carers (response rate=29.8%) who were listed in a community-based brain tumor support group database. Measures used were the Functional Assessment of Cancer Therapy-General (FACT-G) and the Hospital Anxiety and Depression Scale (HADS). Queensland population-based norms for the FACT-G were used for comparison., Results: On average, as compared with population norms, the FACT-G summary scores of the patients (mean=74.6, S.D.=18.6) and carers (mean=76.7, S.D.=17.7) were between 0.5 and 1 S.D. lower, representing a clinically significant reduction in their quality of life. Among patients and carers, 30% and 40%, respectively, reported anxious moods and 17% and 10%, respectively, reported depressed moods on the HADS. Significant correlations were observed between the FACT-G and HADS subscales, particularly emotional well-being and anxiety, as well as physical and functional well-being and depression, and between patients' and their carers' quality of life. Among the patients, predictors of lower quality of life were older age and female sex, whereas for the carers, there was a trend for lower quality of life among those looking after a patient with a high-grade disease., Conclusions: The degree of detriment to quality of life by a brain tumor for patients and that for their carers are similar and clinically significant. The association between the FACT-G subscales and the HADS indicates that improvements could be achieved by alleviating emotional distress and improving functional well-being.

While there are numerous uncertainties surrounding prostate cancer's detection and treatment, more research focusing on the psychological needs of prostate patients is required. This study investigated the support and psychological care needs of men with prostate cancer. Patients were approached during urological oncology clinics and asked to complete the: Support Care Needs Survey (SCNS), Support Care Preferences Questionnaire, EORTC QLQ-C30 (Version 3) Measure plus Prostate Module, and the Hospital Anxiety and Depression Scale (HADS). Of the 249 patients meeting study entry criteria, there was an 89% response rate resulting in a cohort of 210 patients. The data showed that significant unmet need exists across a number of domains in the areas of psychological and health system/information. The more commonly reported needs were 'fears about cancer spreading (44%),' 'concerns about the worries of those close to you (43%),' and 'changes in sexual feelings (41%).' Half of all patients reported some need in the domain of sexuality, especially men younger than 65 years. Needs were being well met in the domain of patient care and support. A significant number of patients reported having used or desiring support services, such as information about their illness, brochures about services and benefits for patients with cancer (55%), a series of talks by staff members about aspects of prostate cancer (44%), and one-on-one counselling (48%). Quality of life (QoL) was most negatively impacted in those who: were < or =65 years old, had been diagnosed within one year, or had metastatic disease. Men < or =65 had decreased social functioning, greater pain, increased sleep disturbance, and were more likely to be uncomfortable about being sexually intimate. Patients recently diagnosed had increased fatigue, more frequent urination, greater disturbance of sleep, and were more likely to have hot flushes. Those with advanced disease scored lower on 12 out of 15 QoL categories. PSA level had no effect on QoL or anxiety/depression scores. Men with advanced disease had greater levels of depression and those < or =65 years old were more likely to be anxious. Although most men with prostate cancer seem to function quite well, a substantial minority report areas of unmet need that may be targets for improving care., (Copyright 2003 John Wiley & Sons, Ltd.)

Objective: To describe the decision-making processes used by men diagnosed with localized prostate cancer who were considering treatment., Patients and Methods: Men newly diagnosed with localized prostate cancer from outpatient urology clinics and urologists' private practices were approached before treatment. Their decision-making processes and information-seeking behaviour was assessed; demographic information was also obtained., Results: Of 119 men approached, 108 (90%) were interviewed; 91% reported non-systematic decision processes, with deferral to the doctor, positive and negative recollections of others' cancer experiences, and the pre-existing belief that surgery is a better cancer treatment being most common. For systematic information processing the mean (sd, range) number of items considered was 4.19 (2.28, 0-11), with 57% of men considering four or fewer treatment/medical aspects of prostate cancer. Men most commonly considered cancer stage (59%), urinary incontinence (55%) and impotence (51%) after surgery, and low overall mortality (45%). Uncertainty about probabilities for cure was reported by 43% of men and fear of cancer spread by 37%. Men also described uncertainty about the probabilities of side-effects (27%), decisional uncertainty (25%) and anticipated decisional regret (18%). Overall, 73% of men sought information about prostate cancer from external sources, most commonly the Internet, followed by family and friends., Conclusions: In general, men did not use information about medical treatments comprehensively or systematically when making treatment decisions, and their processing of medical information was biased by their previous beliefs about cancer and health. These findings have implications for the provision of informational and decisional support to men considering prostate cancer treatment.

Background: Although the Australian Cancer Society recommends against performing PSA tests to screen for prostate cancer, many Australian men currently undergo such screening. This study investigated attitudinal variables that may predict prostate cancer screening behaviors in this context., Methods: A questionnaire was administered by mail in a two-phase procedure, first to a sample of 1,461 men (46% response), then to 919 men from the initial sample. Prostate cancer screening behaviors of men > 40 years old were examined. The questionnaire assessed worry about prostate cancer, perceived vulnerability to prostate cancer, belief in the efficacy of PSA testing for detection, having received a PSA test for detection, and the presence of urologic symptoms at the time of testing., Results: Men who had had PSA testing with urologic symptoms at the time of the test were more worried about prostate cancer and perceived themselves as more vulnerable to prostate cancer compared with both asymptomatic tested and untested men. Men who had undergone PSA testing believed the test to be more effective in the detection of prostate cancer than did men who had not., Conclusions: Urologic symptoms act as a risk cue for men to prostate cancer. Asymptomatic men should be considered separately from symptomatic men in the investigation of psychological variables predictive of seeking screening for prostate cancer. These findings are discussed in terms of both the focus and design of interventions to alter prostate cancer screening behavior and their implications for the clinical management of men with urologic symptoms.

Purpose/objectives: To describe difficulties experienced by women after treatment for primary breast cancer., Design: Descriptive and exploratory., Setting: Queensland, Australia., Sample: 245 women (70% response rate) less than 16 weeks postsurgery for breast cancer completed a survey. The mean age for this sample was 55 years; 71% had undergone mastectomy, and 29% had undergone conservative breast surgery., Methods: Focus groups were used to generate items for the survey, "Experience of Breast Cancer Questionnaire" (EBCQ). The EBCQ and the psychological subscale of the Rotterdam Symptom Checklist (RSCL) were administered by mail to the sample., Main Research Variables: Psychological distress, fear of recurrence, decisional uncertainty, informational support, self-image and social relationships, sexual morbidity, and physical effects of treatments., Findings: Factor analysis of the EBCQ identified five factors, accounting for 60% of the variance. These included psychological effects, treatment concerns, physical effects, self-image, and chemotherapy effects. Four of the five subscales had reliability coefficients of greater than 0.80. Psychological effects included cognitive and emotional effects. Treatment concerns included decisional uncertainty and poorly perceived informational support. Physical effects reflected the symptom pattern of axillary dissection. Self-image included breast loss and social isolation., Conclusions: Nurses who assist women in adjusting to breast cancer should consider the effect of fear of recurrence and perceptions of body image on the recovery process. Because participation in treatment decisions may increase the demands on women at diagnosis, informational support appropriate to each woman's needs is essential. How self-esteem can affect self-image and social relationships after breast cancer requires further investigation., Implications for Nursing Practice: Understanding the experience of illness from the perspective of the patient assists nurses in validating their nursing practice and provides clinically relevant information to guide intervention. In particular, supportive psychological care should target both emotional and cognitive responses to breast cancer. Informational support is integral to a patient's satisfaction with treatment decisions and is likely to predict adjustment. When assisting women to adjust to self-image changes, nurses may need to target women's perceptions about their body image.

Purpose/objectives: To describe women's experiences after treatment for gynecologic cancer in relation to psychosocial and physical difficulties and perceptions of the helpfulness of healthcare professionals., Design: Descriptive, retrospective, mailed survey., Setting: Women previously treated for gynecologic cancer at a large urban hospital in Queensland, Australia., Sample: Eighty-two women of all ages completed the survey. Diagnoses included cervical (45%), uterine (30%), ovarian (20%), and vulvar (4%) cancer., Methods: A self-report questionnaire and elicited demographic/medical data and qualitative data about women's experiences. Researchers also explored subjects' perceptions of the helpfulness of nurses, doctors, and social workers., Main Research Variables: Psychosocial and physical difficulties; informational, emotional, and practical support; personal coping strategies., Findings: Women described a range of psychosocial difficulties including depression, anxiety, and fear of dying. Physical side effects included fatigue, pain, bladder dysfunction, and vaginal problems. Women most often described emotional support from family members as assisting them to cope with difficulties. The most commonly described personal coping strategy was the use of positive thinking. Descriptions of how healthcare professionals were helpful reflected their roles within the healthcare system., Conclusions: Women's existing social supports may be most important in determining how they cope with gynecologic cancer. Patients may evaluate the assistance provided by healthcare professionals in relation to professional roles., Implications for Nursing Practice: Nurses are uniquely positioned to provide informational support to patients. However, patients' immediate difficulties and their perceptions of the nurse's role as helper may interfere with this process.