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In this randomized trial, the addition of a form of group therapy called supportive–expressive group therapy to standard medical care did not prolong the survival of women with metastatic breast cancer. The therapy did, however, alleviate psychological symptoms. In this randomized trial, the addition of group therapy to standard care did not prolong survival. In 1989, Spiegel et al. 1 reported a randomized trial of supportive–expressive group therapy in women with metastatic breast cancer. Supportive–expressive group therapy is a standardized treatment for those with life-threatening illness that encourages participants to express feelings and concerns about their illness and its effect on their lives in the supportive environment of a therapist-led group. The women who participated in such therapy lived a mean of 18 months longer than the women in the control group. 2 , 3 However, since the statistical analysis of survival had not been planned, these results called for further investigation. Two recent randomized trials of . . .

If you are experiencing a temporary appearance-related change, remind yourself that it won't last forever. You can feel a greater sense of control by becoming more attentive to things you say to yourself and finding ways to make those messages more encouraging and compassionate. Instead of thinking, \"My body is so unattractive,\" for example, tell yourself something like... \"My hair may be falling out but I have beautiful eyes and my body is working hard to help me through this stressful time. My hair will come back and others tell me the new hair is softer, more lustrous and healthy-looking. \"

As survival has improved in patients with metastatic breast cancer, quality of life issues have become more important in clinical and research assessment of treatment. We examined psychological aspects of sexuality, body image and health-related quality of life (HRQOL) in 19 patients who had completed high dose chemotherapy and peripheral stem cell transfusion (HDC/PBSCT), and in 19 who had undergone conventional chemotherapy (CC). There were no differences in mean age, time since treatment or demographic variables except education level. We found no significant differences in HRQOL (Functional Living Index-Cancer) nor on the Body Image Scale. On a measure of sexual fears, 74% of the HDC/PBSCT patients and 63% of the CC patients thought that cancer would make them unattractive to their mates. As well, 68% of the HDC/PBSCT patients and 37% of the CC women were fearful of sex being painful as a result of their cancer (p<0.01). Sixty eight percent of HDC/PBSCT women and 47% of CCs had change in level of sexual desire since treatment following their diagnosis of metastatic disease. Eighty five per cent of HDC/PBSCT and all CC women experienced this as decreased desire. We found few significant differences between the groups, but there were noteworthy effects on body image and psychological aspects of sexuality with both treatments. Key words: Breast cancer, Sexuality, Body image, Health-related quality of life INTRODUCTION Breast cancer is the most common malignancy in women, responsible for 27% of malignant tumours and 20% of cancer deaths. Once metastatic disease is documented, it has been considered incurable, with a median survival time of less than 2 years (Henderson, 1991). Poor survival has lead to aggressive high dose chemotherapy regimes with autologous peripheral blood stem cell transplant support (HDC/PBSCT). Recently, it has been shown that at least 50% of women undergo remission with high dose chemotherapy, compared with 5-15% treated with multi-dose conventional chemotherapy (Booser & Hortobagyi, 1992). As length of survival following a cancer diagnosis has increased, there has been a shift in focus from dying of cancer to living with the disease. Interest has been directed, in general, toward the evaluation of the effects of breast cancer and related medical therapies on health-related quality of life (HRQOL) (Baum, Ebbs, Fallowfield, & Fraser, 1990; Boyd, Selby, Sutherland, & Hogg, 1988: Coates, Gebski, Stat, Bishop, Jeal, Woods, Snyder, Tatersall, Byrne, Harvey, & Gill. 1987; Hallgren, Paterson, & Arcand, 1984; Levine, Guyatt, Gent, De Pauw, Goodyear, Hryniuk, Arnold, Findlay, Skillings, Bramwell, Levin, Bush, Abu-Zahra, & Kotalik, 1988). The area of quality of life assessment is not without controversy, particularly in the definition of the construct. The present literature consensus defines \"health-related quality of life\" as encompassing three major domains: physical well-being, psychological state and social functioning. Other areas are also currently being included such as personal financial impacts, and sexuality and body image. There is an emerging literature on HRQOL in breast cancer patients during treatment in HDC/PBSCT programs (Ahles, Tope, Furstenburg, Hann & Mills, 1996; Larsen, Gardulf, & Nordstrom, 1996; Litwins, Rodrique, & Weiner, 1994; Weiner, 1994). McQuellon and colleagues (1976) have recently reported that long-term quality of life in breast cancer patients is unchanged following HDC/PBSCT. These authors also reported that in structured interviews, concerns about physical appearance and about personal and physical relations emerged. The substantial physical illness immediately after high-dose chemotherapy is reflected in poor HRQOL, but this rebounds to normal levels within one month following discharge (Cumming, Nabholtz, Wentzel, Handman, Clinch, Sansregret, & Cumming, 1996). There are no published comparisons of quality of life following conventional and high-dose chemotherapy in a population of breast cancer patients. Further, physicians dealing with clinical and research problems do not generally ask about side effects of treatment in which there is substantial subjective patient input. In particular, until recently researchers have placed little emphasis on sexuality and body image during and after either high-dose or conventional forms of treatment (Love, Levanthal, Easterling, Nerenz, 1989). Women believe themselves to be uninformed about the sexual side effects of cancer treatment (Kaplan, 1994) and about body image (Mathieson, 1994). They view these areas to be of major concern (Hopwood, 1993). The goal of the present study, therefore, was to examine health-related quality of life, sexuality, and body image in women with metastatic breast cancer who had undergone either conventional or high-dose chemotherapy. SUBJECTS AND METHODS SUBJECTS The subjects in the study were 38 women, age 30 to 63 years, from urban and rural areas of Western Canada.

Hundleby answers questions about the ideal ways to reconnect the body, mind, and spirit of cancer patients that undergo chemotherapy. Among other things, she avers that one needs time to adjust and to heal, both physically and emotionally, to any changes that will be experienced as a result of cancer therapy, such as hair loss or loss of a breast or ovary.

Q. How can I manage the physical changes that may happen as a result of cancer treatment?

If you are experiencing a temporary appearance-related change, remind yourself that it won't last forever. You can feel a greater sense of control by becoming more attentive to things you say to yourself and finding ways to make those messages more encouraging and compassionate. Instead of dunking, \"My body is so unattractive,\" for example, tell yourself something like... \"My hair may be falling out but I have beautiful eyes and my body is working hard to help me through this stressful time. My hair will come back and others tell me the new hair is softer, more lustrous and healthy-looking.\"

Interstitial cystitis (IC), is a painful, chronic and often debilitating disease of the bladder. It is typically ten (10) times more common in women than in men, and often strikes women during their prime of life. Symptoms are a marked increase in urinary urgency and frequency, along with pain/and or burning. While the etiology of interstitial cystitis is not fully known, recent medical researchers and physicians posit that lymphovascular, neurogenic, infectious, environmental, endocrinologic, psychoneurotic, inflammatory (including autoimmune) mechanisms may be involved. Psychological factors have been implicated as contributing to predisposition, onset, or the course of interstitial cystitis, however numerous studies noted in the urological literature have primarily addressed the physiological aspects of this condition. Psychological or psychosomatic components as they may relate to IC have only been given passing consideration. In this exploratory study, psycho-social factors were investigated with fifty-six (56) IC patients, forty-four (44) urinary tract infection patients and forty-four (44) persons in a random control group. Four instruments were administered to all participants: the State-Trait Anxiety Inventory (Spielberger, 1983); the Adult Irrational Ideas Inventory (Davies & Zingle, 1970); the Internal-External Locus of Control (Rotter, 1966); the Multidimensional Health Locus of Control (Wallston, Wallston & DeVellis, 1978) and the Millon Behavioral Health Inventory (Millon, Green & Meagher, 1982). Thirty of the interstitial cystitis patients also participated in an indepth interview to gain insight into the experience of living with this disease. The overall effect on all measures taken together was found to be significant. Differences among groups on individual variables were assessed using a univariate F test. While differences on eighteen (18) variables were not significant, the following individual sub-scales were found to be significant: state anxiety, internal health locus of control, recent stress, premorbid pessimism, somatic anxiety, emotional vulnerability, gastrointestinal susceptibility, allergic inclination, and cardiovascular tendency. As a result of this exploratory investigation, further research is needed to examine in greater depth some of the significant findings, as well as to probe other variables which were not considered specifically within the confines of this study.