1503 Background: Patients with brain cancer develop neurobehavioral dysfunction and fatigue that compromise their performance of daily activities. We report results from evaluating the efficacy and safety of modafinil treatment for... more
1503 Background: Patients with brain cancer develop neurobehavioral dysfunction and fatigue that compromise their performance of daily activities. We report results from evaluating the efficacy and safety of modafinil treatment for tumor/therapy sequelae in this medically fragile patient population. Methods: Patients: 21–65 years old with primary malignant disease or nonmalignant cerebral tumors treated with neurosurgical resection, radiotherapy, and/or chemotherapy. Clinical Global Impression of Severity ratings of mild to severe attention/memory impairment and/or fatigue. Measures: Trail Making (TM) A and B, Symbol Digit Modalities (SDM), Verbal Fluency (VF), Hamilton Depression Scale (HAM-D), Fatigue Severity Scale (FSS), Visual Analogue Fatigue Scale (VAFS), Modified Fatigue Impact Scale (MFIS). Design: Double-blind dose-controlled randomization (200 or 400 mg/day modafinil in divided doses) 3 wks; Washout 1wk; Open label extension 8 wks. Statistical analyses: Changes from baseline at scheduled visits (1, 3, 4, 8, 12 wks) using paired t-tests or Wilcoxon Signed Rank tests as appropriate. Results: Thirty patients, 63% male, mean age (SD) = 45.3 (11.7) yrs were accrued from 6/03–10/05. Illness severity: moderate 3 (10%), marked 13 (43%), severe 14 (47%). Tumor histology: glioblastoma multiforme 8 (27%), anaplastic glioma 10 (33%), low grade glioma 10 (33%), meningioma 1 (3%), CNS lymphoma 1 (3%). Treatment: neurosurgical resection 93%, radiotherapy 87%, chemotherapy 70%. The table shows relationships of nine variables at baseline and 8 and 12 weeks after initiation of modafinil. Adverse events reported by ≥4 patients: headache 13 (42%); insomnia 8 (26%); dizziness 7 (23%); dry mouth 7 (23%); depressed consciousness 5 (16%); nausea 4 (13%). Conclusions: Results show improvement across cognitive, mood, and fatigue outcome measures. Modafinil was generally well tolerated, with a low incidence of adverse events. Greatest improvements in outcomes were observed 8 wks after baseline. [Table: see text] [Table: see text]
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Sixty daughters whose mothers had breast cancer were cross-sectionally studied. Daughters age 11-20 reported feeling significantly more uncomfortable about involvement in their mothers' illness than daughters age 20+. Daughters... more
Sixty daughters whose mothers had breast cancer were cross-sectionally studied. Daughters age 11-20 reported feeling significantly more uncomfortable about involvement in their mothers' illness than daughters age 20+. Daughters whose mothers died were more likely to report long-term life plan changes and role changes with their mothers during the mothers' illness. The Global Symptom Index was predicted by the daughter's perceived degree of involvement with her mother (during her mother's illness), current emotional resolution (about her mother's illness), and sexual satisfaction. Sexual satisfaction was predicted by role changes during the mother's illness, frequency of sexual relations, and a depression scale.
Research Interests: Health Behavior, Family, Breast Cancer, Body Image, Adolescent, and 15 moreHuman Sexuality, Humans, Child, Female, Attractiveness, Clinical Sciences, Aged, Family Health, Adult, Age Factors, Chi Square Distribution, Cross Sectional Studies, attitude to health, Child behavior disorders, and Breast Neoplasms
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Psychological problem frequencies of very ill, homebound cancer patients were studied using an instrument entitled "Psychosocial Problem Categories for Homebound Cancer Patients." This instrument contains thirteen major... more
Psychological problem frequencies of very ill, homebound cancer patients were studied using an instrument entitled "Psychosocial Problem Categories for Homebound Cancer Patients." This instrument contains thirteen major categories of problems and fifty individual problems. A total of 570 patient records were obtained from two visiting nurse agencies in two different counties. Records were rated by a pair of trained raters, with level of interrater reliability being r = 0.96. Intervention frequencies by visiting health care professionals were also assessed. Percentages are based on at least one mention of problem or intervention. The five most frequent problem categories included: 1) Somatic side effects, 30% of total problems, of which pain involved 13% of total problems, 2) Patient mood disturbance, 15% of total problems, 3) Equipment problems, 8% of total problems, 4) Family relationship impairment, 7% of total problems, and 5) Cognitive impairment, 6% of total problems. The three most frequent interventions included: 1) Instructor/reinforcement to patient/family, 22% of total interventions, 2) No intervention for problem, 17% of total interventions, and 3) Counseling/emotional support, 17% of total interventions. Because the assessment instrument showed high interrater reliabilities for the two demographically dissimilar patient populations, it may be adaptable to heterogeneous populations.
Research Interests: Psychology, Family, Medicine, Counseling, Psychosomatic Medicine, and 15 moreHumans, Female, Male, Psychological Intervention, Patient Compliance, Psychosocial, Middle Aged, Adult, Cognition disorders, professional patient relations, Breast Neoplasms, Affective symptoms, Psychology and Cognitive Sciences, Medical and Health Sciences, and lung neoplasms
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Research Interests: Psychology, Clinical Psychology, Personality Assessment, Cystic Fibrosis, Adolescent, and 15 moreMedicine, Anxiety, Humans, Female, Male, Defense Mechanisms, Social Adjustment, Clinical Sciences, Adult, Somatoform disorders, Age Factors, ANXIETY, Intelligence tests, Mmpi, and Minnesota Multiphasic Personality Inventory-2
Research Interests: Psychology, Medicine, Anxiety, Psychosomatic Medicine, Affect, and 15 moreProspective studies, Humans, Female, Male, Middle Aged, Family Health, Bone Marrow Transplantation, Psychosomatic, Adult, Analysis of Variance, Chi Square Distribution, ANXIETY, Psychology and Cognitive Sciences, Medical and Health Sciences, and Lymphocyte Count
Research Interests: Clinical Psychology, Health Behavior, Family, Breast Cancer, Body Image, and 15 moreAdolescent, Child, Female, Feeling, Clinical Sciences, Aged, Family Health, Adult, Age Factors, Chi Square Distribution, Cross Sectional Studies, Daughter, attitude to health, Child behavior disorders, and Breast Neoplasms
The traumatic experience of the discovery of a lump in the breast, the diagnosis of cancer and eventual mastectomy have focused medical attention on the importance of providing adequate psychosocial care for mastectomy patients. This... more
The traumatic experience of the discovery of a lump in the breast, the diagnosis of cancer and eventual mastectomy have focused medical attention on the importance of providing adequate psychosocial care for mastectomy patients. This paper outlines a comprehensive program now underway. The program includes the premastectomy (preventive), postoperative (interventive) and recovery (postventive) periods. To secure more information for this program, an initial project examining the psychological effects of mastectomy on women and their spouses has been undertaken. It is anticipated that these findings will be helpful in identifying some of the problems encountered and aid in the success of the program in attaining the desired results.
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Stress-producing factors in oncology nursing are described with special attention to the differences between the stresses inherent in the patient-oncology nurse relationship and the patient-oncologist (physician) relationship. Danger... more
Stress-producing factors in oncology nursing are described with special attention to the differences between the stresses inherent in the patient-oncology nurse relationship and the patient-oncologist (physician) relationship. Danger signals which signify emotional decompensation in oncology work are discussed. Personal characteristics are described which have proven valuable criteria in selecting nurses who will be capable of adapting to the oncology setting. A formal support mechanism which can be provided by the oncology unit and development of an informal peer support network are discussed. A professional maturing process which evolves from development of a philosophy compatible with oncology nursing is described.
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The psychosocial outcomes of testicular cancer and Hodgkin's disease were compared to test our hypotheses that more specific dysfunction and less hiding of symptoms would be found in the former group, as cancer visibly affects a... more
The psychosocial outcomes of testicular cancer and Hodgkin's disease were compared to test our hypotheses that more specific dysfunction and less hiding of symptoms would be found in the former group, as cancer visibly affects a sexual organ. Since those with Hodgkin's disease could more easily deny the disease, poorer psychosocial adjustment was predicted. The sample consists of 85 men with Hodgkin's disease and 88 men with testicular cancer (seminomatous, n = 39; or nonseminomatous, n = 49). They were interviewed once, at least 1 year following the end of treatment. Measures of sociodemographic characteristics, physical functioning, psychologic distress, and social outcomes were collected. Treatment data were collected from medical records. Men with testicular cancer report more focused symptoms: less sexual enjoyment and poor health habits. Men with Hodgkin's disease report more generalized symptoms: fatigue, energy loss, and work impairment. Multivariate analysis indicates that most of these differences are site-related; independent effects of treatment on outcomes were found for more generalized symptoms. Contrary to expectations, both groups reported similar levels of infertility and erectile dysfunction. The response to testicular cancer is site-specific, while the response to Hodgkin's disease is related to both site and treatment (stage-related).
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Research Interests: Psychology, Intelligence, Persuasion, Medicine, Humans, and 15 moreCult, Attitude, American, Religion and psychology, Interpersonal Relations, Psychological Tests, Coercion, Time Factors, PERSUASIVE COMMUNICATION, Hostility, Superego, Psychiatric Status Rating Scales, Family Characteristics, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Organ transplantation is a life-saving mechanism with a large public health burden given the necessity of individuals to donate their organs in the event of their own death. Understanding the psychological and medical sequelae of... more
Organ transplantation is a life-saving mechanism with a large public health burden given the necessity of individuals to donate their organs in the event of their own death. Understanding the psychological and medical sequelae of individuals receiving an organ transplant is invaluable in a successful transplant. The waiting period for transplantation is the most psychologically difficult period, and is an important window during which to intervene psychologically and medically. Patients who are hospitalized during this waiting period make up the most vulnerable population given the psychological difficulties of not only awaiting transplant but of a prolonged and difficult hospitalization. This paper is a first step in understanding the psychological landscape of hospitalized patient’s awaiting transplant and the potential research avenues and intervention strategies that may be utilized in order to decrease the psychological burden as well as influence successful medical outcomes in organ transplantation.
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Adjuvant chemotherapy for breast cancer is undeniably effective in increasing survival rates but many breast cancer survivors (BCS) exhibit side effects including nausea, fatigue, stress, and neurocognitive deficits, known as... more
Adjuvant chemotherapy for breast cancer is undeniably effective in increasing survival rates but many breast cancer survivors (BCS) exhibit side effects including nausea, fatigue, stress, and neurocognitive deficits, known as “chemobrain.” Objectives This pilot study explored how neurotherapy, or EEG biofeedback, a non-pharmacological approach, improved neurocognitive, behavioral, and neurophysiological deficits associated with BCS who underwent chemotherapy. Methods Subjects underwent 18 sessions of EEG biofeedback training, in which audio and visual feedback occurred with successful shifting of EEG patterns. Results Quantitative EEG and assessment tests demonstrated neurophysiological, cognitive, and behavioral deficits in all nine subjects prior to training. EEG biofeedback resulted in significant improvements in neurophysiological, neurocognitive, and psychological functions in all nine subjects after training. Conclusions We propose that this intervention and related forms of E...
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Parenting attitudes of female heroin addicts were investigated in a single factor design which compared addict mothers, addict non-mothers, nonaddict mothers, and nonaddict nonmothers. A principal components factor analysis was performed... more
Parenting attitudes of female heroin addicts were investigated in a single factor design which compared addict mothers, addict non-mothers, nonaddict mothers, and nonaddict nonmothers. A principal components factor analysis was performed on the PARI and used as the dependent measure. A factor labeled "authoritarian overinvolvement" emerged which significantly differentiated between groups. Further, the effects of mothering and addiction proved to be additive such that addict mothers were extremely high on this scale. This result was discussed in terms of the parental home environment of addict women.
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Objective:Exploration of complicated grief focusing on the relationship of post-traumatic stress disorder (PTSD) and complicated grief in a population of women at high risk for developing breast cancer. Special reference is made to women... more
Objective:Exploration of complicated grief focusing on the relationship of post-traumatic stress disorder (PTSD) and complicated grief in a population of women at high risk for developing breast cancer. Special reference is made to women who have experienced a material death.Method:We reflected on the clinical attributes of the Revlon UCLA High Risk Clinic population in terms of their own perceived risk of developing breast cancer. For part of our population, their perceived risk was coupled with their reactions to the loss of their mothers to breast cancer. We compared and contrasted this pattern of reactions to those described by Licihtenthal et al. (2004) in their developmental review of complicated grief as a distinct disorder.Results:We concluded that our population of women differed from Lichtenthal et al.'s (2004) model for complicated grief. Lichtenthal's group postulated that the key element of complicated grief involves the protracted nature of separation anxiety a...
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Research Interests: Psychology, Computer Science, Adaptation, Medicine, Nucleus Accumbens, and 15 moreReward, Brain, Humans, Negative Affect, Psychological, Functional Magnetic Resonance Imaging, Neuroimage, Male, Magnetic Resonance, Physiological, Grief, Adult, Task Performance and Analysis, Psychology and Cognitive Sciences, and Medical and Health Sciences
The long-term psychosocial impact of adult daughters caring for their mothers with breast cancer has been recognized but understudied. The objectives of this study were to characterize the psychosocial functioning of women who served as... more
The long-term psychosocial impact of adult daughters caring for their mothers with breast cancer has been recognized but understudied. The objectives of this study were to characterize the psychosocial functioning of women who served as informal caregivers during their mothers. treatment for breast cancer in two distinct samples, community and high risk clinic, and to determine differences in psychosocial functioning between the two samples. Using a cross-sectional design, a sample of mostly married, Caucasian and college educated women (N = 59) were administered a battery of questionnaires assessing socio-demographic and psychosocial factors (i.e. coping, caregiving tasks and difficulty, social support, spirituality, mental distress, depressive symptoms). Using descriptive analysis, chi-square and T tests, results demonstrated significant differences between the two samples in time since caregiving, with the community sample reporting few years since the caregiving episode (e.g. 2.1 versus 15.1 years); coping strategies, with the clinic sample reporting higher scores on active coping, behavioral disengagement, planning, and self-blame; support type care tasks difficulty, with the clinic sample reporting higher scores on emotional support and tangible support, and all domains of spirituality (e.g. peace, meaning, faith), with higher levels being reported by the community sample. Although participants did not exhibit clinically significant levels of emotional distress, almost 25% of the community sample and 10% of the clinic sample had clinically significant depressive symptoms. Findings underscore the need for interventions tailored for caregivers to consider the unique psychosocial characteristics of caregivers across settings.
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This paper examines whether a relationship exists between paternal psychological stability and daughters' symptomatology following the death of a wife/mother from breast cancer. Specifically, is there a relationship between paternal... more
This paper examines whether a relationship exists between paternal psychological stability and daughters' symptomatology following the death of a wife/mother from breast cancer. Specifically, is there a relationship between paternal parenting style and the daughters' subsequent capacity to form committed relationships later in life? We assessed 68 adult daughters (average age = 23.5 years) since the mother's breast cancer diagnosis by means of a semistructured clinical interview and psychological testing. The daughters were subdivided into three psychiatric risk groups. Those in the highest risk group were most likely to be single and to have high CES-Depression and STAI-Anxiety scores. Daughters in the highest risk group were also most likely to have fathers who abused substances, fathers who had experienced a serious psychiatric event, and families with the most closed communication about the mother's cancer. Psychopathology in fathers correlated with increasing an...
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Abstract 1. Administered a questionnaire to 41 3270 yr old women who had had mastectomies to investigate aspects of the procedure itself, pre-and postmastectomy adjustment, effects on sexual relationships, and the influence of age.... more
Abstract 1. Administered a questionnaire to 41 3270 yr old women who had had mastectomies to investigate aspects of the procedure itself, pre-and postmastectomy adjustment, effects on sexual relationships, and the influence of age. Although most ...
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Eighty-eight men with a diagnosis of either seminomatous or nonseminomatous testicular cancer were recruited for intensive psychosocial assessment by personal interview and psychological testing. The interviews were conducted, on the... more
Eighty-eight men with a diagnosis of either seminomatous or nonseminomatous testicular cancer were recruited for intensive psychosocial assessment by personal interview and psychological testing. The interviews were conducted, on the average, 45 months after treatment had ended. The men experienced significant depletion of energy, increased fear of cancer, interference with sleep and cognitive function, and sexual difficulties during and after
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Psychological problem frequencies of very ill, homebound cancer patients were studied using an instrument entitled "Psychosocial Problem Categories for Homebound Cancer Patients." This instrument contains thirteen major... more
Psychological problem frequencies of very ill, homebound cancer patients were studied using an instrument entitled "Psychosocial Problem Categories for Homebound Cancer Patients." This instrument contains thirteen major categories of problems and fifty individual problems. A total of 570 patient records were obtained from two visiting nurse agencies in two different counties. Records were rated by a pair of trained raters, with level of interrater reliability being r = 0.96. Intervention frequencies by visiting health care professionals were also assessed. Percentages are based on at least one mention of problem or intervention. The five most frequent problem categories included: 1) Somatic side effects, 30% of total problems, of which pain involved 13% of total problems, 2) Patient mood disturbance, 15% of total problems, 3) Equipment problems, 8% of total problems, 4) Family relationship impairment, 7% of total problems, and 5) Cognitive impairment, 6% of total problems. The three most frequent interventions included: 1) Instructor/reinforcement to patient/family, 22% of total interventions, 2) No intervention for problem, 17% of total interventions, and 3) Counseling/emotional support, 17% of total interventions. Because the assessment instrument showed high interrater reliabilities for the two demographically dissimilar patient populations, it may be adaptable to heterogeneous populations.
Research Interests: Family, Home Care, Counseling, Lung Cancer, Humans, and 15 moreFemale, Male, Patient Compliance, Cervical Cancer, Middle Aged, Adult, Multiple regression analysis, Cancer Patient, Cognition disorders, Multiple regression Model, professional patient relations, Breast Neoplasms, Affective symptoms, Medical and Health Sciences, and lung neoplasms
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A case of a 16-year-old with aplastic anemia who presented extraordinary management problems during a 10-week hospitalization is analyzed from several perspectives. The case is viewed in the context of convergent systems which did not... more
A case of a 16-year-old with aplastic anemia who presented extraordinary management problems during a 10-week hospitalization is analyzed from several perspectives. The case is viewed in the context of convergent systems which did not interface smoothly, hence the patient’s "unmanageability." These convergent systems included the patient’s family, the ward personnel, which included nurses, house-staff, and three attending physicians over the 10-week period, and the patient himself. The patient’s medical course and psychological course are also delineated on a week-by-week basis over the course of the hospitalization.