A cancer diagnosis produces important disruptions in a person's life that can lead to a reconsideration of one's roles, values, purposes, and goals. This may threaten one's identity, which can be defined as an implicit self-theory construed using different identity processing styles (IPSs), categorised as informational, normative, and diffuse-avoidant. This study examined IPSs, commitment to identity, and their relationship to psychosocial outcomes in head and neck cancer (HNC) survivors. Sixty patients (age: M = 57.4, SD = 9.9) were recruited from an HNC outpatient clinic. Participants were at least 1 year posttreatment, on medical follow up, and free of recurrence. All participants completed questionnaires assessing IPS, quality of life (QoL), anxiety and depression, positive and negative perceptions of illness impact, and body image concerns. Correlational analyses showed that commitment to identity was significantly related to higher QoL, illness impact, and anxiety. A normative IPS was related to higher QoL. A diffuse-avoidant IPS was related to a negative perception of illness impact. A bootstrapped multiple regression analysis showed that only the normative IPS was a significant predictor of overall QoL. For this sample of HNC patients, a stronger commitment to normative goals, values, and beliefs contributed to the preservation of identity and to a greater sense of well-being during survivorship. Many forms of psychotherapy include a focus on various aspects of identity, some more directly than others. We discuss how such therapies may be applied to improve psychosocial outcomes in HNC patients.

PURPOSE:Gastrointestinal (GI) cancer patients often suffer high rates of distress and social isolation, partially due to symptoms that are embarrassing or difficult to discuss with family or friends. Group support therapies mitigate illness-related stigma and standardization; however, men, in particular, are more averse to joining. Through an ongoing men-only GI cancer support group, this study sought to understand who joined the groups, what facilitated group uptake, and explore men's reasons for enrolling in the group.METHODS:A mixed-methods study design and analysis were used. A qualitative design utilizing open-ended, semi-structured interviews and thematic analysis were used; Theory of Planned Behavior (TPB) directed the inquiry towards facets of group uptake. Standardized measures were also used to assess distress, coping, and quality of life (QoL) and compared with normative values for cancer and general population. Data from qualitative and quantitative findings were triangulated.RESULTS:Participants included 35 male GI cancer patients, aged 28-72, at varying stages of illness and treatment. Themes related to group uptake and enrollment were endorsement; composition; and attitudes, and reasons for joining were learning new coping techniques and affiliations with similar others. Men's QoL and psychological distress scores were on par with cancer patient norms. The scores obtained from quantitative scales corroborated with our qualitative findings.CONCLUSIONS:Despite psychosocial, demographic, and clinical variations, participants were keen on joining a male-only Supportive-Expressive Therapy (SET) group to address their emotional, informational, and supportive care needs and express their solidarity for other patients.IMPLICATIONS FOR CANCER SURVIVORS:Findings bear clinical relevance for designing GI male-centered group formats that endorse men's needs and facilitate their accessibility to group support interventions.

Objective: A long-term tracheostomy can be a life-altering event and can have significant effects on patients' quality of life (QOL). There is currently no instrument available to evaluate tracheostomy-specific QOL. To address this deficiency, the objective of this study was to create and preliminarily validate a pilot tracheostomy-specific QOL questionnaire to assess its feasibility.Methods: A multidisciplinary team developed the pilot tracheostomy-specific QOL questionnaire (TQOL) in 3 phases: item generation, item review, and scale construction. The survey was administered at 0 and 2 weeks to a pilot group of tracheostomy patients with concurrent administration of a validated general QOL questionnaire at week 0. Convergence validity, test-retest reliability, and internal consistency were the primary outcome measures.Results: A total of 37 patients completed the study (mean tracheostomy duration = 90 weeks). The convergence validity of the TQOL was moderately strong (r = 0.72), and the test-retest reliability was strong (r = 0.75). The TQOL also demonstrated good internal consistency (Cronbach's alpha = 0.82).Conclusion: The TQOL has moderately strong internal consistency, convergence validity, and test-retest reliability. While additional refinement and validation may improve the questionnaire, these initial results are promising and support further development of this tool.

BACKGROUND:Research on the implication of experiential avoidance in the aetiology and maintenance of diverse forms of psychopathology has grown considerably over the last 10 years. However, the potential contribution of experiential avoidance to cancer-related distress has received limited attention. Accordingly, the objective of this study was to examine the association between experiential avoidance, symptoms of anxiety and depression, and quality of life (QoL) during the course of a psychological group intervention for women with breast cancer. METHODS:Fifty-four women with breast cancer participated in a psychological group intervention designed to reduce distress and improve QoL. Participants completed measures of experiential avoidance, anxiety and depressive symptoms, and QoL upon the first and last sessions. RESULTS:A path analysis revealed that, after controlling for baseline measures, smaller reductions in experiential avoidance during the course of the intervention predicted smaller reductions in anxiety and depressive symptoms. Also, experiential avoidance had a negative indirect effect on QoL via depressive symptoms. CONCLUSIONS:Experiential avoidance may perpetuate the emotional problems commonly found in women with breast cancer and attenuate improvements associated with participation in psychological interventions. Implications for clinical practice in psycho-oncology are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

Objective: Experiencing cancer can give rise to existential concerns causing great distress, and consequently drive individuals to make sense of what cancer may mean to their lives. To date, meaning-based research in the context of cancer has largely focused on one possible outcome of this process, the emergence of positive meanings (e. g. post-traumatic growth). However, negative meanings may also be ascribed to cancer, simultaneously with positive meanings. This study focused on the nature of the co-existence of positive and negative meanings in a sample of individuals diagnosed with colorectal cancer to find out whether negative meaning had an impact on quality of life and psychosocial adjustment above and beyond positive meaning.Methods: Participants were given questionnaires measuring meaning-made, quality of life, and psychological distress. Semi structured interviews were conducted with a subgroup from the original sample.Results: Hierarchical multiple regression analyses revealed that negative meaning-made (i.e. helplessness) was a significant predictor of poor quality of life and increased levels of depression/anxiety above and beyond positive meaning-made (i.e. life meaningfulness, acceptance, and perceived benefits). Correlational analyses and interview data revealed that negative meaning made was mainly associated with physical and functional disability, while positive meaning made was mostly related to emotional and psychological well-being.Significance of results: Meanings of varying valence may simultaneously be ascribed to cancer as it impacts different life dimensions, and they may independently influence quality of life and psychosocial adjustment. The presence of positive meaning was not enough to prevent the detrimental effects of negative meaning on psychosocial adjustment and quality of life among individuals taking part in this study. Future attention to negative meaning is warranted, as it may be at least as important as positive meaning in predicting psychosocial adjustment and quality of life following a cancer diagnosis.

A new ambulatory consultative clinic with integrated assessments by palliative care, radiation oncology, and allied health professionals was introduced to (1) assess patients with brain metastases at a regional comprehensive cancer center and (2) inform and guide patients on management strategies, including palliative radiotherapy, symptom control, and end-of-life care issues. We conducted a quality assurance study to inform clinical program development.

Few studies describe quality of life (QoL) outcomes following gastrectomy for gastric cancer using a validated instrument. The gastric cancer module for the Functional Assessment of Cancer Therapy system of QoL measurement tools (FACT‐Ga) was utilized to determine the changes in QoL following gastrectomy, and during the disease course.

AbstractObjective:The number of diagnosed cases of stomach cancer in Western countries is relatively small compared to prevalence rates in Eastern populations. This disparity creates a general lack of information and understanding of the experience of patients treated for this disease in North America. Surgical removal of the stomach, also called total gastrectomy (TG), is presently the only curative treatment available to patients with stomach cancer. Considering the impact such a procedure may have, very little is known about what factors influence an individual's postsurgical quality of life (QL).Method:This article reviews current literature and examines three unique case studies. Semi-structured interviews were analyzed using content analysis, a qualitative analytic approach for reporting combined subject responses.Results:Participants included one 37-year-old man with multiple polyps in his stomach and a family history of stomach cancer, one 18 year-old man with a confirmed CDH1 mutation and a family history of stomach cancer, and one 33-year-old man with confirmed metastatic gastric adenocarcinoma. Subjective patient experience was categorized into: (1) making the decision, (2) treatment impact, and (3) life after TG. Prior to surgery, all patients carefully evaluated their perceived risk compared to the treatment consequences and indicated that a certain event triggered their decision. The largest treatment impacts were learning to eat again and adjusting to the physical changes. Each patient endorsed that their experience made them appreciate and make the most of life.Significance of results:This currently represents the only study to investigate the lived experience of TG for prophylaxis or palliation in individuals with and without genetic risk for stomach cancer. Understanding this process will allow all members of the cancer care team, and the patients themselves, to better understand the factors involved in decision making and postoperative adjustment. Fruitful avenues for future research are discussed.

Purpose/Objective(s)To describe qualitatively the early experience of an integrated multidisciplinary palliative oncology clinic for the management of patients with brain metastases.Materials/MethodsCase scenarios.ResultsOngoing.ConclusionsThe diagnosis of brain metastases represents a pivotal transition in the cancer journey and forewarns a period of functional decline before death. As priorities for improving end-of-life care in Canada have been articulated recently in the literature, there is a need to revitalize clinical practice towards better integration of services for this patient population. To help ensure patients with brain metastases receive timely and comprehensive assessment for initial consultation and ongoing care, an ambulatory Multidisciplinary Palliative Brain Metastases Clinic is established at a regional tertiary cancer centre, with collaboration among allied disciplines including advanced practice nursing (APN), spiritual care, psychosocial oncology, neurology, palliative care and radiation oncology. The aim of the clinic is to provide rapid response and "one-stop" visit with the appropriate discipline for symptom control, psychosocial/emotional/spiritual support, advanced care planning and transitional services in the community. This presentation will describe qualitatively the operational principles and logistics of this dedicated brain metastases clinic, including the navigator role of the APN. Communication with patient and family regarding treatment options, aggressiveness of goals of care, and quality of life is emphasized. The role of each discipline and the integration of diverse clinical expertise towards a collaborative and functioning team is explained. Case scenarios are used to illustrate the range of patients served by this clinic. By providing patients and families with multidisciplinary biomedical, psychosocial and spiritual support, this specialized palliative oncology clinic serves as a model to improve patient-centered decision-making, support and therapy during their transition towards end-of-life care. Purpose/Objective(s)To describe qualitatively the early experience of an integrated multidisciplinary palliative oncology clinic for the management of patients with brain metastases. To describe qualitatively the early experience of an integrated multidisciplinary palliative oncology clinic for the management of patients with brain metastases. Materials/MethodsCase scenarios. Case scenarios. ResultsOngoing. Ongoing. ConclusionsThe diagnosis of brain metastases represents a pivotal transition in the cancer journey and forewarns a period of functional decline before death. As priorities for improving end-of-life care in Canada have been articulated recently in the literature, there is a need to revitalize clinical practice towards better integration of services for this patient population. To help ensure patients with brain metastases receive timely and comprehensive assessment for initial consultation and ongoing care, an ambulatory Multidisciplinary Palliative Brain Metastases Clinic is established at a regional tertiary cancer centre, with collaboration among allied disciplines including advanced practice nursing (APN), spiritual care, psychosocial oncology, neurology, palliative care and radiation oncology. The aim of the clinic is to provide rapid response and "one-stop" visit with the appropriate discipline for symptom control, psychosocial/emotional/spiritual support, advanced care planning and transitional services in the community. This presentation will describe qualitatively the operational principles and logistics of this dedicated brain metastases clinic, including the navigator role of the APN. Communication with patient and family regarding treatment options, aggressiveness of goals of care, and quality of life is emphasized. The role of each discipline and the integration of diverse clinical expertise towards a collaborative and functioning team is explained. Case scenarios are used to illustrate the range of patients served by this clinic. By providing patients and families with multidisciplinary biomedical, psychosocial and spiritual support, this specialized palliative oncology clinic serves as a model to improve patient-centered decision-making, support and therapy during their transition towards end-of-life care. The diagnosis of brain metastases represents a pivotal transition in the cancer journey and forewarns a period of functional decline before death. As priorities for improving end-of-life care in Canada have been articulated recently in the literature, there is a need to revitalize clinical practice towards better integration of services for this patient population. To help ensure patients with brain metastases receive timely and comprehensive assessment for initial consultation and ongoing care, an ambulatory Multidisciplinary Palliative Brain Metastases Clinic is established at a regional tertiary cancer centre, with collaboration among allied disciplines including advanced practice nursing (APN), spiritual care, psychosocial oncology, neurology, palliative care and radiation oncology. The aim of the clinic is to provide rapid response and "one-stop" visit with the appropriate discipline for symptom control, psychosocial/emotional/spiritual support, advanced care planning and transitional services in the community. This presentation will describe qualitatively the operational principles and logistics of this dedicated brain metastases clinic, including the navigator role of the APN. Communication with patient and family regarding treatment options, aggressiveness of goals of care, and quality of life is emphasized. The role of each discipline and the integration of diverse clinical expertise towards a collaborative and functioning team is explained. Case scenarios are used to illustrate the range of patients served by this clinic. By providing patients and families with multidisciplinary biomedical, psychosocial and spiritual support, this specialized palliative oncology clinic serves as a model to improve patient-centered decision-making, support and therapy during their transition towards end-of-life care.

BACKGROUND: Recently, the Functional Assessment of Cancer Therapy-Gastric (FACT-Ga) was developed to measure the quality of life (QoL) of patients with gastric cancer. This newly developed instrument has not yet been validated. METHODS: Eighty-two patients with gastric adenocarcinoma completed questionnaires at baseline. The FACTGa scores were measured as a function of disease stage and performance status, and they were correlated with the Medical Outcomes Study 36-item short-form health survey (SF-36), the Beck Depression Inventory-II, the Marlow-Crowne Social Desirability Scale, the Paulhus Deception Scale, and the State-Trait Anxiety Inventory. Patients received a second questionnaire 2 weeks after baseline to evaluate test-retest reliability and again at 3 months to evaluate the sensitivity of the FACT-Ga to changes in performance status and to estimate the minimally important differences in scores that represented meaningful change. RESULTS: The internal and test-retest reliability of the FACT-Ga instrument was adequate. With the exception of the social well being subscale, all FACT-Ga scores were correlated as hypothesized with other measures. Relevant components of the FACT-Ga were sensitive to changes in performance status. CONCLUSIONS: The current results indicated that the FACT-Ga provides a valid and reliable measurement of QoL in patients with gastric adenocarcinoma. It is a useful instrument for QoL assessment in clinical trials, and it also may be useful for the detection of significant changes in the QoL of individual patients. Cancer 2011;117:1302-12. (C) 2010 American Cancer Society

Little is known about cancer patients who seek specific educational interventions on cancer-related fatigue (CRF). The objectives of this study were (1) to describe the level of CRF, and emotional distress; social support; coping styles; and quality of life of patients who chose to attend a 1-hour educational session on CRF and (2) to examine the relationship between the selected demographic, psychosocial, and treatment-related variables and CRF. A questionnaire-based survey of 41 cancer patients who volunteered after a 1-hour education session on CRF at the Tom Baker Cancer Centre was conducted. The sample consisted mostly of married white women who lived in an urban environment. The average age was 56 years, and participants had an average of 14 years of education; 78% of the sample reported moderate to severe fatigue, 27% had significant levels of emotional distress, and 63% had a problematic coping style. Higher fatigue was associated with emotional distress, poorer quality of life, hopelessness, and reduced social support. To conclude, patients who self-refer to an educational session on CRF present a wide range of emotional difficulties and problematic coping styles. Therefore, educational sessions with patients with CRF should emphasize coping with emotional distress and building a support system.

Neuropsychiatric problems, and how they interact to impact on quality of life (QOL) in brain tumor patients, are generally poorly understood. The objectives of this study were: (1) to document the prevalence of depression, fatigue, emotional distress, and existential issues in a sample of brain tumor patients (2) to examine the interconnectedness of these problems, and (3) to explore their relationship with disease-related variables and QOL. This is a cross-sectional, questionnaire-based survey of 73 patients with primary brain tumors who presented to a neurological clinic at a tertiary cancer centre for ongoing care. Data for 60 participants (29 women, 31 men) who completed validated questionnaires were retained for analysis. Results showed that there was a high burden of depressive symptoms as measured by the Beck Depression Inventory-II (mean score 11.1, SD 7.4), with 38% of the sample scoring in the clinically depressed range. Overall QOL scores for this sample were similar to a reference sample of brain tumor patients. The scores on the existential subscale of the McGill Quality of Life questionnaire were comparable to those of a reference sample of cancer patients receiving ongoing care (mean score 7.2; SD 1.7). Fifty per cent of the sample could be classified as struggling with existential issues. Although scores reflecting depression, fatigue, emotional distress, and existential problems were interrelated, the presence of depressive symptoms was the single most important independent predictor of QOL in this cohort of brain tumor patients. Implications for treatment are discussed.