Objective This cross sectional study aimed to characterize fears of recurrence among women newly diagnosed with gynecologic cancer. The study also evaluated models predicting the impact of recurrence fears on psychological distress through social and cognitive variables. Methods Women (N = 150) who participated in a randomized clinical trial comparing a coping and communication intervention to a supportive counseling intervention to usual care completed baseline surveys that were utilized for the study. The survey included the Concerns about Recurrence Scale (CARS), Beck Depression Inventory (BDI), Impact of Event Scale (IES), and measures of social (holding back from sharing concerns and negative responses from family and friends) and cognitive (positive reappraisal, efficacy appraisal, and self-esteem appraisal) variables. Medical data was obtained via medical chart review. Results Moderate-to-high levels of recurrence fears were reported by 47% of the women. Younger age (p < .01) and functional impairment (p < .01) correlated with greater recurrence fears. A social-cognitive model of fear of recurrence and psychological distress was supported. Mediation analyses indicated that as a set, the social and cognitive variables mediated the association between fear of recurrence and both depression and cancer-specific distress. Holding back and self-esteem showed the strongest mediating effects. Conclusion Fears of recurrence are prevalent among women newly diagnosed with gynecologic cancer. Social and cognitive factors play a role in women’s adaptation to fears and impact overall psychological adjustment. These factors may be appropriate targets for intervention.

Background: We previously developed Pisando Fuerte (PF), a linguistically and culturally appropriate version of "Stepping On", an evidence-based fall prevention program building on self-efficacy and adult learning principles. The purpose of this study is to describe the implementation of PF at two community organizations in Wisconsin. Methods: PF consisted of 2 h sessions delivered in Spanish over the course of 8 weeks by two trained leaders, at two community sites in Wisconsin. Participants identified strategies for falls prevention and practiced progressive balance and strength exercises. The RE-AIM framework guided the mixed-methods evaluation. Falls Behavioral Risk Scale (FaB) (Outcomes), and uptake of protective behaviors (Individual Maintenance) were evaluated 6 months after completion. Fidelity of delivery (Implementation) was evaluated by an independent assessor for three sessions at each site using a-priori criteria based on key elements of Stepping On. Results: Twenty-four Hispanic/Latino individuals, whose primary language is Spanish, were enrolled in two workshops. The mean age was 70.5 years; 71% were female, and five reported a fall in the year prior. Outcomes: There was a non-statically significant decrease in the number of falls per person [RR: 0.33 (95%CI: 0.096-1.13)] at 6 months. There was a statistically significant improvement of the mean Falls Behavioral Risk Scale (FaB) (baseline = 2.69 vs. 6-months post-intervention = 3.16, p < 0.001). Adoption: Barriers to adoption included leader training in English, time to identify Spanish-speaking guest experts, and time to prepare for each session. Implementation: Satisfactory fidelity of delivery was achieved in 69% of the elements; fidelity lapses were more common in the use of adult learning strategies and programmatic aspects. Eighty eight percent of participants completed the program, and 95% of them adequately demonstrated the exercises. Maintenance: At 6 months, 57.9% of participants continued doing exercises, 94% adopted safer walking strategies, and 67% executed at least one home safety recommendation. These results are similar to those seen in the original Stepping On program. Conclusions: Our study shows good fidelity of delivery with implementation of "Pisando Fuerte". Pre-post data demonstrate a significant reduction in falls behavioral risk among Hispanic/Latino participants, similar to results with "Stepping On".

Objective Little attention has been paid to the role of holding back sharing concerns in the psychological adaptation of women newly diagnosed with gynecological cancers. The goal of the present study was to evaluate the role of holding back concerns in psychosocial adjustment and quality of life, as well as a possible moderating role for emotional expressivity and perceived unsupportive responses from family and friends. Method Two hundred forty four women diagnosed with gynecological cancer in the past eight months completed measures of holding back, dispositional emotional expressivity, perceived unsupportive responses from family and friends, cancer-specific distress, depressive symptoms, and quality of life. Results Emotional expressivity moderated the association between holding back and cancer- specific distress and quality of life, but not depressive symptoms. Greater holding back was more strongly associated with higher levels of cancer-related distress among women who were more emotionally expressive than among women who were less expressive. Perceived unsupportive responses did not moderate the associations between holding back and psychosocial outcomes. Conclusion Holding back sharing concerns was more common in this patient population than other cancer populations. Dispositional expressivity played a role in how harmful holding back concerns was for women, while unsupportive responses from family and friends did not.

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