Objectives Sexual morbidity is a distressing and undertreated problem in gynecological cancer survivorship known to occur early and persist well beyond the period of physical recovery. Although often studied as a separate domain, sexuality represents an integral component of psychological adjustment and quality of life (QoL) that is adversely affected by cancer treatments. The present study tests the association between sexual morbidity, and adverse psychological adjustment and QoL outcomes. Methods A cross-sectional design was used. The participants were gynecological (cervical, endometrial, ovarian, and vulvar) cancer survivors who were partnered (N = 186), whose cancer was diagnosed 2 to 10 years previously, and who were at least 6 months post any cancer therapy. Most had been found to have early-stage disease (70%) and were treated with hysterectomy (77%), chemotherapy (43%), and/or radiotherapy (23%). Sexual morbidity was operationalized as a multidimensional construct including sexual behavior, sexual functioning, and subjective sexual satisfaction, assessed by patient self-report. Outcomes included self-reported depressive symptoms, traumatic stress symptoms, cancer-specific stress, stress about body changes, and QoL. Nurse-rated of performance status and disruptive signs/symptoms of treatment toxicity, as well as relevant sociodemographic and disease variables were collected as potential controls. Results Hierarchical multiple regression analyses tested sexual morbidity as a predictor of poor outcomes. All statistical models were significant, accounting for 12% to 53% of the variance in psychological adjustment/QoL. Sexual morbidity covaried with worsened depressive symptoms, body change stress, and psychological QoL beyond the negative contributions of (older) age, (poorer) performance status, and (greater) fatigue. Notably, disease and treatment variables were not statistically significant correlates of psychological adjustment or QoL. Conclusions These findings suggest that prevention or treatment of sexual morbidity might foster improved psychological adjustment/QoL. Given the high rates of sexual morbidity in this population and the connection between sexuality and broader psychological adjustment/QoL, there is a clear need for better integration of sexuality rehabilitation into routine clinical care.

Objective New regulations and guidelines require implementation of screening and evidence based psychological treatment (EBT) for cancer patients, but little research exists to assist psychosocial care providers with implementation. This study aimed to develop a conceptual framework for community providers to consider as they embark on implementation of EBTs. Methods Full-time psychosocial care providers received training in delivery of a cancer-specific EBT and then received implementation support. Qualitative data were collected in two phases. In Phase I, after training, trainees (N=63) participated in six monthly group conference calls with 6-8 trainees and EBT trainers. Qualitative data from the calls were analyzed using a grounded theory paradigm. In Phase II, the resultant framework was piloted with additional trainees (N=73) during EBT training to prompt early planning for implementation at their home institutions. Results In Phase I, themes of “person” (i.e., attitudes, vocalizations, and behaviors of others) and “environment” factors (i.e., material, monetary, and time resources of organizations) affecting implementation emerged. It appeared that both factors influenced how easily barriers could be addressed, though positive person factors also appeared to positively influence environment factors. In Phase II, trainees found the framework acceptable and considered it when generating solutions for implementation challenges. Conclusions The framework suggests tailoring implementation efforts to consider person and environment factors. As person support is developed, any resource limitations of the environment may be more easily addressed.

Spouses of patients experience role strains as a result of informal caregiving, which has been associated with mood in numerous research studies. However, most research is on female caregivers, and little is known about the experience of male spouses, or of the caregiving provided to fibromyalgia patients. The Stress Process Model was used to examine mediators and moderators of the relation between role strain and mood among 135 husbands of women with fibromyalgia. Results indicated that the more activities of daily living and instrumental activities of daily living performed by the husband, the greater the role strain. Role strain was associated with worse mood. A test of the Stress Process Model supported a partial mediation model, where social support and emotion-focused coping partially mediated the relation between role strain and mood. No evidence was found for a moderation model or for problem-focused coping as a mediator. Our research suggests significant impairment and caregiving needs among this patient population, which in turn relates to the mood of the husband who is also an informal caregiver. Our findings also support the Stress Process Model in explaining the complexity of caregiving effects. The results of the study suggest avenues for intervention for individuals strained by their partners' illness.Spouses of chronically ill individuals have poorer mental health than comparison groups and the general population [1,2]. Spouses may be affected because the illness may require informal caregiving, including assistance with activities of daily living (ADLs; such as toileting, dressing), instrumental activities of daily living (IADLs; such as shopping), and taking over responsibilities that the patient can no longer perform (such as cleaning, cooking). These caregiving responsibilities may interfere with spouses' abilities to perform other roles, resulting in role strains.Role strains, experienced daily by most individuals, are defined as the difficulties felt by individuals who have multiple roles with accompanying obligations [3]. For caregivers, the additional responsibility of helping a patient with a health condition may divert much needed resources from the other roles currently fulfilled by the individual, causing role strain. Roles typically examined for strain include work, domestic environment, sexual relations, family relations, and social relations. Of the employed caregiving husbands in a national study of frail elderly, 32% reported working fewer hours, 28% indicated they rearranged their schedule, and 24% took time off without pay because of their wives' illness [4]. In the domestic environment, husbands report an increase in the amount of time spent on household chores as a direct result of their wives' illness or disability [5]. A chronic illness may affect the couple's sexual relations as well. For example, patients with a rheumatic disease listed pain or weakness, fatigue, and lack of interest as the top *Address correspondence to this author at the IUPUI, Department of P...

No abstract