PTSD, diagnosed according to DSM-IV criteria, is more common in survivors of cancer than it is in the general population. Estimates of the occurrence of PTSD in patients with a history of cancer depend upon clinical and demographic factors, as well as upon study design.

The aim of this study was to identify the distress, unmet needs and concerns of head and neck cancer (HNC) survivors in the first 5 years after treatment. Two hundred and eighty HNC survivors from three Scottish health boards responded to a cross-sectional postal survey in 2011. Questionnaires included the Distress Thermometer, Patient Concerns Inventory (PCI) and an adapted version of the PCI to measure unmet needs. One-third of the survivors had moderate or severe levels of distress, and 74% had at least one unmet need. The most common concerns and unmet needs included oral and eating problems, fear of recurrence and fatigue. Multivariate analysis revealed that being younger, out of work (not retired), ever having had a feeding tube fitted, having a greater number of comorbidities and living alone were associated with higher levels of distress, concerns and unmet needs. The diversity of concerns and unmet needs identified in this study highlights the importance of holistic needs assessment as part of follow-up care for HNC survivors with tailoring of support for particular concerns. Specific information resources and self-management strategies are required to help HNC survivors with the practical and functional consequences of HNC treatment.

Abstract:Purpose This study aimed to assess quality of life (QoL) in head and neck cancer (HNC) survivors, and determine factors predictive of poor QoL in the first five years after the end of treatment. Methods A cross-sectional survey, including the Quality of Life in Adult Cancer Survivors (QLACS) measure, was sent to HNC survivors in three Scottish health regions, with responses linked to routinely collected clinical data. Independent sample t-tests, ANOVAs, Pearson correlations and multiple hierarchical regressions were used to explore associations between and to determine the contribution made by demographic, lifestyle and clinical factors to predicting 'generic' and 'cancer-specific' quality of life. Results 280 patients (65%) returned questionnaires. After adjustment, multivariate analysis showed that younger age, lower socio-economic status, unemployment and selfreported comorbidity independently contributed to poorer generic and cancer-specific quality of life. In addition to these factors, having had a feeding tube or a diagnosis of oral cavity cancer were independently predictive of poorer cancer-specific quality of life. Conclusions Socio-economic factors and co-morbidity are important predictors of QoL in HNC survivors. These factors and the detrimental long-term effects of feeding tubes need Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporationfurther attention in research and practice.

Objective We compared social support with other potential psychosocial predictors of posttraumatic stress after cancer. These included family identification, or a sense of belonging to and commonality with family members, and family constraints, or the extent to which family members are closed, judgmental, or unreceptive in conversations about cancer. We also tested the hypothesis that family constraints mediate the relationship between family identification and cancer‐related posttraumatic stress. Methods We used a cross‐sectional design. Surveys were collected from 205 colorectal cancer survivors in Tayside, Scotland. Results Both family identification and family constraints were stronger independent predictors of posttraumatic stress than social support. In multivariate analyses, social support was not a significant independent predictor of posttraumatic stress. In addition, there was a significant indirect effect of family identification on posttraumatic stress through family constraints. Conclusions Numerous studies demonstrate a link between social support and posttraumatic stress. However, experiences within the family may be more important in predicting posttraumatic stress after cancer. Furthermore, a sense of belonging to and commonality with the family may reduce the extent to which cancer survivors experience constraints on conversations about cancer; this may, in turn, reduce posttraumatic stress.

Background: Self-esteem is a common factor in many mental health problems, including anxiety and depression. A cognitive behavioural therapy (CBT)-based protocol called ‘Overcoming Low Self-Esteem’ is available; the use of this protocol in a group format has been associated with improvements in self-esteem. However, it is unclear whether improvements persist after the end of a group-based version of this programme. Aims: We aimed to assess whether changes in self-esteem, anxiety and depression persist 3 months after the end of a group version of the Overcoming Low Self-Esteem programme. Method: Using data from the National Health Service in Fife, Scotland, we analysed whether there were improvements on self-report measures of self-esteem, anxiety and depression from the beginning of the group to the end of the group and at a follow-up session 3 months later. Results: Significant improvements in self-esteem, anxiety and depression are maintained at 3 months follow-up. Conclusions: The Overcoming Low Self-Esteem group seems to be associated with improved self-esteem, anxiety and depression. However, further research from randomised controlled trials is needed to establish a causal link between the programme and improved psychological outcomes.

Using a person-centred approach, this study inspected multi-trajectories of conduct problems, hyperactivity/inattention and peer problems, and associated risk factors for group membership. The sample included 3,578 children (50.8% males) from a population birth cohort in Scotland (Growing Up in Scotland). The parental version of the Strengths and Difficulties Questionnaire (SDQ) was used when children were 4, 5, 6, 7, and 10 years old. Antecedent factors at the perinatal, child, and family levels were collected using parental reports, observation, and standardised assessments at 10, 24, and 36 months. A group-based multi-trajectory analysis was employed. Findings showed that a six-group model best fit the data. Identified groups included non-engagers, normative, decreasing externalising/low peer problems, low externalising/moderate peer problems, moderate externalising/increasing peer problems and multimorbid moderate-high chronic. Findings suggest multimorbidity between externalising behaviours and peer problems in the more elevated groups. Two common protective factors emerged across all groups: caregiver mental health and parent-infant attachment. Identified risk factors were specific to group membership. Risk factors for the most elevated group included single-parent status, social deprivation, previous neonatal intensive care unit admission, child sex, whilst children’s expressive language was a protective factor. Taken together, findings contribute to the emerging literature modelling trajectories of externalising behaviours and peer problems simultaneously and have important practical implications for prevention of problems in childhood, by identifying targets at the perinatal, child, and family levels.

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