Cranial Irradiation

Cranial irradiation can be the primary or adjuvant treatment for brain tumors, and may be carried out prophylactically, for example, in limited-stage small cell lung cancer and some hematological malignancies. While neurons do not have the rapid dividing characteristic usually targeted by radiation, radiation has effects on their glial supports and vasculature. Leukoencephalopathy typically occurs at doses above 55 Gy and appear 1-2 years following treatment.30 As a result, slowed mentation and...

The Extremities and Bone

Radiation can damage lymphatics and cause lymphedema independently of surgery. When combined with surgical lymph node dissection, however, the risk of lym-phedema is compounded. Radiation weakens bone. For example, painful sacral fractures are a late effect of pelvic radiation that can be concerning for local recurrence or osseous spread of a malignancy like rectal cancer. A history of radiation is associated with increased risk of spinal compression fractures within the field. Recently an...

Epidemiology Of Pain In Cancer Survivors

While surveys have not been done specifically for pain, some information can be gleaned from quality of life surveys of cancer survivors. Information on the prevalence of pain in cancer survivors is sometimes contradictory. In some studies the prevalence of pain may actually be lower than in a control group, and may differ between studies. There are a number of possible explanations. Recruitment strategies may be different, leading to different populations studied. As many pain syndromes can...

Chest Radiation

Chest irradiation can damage any of the structures in the chest. For example, breast irradiation can in some cases interfere with lactation.31 Acute radiation pneumonitis can progress to long-term focal pulmonary fibrosis and decreased lung capacity in a minority of patients. Its risk is related to both the total dose delivered and the volume of lung treated.32 Dyspnea and cough are the most common symptoms, and imaging shows interstitial fibrosis which can be progressive. It can eventually...

Info

Avedis Donabedian who might be considered the father of quality, described a model of understanding quality in health services incorporating the structure, process, and outcomes of the service2 where (a) Structure encompasses the characteristics of medical care that are relatively unchanging i.e., the materials and manpower available for care. (b) Process addresses the content of that care, i.e., how the patient was moved through and out of the health care system and the services that were...

Intervention Research

Several approaches intended to reduce stress primarily through emotion-focused coping have been investigated. Emotion-focused coping refers to dealing directly with the emotional concomitants of life events, such as distress and existential angst, rather than trying to solve the problem directly it is useful in circumstances when one has little or no control over the specific situation, such as fears of cancer recurrence or death and dying.68 Our experience is predominantly in the application...

Socioeconomic Status

Socioeconomic status (SES) remains the most widely studied variable in the area of health disparity. In many instances it is the most notable difference between Caucasians and minorities. SES is difficult to assess because income level, the most direct assessment of SES, is not routinely obtained when treating cancer patients. As a result SES is a value that must be estimated based on census tract data, patient location, or some other indirect assessment. The significance of SES as a...

Impact Of Problem Solving

Others have also looked to problem-solving training as a potentially important intervention strategy to help cancer patients and their families. For example, Fawzy et al. developed a multicomponent treatment package that included PST and focused on patients who were newly diagnosed with malignant melanoma.60 Cancer patients were randomly assigned to one of two conditions a 6-week structured group intervention that included PST, stress management training, group support, and health education,...

Problem Solving for Caregivers of Cancer Patients

Family members who are responsible for the day-to-day care of cancer patients can also experience high levels of distress and frequent problems. As such, we have also hypothesized that training such individuals themselves in problem-solving skills may be a particularly useful approach in helping family caregivers to cope more effectively in this role.55,56The Prepared Family Caregiver Course adapted the D'Zurilla and Nezu57 PST model as a means of providing the following types of information to...

Correlates Of Adjustment

As described briefly in the section on medical adaptive tasks, physical symptomatology and health status are often found to be strongly correlated with depression and QOL.3,31,32,34 Pain and fatigue in particular are associated with higher levels of distress.3,15 In women with metastatic breast cancer, both pain intensity and frequency have been correlated with depression and mood disturbance.43 However, as many of these studies are cross-sectional, it is not...

Patient Related Barriers to Smoking Cessation

There are several patient level barriers for smoking cessation in cancer survivors including high nicotine dependency, urgency of cessation advice, cancer-specific health beliefs, psychological distress, disease and treatment variables, social network influences and misreporting of smoking status. Table 3. Smoking Cessation in Cancer Survivors Improved survival rate Fewer treatment complications Improved treatment efficacy Reduced risk of disease recurrence and 2nd primary tumor Improved...

Surgery

(i) Post surgical pain syndromes are now recognized as a distinct clinical entity with an overall incidence of 1-2 .32 In addition to the syndromes mentioned in this chapter, these include syndromes of post-Coronary Artery Bypass Graft pain, post-sternotomy pain,33 and post-herniorrhaphy pain.34 During surgery, nociceptive stimulation leads to a barrage of C fiber impulses that activate spinal cord receptors and result in the development of central sensitization and a clinical hyperalgesic...

Existential and Spiritual Outcomes

Our more recent work has evolved to investigate the effects of MBSR on the types of existential outcomes described in the introduction. One way of examining these personally meaningful outcomes is through patient self-assessment using questionnaires developed to measure constructs such as benefit-finding and spirituality. We assessed posttraumatic growth using the Post-Traumatic Growth Inventory (PTGI) and Spirituality using the Functional Assessment of Chronic Illness Therapy-Spiritual Well...

Two Views of Well Being

At this point, I should clarify what I mean by emotional well-being. Ryan and Deci7 noted that the study of well-being in psychology emerged from two relatively distinct, though overlapping, philosophical perspectives (a) the hedonicposition, which views well-being in terms of the experience of personal happiness or the balance between positive and negative affect and (b) the eudaimonic position, which holds that well-being involves the quest to achieve growth, purpose, and meaning in one's...

The Quantitative Burden Based On Cancer Statistics

Understanding the burden of cancer survivorship also requires a quantitative appreciation of the incidence of cancer, the mortality of the disease, and the resulting number of accumulating survivors. The American Cancer Society publishes an annual summary of cancer statistics.14 Based on data from the National Cancer Institute and mortality data from the National Center for Health Statistics, it is estimated that in the United States for 2005, a total of 1,372,910 new cancer cases and 570,280...

Jos Verbeek and Evelien Spelten

The situation of cancer patients returning to work has taken a turn for the better. Where early research reported profound job discrimination of cancer patients (e.g. Feldman1), recent literature suggests that breast cancer patients are only slightly less frequently unemployed than their healthy controls.1 Maunsell et al. found a statistically significant 7 difference in risk of being unemployed between breast cancer survivors and healthy controls 3 years after diagnosis and concludes that job...

Biopsychosocial Perspective On The Pain Experience Of Cancer Survivors

Pain symptoms in cancer survivors can arise from multiple causes including adverse effects of cancer treatment, infection, and musculoskeletal problems (see Chapter 9).7-10 Research suggests that 30-60 of individuals with cancer will continue to experience pain symptoms that will persist in the posttreatment period.2,11-17 Neuropathic pain and somatic pain conditions are the most common pain diagnoses in cancer survivors.18-20 Compared to other domains of pain research, the psychosocial...

Measures to Prevent Postmastectomy Pain

The effect of special attention to preserving the intercostobrachial nerve was studied in a group of 120 patients, who were randomized to either sacrifice or preservation of the nerve. The number of patients who experienced pain, numbness, and altered sensation was halved in the preservation group postoperatively but not at follow-up 3 months later.111 The role of axillary dissection is highlighted by a study comparing 85 patients who underwent axillary dissection to 65 patients who had...

Adaptive Tasks In Living With Advanced Cancer

To date the psychologically relevant issues receiving the greatest attention in this population have been pain, fatigue, and depression (see special issue no. 32 of JNCI, 2004). The ramifications of AC likely extend well beyond these important concerns into a number of other diverse domains. As treatment advances have prolonged and improved the QOL of many people with metastatic disease, increased clinical and empirical attention has been directed to their psychosocial concerns. Of note, much...

The Impact Of Cancer On Relationships

Understanding the impact of cancer on relationships is important because cancer occurs in an interpersonal context. The diagnosis and treatment of cancer affect not only the patient, but also their significant others, including family and friends. Partners of cancer patients may experience significant decrements in physical, emotional, and social functioning that appear to parallel the patient's own response to their cancer.6,14 Levels of adjustment in cancer patients and their partners also...

References

Davis, F.G., McCarthy, B.J., Freels, S., Kupelian, V., and Bondy, M.L. The conditional probability of survival of patients with primary malignant brain tumors. Cancer 1999 85 485-91. 2. Hatteville, L., Mahe, C., and Hill, C. Prediction of the long-term survival in breast cancer patients according to the present oncological status. Stat. Med. 2002 21 2345-54. 3. Wallace, R.B., and Doebbeling, B.N. Public Health and Preventive Medicine. Appleton & Lange Stamford, CT, 1998. 4. Hewitt, M.,...

Biological Outcomes

We have also become interested in the effects of MBSR on some of the biological processes identified by researchers as affected by cancer treatments, which may have potential consequences in terms of future health and disease recurrence. In the study described above with breast and prostate survivors an average of 1.1 years post-treatment, we investigated immune function by looking at the counts of a number of lymphocyte subsets, including T cells (divided into helper and cytotoxic T cells) and...

Psychosocial Influences On Painrelated Limitations In Cancer Survivors

Many individuals either discontinue or avoid activities that are associated with pain.97,98 These might include activities of daily living, social and recreational activities, or occupational activities.23 Research suggests that 15-20 of individuals with chronic musculoskeletal pain conditions will become permanently occupation-ally disabled.99,100 Few research investigations have addressed the nature or severity of functional limitations due to pain in cancer survivors.17,23,101 It is possible...

Contributors

Ahles, PhD Director of the Neurocognitive Research Laboratory, Memorial Sloan-Kettering Cancer Center, New York, NY Carlynn A. Alt, PhD, PT, MS Assistant Professor, Exercise Science Program, Department of Physical Therapy Marquette University, Miluankee, WI Jane Alavi, MD Professor Emeritus, Department of Medicine, University of Pennsylvania Department of Medicine, Philadelphia, PA Tammy Beran, MA Graduate Student, Department of Psychology, University of California, Los Angeles, Los...

Clare Stevinson Kristin L Campbell Christopher M Sellar and Kerry S Courneya

Interest in the potential of exercise as a therapeutic intervention for a wide range of clinical populations is growing steadily. A body of research has established physical activity as having a role in the prevention and or management of several chronic medical conditions,1 including coronary heart disease,2 stroke,3 hypertension,4 non-insulin-dependent diabetes,5 obesity,6 musculoskeletal disorders,7 and mental health problems.8 Evidence of the effects of physical exercise in protecting...

Linda A Jacobs Jane Alavi Angela DeMichele Steven Palmer Carrie Stricker and David Vaughn

Cancer survivors experience a number of physiological and psychological sequelae, called late effects, as a consequence of their cancer treatment. In pediatric oncology, late effects of treatment have been studied for over two decades,1-2 and are therefore better understood than late effects as a result of cancer treatment during adulthood. However, identified late effects in adults include diverse phenomena such as decreased cognitive functioning in breast cancer survivors3 and increased...

Robert J Ferguson Raine Riggs Tim Ahles and Andrew J Saykin

Dysfunction in memory and attention associated with cancer treatment has gained increased attention over the past two decades. In 1999 the President's Cancer Panel1 and the National Coalition for Cancer Survivorship2 formally recognized the problem as a quality of life matter that deserved higher priority in clinical research. With nearly 1 million chemotherapy recipients annually in the United States alone, the problem is widespread. Over this same time span, research has clearly documented...

Common Measurement Characteristics of Quality of Life Scales

Three basic measurement characteristics found in a good assessment tool are reliability, validity, and responsiveness.47-49 Reliability is primarily concerned with the stability of items within a test and the uniformity between test scores over time. Two common forms of test reliability are internal consistency how well items hang together and test-retest reliability the stability of scores over repeated measurements . Test validity deals with the degree to which an instrument accurately...

Handbook of Cancer Survivorship

Michael Feuerstein, Ph.D, MPH, ABPP Uniformed Services University of the Health Science Department of Medical and Clinical Psychology and Preventive Medicine and Biometrics 4301 Jones Bridge Road Bethesda, MD 20814 USA Library of Congress Control Number 2006929207 ISBN-10 0-387-34561-2 e-ISBN-10 0-387-34562-0 ISBN-13 978-0-387-34561-1 e-ISBN-13 978-0-387-34562-8 2007 Springer Science Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without...