Optimizing the measurement of health‐related quality of life in adolescents and young adults with cancer

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163469/2/cncr33155.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163469/1/cncr33155_am.pd

Change in longitudinal trends in sleep quality and duration following breast cancer diagnosis: results from the Women's Health Initiative

Breast cancer survivors frequently report sleep problems, but little research has studied sleep patterns longitudinally. We examined trends in sleep quality and duration up to 15 years before and 20 years after a diagnosis of breast cancer, over time among postmenopausal women participating in the Women's Health Initiative (WHI). We included 12,098 participants who developed invasive breast cancer after study enrollment. A linear mixed-effects model was used to determine whether the time trend in sleep quality, as measured by the WHI Insomnia Rating Scale (WHIIRS), a measure of perceived insomnia symptoms from the past 4 weeks, changed following a cancer diagnosis. To examine sleep duration, we fit a logistic regression model with random effects for both short (<6 h) and long (≥9 h) sleep. In addition, we studied the association between depressive symptoms and changes in WHIIRS and sleep duration. There was a significantly slower increase in the trend of WHIIRS after diagnosis (β = 0.06; p = 0.03), but there were non-significant increases in the trend of the probability of short or long sleep after diagnosis. The probability of depressive symptoms significantly decreased, though the decrease was more pronounced after diagnosis (p < 0.01). Trends in WHIIRS worsened at a relatively slower rate following diagnosis and lower depression rates may explain the slower worsening in WHIIRS. Our findings suggest that over a long period of time, breast cancer diagnosis does not adversely affect sleep quality and duration in postmenopausal women compared to sleep pre-diagnosis, yet both sleep quality and duration continue to worsen over time.WHI - National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services [HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, HHSN268201600004C]; Ohio State University Susan G Komen Graduate Trainee Program [GTDR15334082]Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Positive Psychosocial Functioning in Later Life: Use of Meaning-Based Coping Strategies by Nursing Home Residents

This study examined factors associated with positive psychosocial functioning in 94 cognitively intact nursing home residents reporting poor physical health. It was hypothesized that greater use of meaning-based coping strategies would be associated with higher levels of positive psychosocial functioning. Participants completed an interview containing measures of coping, affect, psychological well-being, depression, and activities of daily living. Findings suggest that meaning-based coping variables (positive reappraisal, perceived uplifts) accounted for significant variance in positive psychosocial variables but not distress variables. In contrast, physical health variables accounted for significant variance in distress but not positive psychosocial variables. Results support the view that the absence of distress does not necessarily imply optimal mental health. Thus, a comprehensive assessment of mental health in older adults requires inclusion of indices of both positive and negative psychological and social functioning

A randomized preference trial of cognitive-behavioral therapy and yoga for the treatment of worry in anxious older adults

Background: Worry is a common problem among older adults. Cognitive-behavioral therapy is the most studied nonpharmacological intervention and it has demonstrated efficacy in reducing late-life worry and anxiety. Although the evidence-base is smaller, yoga has been shown to reduce anxiety and stress. However, little is known about the relative effectiveness of these two nonpharmacological interventions. Further, the impact of patient preference on outcomes is unknown.Purpose: The purpose to this study is to compare the effectiveness of cognitive-behavioral therapy (CBT) with yoga for improving late-life worry, anxiety, and sleep. We will also examine the effects of preference and selection on outcomes, adherence, and attrition. Methods: We are conducting a two-stage randomized preference trial comparing CBT and yoga for the reduction of worry in a sample of anxious older adults. Five hundred participants will be randomized to either the preference trial (participants choose the intervention; N = 250) or to the randomized trial (participants are randomized to one of the two interventions; N = 250) with equal probability. CBT consists of 10 telephone-based sessions with an accompanying workbook. Yoga consists of 10 weeks of group yoga classes (twice a week) that is modified for use with older adults. Conclusions: The study design is based on feedback from anxious older adults who wanted more nonpharmacological options for intervention as well as more input into the intervention they receive. It is the first head-to-head comparison of CBT and yoga for reducing late-life worry and anxiety. It will also provide information about how intervention preference affects outcomes. Trial registration: ClinicalTrials.gov NCT02968238. Keywords: Randomized preference trial, Late-life anxiety, Cognitive-behavioral therapy, Yog

A longitudinal investigation of coping strategies and quality of life among younger women with breast cancer

It is generally assumed that coping strategies impact quality of life (QOL). It is plausible that QOL determines use of coping strategies. This research examines coping strategies over time and the reciprocal relationship between coping strategies and QOL among younger women with breast cancer. Women with breast cancer (N = 267; mean age = 43 years) completed surveys within 6 months of diagnosis and 6 weeks and 6 months later. Surveys included questions on coping strategies, QOL, medical factors, and sociodemographics. Positive cognitive restructuring was the most frequently used strategy. Over time, use of seeking social support, spirituality, and wishful thinking declined, while detachment increased. Prior QOL predicted three subsequent coping strategies (seeking social support, keeping feelings to self, wishful thinking). Coping strategies were minimally related to subsequent QOL. Coping strategies and QOL are dynamic processes. QOL may predict coping strategies equally or more than vice versa

Impact of Criteria-Based Diagnosis of Burning Mouth Syndrome on Treatment Outcome

AIMS: Burning mouth syndrome (BMS) primarily affects postmenopausal women and is often difficult to treat successfully. Treatment outcomes have been problematic because of failure to distinguish between patients with BMS and patients presenting with oral burning (OB) resulting from other clinical abnormalities. The purpose of this study was to determine characteristics that might uniquely identify BMS patients from patients with OB and to determine whether proper classification influences treatment outcome. METHODS: The clinical sample consisted of 69 patients (83% female) with an average age of 62 years, pain duration of 2.45 years, and visual analog scale pain rating of 49 mm (rated from 0 to 100 mm). All patients underwent a clinical exam and completed the Multidimensional Pain Inventory and Symptom Checklist 90-Revised. RESULTS: There were no differences between the BMS and OB groups with respect to age, pain duration, pain intensity, life interference, and levels of psychologic distress. Patients with OB demonstrated more clinical abnormalities than BMS patients. Hyposalivation and greater use of prescription medications, most notably hormone replacement therapy, were more common in the OB group compared with the BMS group. When treatment was provided that corrected an identifiable abnormality, significantly more OB than BMS patients reported greater than 50% relief from baseline pain rating. CONCLUSION: These data indicate that while BMS and OB groups may initially present with similar clinical and psychosocial features, they are distinguishable with careful diagnosis that often enables successful management of symptoms for each group