CAPO Digest

CAPO Digests are summaries of recent psychosocial oncology research which have published in peer-reviewed journals in and out of the main psychosocial oncology outlets that may be of interest to CAPO members. We hope you enjoy these Digests. If you are interested in submitting a CAPO Digest please contact the CAPO office at [email protected].


  • 15 Aug 2018 2:07 PM | Anonymous

    Digest Commentator: Marguerite Gollish, B.A., University of Ottawa

    Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    Latino cancer patients present a higher risk for poor mental health outcomes than non-Latino whites, with higher rates of depressive symptoms for Latinas with breast cancer. Given these results, it is concerning that Latinos are also less likely than non-Latino whites to receive treatment and services to improve these outcomes. The study by Costas-Muniz and colleagues aimed to investigate interest in and self-reported use of psychosocial services before and after a breast cancer diagnosis, comparing groups of Latina and non-Latina white cancer survivors.

    Methods: A questionnaire was mailed to 409 Latina and 514 non-Latina white breast cancer survivors who were in remission and who had received treatment at a single comprehensive oncology centre in the United States. Ninety-seven Latinas and 168 non-Latina white patients returned the questionnaire with an overall response rate of 30%. The questionnaire contained demographic and medical items, and self-reported use of psychosocial services before and after the cancer diagnosis. The type of service and type of professional was assessed, as well as frequency of service use.

    Results: Both Latinas and non-Latina white breast cancer survivors had similar rates of contact with a psychological service provider prior to diagnosis (34%), except for religious counselling. Non-Latina whites were less likely (6%) to have had contact with a religious counsellor than Latinas (13%). After diagnosis, 43% of participants (49% Latinas and 40% non-Latina whites) reported needing or wanting psychosocial services, but of these only 61% reported using a psychosocial service. While Latinas were less likely to have had contact with social workers and to use psychotropic medication, there were no significant differences between the groups when it came to contact with psychologists or psychiatrists, or the use of psychotherapy or counselling. Although there were no significant differences in the proportion of Latinas and non-Latina whites who reported needing psychosocial services, non-Latina whites were overall more likely to have had more frequent contact with a mental health professional.

    Why I liked the article: The authors provided particularly interesting considerations of how cultural and linguistic issues could explain the differences in the use of religious counselling and the use of psychotropic medication. It demonstrated a need for interventions for breast cancer survivors that take these cultural and linguistic differences into account.

    Article: Costas-Muñiz, R., Hunter-Hernández, M., Garduño-Ortega, O., Morales-Cruz, J., & Gany, F. (2017). Ethnic differences in psychosocial service use among non-Latina white and Latina breast cancer survivors. Journal of Psychosocial Oncology, 1–14.  https://doi.org/10.1080/07347332.2017.1310167

    Journal website: http://www.tandfonline.com/toc/wjpo20/current

    Author website: http://vivo.med.cornell.edu/display/cwid-roc2032


  • 15 Aug 2018 2:06 PM | Anonymous

    Digest Commentator: Keith Wilson, PhD, CPsych. Emeritus Clinician Investigator, Clinical Epidemiology Program, Ottawa Hospital Research Institute

    Edited by: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    For most women undergoing chemotherapy for breast cancer, hair loss (alopecia) is a distressing side effect of treatment. It has been known for some time that cooling the scalp during chemotherapy sessions can reduce the extent of alopecia in some people. The mechanism seems to be that cooling the scalp reduces blood flow – and the corresponding delivery of toxic chemotherapy drugs – to the sensitive hair follicles. Commercial cooling machines have been developed, and are available for use in some centres. To date, however, the efficacy of scalp cooling for preventing chemotherapy-induced alopecia has never been evaluated in a large randomized controlled trial.

    Nangia et al (2017) conducted a multi-centre study of 182 women with Stage I-II breast cancer who were receiving adjunct taxane-based or anthracycline-based chemotherapy which typically cause marked alopecia. Participants were assigned randomly to a scalp-cooling protocol or to a control group that did not receive scalp cooling. The cooling protocol required patients to wear a helmet-like cap for 30 minutes before each chemotherapy session, during the session, and for 90 minutes after. A liquid coolant was circulated through the cap to reduce scalp temperature. The primary outcome for hair preservation was a standard grading system, in which a clinician rated the extent of the patient’s hair loss.

    The authors reported that 142 patients, 95 in the cooling group and 47 in the control were evaluable in a planned interim analysis. Of the 95 patients who received the cooling protocol, 5%  had no hair loss at all, and a further 45% had <50% loss: an overall response rate of 50%. None of the control participants achieved that degree of hair preservation. Furthermore, all of the control participants went on to wear a wig or head wrap in their daily lives, whereas 37% of the treatment group felt no need to do so.

    This study also examined whether broad domains of quality of life were improved with the scalp cooling intervention, but there was no evidence that depression, anxiety, or social functioning were different between the two groups. It was also noted that different sites of the multi-centre trial had different success rates; apparently, there are technical issues involved in fitting the cooling caps that require training. Interestingly, however, a companion article in the same issue of JAMA reported that in routine use, up to 66% of patients can be helped with this approach.

    Why I liked this article: There are individual differences in how people respond to chemotherapy-induced alopecia. Some women embrace their hair loss, some accept it with resignation, and others feel stigmatized. The value of scalp cooling in reducing this troubling side effect seems to be underestimated. As with most novel interventions, there are unanswered questions – including who will pay the estimated $2000 to $4000 cost per patient. Concurrent scalp cooling during a chemotherapy session can also be quite uncomfortable for some individuals. In general, however, it is remarkable that a cosmetically meaningful reduction in alopecia can be achieved in about 50% of women who are receiving chemotherapy for breast cancer, using such a low-tech concept. That’s pretty cool.

    Article. Nangia, J., Wang, T., Osborne, C., Niravath, P., Otte, K., Papish, S., Holmes, F., Abraham, J., Lacouture, M., Courtwright, J., Paxman, R., Rude, M., Hilsenbeck, S., Osborne, C.K., & Rimawi, M. (2017). Effect of a scalp cooling device on alopecia in women undergoing chemotherapy for breast cancer: the SCALP randomized clinical trial. Journal of the American Medical Association, 317, 596-605. doi:10.1001/jama.2016.20939

    Journal website: http://jamanetwork.com/

    Dr. Morris’ university webpage: http://surgery.med.umich.edu/general/patient/faculty/ammsurg.shtml


    CAPO Digests are summaries of recent psychosocial oncology research which have been published in peer-reviewed journals in and out of the main psychosocial oncology outlets that may be of interest to CAPO members. We hope you enjoy these Digests. If you are interested in submitting a Digest please contact the CAPO office at [email protected]


  • 15 Aug 2018 2:06 PM | Anonymous

    Digest Commentator: Chad Hammond, PhD, Postdoctoral Fellow, School of Rehabilitation Sciences, University of Ottawa

    Edited by: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    Indigenous peoples are often left behind other populations in terms of accessing quality healthcare. In the area of cancer care, for example, their survival rates have lagged behind those of non-Indigenous populations despite recent improvements in cancer screening techniques and treatments. A long, continuing history of institutional racism, dismissal, and mistreatment leaves many Indigenous peoples distrustful and fearful of ‘becoming a patient.’ In many ways, the article by Morris and colleagues captures the current status of Indigenous patient-provider relationships among American Indian and Alaskan Native (AI/AN) patients. Their investigation was sparked by a very appropriate and timely question: how do AI/AN patients and their surgeons perceive the decision-making process around cancer treatment?

    Over three years, Dr. Morris and colleagues recruited AI/AN patients (multiple cancer sites) and their surgeons to rate their exchanges with each other. Although somewhat vaguely stated, the authors mention they abided by research protocols developed for respectful engagement with Indigenous communities—an essential ingredient toward developing trust between communities and institutions of research as well as of healthcare. A total of 49 AI/AN patients (62% response rate) completed a host of surveys, among them the Collaboration and Satisfaction about Care Decision scale, Ethnic Identity scale, Everyday Discrimination scale, and the Wake Forest Trust scale. Fourteen surgeons (37% response rate) were also surveyed and interviewed.

    The results of this study presented a promising image of patient-provider collaboration. Several domains of trust in providers (including honesty, confidentiality, collaborative decision-making, etc.) were rated quite highly, especially the domain of competence with 78% of patients agreeing or strongly agreeing with a statement about physician competence. Provider fidelity (caring/advocating for patient) was rated the lowest with 53% of patients agreeing or strongly agreeing with a statement about physician fidelity. Without making any causal claims, the authors reported that patients’ higher satisfaction, perceived quality of care, and sense of collaboration were correlated with their adherence to treatment. Twenty-six percent of patients reported non-adherence to treatment and their reasons were mostly non-clinical, citing personal and socio-economic circumstances (e.g., poverty), lack of proper access, and mistrust as potential factors in reducing adherence. Importantly, in all domains providers rated the quality of interaction and collaboration higher than AI/AN patients.

    This article is a hopeful gem, asking hard questions around Indigenous participation in healthcare and discovering that the default patient-provider relationship is not adversarial—many AI/AN patients give a vote of confidence in their providers. There are, however, domains needing improvement toward more cooperative, coordinated planning of treatments. The stark difference in patient ratings of provider competence versus fidelity is a powerful one; it suggests that Indigenous patients usually see their healthcare providers as effective healers but not always as loyal allies. The authors suggest that for AI/AN patients trust may matter more than satisfaction. Many Indigenous peoples, bearing the memories of trust betrayed by settler institutions and governments, know this intuitively.

    Morris, A. M., Doorenbos, A. Z., Haozous, E., Meins, A., Javid, S., & Flum, D. R. (2016). Perceptions of cancer treatment decision making among American Indians/Alaska Natives and their physicians. Psycho‐Oncology 25,1050-6. doi: 10.1002/pon.4191. Epub 2016 Jul 6

    Psycho-Oncology website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611

    Dr. Morris’ university webpage: http://surgery.med.umich.edu/general/patient/faculty/ammsurg.shtml


    CAPO Digests are summaries of recent psychosocial oncology research which have been published in peer-reviewed journals in and out of the main psychosocial oncology outlets that may be of interest to CAPO members. We hope you enjoy these Digests. If you are interested in submitting a Digest please contact the CAPO office at [email protected]



  • 15 Aug 2018 2:05 PM | Anonymous

    Digest Commentator: Stephanie Saunders, MA student, Jennifer Brunet PhD

    Edited by: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    Medical advancement in cancer treatments have led to improved surgical outcomes and survival in locally advanced rectal cancer patients. In particular, neoadjuvant chemoradiation therapy (NACRT), followed by surgical resection, has become the standard regimen for rectal cancer patients, as it improves local control of cancer. Although this leads to enhanced prognosis, NACRT is associated with a host of adverse side effects that negatively impact patients’ wellbeing. Whereas many researchers have reported that exercise is an effective strategy to mitigate these negative treatment side effects in a range of cancers (e.g., breast, prostate, colon), few of these studies have been performed in patients with rectal cancer, and, to date, no studies have looked at the influence of exercise on NACRT side effects.

    The current study examined study feasibility and safety of an aerobic exercise intervention in 18 patients diagnosed with rectal cancer during and immediately after NACRT. Forty-five participants were screened for eligibility by their medical oncologist at the time of their first radiation consultation. The study coordinator followed-up with 32 patients who were deemed eligible to participate, and scheduled initial exercise assessment for 18 interested participants.

    Morielli and colleagues (2016) had participants engage in a supervised aerobic exercise program, consisting of warm up and cool down, and a tailored session on a variety of aerobic modalities (e.g., treadmill, upright bike, recumbent bike, elliptical, and rower). The program ran three times per week throughout their NACRT treatment (6 weeks). Upon completion of their NACRT treatment, participants were given an unsupervised aerobic exercise program, cumulating in 150 minutes per week, for 6-8 weeks until their surgical resection.

    The authors found a high study eligibility (32/45,71%), high recruitment rate (18/32, 56%), and high retention rate (14/18, 78%), all of which are comparable to rates of other Phase 1 exercise intervention studies in other commonly studied cancers (e.g., breast and lymphoma). Additionally, secondary findings suggest that while health-related fitness outcomes (i.e., cardiorespiratory fitness level, psychosocial functioning, quality of life) declined during NACRT, they recovered afterwards to baseline levels, and in some cases improved beyond pre-NACRT levels. These results provide early evidence that exercise training among eligible patients with rectal cancer undergoing NACRT is both safe and feasible. In addition, exercise may have potential protective health effects during NACRT, as health-related fitness outcomes increased upon completion of treatment of NACRT prior to surgery. As this was a feasibility study without a control group, more research is needed to determine the effectiveness of the intervention and the effect of exercise on health outcomes.

    What I liked about this article: The current literature has shown that exercise is beneficial to a range of cancer populations; however its effects on patients with rectal cancer are understudied. Morielli and colleagues’ (2016) article is among the first to provide an indication of the role exercise can play in ameliorating negative side effects of NACRT in patients with rectal cancer. Further, as the authors have shown eligibility and recruitment rates over 50%, patients with rectal cancer are both highly interested, and able, to participate in exercise training opportunities. As a result of this study, researchers have an exciting opportunity to further explore the relationship between exercise and NACRT side effects, as well as investigate the benefits of exercise training in a population that has shown interest in participating in exercise-based studies.

    Journal website: https://onf.ons.org

    Morielli, A. R., Usmani, N., Boulé, N. G., Tankel, K., Severin, D., Nijjar, T., … & Courneya, K. S. (2016). A phase I study examining the feasibility and safety of an aerobic exercise intervention in patients with rectal cancer during and after neoadjuvant chemoradiotherapy. Oncology Nursing Forum, 43(3), 352-362.


    CAPO Digests are summaries of recent psychosocial oncology research which have been published in peer-reviewed journals in and out of the main psychosocial oncology outlets that may be of interest to CAPO members.  We hope you enjoy these Digests. If you are interested in submitting a Digest please contact the CAPO office at [email protected]


  • 15 Aug 2018 2:05 PM | Anonymous

    Digest Commentator: Joan L. Bottorff, PhD, RN, FCAHS, FAAN, School of Nursing and Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia’s Okanagan Campus

    Edited by: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    Tobacco use has been established as a causal factor for a number of cancers and has been a primary focus for cancer prevention efforts.  However, less attention has been given to the risks of tobacco use among patients with cancer who continue to smoke. The evidence presented in the article by Passarelli and colleagues adds to the growing body of literature that we need to address continued smoking among those with cancer to reduce mortality and morbidity.  In this observational study, the authors followed up a sample of 20,691 breast cancer survivors in the United States to evaluate the association between smoking status before and after a breast cancer diagnosis, and mortality from breast cancer and smoking-related disease. Persistent smoking among survivors in this study was associated with a statistically significant 25% increase in relative risk of breast cancer death.  Women who continued to smoke also had a higher risk of death from respiratory cancer, noncancer respiratory disease, and cardiovascular disease. Women who quit smoking post-diagnosis had a 33% lower relative risk of death from breast cancer and other causes compared to those who continued to smoke, although this was not statistically significant.

    What I liked about this article:  This is a large population based study that provides a solid evidence base for promoting smoking cessation.  Although the factors by which smoking effects tumor progression are not fully understood, the results not only point to the adverse outcomes for those with a history of breast cancer who continue to smoke but also obligate us all to offer smoking cessation to women with breast cancer.  Respectful, women-centred approaches to smoking cessation can serve as an important foundation for offering cessation support to women with breast cancer. This study suggests the time is now for prescribing and supporting smoking cessation with every woman with breast cancer who smokes at every visit in order to optimize survival and overall health. The findings of Passarelli et al. can help us advocate for the resources we need to augment resources for smoking cessation in clinical practice.

    Article:  Passarelli, M.N., Newcomb, P.A., Hampton, J.M., Trentham-Dietz, A., Titus, L.J., Egan, K.M., Baron, J.A., & Willett, W.C. (2016).  Cigarette smoking before and after breast cancer diagnosis: Mortality from breast cancer

    Journal website: http://jco.ascopubs.org/content/34/12/1315.full.pdf+html?sid=8fa86d13-4eaa-4135-8e87-2c87c6456da1

    Author website: http://profiles.ucsf.edu/michael.passarelli


    CAPO Digests are summaries of recent psychosocial oncology research which have been published in peer-reviewed journals in and out of the main psychosocial oncology outlets that may be of interest to CAPO members.  We hope you enjoy these Digests. If you are interested in submitting a Digest please contact the CAPO office at [email protected]



  • 15 Aug 2018 2:03 PM | Anonymous

    Digest Commentator: Teja Voruganti, MD-PhD student, University of Toronto

    Edited by: Mary Ann O’Brien, Department of Family and Community Medicine, University of Toronto and Jennifer Brunet, School of Human Kinetics, University of Ottawa

    With a patient population that is aging and increasingly diverse, it is crucial that doctors be aware of and incorporate patient values and preferences into end-of-life (EOL) discussions, However, these conversations can be challenging to initiate for a number of reasons, though there is a dearth of research as to what these are. Periyakoil et al. 2015 have conducted a study to identify and explore doctor-reported barriers to having EOL discussions with patients.

    Using a cross-sectional design, 1040 of 1234 (84%) senior medical residents at two academic hospitals were recruited to complete a survey. Participants were sampled from a variety of medical subspecialties and were advanced enough in their training to have experienced caring for seriously ill patients at the end of life. The survey consisted of three questions, one of which asked for a rating on a 5-point scale of whether EOL discussions with patients of diverse backgrounds was challenging and another was an open-ended question of barriers faced in conducting EOL conversations. A mixed methods approach to analysis was done. The quantified responses were analyzed with respect to medical specialty, identifying barriers more important to specific specialties. A qualitative approach was used to analyze open-ended responses from all participants.

    The majority of participants were Caucasian or Asian (82.3%). Most trainees (85.7%) reported that having EOL conversations was challenging, with participants of Asian and African American ethnicities indicating that they struggled most. Of six barriers identified, “language and medical interpretation” in interactions with patients and families was reported to be most problematic by all participating residents. Other barriers included perceptions of patients’ religious beliefs and expectations about EOL, physicians’ ignorance about cultural practices at EOL, patients’ cultural differences in decision making and truth handling, limited patient health literacy, and patient mistrust of the medical system. Specialty-based differences in rating the relative importance of each barrier were observed. Emergency medicine specialists rated limited patient health literacy as higher relative to other specialties; neurologists reported that doctors’ ignorance of cultural beliefs/practices was a major barrier; and psychiatrists rated patients’ cultural differences in decision making/truth handling as more challenging to EOL discussions.

    Why I liked this article: This study has identified six major barriers to the effective conduct of EOL discussions. An important implication of this study is that it demonstrates a clear need to better train doctors in ways to facilitate EOL discussions that are culturally-sensitive and meaningful to a patient’s own situation. As the population lives longer and becomes more ethnically diverse, an awareness of these barriers may serve as a framework for developing appropriate knowledge and attitudes in the care management of patients especially in fields such as oncology.

    Article. Periyakoli, VS, Neri, E, Kraemer, H (2015). No easy talk: a mixed methods study of doctor reported barriers to conducting effective end-of-life conversations with diverse patients. PLoS ONE 10(4): e0122321. doi:10.1371/journal.pone.0122321

    Journal website: http://journals.plos.org/plosone/

    Author website: https://med.stanford.edu/profiles/vj-periyakoil


    CAPO Digests are summaries of recent psychosocial oncology research which have been published in peer-reviewed journals in and out of the main psychosocial oncology outlets that may be of interest to CAPO members.  We hope you enjoy these Digests. If you are interested in submitting a Digest please contact the CAPO office at [email protected]


  • 15 Aug 2018 2:01 PM | Anonymous

    Digest Commentator:

    Paquito Bernard a,b,c , Josée Savard a,b,c

    • Université Laval Cancer Research Center, Québec, Québec, Canada
    • School of Psychology, Université Laval, Québec, Québec, Canada
    • CHU de Québec – Université Laval Research Center, Québec, Québec, Canada

    Edited by: Jennifer Brunet, School of Human Kinetics, University of Ottawa, Mary Ann O’Brien, Department of Family and Community Medicine, University of Toronto

    Park et al. (2015) examined the effects of oncologists’ exercise recommendations among breast and colorectal cancer survivors. The investigators assigned participants, after completion of cancer treatments, to one of three conditions: control (i.e., conventional consultation); exercise recommendations only (i.e., emphasizing possible benefits from moderate intensity physical activity on risk of cancer recurrence); exercise recommendations with motivation tools (i.e., DVDs, diary and pedometers) plus one educational session administered by an exercise specialist. DVDs presented 3 sets of different resistance exercises without equipment. Participants recorded steps walked by day in diary. Self-reported physical activity assessed 4 weeks after brief intervention was the primary outcome. Quality of life was also measured with European Organization for Research and Treatment of Cancer (EORTC) QLQ C-30 questionnaire.

    121 breast cancer survivors and 41 colorectal cancer survivors were recruited. The study retention rate was good (80%). Intent-to-treat analyses indicated that the addition of motivation tools and one educational session to the oncologist’s exercise recommendation significantly increased self-reported duration of moderate intensity exercise and duration of total exercise as compared to the control group. Participants who received the motivation tools and one educational session in addition to the exercise recommendations increase their total exercise time by almost 80 minutes per week. Participants who were assigned to the control group or who only received oncologist’s exercise recommendations did not significantly modify their exercise behaviours. No between-group difference was found on global quality of life.

    This recent investigation shows that oncologists’ recommendations to increase exercise may not enough to change breast cancer survivors and colorectal cancer survivors’ exercise behaviour, which supports the idea that exercise recommendations should be accompanied by adapted motivational tools and a consultation with an exercise specialist.

    Why we liked this article: Unfortunately, too often, physical activity promotion in oncology is conceptualized as a simple prescription from the oncologist. But physical activity is a complex health behaviour and becoming physically active is an important challenge for cancer survivors. This study highlights that a tailored  intervention is effective. This investigation also suggests that integrating exercise specialists in oncology services may be important.

    Park, J.-H., Lee, J., Oh, M., Park, H., Chae, J., Kim, D.-I., … Jeon, J. Y. (2015). The effect of oncologists’ exercise recommendations on the level of exercise and quality of life in survivors of breast and colorectal cancer: A randomized controlled trial. Cancer, 121(16), 2740‑2748. http://doi.org/10.1002/cncr.29400


    CAPO Digests are summaries of recent psychosocial oncology research which have been published in peer-reviewed journals in and out of the main psychosocial oncology outlets that may be of interest to CAPO members.  We hope you enjoy these Digests. If you are interested in submitting a Digest please contact the CAPO office at [email protected]




  • 15 Aug 2018 2:01 PM | Anonymous

    Digest Commentator: Josée Savard, Ph.D., School of Psychology, Université Laval, CHU de Québec-Université Laval Research Center, and Université Laval Cancer Research Center

    Edited by: Jennifer Brunet, School of Human Kinetics, University of Ottawa

    Childhood trauma is far too common as some research indicates that 45% of primary care patients have experienced some form of abuse during their childhood. In people diagnosed with cancer, childhood adversity has previously been found to be associated with higher levels of symptoms such as fatigue, psychological distress, and stress. This article reports on a pilot longitudinal study aiming to explore associations of childhood trauma with fatigue, depression, and stress in women undergoing radiotherapy for breast cancer. Another goal, more groundbreaking, was to investigate the possible role of inflammation.

    Twenty women with 0-IIIA breast cancer about to receive whole-breast radiotherapy were enrolled in this study. They were evaluated 1 week before radiation (T1), week 6 of radiation (T2) and 6 weeks after radiation (T3). At each time point, participants completed the Multidimensional Fatigue Inventory, the Inventory of Depression Symptomatology and the Perceived Stress Scale (PSS). Peripheral blood draws were taken at T1 to measure various markers of inflammation. At T3, participants filled out the Childhood Trauma Questionnaire (CTQ), a 28-item questionnaire that assesses a history of childhood physical, sexual, and emotional abuse, and physical and emotional neglect.

    Eight participants (40%) reported a history of childhood trauma (CTQ+). CTQ+ women obtained significantly higher fatigue, depression, and stress scores across all time points than women who did not report childhood abuse and neglect (CTQ-), although post hoc analyses indicated that differences between both groups of women were significant at T1 only. In addition, after controlling for some potential confounding variables (e.g., age, education, marital status), the differences in levels of cancer-related symptoms between CTQ+ and CTQ- women generally diminished, except for PSS scores. Analyses also indicated that radiotherapy did not significantly exacerbate any of the symptoms differentially in CTQ+ women as compared to CTQ- women. More severe symptoms of fatigue, depression and stress were associated with higher baseline levels of several inflammatory markers, namely c-reactive protein, interleukin (IL)-6 and IL-1 receptor agonist, but only in CTQ+ women. Overall, although replication with a larger sample is warranted, this study suggests that childhood trauma is a significant risk factor for cancer-related psychological distress and that inflammation could constitute a mechanism through which early negative experiences may have such a detrimental effect.

    Why I liked this article: While this is a small-scale pilot study and mediation could not really be tested, I liked that it was a first attempt to identify inflammation as a possible underlying biological mechanism linking childhood trauma with cancer-related psychological symptoms. In terms of clinical implications, this literature generally suggests that patients with a history of childhood adversity constitute a high-risk group for psychological distress before and after cancer treatment that could be specifically targeted in a screening and prevention program. Moreover, if the role of inflammatory processes is confirmed in future research, it could inspire the development of new pharmacological and non-pharmacological treatment avenues directly targeting inflammation.

    Article. Han, T. J., Felger, J. C., Lee, A., Mister, D., Miller, A. H., & Torres, M. A. (2015). Association of childhood trauma with fatigue, depression, stress, and inflammation in breast cancer patients undergoing radiotherapy. Psycho-Oncology. doi:10.1002/pon.3831

    Journal website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611

    Author website: http://radiationoncology.emory.edu/people/physicians/torres-mylin.html


  • 15 Aug 2018 2:00 PM | Anonymous

    Digest Commentators:

    Adina Coroiu1 & Elena Ivanova2

    1Department of Educational and Counselling Psychology, McGill University

    2Department of Psychology, McGill University

    Edited by: Jennifer Brunet, School of Human Kinetics, University of Ottawa

    Physical activity (PA) is a widely studied topic within psycho-oncology, with over 9,000 articles recently identified on the subject by Kampshoff and colleagues. Despite the growing interest in PA, a valid measure to quantify and determine if cancer survivors’ levels of PA meet the recommended levels of at least 150 minutes of moderate activity or at least 75 minutes of vigorous activity is lacking. Amireault, Godin, Lacombe, and Sabiston (2015) addressed this gap in the literature by validating the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ). The GSLTPAQ is a brief self-report measure that assesses the duration, intensity (i.e., mild, moderate, and vigorous), and frequency of PA performed during the past 7 days. This scale can be used to classify individuals into two activity categories: active (scores ≥ 24) or insufficiently active (scores ≤ 23). The GSLTPAQ is an ideal measure to quantify and compare cancer survivors’ levels of PA against the recommended levels of PA due to its brief format and low administration burden. If validated, this questionnaire could be used in studies seeking to understand the impact of PA behavior on physical and psychosocial health outcomes, as well as in epidemiological studies to determine the prevalence of (in)activity in this clinical population.

    In their study, Amireault and colleagues compared PA data obtained using the GSLTPAQ with PA data obtained using accelerometers (GT3X, Actigraph, Pensacola, Florida), with the aim of assessing the accuracy of the GSLTPAQ to classify cancer survivors’ activity levels according to the aforementioned PA guidelines. A total of 199 adult women with a first diagnosis of breast cancer were recruited from various hospitals in Montreal, QC. They were asked to wear an accelerometer (i.e., a physical activity monitoring device) for 7 consecutive days and complete the GSLTPAQ. Based on the accelerometer data, 27.2% of the sample were active. This percentage was lower than the percentage obtained using the GSLTPAQ (i.e., 33.8%). Further, 75.3% of sample were correctly categorized using the GSLTPAQ as being insufficiently active, that is as notmeeting PA guidelines. A smaller percentage, however, were correctly categorized as active (58.5%), that is as meeting PA guidelines.Overall, the authors suggested that the GSLTPAQ is more accurate at identifying insufficiently active women than at identifying active women.

    Why we liked this article: We liked this article because the GSLTPAQ has research and practical implications, and the authors established its validity for use with breast cancer survivors. The practical and research implications include: low administration burden, minimum training demands, and low cost, which makes the GSLTPAQ feasible to use for large-scale studies. Further, this measure has clinical utility in that it can be used as a screener to identify inactive breast cancer survivors who would benefit from interventions designed to increase physical activity levels.

    Article: Amireault, S., Godin, G., Lacombe, J., & Sabiston, C. M. (2015). Validation of the Godin-Shephard Leisure-Time Physical Activity Questionnaire classification coding system using accelerometer assessment among breast cancer survivors. Journal of Cancer Survivorship, 1-9. doi: 10.1007/s11764-015-0430-6

    Journal Website: http://link.springer.com/article/10.1007/s11764-015-0430-6

    Authors Websites: http://www.jgh.ca/en/BHRG_AdinaCoroiu; https://www.mcgill.ca/healthpsychologylab/health-psychology-laboratory


  • 15 Aug 2018 2:00 PM | Anonymous

    Digest Commentators: Beth Edwards, PhD Candidate, Dalla Lana School of Public Health, University of Toronto & Lynn R Gauthier, Postdoctoral Fellow, ELLICSR Health Wellness and Cancer Survivorship Centre, Princess Margaret Cancer Centre, University Health Network

    With the aging population and focus on community-based care, more older patients and their caregivers will manage cancer pain at home. Age-related comorbidities and functional decline add to pain management complexity. Little is known about how older patients and caregivers navigate these challenges. Therefore, McPherson et al. conducted a study to describe the roles and perceptions of older cancer patients and their caregivers managing cancer pain at home.

    Using a qualitative descriptive approach with an inductive thematic analysis, they analyzed data collected through semi-structured interviews with 18 patients and 15 caregivers. Although the goal was to understand pain management among patient-caregiver dyads, interviews were primarily conducted with patients and caregivers separately. Patients were 65 years of age or older, had advanced cancer, experienced pain for at least 1 month, and received home palliative care. Most patients required assistance with daily activities and had moderate pain. Most caregivers lived with and were partners of the patients they cared for.

    A qualitative approach is especially suited to understanding such a complex phenomenon. McPherson et al. clearly outlined their methods including interview guides, detailed analytic description, and appropriate references. As such, this article is appropriate for those interested in qualitative research approaches, as well as those interested in understanding the challenges of pain management among older patients and caregivers.

    Analysis revealed two main themes related to pain assessment and management, with four subthemes each. Briefly, in one theme, patients and caregivers discussed challenges related to “adopting roles in pain assessment”. While patients adopted the lead role, they were not always forthcoming about reporting pain. Caregivers adopted the communication role when patients did not communicate with healthcare professionals. Elsewhere within this theme, patients described the multidimensional experience of pain. Some did not use the word “pain”, but used words like “discomfort”, “cramp”, and “ache”. They also described their reluctance to burden caregivers, especially when caregivers had health challenges themselves. Caregivers described verbal and nonverbal cues and relied on their personal history with the patient to assess pain. Some caregivers’ assessments were impacted by their own pain and health history. In the other theme, caregivers described patients’ desire to remain in control of pain management, but age-related impairments and treatment side effects made self-management difficult. Patients described reluctance towards pharmacological management, whereas caregivers remained open to pharmacological approaches. Some patients described a desire to sacrifice pain control to avoid analgesic side effects. Both patients and caregivers discussed fears of addiction and beliefs that pain is an inevitable consequence of aging and cancer. Here, an interesting dyadic analysis revealed that patient and caregiver pain management goals were not always congruent. Cognitive impairment was identified throughout as a challenge to pain assessment and management.

    These data outline for healthcare professionals the challenges faced by older patients and their caregivers managing pain at home, including the impact of functional limitations, cognitive impairment, and the potential impact of caregivers’ own health challenges. As a result, this study clearly identifies an urgent need for education to address fears of addiction and side effects, and beliefs about the inevitability of pain as well as future research to further elucidate dyadic coping with cancer pain across the adult lifespan.

    McPherson, C.J., Hadjistavropoulos, T., Devereaux, A., Lobchuk, M. (2014). A qualitative investigation of the roles and perspectives of older patients with advanced cancer and their family caregivers in managing pain in the home. BMC Palliative Care, 13(39). http://dx.doi.org/10.1186/1472-684X-13-39

    Journal website: http://www.biomedcentral.com/bmcpalliatcare

    Author website: http://www.health.uottawa.ca/sn/personnel/cmcpherson.htm


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