Cognitive Effects of Cancer Chemotherapy in Adult Cancer Survivors: Cognitive-Behavioral Management

Problems of memory and attention following cancer chemotherapies have gained increasing research attention in the last 2 decades. The President’s Cancer Panel and the National Coalition for Cancer Survivorship formally recognized the problem as a quality of life matter in the 1990s (Ferrell and Hassey in Oncology 11:565–576, 1997; President’s Cancer Panel in Cancer Care Issues in the United States: Quality of Care, Quality of Life, National Cancer Program, National Cancer Institute, 1999). In combination with an aging population, advances in biomedical technologies for detection and treatment of life-threatening cancers, more people than ever are living with cancer or have been diagnosed and treated for cancer. An estimated 10-million individuals living in the U.S. are considered to be in “cancer survivorship” (Institute of Medicine 2005). Given the potential large scope of the problem of cognitive effects of cancer chemotherapies, there is a strong demand to address this survivorship matter and develop methods to optimally manage it. This article will summarize the current knowledge of chemotherapy-related cognitive change and describe a developing cognitive-behavioral treatment that is being studied to aid survivors with chemotherapy-related cognitive problems.     

The Familial Cancer Program of the Vermont Cancer Center: Development of a Cancer Genetics Program in a Rural Area

In response to many scientific discoveries linking cancer in certain families to inherited factors, the Vermont Cancer Center established the Familial Cancer Program (FCP) in December 1993. This multifaceted program combines the expertise of clinicians and researchers in many disciplines, including genetics, oncology, psychology, and molecular biology. The program's goals are identification of families in its region with excess cancer, provision of clinical services to such families, and use of research protocols when available and appropriate. This article describes the experience of setting up a familial cancer program in a rural area and discusses both successes and challenges in such an endeavor.     

Qualitative Cancer Genetic Counseling Research, Part I: Ethnography in a Cancer Clinic

This is a report of the experience of several months' ethnographic research by a genetic counselor researcher in a cancer treatment clinic. One goal of the exercise was to directly experience a method of qualitative research known as ethnography, which relies heavily on participant-observation, in an applied clinical setting. Another goal was to explore a previously undescribed research area in the genetic counseling literature, namely, the meaning of cancer and cancer treatment for affected individuals and their support companions. Here we report on a personal account of the experiences of conducting and publishing the research. The preliminary analysis and results of this field experience are published elsewhere (Peters et al. (2001) J Genet Counsel 10(2):151–168.). These initial findings support the feasibility of genetic counselors, who are trained in specific social science methodologies, to conduct qualitative research pertinent to genetic counseling practice.This work was completed at the University of Pittsburgh before employment at the National Cancer Institute (NCI) and does not represent the views of the NCI, the National Institutes of Health, the Department of Health and Human Services, or the Federal Government     

Children and Adolescents of Cancer Patients: The Impact of Cancer on the Family

In this article, extant literature was reviewed to examine the impact of parental cancer on the family. Many researchers and scholars have hypothesized that parental illnesses, like cancer, can affect all levels of the family system. However, most psychosocial research to date has focused on how cancer affects the patient and the couple. Consequently, little is known about how parental cancer affects the psychosocial development of children and adolescents. Therefore, research is needed to explore how children and adolescents are negatively impacted or protected from the effects of living with a parent who has cancer. More specifically, longitudinal studies that examine the mechanisms by which the cancer affects children's and adolescents' functioning can help physicians and family therapists clinically intervene in more efficacious ways.     

Cervical Cancer Survivors: Meaning in Life

This study endeavors to understand the meaning in life of cervical cancer survivors in India using narrative analysis. Cervical Cancer survivor participants were interviewed to obtain a holistic view of their experiences in their own words, which was followed by administration of Thematic Apperception Test. Interview data was analyzed using Narrative Analysis. The narratives indicated that the participants viewed life being predestined and guided by fate. In some cases the realization of immortality resulted in peace and satisfaction. This renewed meaning was strongly mediated by faith in God and increased religiosity which facilitated hope and resilience. Strong support systems further enhanced meaning in their lives. However, underlying factors like fatigue, fear of recurrence of the disease and perceived burden continue to be distressing factors. On the other hand, some participants who experienced a preoccupation with somatic complaints and ambivalent feelings toward God experienced a sense of meaninglessness, lack of purpose and diminished hope. The most frequently used defense mechanisms were sublimation, reaction formation, undoing, displacement and projection.     

Cancer during pregnancy: Two case studies

When a pregnant woman develops cancer, death and life are competing in her body and in her mind. In this article, two cases of pregnant cancer patients are described. The pregnant women were accompanied through their journey toward delivery and during the first months with their newborn. The process of being in intensive cancer treatment during pregnancy, of giving birth, and of building an early relationship with the infant is explored.     

Family History of Pancreatic Cancer in a High-Risk Cancer Clinic: Implications for Risk Assessment

Detailed family history is a critical element of cancer risk assessment. The relative importance of pancreatic cancer (PC) in a close family member, particularly in hereditary breast-ovarian syndrome (HBOS), is not clearly defined. We use a case-control design to investigate the importance of a family history of PC to cancer risk assessment. Case and control families were identified from the University of Chicago Cancer Risk database (1994–2005). Pedigrees were analyzed for personal and familial clinical cancer data. Cases included all new subjects (probands) reporting a close relative (first or second degree) with PC. Controls included the probands enrolled in the database immediately prior to and subsequent to each case (i.e. two controls for each case). From 1,231 pedigrees, 103 PC were reported by the proband in 87 unique families. Many probands reported multiple or early-onset PCs: one third (28/87) of case families met criteria for a familial PC syndrome [≥2 first-degree relatives with PC (n = 10) or PC diagnosed ≤50 (n = 18)]. Of these families, the majority (75%) concurrently met criteria suggestive of hereditary breast-ovarian syndrome (HBOS). Because of a family history consistent with HBOS, at least one individual from each of 29 case and 55 control families underwent genetic testing for BRCA1/2. Among case families, 19 of 29 (66%) had a BRCA1/2 mutation compared with 16 of 55 (29%) controls. A significant association between family history of PC and a BRCA1/2 mutation was seen (OR 3.78, 1.32–10.9). This point estimate was strengthened but less precise in the non-Ashkenazi Jewish subset of tested families (OR 6.03, 1.68–22.14). In a high-risk population, a family history of PC, though infrequently reported, is nonetheless clinically meaningful. In risk assessment for HBOS, identifying a family history of PC should strongly raise the suspicion of an unrecognized BRCA1/2 mutation.     

On Using a Cancer Center Cancer Registry to Identify Newly Affected Women Eligible for Hereditary Breast Cancer Syndrome Testing: Practical Considerations

The goals of this research were to describe the process of identifying and recruiting individuals registered with a cancer center's cancer registry who were eligible to participate in cancer genetic research. This study specifically focused on younger women with personal and family cancer histories strongly suggestive of hereditary breast cancer syndromes, as determined by genetic counselor review. Of special interest was to determine the proportion of women from minority backgrounds who were (a) identifiable in this manner and (b) interested in genetic testing for hereditary breast cancer through a family cancer clinical research program. An initial query of the 292 cases of women newly affected with breast cancer and contained within the registry indicated that 124 met demographic eligibility criteria. The personal and family cancer histories of each of these women were then reviewed by a genetic counselor and the remaining, eligible patients (n = 31) were subsequently contacted by mail and telephone: approximately three-fifths (18/31) of these patients were White and two-fifths (13/31) were Black or of another racial background. Of the women who were sent one or more study-related mailings, 10% (3/31) were unreachable by telephone due to incorrect contact information, 32% (10/31) were reachable by telephone but unresponsive to messages left, 26% (8/31) had already participated in the family cancer program (i.e., were positive controls), 6% (2/31) were interested in participating in the program, 23% (7/31) were uninterested in participating in the program, and 3% (1/31) were later determined to be ineligible. Comparing the racial backgrounds of women who were either positive controls or interested in participating (i.e., “tester” category) to women who were either unreachable, nonresponsive, uninterested, or ineligible (i.e., “nontester” category), there was a nonsignificant trend for more non-White women to fall into the nontester than tester category, Fisher's Exact Test = .09. This work underscores practical steps in planning and carrying-out cancer genetic testing research among women newly affected with breast cancer and members of special populations. It also underscores the role that genetic counseling professionals play in this process.     

Promotion of Cancer Family History Awareness: Jameslink Cancer Risk Assessment Tool at Community Health Fairs

This article examines the impact of providing personalized familial cancer risk assessments with the Jameslink Cancer Risk Assessment Tool. Users of the Jameslink (N = 166) at eight community health fairs completed a survey including demographic, psychosocial and behavioral variables to better understand responses to the Jameslink. No differences were found between whites and those of other races for variables of interest, indicating suitability of the Jameslink for diverse populations. Those with higher Jameslink-assessed risk had higher perceived risk of cancer. Approximately half (53.8%) reported that they would speak to their physician about their Jameslink-assessed risk. A regression found Jameslink-assessed risk, cancer worry, and perceived risk of cancer predicted intentions to speak to a physician about their risk. In addition, open-ended data provided suggestions to improve the Jameslink. Changes in content and format were suggested; however most were happy with the program and encouraged its promotion. The lack of findings for differences as a function of race bolsters the use of computerized Cancer Risk Assessment Tools in diverse communities. The positive feedback of users and the close association between cancer risk assessment, perceived risk, and intention to speak to a physician are supportive of continued use and development of Cancer Risk Assessment Tools in the community to promote awareness of cancer risk.     

Responses to Parental Cancer: A Clinical Perspective

Parental cancer constitutes a unique stressor, and newly diagnosed patients often express deep concerns about how their children will adapt to the illness and treatments. Although data on this underserved group of second-order patients is growing, the literature has yielded limited practical information for the clinician working with cancer patients who have children at home. The present study examines long-term adjustment in two samples of grown daughters of cancer patients. Subjects reported having experienced significant emotional upheaval and substantial family disruption during the acute phase of their parents' diagnosis and treatments. Many of the family problems were related to difficulties with the healthy parent. Subjects also recalled numerous positive changes during this acute phase of adjustment to the stressor. Over the long term, subjects did not differ from comparison women on several measures of psychological adjustment, suggesting that children of cancer patients are not necessarily at elevated risk for long-term psychological maladjustment. Nevertheless, many subjects continued to experience a lasting subjective impact of their cancer experiences that appeared to be too subtle or existential to be measured by general psychological instruments. Most of these changes were positive, and deriving a sense of benefit from the experience was a near-universal phenomenon. Subjects discussed what helped and hindered their coping efforts, and made a number of recommendations to others facing this family stressor. Inadequate communication about the cancer was identified by many subjects as an impediment to their eventual adjustment.     

Living with Cancer: Impact of Expressive Arts

This single case study explored the impact of participation in an expressive arts support group on a Caucasian female with lymphoma. The creative art process, a peer support group, and a five point data collection method were deployed. Four major themes emerged reflecting the impact of participation in the support group reshaping the occupational identity of the patient. This study combined the benefits of traditional support groups and expressive art activities, and demonstrated the holistic ability of occupational therapy to support a female cancer patient to reestablish her occupational identity as a catalyst to recovery.     

癌症基因组研究:问题与启示

癌症是目前威胁人类健康的最危险的杀手之一。在西方国家 ,每 3个人中有 1人患有癌症 ,每 5个人中有 1个人死于癌症[1] 。随着现代生物医学的发展 ,人们已经认识到癌症是最常见的基因疾病 ,其发生与ＤＮＡ序列异常有关。ＤＮＡ的突变和复制错误会不断引起序列的细微改变 ,当体细胞突变替换了某个重要基因的功能 ,突变细胞优势生长而形成肿瘤 ,相关靶基因的附加突变和克隆扩增 ,造成了肿瘤组织的浸润和转移。目前人们已鉴定了大约 30个抑癌基因和 10 0多个癌基因。分离这些基因最有效的传统方法是基因作图策略 ;在较小的基因组片段上将其定位…     

Generations Lost: A Cancer Genetics Case Report

The process of cancer genetic counseling can unearth issues that, sometimes unbeknownst to the counselor, are emotionally and psychologically significant to the patient. The following case report illustrates how the precounseling process of obtaining a medical chart on a deceased parent affected two sister counselees. This medical chart helped these sisters to reconnect with the mother they lost as children and to better understand her struggle with breast cancer. This case also chronicles the counselor's professional growth and discovery during this process.     

Cancer Metaphors: Taiwan and the United States

The Cancer Metaphors Test, a measure of the imagery of cancer, was administered to a sample of 138 Taiwanese college students and 167 United States college students, equated on age and gender, and presumed not to be different on academic achievement and socioeconomic level. A factor analysis of the Taiwanese protocols replicated the factor structure previously found on the CMT for United States respondents. Significant differences were obtained on two of the four CMT factors, with Taiwanese students scoring higher on both Terminal Pessimism and Future Optimism. Such differences are discussed in terms of differential coping strategies.