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Biomedical subjects

T G Burish

Publications and source records attributed to T G Burish.

At least 19 recordsLinked to original sources
PubMed2000

The role of behavioral and psychosocial science in reducing cancer morbidity and mortality.

Behavioral and psychosocial science has the potential to contribute much to the overall effort to reduce cancer morbidity and mortality and to improve the quality of life for cancer patients and their families. However, for a variety of reasons, including a lack of sustained funding for research and training and a lack of confidence by some in the potential payoff for investments in the area, this potential has not only not been realized but also not been adequately explored. A special subcommittee of "The March" Research Task Force studied research in this area and issued a report making several recommendations for future funding for psychosocial and behavioral research in cancer. This article reports those recommendations and the reasons the committee supported them.

Behavioral Medicine↗
PubMed1997

Energy level and sleep quality following bone marrow transplantation.

While problems with sleep and energy level (ie fatigue) are commonly reported during recovery from bone marrow transplantation (BMT), little in-depth information regarding these two problem areas in BMT patients is available. Using both questionnaire and telephone interview methods, information regarding current sleep and energy level problems was obtained from 172 adult BMT survivors drawn from five different BMT treatment centers. Respondents were a mean of 43.5 months post-BMT at the time of the initial assessment. Similar questionnaire data was obtained from 137 respondents (80%) at a follow-up assessment 18 months after the initial assessment. Results suggested that half to two-thirds of disease-free BMT recipients experience problems with regard to current energy level or sleep quality. While for the majority of patients these problems were rated as mild, 15-20% of BMT recipients showed moderate to severe problems in these areas with corresponding decrements in quality of life. Furthermore, both cross-sectional and longitudinal analyses suggested that problems in these areas did not simply abate with time. Only low to moderate correlations were obtained between indices of sleep and energy problems and measures of anxious and depressed mood. Finally, the presence of current sleep problems was associated with older age at BMT, receipt of TBI during pre-BMT conditioning, and female gender. Further research needs to address the specific etiology of chronic problems with sleep and energy level in BMT recipients as well as evaluate biobehavioral strategies for managing these problems.

Adult↗
PubMed1996

Frequency and clinical implications of delayed nausea and delayed emesis.

Studies of the adverse effects of cancer chemotherapy often do not distinguish between delayed and persistent nausea and emesis. Although persistent nausea is simply acute nausea that continues beyond the treatment day, postchemotherapy delayed nausea and delayed vomiting first develop after an initial 24 h free of these symptoms. To access its occurrence in clinical practice, we conducted a structured examination of chemotherapy-induced delayed nausea and emesis in consecutive chemotherapy patients unselected for diagnosis, chemotherapy, or antiemetic usage. Three hundred twenty-seven consecutive with histologically confirmed cancer were followed through three consecutive chemotherapy treatments at three geographically separate institutions. Patient-reported assessments of nausea and emesis were made for each 6-h period over 3 days after chemotherapy. One in three patients developed delayed nausea and one in four incurred delayed emesis. Of >950 chemotherapy treatments assessed, approximately 1 in 6 were characterized by delayed nausea and 1 in 9 by delayed vomiting. We conclude that nausea and emesis that first begin >24 h after chemotherapy are a significant clinical concern. Patients receiving cancer chemotherapy without being admitted to the hospital should be informed of the possible occurrence of delayed nausea and vomiting and be given adequate and appropriate antiemetic medication for use at home for the prevention of these delayed side effects.

Adolescent↗
PubMed1995

Quality of life following bone marrow transplantation: findings from a multicentre study.

Questionnaires assessing a range of quality of life (QOL) outcomes were completed by 200 adult bone marrow transplant (BMT) recipients from five BMT treatment centres. Respondents had undergone allogeneic (46%) or autologous BMT (54%) for a haematological malignancy and were disease free and at least 12 months post BMT (mean 43 months). Variability in post-BMT QOL was reported with deficits in physical, sexual and occupational functioning particularly likely. Allogeneic recipients reported poorer QOL than autologous recipients. Greater age at BMT, lower level of education and more advanced disease at BMT were consistent risk factors for poorer QOL. Contrary to previous research, evidence for improved functional status with the passage of time post BMT was obtained. Factors generally not associated with post-BMT QOL included disease diagnosis, dose of total body irradiation, presence of chronic graft-versus-host disease (GVHD), type of GVHD prophylaxis and extent of marrow graft match. In conclusion, while many BMT recipients reported normal QOL, the majority indicated that their QOL was compromised relative to premorbid status. Prospective, longitudinal research will be necessary to further identify risk factors for poor post-BMT QOL and identify the temporal trajectory of post-BMT QOL.

Adult↗
PubMed1995

'Returning to normal' following bone marrow transplantation: outcomes, expectations and informed consent.

The psychosocial impact of bone marrow transplantation (BMT) was investigated in 172 disease-free adult BMT survivors drawn from five different BMT treatment centers. Respondents were a mean of 43.5 months after BMT. Both questionnaire and interview assessments were utilized. Survivors' perceptions of whether they had 'returned to normal' following BMT, recollections of pre-BMT expectations for returning to normal and current psychological distress were assessed. The results indicated that only a minority of respondents considered themselves to have 'returned to normal' following BMT. Reports of less than normal physical, cognitive, occupational, sexual and/or interpersonal functioning were common. In contrast, few patients reported pre-BMT expectations for such. Discordance between pre-BMT expectations for returning to normal and current functional status was associated with greater current psychological distress. Finally, despite the presence of any functional deficits and despite any discordance between pre-BMT expectations and current functional status, survivors' evaluations of their decision to pursue BMT were generally quite positive. Results are discussed in terms of their implications for: (1) the process of obtaining informed consent for BMT, and (2) clinical strategies for enhancing post-BMT psychological adjustment.

Activities of Daily Living↗
PubMed1994

Behavioral aspects of clinical trials. An integrated framework from behavior theory.

A less-than-optimal proportion of patients with cancer are entered into National Cancer Institute-sponsored clinical trials. This article reviews the literature on accrual in oncology clinical trials to characterize the extent of the problem, identify reasons for low accrual, and suggest ways to promote accrual. Four well known theories of health behavior (the Health Belief Model, Subjective Expected Utility Theory, Protection Motivation Theory, and the Theory of Reasoned Action) point to central concepts involved in understanding patient health-related behavior: (1) the probability that an unwelcomed health event will happen to a patient, (2) the severity of that event if it does occur, (3) the effectiveness of a particular behavior (such as taking part in a clinical trial) to modify the severity, and (4) the cost of adopting that behavior. These concepts form a framework for integrating the available information about accrual to clinical oncology trials. Patient and physician factors previously related to clinical trials suggest specific recommendations for increasing accrual to clinical oncology trials.

Clinical Trials as Topic↗
PubMed1994

Symptom control in psychosocial oncology.

A major thrust in psychosocial oncology has been to use psychosocial and behavioral techniques to prevent and manage the adverse symptoms associated with cancer and its treatment. This article defines the field of symptom management in psychosocial oncology and reviews its early and recent history. Recent progress in the field is reviewed, with a focus on several thematic advances in theory and practice. Finally, an agenda is suggested for the next decade of research, with attention given to research needs, research policy, and training issues.

Attitude to Health↗
PubMed1993

Cognitive distraction and relaxation training for the control of side effects due to cancer chemotherapy.

Sixty cancer chemotherapy patients were randomly assigned to one of six conditions formed by a 3(cognitive distraction, relaxation training, no intervention) x 2(high anxiety, low anxiety) factorial design. All patients were followed for five consecutive chemotherapy sessions. Outcome measures included patient reports, nurse observations, and physiological indices. Results indicated that distraction patients reported less nausea prior to chemotherapy and lower systolic blood pressures after chemotherapy than controls. Relaxation training patients reported less nausea prior to chemotherapy and exhibited lower systolic and diastolic blood pressures after chemotherapy than control patients. There were no significant differences between distraction and relaxation training patients on any measure. Patients with high initial levels of anxiety exhibited continually elevated levels of distress throughout the chemotherapy experience; however, anxiety level did not interact with the effectiveness of the treatment interventions. Overall, the data support the use of both cognitive distraction and relaxation training for reducing the distress of chemotherapy with both high and low-anxiety patients and suggest that at least some of the effects of relaxation training can be achieved with distraction alone.

Adult↗
PubMed1992

Psychological techniques for controlling the adverse side effects of cancer chemotherapy: findings from a decade of research.

Cancer patients receiving chemotherapeutic treatments often experience unpleasant side effects that compromise the quality of their life and may be so severe that they lead to suboptimal drug dosages, missed treatments, or even discontinuation of treatment. In recent years it has been discovered that some of these side effects result from maladaptive learning. This article reviews over 10 years of research conducted at Vanderbilt University on the prevention and treatment of these psychological side effects. This research includes the assessment of the efficacy of a behavioral relaxation technique, the exploration of procedures that make this intervention clinically practical for widespread application, research aimed at predicting which patients will and will not benefit from the intervention, and the comparison of this intervention to alternative treatment approaches. The review of this research generates four major conclusions and points to several important areas for future inquiry.

Adaptation, Psychological↗
PubMed1992

Effectiveness of biofeedback and relaxation training in reducing the side effects of cancer chemotherapy.

Assessed the effectiveness of electromyographic (EMG) and skin-temperature (ST) biofeedback and relaxation training (RT) in reducing the aversiveness of cancer chemotherapy. Eighty-one cancer patients, equated on several individual-difference variables, were randomized to one of six groups formed by a 3 (EMG Biofeedback, ST Biofeedback, No Biofeedback) x 2 (RT, No RT) factorial design. Outcome was assessed with physiological, patient-reported, and nurse-reported indices taken over five consecutive chemotherapy treatments. RT patients showed decreases in nausea and anxiety during chemotherapy and physiological arousal after chemotherapy. EMG and ST biofeedback reduced some indices of physiological arousal but had no other effects on chemotherapy side effects. These findings suggest that RT can be effective in reducing the adverse consequences of chemotherapy and that the positive effects found for biofeedback in prior research were due to the RT that was given with the biofeedback, not to the biofeedback alone.

Adolescent↗
PubMed1991

Physiologic and psychobehavioral research in oncology.

A major thrust in research in psychosocial oncology is the study of the interaction of psychologic and physiologic variables. This discussion reviews the current status and future directions of such research. Areas addressed include pain, nausea and vomiting with chemotherapy, sexuality, effects of cancer on psychologic and neuropsychologic function, impact of psychologic factors on cancer and its treatment, and psychoneuroimmunology. In addition, specific recommendations for strategies to facilitate research in these areas of psychosocial oncology are proposed.

Adult↗
PubMed1991

Progress in psychosocial and behavioral cancer research. The need for enabling strategies.

A major component of the Second Workshop on Methodology in Behavioral and Psychosocial Cancer Research was a discussion of enabling strategies, that is, strategies by which future goals and needs in the area of psychosocial and behavioral oncology might be accomplished. This report describes and comments on the discussion that took place at a special plenary session at which representatives from four funding agencies, the American Cancer Society, National Cancer Institute, National Institute of Mental Health, and National Science Foundation, presented their views and their agencies' programs for promoting research in psychosocial and behavioral oncology. It is concluded that much progress has been made in the field and that strategies are in place for ensuring continued progress. However, suggestions are also made for new strategies that might accelerate and broaden that progress.

Attitude to Health↗
PubMed1991

Behavioral and psychosocial cancer research. Building on the past, preparing for the future.

This report identifies five general conclusions that emerged from the Second Workshop on Methodology in Behavioral and Psychosocial Cancer Research. These conclusions address diverse topics, including a focus on areas other than methodology; an emphasis on the transfer of technology and knowledge to applied settings; a recognition of the role of basic behavioral research in answering clinical questions; the need to recognize and strengthen ties between the field of behavioral and psychosocial oncology and the basic behavioral and social science fields from which it emerged; and the importance of additional research on minorities and other special populations. It is suggested that meeting the challenges posed in each of these five areas is critical to continued progress in the field.

Attitude to Health↗
PubMed1991

Preparing patients for cancer chemotherapy: effect of coping preparation and relaxation interventions.

Sixty cancer chemotherapy patients were randomly assigned to one of four treatments: (a) relaxation training with guided relaxation imagery (RT), (b) general coping preparation package (PREP), (c) both RT and PREP, or (d) routine clinic treatment only. All patients were assessed on self-report, nurse observation, family observation, and physiological measures and were followed for five sequential chemotherapy treatments. Results indicate that the PREP intervention increased patients' knowledge of the disease and its treatment, reduced anticipatory side effects, reduced negative affect, and improved general coping. RT patients showed some decrease in negative affect and vomiting, but not as great as in past studies. The data suggest that a relatively simple, one-session coping preparation intervention can reduce many different types of distress associated with cancer chemotherapy and may be more effective than often-used behavioral relaxation procedures.

Adaptation, Psychological↗
PubMed1990

Cognitive dysfunction in adult survivors of allogeneic marrow transplantation: relationship to dose of total body irradiation.

Bone marrow transplant (BMT) patients are exposed to several potential sources of neurologic damage including the neurotoxicity of pre-BMT preparative regimens. The latter generally include a combination of total body irradiation (TBI) and high-dose chemotherapy. Cognitive functioning in 30 adult allogeneic BMT patients (mean of 47 months post-BMT) treated for either acute or chronic leukemia was assessed by two standardized self-report questionnaires. Consistent with hypothesis, results of both univariate and multivariate analyses indicated that increased dose of TBI was associated with increased cognitive dysfunction. Furthermore, this relationship remained even after the impact of psychological distress upon cognitive functioning was accounted for. TBI-related cognitive impairment primarily involved slowed reaction time, reduced attention and concentration, and difficulties in reasoning and problem-solving. These results complement previous findings of an inverse association between dose of TBI and self-perceptions of health and physical functioning in BMT survivors and indicate the importance of including quality of life measures in clinical trials of therapeutic innovations in the field of BMT.

Adolescent↗