BODY IMAGE AND SEXUAL FUNCTIONING IN BREAST CANCER SURVIVORS

Background: For breast cancer survivors, sexual problems are one of the most common and distressing sequelae of cancer and its treatment. However, sexual problems are often undiagnosed and untreated. One potentially important, but understudied, risk factor for poor sexual adjustment after breast cancer is body image concern. For example, physical changes in appearance as a result of cancer treatment may alter how women perceive themselves and their bodies which may in turn increase risk for sexual problems. Therefore, the current study was designed to evaluate whether body image predicted sexual dysfunction and sexual dissatisfaction following breast cancer. In addition, mediation analyses evaluated body image as a mediator of the relationship between number of cancer-related changes in appearance and sexual dissatisfaction and sexual dysfunction. Mediation analyses also examined body image concerns during sexual activity as a mediator of the relationship between body image concerns and sexual dissatisfaction and dysfunction.   Methods: A sample of 219 U.S. breast cancer survivors was recruited via breast cancer websites, blogs, and social media websites to complete an online self-report survey about body image and sexual functioning after diagnosis and treatment for breast cancer.   Results: Participants' mean age was 47.3 years with an average time since diagnosis of 4.4 years. Women were predominantly European American, married, and diagnosed with Stage I or II breast cancer. On average, women in this sample experienced 6.1 (SD = 2.2) changes in their physical appearance due to cancer treatment, such as hair loss, breast disfigurement and changes to their skin. Sexual problems were common with 69% (n = 72) of sexually active survivors (n = 104) meeting criteria for sexual dysfunction. High levels of body image concerns were also reported. In regression analyses, medical treatment variables, general distress, and body image variables predicted sexual dissatisfaction, whereas only medical treatment variables and general distress predicted sexual dysfunction. Results from mediation analyses indicated that body image mediated the relationship between having a greater number of cancer-related changes in appearance and lower levels of post-treatment sexual dissatisfaction. Two of the body image variables also significantly mediated the relationship between experiencing a greater number of changes in appearance and post-treatment sexual dysfunction. Finally, higher levels of body image concern during sexual activity mediated the relationship between body image and sexual dysfunction as well as sexual dissatisfaction.  Conclusion: Overall, results suggest that body image concerns and sexual problems are prevalent and distressing for a majority of women diagnosed and treated for breast cancer. Many women also experience multiple changes in their physical appearance. In addition, body image concerns may be amplified in a sexual context due to the increased exposure of one's body during sexual activity. Implications for further research, routine assessment, and clinical management of these symptoms are discussed.  M.A

Measurement of Patient Confidence in Self-Management of Atrial Fibrillation: Initial Validation of The Confidence in Atrial fibriLlation Management (CALM) Scale

BACKGROUND: The patient experience of atrial fibrillation (AF) involves several daily self-care behaviors and ongoing confidence to manage their condition. Currently, no standardized self-report measure of AF patient confidence exists. The purpose of this study is to provide preliminary support for the reliability and validity of a newly developed confidence in AF management measure. METHODS: This study provides preliminary analysis of the Confidence in Atrial FibriLlation Management (CALM) scale, which was rationally developed to measure patient confidence related to self-management of AF. The scale was provided to a sample of AF patients N=120, (59% male) electronically through a patient education platform. Principle components analysis (PCA) and Cronbach’s alpha were employed to provide preliminary assessment of the validity and reliability of the measure. RESULTS: PCA identified a four-factor solution. Internal consistency of the CALM was considered excellent with Cronbach’s α = .910. Additional PCA confirmed the value of a single factor solution to produce a total confidence score for improved utility and ease of clinical interpretation. CONCLUSIONS: Initial assessment of a novel scale measuring patient confidence in managing AF provided promising reliability and validity. Patient confidence in self-management of AF may prove useful as a key marker and endpoint of the patient experience beyond QOL

Defibrillator Shocks and Their Impact on Objective and Subjective Patient Outcomes: Results from the Painfree SST Clinical Trial

BACKGROUND: The impact of ICD shock on device-measured activity and patient reported outcomes is unknown. OBJECTIVE: The purpose of this study was to analyze the acute and long-term effects of ICD shock on objective behavioral data (i.e., device-based physical activity) and subjective patient reported outcomes (e.g., quality of life and shock anxiety). METHODS: The PainFree SST clinical trial included 2,770 patients with a single or dual-chamber ICD, or cardiac resynchronization defibrillator (CRT-D) who were followed for 22 ± 9 months. Participants completed measures of quality of life (EuroQol 5-D [EQ5D]) and shock anxiety (Florida Shock Anxiety Scale [FSAS]) at baseline, bi-annual visits, and monthly for 6 months following an ICD shock. Daily physical activity data were obtained from a built-in device accelerometer. RESULTS: Average daily activity was 185.3 ± 119.4 minutes/day. Activity was significantly reduced after an ICD shock (p<0.0001) and recovered to a normal level after approximately 90 days. ICD shock was also associated with decreased quality of life (EQ5D Health Score) and increased EQ5D anxiety scores, but it did not impact mobility, self-care, activity, or pain. Similarly, shock anxiety (FSAS) increased in shocked patients and remained significantly elevated at 24 months, regardless of appropriate or inappropriate shock delivery. CONCLUSIONS: ICD shocks have a long-lasting, adverse impact on both objective, device-measured physical activity and subjective patient reported outcomes of quality of life and shock anxiety. Successful management of ICD patients requires attention to clinically relevant behavioral and psychological outcomes to expedite recovery and return to activities of daily living

Development of the Peripartum Cardiomyopathy Quality Of Life Registry

Peripartum cardiomyopathy (PPCM) is a relatively rare form of heart failure that develops in young women in the third trimester of pregnancy or during the postpartum period. Despite its potentially devastating impact on new mothers and their families, no prior studies have evaluated the extent to which PPCM and its treatment negatively affect survivors' long-term physical health and emotional recovery. The current study sought to develop a prospective online research registry to examine clinically relevant behavioral and psychosocial outcomes in women with PPCM. A conceptual model was also developed and used to evaluate predictors of depression. Seventy-five PPCM patients (mean age of 35.0 years, SD = 5.8 years) enrolled in the registry. Among PPCM patients in this sample, 35% endorsed symptoms of clinical depression which was associated with worse adherence to scheduled medical appointments. More than half the women in this cohort (52%) endorsed clinical levels of generalized anxiety. High levels of cardiac anxiety, good maternal social support, poor adherence to heart failure self-care behaviors and reproductive risk behaviors were also found. Finally, multivariate analyses revealed that physical health significantly predicted depression (p = 0.004). The addition of generalized anxiety and disease-specific distress to the regression model significantly increased R2 (p [less than] 0.001) and explained an additional 38.1% of the variation in depression. Demographic factors and disease severity were not significantly associated with depression. In sum, data from this study support the prevalence and persistence of adverse behavioral and psychosocial outcomes in women with PPCM. Further research, assessment and intervention is warranted to facilitate patient education and improve patient care

Development of the Peripartum Cardiomyopathy Quality Of Life Registry

Peripartum cardiomyopathy (PPCM) is a relatively rare form of heart failure that develops in young women in the third trimester of pregnancy or during the postpartum period. Despite its potentially devastating impact on new mothers and their families, no prior studies have evaluated the extent to which PPCM and its treatment negatively affect survivors' long-term physical health and emotional recovery. The current study sought to develop a prospective online research registry to examine clinically relevant behavioral and psychosocial outcomes in women with PPCM. A conceptual model was also developed and used to evaluate predictors of depression. Seventy-five PPCM patients (mean age of 35.0 years, SD = 5.8 years) enrolled in the registry. Among PPCM patients in this sample, 35% endorsed symptoms of clinical depression which was associated with worse adherence to scheduled medical appointments. More than half the women in this cohort (52%) endorsed clinical levels of generalized anxiety. High levels of cardiac anxiety, good maternal social support, poor adherence to heart failure self-care behaviors and reproductive risk behaviors were also found. Finally, multivariate analyses revealed that physical health significantly predicted depression (p = 0.004). The addition of generalized anxiety and disease-specific distress to the regression model significantly increased R2 (p [less than] 0.001) and explained an additional 38.1% of the variation in depression. Demographic factors and disease severity were not significantly associated with depression. In sum, data from this study support the prevalence and persistence of adverse behavioral and psychosocial outcomes in women with PPCM. Further research, assessment and intervention is warranted to facilitate patient education and improve patient care

Measurement of patient confidence in self‐management of atrial fibrillation: Initial validation of the Confidence in Atrial fibriLlation Management (CALM) Scale

BACKGROUND: The patient experience of atrial fibrillation (AF) involves several daily self-care behaviors and ongoing confidence to manage their condition. Currently, no standardized self-report measure of AF patient confidence exists. The purpose of this study is to provide preliminary support for the reliability and validity of a newly developed confidence in AF management measure. METHODS: This study provides preliminary analysis of the Confidence in Atrial FibriLlation Management (CALM) scale, which was rationally developed to measure patient confidence related to self-management of AF. The scale was provided to a sample of AF patients N=120, (59% male) electronically through a patient education platform. Principle components analysis (PCA) and Cronbach’s alpha were employed to provide preliminary assessment of the validity and reliability of the measure. RESULTS: PCA identified a four-factor solution. Internal consistency of the CALM was considered excellent with Cronbach’s α = .910. Additional PCA confirmed the value of a single factor solution to produce a total confidence score for improved utility and ease of clinical interpretation. CONCLUSIONS: Initial assessment of a novel scale measuring patient confidence in managing AF provided promising reliability and validity. Patient confidence in self-management of AF may prove useful as a key marker and endpoint of the patient experience beyond QOL

Psychiatric history, post-discharge distress, and personality characteristics among incident female cases of takotsubo cardiomyopathy: A case-control study

BACKGROUND: The role of psychological factors in the onset of takotsubo cardiomyopathy (TC) is still controversial. Associations with previous psychiatric conditions are registry-based; associations with personality characteristics and psychological sequelae of TC have been largely unexplored. This case-control study sought to study pre-admission psychiatric morbidity, personality traits, and post-discharge distress in incident cases of TC. METHODS: TC cases (Mayo clinic criteria) and acute myocardial infarction (MI) controls were recruited among women admitted to two Emergency Departments in New England. Healthy controls (HC) were recruited from a volunteers\u27 registry. Preadmission psychiatric history (DSM-IV-TR) was abstracted from the medical record. PTSD symptoms (Impact of Events Scale); distress (Hospital Anxiety and Depression Scale); perceived stress (PS scale) and personality traits (optimism; hostility, type D personality) were collected via phone interview one month after discharge. RESULTS: From March 2013 through October 2015, 107 participants (45 TC, 32 MI and 30 HC) were enrolled. The prevalence of preadmission anxiety disorders was 24.4% in TC, 9.4% in MI, and 0 in HC (p = 0.007) while that of mood disorders was similar across groups. TC had higher psychological distress, perceived stress, and PTSD symptoms post-discharge vs. MI and HC. In adjusted models, PTSD symptoms remained higher in TC vs. MI (b = 0.55, p \u3c 0.05) and vs. HC (b = 0.92, p \u3c 0.01). Optimism and hostility scores were similar across groups, while type D (social inhibition) scores were higher in TC and MI vs. HC. CONCLUSIONS: Preadmission anxiety, but not depression, was associated with the occurrence of TC. High distress and PTSD symptoms post-discharge indicate that TC women may be at risk for poor psychological adjustment