PRISM :: Browsing by Author "Carlson, Linda E."

Browsing by Author "Carlson, Linda E."

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Open Access
Affect and Mindfulness as Predictors of Change in Mood Disturbance, Stress Symptoms, and Quality of Life in a Community-Based Yoga Program for Cancer Survivors
(Hindawi Limited, 2013) Ekkekakis, Panteleimon; Carlson, Linda E.; Mackenzie, Michael J.; Culos-Reed, S. Nicole; Paskevich, David M.
Little attention has been paid to the psychological determinants by which benefits are accrued via yoga practice in cancer-related clinical settings. Using a longitudinal multilevel modeling approach, associations between affect, mindfulness, and patient-reported mental health outcomes, including mood disturbance, stress symptoms, and health-related quality of life (HRQL), were examined in an existing seven-week yoga program for cancer survivors. Participants (N = 66) were assessed before and after the yoga program and at three- and six-month follow-ups. Decreases in mood disturbance and stress symptoms and improvements in HRQL were observed upon program completion. Improvements in mood disturbance and stress symptoms were maintained at the three- and six-month follow-ups. HRQL exhibited further improvement at the three-month follow-up, which was maintained at the six-month follow-up. Improvements in measures of well-being were predicted by initial positive yoga beliefs and concurrently assessed affective and mindfulness predictor variables. Previous yoga experience, affect, mindfulness, and HRQL were related to yoga practice maintenance over the course of the study.
Open Access
Affect and Mindfulness as Predictors of Change in Mood Disturbance, Stress Symptoms, and Quality of Life in a Community-Based Yoga Program for Cancer Survivors
(2013-05-23) Mackenzie, Michael J.; Carlson, Linda E.; Ekkekakis, Panteleimon; Paskevich, David M.; Culos-Reed, S. Nicole
Little attention has been paid to the psychological determinants by which benefits are accrued via yoga practice in cancer-related clinical settings. Using a longitudinal multilevel modeling approach, associations between affect, mindfulness, and patient-reported mental health outcomes, including mood disturbance, stress symptoms, and health-related quality of life (HRQL), were examined in an existing seven-week yoga program for cancer survivors. Participants were assessed before and after the yoga program and at three- and six-month follow-ups. Decreases in mood disturbance and stress symptoms and improvements in HRQL were observed upon program completion. Improvements in mood disturbance and stress symptoms were maintained at the three- and six-month follow-ups. HRQL exhibited further improvement at the three-month follow-up, which was maintained at the six-month follow-up. Improvements in measures of well-being were predicted by initial positive yoga beliefs and concurrently assessed affective and mindfulness predictor variables. Previous yoga experience, affect, mindfulness, and HRQL were related to yoga practice maintenance over the course of the study.
Open Access
Cancer and Complementary Therapies: Current Trends in Survivors’ Interest and Use
(SAGE Publications, 2018-4-9) Carlson, Linda E.; Qureshi, Maryam; Zelinski, Erin
Cancer survivors use complementary therapies (CTs) for a variety of reasons; however, with interest and use reportedly on the rise and a widening range of products and practices available, there is a need to establish trends in and drivers of interest. We aimed to determine (1) frequencies of use, level of interest, and barriers for 30 specific CTs and (2) whether physical symptoms, perceived stress (PS), or spiritual well-being were related to interest levels.
Open Access
Characterizing Pain in Long-Term Survivors of Childhood Cancer
(2020-08-04) Patton, Michaela; Schulte, Fiona S.M.; Noel, Melanie; Carlson, Linda E.; Birnie, Kathryn A.
Many long-term survivors of childhood cancer (LTSCCs) experience late- and long-term effects from their treatments, including pain. Yet, pain is poorly understood among LTSCCs. The current study aims to 1a) identify rates and patterns of chronic pain 1b) describe multiple dimensions of pain, and 2) test predictors of chronic pain in LTSCCs. Survivors [n=140; 48.6% male, Mage=17.3 years (SD=4.9)] were recruited from across Canada. Participants completed the Pain Questionnaire, Pain Catastrophizing Scale, Pediatric Quality of Life Inventory, Patient Reported Outcome Measurement Information System (PROMIS) – Pain Interference, Anxiety, and Depression scales, Child Posttraumatic Stress Scale, the Posttraumatic Stress Disorder Checklist for the DSM-V, and the Cancer Worry Scale. It was found that 26% of LTSCCs reported experiencing chronic pain. An exploratory cluster analysis revealed that 20% of survivors had a moderate to severe chronic pain problem based on measures of pain intensity and interference. The combination of anxiety, depression, PTSS, cancer worry, current age, age at diagnosis, pain catastrophizing, and sex significantly predicted the presence of chronic pain, χ2(8, N = 123) = 27.87, p < .001. Higher pain catastrophizing (OR = 1.09; 95% CI = 1.03-1.15) and older current age (OR = 1.13; 95% CI = 1.01-1.27) were significant predictors of chronic pain. LTSCCs should be screened for the presence and magnitude of chronic pain during their long-term follow-up visits so appropriate interventions can be discussed. Future research should investigate pain interventions tailored for this population.
Open Access
Documenting patients’ and providers’ preferences when proposing a randomized controlled trial: a qualitative exploration
(2022-03-06) Oberoi, Devesh; Kwok, Cynthia; Li, Yong; Railton, Cindy; Horsman, Susan; Reynolds, Kathleen; Joy, Anil A.; King, Karen M.; Lupichuk, Sasha M.; Speca, Michael; Culos-Reed, Nicole; Carlson, Linda E.; Giese-Davis, Janine
Abstract Background With advances in cancer diagnosis and treatment, women with early-stage breast cancer (ESBC) are living longer, increasing the number of patients receiving post-treatment follow-up care. Best-practice survivorship models recommend transitioning ESBC patients from oncology-provider (OP) care to community-based care. While developing materials for a future randomized controlled trial (RCT) to test the feasibility of a nurse-led Telephone Survivorship Clinic (TSC) for a smooth transition of ESBC survivors to follow-up care, we explored patients’ and OPs’ reactions to several of our proposed methods. Methods We used a qualitative study design with thematic analysis and a two-pronged approach. We interviewed OPs, seeking feedback on ways to recruit their ESBC patients for the trial, and ESBC patients, seeking input on a questionnaire package assessing outcomes and processes in the trial. Results OPs identified facilitators and barriers and offered suggestions for study design and recruitment process improvement. Facilitators included the novelty and utility of the study and simplicity of methods; barriers included lack of coordination between treating and discharging clinicians, time constraints, language barriers, motivation, and using a paper-based referral letter. OPs suggested using a combination of electronic and paper referral letters and supporting clinicians to help with recruitment. Patient advisors reported satisfaction with the content and length of the assessment package. However, they questioned the relevance of some questions (childhood trauma) while adding questions about trust in physicians and proximity to primary-care providers. Conclusions OPs and patient advisors rated our methods for the proposed trial highly for their simplicity and relevance then suggested changes. These findings document processes that could be effective for cancer-patient recruitment in survivorship clinical trials.
Open Access
Exploring patient experiences and acceptability of group vs. individual acupuncture for Cancer-related pain: a qualitative study
(2022-06-13) Oberoi, Devesh; Reed, Erica N.; Piedalue, Katherine-Ann; Landmann, Jessa; Carlson, Linda E.
Abstract Background Individual acupuncture (AP) is a safe and effective treatment for cancer-related pain and other symptoms in cancer survivors. However, access to individual AP is limited, and costs can be prohibitive. Group AP could be a more cost-effective alternative as it is less expensive and non-inferior to individual AP for pain relief. Despite growing evidence in favour of group AP, patient acceptability and experience of group AP in cancer patients is relatively unknown. This exploratory study sought to compare patient experiences and acceptability of group versus individual AP in cancer patients. Methods Semi-structured, open-ended, in-depth interviews were conducted in a subset of 11 cancer patients enrolled in a randomized non-inferiority trial of group vs. individual AP for cancer pain. Participants for this study were recruited via purposive sampling, aiming for diversity in age, sex, education, employment, cancer types, and treatment arms. Data was analyzed using inductive thematic analysis. Results Two major themes were identified: a) overall experience of AP treatment b) value of AP. Participants across both treatment arms acknowledged improvement in pain, quality of sleep, mood and fatigue. Participants in the group AP arm reported a significant increase in perceived social support, while participants in the individual arm valued privacy and one-on-one interaction with the acupuncturist. Although some participants in the group arm had privacy-related concerns before the commencement of the program, these concerns waned after a few AP sessions. Participants across both the treatment arms reported cordial clinician-patient relationship with the acupuncturist. Willingness to pursue AP treatment in the future was comparable across both the treatment arms and was limited by out-of-pocket costs. Conclusion Patient acceptability and experience of treatment in group AP was on par with individual AP. Group AP may further augment perceived social support among patients and privacy concerns, if any, subside after a few sessions. Trial registration ClinicalTrials.gov ( NCT03641222 ). Registered 10 July 2018 - Retrospectively registered.
Open Access
Group versus Individual Acupuncture (AP) for Cancer Pain: A Randomized Noninferiority Trial
(2020-04-13) Reed, Erica Nicole; Landmann, Jessa; Oberoi, Devesh; Piedalue, Katherine-Ann L.; Faris, Peter; Carlson, Linda E.
Background. A service delivery model using group acupuncture (AP) may be more cost-effective than individual AP in general, but there is little evidence to assess whether group AP is a comparable treatment in terms of efficacy to standard individual AP. The study aimed to compare the group to individual delivery of 6-week AP among cancer patients with pain. Methods. The study design was a randomized noninferiority trial of the individual (gold standard treatment) vs. group AP for cancer pain. The primary outcome was pain interference and severity, measured through the Brief Pain Inventory (BPI). Secondary outcomes included measures of mood, sleep, fatigue, and social support. Changes in outcomes from pre- to postintervention were examined using linear mixed effects modeling and noninferiority was inferred using a noninferiority margin, a difference of change between the two arms and 95% CIs. Pain interference was tested with a noninferiority margin of 1 on the BPI, while pain severity and secondary outcomes were compared using conventional statistical methods. Results. The trial included 74 participants randomly allocated to group (35) or individual (39) AP. The noninferiority hypothesis was supported for pain interference [Ө − 1, Δ 1.03, 95% CI: 0.15–2.20] and severity [Ө − 0.81, Δ 0.52, 95% CI:.33–1.38] as well as for mood [Ө − 7.52, Δ 9.86, 95% CI: 0.85–18.86], sleep [Ө − 1.65, Δ 2.60, 95% CI: 0.33–4.88], fatigue [Ө 8.54, Δ − 15.57, 95% CI: 25.60–5.54], and social support [Ө.26, Δ − 0.15, 95% CI: − 0.42–0.13], meaning that group AP was not inferior to individual AP treatment. Both arms evidenced statistically significant improvements across all symptoms before and after the intervention. Effect sizes for the group vs. individual AP on outcomes of pain, sleep, mood, and social support ranged from small to very large and were consistently larger in the group condition. The total average cost-per-person for group AP ($221.25) was almost half that of individual AP ($420). Conclusions. This is the first study to examine the noninferiority of group AP with the gold standard individual AP. Group AP was noninferior to individual AP for treating cancer pain and was superior in many health outcomes. Group AP is more cost-effective for alleviating cancer pain and should be considered for implementation trials.
Open Access
High levels of untreated distress and fatigue in cancer patients
(Springer Nature, 2004-5-25) Lamont, L.; Bultz, B.D.; Simpson, J.S.A.; Robinson, J.; Pelletier, G.; Martin, M.; MacRae, J.H.; Carlson, Linda E.; Angen, M.; Cullum, J.; Goodey, E.; Koopmans, J.; Tillotson, L.; Speca, M.
The purpose of the study was to assess a large representative sample of cancer patients on distress levels, common psychosocial problems, and awareness and use of psychosocial support services. A total of 3095 patients were assessed over a 4-week period with the Brief Symptom Inventory-18 (BSI-18), a common problems checklist, and on awareness and use of psychosocial resources. Full data was available on 2776 patients. On average, patients were 60 years old, Caucasian (78.3%), and middle class. Approximately, half were attending for follow-up care. Types of cancer varied, with the largest groups being breast (23.5%), prostate (16.9%), colorectal (7.5%), and lung (5.8%) cancer patients. Overall, 37.8% of all patients met criteria for general distress in the clinical range. A higher proportion of men met case criteria for somatisation, and more women for depression. There were no gender differences in anxiety or overall distress severity. Minority patients were more likely to be distressed, as were those with lower income, cancers other than prostate, and those currently on active treatment. Lung, pancreatic, head and neck, Hodgkin's disease, and brain cancer patients were the most distressed. Almost half of all patients who met distress criteria had not sought professional psychosocial support nor did they intend to in the future. In conclusion, distress is very common in cancer patients across diagnoses and across the disease trajectory. Many patients who report high levels of distress are not taking advantage of available supportive resources. Barriers to such use, and factors predicting distress and use of psychosocial care, require further exploration.
Open Access
Individualized quality of life, standardized quality of life, and distress in patients undergoing a phase I trial of the novel therapeutic Reolysin (reovirus)
(Springer Nature, 2005) Morris, Donald G.; Carlson, Linda E.; Bultz, Barry D.
The purpose of this study was to evaluate the individualized and standardized quality of life (QL) and psychological distress of patients participating in a Phase I trial of the novel therapeutic reovirus (Reolysin).
Open Access
Mindfulness-Based Cancer Recovery (MBCR) versus Supportive Expressive Group Therapy (SET) for distressed breast cancer survivors: evaluating mindfulness and social support as mediators
(Springer Nature, 2016-10-08) Schellekens, Melanie. P. J.; Carlson, Linda E.; Drysdale, Elaine; Stephen, Joanne; Speca, Michael; Labelle, Laura E.; Tamagawa, Rie; Savage, Linette Lawlor; Dirkse, Dale; Pickering, Barbara; Sample, Sarah
Despite growing evidence in support of mindfulness as an underlying mechanism of mindfulness-based interventions (MBIs), it has been suggested that nonspecific therapeutic factors, such as the experience of social support, may contribute to the positive effects of MBIs. In the present study, we examined whether change in mindfulness and/or social support mediated the effect of Mindfulness-Based Cancer Recovery (MBCR) compared to another active intervention (i.e. Supportive Expressive Group Therapy (SET)), on change in mood disturbance, stress symptoms and quality of life. A secondary analysis was conducted of a multi-site randomized clinical trial investigating the impacts of MBCR and SET on distressed breast cancer survivors (MINDSET). We applied the causal steps approach with bootstrapping to test mediation, using pre- and post-intervention questionnaire data of the participants who were randomised to MBCR (n = 69) or SET (n = 70). MBCR participants improved significantly more on mood disturbance, stress symptoms and social support, but not on quality of life or mindfulness, compared to SET participants. Increased social support partially mediated the impact of MBCR versus SET on mood disturbance and stress symptoms. Because no group differences on mindfulness and quality of life were observed, no mediation analyses were performed on these variables. Findings showed that increased social support was related to more improvement in mood and stress after MBCR compared to support groups, whereas changes in mindfulness were not. This suggests a more important role for social support in enhancing outcomes in MBCR than previously thought.
Open Access
Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors
(Wiley, 2014-11-03) Beattie, Tara L.; Speca, Michael; Degelman, Erin S.; Fick, Laura J.; Tamagawa, Rie; Faris, Peter; Giese-Davis, Janine; Carlson, Linda E.
Group psychosocial interventions including mindfulness-based cancer recovery (MBCR) and supportive-expressive group therapy (SET) can help breast cancer survivors decrease distress and influence cortisol levels. Although telomere length (TL) has been associated with breast cancer prognosis, the impact of these two interventions on TL has not been studied to date.
Open Access
Mindfulness-based cognitive therapy for psychological distress in pregnancy: study protocol for a randomized controlled trial
(Springer Nature, 2016-10-13) Giesbrecht, Gerald F.; Dimidjian, Sona; Madsen, Joshua W.; Carlson, Linda E.; Letourneau, Nicole L.; Tomfohr-Madsen, Lianne M.; Campbell, Tavis S.
Clinically significant psychological distress in pregnancy is common, with epidemiological research suggesting that between 15 and 25 % of pregnant women experience elevated symptoms of stress, anxiety, and depression. Untreated psychological distress in pregnancy is associated with poor obstetrical outcomes, changes in maternal physiology, elevated incidence of child physical and psychological disorders, and is predictive of maternal postpartum mood disorders. Despite the wide-ranging impact of antenatal psychological distress on mothers and their children, there is a gap in our knowledge about the most effective treatments that are available for psychological distress experienced in pregnancy. Additionally, no trials have focused on potential physiological changes that may occur as a result of receiving mindfulness training in pregnancy. The proposed trial will determine the effectiveness of an 8-week modified Mindfulness-based Cognitive Therapy (MBCT) intervention delivered during pregnancy.
Open Access
Mindfulness-Based Interventions for Physical Conditions: A Narrative Review Evaluating Levels of Evidence
(Hindawi Limited, 2012) Carlson, Linda E.
Research on mindfulness-based interventions (MBIs) for treating symptoms of a wide range of medical conditions has proliferated in recent decades. Mindfulness is the cultivation of nonjudgmental awareness in the present moment. It is both a practice and a way of being in the world. Mindfulness is purposefully cultivated in a range of structured interventions, the most popular of which is mindfulness-based stress reduction (MBSR), followed by mindfulness-based cognitive therapy (MBCT). This paper begins with a discussion of the phenomenological experience of coping with a chronic and potentially life-threatening illness, followed by a theoretical discussion of the application of mindfulness in these situations. The literature evaluating MBIs within medical conditions is then comprehensively reviewed, applying a levels of evidence rating framework within each major condition. The bulk of the research looked at diagnoses of cancer, pain conditions (chronic pain, low back pain, fibromyalgia, and rheumatoid arthritis), cardiovascular disease, diabetes, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and irritable bowel syndrome. Most outcomes assessed are psychological in nature and show substantial benefit, although some physical and disease-related parameters have also been evaluated. The field would benefit from more adequately powered randomized controlled trials utilizing active comparison groups and assessing the moderating role of patient characteristics and program "dose" in determining outcomes.
Open Access
Mindfulness-Based Interventions for Physical Conditions: A Narrative Review Evaluating Levels of Evidence
(2012-11-14) Carlson, Linda E.
Research on mindfulness-based interventions (MBIs) for treating symptoms of a wide range of medical conditions has proliferated in recent decades. Mindfulness is the cultivation of nonjudgmental awareness in the present moment. It is both a practice and a way of being in the world. Mindfulness is purposefully cultivated in a range of structured interventions, the most popular of which is mindfulness-based stress reduction (MBSR), followed by mindfulness-based cognitive therapy (MBCT). This paper begins with a discussion of the phenomenological experience of coping with a chronic and potentially life-threatening illness, followed by a theoretical discussion of the application of mindfulness in these situations. The literature evaluating MBIs within medical conditions is then comprehensively reviewed, applying a levels of evidence rating framework within each major condition. The bulk of the research looked at diagnoses of cancer, pain conditions (chronic pain, low back pain, fibromyalgia, and rheumatoid arthritis), cardiovascular disease, diabetes, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and irritable bowel syndrome. Most outcomes assessed are psychological in nature and show substantial benefit, although some physical and disease-related parameters have also been evaluated. The field would benefit from more adequately powered randomized controlled trials utilizing active comparison groups and assessing the moderating role of patient characteristics and program “dose” in determining outcomes.
Open Access
Mindfulness-based stress reduction improves distress in two different chronic illnesses
(ScopeMed International Medical Journal Management and Indexing System, 2012) Zernicke, Kristin; Carlson, Linda E.; Campbell, Tavis; Blustein, Philip; Zhong, Lihong; Lounsberry, Joshua; LawlorSavage, Linette
Background: Distress is well recognized as endemic in cancer populations: less is known about distress in Irritable Bowel Syndrome (IBS). Purpose: This study compared distress between individuals with IBS (n=51) and those with cancer (n=147) participating in Mindfulness-Based Stress Reduction (MBSR). Methods: Patients completed mood and symptoms of stress questionnaires pre- and post- MBSR intervention as well as at 6-month follow-up. Results: The IBS group demonstrated higher baseline total symptoms of stress and more muscle tension, sympathetic nervous system arousal, and neurological/GI symptoms. They also had higher baseline tension/anxiety scores on the mood measure. While both groups decreased significantly post-MBSR on total stress symptoms and mood disturbance scores, the IBS group showed a small increase in stress symptoms between post-program and 6-month follow-up. Conclusions: These findings highlight the high levels of distress associated with IBS, and support evidence that MBSR may be beneficial in reducing both IBS and cancer related distress.
Open Access
Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: randomised controlled trial of computerised vs personalised triage
(Springer Nature, 2012-7-24) Carlson, Linda E.; Bultz, B.D.; Zhong, L.; Groff, S.L.; Waller, A.
This randomised controlled trial examined the impact of screening for distress followed by two different triage methods on clinically relevant outcomes over a 12-month period.
Open Access
Open to Exploration? Association of Personality Factors With Complementary Therapy Use After Breast Cancer Treatment
(SAGE Publications, 2018-1-24) Toivonen, Kirsti I.; Carlson, Linda E.; Stephen, Joanne; Speca, Michael; Tamagawa, Rie
Many cancer survivors seek complementary therapies (CTs) to improve their quality of life. While it is well-known that women who are younger, more highly educated, and have higher incomes are more likely to use CTs, individual differences such as personality factors have been largely unexplored as predictors of CT use.
Open Access
Reply: benefits of screening cancer patients for distress still not demonstrated
(Springer Nature, 2013-01-31) Groff, S.L.; Bultz, B.D.; Zhong, L.; Carlson, Linda E.; Waller, A.
Open Access
Reply: Comment on ‘Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: randomised controlled trial of computerised vs personalised triage’ – Psychological distress in patients with cancer: is screening the effective solution?
(Springer Nature, 2013-06) Bultz, B.D.; Groff, S.L.; Waller, A.; Carlson, Linda E.
Open Access
Screening for distress, the 6th vital sign: common problems in cancer outpatients over one year in usual care: associations with marital status, sex, and age
(Springer Nature, 2012-10-2) Neri, Eric; Bultz, Barry D.; Dunlop, Bernie; Rancourt, Kate M.S.; Adamyk-Simpson, Jassandre; Giese-Davis, Janine; Waller, Amy; Carlson, Linda E.; Groff, Shannon; Zhong, Lihong; Bachor, Sacha M.
Very few studies examine the longitudinal prevalence of problems and the awareness or use of clinical programs by patients who report these problems. Of the studies that examine age, gender and marital status as predictors of a range of patient outcomes, none examines the interactions between these demographic variables. This study examined the typical trajectory of common practical and psychosocial problems endorsed over 12 months in a usual-care sample of cancer outpatients. Specifically, we examined whether marital status, sex, age, and their interactions predicted these trajectories. We did not actively triage or refer patients in this study in order to examine the natural course of problem reports.