Pascal Jean-Pierre

Memory can be deleteriously affected by cancer treatment. It is important to quantify these effects, to assess the effectiveness of interventions to ameliorate them, and to monitor changes in cancer patients’ memories over time. However, brief and reliable screening measures of cancer treatment-related memory problems are lacking. We report on the latent structure and reliability analysis of a brief patient self-reported cancer-related memory problem screening measure (SRMP). Participants (N=781) included in this analysis were part of a larger study on cancer-related fatigue. Patients completed the Fatigue Symptom Checklist (FSCL) at four time points. Five items from the FSCL that assess memory problems were aggregated into the SRMP. Suitability of the data for latent structure analysis was determined using the various criteria: Kaiser-Myer-Olkin, Bartlett’s Test of sphericity, Kaiser’s simplest criterion test of eigenvalue (λ) >1, and the presence of item-correlation coefficients of r ≥ 0.30. Principal components analysis (PCA) and Cronbach coefficient alphas (αs) were calculated to determined validity and internal consistency of the SRMP. Reliability assessment of the SRMP revealed high internal consistency of the SRMP as indicated by α = 0.90. The PCA revealed a one-dimensional measure with a single component with λ > 1 that explained 71% of the variance. The KMO value was .87, and the Bartlett’s Test of Sphericity was significant (p < 0.001). Subsequent reliability assessments of the SRMP revealed αs of 0.90 and above, all with one component explaining 71% to 73% of the variances. The results support the use of the SRMP as a one-dimensional brief screening measure of cancer treatment-related memory problems. The SRMP could be used as an initial indicator of underlying memory problems that may need further examination. Future studies need to establish the construct validity of the SRMP.

Background: There is limited high-quality evidence about the impact of patient navigation (PN) on outcomes for patients with diagnosed cancer. Methods: We pooled data from two sites from the national Patient Navigation Research Program. Patients (n = 438) with newly diagnosed breast (n = 353) or colorectal cancer (n = 85) were randomized to PN or usual care. Trained lay navigators met with patients randomized to PN to help them assess treatment barriers and identify resources to overcome barriers. We used intent-to-treat analysis to assess time to completion of primary treatment, psychologic distress (impact of events scale), and satisfaction (patient satisfaction with cancer-related care) within 3 months after initiation of cancer treatment. Results: The sample was predominantly middle-aged (mean age = 57) and female (90%); 44% were race-ethnic minorities (44%), 46% reported lower education levels, 18% were uninsured, and 9% reported a non-English primary language. The randomized groups were comparable in baseline characteristics. Primary analysis showed no statistically significant group differences in time to completion of primary cancer treatment, satisfaction with cancer-related care, or psychologic distress. Subgroup analysis showed that socially disadvantaged patients (i.e., uninsured, low English proficiency, and non-English primary language) who received PN reported higher satisfaction than those receiving usual care (all P < 0.05). Navigated patients living alone reported greater distress than those receiving usual care. Conclusions: Although the primary analysis showed no overall benefit, the subgroup analysis suggests that PN may improve satisfaction with care for certain disadvantaged individuals. Impact: PN for cancer patients may not necessarily reduce treatment time nor distress. Cancer Epidemiol Biomarkers Prev; 21(10); 1673–81. ©2012 AACR.

Purpose Cancer and its treatments are associated with psychological distress that can negatively impact self-perception, psychosocial functioning, and quality of life. Patients with head and neck cancers (HNC) are particularly susceptible to psychological distress. This study involved a cross-validation of the Measure of Body Apperception (MBA) for HNC patients. Methods One hundred and twenty-two English-fluent HNC patients between 20 and 88 years of age completed the MBA on a Likert scale ranging from “1 = disagree” to “4 = agree.” We assessed the latent structure and internal consistency reliability of the MBA using Principal Components Analysis (PCA) and Cronbach's coefficient alpha (α), respectively. We determined convergent and divergent validities of the MBA using correlations with the Hospital Anxiety and Depression Scale (HADS), observer disfigurement rating, and patients' clinical and demographic variables. Results The PCA revealed a coherent set of items that explained 38 % of the variance. The Kaiser–Meyer–Olkin measure of sampling adequacy was 0.73 and the Bartlett's test of sphericity was statistically significant (χ ² (28) = 253.64; p < 0.001), confirming the suitability of the data for dimension reduction analysis. The MBA had good internal consistency reliability (α = 0.77) and demonstrated adequate convergent and divergent validities based on statistically significant moderate correlations with the HADS (p < 0.01) and observer rating of disfigurement (p < 0.026) and nonstatistically significant correlations with patients' clinical and demographic variables: tumor location, age at diagnosis, and birth place (all p _s > 0.05). Conclusions The MBA is a valid and reliable screening measure of body apperception for HNC patients.

Cancer-related cognitive dysfunction remains after controlling for variables such as socioeconomic and racial/ethnic status; it should be more systematically assessed and treated among patients and survivors.

Background Patient satisfaction (PS), a key measure of quality of cancer care, is a core study outcome of the multi-site National Cancer Institute-funded Patient Navigation Research Program. Despite large numbers of underserved monolingual Spanish speakers (MSS) residing in USA, there is no validated Spanish measure of PS that spans the whole spectrum of cancer-related care. The present study reports on the validation of the Patient Satisfaction with Cancer Care (PSCC) measure for Spanish (PSCC-Sp) speakers receiving diagnostic and therapeutic cancer-related care. Methods Original PSCC items were professionally translated and back translated to ensure cultural appropriateness, meaningfulness, and equivalence. Then, the resulting 18-item PSCC-Sp measure was administered to 285 MSS. We evaluated latent structure and internal consistency of the PSCC-Sp using principal components analysis (PCA) and Cronbach coefficient alpha (α). We used correlation analyses to demonstrate divergence and convergence of the PSCC-Sp with a Spanish version of the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I-Sp) measure and patients' demographics. Results The PCA revealed a coherent set of items that explicates 47% of the variance in PS. Reliability assessment demonstrated that the PSCC-Sp had high internal consistency (α = 0.92). The PSCC-Sp demonstrated good face validity and convergent and divergent validities as indicated by moderate correlations with the PSN-I-Sp (p = 0.003) and nonsignificant correlations with marital status and household income (all p _s > 0.05). Conclusion The PSCC-Sp is a valid and reliable measure of PS and should be tested in other MSS populations.

Background: Patient navigators are trained to help patients effectively access and use healthcare resources in order to facilitate timely completion of recommended cancer screening, diagnostic care, and treatment. Patient navigators provide logistic, instrumental, and psychosocial support to cancer patients. Yet few studies have examined patient–navigator relationships, particularly for Spanish‐speaking patients with low English proficiency. We aimed to validate a Spanish version of the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN‐I‐Sp) scale.Methods: We translated and back‐translated the PSN‐I into Spanish and administered the resulting PSN‐I‐Sp to 222 Spanish‐fluent participants. We conducted a principal components analysis and assessed Cronbach's coefficient alpha (α) to evaluate the latent structure and the internal consistency of the PSN‐I‐Sp. We also completed correlation analyses to examine divergence and convergence of the PSN‐I‐Sp with the Spanish version of the Patient Satisfaction with Cancer‐Related Care (PSCC‐Sp) and the patients' demographics.Results: The principal components analysis revealed a one‐dimensional PSN‐I‐Sp measure that explained 82.0% of the variance. The reliability assessment revealed high internal consistency (α = 0.97). The PSN‐I‐Sp demonstrated good face validity and adequate convergent and divergent characteristics as indicated by a moderate correlation with scores on the PSCC‐Sp (allps < 0.0001) and a non‐statistically significant correlation with marital status (allp > 0.05).Conclusion: The PSN‐I‐Sp is a valid and internally consistent measure of satisfaction with interpersonal relationship with a patient navigator for Spanish‐speaking participants. Copyright © 2011 John Wiley & Sons, Ltd.

Background: Patient navigation (PN) is a method for addressing racial–ethnic and socioeconomically based disparities in cancer‐related care. Patient navigators provide logistic and emotional support to underserved patients to facilitate successful completion of diagnostic and treatment care. Yet, little is known about patient satisfaction with the relationship with a navigator due to a dearth of instruments measuring satisfaction.Objective: The objective of this study was to validate the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN‐I) measure for patients undergoing diagnostic and/or therapeutic cancer care.Methods: We administered the PSN‐I to 783 participants from the nine different sites of the National Cancer Institute sponsored Patient Navigation Research Program. We evaluated the latent structure and internal consistency of the PSN‐I using principal components analysis (PCA) and Cronbach coefficient alpha (α), respectively. We used correlation analyses to examine divergence and convergence of the PSN‐I with the Patient Satisfaction with Cancer‐related Care (PSCC), the Rapid Estimate of Adult Literacy in Medicine (REALM) Long Form, and patients' demographics.Results: The PCA revealed a coherent set of items that explicates 76.6% of the variance in PSN‐I. Reliability assessment revealed high internal consistency (αranging from 0.95 to 0.96). The PSN‐I had good face validity as well as convergent and divergent validities as indicated by moderate correlations with score on the PSCC (allps < 0.0001) and non‐significant correlations with primary language, marital status, and scores on the REALM Long Form (allps > 0.05).Conclusion: The PSN‐I is a valid and suitable measure of satisfaction with a patient navigator for the present sample. Copyright © 2011 John Wiley & Sons, Ltd.

Cancer health disparities affecting low-income and minority patients are well documented. Root-causes are multifactorial, including diagnostic and treatment delays, social and financial barriers, and poor communication. Patient navigation and communication coaching (activation) are potential interventions to address disparities in cancer treatment. The purpose of this clinical trial is to test the effectiveness of an intervention combining patient navigation and activation to improve cancer treatment. The Rochester Patient Navigation Research Program (PNRP) is a National Cancer Institute-sponsored, patient-level randomized trial (RCT) of patient navigation and activation, targeting newly-diagnosed breast and colorectal cancer patients in Rochester, NY. The goal of the program is to decrease cancer health disparities by addressing barriers to receipt of cancer care and promoting patient self-efficacy. The intervention uses trained, paraprofessional patient navigators recruited from the target community, and a detailed training and supervisory program. Recruited patients are randomly assigned to receive either usual care (except for baseline and follow-up questionnaires and interviews) or intervention. The intervention patients receive tailored assistance from their patient navigators, including phone calls, in-person meetings, and behind-the-scenes coordination of care. A total of 344 patients have been recruited. Outcomes measured at three month intervals include timeliness of care, patient adherence, patient satisfaction, quality of life, self-efficacy, health literacy, and cancer knowledge. This unique intervention combining patient navigation and patient activation is designed to address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of patient navigation programs. clinicaltrials.gov identifier NCT00496678

BACKGROUND: Patient satisfaction is an important outcome measure of quality of cancer care and 1 of the 4 core study outcomes of the National Cancer Institute (NCI)‐sponsored Patient Navigation Research Program to reduce race/ethnicity‐based disparities in cancer care. There is no existing patient satisfaction measure that spans the spectrum of cancer‐related care. The objective of this study was to develop a Patient Satisfaction With Cancer Care measure that is relevant to patients receiving diagnostic/therapeutic cancer‐related care.METHODS: The authors developed a conceptual framework, an operational definition of Patient Satisfaction With Cancer Care, and an item pool based on literature review, expert feedback, group discussion, and consensus. The 35‐item Patient Satisfaction With Cancer Care measure was administered to 891 participants from the multisite NCI‐sponsored Patient Navigation Research Program. Principal components analysis (PCA) was conducted for latent structure analysis. Internal consistency was assessed using Cronbach coefficient alpha (α). Divergent analysis was performed using correlation analyses between the Patient Satisfaction With Cancer Care, the Communication and Attitudinal Self‐Efficacy–Cancer, and demographic variables.RESULTS: The PCA revealed a 1‐dimensional measure with items forming a coherent set explaining 62% of the variance in patient satisfaction. Reliability assessment revealed high internal consistency (α ranging from 0.95 to 0.96). The Patient Satisfaction With Cancer Care demonstrated good face validity, convergent validity, and divergent validity, as indicated by moderate correlations with subscales of the Communication and Attitudinal Self‐Efficacy–Cancer (all P < .01) and nonsignificant correlations with age, primary language, marital status, and scores on the Rapid Estimate of Adult Literacy in Medicine Long Form (all P > .05).CONCLUSIONS: The Patient Satisfaction With Cancer Care is a valid tool for assessing satisfaction with cancer‐related care for this sample. Cancer 2011. © 2010 American Cancer Society.

BACKGROUND: Cancer‐related fatigue is a debilitating symptom affecting psychosocial functioning and quality of life in 70% to 100% of cancer patients during and after treatment. The authors examined the effect of 200 mg of modafinil daily on the severity of cancer‐related fatigue.METHODS: The authors conducted a multicenter, randomized, double‐blind, placebo‐controlled, phase 3, clinical trial to examine the effect of modafinil on patient‐reported fatigue in cancer patients undergoing chemotherapy. A sample of 877 cancer patients beginning chemotherapy at 23 geographically separate University of Rochester Cancer Center (URCC) Community Clinical Oncology Program (CCOP) affiliates were assessed for fatigue. Patients who reported fatigue (N = 867) were randomly assigned to receive either 200 mg of oral modafinil (Provigil) daily or a placebo. Treatment began on Day 5 of Cycle 2 and ended after Day 7 of Cycle 4. Fatigue and depression were assessed during Cycles 2 to 4 by using psychometrically valid measures. Group differences (treatment vs control) in the worst level of fatigue during the previous week at Cycle 4 were examined by using an analysis of covariance (ANCOVA) adjusting for baseline fatigue (Cycle 2).RESULTS: There were 631 patients (315 modafinil, 316 placebo) who provided evaluable data. ANCOVA showed a significant interaction between treatment condition and baseline fatigue (P = .017), where patients with severe baseline fatigue (n = 458) benefited from modafinil, whereas patients with mild or moderate fatigue did not. Modafinil had no statistically significant effect on depression (P > .05).CONCLUSIONS: Modafinil may be useful in controlling cancer‐related fatigue in patients who present with severe fatigue but is not useful in patients with mild or moderate fatigue. Cancer 2010. © 2010 American Cancer Society.