摘要:

AbstractThe effectiveness of a preoperative psychotherapeutic intervention with breast cancer patients was assessed in a randomized controlled trial: (1) preoperative interview plus a 30‐minute preoperative psychotherapeutic intervention; (2) preoperative interview plus a 30‐minute chat to control for the effects of attention; (3) preoperative interview only; and (4) routine hospital care control. A clinical psychologist interviewed the patient in hospital the afternoon before surgery. A consultant surgeon trained in listening and counselling skills conducted a 30‐minute psychotherapeutic intervention or chat. Psychological measures included anxiety and depression, body image distress, stressful life events, social support, and coping. Patients receiving a preoperative interview had lower body image distress at 3 months and 1 year than controls. Controls also showed significantly less Fighting Spirit in 1‐year interviews, and more control patients were cases for both anxiety and depression on Present State Examination criteria at 1 year than patients in the experimental groups. The psychotherapeutic intervention was superior to the chat among patients with severe stressful life events. Patients in the chat condition used their 30 minutes with the surgeon to explore symbolically themes of loss and restitution. In a multivariate model for predicting psychological outcome at 3 months and 1 year, experimental group remained a significant predictor when surgical procedure and age were included in the regression equation. Patients undergoing sector mastectomy had lower body image distress scores than mastectomy patients both at 3 months and 1 year. Psychological morbidity in the sample was high preoperatively (59%) and at 1 year (39%), but detection of morbidity by health professionals was poor. Predictors of caseness at follow‐up included caseness preoperatively, severe stressful life events, age, marital status, and social support. Implications of the findings for the care of cancer patients in hospital are

ISSN:1057-9249    

DOI:10.1002/pon.2960040102

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe present investigation was designed to test whether, and in which manner, the cancer patients judge their emotional state differently to their care providers. Emotional distress and hope are rated by the patients, the physicians concerned, nurses, next of kin and interviewers respectively. Compared with the external observers (as well as the self‐images of the next of kin), the patients rate their distress significantly lower. The ratings that both they and their next of kin give for their hope are significantly higher than those given by professional care givers. The relatives' estimates of the patients' states are more strongly correlated with their own self‐reports than with those of the patients. In addition, the factorial structures differ from one level of perception to the next. The differences revealed by the present study are discussed in the light of social comparison processes and with reference to the patient's specific relations to his professional and natural support

ISSN:1057-9249    

DOI:10.1002/pon.2960040103

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractA total of 520 patients were assessed within 8 weeks of diagnosis to explore the effect of age on psychological adjustment to cancer. Patients with cancers of the breast, colon, testicle, female reproductive tract and with lymphoma were included. Three measures of adjustment were used: DSM‐III diagnoses of depression and/or anxiety, frequency of specific concerns and the total number of patient concerns. For depression and anxiety diagnoses combined, the cases were significantly younger than the non‐cases (mean = 49.4 versus 53.7 years,p<0.01). Younger patients also had significantly higher concern scores (p<0.001). Younger patients were more likely to report concerns relating to the illness itself, treatment, feeling different, feeling upset, the future, finances, relationship with partner and others and sexuality. No age effect was seen for more practical concerns relating to physical symptoms, restriction of activities, job or amount of support received. Younger patients appear to experience greater difficulties adjusting to a cancer diagnosis but particular attention should be paid to the practical issues faced by older cancer patie

ISSN:1057-9249    

DOI:10.1002/pon.2960040104

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractSixty‐three patients with Hodgkin's disease and non‐Hodgkin's lymphoma were followed up for exactly 5 years after first diagnosis. Survival analysis was carried out using the log‐rank test (univariate) and Cox's proportional hazards regression method (multivariate). Variables examined were: age at diagnosis; gender; stage; symptoms; type of disease; grade of tumour, performance status; presence or absence of hypnotherapy or relaxation training; Eysenck Personality Inventory L‐scores; and Hospital Anxiety and Depression Scale scores. At diagnosis, in keeping with previous studies, L‐scores were high. Although L‐scores can be raised for several reasons, the L‐scale may be a useful measure of the cancer‐prone (type C) personality. Moreover, as predicted, L‐scores were associated with an increased risk of death within 5 years; L‐scores emerged as an independent risk factor as did depression scores. A relaxation‐based intervention may also have enhanced survival. Replication in the lymphomas, and investigation in other cancers,

ISSN:1057-9249    

DOI:10.1002/pon.2960040105

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractA new instrument designed to assess the treatment team's attitudes towards individual families was field tested to assess its correlation with missed appointments. We hypothesized that positive attitudes about families would be associated with high treatment adherence as measured by appointment keeping. The oncologists rated ease of working with parents, estimated appointment adherence and child's degree of illness in 18 children being treated for cancer. The 35 cohabitating parents were assessed for marital discord and parental‐estimated appointment adherence. Actual appointment adherence was determined by clinic chart review. Physician‐estimated adherence varied systematically with each physician and degree of the patient's morbidity. Factors related to actual adherence include: physician's discomfort in working with parents, father's estimate of home‐treatment adherence, with a statistical trend for distance travelled to be inversely related to adherence. Neither marital discord nor parent‐estimated adherence was related to appointment adherence. Results are discussed in terms of implications for facilitating ad

ISSN:1057-9249    

DOI:10.1002/pon.2960040106

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractPsychological and social problems have been documented as sequelae of mastectomy. Patients may experience depression, anxiety, decreased sexual interest, negative changes in body image, fears of recurrence and concerns regarding the mastectomy site or prosthesis. Immediate breast reconstruction, using improved techniques such as the TRAM flap, have lessened the negative psychological impact of mastectomy but whether these procedures themselves result in psychologic or sexual impairment has not been reported. We, therefore, report four patients, three of whom were self‐referred for psychiatric evaluation, who experienced changes in body image and sexual response after TRAM flap reconstruction. Although the TRAM flap procedure cannot be specifically implicated, the similar presentation and complaints in these four cases suggest a possible association that warrants more rigorous stud

ISSN:1057-9249    

DOI:10.1002/pon.2960040107

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

摘要:

AbstractCancer patients' complaints of impaired cognition following chemotherapy are fairly common but poorly documented among adult patients. Neuropsychological testing was used to evaluate current cognitive functioning of 28 stage I and II breast cancer patients (ages 28–54) who had completed 3 to 18 months of adjuvant chemotherapy, from 0.5 to 12 months prior to testing. Effects of drug regimen, length of treatment and level of depression on cognitive functioning were examined. Despite estimated high‐normal pre‐morbid intelligence (mean FSIQ 113) patients scored significantly below age‐, education‐, and gender‐corrected test norms in areas of verbal and visual memory, mental flexibility and speed of processing, attention and concentration, visuospatial ability and motor function. Of patients, 75% scored ‐2SDs (moderate impairment) on one or more test measures. Level of cognitive impairment was unrelated to depression, type of chemotherapy and time since treatment, but was positively related to length of chemotherapy treatment. These preliminary findings suggest that cognitive impairment may follow conventional adjuvant chemotherapy treatment and warrant replication with a controlled and more rigorous longit

ISSN:1057-9249    

DOI:10.1002/pon.2960040108

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

ISSN:1057-9249    

DOI:10.1002/pon.2960040109

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

ISSN:1057-9249    

DOI:10.1002/pon.2960040110

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY

ISSN:1057-9249    

DOI:10.1002/pon.2960040111

出版商:John Wiley&Sons, Ltd.    

年代:1995

数据来源: WILEY