Introduction This study evaluates the concordance of treatment summaries (TSs) and survivorship care plans (SCPs) delivered to breast cancer survivors within the LIVESTRONG™ Network of Survivorship Centers of Excellence with Institute of Medicine (IOM) recommendations and describes additional structure/process variables. Method Seven NCI-designated comprehensive cancer centers and six community-based centers participated. TS/SCPs for 65 patients were rated against IOM recommendations using a study-derived checklist, and surveys were administered to better understand the structure and process of delivering TSs/SCPs. Results On average, fewer than half of IOM content recommendations were met for TSs (M=46%) and less than two thirds for SCPs (M=59%). No sites achieved ≥75% overall concordance with IOM recommendations for TSs and only two of 13 met this criterion for SCPs. Content domain scores across sites varied widely, as did the number of sites addressing domain content with ≥75% concordance. Nonetheless, resources required for document preparation and delivery were substantial. Discussion Gaps in concordance with IOM recommendations exist even in dedicated survivorship centers. A substantial time burden was also noted. Further research is needed to determine which informational elements are essential, to develop and test strategies for improving efficiency and reach, and to determine if outcomes of survivorship care planning warrant the resources required in their preparation and delivery. Implications for survivors TSs and SCPs have been recommended for all cancer survivors. Essential elements must be determined, approaches made more efficient, outcome improvements demonstrated, and cost-benefit analyses determined before survivors should expect widespread implementation of this recommendation for survivorship care.

The treatment programme was superior to routine care on outcomes relating to illness and service use, and the cost was comparable to the control treatment.

This study compared three groups of women--outpatient depressed, inpatient depressed, and community control--and their husbands on a range of variables including marital functioning and styles of coping with conflict. Outpatient depressed couples reported greater marital distress and more destructive and less constructive tactics for resolving conflict than did community control couples. They also were more likely to have been previously married and to express regrets about having married their current husbands. There were smaller and less consistent differences for couples with inpatient depressed spouses, although inpatient couples with younger wives were similar to outpatient depressed couples. Both groups of depressed women and their husbands reported fewer expressions of affection and more complaints about the marriage than did control couples. Results are discussed in terms of interpersonal perspectives on depression.

Objective Breast cancer survivors report adverse sexual effects (sexual morbidity) such as disrupted sexual function, sexual distress and body dissatisfaction. However, most studies have failed to evaluate the persistence of these effects in long-term survivors. The present study comprehensively assessed the prevalence and predictors of sexual/body image problems among survivors three or more years post diagnosis. Design/outcome measures Eighty-three breast cancer survivors completed surveys a median of seven years post diagnosis. Survey items probed demographic, diagnostic and clinical information, in addition to sexual activity, sexual function (Female Sexual Function Index [FSFI]), body image, and distress regarding body changes and sexual problems (Female Sexual Distress Scale-revised; FSDS-R). Results Seventy-seven percent of all participants and 60% of sexually active participants qualified for sexual dysfunction based on the FSFI. Between 37 and 51% met criteria for female sexual dysfunction, based on two FSDS-R clinical cut-offs. Body satisfaction was worse than normative values, while body change stress was mid-range. Notable sexual morbidity predictors included mastectomy, which was associated with worse sexual/body change distress, and post-treatment weight gain, which predicted greater body dissatisfaction/body change stress. Conclusions Breast cancer survivors report substantial sexual morbidity years after treatment, especially after mastectomy or post-treatment weight gain. Breast cancer patients and their providers should be aware of these potential sexual effects.

Despite contradictory findings, the belief that psychotherapy promotes survival in people who have been diagnosed with cancer has persisted since the seminal study by D. Spiegel, J. R. Bloom, H. C. Kramer, and E. Gottheil (1989). The current authors provide a systematic critical review of the relevant literature. In doing so, they introduce some considerations in the design, interpretation of results, and reporting of clinical trials that have not been sufficiently appreciated in the behavioral sciences. They note endemic problems in this literature. No randomized clinical trial designed with survival as a primary endpoint and in which psychotherapy was not confounded with medical care has yielded a positive effect. Among the implications of the review is that an adequately powered study examining effects of psychotherapy on survival after a diagnosis of cancer would require resources that are not justified by the strength of the available evidence.

Although an intense negative emotional reaction to breast cancer was common, PTSD had low prevalence. Results suggest that using a trauma framework to understand the experience of most patients with cancer may be inaccurate.

These results suggest that Internet based peer-to-peer interactions may not necessarily be universally beneficial despite the positive experiences reported by many participants. Further research is needed to understand the magnitude of this effect with a larger sample. Moreover, these results raise questions about the need to understand the comparative effectiveness of Internet-based communications by group structure (i.e., unstructured/structured; unmoderated/moderated) and the effect of content (i.e., expression of fear/anxiety, insightful disclosures, etc.) on outcomes.

BACKGROUND.The purpose of the current study was to identify unmet psychosocial needs of cancer survivors, understand the distribution of needs across subgroups, and compare unmet needs in 2005 with those identified by Houts et al. in 1986.METHODS.Using a sequential mixed methods design, qualitative interviews were conducted with 32 cancer survivors or family members to identify the psychosocial needs of people from the time of cancer diagnosis through survivorship. These data were used to modify a needs assessment that was mailed to a stratified random sample of survivors obtained from the Pennsylvania Cancer Registry.RESULTS.A total of 614 survivors returned usable questionnaires. Nearly two‒thirds of respondents reported experiencing at least 1 unmet psychosocial need, particularly emotional, physical, and treatment‒related needs. It is likely that unmet needs in insurance, employment, information, and homecare increased during the 20‒year interval between surveys. Demographics associated with increased unmet need included later stage of disease at the time of diagnosis, younger age, more comorbidities, and lower income.CONCLUSIONS.Unmet psychosocial need remains high despite 20 years of effort to address psychosocial issues. This may be due to a mismatch between needs and services. Unmet need may be related to access issues, a lack of awareness of resources, “new” needs that have arisen in a changing healthcare climate, and patient preferences for types of service. Cancer treatment staff should be especially alert for psychosocial problems in younger individuals with an additional illness burden. Cancer 2007. © 2007 American Cancer Society.