Overweight and obese patients with osteoarthritis (OA) experience more OA pain and disability than patients who are not overweight. This study examined the long-term efficacy of a combined pain coping skills training (PCST) and lifestyle behavioral weight management (BWM) intervention in overweight and obese OA patients. Patients (N=232) were randomized to a 6-month program of: 1) PCST + BWM; 2) PCST-only; 3) BWM-only; or 4) standard care control. Assessments of pain, physical disability (Arthritis Impact Measurement Scales [AIMS] physical disability, stiffness, activity, and gait), psychological disability (AIMS psychological disability, pain catastrophizing, arthritis self-efficacy, weight self-efficacy), and body weight were collected at four time points (pretreatment, post-treatment, and 6 months and 12 months after the completion of treatment). Patients randomized to PCST+ BWM demonstrated significantly better treatment outcomes (average of all three post-treatment values) in terms of pain, physical disability, stiffness, activity, weight self-efficacy, and weight when compared to the other three conditions (p’s <.05). PCST+BWM also did significantly better than at least one of the other conditions (i.e., PCST-only, BWM-only, or standard care) in terms of psychological disability, pain catastrophizing, and arthritis self-efficacy. Interventions teaching overweight and obese OA patients pain coping skills and weight management simultaneously may provide the more comprehensive long-term benefits.

This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all P's ≤ 0.05) of variance in measures of pain (partial r 2 [pr 2 ] = 0.10), psychological disability (pr 2 = 0.20), physical disability (pr 2 = 0.11), and gait velocity at normal (pr 2 = 0.04), fast (pr 2 = 0.04), and intermediate speeds (pr 2 = 0.04). Painrelated fear explained a significant proportion of the variance in measures of psychological disability (pr 2 = 0.07) and walking at a fast speed (pr 2 = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear.

Objective We studied patients’ experiences with oncology providers regarding communication about sexual issues during and after treatment for cancer. Methods During development of the Patient-Reported Outcomes Measurement Information System (PROMIS®) Sexual Function measure, we collected focus group and survey data on communication with oncology professionals about sexual problems. We conducted 16 focus groups with patients and survivors (n = 109) and analyzed the discussions for major themes, including experiences discussing sex during oncology visits. During testing of the PROMIS Sexual Function measure, we assessed experiences discussing sexual problems with oncology professionals (n = 819) and measured bivariate associations between asking for information from clinicians and sexual function and satisfaction with sex life. Results Most patients and survivors (74%) thought discussions with oncology professionals about sexual problems were important, but whether they had ever received information about sexual function from a provider varied by cancer type (23% lung, 29% breast, 39% colorectal, and 79% prostate). Those who had asked an oncology professional about sexual problems had significantly greater interest in sexual activity as well as more sexual dysfunction. Conclusions Sexual problems are a widespread concern among patients and survivors, but there is much variation in experiences of communication about sexual issues and many patients do not receive the information they need from their oncology providers. There are large differences in sexual function between patients who do and do not ask providers about sexual problems. Sexual health has yet to be fully integrated into oncology care, even for cancers involving sex organs.

Introduction Discussions about sexual health are uncommon in clinical encounters, despite the sexual dysfunction associated with many common health conditions. Understanding of the importance of sexual health and sexual satisfaction among US adults is limited. Aim To provide epidemiologic data on the importance of sexual health for quality of life and people’s satisfaction with their sex lives and to examine how each is associated with demographic and health factors. Methods Data are from a cross-sectional, self-report questionnaire from a sample of 3515 English-speaking US adults recruited from an online panel that uses address-based probability sampling. Main Outcome Measures We report ratings of importance of sexual health to quality of life (single item with 5-point response) and the PROMIS® Satisfaction with Sex Life score (5 items, each with 5-point responses, scores centered on the US mean). Results High importance of sexual health to quality of life was reported by 62.2% of men (95% CI, 59.4%–65.0%) and 42.8% of women (95% CI, 39.6%–46.1%; P < .001). Importance of sexual health varied by sex, age, sexual activity status, and general self-rated health. For the 55% of men and 45% of women who reported sexual activity in the previous 30 days, satisfaction with sex life differed by sex, age, race/ethnicity (among men only), and health. Men and women in excellent health had significantly higher satisfaction than participants in fair or poor health. Women with hypertension reported significantly lower satisfaction (especially younger women), as did men with depression or anxiety (especially younger men). Conclusion In this large study of US adults’ ratings of the importance of sexual health and satisfaction with sex life, sexual health was a highly important aspect of quality of life for many participants, including participants in poor health. Moreover, participants in poorer health reported lower sexual satisfaction. Accordingly, sexual health should be a routine part of clinicians’ assessments of their patients. Health care systems that state a commitment to improving patients’ overall health must have resources in place to address sexual concerns. These resources should be available for all patients across the life span.

The authors investigated the relationship between stress at initial cancer diagnosis and treatment and subsequent quality of life (QoL). Women (n = 112) randomized to the assessment-only arm of a clinical trial were initially assessed after breast cancer diagnosis and surgery and then reassessed at 4 months (during adjuvant treatment) and 12 months (postadjuvant treatment). There were 3 types of stress measured: number of stressful life events (K. A. Matthews et al., 1997), cancer-related traumatic stress symptoms (M. J. Horowitz, N. Wilner, & W. Alvarez, 1979), and perceived global stress (S. Cohen, T. Kamarck, & R. Mermelstein, 1983). Using hierarchical multiple regressions, the authors found that stress predicted both psychological and physical QoL (J. E. Ware, K. K. Snow, & M. Kosinski, 2000) at the follow-ups (all ps < .03). These findings substantiate the relationship between initial stress and later QoL and underscore the need for timely psychological intervention. Keywords stress; quality of life; breast cancerThe impact of a breast cancer diagnosis and its treatment on quality of life (QoL) is well documented (e.g., Ganz et al., 1996;Holzner et al., 2001). Shapiro et al. (2001), in their review of the relationship between QoL and psychosocial variables in breast cancer patients, noted that "the biomedical model of disease, though crucial, does not take into account all of the complex factors involved in cancer … a broader, more integrative framework, which includes psychosocial factors, is needed" (p. 502). The biobehavioral model of cancer stress and disease course offers such a framework (see Andersen, Kiecolt-Glaser, & Glaser, 1994, for a complete discussion). In this conceptual model, cancer diagnosis and cancer treatments are defined as objective, negative events. Although negative events do not always produce stress, data from many studies document severe acute stress at cancer diagnosis and treatment (e.g., Andersen, Anderson, & deProsse, 1989;Epping-Jordan et al., 1999;Maunsell, Brisson, & Deschenes, 1992). Even when stress declines from the peak at diagnosis (Edgar, Rosberger, & Nowlis, 1992), many QoL difficulties remain and new ones may arise during treatment and/or recovery (e.g., psychological distress; relationship, social, and occupational disruption; loss of physical stamina and fatigue; financial problems; Bleiker, Pouwer, van der Ploeg, Leer, & Ader, 2000;Ganz et al., 1996;Holzner et al., 2001). The biobehavioral model postulates that higher initial stress levels (i.e., stress at the time of cancer diagnosis and treatment) can, over time, contribute to lower QoL for cancer patients.To examine the hypothesized longitudinal relationship between stress and QoL, we used stress at initial diagnosis and surgical treatment as a predictor of QoL outcomes as patients received additional difficult treatments (i.e., chemotherapy, radiation) and as they recovered (i.e., when treatments ended and medical follow-up began). As the biobehavioral model does not specify or define stress per se, ...