This study was an attempt to identify vulnerability factors in two cohorts of daughters of breast cancer patients. One cohort consisted of daughters whose mothers survived breast cancer and the other consisted of daughters whose mothers died from breast cancer. The results revealed significant main effects. Greater caretaking involvement was associated with higher levels of cancer-related grief. Maternal loss to breast cancer predicted higher levels of cancer-related depression. Also, a history of a depression diagnosis in the daughters was associated with current depressive symptoms. Several significant interactions also emerged. Survival status of the mother and level of daughters? involvement in mother?s breast cancer was shown to significantly affect the daughters? current depressive symptoms. Daughters who reported the lowest level of involvement with their mother?s breast cancer reported the highest level of current depressive symptoms. Daughters who were less than 12 years of age at the time of their mother?s diagnosis reported significantly higher current state anxiety than daughters who were 12 to 19 at the time of their mother?s diagnosis. Daughters whose mothers died from breast cancer, who also had a past diagnosis of depression, reported significantly higher levels of cancer-related depression than daughters without a past diagnosis of depression. We concluded that maternal death among daughters who reported very low caretaking involvement reflects the most significant vulnerability to show current depressive symptoms. We also concluded that daughters possessing potential genetic vulnerability to depression are the

Objective: We examined benefit finding in patients with lung cancer, including level of benefit finding and change in benefit finding over time, and tested a predictive model postulating that greater impact of and engagement with the stressor promotes benefit finding. Methods: Patients diagnosed with a primary lung cancer within the past 6 months (M516 weeks post-diagnosis) completed measures of benefit finding, cancer-related intrusions, perceived stressfulness, coping, and demographic and medical information at study entry (T1; n5118) and 3 months later (T2; n579). Results: Level of benefit finding at both assessments was to a 'mild-to-moderate degree'. Benefit finding increased over time for patients with small cell carcinoma, but not for those with nonsmall cell carcinoma. The proposed model explained 33% of the variance in T1 benefit finding, and 64% (using T1 coping measures) and 71% (using T2 coping measures) of the variance in T2 benefit finding. Greater benefit finding was associated with having small cell lung cancer, higher cancer-related intrusions, lower perceived cancer-related stress, and greater approach-oriented coping. Positive reframing coping emerged as the single unique approachoriented coping scale predicting benefit finding at T1, and emotional approach coping was the single unique approach-oriented coping scale predicting benefit finding at T2. Conclusion: Findings provide general support for a theoretical model positing that stressor impact and engagement with the stressor contribute to the development of benefit finding after cancer. Future research with larger, more diverse samples is needed to confirm and extend these findings.

Little is known about pain among long-term adult survivors of childhood cancers. The study investigated pain prevalence in this population compared with sibling controls and examined pain-related risk factors. Three self-reported pain outcomes including pain conditions, prescription analgesics used, and pain attributed to cancer and treatment were assessed among 10,397 cancer survivors and 3034 sibling controls from the Childhood Cancer Survivor Study. Pain conditions (pain/abnormal sensation, migraines, and other headaches) were reported by 12.3%, 15.5%, and 20.5% of survivors, respectively; 16.7% of survivors reported use of prescription analgesics, and 21% attributed pain to cancer and treatment. Risks of reporting pain conditions and using prescription analgesics were higher among survivors than siblings, adjusting for sociodemographic factors. Younger age at diagnosis and a history of non-Hodgkin lymphoma, Wilms tumor, or neuroblastoma (compared to leukemia) were associated with greater risk of reporting pain conditions. A history of bone cancer or soft tissue sarcoma (compared to leukemia) was associated with greater risks of using prescription analgesics and cancer-related pain attribution. Nonbrain- directed scatter irradiation was associated with elevated risk for migraines and cancer-related pain attribution. Female gender and lower educational attainment were associated with increased reports of all 3 pain outcomes; minority status, unemployment, and being single were associated with greater risks for reporting pain conditions. These findings contribute to the understanding of pain and associated risk factors among adult survivors of childhood cancer and suggest areas of focus for pain intervention.

Little is known about pain among long-term adult survivors of childhood cancers. The study investigated pain prevalence in this population compared with sibling controls and examined pain-related risk factors. Three self-reported pain outcomes including pain conditions, prescription analgesics used, and pain attributed to cancer and treatment were assessed among 10,397 cancer survivors and 3034 sibling controls from the Childhood Cancer Survivor Study. Pain conditions (pain/abnormal sensation, migraines, and other headaches) were reported by 12.3%, 15.5%, and 20.5% of survivors, respectively; 16.7% of survivors reported use of prescription analgesics, and 21% attributed pain to cancer and treatment. Risks of reporting pain conditions and using prescription analgesics were higher among survivors than siblings, adjusting for sociodemographic factors. Younger age at diagnosis and a history of non-Hodgkin lymphoma, Wilms tumor, or neuroblastoma (compared to leukemia) were associated with greater risk of reporting pain conditions. A history of bone cancer or soft tissue sarcoma (compared to leukemia) was associated with greater risks of using prescription analgesics and cancer-related pain attribution. Nonbrain- directed scatter irradiation was associated with elevated risk for migraines and cancer-related pain attribution. Female gender and lower educational attainment were associated with increased reports of all 3 pain outcomes; minority status, unemployment, and being single were associated with greater risks for reporting pain conditions. These findings contribute to the understanding of pain and associated risk factors among adult survivors of childhood cancer and suggest areas of focus for pain intervention.

Introduction Population-based estimates of emotional distress in cancer survivors are lacking, and little is known about specific correlates of clinically meaningful distress. Methods Combined 2003?2005 National Health Interview Surveys (NHIS) data were analyzed to evaluate differences in non-somatic distress (measured using the Kessler 6) for those with a history of cancer, those with other chronic health conditions, and healthy adults. Results The prevalence of clinically meaningful distress was higher in cancer survivors (5.7%) than those with other health conditions (4.3%) or healthy adults (0.7%). In multivariate models, the strongest correlates of serious distress were younger age, lower educational attainment, lack of health insurance coverage, being unmarried, and having pain, fair/poor health status, or other comorbid conditions. While predictors of distress overlapped considerably between those with cancer and other chronic health conditions, having a history of cancer significantly magnified the effects of age, number of children and elders in the household, and access to health insurance on distress. Discussions/Conclusions The impact of psychological distress is more severe in those with cancer than those living with other chronic health conditions. Those at greatest risk appear to be those with fewer resources to manage their illness. Implications for cancer survivors Identifying and understanding correlates of clinically meaningful distress may improve efforts to prevent, identify, and treat significant distress in cancer survivors.

OBJECTIVE: The purpose of this study was to evaluate the prevalence of online support group (OSG) use by those with chronic health problems and to identify characteristics associated with use of OSGs and face-to-face groups. METHODS: 6, 795 Californians living with chronic health problems were asked to describe OSG use, face-to-face support group use, and frequency/perceived benefit of support group use. RESULTS: 16% had used a face-to-face group for health, and 1.8% reported having used an OSG. OSG use was associated with depression/anxiety (OR = 3.51), stroke (OR = 3.03), diabetes (OR = 2.96), cancer (OR = 2.86), and arthritis (OR = 2.52). Use of OSGs was also associated with greater education (OR = 12.2), higher income (OR = 3.1), use of complementary/alternative therapies (OR = 5.2), and worse health status (OR = 3.1). Those with asthma (OR = 0.4), over age 65 (OR = 0.2), and Latinos (OR = 0.2) were less likely to use OSGs. CONCLUSION: Prevalence of use of OSGs for those with chronic health conditions is low, but internet-based health-related services have potential to increase the reach of support services for those living with chronic conditions.

Introduction: The goal of this study was to characterize the prevalence and intensity of supportive care needs and interest in specific supportive care services among individuals with lung cancer. Method: Participants (n=5109) were recruited from two medical centers in Southern California to complete questionnaires on physical and psychological functioning following diagnosis of lung cancer. Results: Participants reported the greatest need in the physical and daily living domain, followed by psychological needs, health system and informational needs, and patient care support needs. The most common unmet need was a lack of energy and tiredness (75%). Higher levels of supportive care needs were associated with worse physical functioning, greater symptom bother, lower satisfaction with health care, and higher levels of intrusive thoughts about cancer. The sample was most interested in receiving additional information about their disease and treatment (61.0%), exercise-related information and support (54.3%), and assistance dealing with fatigue (46.7%). Over 91% expressed interest in at least one specific supportive care service, and 51.4% were interested in one or more psychological services. Conclusion and implications for cancer survivors: Our findings suggest that lung cancer survivors have many unmet needs. Patients who report higher physical distress and intrusive stress symptoms, or lower satisfaction with their health care, may experience the highest level of supportive care need and intervention.

Psychological interventions provide linguistic data that are particularly useful for testing mechanisms of action and improving intervention methodologies. For this study, emotional expression in an Internet-based intervention for women with breast cancer (n = 63) was analyzed via rater coding and 2 computerized coding methods (Linguistic Inquiry and Word Count [LIWC] and Psychiatric Content Analysis and Diagnosis [PCAD]). Although the computerized coding methods captured most of the emotion identified by raters (LIWC sensitivity = .88; PCAD sensitivity = .83), both over-identified emotional expression (LIWC positive predictive value = .31; PCAD positive predictive value = .19). Correlational analyses suggested better convergent and discriminant validity for LIWC. The results highlight previously unrecognized deficiencies in commonly used computerized content-analysis programs and suggest potential modifications to both programs that could improve overall accuracy of automated identification of emotional expression. Although the authors recognize these limitations, they conclude that LIWC is superior to PCAD for rapid identification of emotional expression in text.

Objectives: The primary aim of the study was to identify specific strengths and challenges of facilitating online cancer support groups relative to face-to-face groups through the use of deductive qualitative analysis. A secondary aim was to quantitatively validate the identified strengths and challenges.Methods: To better understand how facilitators' roles in online support groups (OSGs) might differ from face-to-face (F2F) support groups, we compared the professional experiences of facilitators from both F2F and OSGs at The Wellness Community. Transcripts from online supervision sessions among OSG facilitators were analyzed using deductive qualitative analysis. A pool of items was developed to measure the primary themes derived from the qualitative analysis and administered to a sample of both F2F and online cancer support group facilitators.Results: Strengths and weaknesses of online support group leaders could be captured in three categories: group processes, structural elements, and facilitator roles. Positive perceptions of group processes, structural elements, and facilitator roles were significantly higher among F2F facilitators than OSG facilitators.Conclusion: OSG facilitators described their online groups as helpful to participants and identified some aspects of online groups that promoted more active processing of cancer experiences among group participants. Additionally, they reported that learning how to facilitate an online group strengthened their skills in facilitating face-to-face groups. However, OSGs do appear to present significant challenges to facilitation. These challenges are discussed with particular attention given to ways in which online facilitators have developed " work-arounds " for addressing shortcomings of the internet as a medium for delivering psychosocial services.

Accurately detecting emotional expression in women with primary breast cancer participating in support groups may be important for therapists and researchers. In 2 small studies (N = 20 and N = 16), the authors examined whether video coding, human text coding, and automated text analysis provided consistent estimates of the level of emotional expression. In Study 1, the authors compared coding from videotapes and text transcripts of face-to-face groups. In Study 2, the authors examined transcripts of online synchronous groups. The authors found that human text coding significantly overestimated Positive Affect and underestimated Defensive/Hostile Affect compared with video coding. They found correlations were low for Positive Affect but moderate for negative affect between Linguistic Inquiry Word Count (LIWC) and video coding. The implications of utilizing text-only detection of emotion are discussed.

BACKGROUND: Data from the National Health Interview Survey suggest that the utilization of mental health services among cancer survivors is low and unmet needs are high for some. However, to the authors' knowledge little is known regarding the prevalence and predictors of participation in health-related support groups. METHODS: A total of 9187 participants in the California Health Interview Survey Complementary and Alternative Medicine (CHIS-CAM) study completed a telephone interview in 2003 (1844 participants with cancer and 4951 participants with other chronic health problems). Participants were asked to describe previous/ current support group use, benefits of support group use, and physician involvement in decisions regarding support groups. Weighted logistic regression analyses were conducted using SUDAAN software to examine patterns of support group use. RESULTS: The prevalence of support group use was found to be higher among cancer survivors (23.7%) than those with another chronic health condition (14.5%). Predictors of support group use were found to be similar across groups and included female gender, greater education, use of complementary and alternative medicine (CAM), depression, and anxiety. Age, health insurance, and presence of depression predicted support group use differently for cancer survivors and those with other conditions. The percentages of those perceiving support groups to be beneficial varied from 35.1% for those with skin cancer to 96% for those with cervical cancer. The percentage of participants reporting that their physician recommended a support group was low (10.2%). CONCLUSIONS: Health-related support groups are used by nearly 1 in 4 cancer survivors, but levels of utilization differ across subgroups. An understanding of how cancer survivors use support groups highlights shortcomings in psychosocial care and suggests that additional efforts to overcome barriers to care are needed.

Emotional expression and cognitive efforts to adapt to cancer have been linked to better psychological adjustment. However, little is known about the relationship between linguistic indicators of emotional and cognitive coping efforts and corresponding self-report measures of related constructs. In this study, we sought to evaluate the interrelationships between self-reports of emotional suppression and linguistic indicators of emotional and cognitive coping efforts in those living with cancer. Seventy-one individuals attending a community cancer support group completed measures of emotional suppression and mood disturbance and provided a written narrative describing their cancer experience. Self-reports of emotional suppression were associated with more rather than less distress. Although linguistic indicators of both emotional expression and cognitive processing were generally uncorrelated with self-report measures of emotional suppression and mood disturbance, a significant interaction was observed between emotional suppression and use of cognitive words on mood disturbance. Among those using higher levels of emotional suppression, increasing use of cognitive words was associated with greater levels of mood disturbance. These findings have implications for a) the therapeutic use of emotion in psychosocial interventions and b) the use of computer-assisted technologies to conduct content analysis.

BACKGROUND: Internet-based methods for provision of psychological support and intervention to cancer survivors hold promise for increasing the public impact of such treatments. PURPOSE: The goal of this controlled pilot study was to examine the effect and potential mechanisms of action of a self-guided, Internet-based coping-skills training group on quality of life outcomes in women with early-stage breast cancer. METHODS: Sixty-two women completed baseline evaluations and were randomized into either a small online coping group or a waiting-list control condition. RESULTS: No main effects for treatment were observed at the 12-week follow up. However, there was a significant interaction between baseline self-reported health status and treatment, such that women with poorer self-perceived health status showed greater improvement in perceived health over time when assigned to the treatment condition. Linguistic analyses revealed that positive changes across quality of life variables were associated with greater expression of negative emotions such as sadness and anxiety, greater cognitive processing, and lower expression of health-related concerns. CONCLUSIONS: These results demonstrate the potential efficacy of self-guided Internet coping groups while highlighting the limitations of such groups.

The present study examined the feasibility of evaluating online communication of cancer patients using an automated content analysis program modified for application to cancer-related communication. Public messages posted to the Breast Cancer Discussion List and the Prostate Problems Mailing List were content analyzed uasing an augmented version of Linguistic Inquiry and Word Count to evaluate communication styles within these two cancer types. Breast cancer patients were more likely to submit multiple messages to the list and made greater use of words related to emotional disclosure and cognitive processing compared with prostate cancer patients. Prostate cancer patients were less likely to seek emotional support or repeated interaction with other patients, and more of their communication focused on cancer-related information. Use of cancer-specific word libraries significantly increased word identification within these samples. Content analysis of online communication appears to be a promising method for detecting communication differences among subgroups of cancer patients.

Many well-designed studies have shown psychosocial treatments for cancer to be efficacious for improving patients' quality of life, but the actual impact of these treatments may be limited by low rates of participation. Web-based treatment formats could improve effectiveness by increasing availability and accessibility. Two phases of a feasibility study are reported in this article. In the first phase, we sought to assess internet access and perceived interest in online support among 136 women with breast cancer (June-October, 1999). Levels of interest in participating in an online psychosocial treatment were associated with age, outcome expectancy, and barriers to using the internet but not stage or time since diagnosis. In the second phase, we document accrual rates among several methods of recruitment during a randomized trial (February-December, 2001) and report changes over time in internet access. Recruitment rates were substantially higher when a study representative was available in clinic to provide information about the treatment than for all other methods of recruitment. Access to the internet increased between 1999 (63%) and 2001 (70%) and varied across age groups. These results suggest that internet-based psychosocial treatments, with notable limitations, are feasible for increasing the impact of psychosocial care