Andrea Cohee

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https://hdl.handle.net/1805/26638

Caring for the Carers: The Psychosocial Impact of Breast Cancer on Partners

Andrea Cohee is an Assistant Professor in the IUPUI School of Nursing. Her program of research focuses on psychosocial outcomes in survivors and their partners following a breast cancer diagnosis. Her work examines the relationship between social constraints, cognitive processing, and fear of recurrence and depression in both breast cancer survivors and their partners. She is currently building on her previous research to develop interventions targeting fear of a cancer recurrence in survivors and their partners. Her long-term goal is to develop interventions for cancer survivors and their partners to improve quality of life outcomes that can be implemented into the clinical setting.

Professor Cohee's translation of research into practical interventions for breast cancer survivors and their partners to improve quality of life is another excellent example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.

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Now showing 1 - 10 of 25

Symptom Treatment Preferences of Cancer Survivors: Does Fatigue Level Make a Difference?
(LWW, 2021) Krueger, Ellen; Secinti, Ekin; Mosher, Catherine E.; Stutz, Patrick V.; Cohee, Andrea A.; Johns, Shelley A.
Background Cancer-related fatigue (CRF) is among the most prevalent symptoms in cancer survivors and often co-occurs with other symptoms. However, little is known about survivors' preferences for treating CRF and associated symptoms. Objective The aim of this study was to examine cancer survivors' interest in learning skills to manage CRF and associated symptoms and their interest in various nonpharmacologic interventions and modalities. These outcomes were compared between survivors with high and normal fatigue. Methods Breast, gastrointestinal, lung, and prostate cancer survivors (N = 338) completed a 1-time survey, including a Patient-Reported Outcomes Measurement Information System fatigue measure and a checklist assessing interest in learning skills to manage CRF and associated symptoms as well as interest in nonpharmacologic interventions and modalities. Results Many cancer survivors reported interest in learning skills to manage CRF (range, 35%-78%) and associated symptoms (range, 13%-48%). Compared with survivors with normal fatigue (n = 180), highly fatigued survivors (n = 158; Patient-Reported Outcomes Measurement Information System fatigue T score ≥ 55) were more likely to report interest in learning skills to manage various symptoms, self-compassion training, and programs offered individually and in person. Interest in other interventions and modalities did not vary by fatigue level. Conclusions Many cancer survivors, especially those with high fatigue, report interest in learning symptom management skills. Given survivors' high level of interest in complementary and integrative health interventions, future research should continue to assess their impact on symptoms and functioning.
Genitourinary Symptoms in Breast Cancer Survivors: Prevalence, Correlates, and Relationship With Sexual Functioning
(ONS, 2021) Sheng, Ying; Carpenter, Janet S.; Cohee, Andrea A.; Storey, Susan; Stump, Timothy E.; Monahan, Patrick O.; Cella, David; Champion, Victoria L.
Objectives To evaluate (a) the prevalence of genitourinary symptoms, (b) which demographic and clinical factors predict genitourinary symptoms, and (c) the association between genitourinary symptoms and sexual functioning in breast cancer survivors. Sample & setting A secondary analysis of cross-sectional, patient-reported outcomes data from 1,085 breast cancer survivors was conducted. Methods & variables Prevalence and correlations with demographics, clinical factors, and sexual functioning were identified using descriptive analysis, multivariable logistic regression analysis, chi-square tests, t tests, and Pearson correlation coefficients. Results Symptoms included vaginal/vulvar irritation, pelvic discomfort, problems with urinary control, vaginal infection, and vaginal bleeding. Younger age, more comorbidities, and taking treatment for menopausal symptoms were significantly related to reporting genitourinary symptoms. Experiencing more symptoms was associated with lower sexual functioning. Implications for nursing The prevalence, correlates, and relationship of genitourinary symptoms with sexual functioning supports the assessment and treatment of these symptoms as part of routine care for breast cancer survivors.
Breast Cancer Survivors' Perceptions of Partners' Intervention Needs
(2018) Cohee, Andrea A.; Johns, Shelley A.
Breast cancer survivors and their partners report similar levels of fear of recurrence; however, partners are rarely the subject of intervention. Survivors' perceptions for partners' interests and barriers in a survivorship education intervention are discussed.
A Multisite Health System Survey to Assess Organizational Context to Support Evidence-Based Practice
(Wiley, 2019) Pittman, Joyce; Cohee, Andrea; Storey, Susan; LaMothe, Julie; Gilbert, Jason; Bakoyannis, Giorgos; Ofner, Susan; Newhouse, Robin
Background Implementation and sustainability of a culture of evidence-based practice (EBP) require a systematic approach. A baseline assessment of the organizational context can inform implementation efforts. Aims To examine organizational hospital context and provider characteristics associated with EBP readiness and to describe EBP context across hospitals. Methods A nonexperimental descriptive correlational design was used to conduct a web-based survey of direct-care registered nurses (N = 701) and nurse managers (N = 94) across a large Midwestern multisite healthcare system using the Alberta Context Tool (ACT). Results Many significant relationships existed among nurse characteristics and ACT domains, including age (lower age had higher Leadership, Evaluation, and Formal Interactions), education (graduate education had lower Social Capital than a bachelor's or associate degree), role (direct-care nurses had lower Culture than managers and lower Social Capital), and work status (full-time employees had lower Evaluation and Social Capital). EBP context across type of hospitals is similar, with marginal differences in Social Capital and Organizational Slack (higher in critical access hospitals). Linking Evidence to Action Assessing organizational context to support EBP is the first step in developing and enhancing a sustainable culture of inquiry. The ACT has been tested across countries, settings, and healthcare disciplines to measure perception of readiness of the practice environment toward EBP. Optimal organizational context is essential to support EBP and sustain the use of evidence in professional nursing practice. Nursing leaders can use baseline assessment information to identify strengths and opportunities to enhance EBP implementation. Enhancing organizational context across nurse characteristics (e.g., age, role, and work status) to acknowledge nurses’ contributions, balance nurses’ personal and work life, enhance connectedness, and support work culture is beneficial. Fostering development of Social Capital in nurses is needed to influence EBP readiness. A systematic and standardized approach to foster EBP across health systems is key to successful implementation.
4024 Theory and Scale Development for Cancer-Related Self-Efficacy in Partners of Breast Cancer Survivors
(2020) Cohee, Andrea; Draucker, Claire; Monahan, Patrick; Champion, Victoria
OBJECTIVES/GOALS: Specific aims are to: (Qualitative aim) Develop a new measure of cancer-related self-efficacy in partners (BCSES-P) and obtain feedback on the items (Quantitative) Evaluate the psychometric properties of the BCSES-P including: dimensionality, factor analysis, and construct validity assessing the relationships posited METHODS/STUDY POPULATION: 2- Phase Approach: 1) Item development and 1) Item testing Phase 1 Stage 1: Literature review to identify additional covariates Stage 2: Focus groups and individual interviews to determine partners’ needs Sample size: 20 partners (18 years of age or older, identifying as being in a committed relationship with a BCS) Design: cross-sectional, qualitative interviews Stage 3: Develop candidate items Stage 4: Cognitive interviews Stage 5: Finalize items with research team Phase 2 Preliminary psychometric testing Dimensionality Internal consistency reliability Construct validity Sample size: 150 partners Design: cross-sectional, online survey RESULTS/ANTICIPATED RESULTS: The BCSES-P will be unidimensional as assessed by exploratory factor analysis. The BCSES-P will demonstrate an internal consistency coefficient of 0.70 or above. Construct validity of the BCSES-P will be demonstrated by support of the following theoretical relationships: Cancer-related self-efficacy will be positively related to marital satisfaction and sexual functioning (social well- being) and the distal outcome, overall QoL. Cancer-related self-efficacy will be negatively related to fatigue (physical well-being), fear of recurrence, depression, and anxiety (psychological well-being). DISCUSSION/SIGNIFICANCE OF IMPACT: Findings will guide intervention development to improve partners’ quality of life The BCSES-P will be the first scale to measure partners’ cancer-related self-efficacy. This study will highlight a holistic approach to studying the long-term effects of breast cancer on partners.
Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3-arm pilot randomized controlled trial
(Wiley, 2020) Johns, Shelley A.; Stutz, Patrick V.; Talib, Tasneem; Cohee, Andrea A.; Beck-Coon, Kathleen A.; Brown, Linda F.; Wilhelm, Laura R.; Monaham, Patrick O.; LaPradd, Michelle L.; Champion, Victoria L.; Miller, Kathy D.; Giesler, R. Brian
Background Fear of cancer recurrence (FCR) has a profound negative impact on quality of life (QOL) for many cancer survivors. Breast cancer survivors (BCS) are particularly vulnerable, with up to 70% reporting clinically significant FCR. To the authors' knowledge, evidence-based interventions for managing FCR are limited. Acceptance and commitment therapy (ACT) promotes psychological flexibility in managing life's stressors. The current study examined the feasibility and preliminary efficacy of group-based ACT for FCR in BCS. Methods Post-treatment BCS (91 patients with stage I-III disease) with clinical FCR randomly were assigned to ACT (6 weekly 2-hour group sessions), survivorship education (SE; 6 weekly 2-hour group sessions), or enhanced usual care (EUC; one 30-minute group coaching session with survivorship readings). FCR severity (primary outcome) and avoidant coping, anxiety, post-traumatic stress, depression, QOL, and other FCR-related variables (secondary outcomes) were assessed at baseline (T1), after the intervention (T2), 1 month after the intervention (T3), and 6 months after the intervention (T4) using intent-to-treat analysis. Results Satisfactory recruitment (43.8%) and retention (94.5%) rates demonstrated feasibility. Although each arm demonstrated within-group reductions in FCR severity over time, only ACT produced significant reductions at each time point compared with baseline, with between-group differences at T4 substantially favoring ACT over SE (Cohen d for effect sizes, 0.80; P < .001) and EUC (Cohen d, 0.61; P < .01). For 10 of 12 secondary outcomes, only ACT produced significant within-group reductions across all time points. By T4, significant moderate to large between-group comparisons favored ACT over SE and EUC with regard to avoidant coping, anxiety, depression, QOL, and FCR-related psychological distress. Conclusions Group-based ACT is a feasible and promising treatment for FCR and associated outcomes in BCS that warrants testing in larger, fully powered trials.
The impact of fear of cancer recurrence on healthcare utilization among long-term breast cancer survivors recruited through ECOG-ACRIN trials
(Wiley, 2021) Vachon, Eric; Krueger, Ellen; Champion, Victoria L.; Haggstrom, David A.; Cella, David; Cohee, Andrea A.
Objective To examine the relationship between fear of cancer recurrence (FCR) and healthcare utilization among long-term breast cancer survivors (BCS). Methods In a cross-sectional survey study, 505 younger survivors (YS: ≤45 years) and 622 older survivors (OS: 55–70 years) 3–8 years from diagnosis completed a questionnaire assessing demographics, medical history, FCR, and healthcare utilization. Healthcare utilization consisted of breast cancer (BC) and non-BC-related routine and nonroutine utilization. Results YS had significantly higher FCR than OS (p < 0.01). Independent of age, FCR was significantly associated with all three types of BC-related utilization (p < 0.05). In the multivariate models, we found a significant, positive interaction effect between FCR and increased comorbidities on nonroutine BC appointments (p = 0.01) and BC-related emergency room visits (p = 0.03). Additionally, comorbidities were associated with non-BC-related utilization (p < 0.01), and nonwhites were more likely to utilize nonroutine resources, both BC and non-BC-related (p < 0.01). Conclusions Increased FCR has been associated with hypervigilance among survivors and may lead to increased healthcare utilization. YS are at higher risk for increased FCR and psychosocial concerns, which may lead to overutilization. Providers should be aware that higher FCR may be related to increased use of healthcare resources and that these patients might be better served with supportive resources to increase quality of life and decrease inappropriate utilization. While this study provides increased evidence of the relationship between FCR and healthcare utilization, interventions are needed for survivors at risk to address unmet needs, especially as life expectancy increases among BCS.
Predictors of depression outcomes in adults with cancer: A 12 month longitudinal study
(Elsevier, 2020) Cohee, Andrea A.; Kroenke, Kurt; Vachon, Eric; Wu, Jingwei; Tu, Wanzhu; Johns, Shelley A.
The prevalence of depression in patients with cancer ranges from 8% to 24% within the first year of receiving a cancer diagnosis. Identifying predictors of depression outcomes may facilitate tailored or more intensive treatment in patient subgroups with a poorer prognosis for depression improvement. The objective of this study was to determine predictors of depression severity and improvement over 12 months among adults with cancer. Methods Longitudinal analysis of data from the Indiana Cancer Pain and Depression trial was performed in 309 patients (n = 309) with cancer-related depression. Depression outcomes were assessed at baseline, 1, 3, 6, and 12 months and included depression severity (Hopkins Symptom Checklist-20) and global improvement (Depression Global Rating of Improvement (DGRI)). Multivariable repeated measures analyses, adjusting for treatment group, baseline depression, and time point, were conducted to determine symptom (pain), demographic, and clinical predictors of depression outcomes over 12 months. Results Pain was particularly important, with a clinically meaningful reduction in pain predicting a 12–24% greater odds of depression global improvement. Other factors that independently predicted better depression outcomes over 12 months included female sex, newly-diagnosed or maintainence/disease-free cancer, fewer comorbid medical conditions, and higher socioeconomic status. As expected, the three covariates adjusted for in the model (treatment group, passage of time, and baseline depression severity) also predicted depression outcomes. Conclusion Pain as well as several demographic and clinical factors predict depression outcomes over 12 months. These findings may help identify patient subgroups requiring closer monitoring and more intensive or tailored depression treatment.
Association of cognitive impairment and breast cancer survivorship on quality of life in younger breast cancer survivors
(Springer, 2021) Von Ah, Diane; Crouch, Adele D.; Monahan, Patrick O.; Stump, Timothy E; Unverzagt, Frederick W.; Storey, Susan; Cohee, Andrea A.; Cella, David; Champion, Victoria L.
Purpose Younger breast cancer survivors (BCS) often report cognitive impairment and poor quality of life (QoL), which could be interrelated. The purpose of this study was to examine the association of cognitive impairment and breast cancer status (BCS versus healthy control (HC)), with QoL, which included psychological (depressive symptoms, well-being, perceived stress, and personal growth) and physical well-being (physical functioning and fatigue). Methods Four hundred ninety-eight BCS (≤45 years at diagnosis) who were 3 to 8 years post-chemotherapy treatment and 394 HC completed subjective questionnaires and a one-time neuropsychological assessment, including tests of attention, memory, processing speed, and verbal fluency. For each test, cognitive impairment was defined as scoring 1.5 and 2.0 standard deviations below the mean of the HC group. Separate linear regression models for each outcome were ran controlling for known covariates. Results BCS reported significantly more memory problems than HC (p < 0.0001), with up to 23% having significant impairment. Cognitive performance did not differ significantly between BCS and HCs. BCS vs. HCs had greater depression and fatigue, yet more personal growth. Objective and subjective cognitive impairment were significantly related to greater depressive symptoms and perceived stress and lower well-being and physical functioning; whereas, objective impairment was related to less personal growth and subjective impairment was related to greater fatigue. Conclusions Younger BCS report significant cognitive impairment years after treatment which may relate to greater decrements in QoL.
Psychometric development of a new body image scale for breast cancer survivors
(Health care for women international, 2020) Biederman, Erika; Cohee, Andrea; Monahan, Patrick; Stump, Timothy; Champion, Victoria
The purpose of this study was to psychometrically test a body image scale for breast cancer survivors (BCS). Data (n = 1127 BCSs) were obtained via telephone and mailed questionnaires. Psychometric testing was conducted using Cronbach’s alpha, item-total correlations, factor analysis, linear regression, and Pearson’s correlations. Data demonstrated a unidimensional seven-item scale with Cronbach’s alpha = 0.88 and item-total correlations ranging from 0.367 to 0.829. Construct validity was demonstrated with 48% of the variance in well-being explained by constructs in the conceptual model [F(14,784) = 48.35, p < .001]. The body image scale demonstrated high internal consistency reliability, unidimensionality, and construct validity.

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