Improvements In Emotional Well-being Research Articles

Active Living After Cancer (ALAC) program: An avenue to improve physical functioning and moderate-intensity physical activity in gynecologic cancer survivors.

e24034 Background: Active Living After Cancer (ALAC) is a 12-week evidence-based program funded by the Cancer Prevention and Research Institute of Texas (CPRIT) to provide physical activity and survivorship education to cancer survivors. Given the limited data evaluating the effects of physical activity educational programs in gynecologic cancer survivors, we aim to assess the effects of the ALAC intervention in this patient population. Methods: A retrospective analysis was performed on gynecologic cancer survivors who participated in ALAC from 2017 to 2021. The 12-week ALAC program included weekly meetings (in-person or virtual) led by a facilitator providing physical activity behavioral skills training, leading 10 minutes of exercise, and discussing topics related to cancer survivorship. Surveys and functional testing assessments were collected pre- and post-program which included: The Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) and 30-second sit-to-stand. A patient-reported outcomes survey was used to assess patient perceived benefits and program satisfaction. Results: Thirty-two patients participated in ALAC and 22 completed pre- and post-program assessments. The mean age of participants was 60.2 years (range 50.7-69.7 years) and mean number of classes attended was 8 (range 0-12 classes). Prior cancer diagnoses included 14 cervical, 11 uterine, and 7 ovarian cancers. A significant improvement was seen pre- and post-ALAC in moderate-intensity physical activity minutes (n = 17, 97 vs 252 minutes, p = 0.007) by GSLTPAQ and 30-second sit-to-stand test (n = 16, 12.3 vs 15.8 repetitions, p = 0.003) in our cohort. The post-ALAC patient reported outcome survey (n = 22) revealed improvement in emotional well-being (90%), physical well-being (91%), physical activity level (100%), comfort speaking openly in a group (85%), and willingness to discuss their cancer journey (66%). Overall, 95.3% of participants were satisfied with the ALAC program and 100% of participants would recommend the ALAC program to other cancer survivors. Conclusions: Educational physical activity-based programs like ALAC improve physical functioning and moderate-intensity physical activity in gynecologic cancer survivors. Further studies on the long-term health benefits of structured educational programs which promote active lifestyles in gynecologic cancer survivors are needed in larger patient cohorts.

The health-related quality of life changes following surgery in patients with colorectal cancer: a longitudinal study.

Colorectal cancer (CRC) is commonly treated with surgery and its success is frequently defined by cure rates. Impact on other aspects of health and wellbeing are less frequently considered in clinical practice. Patient-reported outcome measures (PROMs) provide a useful means of assessing such impacts. This study examines changes in health-related quality of life (HRQoL) after surgical resection using PROMs. A prospective, longitudinal study was undertaken in 49 adults receiving curative surgery for CRC. Participants completed the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) before surgery, and at 2 to 4 weeks, 3 and 6months post-surgery. Linear mixed models were used to analyse FACT-C wellbeing and subscale scores. Patients reported a clinically important deterioration in functional and physical wellbeing 2 to 4 weeks post-surgery (both P < 0.05); differences at 6months after surgery were trivial. Conversely, patients reported clinically important improvement in emotional wellbeing at 2 to 4 weeks post-surgery; this improvement was sustained at 3 and 6months post-surgery (all P < 0.05). For social wellbeing and colorectal cancer-specific concerns, changes from before surgery at follow-up assessments were not statistically significant (all P > 0.05). While physical aspects of HRQoL are affected in the short term by CRC surgery, clinically significant improvement in emotional wellbeing are reported early (2 to 4 weeks post-surgery). Future research may help identify patients who are at greater risk of surgical impacts on health and wellbeing.

Football and Zumba Training in Female Hospital Staff: Effects after 12 and 40 Weeks on Self-Reported Health Status, Emotional Wellbeing, General Self-Efficacy and Sleep Problems.

Background: This 40-weeks intervention study evaluates the effects on self-reported health status, emotional wellbeing, general self-efficacy and sleep problems among female hospital employees. Methods: 107 employees were cluster-randomized into three groups; football (FG), Zumba (ZG) and control (CG). Outcome measurements were conducted at baseline, 12 and 40 weeks. Weekly training frequencies in the first 12 and next 28 weeks were 2.4 ± 0.3 and 0.8 ± 0.2 in FG and 2.3 ± 0.3 and 0.9 ± 0.2 in ZG. Results: Compared to the CG, the ZG showed significant improvement in self-reported health status (p = 0.025), a reduced frequency of poor and restless sleep (on a 0–4 scale) (p = 0.004), as well as a tendency for reduction in the frequency of problems falling asleep (p = 0.055) and overall sleep problems (p = 0.051). Between baseline and 12 weeks, both the FG (p = 0.017) and the ZG (p = 0.017) showed within-group improvements in emotional wellbeing, whereas this improvement was maintained only in the ZG between baseline and 40 weeks (p = 0.002). The FG showed a significant within-group improvement in general self-efficacy (p = 0.012) between baseline and 12 weeks follow-up, with no such improvements in the other groups. Conclusion: The present findings revealed that a physical activity intervention with Zumba as well as football training may improve mental health and sleep outcomes in female hospital staff.

Prevalence and patterns of meditation related unpleasant experiences among community based yoga practitioners

Yoga is mainly known to restrain the emotional ripples in the mind but according to some studies, it may lead to some overwhelming challenges like uncontrolled emotional venting as meditation-induced adverse effects, along with benefits. This study intended to assess the prevalence and patterns of meditation-related unpleasant experiences (UEs), among 300 community-based yoga practitioners. In this mixed-methods study, a semi-structured interview schedule was developed to carry out the self-assessment survey. The Chi-square test of association was used for finding the pattern between the UEs and other variables. Total 114 (38%) respondents agreed to experience UEs. UEs were reported more in females (&lt;0.01). Reporting of UEs was found to be associated with a longer history of yoga practice (&lt;0.01), &gt; 20 minutes of daily meditation (&lt;0.05), perceived therapeutic effects of yoga in physical suffering (&lt;0.01), perceived improvement in emotional well-being (&lt;0.01), perceived reduction in negative emotional constructs like stress (&lt;0.01), depression (&lt;0.01), and anxiety (&lt;0.01), due to yoga. The study suggests a high prevalence of UEs, which may be associated more with female yoga practitioners, longer yoga and particularly meditation practice, yoga-induced improvement in emotional well-being, stress, depression, and anxiety, and the therapeutic effects of yoga in the physical sufferings.

Effects of a Bacopa monnieri extract (Bacognize®) on stress, fatigue, quality of life and sleep in adults with self-reported poor sleep: A randomised, double-blind, placebo-controlled study

In this 28-day, randomised, double-blind, placebo-controlled trial, 100 adults with self-reported poor sleep received either a placebo or a standardised Bacopa monnieri extract (150 mg twice daily). Outcome measures included the Bergen Insomnia Scale (primary outcome measure), Functional Outcomes of Sleep Questionnaire, Pittsburgh Sleep Diary, Short Form-36 Health Survey, and the Depression, Anxiety, and Stress Scale. Changes in salivary concentrations of cortisol, dehydroepiandrosterone sulfate, immunoglobulin A (sIgA), α-amylase (sAA), C-reactive protein, melatonin, and the fatigue biomarker index were also assessed. Based on the Bergen Insomnia Scale, Bacopa monnieri did not improve sleep patterns more than the placebo; however, it was associated with greater improvements in emotional wellbeing, general health, and pain-related symptoms. Bacopa monnieri was also associated with greater reductions in sIgA and sAA compared to the placebo. Future clinical trials using varying doses, treatment periods, and objective outcome measures will be important to validate these findings.

Short-Term Effects of Gender-Affirming Hormone Therapy on Dysphoria and Quality of Life in Transgender Individuals: A Prospective Controlled Study.

BackgroundGender affirming hormone therapy (GAHT), whilst considered the standard of care in clinical guidelines for the treatment of many transgender (trans) people is supported by low quality evidence. In this prospective longitudinal controlled study, we aimed to examine the effect of newly commencing GAHT on gender dysphoria and quality of life (QoL) over a 6 month period.MethodsAdult trans (including those with binary and/or non-binary identities) people newly commencing standard full-doses of masculinising (n = 42; 35 = trans masculine, 7 = non-binary) or feminising (n = 35; 33 = trans feminine, 2 = non-binary) GAHT and cisgender participants (n=53 male, n=50 female) were recruited to participate in this longitudinal prospective study. This analysis of gender dysphoria measured by the Gender Preoccupation and Stability Questionnaire and QoL measured by the RAND Short-Form 36 Health survey at baseline, 3 and 6 months after commencement of GAHT was a prespecified secondary outcome. Dysphoria and QoL over time in those starting GAHT compared to cisgender comparison group matched for their presumed sex at birth is reported as the mean difference (95% confidence interval) adjusted for age.ResultsIn trans people initiating masculinising GAHT, there was a decrease in gender dysphoria with adjusted mean difference -6.80 (-8.68, -4.91), p < 0.001, and a clinically significant improvement in emotional well-being [adjusted mean difference 7.48 (1.32, 13.64), p = 0.018] and social functioning [adjusted mean difference 12.50 (2.84, 22.15), p = 0.011] aspects of QoL over the first 6 months of treatment relative to the cisgender female comparison group. No significant differences were observed in other QoL domains. In trans people initiating feminising GAHT, there was a decrease in gender dysphoria [adjusted mean difference -4.22 (-6.21, -2.24), p < 0.001] but no differences in any aspects of QoL were observed.ConclusionsIn the short-term, our findings support the benefit of initiating masculinising or feminising GAHT for gender dysphoria. Masculinising GAHT improves emotional well-being and social functioning within 6 months of treatment. Multidisciplinary input with speech pathology and surgery to support trans people seeking feminisation is likely needed. Further longitudinal studies controlled for other confounders (such as the presence of social supports) contributing to QoL are needed.

Health-related quality of life after Gamma Knife radiosurgery in patients with 1\u201310 brain metastases

PurposeIncreasingly more patients with multiple (> 4) brain metastases (BM) are being treated with stereotactic radiosurgery (SRS). Preserving patients’ health-related quality of life (HRQoL) is an important treatment goal. The aim of this study was to assess (individual) changes in HRQoL in patients with 1–10 BM over time.MethodsA total of 92 patients were assessed before (n = 92) and at 3 (n = 66), 6 (n = 53), and 9 (n = 41) months after Gamma Knife radiosurgery (GKRS), using the Functional Assessment of Cancer Therapy-Brain (FACT-Br). The course of HRQoL was analyzed using linear mixed models. Clinical minimally important differences were used to evaluate individual changes.ResultsAt group level, patients’ physical well-being worsened, whereas emotional well-being improved over 9 months. Scores on other HRQoL subscales did not change significantly. Number (1–3 versus 4–10) and volume (small, medium, and large) of BM did not influence HRQoL over time, except for the subscale additional concerns; medium intracranial tumor volume was associated with less additional concerns. On the individual level as well, physical well-being declined while emotional well-being improved in most patients over 9 months after GKRS. At patient level, however, most patients had both declines as well as improvements in the different HRQoL aspects.ConclusionOur results indicate that even in patients with up to 10 BM, both at group and individual subscale level, aspects of HRQoL remained stable over nine months after GKRS, except for an improvement in emotional well-being and a decline in physical well-being. Nevertheless, HRQoL scores varied considerably at the individual patient level.Trail registration numberClinicalTrials.gov Identifier: NCT02953756, November 3, 2016.

Mediterranean Diet and the Emotional Well-Being of Students of the Campus of Melilla (University of Granada).

A certain link exists between the consumption of particular groups of food and well-being. In this study, we analyzed in depth the relationship between strict adherence to the Mediterranean diet (MD) and emotional well-being through a descriptive, exploratory, transversal, and correlational study of students from the Campus of Melilla, University of Granada, Spain. The sample consisted of 272 individuals. Adherence to the MD was measured with the PREvención con DIetaMEDiterránea (PREDIMED) questionnaire, emotional well-being (both positive and negative affection) with the Spanish version of the Positive and Negative Affect Schedule (PANAS), the state of perceived health with the Short Form-36 (SF36), and the degree of physical activity using the International Physical Activity Questionnaire Short Form (IPAQ-SF). A strict adherence to the MD was found to be significantly related to positive emotional state (β = 0.018, p = 0.009). The perceived state of health (β = 0.192, p < 0.001), mental role (β = 0.346, p < 0.001), and physical activity (β = 0.155, p = 0.007) were found to be predictive factors of a positive emotional state. Conversely, the relationship between the adherence to the MD and a negative emotional state was not significant. Various components of the MD were found to be independently connected to well-being. The results suggest that adopting a nutritional pattern such as the MD is linked to an improvement in emotional well-being.

Influence of built environment on quality of life changes in African-American patients with non-metastatic breast cancer.

Research links the built environment to health outcomes, but little is known about how this affects quality of life (QOL) of African American breast cancer patients, especially those residing in disadvantaged neighborhoods. Using latent trajectory models, we examined whether the built environment using Google Street View was associated with changes in QOL over a 2-year follow-up in 228 newly diagnosed African American breast cancer patients. We measured QOL using the RAND 36-Item Health Survey subscales. After adjusting for covariates, improvement in emotional well-being and pain over time was greater for women living on streets with low-quality (vs. high-quality) sidewalks.

Abstract P2-13-18: Catalyzing navigation for breast cancer survivors (CaNBCS)

Abstract Background; Survivorship care plans (SCPs) are personalized documents, provided at the end of the treatment by patients’ oncology clinicians that summarize the diagnosis and treatment, late and long-term adverse effects, ongoing surveillance for recurrence, screening for new cancers, and health maintenance of cancer survivors. Considered as a tool for cancer survivors, experts in cancer survivorship and accrediting organizations such as Commission on Cancer (CoC) have endorsed the use of SCPs even in the absence of firm evidence of their efficacy. Safety net hospitals are at the forefront of providing care for vulnerable low-income cancer survivors who may also have low educational attainment, low health literacy, and limited English proficiency. Cancer survivors who are racial and ethnic minorities and low income may experience higher symptom burden and limitation of function. Prior work has shown that patients who in safety net health setting, do not benefit from SCPs and only 25% share them with their primary care providers. Methods This study is a pilot randomized clinical trial to assess the role of patient navigation in cancer survivors. Breast cancer survivors were randomized to SCPs with or without patient navigation. In the intervention, arm navigators discussed the survivorship care planning and issues with patients at the time of delivery, 6 weeks by phone, at 3 months and then at 6 months. The primary outcome was breast cancer-related quality of life (QOL) was assessed by FACT B questionnaire. The secondary outcome was self-efficacy. In addition, we conducted focus groups for cancer survivors, patient navigators, and oncology providers to understand their perspective. Cancer survivors who had completed the treatment for breast cancer within 1-5 years were eligible to participate in the study. Participants spoke English(N=20), Chinese (n =10) or Spanish (n=10). Results: There were 20 participants in each arm, 10 English speaking and 5 each Spanish and Chinese speaking. At 6 months and final follow up, 32 patients were available for analysis. One patient developed metastatic cancer, two patients had changes in their insurance status and five were not available for final analysis. We performed Wilcoxon non-parametric analysis to assess changes in all five domains of FACT B. There were trends towards improvement in the change in emotional well-being score, functional well-being score and overall QOL in the intervention arm, but it was not statistically significant. Physical well-being score change was similar. There was no difference in the mean self-efficacy scores for both arms. At baseline, 57.7% breast cancer survivors reported being not all/a little bit satisfied with their sex life and 53.9% reported not all/a little bit feeling sexually attractive. 87.5 % of survivors reported having accepted their illness quite a bit/ very much. Conclusions Our study successfully recruited patient from a diverse patient population in safety net settings. Patient navigation combined with survivorship care showed encouraging trends in improvement in emotional well-being, physical well-being, and QOL, although it was not statistically significant. There was no difference in mean self-efficacy score. We are currently analyzing the qualitative data to assess the implementation of the intervention. Citation Format: Niharika Dixit, Barbara Cicerelli, Roy Cherian, Nancy Burke. Catalyzing navigation for breast cancer survivors (CaNBCS) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-13-18.

The Effects of a High Fiber Beta Glucan Talbina Meal on Emotional Well-being Among Syrian Refugees in Metropolitan Detroit (P08-076-19)

ObjectivesThe on-going Syrian War has affected Syrians’ mental health, causing anxiety, depression, stress, and mood disturbances. Barley β- glucan is a soluble fiber and its benefits for mental health have been reported in the literature. This study was designed to assess the possible therapeutic effects of β-glucan supplementation as a natural remedy for emotional disturbance control/prevention using a traditional Islamic homestyle meal, “Talbina”, a semi-solid meal made from ground whole grain, hulled barley (Hordeum vulgare). MethodsA single-blind randomized crossover design was conducted in free-living, stressed Syrian refugees using barley flour (active, AC) for 28 days and rice flour (placebo, PL) for 14 days as part of a breakfast. Subjects (14 females and 9 males, mean age: 41 ± 10 yrs) with normal-to-mild depression and anxiety scores were recruited from the Islamic Center of Detroit. More than 60% of the subjects self-rated their general health as good or very good. Only 4.3% reported poor mental health, and nearly 60% of the subjects reported having at least one non-communicable disease. Arabic validated self-administered questionnaires: The Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), and The Profile of Mood States-short form (POMS-SF) were used to measure anxiety and depression states, stress, and mood, respectively. Body weight and height data were also collected. ResultsSubjects without depression showed a reduction in body mass index (BMI) at the end of the AC phase compared to the PL phase while depressed subjects showed an increase in BMI. The difference between these groups was significant (−.5 ± .5 kg/m2 vs .2 ± .8, P = 0.04). The results showed no differences in anxiety, depression, stress and mood scores between the AC and PL phases. ConclusionsThe findings of this study showed no significant improvement in emotional well-being, depression, or stress levels by eating Talbina. But the subjects with anxiety were benefited significantly by taking part in this study regardless of the key ingredients of their meals. These findings suggest that refugee communities need further social support. Future studies should be conducted with a higher dosage of β-glucan for a longer duration and with a larger sample size to examine the beneficial effects of β-glucan. Funding SourcesThe Department of Nutrition and Food Science at Wayne State University and the Department of Clinical Nutrition at Umm Al-Qura University.

Effects of Self-Control Training on Emotional Wellbeing and Opioid Craving Among Men with Opioid Use Disorder

Background: Today, opioid use is recognized as a global concern, threatening people’s physical and mental health. Objectives: This study was conducted to investigate the effects of self-control training on emotional wellbeing and opioid craving among men with opioid use disorder. Methods: In this quasi experimental study, the sample included all men with opioid use disorder, who were admitted to drug treatment centers of district 6, Tehran, Iran during year 2015. Fifty subjects were initially selected, matched, and randomly assigned to experimental and control groups (25 cases per group). After a diagnostic interview, the subjects were asked to complete the pretests, including the cognitive emotion regulation questionnaire (CERQ), facial expression recognition test (FERT), emotional processing scale (EPS), toronto alexithymia scale (TAS), and craving beliefs questionnaire (CBQ). The experimental group participated in 10 weekly sessions of self-control training. A week after the intervention, both groups were tested using the same instruments. For data analysis, multiple analysis of variance (MANOVA) test was applied in SPSS version 18. Results: Self-control training caused a significant increase in positive emotion regulation (P < 0.001), emotion recognition (P = 0.002), and emotion processing (P < 0.001), while reducing negative emotion regulation (P = 0.002), alexithymia (P < 0.001), and opioid craving in men with opioid use disorder (P < 0.001). Conclusions: Self-control training exerts a significant effect on the improvement of emotional wellbeing in men with opioid use disorder and reduces their opioid craving.

Tinnitus: psychosomatic aspects

Tinnitus is a common symptom of unclear origin that can be multifactorially caused and maintained. It is frequently, but not inevitably, associated with hearing loss. Emotional distress and maladaptive coping strategies -that are associated with or amplified by the tinnitus percept- pose key targets for psychological interventions. Once somatic contributors are identified and treated as applicable, psychological approaches comprise normalizing psychoeducational and psychotherapeutic interventions. Measures to improve hearing perception (e. g., hearing aids or cochlear implants) can also contribute to tinnitus habituation through direct (improvement of hearing perception) or indirect (improvement of emotional wellbeing or quality of life) effects.

Effectiveness of plant-based diets in promoting well-being in the management of type 2 diabetes: a systematic review

Diet interventions have suggested an association between plant-based diets and improvements in psychological well-being, quality of life and glycated hemoglobin (HbA1c) control in populations with diabetes. The aims of this...

Testimonial Therapy: Impact on social participation and emotional wellbeing among Indian survivors of torture and organized violence

Traumatizing events, such as torture, cause considerable impairments in psycho-social functioning. In developing countries, where torture is often perpetrated, few resources exist for the provision of therapeutic or rehabilitating interventions. The current study investigated the effectiveness of Testimonial Therapy (TT) as a brief psycho-social intervention to ameliorate the distress of Indian survivors of torture and related violence. Three outcome measures (the WHO-5 Well-Being Scale, Social Participation-Scale and Pain and Anger Analogue) were compared before and after receiving TT, and semi structured interviews were conducted with survivors who had previously received TT. Participants showed significant improvements in emotional well-being, social participation, and self-perceived pain and anger. Furthermore, three qualitative interviews with survivors indicated that TT had a positive impact at the community level. Although the study was conducted without a control group for comparison, TT appeared to be an effective method for improving well-being and ameliorating distress among survivors of torture. Furthermore, TT can potentially promote community empowerment. However, more research on this aspect is needed.

Gender differences in response to a school-based mindfulness training intervention for early adolescents

Mindfulness training has been used to improve emotional wellbeing in early adolescents. However, little is known about treatment outcome moderators, or individual differences that may differentially impact responses to treatment. The current study focused on gender as a potential moderator for affective outcomes in response to school-based mindfulness training. Sixth grade students (N = 100) were randomly assigned to either the six weeks of mindfulness meditation or the active control group as part of a history class curriculum. Participants in the mindfulness meditation group completed short mindfulness meditation sessions four to five times per week, in addition to didactic instruction (Asian history). The control group received matched experiential activity in addition to didactic instruction (African history) from the same teacher with no meditation component. Self-reported measures of emotional wellbeing/affect, mindfulness, and self-compassion were obtained at pre and post intervention. Meditators reported greater improvement in emotional wellbeing compared to those in the control group. Importantly, gender differences were detected, such that female meditators reported greater increases in positive affect compared to females in the control group, whereas male meditators and control males displayed equivalent gains. Uniquely among females but not males, increases in self-reported self-compassion were associated with improvements in affect. These findings support the efficacy of school-based mindfulness interventions, and interventions tailored to accommodate distinct developmental needs of female and male adolescents.

A Pilot Study of a Mindfulness-Based Art Therapy Intervention in Outpatients With Cancer.

Patients with cancer frequently experience physical and psychological distress that can worsen their quality of life. We assessed the outcomes of an 8-week mindfulness-based art therapy (MBAT) intervention, Walkabout: Looking In, Looking Out, on symptoms, sleep quality, health-related quality of life, sense of coherence (SOC), and spirituality in outpatients with cancer. A 1-group, pre-post intervention design with repeated measures at baseline, week 4, and week 8. Despite a small pilot sample (n = 18), we found large effect sizes and statistically significant improvements from week 1 to week 8 in depression, the comprehensibility subscale of the SOC, and each subscale of spirituality, that is, peace, meaning, and faith. There were no significant changes in physical functioning, pain, sleep, tiredness, drowsiness, nausea, and appetite. The MBAT intervention, Walkabout, seems to meet key palliative care goals including improvement in emotional well-being, comprehensibility, and meaning making among outpatients with cancer.

What Works Best For Whom? Exploring the Efficacy of Two Psychosocial Interventions in Palliative Care (FR419D)

•Understand two approaches to addressing emotional well-being and preparation for end of life in patients living with serious illness.•Understand sub-population differences in which approach works best for whom, among two interventions. Attention to psychosocial aspects of care are central to comprehensive palliative care. Yet, our understanding of which interventions are best applied to which patient populations is in its infancy requiring increased evidence. Identify the optimal treatment to address psychosocial well-being by comparing the efficacy of two psychosocial interventions among palliative care patients. This secondary analysis of a trial (n=135) included patients with advanced cancer, CHF, or ESRD; one arm received the Outlook intervention, designed to address issues of life completion and preparation, and a second arm received relaxation meditation (RM). Primary outcomes: completion and preparation (QUAL-E); secondary outcomes: anxiety (POMS) quality of life (FACT-G) and spiritual well-being (FACITsp) sub-scales of faith, meaning, and peace. This study employed QUINT analyses to examine these RCT data to determine how best to address preparation for end-of-life and emotional well-being. This recently developed methodology explores and identifies which patient subgroup(s) shows greater improvements with which intervention. Sample: 56% male; 70% cancer; 54% married; and 51% White. Different sub-groups of patients responded variably to the different treatments. For example, those with low spiritual well-being at baseline showed greater improvements in emotional well-being and decreases in anxiety with RM compared to Outlook. In contrast, for those with high spiritual well-being at baseline, Outlook resulted in greater improvements in emotional well-being and decreases in anxiety. Outlook showed greater improvements in preparation for the end of life for those with low preparation at baseline; RM showed greater improvement in preparation for patients with high preparation at baseline but poor ADL function. Identifying the optimal treatment for a given patient is a primary goal of palliative care. We demonstrated that different interventions work variably for unique patient sub-populations.

Changes in Quality of Life in Indolent Non-Hodgkin Lymphoma 3 Years after Diagnosis

Background:Most indolent non-Hodgkin lymphomas (NHL) are considered incurable and are characterized by relapse and remission. Quality of life (QOL) can be affected by disease burden, side effects of treatment, and psychosocial effects of living with an incurable cancer. However, little is known about QOL in this population. We sought to describe QOL at diagnosis, change in QOL over time, and determinants of QOL in patients with indolent NHL.Methods:Newly diagnosed lymphoma patients were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource. Eligibility criteria included age ≥18 years; exclusion criteria included HIV-positive, non-US residency, and inability to complete surveys in English. All pathology was reviewed by a hematopathologist. Patients with indolent B-cell NHL were included in this analysis. QOL was measured at baseline (BL) and 3 year follow-up (FU3) with the Functional Assessment of Cancer Therapy-General scale (FACT-G), which measures 4 QOL domains: physical, social/family, emotional, and functional well-being (WB), and a single item Linear Analogue Self-Assessment (LASA) for measuring overall QOL. Patients who did not complete ≥80% of FACT-G questions were excluded. Clinical data were abstracted according to a standard protocol and patients were systematically followed for events (progression, re-treatment, and death). CLL patients were excluded for event analysis due to differing definitions of outcome (progression/retreatment vs. time to first treatment). Treatment was defined as any systemic therapy (including chemotherapy, targeted agents, or antibody therapy) or radiation. QOL scores were transformed to a 0-100 scale with 100 representing the best WB or QOL for analysis. Change in QOL was assessed using the raw difference in QOL scores (i.e., FU3-BL) on the 0-100 scale with positive change scores representing improvements; minimally important difference was defined as 7 points on the transformed FACT-G subscales per previously established cutoffs (Yost and Eton, Eval & Health Prof. 2005 Jun;28:172-91). Changes in QOL from BL to FU3 were assessed using one-sample t-test of change scores vs zero.Results:1050 patients with indolent NHL enrolled between 9/02-12/2012 and with both pre-treatment and 3 year QOL were included. QOL was collected after initiation of therapy in 215 patients (20%) and prior to therapy in 835 (80%). Subtype was 41% CLL/SLL, 32% grade 1-2 FL, 14% extranodal marginal zone, and 13% other (lymphoplasmacytic lymphoma and other). Median age was 62 years and 55% were male. At the FU3 assessment, 577 patients (55%) had received treatment, 42 (4%) transformed, and 53 (25%) had an event.Emotional WB significantly improved from BL to FU3 (mean +5.9, SD 13.3, p<0.001) while social/family WB significantly decreased (mean -4.8, SD 20.5, p<0.001). Functional WB, physical WB, overall FACT-G, and overall QOL LASA were not significantly different at FU3. These findings were similar in those who were treated vs. those who were observed. We also assessed the results stratified by non-CLL patients who had progression or retreatment between BL and FU3. In patients with an event in the first 3 years, emotional WB had a significant improvement from BL to FU3 (mean +3.6, SD 13.6, p=0.002) and overall QOL LASA decreased (mean -4.0, SD 20.0, p=0.01). In patients without an event, improvements were reported in functional WB (mean +2.1, SD 18.2, p=0.01), physical WB (mean +2.5, SD 13.9, p=0.001), emotional WB (mean +7.0, SD 15.0, p<0.001), and overall QOL LASA (mean +1.1, SD 11.4, p=0.03), while social/family WB decreased (mean -6.2, SD 20.3, p<0.001). Sensitivity analysis showed that results were consistent in the subset of patients who had BL QOL collected prior to initiating therapy. While many changes were statistically significant, they were small in magnitude; only the improvement in emotional WB in the entire cohort approached clinical significance and met that criterion in those without an event.Conclusions:In this large sample of patients with indolent lymphoma, QOL generally remained stable from diagnosis to FU3 while emotional WB showed improvement, suggesting psychosocial adaptation by the patient. Mean score changes in functional WB, physical WB, emotional WB, social/family WB, and overall QOL were more pronounced in patients without an event in the first 3 years since diagnosis. DisclosuresShanafelt:Hospira: Research Funding; AbbVie: Research Funding; Celgene: Research Funding; GlaxoSmithKline: Research Funding; Genentech: Research Funding; Jannsen: Research Funding; Pharmacyclics: Research Funding.

Effects of a Translational Community-Based Multimodal Exercise Program on Quality of Life and the Influence of Start Delay on Physical Function and Quality of Life in Breast Cancer Survivors: A Pilot Study.

The purpose of this investigation was 2-fold: (1) to investigate the effects of a translational 12-week community-based multimodal exercise program on quality of life (QoL) in breast cancer survivors (BCS) and (2) to examine the influence of a start delay on physical function and QoL in BCS. Fifty-two female BCS completed a 12-week program consisting of 90-minute supervised exercise sessions at a frequency of 2 supervised sessions per week. Exercise sessions consisted of three 30-minute components: (1) aerobic conditioning, (2) resistance exercise training, and (3) balance and flexibility training. Significant (P < .05) improvements in QoL were identified post-program completion. Cohort stratification comparison between the early start (<1 year since completion of oncologic treatment) and late start (>1 year since completion of oncologic treatment) revealed no significant (P > .05) differences between the early start and late start groups on improvements in physical function. Regarding the influence of start delay on QoL, the early start group showed significant (P < .05) improvement in emotional well-being. No other significant differences in improvement in QoL were detected between the early start and late start groups. Regardless of start delay, meaningful improvements in physical function and QoL were found after completing the community-based multimodal exercise program. Early participation in community-based exercise programming may benefit BCS’ emotional well-being compared to later participation.