Dale J Langford1, Bruce Cooper2, Steven Paul2, Janice Humphreys3, Marilyn J Hammer4, Jon Levine5, Yvette P Conley6, Fay Wright7, Laura B Dunn8, Christine Miaskowski2. 1. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA. 2. School of Nursing, University of California, San Francisco, San Francisco, California, USA. 3. School of Nursing, Duke University, Durham, North Carolina, USA. 4. Dana Farber Cancer Institute, Boston, Massachusetts, USA. 5. School of Nursing, University of California, San Francisco, San Francisco, California, USA; School of Dentistry, University of California, San Francisco, San Francisco, California, USA. 6. School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 7. Rory Meyers College of Nursing, New York University, New York, New York, USA. 8. Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA. Electronic address: laura.dunn@stanford.edu.
Abstract
CONTEXT: Cancer and its treatment are inherently stressful and stress impacts important patient outcomes. Patients vary considerably in their response to stress. Understanding this variability requires a patient-centered multidimensional approach. OBJECTIVES: The objectives of this study were to identify and characterize patient subgroups with distinct multidimensional stress profiles (stress appraisal, exposure, and adaptation) during cancer treatment. METHODS: Among 957 patients undergoing chemotherapy for breast, gastrointestinal, gynecological, or lung cancer, latent profile analysis was performed to identify patient subgroups using concurrent evaluations of global (Perceived Stress Scale) and cancer-specific (Impact of Events Scale-Revised) stress, lifetime stress exposure (Life Stressor Checklist-Revised), and resilience (Connor-Davidson Resilience Scale-10). RESULTS: Three latent classes were identified: "Normative" (54.3%; intermediate global stress and resilience, lower cancer-related stress, lowest life stress); "Stressed" (39.9%; highest global and cancer-specific stress scores, lowest resilience, most life stress); and "Resilient" (5.7%; lowest global stress, cancer-specific stress comparable to Normative class, highest resilience, intermediate life stress). Characteristics that distinguished the Stressed from the Normative class included the following: younger age, female gender, lower socioeconomic status, unmarried/partnered, living alone, poorer functional status, and higher comorbidity burden. Compared to Stressed patients, Resilient patients were more likely to be partnered, to not live alone, and had a higher functional status. No demographic or clinical characteristics differentiated Normative from Resilient patients. Exposure to specific life stressors differed significantly among the classes. CONCLUSION: A subset of patients warrants intensive psychosocial intervention to reduce stress and improve adaptation to cancer. Intervention efforts may be informed by further study of Resilient patients.
CONTEXT: Cancer and its treatment are inherently stressful and stress impacts important patient outcomes. Patients vary considerably in their response to stress. Understanding this variability requires a patient-centered multidimensional approach. OBJECTIVES: The objectives of this study were to identify and characterize patient subgroups with distinct multidimensional stress profiles (stress appraisal, exposure, and adaptation) during cancer treatment. METHODS: Among 957 patients undergoing chemotherapy for breast, gastrointestinal, gynecological, or lung cancer, latent profile analysis was performed to identify patient subgroups using concurrent evaluations of global (Perceived Stress Scale) and cancer-specific (Impact of Events Scale-Revised) stress, lifetime stress exposure (Life Stressor Checklist-Revised), and resilience (Connor-Davidson Resilience Scale-10). RESULTS: Three latent classes were identified: "Normative" (54.3%; intermediate global stress and resilience, lower cancer-related stress, lowest life stress); "Stressed" (39.9%; highest global and cancer-specific stress scores, lowest resilience, most life stress); and "Resilient" (5.7%; lowest global stress, cancer-specific stress comparable to Normative class, highest resilience, intermediate life stress). Characteristics that distinguished the Stressed from the Normative class included the following: younger age, female gender, lower socioeconomic status, unmarried/partnered, living alone, poorer functional status, and higher comorbidity burden. Compared to Stressed patients, Resilient patients were more likely to be partnered, to not live alone, and had a higher functional status. No demographic or clinical characteristics differentiated Normative from Resilient patients. Exposure to specific life stressors differed significantly among the classes. CONCLUSION: A subset of patients warrants intensive psychosocial intervention to reduce stress and improve adaptation to cancer. Intervention efforts may be informed by further study of Resilient patients.
Authors: Tara Stacker; Kord M Kober; Laura Dunn; Carol Viele; Steven M Paul; Marilyn Hammer; Yvette P Conley; Jon D Levine; Christine Miaskowski Journal: Cancer Nurs Date: 2022-03-02 Impact factor: 2.760
Authors: Vivian Huang; Lynda Mackin; Kord M Kober; Steven M Paul; Bruce A Cooper; Yvette P Conley; Marilyn J Hammer; Jon D Levine; Christine Miaskowski Journal: Support Care Cancer Date: 2022-09-06 Impact factor: 3.359
Authors: Carolyn J Presley; Nicole A Arrato; Sarah Janse; Peter G Shields; David P Carbone; Melisa L Wong; Ling Han; Thomas M Gill; Heather G Allore; Barbara L Andersen Journal: JCO Oncol Pract Date: 2021-05-03
Authors: Paule V Joseph; Alissa Nolden; Kord M Kober; Steven M Paul; Bruce A Cooper; Yvette P Conley; Marilyn J Hammer; Fay Wright; Jon D Levine; Christine Miaskowski Journal: J Pain Symptom Manage Date: 2020-11-28 Impact factor: 5.576
Authors: Christine Miaskowski; Steven M Paul; Karin Snowberg; Maura Abbott; Hala Borno; Susan Chang; Lee M Chen; Bevin Cohen; Marilyn J Hammer; Stacey A Kenfield; Kord M Kober; Jon D Levine; Rachel Pozzar; Kim F Rhoads; Erin L Van Blarigan; Katherine Van Loon Journal: J Pain Symptom Manage Date: 2020-09-02 Impact factor: 3.612
Authors: Raymond Javan Chan; Bruce Cooper; Louisa Gordon; Nicolas Hart; Chia Jie Tan; Bogda Koczwara; Kord M Kober; Alexandre Chan; Yvette P Conley; Steven M Paul; Christine Miaskowski Journal: BMC Cancer Date: 2021-08-02 Impact factor: 4.430