Dyadic Coping in Patients Undergoing Radiotherapy for Head and Neck Cancer and Their Spouses

Background: Head and neck cancer (HNC) adversely affects the psychological (i.e., depression, anxiety) and marital adjustment of patients and their spouses. Dyadic coping refers to how couples cope with stress. It includes positive actions like sharing practical or emotional concerns (i.e., problem- and emotion-focused stress communication; PFSC, EFSC), and engaging in problem- or emotion-focused actions to support each other (problem- and emotion-focused dyadic coping; PFDC, EFDC). It also includes negative actions like avoidance (negative dyadic coping; NEGDC). In this secondary analysis of a randomized pilot trial of a couple-based intervention called SHARE (Spouses coping with the Head And neck Radiation Experience), we first examined associations between patients’ and spouses’ dyadic coping (and satisfaction with dyadic coping; SATDC) and their own/each other’s psychological and marital adjustment. Next, we examined the effects of SHARE relative to usual medical care (UMC) on patients’ and spouses’ dyadic coping. Finally, we examined whether changes in dyadic coping were associated with changes in patients’ and spouses’ psychological and marital adjustment.Methods and Measures: Thirty HNC patients (80% men) and their spouses (N = 60) completed baseline surveys prior to initiating radiotherapy (RT) and were randomized to SHARE or UMC. One month after RT, they completed follow-up surveys.Results: Baseline multilevel Actor-Partner Interdependence Models revealed significant actor effects of PFSC (effect size r = −0.32) and PFDC (r = −0.29) on depression. For marital adjustment, significant actor effects were found for PFSC, PFDC, EFDC, and SATDC (p < 0.05, r = 0.23 to 0.38). Actor (r = −0.35) and partner effects (r = −0.27) for NEGDC were also significant. Moderate to large effect sizes were found in favor of SHARE on PFSC (Cohen’s d = 1.14), PFDC (d = 0.64), NEGDC (d = −0.68), and SATDC (d = 1.03). Improvements in PFDC were associated with reductions in depression and anxiety (p < 0.05); and, improvements in SATDC were associated with improvements in anxiety and marital adjustment (p < 0.05).Conclusion: The SHARE intervention improved positive and decreased negative dyadic coping for patients and spouses. Increases in positive dyadic coping were also associated with improvements in psychological and marital adjustment. Although findings are preliminary, more research on ways to integrate dyadic coping into oncology supportive care interventions appears warranted

Effects of diet and exercise on weight-related outcomes for breast cancer survivors and their adult daughters: an analysis of the DAMES trial

Purpose Few trials have aimed to promote diet and exercise behaviors in both cancer survivors and their family members and examine their associations with weight-related outcomes. We conducted a secondary analysis to examine associations between change in diet and exercise behaviors and weight-related outcomes for overweight breast cancer survivors and their overweight adult daughters in the Daughters And MothErS Against Breast Cancer (DAMES) randomized trial. Methods The DAMES trial assessed the impact of two iteratively tailored, mailed print diet and exercise interventions against standard brochures over a 12-month period. This analysis examined change in diet and exercise behaviors and weight-related variables from baseline to post-intervention for the 50 breast cancer survivors and their adult daughters randomized to the intervention arms. To reduce the potential for type II error in this pilot, p values <0.10 were considered statistically significant. Results For mothers, change in diet quality was uniquely related to change in BMI (β = −0.12, p = 0.082), weight (β = −0.12, p = 0.060), and waist circumference (β = −0.38, p = 0.001), whereas change in caloric intake was related to waist circumference (β = 0.21, p = 0.002). For daughters, change in caloric intake was related to change in waist circumference (β = 0.12, p = 0.055). However, change in diet quality was not associated with weight-related outcomes in daughters. Additionally, change in exercise was not associated with weight-related outcomes in mothers or daughters. Conclusions Findings support mail-based and other tailored interventions for weight loss in this population, with an emphasis on diet quality for breast cancer survivors and caloric intake for their adult daughters

Survivorship Care For Women Living With Ovarian Cancer: Protocol For a Randomized Controlled Trial

BACKGROUND: Ovarian cancer ranks 12th in cancer incidence among women in the United States and 5th among causes of cancer-related death. The typical treatment of ovarian cancer focuses on disease management, with little attention given to the survivorship needs of the patient. Qualitative work alludes to a gap in survivorship care; yet, evidence is lacking to support the delivery of survivorship care for individuals living with ovarian cancer. We developed the POSTCare survivorship platform with input from survivors of ovarian cancer and care partners as a means of delivering patient-centered survivorship care. This process is framed by the chronic care model and relevant behavioral theory. OBJECTIVE: The overall goal of this study is to test processes of care that support quality of life (QOL) in survivorship. The specific aims are threefold: first, to test the efficacy of the POSTCare platform in supporting QOL, reducing depressive symptom burden, and reducing recurrence worry. In our second aim, we will examine factors that mediate the effect of the intervention. Our final aim focuses on understanding aspects of care platform design and delivery that may affect the potential for dissemination. METHODS: We will enroll 120 survivors of ovarian cancer in a randomized controlled trial and collect data at 12 and 24 weeks. Each participant will be randomized to either the POSTCare platform or the standard of care process for survivorship. Our population will be derived from 3 clinics in Texas; each participant will have received some combination of treatment modalities; continued maintenance therapy is not exclusionary. RESULTS: We will examine the impact of the POSTCare-O platform on QOL at 12 weeks after intervention as the primary end point. We will look at secondary outcomes, including depressive symptom burden, recurrence anxiety, and physical symptom burden. We will identify mediators important to the impact of the intervention to inform revisions of the intervention for subsequent studies. Data collection was initiated in November 2023 and will continue for approximately 2 years. We expect results from this study to be published in early 2026. CONCLUSIONS: This study will contribute to the body of survivorship science by testing a flexible platform for survivorship care delivery adapted for the specific survivorship needs of patients with ovarian cancer. The completion of this project will contribute to the growing body of science to guide survivorship care for persons living with cancer. TRIAL REGISTRATION: ClinicalTrials.gov NCT05752448; https://clinicaltrials.gov/study/NCT05752448. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/48069

In vitro and in vivo assessment of lead toxicity on mammalian female reproduction and effect of antioxidants

Heavy metals are among the environmental toxicants incurring great concern for human and animals because of their toxicity even at low concentrations. Lead (Pb) has been shown to induce severe and long lasting effects on female fertility and pregnancy outcomes in many animal species. The aim of this work was to investigate the effect of Pb on bovine granulosa cells (GCs) and preimplantation embryos and its association with dysregulation of Nrf2 and NF-κB and their downstream genes. We further aimed to study the role of in utero Pb exposure and the possibility of using antioxidant as prophylactic agent against Pb toxicity using rat model. For this, three experiments were conducted. First, in vitro cultured GCs were exposed to Pb toxicity which subsequently attenuated GCs proliferation and altered the cell cycle progression. Lead exposure suppressed the expression of both Nrf2 and NF-κB and their downstream genes. Additionally, Pb challenge on GCs increased the expression of endoplasmic reticulum stress marker genes (GRP78 and CHOP) and the pro-apoptotic gene (caspase-3), while the anti-apoptotic gene (BCL-2) was reduced. Furthermore, treatment of bovine preimplantation embryos with Pb in a stage specific manner resulted in similar phenotypes. Blastocysts derived from different treatment groups exhibited aberrant developmental phenotypes regardless of the exposure stage. Exposure to Pb caused higher accumulation of ROS and reduced blastocyst cell number. Besides, the mRNA and protein levels of NF-κB were elevated with Pb treatment along with TNF-α level. On the contrary, the expression of Nrf2 protein showed significant reduction in all treatment groups. Apoptosis under Pb exposure was manifested by the higher ratio of BAX/BCL-2 and the number of TUNEL positive nuclei as compared to the control blastocysts. Moreover, Pb significantly upregulated DNMT1, a gene involved in maintenance of DNA methylation. In order to investigate the effect of Pb toxicity in vivo, pregnant rats were orally ingested by Pb during the period of organogenesis, while the natural antioxidant, taurine (TA) was given throughout the gestation period. The dams and their fetuses were checked for morphological, biochemical and histopatholgical parameters. Results showed that, Pb caused a significant decline in the maternal body weight gain and an increase in the rate of abortion. Fetuses maternally-received Pb showed growth retardation and malformations in their skeleton. Additionally, Pb induced hematological and biochemical impairments in both dams and fetuses. Histopathological examination of the placenta and hepatic DNA fragmentation revealed the toxicity of Pb. However, these events have been alleviated by TA pretreatment without affecting the normal course of pregnancy. The present work demonstrates that Pb-induced oxidative stress displayed direct deleterious effect on bovine GCs proliferation and preimplantation embryo development. This effect may be in part through disrupting the Nrf2/NF-κB interaction and could vary according to the dose, the period of exposure and the type of cells. It is quite evident that even small doses of Pb are reprotoxic where the soundest approach is to minimize Pb exposure in vivo rather than treatment. Administration of antioxidants such as taurine could be promising approach to be used as a prophylactic agent against environmental heavy metals

Gender Differences in Coping and Psychological Adaptation during the COVID-19 Pandemic

This population-based study investigated gender differences in the use of coping strategies and their relationship to anxiety symptoms during the initial COVID-19 lockdown period in the United States. A national online survey was administered between 13 April 2020 and 8 June 2020. The study sample comprised 1673 respondents (66% women). Overall, 46% reported high levels of anxiety, and women experienced significantly (p p p = 0.001). Additionally, women engaging in high levels of acceptance and positive reframing reported significantly lower anxiety levels than when engag-ing in low levels of acceptance (b1 = −1.03, t = −4.58, p p < 0.001). No significant associations between acceptance and positive reframing levels and anxiety levels were found with men. Overall, these findings extend our understanding of the nature of gender differences in stress responsivity during periods of high psychological distress and can inform the development of mental health interventions to respond to the COVID-19 pandemic and future infectious disease outbreaks

Balancing Work and Cancer Care: Challenges Faced by Employed Informal Caregivers

Individuals with cancer commonly rely on their informal caregivers (e.g., spouse/partner, family member, close friend) to help them manage the demands of the disease and its treatment. Caregiving, including helping with patient care, performing household chores, and providing emotional and practical support, can be particularly demanding for employed caregivers, who must juggle their work responsibilities while providing care. Although a burgeoning literature describes the toll that balancing these oft-competing demands can exact, few resources exist to support employed cancer caregivers. To address this gap, we conducted a narrative review of the impacts of cancer on employed caregivers. We found that employed caregivers experience significant financial impacts in terms of lost time and income. They also experience a variety of work-related (e.g., reduced productivity, absenteeism) and mental health (e.g., stress, burden) impacts. Going forward, prospective studies are needed to characterize changes in caregiver support needs and preferences at different time points along the cancer care continuum (e.g., at diagnosis, during treatment, end-of-life) so that appropriate workplace accommodations can be provided. More population-based studies are also needed to develop models for identifying caregivers who are at increased risk for poor employment or mental health outcomes so that more targeted support programs can be developed. Ultimately, a multipronged effort on behalf of employers, healthcare, and community-based organizations may be needed to support and empower this vulnerable subgroup

Psychosocial and health behavioural impacts of COVID-19 pandemic on adults in the USA: protocol for a longitudinal cohort study

Introduction Although social distancing may help contain the spread of COVID-19, the social isolation and loneliness it causes can heighten stress, contribute to unhealthy lifestyle behaviours and have deleterious effects on social relationships. This ongoing longitudinal cohort study aims to (1) characterise the psychological, social and health behavioural impacts of the COVID-19 pandemic over a 12-month period in the USA; (2) determine whether these impacts differ for certain subgroups based on sociodemographics and other individual-level factors; and (3) explore whether there are modifiable factors (eg, coping, social support) that moderate the effects of the pandemic over time.Methods and analysis Adults (aged ≥18 years) who were fluent in either English or Spanish were recruited via social media and invited to complete an online survey during the 8-week period from 13 April to 8 June 2020 (baseline). Follow-up surveys will be conducted 6 and 12 months after baseline. Data transformations, non-parametric tests or other alternative methods will be used when appropriate. Descriptive statistics and cross-sectional analyses will be performed. Longitudinal associations will be analysed using multilevel modelling with time-variant and time-invariant predictors of change in trajectory over the study period.Ethics and dissemination Research ethics approval was received from the Baylor College of Medicine Institutional Review Board (H-47505). Overall, this study will provide timely information that can be used to inform public health messaging strategies and guide development of assessment tools and interventions to support vulnerable individuals dealing with the long-term impacts of the COVID-19 pandemic

Unilateral erector spinae plane block versus intravenous morphine for postoperative analgesia after Percutaneous nephrolithotomy. A randomized controlled trial

Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Percutaneous nephrolithotomy PCNL surgeries are usually associated with acute postoperative pain. Ultrasound guided nerve block is considered a recent technique for pain management. it provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Erector spinae plane (ESP) block is a novel method of delivering postoperative analgesia after PCNL surgery, technique involves injecting local anaesthetic into the interfascial plane between the erector spinae muscle and the transverse processes.and is therefore devoid of major adverse effects like pneumothorax, spinal cord trauma, and hypotension that can occur with other types of blocks like thoracic paravertebral block (TPVB). The goal of this research was to determine the analgesic efficacy and safety of ultrasound-guided ESP. block done at T8 transverse process level in patients undergoing PCNL surgeries for intraoperative and postoperative analgesia