Catherine Mosher
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Supportive Care for Adults with Advanced Cancer and their Family Caregivers
Dr. Catherine Mosher's field of research, Pyscho-Oncology, is the study of the behavioral, psychological, and social aspects of cancer. She is interested in the experiences of both patients and their family caregivers. We know that patients often suffer from a range of debilitating symptoms such as depression, anxiety, pain and fatigue. And family caregivers are often just as distressed, if not more distressed, than the patients themselves.
Dr. Mosher's research aims to address both patients' and family caregivers' concerns by developing and testing new counseling approaches. The approaches are delivered over the telephone and online to have the broadest reach to patients and caregivers throughout the state of Indiana.
Dr. Mosher's goal is to implement and disseminate these counseling interventions into clinical practice for improved outcomes for patients with advanced cancer and their family caregivers is another excellent example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.
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Item Randomised trial of expressive writing for distressed metastatic breast cancer patients(Elsevier, 2012-01-01) Mosher, Catherine E.; DuHamel, Katherine N.; Lam, Joanne; Dickler, Maura; Li, Yuelin; Massie, Mary Jane; Norton, LarryWomen with metastatic breast cancer and significant psychological distress (N = 87) were assigned randomly to engage in four home-based sessions of expressive writing or neutral writing. Women in the expressive writing group wrote about their deepest thoughts and feelings regarding their cancer, whereas women in the neutral writing group wrote about their daily activities in a factual manner. No statistically significant group differences in existential and psychological well-being, fatigue and sleep quality were found at 8-weeks post-writing. However, the expressive writing group reported significantly greater use of mental health services during the study than the neutral writing group (55% vs. 26%, respectively; p < 0.05). Findings suggest that expressive writing may improve the uptake of mental health services among distressed cancer patients, but is not broadly effective as a psychotherapeutic intervention.Item Distressed family caregivers of lung cancer patients: an examination of psychosocial and practical challenges(Springer, 2013-02) Mosher, Catherine E.; Jaynes, Heather A.; Hanna, Nasser; Ostroff, Jamie S.Purpose: Lung cancer and its treatment impose many demands on family caregivers, which may increase their risk for distress. However, little research has documented aspects of the caregiving experience that are especially challenging for distressed caregivers of lung cancer patients. This study aimed to explore caregivers' key challenges in coping with their family member's lung cancer. Methods: Single, semi-structured qualitative interviews were conducted with 21 distressed family caregivers of lung cancer patients. Results: Caregivers described three key challenges in coping with their family member's lung cancer. The most common challenge, identified by 38 % of caregivers, was a profound sense of uncertainty regarding the future as they attempted to understand the patient's prognosis and potential for functional decline. Another key challenge, identified by 33 % of caregivers, involved time-consuming efforts to manage the patient's emotional reactions to the illness. Other caregivers (14 %) characterized practical tasks, such as coordinating the patient's medical care, as their greatest challenge. Conclusions: Results suggest that clinical efforts are needed to assist distressed caregivers in providing practical and emotional support to the patient and attending to their own emotional needs.Item Support Service Use and Interest in Support Services among Distressed Family Caregivers of Lung Cancer Patients(Wiley, 2013-07) Mosher, Catherine E.; Champion, Victoria L.; Hanna, Nasser; Jalal, Shadia I.; Fakiris, Achilles J.; Birdas, Thomas J.; Okereke, Ikenna C.; Kesler, Kenneth A.; Einhorn, Lawrence H.; Given, Barbara A.; Monahan, Patrick O.; Ostroff, Jamie S.Objective: This study examined support service use and interest in support services among distressed family caregivers of patients recently entering comprehensive cancer care facilities. Methods: Primary family caregivers of lung cancer patients (N=83) were recruited from three medical centers within 12 weeks of the patient's new visit to the oncology clinic. All family caregivers were screened for psychological distress, and those reporting significant anxiety or depressive symptoms were eligible for this study. Caregivers completed a baseline assessment of support service use (i.e., use of mental health services and complementary and alternative medicine [CAM]) and interest in support services. Support service use was also assessed 3 months later. Results: Although all caregivers reported clinically meaningful distress, only 26% used mental health and 39% used CAM services during the 3-month study period. Patients' receipt of chemotherapy was positively associated with caregivers' mental health service use, whereas greater education and receiving assistance with caregiving tasks were associated with CAM use. Forty percent of caregivers who did not use CAM at baseline were interested in CAM. In addition, 29% of caregivers who did not receive mental health services at baseline were interested in professional psychosocial support, and 29% of caregivers who did not receive staff assistance with practical needs at baseline were interested in this service. Conclusions: Findings suggest that distressed family caregivers of lung cancer patients underuse mental health services and that a sizable minority are interested in professional help with psychosocial and practical needs.Item Long-term Outcomes of the FRESH START Trial: Exploring the Role of Self-efficacy in Cancer Survivors’ Maintenance of Dietary Practices and Physical Activity(Wiley, 2013-04) Mosher, Catherine E.; Lipkus, Isaac; Sloane, Richard; Snyder, Denise C.; Lobach, David F.; Demark-Wahnefried, WendyBackground: This study examined whether changes in self-efficacy explain the effects of a mailed print intervention on long-term dietary practices of breast and prostate cancer survivors. The relationship between change in self-efficacy and long-term physical activity (PA) also was examined. Methods: Breast and prostate cancer survivors (N = 543) from 39 US states and two Canadian provinces participated in the FRESH START intervention trial. Participants were randomly assigned to receive a 10-month program of mailed print materials on diet and PA available in the public domain or a 10-month program of tailored materials designed to increase fruit and vegetable (F&V) intake, decrease fat intake, and/or increase PA. Changes in self-efficacy for F&V intake and fat restriction were analyzed as potential mediators of the intervention's effects on diet at 2-year follow-up. Because we previously found that change in self-efficacy for PA did not vary by group assignment, the relationship between change in self-efficacy and PA at 2-year follow-up was examined across study conditions. Results: Results suggest that change in self-efficacy for fat restriction partially explained the intervention's effect on fat intake (mean indirect effect = -0.28), and change in self-efficacy for F&V consumption partially explained the intervention's effect on daily F&V intake (mean indirect effect = .11). Change in self-efficacy for fat restriction partially accounted for the intervention's impact on overall diet quality among men only (mean indirect effect = 0.60). Finally, change in self-efficacy for PA predicted PA at 2-year follow-up. Conclusions: Findings suggest that self-efficacy may influence long-term maintenance of healthy lifestyle practices among cancer survivors.Item Social correlates of distress following hematopoietic stem cell transplantation: Exploring the role of loneliness and cognitive processing(SAGE, 2012-10-01) Mosher, Catherine E.; Lepore, Stephen J.; Wu, Lisa; Austin, Jane; Valdimarsdottir, Heiddis; Rowley, Scott; Isola, Luis; Redd, William H.; Rini, ChristineThis study investigated whether loneliness and cognitive processing explain the influence of negative (social constraints) and positive (emotional support) relationship qualities on cancer survivors? distress. Participants were 195 cancer survivors who had undergone hematopoietic stem cell transplantation. Path analysis supported the hypothesis that loneliness and cognitive processing would mediate the association between social constraints and distress. Only loneliness mediated the association between emotional support and distress ? an indirect effect significant only when support came from family and friends rather than a partner. Findings suggest that addressing social constraints may enhance cancer survivors? adjustment.Item Support Service Use and Interest in Support Services among Lung Cancer Patients(Wiley, 2013-10) Mosher, Catherine E.; Champion, Victoria L.; Hanna, Nasser; Jalal, Shadia I.; Fakiris, Achilles J.; Birdas, Thomas J.; Okereke, Ikenna C.; Kesler, Kenneth A.; Einhorn, Lawrence H.; Given, Barbara A.; Monahan, Patrick O.; Ostroff, Jamie S.Objective: This study examined support service use and interest in support services among distressed family caregivers of patients recently entering comprehensive cancer care facilities. Methods: Primary family caregivers of lung cancer patients (N=83) were recruited from three medical centers within 12 weeks of the patient's new visit to the oncology clinic. All family caregivers were screened for psychological distress, and those reporting significant anxiety or depressive symptoms were eligible for this study. Caregivers completed a baseline assessment of support service use (i.e., use of mental health services and complementary and alternative medicine [CAM]) and interest in support services. Support service use was also assessed 3 months later. Results: Although all caregivers reported clinically meaningful distress, only 26% used mental health and 39% used CAM services during the 3-month study period. Patients' receipt of chemotherapy was positively associated with caregivers' mental health service use, whereas greater education and receiving assistance with caregiving tasks were associated with CAM use. Forty percent of caregivers who did not use CAM at baseline were interested in CAM. In addition, 29% of caregivers who did not receive mental health services at baseline were interested in professional psychosocial support, and 29% of caregivers who did not receive staff assistance with practical needs at baseline were interested in this service. Conclusions: Findings suggest that distressed family caregivers of lung cancer patients underuse mental health services and that a sizable minority are interested in professional help with psychosocial and practical needs.Item Economic and Social Changes Among Distressed Family Caregivers of Lung Cancer Patients(Supportive Care in Cancer, 2013-03) Mosher, Catherine E.; Champion, Victoria L.; Azzoli, Christopher G.; Hanna, Nasser; Jalal, Shadia I.; Fakiris, Achilles J.; Birdas, Thomas J.; Okereke, Ikenna C.; Kesler, Kenneth A.; Einhorn, Lawrence H.; Monahan, Patrick O.; Ostroff, Jamie S.Purpose: Although costs of lung cancer care have been documented, economic and social changes among lung cancer patients' family caregivers have yet to be fully examined. In addition, research has not focused on caregivers with greater need for support services. This study examined various economic and social changes among distressed family caregivers of lung cancer patients during the initial months of cancer care in the USA. Methods: Lung cancer patients' primary family caregivers with significant anxiety or depressive symptoms were recruited from three medical centers within 12 weeks of the patient's new oncology visit. Caregivers (N = 83) reported demographic and medical information and caregiving burden at baseline. Seventy-four caregivers reported anxiety and depressive symptoms and economic and social changes 3 months later. Results: Seventy-four percent of distressed caregivers experienced one or more adverse economic or social changes since the patient's illness. Common changes included caregivers' disengagement from most social and leisure activities (56%) and, among employed caregivers (n = 49), reduced hours of work (45%). In 18% of cases, a family member quit work or made another major lifestyle change due to caregiving. Additionally, 28% of caregivers reported losing the main source of family income, and 18% reported losing most or all of the family savings. Loss of the main source of family income and disengagement from most social and leisure activities predicted greater caregiver distress. Conclusions: Findings suggest that distressed caregivers of lung cancer patients experience high rates of adverse economic and social changes that warrant clinical and research attention.Item Living with Metastatic Breast Cancer: A Qualitative Analysis of Physical, Psychological, and Social Sequelae(Wiley, 2013) Mosher, Catherine E.; Johnson, Courtney; Dickler, Maura; Norton, Larry; Massie, Mary Jane; DuHamel, KatherineWomen with metastatic breast cancer face a wide range of medical, practical, and emotional challenges that impact their quality of life. Research to date, however, has not focused on the quality-of-life concerns of metastatic breast cancer patients with significant distress. The present study examined a range of concerns among distressed metastatic breast cancer patients, including physical and emotional distress, social functioning, and existential issues. Forty-four distressed women with metastatic breast cancer wrote their deepest thoughts and feelings regarding their illness. These essays were thematically analyzed for effects of the illness on quality of life. Three themes were identified in patients’ essays. First, metastatic breast cancer and its treatment may result in a number of quality-of-life concerns, including physical symptom burden, emotional distress, body image disturbance, and disrupted daily activities. Second, social constraints on disclosure of cancer-related concerns may exacerbate patients’ distress. Third, many women experience a heightened awareness of life’s brevity and search for meaning in their cancer experience. Results highlight a range of quality-of-life concerns following a metastatic breast cancer diagnosis and suggest that addressing social constraints on cancer-related disclosure and the search for meaning may improve patients’ psychological adjustment.Item Addiction to indoor tanning: Relation to anxiety, depression, and substance use(AMA, 2010-04-01) Mosher, Catherine E.; Danoff-Burg, SharonTo assess the prevalence of addiction to indoor tanning among college students and its association with substance use and symptoms of anxiety and depression.Two written measures, the CAGE (Cut down, Annoyed, Guilty, Eye-opener) Questionnaire, used to screen for alcoholism, and the Diagnostic and Statistical Manual of Mental Disorders(Fourth Edition, Text Revision) (DSM-IV-TR) criteria for substance-related disorders, were modified to evaluate study participants for addiction to indoor tanning. Standardized self-report measures of anxiety, depression, and substance use also were administered.A large university (approximately 18 000 students) in the northeastern United States.A total of 421 college students were recruited from September through December 2006.Self-reported addiction to indoor tanning, substance use, and symptoms of anxiety and depression.Among 229 study participants who had used indoor tanning facilities, 90 (39.3%) met DSM-IV-TR criteria and 70 (30.6%) met CAGE criteria for addiction to indoor tanning. Students who met DSM-IV-TR and CAGE criteria for addiction to indoor tanning reported greater symptoms of anxiety and greater use of alcohol, marijuana, and other substances than those who did not meet these criteria. Depressive symptoms did not significantly vary by indoor tanning addiction status.Findings suggest that interventions to reduce skin cancer risk should address the addictive qualities of indoor tanning for a minority of individuals and the relationship of this behavior to other addictions and affective disturbance.Item Long-Term Dietary Outcomes of the FRESH START Intervention for Breast and Prostate Cancer Survivors(Elsevier, 2011) Christy, Shannon M.; Mosher, Catherine E.; Sloane, Richard; Snyder, Denise C.; Lobach, David F.; Demark-Wahnefried, WendyBackground Cancer survivors are at increased risk for secondary cancers and other diseases. Healthy dietary practices may improve cancer survivors' health and well-being. Objective The durability of the effects of the FRESH START intervention, a program of sequentially tailored mailed materials, and standardized mailed materials (for controls) on cancer survivors' dietary outcomes was assessed over a 2-year period. Greater dietary gains were expected for FRESH START participants relative to controls. Design Participants were randomized to receive tailored vs standardized 10-month mailed print interventions promoting diet and exercise behaviors. Data were collected at baseline and 1- and 2-year follow-ups. Participants/setting Breast and prostate cancer survivors (n=543) were recruited from 39 states and two provinces within North America. A total of 489 participants completed the 2-year follow-up assessment (10% attrition). Intervention Participants were randomly assigned to either a 10-month program of tailored mailed print materials promoting fruit and vegetable consumption, reduced total and saturated fat intake, and/or increased exercise or to a 10-month program of publicly available mailed materials on diet and exercise. Main outcome measures Telephone surveys (supported with blood biomarkers) assessed dietary habits at baseline and 1- and 2-year follow-ups. Statistical analyses performed Paired-samples t tests were conducted to examine the durability of the intervention's effects on dietary outcomes within each study arm. Arm differences in follow-up outcomes were then tested with the general linear model, controlling for the baseline value of the outcomes. Results Both arms reported decreased saturated fat intake, increased servings of fruits and vegetables, and better overall diet quality at year 2 relative to baseline. However, FRESH START participants reported better overall diet quality and lower total and saturated fat intake compared to controls at the 2-year follow-up. Conclusions Results suggest that mailed material interventions, especially those that are tailored, can produce long-term dietary improvement among cancer survivors.