Leah E. Walsh

Background: Hematopoietic stem cell transplantation (HCT) is an intensive and invasive procedure used in cancer treatment that depends heavily on the involvement of caregivers and places them at high risk for posttraumatic stress disorder (PTSD) symptoms. These symptoms are frequently overlooked in oncology and general health care settings. The suitability and utility of the Primary Care PTSD Screen for DSM ‐ 5 (PC‐PTSD‐5) within cancer caregivers remains uncertain. This study sought to evaluate its performance as a brief (five‐item) case finding screening alternative to the longer (20‐item) PTSD Checklist for DSM‐5 (PCL‐5) in caregivers of survivors who received an HCT 1–5 years ago. Method: A total of 106 caregivers completed the PC‐PTSD‐5 and PCL‐5 during recruitment for a randomized clinical trial. Optimal cut scores for identifying probable PTSD and item performance were determined using indices correcting for chance and item response theory analyses. Results: Of the caregivers evaluated, 33% screened as positive for probable DSM‐5 PTSD using the PCL‐5. The PC‐PTSD‐5 exhibited acceptable internal consistency and significant associations with PCL‐5 scores (total, r = 0.79; items r [range] [0.60–0.69]). A cutoff score of 3 provided optimal sensitivity for screening (κ[Se] = 1). Item response theory analyses indicated the need for the complete PC‐PTSD‐5 items to provide the greatest information across varying levels of PTSD. Conclusion: Although not an instrument validation study, these findings provide preliminary support for using the PC‐PTSD‐5 as a succinct, effective screening tool among cancer caregivers in a clinical context.

Background: Patients with monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM), precursors to multiple myeloma, need supports for the psychological sequelae of medical uncertainty.Aims: This secondary and exploratory analysis of psychosocial outcomes from a randomized controlled trial evaluated a mind‐body intervention, the Stress Management and Resiliency Training: Relaxation Response Resiliency Program (SMART‐3RP) for perceived stress, global distress and secondary distress (depression, anxiety, NF‐κB DNA‐binding activity) and well‐being (coping ability, mindfulness, optimism, gratitude) indices for individuals with MGUS and SMM.Methods: Participants were randomized to immediate treatment (n = 45) or waitlist control (n = 48), providing data at baseline (T1), 3 months (T2), and 6 months (T3).Results: Compared to waitlist control, the immediate treatment group experienced greater T1‐T2 reductions in global distress (M_diff = −1.04, p = 0.04), but not perceived stress (M_diff = −1.67, p = 0.12). Participants receiving immediate treatment also experienced greater reductions in depression (M_diff = −4.22, p < 0.001) and improvements in coping abilities (M_diff = 0.36, p < 0.001) and optimism (M_diff = 1.39, p = 0.02), with no significantly different changes in mindfulness (M_diff = 4.36, p = 0.14), anxiety (M_diff = −1.23, p = 0.26), gratitude (M_diff = 0.59, p = 0.47), or NF‐κB activity (M_diff = −0.16, p = 0.23).Conclusions: The SMART‐3RP demonstrated efficacy for global distress and other important outcomes for individuals with MGUS and SMM. Stress reduction did not significantly differ from waitlist control.Trial Registration: ClinicalTrials.gov Registration #: NCT01955395

Objective: A recent randomized trial of a group psychosocial telehealth intervention (STRIDE) improved anxiety, depression, quality of life (QOL), symptom distress, coping, and self‐efficacy to manage symptoms related to taking adjuvant endocrine therapy (AET) in women with non‐metastatic hormone receptor‐positive breast cancer. This study examined whether changes in coping and self‐efficacy mediated intervention effects on anxiety, depression, QOL, and symptom distress.Method: Women (N = 100) were recruited between 10/2019‐06/2021 from Massachusetts General Hospital and were randomized to STRIDE or to the medication monitoring control group. Participants completed self‐report measures of anxiety and depression (Hospital Anxiety and Depression Scale), QOL (Functional Assessment of Cancer Therapy‐Breast Cancer scale), symptom distress (Breast Cancer Prevention Trial Symptom Scale), coping (Measure of Current Status–Part A), and self‐efficacy (Self Efficacy for Managing AET Symptoms) at baseline and 24‐week follow‐up. Mediated regression models tested whether changes in coping ability and self‐efficacy mediated the intervention effects on anxiety, depression, QOL, and symptom distress, controlling for key variables.Results: Improvements in coping across the 24‐week study period mediated the effect of STRIDE on anxiety symptoms (indirect effect, B = −0.61, SE = 0.28, 95% CI: −1.28, −0.17), depressive symptoms (indirect effect, B = −0.50, SE = 0.21, 95% CI: −0.97, −0.15), and QOL (indirect effect, B = 3.80, SE = 1.25, 95% CI: 1.54, 6.49), but not symptom distress. Changes in self‐efficacy did not mediate improvements in any of the proposed outcomes.Conclusion: Coping is an essential component of a brief group psychosocial intervention that drives improvements in mood and QOL for women with non‐metastatic hormone receptor‐positive breast cancer taking AET.Clinical trial registration: NCT03837496.

Objectives: The investigators conducted a psychosocial needs assessment of mesothelioma patients through self-report measures of quality of life (QOL), coping, depression, and social support.Methods: Patients with malignant pleural mesothelioma (MPM) (N = 67) completed a battery of assessments at a single timepoint after being approached during routine medical oncology clinic appointments or by letter.Results: Participants were predominately male (70.0%; n = 47) and ranged in age from 35 to 83 years old (M = 65.61, SD = 9.71). Most participants were white (88.0%; n = 59), and 10.0% (n = 7) were identified as Hispanic. The majority were married or living with a partner (93.0%; n = 62) and had some college or more education (64.0%; n = 43). Fourteen percent of participants (n = 11) endorsed significantly elevated depression symptoms. No significant demographic or clinical differences in depressed compared to nondepressed participants were observed, with a trend toward those identifying as Hispanic and those who were divorced as being more likely to be depressed. For the total sample, the most frequently endorsed coping strategies were active coping, emotional support, and acceptance.Significance of results: The present study did not identify any clear correlates of depression or QOL among patients with MPM. This research contributes to the small literature on psychosocial functioning in patients with MPM and provides putative directions for future larger studies and the development of interventions to provide appropriate support to diverse patients with MPM.

Online recruitment via social media for health-related research is increasing. Metrics regarding social media recruitment may increase its use in this field. This study evaluates the feasibility of recruiting individuals with a smoking history through targeted advertising on Facebook for a randomized study focused on lung cancer screening. Individuals completed eligibility questions and were randomized to one of two groups. We analyzed advertisement reach and response patterns, advertisement cost, data integrity and sample representativeness. The advertisement was active for 34 days and resulted in 2111 unique clicks on the survey link. Four hundred thirty-three eligibility entries were collected, and 61 entries were excluded due to failure to correctly answer the data integrity check. Two hundred eighty-two participants met eligibility criteria and were randomized, 191 participants completed questionnaires and 10 entries were subsequently excluded due to a failed attention check. Recruitment utilizing targeted advertising on Facebook is an effective and efficient strategy for health-related research.

Background: Lung cancer screening has the potential to identify lung cancer at an early stage when more treatment options exist. However, discussions with and referrals of screening-eligible patients remain unacceptably low. We need to better understand clinician knowledge, attitudes, and practice patterns to identify strategies to improve lung cancer screening uptake. Prior studies have focused on understanding these factors from physicians only. Nevertheless, many patients receive primary care from nurse practitioners and physician assistants where prevention and early detection conversations are most likely to occur. Therefore, we must engage the full range of clinicians treating screening-eligible patients. Objectives: The aim of this study was to describe attitudes, beliefs and referral practice patterns, lung cancer screening knowledge, and concordance with lung cancer screening guidelines among nurse practitioners, physicians, and physician assistants in the United States. Methods: A descriptive, cross-sectional study was performed using survey methodology with clinical vignettes to examine clinician factors and concordance with U.S. Preventive Services Task Force lung cancer screening guidelines. Results: Participants scored low on attitudes toward shared decision-making, high on the importance of shared decision-making in lung cancer screening, and low on barriers to lung cancer screening referral. In addition, midrange scores on empathy toward patients with smoking history were noted. Lung cancer screening knowledge was low regardless of clinician specialty; the most endorsed response when presented with a hypothetical patient was to refer for lung cancer screening using a chest X-ray. Discussion: Findings demonstrate that most clinicians are nonconcordant with U.S. Preventive Services Task Force guidelines, erroneously believing a chest X-ray is appropriate for lung cancer screening. Clinicians must follow evidence-based practice guidelines, highlighting the need for targeted continuing education about lung cancer screening for clinicians who treat screening-eligible patients.

Objective: In patients with cancer across the illness trajectory, treatment decisions are often influenced by one's perception of their prognosis (i.e., curability of disease, life expectancy, quality of life). However, research on how patients understand their prognosis (i.e., prognostic understanding) has been limited by simplistic measurement tools that fail to capture the complexity of the construct. This study describes the initial development of a measure of prognostic understanding: the Prognostic Understanding Perceptions Scale (PUPS) for use in patients with advanced cancer.Method: An initial pool of 16 candidate items were developed through semi‐structured interviews with 15 experts (oncology, psycho‐oncology and palliative care professionals) and 30 advanced cancer patients. We investigated the dimensionality, internal item structure, item difficulty and item discrimination of the item pool using exploratory factor analysis (EFA), classical test theory (CTT) and item response theory (IRT) analyses. Convergent and divergent validity were based on correlations between PUPS, terminal illness acknowledgement, and self‐report measures of depression, anxiety, hopelessness, and death acceptance.Results: The final measure was comprised of nine items encompassing three factors (perceived curability, illness trajectory, treatment options), yielding strong psychometric properties.Conclusion: These results provide preliminarily support for PUPS as a multifaceted measure of prognostic understanding developed for use in patients with advanced cancer. Preliminary findings also highlight the potential utility of the PUPS for clinical settings, as a means of enhancing communication between patients and physicians.