Symptom experiences in post-treatment cancer survivors: Associations with acceptance and commitment therapy constructs

Purpose: Acceptance and commitment therapy (ACT) has improved symptom and quality-of-life outcomes in pilot research with post-treatment cancer survivors. To further test the ACT model, the present study examined relationships between ACT constructs and subgroups of post-treatment survivors based on the severity of common symptoms. Methods: Survivors who had completed primary treatment for stage I or II cancer (N=203) participated in this one-time survey. Latent class analysis (LCA) was used to identify subgroups of survivors based on the severity of fatigue, sleep disturbance, pain, anxiety, and depressive symptoms. Multinomial logistic regressions employing Vermunt’s 3-step approach were used to examine ACT constructs (e.g., mindfulness, acceptance, values progress) as correlates of survivor subgroups based on symptoms. Results: LCA showed three survivor classes: (1) mild to moderate levels of all symptoms except for normal pain intensity, (2) mild anxiety, moderate fatigue, and normal levels of all other symptoms, and (3) normal levels of all symptoms. Lower mindfulness, acceptance, and values progress and higher cognitive fusion, psychological inflexibility, and values obstruction were associated with a greater likelihood of being in class 1 or 2 than class 3. Conclusion: Findings are consistent with the ACT model. Survivors with greater symptom burden reported greater withdrawal from personally meaningful activities and less acceptance of their cancer diagnosis and internal experiences (e.g., thoughts, feelings, symptoms). Findings provide strong justification for further testing of ACT to reduce symptom-related suffering in cancer survivors

Psychological Processes and Symptom Outcomes in Mindfulness-Based Stress Reduction for Cancer Survivors: A Pilot Study

Objectives Growing evidence supports the efficacy of mindfulness-based interventions for symptoms in cancer survivors. Identifying theory-based psychological processes underlying their effects on symptoms would inform research to enhance their efficacy and cost-effectiveness. We conducted secondary analyses examining the effect of mindfulness-based stress reduction (MBSR) for cancer-related fatigue on mindfulness facets, self-compassion, and psychological inflexibility. We also examined whether changes in these processes were associated with the symptom outcomes of fatigue interference, sleep disturbance, and emotional distress. Methods Thirty-five persistently fatigued cancer survivors (94% female, 77% breast cancer survivors) were randomized to either MBSR for cancer-related fatigue or a waitlist control (WC) condition. Self-report measures were administered at pre-intervention, post-intervention, and 1-month follow-up. Then the WC group received MBSR and completed a post-intervention follow-up. Results Linear mixed modeling analyses of the first three time points showed steady increases over time for certain mindfulness facets (observing, acting with awareness, and nonjudging) and self-compassion in favor of the MBSR group. When analyzing pre- and post-intervention data across study conditions, none of the psychological processes predicted change in fatigue interference. However, increased nonjudging was associated with decreased sleep disturbance (β = −.39, p = 0.003), and increased acting with awareness was associated with decreased emotional distress (β = − 0.36, p = 0.003). Self-compassion did not predict change in symptom outcomes. Conclusions Results point to specific psychological processes that may be targeted to maximize the efficacy of future MBSR interventions for cancer survivors

Mindfulness Training Supports Quality of Life and Advance Care Planning in Adults With Metastatic Cancer and Their Caregivers: Results of a Pilot Study

Background: Emotional distress often causes patients with cancer and their family caregivers (FCGs) to avoid end-of-life discussions and advance care planning (ACP), which may undermine quality of life (QoL). Most ACP interventions fail to address emotional barriers that impede timely ACP. Aim: We assessed feasibility, acceptability, and preliminary effects of a mindfulness-based intervention to facilitate ACP for adults with advanced-stage cancer and their FCGs. Design: A single-arm pilot was conducted to assess the impact of a 6-week group mindfulness intervention on ACP behaviors (patients only), QoL, family communication, avoidant coping, distress, and other outcomes from baseline (T1) to post-intervention (T2) and 1 month later (T3). Participants: Eligible patients had advanced-stage solid malignancies, limited ACP engagement, and an FCG willing to participate. Thirteen dyads (N = 26 participants) enrolled at an academic cancer center in the United States. Results: Of eligible patients, 59.1% enrolled. Attendance (70.8% across 6 sessions) and retention (84.6% for patients; 92.3% for FCGs) through T3 were acceptable. Over 90% of completers reported high intervention satisfaction. From T1 to T3, patient engagement more than doubled in each of 3 ACP behaviors assessed. Patients reported large significant decreases in distress at T2 and T3. Family caregivers reported large significant improvements in QoL and family communication at T2 and T3. Both patients and FCGs reported notable reductions in sleep disturbance and avoidant coping at T3. Conclusions: The mindfulness intervention was feasible and acceptable and supported improvements in ACP and associated outcomes for patients and FCGs. A randomized trial of mindfulness training for ACP is warranted

Relations of Mindfulness and Illness Acceptance With Psychosocial Functioning in Patients With Metastatic Breast Cancer and Caregivers

Objectives: To examine relationships in mindfulness and illness acceptance and psychosocial functioning in patients with metastatic breast cancer and their family caregivers. Sample & setting: 33 dyads from an academic cancer center in the United States. Methods & variables: Participants completed questionnaires on mindfulness, illness acceptance, relationship quality, anxiety, and depressive symptoms. Dyadic, cross-sectional data were analyzed using actor-partner interdependence models. Results: Greater nonjudging, acting with awareness, and illness acceptance among caregivers were associated with patients' and caregivers' perceptions of better relationship quality. Higher levels of these processes were associated with reduced anxiety and depressive symptoms in patients and caregivers. Implications for nursing: Aspects of mindfulness and illness acceptance in dyads confer benefits that are primarily intrapersonal in nature. Nurses may consider introducing mindfulness and acceptance-based interventions to patients and caregivers with adjustment difficulties

Psychological Processes and Symptom Outcomes in Cancer Survivors Following a Mindfulness-Based Stress Reduction Intervention

Mindfulness-based interventions targeting psychological and physical symptoms in cancer survivors have been shown to be efficacious. However, little is known about theory-based psychological processes through which mindfulness-based interventions may decrease symptoms. The present study is a secondary analysis of data from a mindfulness-based stress reduction (MBSR) pilot trial targeting cancer-related fatigue (CRF) in cancer survivors. Thirty-five persistently fatigued cancer survivors were recruited from a university hospital and various community clinics in Indianapolis, Indiana. Participants were randomized to either a 7-week MBSR intervention for CRF or a waitlist control (WC) condition. Measures were administered at pre-intervention, post-intervention, and 1-month follow-up and included levels of mindfulness, acceptance, and self-compassion as well as the symptom outcomes of fatigue interference, sleep disturbance, and distress. I hypothesized that MBSR would lead to increased levels of five facets of mindfulness (i.e., observing, describing, acting with awareness, nonjudging of inner experience, nonreactivity to inner experience), self-compassion, and acceptance as compared to the WC condition. Using a linear mixed modeling approach, significant group by time interactions were only found for observing, acting with awareness, nonjudging, and self-compassion, such that the MBSR group showed steady increases in these processes over time, whereas the WC group’s scores remained relatively stable. In addition, I examined whether positive changes in the five facets of mindfulness were associated with reductions in the three symptoms using multiple linear regression. This hypothesis was partially supported; acting with awareness was the only facet of mindfulness to show a modest association with a decrease in fatigue, but this result fell short of statistical significance. In addition, decreased sleep disturbance was predicted by increases in acting with awareness and nonjudging, while decreased distress was predicted by increases in observing, acting with awareness, nonjudging, and nonreactivity. Results point to specific psychological processes that may be targeted to maximize the efficacy of future MBSR interventions for cancer survivors

Development and Preliminary Validation of a Self-compassion Measure

Indiana University-Purdue University Indianapolis (IUPUI)Research and clinical interest in self-compassion has grown due to its positive links with a variety of physical and psychological health outcomes. This burgeoning interest calls for measures of self-compassion that are theoretically supported and empirically validated. The purpose of this project was to (1) develop a new self-compassion measure, the Self-compassion Inventory (SCI), and (2) test its psychometric properties. To obtain feedback on potential SCI items, a cognitive interviewing study was completed with cancer patients (n = 10). Qualitative findings suggested that, in most cases, items were easily understood and participants’ reasoning for their responses aligned with the intention of each item. After altering certain items based on participant feedback, the scale was then tested with a group of adults with breast, gastrointestinal, lung, and prostate cancer (n = 404). Confirmatory factor analyses suggested a unidimensional structure and internal consistency reliability was excellent. Construct validity of the measure was established through correlations with other psychological variables hypothesized to be related to self-compassion. Evidence of the incremental validity of the SCI relative to the Self-Compassion Scale Short-Form (SCS-SF) also was obtained. For example, the SCI showed smaller correlations with negative psychological variables (e.g., depressive symptoms, anxiety) than the SCS-SF. In supplemental analyses, a 5-item version of the measure, the Brief Self-compassion Inventory (BSCI) was tested and found to have a unidimensional structure, excellent internal consistency, and evidence of validity. Furthermore, measurement invariance testing of the BSCI indicated that the measure could be used across populations of varying genders, cancer types, and stages of illness. Through robust testing, the SCI and BSCI were determined to be psychometrically sound and can be used in both clinical and research settings

Development and preliminary validation of the Brief Self-Compassion Inventory.

Research and clinical interest in self-compassion has grown due to its associations with physical and mental health benefits. Widely used measures of self-compassion have conceptual and psychometric limitations that warrant attention. The purpose of this project was to develop a new self-compassion measure, the Brief Self-Compassion Inventory (BSCI), and test its psychometric properties. We developed items for the BSCI based on theory, prior research, and expert and cancer patient feedback. The BSCI was then tested with adults diagnosed with breast, gastrointestinal, lung, or prostate cancer (N = 404). Confirmatory factor analysis suggested a unidimensional structure, and internal consistency reliability was excellent. Construct validity of the BSCI was established through its correlations with psychological variables hypothesized to be related to self-compassion, such as mindfulness, acceptance of cancer, and other coping strategies. Furthermore, measurement invariance testing of the BSCI indicated that it could be used across patients of varying genders, cancer types, and stages of illness. In conclusion, the 5-item BSCI was determined to be psychometrically sound and suitable for use with adults of varying genders, cancer types, and stages of disease. The measure warrants testing with other medical and nonclinical populations

Zinc Regulates the Stability of Repetitive Minisatellite DNA Tracts During Stationary Phase

Repetitive minisatellite DNA tracts are stable in mitotic cells but unstable in meiosis, altering in repeat number and repeat composition. As relatively little is known about the factors that influence minisatellite stability, we isolated mutations that destabilize a minisatellite repeat tract in the ADE2 gene of Saccharomyces cerevisiae. One mutant class exhibited a novel color segregation phenotype, “blebbing,” characterized by minisatellite instability during stationary phase. Minisatellite tract alterations in blebbing strains consist exclusively of the loss of one 20-bp repeat. Timing experiments suggest that these tract alterations occur only after cells have entered stationary phase. Two complementation groups identified in this screen have mutations in either the high-affinity zinc transporter ZRT1 or its zinc-dependent transcriptional regulator ZAP1. The Δzrt1 mutant specifically affects the stability of minisatellite tracts; microsatellites or simple insertions in the ADE2 reading frame are not destabilized by loss of ZRT1. The Δzrt1 blebbing phenotype is partially dependent on a functional RAD50. Zinc is known for its role as an essential cofactor in many DNA-binding proteins. We describe possible models by which zinc can influence minisatellite stability. Our findings directly implicate zinc homeostasis in the maintenance of genomic stability during stationary phase

The role of gratitude in spiritual well-being in asymptomatic heart failure patients.

Spirituality and gratitude are associated with wellbeing. Few if any studies have examined the role of gratitude in heart failure (HF) patients or whether it is a mechanism through which spirituality may exert its beneficial effects on physical and mental health in this clinical population. This study examined associations bet ween gratitude, spiritual wellbeing, sleep, mood, fatigue, cardiac-specific self-efficacy, and inflammation in 186 men and women with Stage B asymptomatic HF (age 66.5 years ±10). In correlational analysis, gratitude was associated with better sleep (r=-.25, p<0.01), less depressed mood (r=-.41, p<0.01), less fatigue (r=-.46, p<0.01), and better self-efficacy to maintain cardiac function (r=.42, p<0.01). Patients expressing more gratitude also had lower levels of inflammatory biomarkers (r=-.17, p<0.05). We further explored relationships among these variables by examining a putative pathway to determine whether spirituality exerts its beneficial effects through gratitude. We found that gratitude fully mediated the relationship between spiritual wellbeing and sleep quality (z=−2.35, SE=.03, p=.02) and also the relationship between spiritual wellbeing and depressed mood (z=−4.00, SE=.075, p<.001). Gratitude also partially mediated the relationships between spiritual wellbeing and fatigue (z=−3.85, SE=.18, p<.001), and between spiritual wellbeing and self-efficacy (z=2.91, SE=.04, p=.003). In sum, we report that gratitude and spiritual wellbeing are related to better mood and sleep, less fatigue, and more self-efficacy, and that gratitude fully or partially mediates the beneficial effects of spiritual wellbeing on these endpoints. Efforts to increase gratitude may be a treatment for improving wellbeing in HF patients’ lives and be of potential clinical value

The Role of Gratitude in Spiritual Well-Being in Asymptomatic Heart Failure Patients

Spirituality and gratitude are associated with wellbeing. Few if any studies have examined the role of gratitude in heart failure (HF) patients or whether it is a mechanism through which spirituality may exert its beneficial effects on physical and mental health in this clinical population. This study examined associations bet ween gratitude, spiritual wellbeing, sleep, mood, fatigue, cardiac-specific self-efficacy, and inflammation in 186 men and women with Stage B asymptomatic HF (age 66.5 years ±10). In correlational analysis, gratitude was associated with better sleep (r=-.25, p&lt;0.01), less depressed mood (r=-.41, p&lt;0.01), less fatigue (r=-.46, p&lt;0.01), and better self-efficacy to maintain cardiac function (r=.42, p&lt;0.01). Patients expressing more gratitude also had lower levels of inflammatory biomarkers (r=-.17, p&lt;0.05). We further explored relationships among these variables by examining a putative pathway to determine whether spirituality exerts its beneficial effects through gratitude. We found that gratitude fully mediated the relationship between spiritual wellbeing and sleep quality (z=-2.35, SE=.03, p=.02) and also the relationship between spiritual wellbeing and depressed mood (z=-4.00, SE=.075, p&lt;.001). Gratitude also partially mediated the relationships between spiritual wellbeing and fatigue (z=-3.85, SE=.18, p&lt;.001), and between spiritual wellbeing and self-efficacy (z=2.91, SE=.04, p=.003). In sum, we report that gratitude and spiritual wellbeing are related to better mood and sleep, less fatigue, and more self-efficacy, and that gratitude fully or partially mediates the beneficial effects of spiritual wellbeing on these endpoints. Efforts to increase gratitude may be a treatment for improving wellbeing in HF patients' lives and be of potential clinical value