Previous studies on breast cancer recurrence provide a mixed picture of the quality of life of women following a recurrence. To clarify the picture, the present study addresses some previous methodological concerns by offering a multidimensional assessment with follow-up, a matched comparison group of disease-free survivors, and a closer look at the nature of recurrence (local versus metastatic). Fifty-Four of 817 women who participated in an earlier study experienced a recurrence at follow-up, and are compared to a matched sample of 54 women who remained disease-free. Analyses indicate that women who had a recurrence report significantly poorer functioning on various health-related quality of life (HRQOL) domains compared to women who remained disease-free. However, the differences appear to be largely due to the poorer HRQOL of women with metastatic disease. Although women who had a recurrence report good mood, low stress, and good quality of interpersonal relationships, they report significantly higher cancer-specific stress compared to disease-free women at follow-up. Women who had a recurrence also report experiencing both more meaning and vulnerability as a result of breast cancer than disease-free women, but report similar levels of spirituality and benefit-finding at follow-up as disease-free women. These results suggest that although women report relatively good psychosocial adjustment following a recurrence, cancer-specific domains of quality of life are most likely to be negatively affected. These results may be useful in identifying individuals with breast cancer recurrences who are most in need of psychosocial services.

Ovei the past 3 decades, psychological and medical leseaicheis have made enoimous snides in undeistanding the emotional and psychosocial lesponses of individuals who ate diagnosed with and tteated fot cancel. This liteiatuie has developed thiough three overlapping and intenelated phases. Initially, interview and questionnaire studies focused on describing the distiess and dismption associated with cancel diagnosis and tieatment. This line of lesearch was designed to provide the patient and the health care team with an empirically based sense of common responses and concems that would allow them to be prepared for likely outcomes and to identify reactions that weie not within noimal limits. Equally as valuable, these studies confiimed the importance of consideiing quality, as well as length, of suivival in cancel care, a peispective that now is widely accepted, thanks to patient advocates and psychosocial research. As mote became known about the psychosocial expeiiences of individuals with cancel, reseaicheis became inteiested in undeistanding vaiiations in lesponses: Why did some patients appear to have ongoing difficulties, whereas others seemed to retum to prediagnostic quality of life fairly quickly? Thus, in the second phase, tesearcheis attempted to identify peisonal, social, and cancei-ielated predictois of adjustment following the diagnosis of cancel. With knowledge of common difficulties and of chaiacteiistics and resources of 361

The psychometric properties of the Hooper Vsual Organization Test (VOT) have not been well investigated Here the authors present internal consistency and interrater reliability coefficients, and an item analysis, using data from a sample (N = 281) of "cognitively impaired" and "cognitively intact" patients, and patients with undetermined cognitive status. Coefficient alpha for the VOT total sample was .882. An item analysis found that 26 of the 30 items were good at discriminating among patients. Also, the interrater reliabilities for three raters (.992), two raters (.988), and one rater (.977) were excellent. Therefore, the judgmental scoring of the VOT does not interfere significantly with its clinical utility. The authors conclude that the VOT is a psychometrically sound test.

We examined the relations among generalized positive expectations (optimism), prostate-cancer specific expectations, and prostate cancer-related quality of life in a prospective sample of 83 men who underwent robotic assisted laparoscopic prostatectomy (RALP) for prostate cancer. Optimism was significantly associated with higher prostate cancer-specific expectations, β = .36, p < .001. In addition, optimism and prostate cancer-specific expectations were independent prospective predictors of better scores on the following prostate cancer-related quality of life scales: Sexual Intimacy and Sexual Confidence; Masculine Self-Esteem (specific expectations only), Health Worry, Cancer Control, and Informed Decision Making (βs > .21, ps < .05). When considered simultaneously, both optimism and specific expectations contributed uniquely to better Health Worry and Cancer Control scores, optimism was a unique predictor of better Sexual Intimacy and Sexual Confidence scores, and specific expectations uniquely predicted higher scores on Informed Decision Making. Although optimism and prostate-cancer specific expectations are related, they contribute uniquely to several prostate cancer-related quality of life outcomes following RALP and may be important targets for quality of life research with this population.