Clinical Focus

  • Psychology

Academic Appointments

Administrative Appointments

  • Stanford Cancer Survivorship Research Director, Stanford Cancer Center (2010 - Present)

Honors & Awards

  • Outstanding Doctor of Philosophy in Clinical Psychology Award, CSPP-San Diego (2002)
  • ASCO Merit Award, American Society of Clinical Oncology (ASCO) (2008)
  • Young Investigator Award, Multinational Association of Supportive Care in Cancer (MASCC) (2009, 2008)
  • Honorable Mention Poster Award, American Society of Preventive Oncology (ASPO) (2009)
  • National Institutes of Health Summer Distinguished Fellow Award, NIH (2009)
  • Socioeconomic Status Related Cancer Disparities Behavior and Social Science Volunteer Awardee, APA, Washington, DC (2012)

Professional Education

  • California School of Professional Psychology (2005) CA
  • Internship:Sharp Mesa Vista Hospital Psychology Training (2002) CA
  • PhD, California School of Professional Psychology, Clinical Psychology (2002)
  • Fellowship, Stanford University, Stress and Psychooncology (2006)
  • NCI Fellowship, University of Rochester, Cancer Control (2009)
  • MPH, University of Rochester, Clinical Investigation (2009)

Community and International Work

  • Socieconomic Status Related Cancer Disparities (SESRCD)


    Cancer Disparities Program

    Partnering Organization(s)

    American Psychological Association



    Ongoing Project


    Opportunities for Student Involvement


Research & Scholarship

Current Research and Scholarly Interests

My research is in the area of cancer control. I am primarily interested in investigating the impact of cancer treatments on sleep, fatigue and quality of life. My current projects include investigating the impact of behavioral and pharmacological interventions on improving sleep, fatigue and quality of life in cancer patients and survivors. I am also investigating the relationship between dysregulation of the neuroendocrine stress response system, sleep problems, fatigue, and disease progression in cancer patients with primary and metastatic cancers.

Clinical Trials

  • Assessment of Patient Experience During Treatment for Cancer Recruiting

    Assessing the mindset of cancer patients will help us better understand which patients are having difficulty dealing with the diagnosis and treatment that may not otherwise be fully appreciated by their physicians. By identifying such patients, we may then be able to design and implement strategies that can help improve their coping skills both during the treatment as well as after the completion of treatment. In addition to addressing physical concerns and symptoms, this approach will help address the overall emotional impact of a cancer diagnosis as more patients are living as cancer survivors.

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  • Brief Behavioral Therapy in Improving Sleep Disorders in Patients With Stage I-III Breast Cancer Undergoing Chemotherapy Recruiting

    This randomized phase II trial studies how well brief behavioral therapy works in improving sleep disorders in patients with stage I-III breast cancer undergoing chemotherapy. Sleep disorder counseling may reduce fatigue and insomnia as well as improve the well-being and quality of life in patients with breast cancer who are undergoing chemotherapy.

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  • Acupuncture for Sleep Disruption in Cancer Survivors Not Recruiting

    The proposed study will recruit 60 women with breast cancer who finished undergoing treatment who complain of persistent insomnia problems that began with onset of their cancer diagnosis. The eligible women would be randomized and stratified by sleep problems to two arms: (Acupuncture Arm vs. Sham Acupuncture) with a goal of having 48 patients complete the study (we anticipate about 20% attrition rate). The study interventions will begin after patients completed their treatment. The placebo control for acupuncture will be a validated sham acupuncture control Assessments will be made with daily diaries and with weekly questionnaires. PSG data will be collected on the subsample of the population. Data will be gathered via pencil-and-paper measures before, during, immediately following, one month following the completion of treatment and six months after the conclusion of treatment. In addition, actigraphy data (objective sleep continuity data) will be acquired prior to and following treatment

    Stanford is currently not accepting patients for this trial. For more information, please contact David Spiegel, (650) 723 - 6421.

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  • Brief Behavioral Intervention for Insomnia During Chemotherapy Recruiting

    PRIMARY OBJECTIVE(S): The purpose of this study is to test the efficacy of brief behavioral therapy versus control condition that accounts for time and attention (nutrition education) in the treatment of insomnia in humans. SECONDARY OBJECTIVE(S): To assess the impact of different biomarkers on sleep disruption and other patient reported outcomes

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  • Management of Insomnia in Breast Cancer Patients Not Recruiting

    Primary Objective: 1. To provide preliminary data on the effects of armodafinil and Brief Behavioral Therapy for Insomnia (BBT-I) (alone or in combination) on insomnia in breast cancer patients receiving chemotherapy. Secondary Objectives: 1. To provide preliminary data on the influence of armodafinil and BBT-I (alone or in combination) on cancer-related fatigue (CRF) in breast cancer patients receiving chemotherapy. 2. To provide preliminary data on the influence of armodafinil and BBT-I (alone or in combination) on QOL in breast cancer patients receiving chemotherapy. 3. To provide preliminary data on influence of armodafinil and BBT-I (alone or in combination) on endocrine and inflammatory physiological markers (measured by cortisol and inflammatory cytokines markers)

    Stanford is currently not accepting patients for this trial. For more information, please contact Oxana Palesh, PhD, MPH, 650-725-7011.

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  • Intellectual Impairment in Women With Breast Cancer Not Recruiting

    RATIONALE: Breast cancer and its treatment may cause changes in a patient's ability to think, learn, and remember. Gathering information about a woman's genes, brain function, and personal history may help doctors learn more about the disease and plan the best treatment. PURPOSE: 1. To determine changes in brain function that occur following breast cancer chemotherapy. 2. To gain further understanding of the individual differences in brain function changes and recovery based on demographic, medical and treatment variables.

    Stanford is currently not accepting patients for this trial. For more information, please contact Shelli Kesler, PhD, 650-723-0058.

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  • Phase II Early Behavioral Intervention in BMT w/ Sleep Disturbance-Assess QOL+Fatigue+Cognitive f(x) Not Recruiting

    This pilot clinical trial studies early brief behavioral intervention in treating sleep disturbance and improving quality of life in patients undergoing bone marrow transplant (BMT). A brief behavioral intervention may reduce symptoms of insomnia and fatigue and improve quality of life and cognitive function in patients undergoing BMT

    Stanford is currently not accepting patients for this trial. For more information, please contact Oxana Palesh, 650-725-7011.

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2017-18 Courses

Stanford Advisees


All Publications

  • Disrupted brain network functional dynamics and hyper-correlation of structural and functional connectome topology in patients with breast cancer prior to treatment BRAIN AND BEHAVIOR Kesler, S. R., Adams, M., Packer, M., Rao, V., Henneghan, A. M., Blayney, D. W., Palesh, O. 2017; 7 (3)


    Several previous studies have demonstrated that cancer chemotherapy is associated with brain injury and cognitive dysfunction. However, evidence suggests that cancer pathogenesis alone may play a role, even in non-CNS cancers.Using a multimodal neuroimaging approach, we measured structural and functional connectome topology as well as functional network dynamics in newly diagnosed patients with breast cancer. Our study involved a novel, pretreatment assessment that occurred prior to the initiation of any cancer therapies, including surgery with anesthesia. We enrolled 74 patients with breast cancer age 29-65 and 50 frequency-matched healthy female controls who underwent anatomic and resting-state functional MRI as well as cognitive testing.Compared to controls, patients with breast cancer demonstrated significantly lower functional network dynamics (p = .046) and cognitive functioning (p < .02, corrected). The breast cancer group also showed subtle alterations in structural local clustering and functional local clustering (p < .05, uncorrected) as well as significantly increased correlation between structural global clustering and functional global clustering compared to controls (p = .03). This hyper-correlation between structural and functional topologies was significantly associated with cognitive dysfunction (p = .005).Our findings could not be accounted for by psychological distress and suggest that non-CNS cancer may directly and/or indirectly affect the brain via mechanisms such as tumor-induced neurogenesis, inflammation, and/or vascular changes, for example. Our results also have broader implications concerning the importance of the balance between structural and functional connectome properties as a potential biomarker of general neurologic deficit.

    View details for DOI 10.1002/brb3.643

    View details for Web of Science ID 000397564200014

    View details for PubMedID 28293478

  • Aberrant nocturnal cortisol and disease progression in women with breast cancer BREAST CANCER RESEARCH AND TREATMENT Zeitzer, J. M., Nouriani, B., Rissling, M. B., Sledge, G. W., Kaplan, K. A., Aasly, L., Palesh, O., Jo, B., Neri, E., Dhabhar, F. S., Spiegel, D. 2016; 158 (1): 43-50


    While a relationship between disruption of circadian rhythms and the progression of cancer has been hypothesized in field and epidemiologic studies, it has never been unequivocally demonstrated. We determined the circadian rhythm of cortisol and sleep in women with advanced breast cancer (ABC) under the conditions necessary to allow for the precise measurement of these variables. Women with ABC (n = 97) and age-matched controls (n = 24) took part in a 24-h intensive physiological monitoring study involving polysomnographic sleep measures and high-density plasma sampling. Sleep was scored using both standard clinical metrics and power spectral analysis. Three-harmonic regression analysis and functional data analysis were used to assess the 24-h and sleep-associated patterns of plasma cortisol, respectively. The circadian pattern of plasma cortisol as described by its timing, timing relative to sleep, or amplitude was indistinguishable between women with ABC and age-matched controls (p's > 0.11, t-tests). There was, however, an aberrant spike of cortisol during the sleep of a subset of women, during which there was an eightfold increase in the amount of objectively measured wake time (p < 0.004, Wilcoxon Signed-Rank). This cortisol aberration was associated with cancer progression such that the larger the aberration, the shorter the disease-free interval (time from initial diagnosis to metastasis; r = -0.30, p = 0.004; linear regression). The same aberrant spike was present in a similar percent of women without ABC and associated with concomitant sleep disruption. A greater understanding of this sleep-related cortisol abnormality, possibly a vulnerability trait, is likely important in our understanding of individual variation in the progression of cancer.

    View details for DOI 10.1007/s10549-016-3864-2

    View details for Web of Science ID 000379494200005

    View details for PubMedID 27314577

    View details for PubMedCentralID PMC4938753

  • The effect of melatonin on sleep and quality of life in patients with advanced breast cancer. Supportive care in cancer Innominato, P. F., Lim, A. S., Palesh, O., Clemons, M., Trudeau, M., Eisen, A., Wang, C., Kiss, A., Pritchard, K. I., Bjarnason, G. A. 2016; 24 (3): 1097-1105


    Fatigue and sleep problems are prevalent in cancer patients and can be associated with disruption of circadian rhythmicity. In this prospective phase II trial, we sought to assess the effect of melatonin on circadian biomarkers, sleep, and quality of life in breast cancer patients.Thirty-two patients with metastatic breast cancer, receiving hormonal or trastuzumab therapy, took 5 mg of melatonin at bedtime for 2 months. Before starting and after 2 months on melatonin therapy, sleep and circadian rhythmicity were assessed by actigraphy, diurnal patterns of serum cortisol, and the expression of the core clock genes PER2 and BMAL1 in peripheral blood mononuclear cells. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire was completed for subjective parameters.Bedtime melatonin was associated with a significant improvement in a marker of objective sleep quality, sleep fragmentation and quantity, subjective sleep, fatigue severity, global quality of life, and social and cognitive functioning scales. Morning clock gene expression was increased following bedtime melatonin intake. Melatonin did not affect actigraphy measure of circadian rhythmicity, or the diurnal cortisol pattern.These results invite further investigation of melatonin as a potentially useful therapeutic agent for improving sleep and quality of life in cancer patients.

    View details for DOI 10.1007/s00520-015-2883-6

    View details for PubMedID 26260726

  • Modafinil Moderates the Relationship Between Cancer-Related Fatigue and Depression in 541 Patients Receiving Chemotherapy JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY Conley, C. C., Kamen, C. S., Heckler, C. E., Janelsins, M. C., Morrow, G. R., Peppone, L. J., Scalzo, A. J., Gross, H., Dakhil, S., Mustian, K. M., Palesh, O. G. 2016; 36 (1): 82-85
  • 2015 Palliative Care in Oncology Symposium (October 9-10, 2015) Abstracts JOURNAL OF CLINICAL ONCOLOGY Innominato, P. F., Palesh, O., Bjarnason, G. A., Ulusakarya, A., Spiegel, D., Levi, F. 2015; 33 (29)
  • Erratum to: The biology of cancer-related fatigue: a review of the literature. Supportive care in cancer Saligan, L. N., Olson, K., Filler, K., Larkin, D., Cramp, F., Yennurajalingam, S., Escalante, C. P., Del Giglio, A., Kober, K. M., Kamath, J., Palesh, O., Mustian, K. 2015; 23 (9): 2853-?

    View details for DOI 10.1007/s00520-015-2815-5

    View details for PubMedID 26081598

  • Sexuality, Menopausal Symptoms, and Quality of Life in Premenopausal Women in the First Year Following Hematopoietic Cell Transplantation ONCOLOGY NURSING FORUM Tierney, D. K., Palesh, O., Johnston, L. 2015; 42 (5): 488-497


    To describe sexuality, menopausal symptoms, and quality of life (QOL) in premenopausal women in the first year following hematopoietic cell transplantation (HCT). .One-year prospective longitudinal study..Stanford University Medical Center in California..63 premenopausal female recipients of HCT with a mean age of 34.5 years..Three instruments were used.Sexuality, menopausal symptoms, and QOL..At one year post-HCT, women reported absent to low desire and arousal, adequate lubrication less than half of the time, absent or rare orgasm, pain during vaginal penetration more than half the time, and dissatisfaction with overall sex life. Women also reported moderate to severe vasomotor symptoms, including hot flashes, night sweats, and sweating. Twenty-one women were avoiding sexual activity, and 25 women were not sexually active. Mean QOL scores significantly increased (p = 0.028) in the first year, signifying an improvement in QOL. Variables predictive of improved QOL at one year post-HCT include decreased psychosocial and physical symptoms, sexual satisfaction, and pre-HCT QOL score..One year post-HCT, women reported sexual dysfunction, sexual dissatisfaction, and menopausal symptoms, which negatively affect QOL. .Nurses and other healthcare providers working with recipients of HCT can provide anticipatory guidance on potential changes in sexuality and menopausal symptoms to facilitate adaptation by reducing discordance between expectations and new realities. .

    View details for DOI 10.1188/15.ONF.488-497

    View details for Web of Science ID 000363892900010

    View details for PubMedID 26302277

  • The biology of cancer-related fatigue: a review of the literature SUPPORTIVE CARE IN CANCER Saligan, L. N., Olson, K., Filler, K., Larkin, D., Cramp, F., Sriram, Y., Escalante, C. P., Del Giglio, A., Kober, K. M., Kamath, J., Palesh, O., Mustian, K. 2015; 23 (8): 2461-2478


    Understanding the etiology of cancer-related fatigue (CRF) is critical to identify targets to develop therapies to reduce CRF burden. The goal of this systematic review was to expand on the initial work by the National Cancer Institute CRF Working Group to understand the state of the science related to the biology of CRF and, specifically, to evaluate studies that examined the relationships between biomarkers and CRF and to develop an etiologic model of CRF to guide researchers on pathways to explore or therapeutic targets to investigate.This review was completed by the Multinational Association of Supportive Care in Cancer Fatigue Study Group-Biomarker Working Group. The initial search used three terms (biomarkers, fatigue, cancer), which yielded 11,129 articles. After removing duplicates, 9145 articles remained. Titles were assessed for the keywords "cancer" and "fatigue" resulting in 3811 articles. Articles published before 2010 and those with samples <50 were excluded, leaving 75 articles for full-text review. Of the 75 articles, 28 were further excluded for not investigating the associations of biomarkers and CRF.Of the 47 articles reviewed, 25 were cross-sectional and 22 were longitudinal studies. More than half (about 70 %) were published recently (2010-2013). Almost half (45 %) enrolled breast cancer participants. The majority of studies assessed fatigue using self-report questionnaires, and only two studies used clinical parameters to measure fatigue.The findings from this review suggest that CRF is linked to immune/inflammatory, metabolic, neuroendocrine, and genetic biomarkers. We also identified gaps in knowledge and made recommendations for future research.

    View details for DOI 10.1007/s00520-015-2763-0

    View details for Web of Science ID 000356968100033

    View details for PubMedID 25975676

  • Cancer-Related Fatigue, Version 2.2015 JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Berger, A. M., Mooney, K., Alvarez-Perez, A., Breitbart, W. S., Carpenter, K. M., Cella, D., Cleeland, C., Dotan, E., Eisenberger, M. A., Escalante, C. P., Jacobsen, P. B., Jankowski, C., Leblanc, T., Ligibel, J. A., Loggers, E. T., Mandrell, B., Murphy, B. A., Palesh, O., Pirl, W. F., Plaxe, S. C., Riba, M. B., Rugo, H. S., Salvador, C., Wagner, L. I., Wagner-Johnston, N. D., Zachariah, F. J., Bergman, M. A., Smith, C. 2015; 13 (8): 1012-1039
  • Experiences of Mothers Who Are Child Sexual Abuse Survivors: A Qualitative Exploration JOURNAL OF CHILD SEXUAL ABUSE Cavanaugh, C. E., Harper, B., Classen, C. C., Palesh, O., Koopman, C., Spiegel, D. 2015; 24 (5): 506-525
  • Higher Vagal Activity as Related to Survival in Patients With Advanced Breast Cancer: An Analysis of Autonomic Dysregulation PSYCHOSOMATIC MEDICINE Giese-Davis, J., Wilhelm, F. H., Tamagawa, R., Palesh, O., Neri, E., Taylor, C. B., Kraemer, H. C., Spiegel, D. 2015; 77 (4): 346-355


    High levels of high-frequency heart rate variability (HF-HRV), related to parasympathetic-nervous-system functioning, have been associated with longer survival in patients with myocardial infarction and acute trauma and in patients undergoing palliative care. From animal studies linking higher vagal activity with better immune system functioning and reduced metastases, we hypothesized that higher HF-HRV would predict longer survival in patients with metastatic or recurrent breast cancer (MRBC).Eighty-seven patients with MRBC participated in a laboratory task including a 5-minute resting baseline electrocardiogram. HF-HRV was computed as the natural logarithm of the summed power spectral density of R-R intervals (0.15-0.50 Hz). In this secondary analysis of a study testing whether diurnal cortisol slope predicted survival, we tested the association between resting baseline HF-HRV on survival using Cox proportional hazards models.A total of 50 patients died during a median follow-up of 7.99 years. Higher baseline HF-HRV predicted significantly longer survival, with a hazard ratio of 0.75 (95% confidence interval = 0.60-0.92, p = .006). Visceral metastasis status and baseline heart rate were related to both HF-HRV and survival. However, a combination of HF-HRV and heart rate further improved survival prediction, with a hazard ratio of 0.64 (95% confidence interval = 0.48-0.85, p = .002).Vagal activity of patients with MRBC strongly predicted their survival, extending the known predictive window of HF-HRV in cancer beyond palliative care. Vagal activity can be altered by behavioral, pharmacological, and surgical interventions and may be a promising target for extending life expectancy in patients with metastasizing cancer.

    View details for DOI 10.1097/PSY.0000000000000167

    View details for Web of Science ID 000354553000001

    View details for PubMedID 25886831

  • Subjective sleep and overall survival in chemotherapy-naive patients with metastatic colorectal cancer SLEEP MEDICINE Innominato, P. F., Spiegel, D., Ulusakarya, A., Giacchetti, S., Bjarnason, G. A., Levi, F., Palesh, O. 2015; 16 (3): 391-398


    Sleep disorders are prevalent in patients with advanced cancer. Their impact on clinical outcomes is not well understood.A post-hoc analysis was conducted in 361 chemo-naïve patients with metastatic colorectal cancer completing twice the EORTC QLQ-C30 questionnaire within a randomized international phase III trial. The study assessed the effect on overall survival (OS) of subjective sleep complaint, used as a normal or a time-dependent covariate (TDC), using a multivariate Cox proportional hazard model. Prognostic analysis was conducted on the whole study population and separately in each treatment arm (conventional FOLFOX2, or chronomodulated chronoFLO4).Sleep problems were reported by 202 patients (56%) at baseline and by 188 (52%) on treatment. Sleep problems at baseline were independently associated with a higher risk of earlier death (HR: 1.36; p?=?0.011), progression (HR: 1.43; p?=?0.002) and poor treatment response (RR: 0.58; p?=?0.016). TDC analysis confirmed the independent prognostic effect of sleep problems on OS (HR: 1.37; p?=?0.008), while on treatment this effect was only observed using univariate analysis. The negative prognostic value of sleep problems on OS at baseline, on treatment, and as a TDC was greatest on chronoFLO4 compared to FOLFOX2.Subjective sleep problems are associated with poor clinical outcomes in metastatic colorectal cancer patients and affect chronotherapy effectiveness. There is a need for a well-tuned circadian timing system in order to increase chronotherapy activity. Prospective studies are needed for determining the impact of therapeutic approaches on sleep disorders upon quality of life and survival of cancer patients.

    View details for DOI 10.1016/j.sleep.2014.10.022

    View details for Web of Science ID 000351714400016

    View details for PubMedID 25678361

  • Experiences of Mothers Who Are Child Sexual Abuse Survivors: A Qualitative Exploration. Journal of child sexual abuse Cavanaugh, C. E., Harper, B., Classen, C. C., Palesh, O., Koopman, C., Spiegel, D. 2015; 24 (5): 506-525


    Child sexual abuse has been associated with a number of problems affecting women over their lifespan, including difficulties with parenting. However, there is a modest number of qualitative studies examining the impact of child sexual abuse on survivors who are mothers. There is a particular need for qualitative investigations that ask survivors who are mothers general questions about the impact of child sexual abuse on their lives rather than those that specifically ask about the impact of child sexual abuse on parenting. The former approach would allow survivors to describe effects that may impact parenting but that survivors do not consciously link to affecting their parenting. Such information may inform interventions to assist this population of survivors. This secondary data analysis examined themes revealed in interviews with 44 survivors of child sexual abuse who were mothers. Participants were seeking treatment for their child sexual abuse and completed an in-person interview in which they were asked open-ended questions about the sexual abuse they experienced as a child and how their abuse affects them now as adults. The interviews were recorded, transcribed, and coded using thematic analysis. The following six themes emerged from the narratives: (a) being a parent, (b) family of origin dysfunction, (c) the impact of abuse, (d) the abuse history and response to abuse, (e) coping, and (f) hopes and desires for the future. This study highlights several ways in which child sexual abuse impacts survivors who are mothers, areas for further study, and the need for interventions to assist this population in meeting the challenges they face as mothers.

    View details for DOI 10.1080/10538712.2015.1042186

    View details for PubMedID 26301437

  • Health behaviors and needs of melanoma survivors SUPPORTIVE CARE IN CANCER Palesh, O., Aldridge-Gerry, A., Bugos, K., Pickham, D., Chen, J. J., Greco, R., Swetter, S. M. 2014; 22 (11): 2973-2980
  • Health behaviors and needs of melanoma survivors. Supportive care in cancer Palesh, O., Aldridge-Gerry, A., Bugos, K., Pickham, D., Chen, J. J., Greco, R., Swetter, S. M. 2014; 22 (11): 2973-2980


    Little is known about melanoma survivors' long-term symptoms, sun protection practices, and support needs from health providers.Melanoma survivors treated at Stanford Cancer Center from 1995 through 2011 were invited to complete a heath needs survey. We compared responses of survivors by sex, education, time since diagnosis (long-term vs. short-term survivors), and extent of treatment received (wide local excision (WLE) alone versus WLE plus additional surgical or medical treatment (WLE+)).One hundred sixty melanoma survivors (51 % male; 61 % long-term; 73 % WLE+) provided evaluable data. On average, patients were 62 years of age (SD?=?14), highly educated (75 % college degree), and Caucasian (94 %). Overall, participants rated anxiety as the most prevalent symptom (34 %). Seventy percent reported that their health provider did not address their symptoms, and 53 % requested education about melanoma-specific issues. Following treatment, women spent significantly less time seeking a tan compared with men (p?=?0.01), had more extremity swelling (p?=?0.014), and expressed higher need for additional services (p?=?0.03). Long-term survivors decreased their use of tanning beds (p?=?0.03) and time spent seeking a tan (p?=?0.002) and were less likely to receive skin screening every 3-6 months (p?

    View details for DOI 10.1007/s00520-014-2286-0

    View details for PubMedID 24879390

  • Sleep Disruption in Hematopoietic Cell Transplantation Recipients: Prevalence, Severity, and Clinical Management BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION Jim, H. S., Evans, B., Jeong, J. M., Gonzalez, B. D., Johnston, L., Nelson, A. M., Kesler, S., Phillips, K. M., Barata, A., Pidala, J., Palesh, O. 2014; 20 (10): 1465-1484
  • Acupuncture in the Treatment of Cancer-Related Psychological Symptoms INTEGRATIVE CANCER THERAPIES Haddad, N. E., Palesh, O. 2014; 13 (5): 371-385


    Acupuncture is being adopted by cancer patients for a wide range of cancer-related symptoms including highly prevalent psychological symptoms like depression, anxiety, insomnia, and impairment in quality of life. Pharmacological treatment of prevalent symptoms like anxiety, depression, and sleep disturbance can contribute to the high chemical burden already carried by cancer patients, creating additional side effects. As a result, patients and providers alike are interested in evidence-based nonpharmacologic alternatives like acupuncture for these symptoms. This article reviews the current literature (January 2000 through April 2013) for acupuncture in cancer-related psychological symptoms with attention to both efficacy and acupuncture-specific methodology. All published studies that met our review criteria demonstrate a positive signal for acupuncture for the treatment of depression, anxiety, sleep disturbance, and for improving quality of life with most results showing statistical significance. However, there are only a handful of acupuncture studies that were specifically designed to evaluate depression, sleep disturbance, and quality of life as primary outcomes, and no studies were found that looked at anxiety as a primary outcome in this population. Published studies in cancer patients and survivors show that acupuncture treatment is not only safe but also more acceptable with fewer side effects than standard of care pharmacological treatments like antidepressants. Finally, there is wide variability in both the implementation and reporting of acupuncture methods in the literature, with only 2 of 12 studies reporting full details of acupuncture methods as outlined in the revised Standards for Reporting Interventions in Clinical Trials of Acupuncture guidelines, published in 2010 and providing an essential framework for the reporting of acupuncture methodology. This lack of methodological detail affects outcomes, generalizability, and validity of research involving acupuncture. Reasons for ongoing challenges in the development of high-quality acupuncture trials are discussed. In conclusion, results are encouraging for the development of randomized trials to directly evaluate the therapeutic impact of acupuncture in cancer-related psychological symptoms, including depression, anxiety, sleep disturbance, and quality of life, but attention to acupuncture methodological specific challenges in the development of high-quality research is necessary.

    View details for DOI 10.1177/1534735413520181

    View details for Web of Science ID 000340719500001

    View details for PubMedID 24501113

  • The circadian timing system in clinical oncology. Annals of medicine Innominato, P. F., Roche, V. P., Palesh, O. G., Ulusakarya, A., Spiegel, D., Lévi, F. A. 2014; 46 (4): 191-207


    Abstract The circadian timing system (CTS) controls several critical molecular pathways for cancer processes and treatment effects over the 24 hours, including drug metabolism, cell cycle, apoptosis, and DNA damage repair mechanisms. This results in the circadian time dependency of whole-body and cellular pharmacokinetics and pharmacodynamics of anticancer agents. However, CTS robustness and phase varies among cancer patients, based on circadian monitoring of rest- activity, body temperature, sleep, and/or hormonal secretion rhythms. Circadian disruption has been further found in up to 50% of patients with metastatic cancer. Such disruption was associated with poor outcomes, including fatigue, anorexia, sleep disorders, and short progression-free and overall survival. Novel, minimally invasive devices have enabled continuous CTS assessment in non-hospitalized cancer patients. They revealed up to 12-hour differences in individual circadian phase. Taken together, the data support the personalization of chronotherapy. This treatment method aims at the adjustment of cancer treatment delivery according to circadian rhythms, using programmable-in-time pumps or novel release formulations, in order to increase both efficacy and tolerability. A fixed oxaliplatin, 5-fluorouracil and leucovorin chronotherapy protocol prolonged median overall survival in men with metastatic colorectal cancer by 3.3 months as compared to conventional delivery, according to a meta-analysis (P = 0.009). Further analyses revealed the need for the prevention of circadian disruption or the restoration of robust circadian function in patients on chronotherapy, in order to further optimize treatment effects. The strengthening of external synchronizers could meet such a goal, through programmed exercise, meal timing, light exposure, improved social support, sleep scheduling, and the properly timed administration of drugs that target circadian clocks. Chrono-rehabilitation warrants clinical testing for improving quality of life and survival in cancer patients.

    View details for DOI 10.3109/07853890.2014.916990

    View details for PubMedID 24915535

  • Disparities in Health Risk Behavior and Psychological Distress Among Gay Versus Heterosexual Male Cancer Survivors LGBT HEALTH Kamen, C., Palesh, O., Gerry, A. A., Andrykowski, M. A., Heckler, C., Mohile, S., Morrow, G. R., Bowen, D., Mustian, K. 2014; 1 (2): 86-U103
  • Symptoms and palliative care needs of pancreatic adenocarcinoma patients. Journal of palliative medicine Luo, J., Chen, J. J., Deguzman, C., Mustian, K., Insco, M., Fisher, G., Palesh, O. 2014; 17 (6): 640-641

    View details for DOI 10.1089/jpm.2014.0056

    View details for PubMedID 24875242

  • Bedtime misalignment and progression of breast cancer. Chronobiology international Hahm, B., Jo, B., Dhabhar, F. S., Palesh, O., Aldridge-Gerry, A., Bajestan, S. N., Neri, E., Nouriani, B., Spiegel, D., Zeitzer, J. M. 2014; 31 (2): 214-221


    Disruption of circadian rhythms, which frequently occurs during night shift work, may be associated with cancer progression. The effect of chronotype (preference for behaviors such as sleep, work, or exercise to occur at particular times of day, with an associated difference in circadian physiology) and alignment of bedtime (preferred vs. habitual), however, have not yet been studied in the context of cancer progression in women with breast cancer. Chronotype and alignment of actual bedtime with preferred chronotype were examined using the Morningness-Eveningness Scale (MEQ) and sleep-wake log among 85 women with metastatic breast cancer. Their association with disease-free interval (DFI) was retrospectively examined using the Cox proportional hazards model. Median DFI was 81.9 months for women with aligned bedtimes ("going to bed at preferred bedtime") (n?=?72), and 46.9 months for women with misaligned bedtimes ("going to bed later or earlier than the preferred bedtime") (n?=?13) (log rank p?=?0.001). In a multivariate Cox proportional hazard model, after controlling for other significant predictors of DFI, including chronotype (morning type/longer DFI; HR?=?0.539, 95% CI?=?0.320-0.906, p?=?0.021), estrogen receptor (ER) status at initial diagnosis (negative/shorter DFI; HR?=?2.169, 95% CI?=?1.124-4.187, p?=?0.028) and level of natural-killer cell count (lower levels/shorter DFI; HR?=?1.641, 95% CI?=?1.000-2.695, p?=?0.050), misaligned bedtimes was associated with shorter DFI, compared to aligned bedtimes (HR?=?3.180, 95% CI?=?1.327-7.616, p?=?0.018). Our data indicate that a misalignment of bedtime on a daily basis, an indication of circadian disruption, is associated with more rapid breast cancer progression as measured by DFI. Considering the limitations of small sample size and study design, a prospective study with a larger sample is necessary to explore their causal relationship and underlying mechanisms.

    View details for DOI 10.3109/07420528.2013.842575

    View details for PubMedID 24156520

  • Actigraphy-Measured Sleep Disruption as a Predictor of Survival among Women with Advanced Breast Cancer. Sleep Palesh, O., Aldridge-Gerry, A., Zeitzer, J. M., Koopman, C., Neri, E., Giese-Davis, J., Jo, B., Kraemer, H., Nouriani, B., Spiegel, D. 2014; 37 (5): 837-842


    Poor sleep, prevalent among cancer survivors, is associated with disrupted hormonal circadian rhythms and poor quality of life. Using a prospective research design, this study aimed to clarify the relationship between objective measures of sleep efficiency and sleep disruption with survival among women with advanced breast cancer.We examined sleep quality and duration via wrist-worn actigraphy and sleep diaries for 3 days among 97 women in whom advanced breast cancer was diagnosed (age = 54.6 ± 9.8 years). Sleep efficiency was operationalized using actigraphy as the ratio of total sleep time to total sleep time plus wake after sleep onset.As hypothesized, better sleep efficiency was found to predict a significant reduction in overall mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.94-0.98; P < 0.001) at median 6 y follow-up. This relationship remained significant (HR, 0.94; 95% CI, 0.91-0.97; P < 0.001) even after adjusting for other known prognostic factors (age, estrogen receptor status, cancer treatment, metastatic spread, cortisol levels, and depression). Secondary hypotheses were also supported (after adjusting for baseline prognostic factors) showing that less wake after sleep onset (HR, 0.41; 95% CI, 0.25-0.67; P < 0.001), fewer wake episodes, (HR, 0.93; 95% CI, 0.88-0.98; P = 0.007); and shorter wake episode duration (HR, 0.29; 95% CI, 0.14-0.58; P < 0.001) also contributed to reductions in overall mortality.These findings show that better sleep efficiency and less sleep disruption are significant independent prognostic factors in women with advanced breast cancer. Further research is needed to determine whether treating sleep disruption with cognitive behavioral and/or pharmacologic therapy could improve survival in women with advanced breast cancer.

    View details for DOI 10.5665/sleep.3642

    View details for PubMedID 24790261

  • Sleep Disruption in Breast Cancer Patients and Survivors JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Palesh, O., Aldridge-Gerry, A., Ulusakarya, A., Ortiz-Tudela, E., Capuron, L., Innominato, P. F. 2013; 11 (12): 1523-1530


    Sleep disruption is prevalent in patients and survivors of breast cancer. Most patients undergoing chemotherapy will experience transient sleep disruption, and nearly 60% will have chronic sleep problems. Numerous factors contribute to sleep disruption in women diagnosed with breast cancer. Sleep disruption is a consequence of several biological alterations, including circadian disruption and immune and metabolic deregulations. These systems also play significant roles in the control and progression of breast cancer. Sleep disruption is associated with many side effects and psychiatric and medical comorbidities. This article discusses the relationship between stress and posttraumatic stress disorder, depression and fatigue, and how sleep disturbance might be the cause or consequence of these disorders. Current evidence for management of sleep disturbance in breast cancer and high chronic use of hypnotic medication in this population is also discussed. Finally, the differences in management of sleep disturbance during acute cancer care and during the survivorship phase are discussed. More research is needed on accurate and timely assessment of sleep disturbance associated with breast cancer, and additional tailored approaches for the management of sleep problems in breast cancer should be developed.

    View details for Web of Science ID 000328639000010

    View details for PubMedID 24335687

  • Psychosocial correlates of sleep quality and architecture in women with metastatic breast cancer. Sleep medicine Aldridge-Gerry, A., Zeitzer, J. M., Palesh, O. G., Jo, B., Nouriani, B., Neri, E., Spiegel, D. 2013; 14 (11): 1178-1186


    Sleep disturbance is prevalent among women with metastatic breast cancer (MBC). Our study examined the relationship of depression and marital status to sleep assessed over three nights of polysomnography (PSG).Women with MBC (N=103) were recruited; they were predominately white (88.2%) and 57.8±7.7 years of age. Linear regression analyses assessed relationships among depression, marital status, and sleep parameters.Women with MBC who reported more depressive symptoms had lighter sleep (e.g., stage 1 sleep; P<.05), less slow-wave sleep (SWS) (P<.05), and less rapid eye movement (REM) sleep (P<.05). Single women had less total sleep time (TST) (P<.01), more wake after sleep onset (WASO) (P<.05), worse sleep efficiency (SE) (P<.05), lighter sleep (e.g., stage 1; P<.05), and less REM sleep (P<.05) than married women. Significant interactions indicated that depressed and single women had worse sleep quality than partnered women or those who were not depressed.Women with MBC and greater symptoms of depression had increased light sleep and reduced SWS and REM sleep, and single women had worse sleep quality and greater light sleep than married counterparts. Marriage was related to improved sleep for women with more depressive symptoms.

    View details for DOI 10.1016/j.sleep.2013.07.012

    View details for PubMedID 24074694

  • Psychosocial correlates of sleep quality and architecture in women with metastatic breast cancer SLEEP MEDICINE Aldridge-Gerry, A., Zeitzer, J. M., Palesh, O. G., Jo, B., Nouriani, B., Neri, E., Spiegel, D. 2013; 14 (11): 1178-1186


    Sleep disturbance is prevalent among women with metastatic breast cancer (MBC). Our study examined the relationship of depression and marital status to sleep assessed over three nights of polysomnography (PSG).Women with MBC (N=103) were recruited; they were predominately white (88.2%) and 57.8±7.7 years of age. Linear regression analyses assessed relationships among depression, marital status, and sleep parameters.Women with MBC who reported more depressive symptoms had lighter sleep (e.g., stage 1 sleep; P<.05), less slow-wave sleep (SWS) (P<.05), and less rapid eye movement (REM) sleep (P<.05). Single women had less total sleep time (TST) (P<.01), more wake after sleep onset (WASO) (P<.05), worse sleep efficiency (SE) (P<.05), lighter sleep (e.g., stage 1; P<.05), and less REM sleep (P<.05) than married women. Significant interactions indicated that depressed and single women had worse sleep quality than partnered women or those who were not depressed.Women with MBC and greater symptoms of depression had increased light sleep and reduced SWS and REM sleep, and single women had worse sleep quality and greater light sleep than married counterparts. Marriage was related to improved sleep for women with more depressive symptoms.

    View details for DOI 10.1016/j.sleep.2013.07.012

    View details for Web of Science ID 000326625400021

    View details for PubMedID 24074694

  • Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. Journal of clinical oncology Mustian, K. M., Sprod, L. K., Janelsins, M., Peppone, L. J., Palesh, O. G., Chandwani, K., Reddy, P. S., Melnik, M. K., Heckler, C., Morrow, G. R. 2013; 31 (26): 3233-3241


    Thirty percent to 90% of cancer survivors report impaired sleep quality post-treatment, which can be severe enough to increase morbidity and mortality. Lifestyle interventions, such as exercise, are recommended in conjunction with drugs and cognitive behavioral therapy for the treatment of impaired sleep. Preliminary evidence indicates that yoga-a mind-body practice and form of exercise-may improve sleep among cancer survivors. The primary aim of this randomized, controlled clinical trial was to determine the efficacy of a standardized yoga intervention compared with standard care for improving global sleep quality (primary outcome) among post-treatment cancer survivors.In all, 410 survivors suffering from moderate or greater sleep disruption between 2 and 24 months after surgery, chemotherapy, and/or radiation therapy were randomly assigned to standard care or standard care plus the 4-week yoga intervention. The yoga intervention used the Yoga for Cancer Survivors (YOCAS) program consisting of pranayama (breathing exercises), 16 Gentle Hatha and Restorative yoga asanas (postures), and meditation. Participants attended two 75-minute sessions per week. Sleep quality was assessed by using the Pittsburgh Sleep Quality Index and actigraphy pre- and postintervention.In all, 410 survivors were accrued (96% female; mean age, 54 years; 75% had breast cancer). Yoga participants demonstrated greater improvements in global sleep quality and, secondarily, subjective sleep quality, daytime dysfunction, wake after sleep onset, sleep efficiency, and medication use at postintervention (all P ? .05) compared with standard care participants.Yoga, specifically the YOCAS program, is a useful treatment for improving sleep quality and reducing sleep medication use among cancer survivors.

    View details for DOI 10.1200/JCO.2012.43.7707

    View details for PubMedID 23940231

  • Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. Journal of clinical oncology Mustian, K. M., Sprod, L. K., Janelsins, M., Peppone, L. J., Palesh, O. G., Chandwani, K., Reddy, P. S., Melnik, M. K., Heckler, C., Morrow, G. R. 2013; 31 (26): 3233-3241

    View details for DOI 10.1200/JCO.2012.43.7707

    View details for PubMedID 23940231

  • Deconstructing the complexity of PTSD in cancer. Nature reviews. Clinical oncology Palesh, O., Koopman, C. 2013; 10 (8)

    View details for DOI 10.1038/nrclinonc.2013.49-c2

    View details for PubMedID 23774643

  • Cognitive Training for Improving Executive Function in Chemotherapy-Treated Breast Cancer Survivors CLINICAL BREAST CANCER Kesler, S., Hosseini, S. M., Heckler, C., Janelsins, M., Palesh, O., Mustian, K., Morrow, G. 2013; 13 (4): 299-306


    BACKGROUND: A majority of breast cancer (BC) survivors, particularly those treated with chemotherapy, experience long-term cognitive deficits that significantly reduce quality of life. Among the cognitive domains most commonly affected include executive functions (EF), such as working memory, cognitive flexibility, multitasking, planning, and attention. Previous studies in other populations have shown that cognitive training, a behavioral method for treating cognitive deficits, can result in significant improvements in a number of cognitive skills, including EF. MATERIALS AND METHODS: In this study, we conducted a randomized controlled trial to investigate the feasibility and preliminary effectiveness of a novel, online EF training program in long-term BC survivors. A total of 41 BC survivors (21 active, 20 wait list) completed the 48 session training program over 12 weeks. The participants were, on average, 6 years after therapy. Results: Cognitive training led to significant improvements in cognitive flexibility, verbal fluency and processing speed, with marginally significant downstream improvements in verbal memory as assessed via standardized measures. Self-ratings of EF skills, including planning, organizing, and task monitoring, also were improved in the active group compared with the wait list group. CONCLUSIONS: Our findings suggest that EF skills may be improved even in long-term survivors by using a computerized, home-based intervention program. These improvements may potentially include subjective EF skills, which suggest a transfer of the training program to real-world behaviors.

    View details for DOI 10.1016/j.clbc.2013.02.004

    View details for Web of Science ID 000321239600011

    View details for PubMedID 23647804

  • Breast cancer: Post-traumatic stress disorder-prevalent and persistent. Nature reviews. Clinical oncology Palesh, O., Koopman, C. 2013; 10 (5): 252-254

    View details for DOI 10.1038/nrclinonc.2013.49

    View details for PubMedID 23568418

  • Reduced hippocampal volume and verbal memory performance associated with interleukin-6 and tumor necrosis factor-alpha levels in chemotherapy-treated breast cancer survivors BRAIN BEHAVIOR AND IMMUNITY Kesler, S., Janelsins, M., Koovakkattu, D., Palesh, O., Mustian, K., Morrow, G., Dhabhar, F. S. 2013; 30: S109-S116

    View details for DOI 10.1016/j.bbi.2012.05.017

    View details for Web of Science ID 000316510800013

    View details for PubMedID 22698992

  • Reduced hippocampal volume and verbal memory performance associated with interleukin-6 and tumor necrosis factor-alpha levels in chemotherapy-treated breast cancer survivors. Brain, behavior, and immunity Kesler, S., Janelsins, M., Koovakkattu, D., Palesh, O., Mustian, K., Morrow, G., Dhabhar, F. S. 2013; 30: S109-16


    Many survivors of breast cancer show significant cognitive impairments, including memory deficits. Inflammation induced by chemotherapy may contribute to hippocampal changes that underlie these deficits. In this cross-sectional study, we measured bilateral hippocampal volumes from high-resolution magnetic resonance images in 42 chemotherapy-treated breast cancer survivors and 35 healthy female controls. Patients with breast cancer were, on average, 4.8 ± 3.4 years off-therapy. In a subset of these participants (20 breast cancer, 23 controls), we quantified serum cytokine levels. Left hippocampal volumes and memory performance were significantly reduced and interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF?) concentrations were significantly elevated in the breast cancer group compared to controls. In the breast cancer group, lower left hippocampal volume was associated with higher levels of TNF? and lower levels of IL-6 with a significant interaction between these two cytokines suggesting a potential modulatory effect of IL-6 on TNF?. Verbal memory performance was associated with cytokine levels and left hippocampal volume in both groups. These findings provide evidence of altered hippocampal volume and verbal memory difficulties following breast cancer chemotherapy that may be mediated by TNF? and IL-6.

    View details for DOI 10.1016/j.bbi.2012.05.017

    View details for PubMedID 22698992

  • Distress management. Journal of the National Comprehensive Cancer Network Holland, J. C., Andersen, B., Breitbart, W. S., Buchmann, L. O., Compas, B., Deshields, T. L., Dudley, M. M., Fleishman, S., Fulcher, C. D., Greenberg, D. B., Greiner, C. B., Handzo, G. F., Hoofring, L., Hoover, C., Jacobsen, P. B., Kvale, E., Levy, M. H., Loscalzo, M. J., McAllister-Black, R., Mechanic, K. Y., Palesh, O., Pazar, J. P., Riba, M. B., Roper, K., Valentine, A. D., Wagner, L. I., Zevon, M. A., McMillian, N. R., Freedman-Cass, D. A. 2013; 11 (2): 190-209


    The integration of psychosocial care into the routine care of all patients with cancer is increasingly being recognized as the new standard of care. These NCCN Clinical Practice Guidelines in Oncology for Distress Management discuss the identification and treatment of psychosocial problems in patients with cancer. They are intended to assist oncology teams identify patients who require referral to psychosocial resources and to give oncology teams guidance on interventions for patients with mild distress to ensure that all patients with distress are recognized and treated.

    View details for PubMedID 23411386

  • Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer. Nature and science of sleep Palesh, O., Peppone, L., Innominato, P. F., Janelsins, M., Jeong, M., Sprod, L., Savard, J., Rotatori, M., Kesler, S., Telli, M., Mustian, K. 2012; 4: 151-162


    Sleep problems are highly prevalent in cancer patients undergoing chemotherapy. This article reviews existing evidence on etiology, associated symptoms, and management of sleep problems associated with chemotherapy treatment during cancer. It also discusses limitations and methodological issues of current research. The existing literature suggests that subjectively and objectively measured sleep problems are the highest during the chemotherapy phase of cancer treatments. A possibly involved mechanism reviewed here includes the rise in the circulating proinflammatory cytokines and the associated disruption in circadian rhythm in the development and maintenance of sleep dysregulation in cancer patients during chemotherapy. Various approaches to the management of sleep problems during chemotherapy are discussed with behavioral intervention showing promise. Exercise, including yoga, also appear to be effective and safe at least for subclinical levels of sleep problems in cancer patients. Numerous challenges are associated with conducting research on sleep in cancer patients during chemotherapy treatments and they are discussed in this review. Dedicated intervention trials, methodologically sound and sufficiently powered, are needed to test current and novel treatments of sleep problems in cancer patients receiving chemotherapy. Optimal management of sleep problems in patients with cancer receiving treatment may improve not only the well-being of patients, but also their prognosis given the emerging experimental and clinical evidence suggesting that sleep disruption might adversely impact treatment and recovery from cancer.

    View details for PubMedID 23486503

  • A randomized, controlled, double-blinded clinical trial of gabapentin 300 versus 900 mg versus placebo for anxiety symptoms in breast cancer survivors BREAST CANCER RESEARCH AND TREATMENT Lavigne, J. E., Heckler, C., Mathews, J. L., Palesh, O., Kirshner, J. J., Lord, R., Jacobs, A., Amos, E., Morrow, G. R., Mustian, K. 2012; 136 (2): 479-486


    Gabapentin is used for the treatment of hot flashes and neuropathic pain in breast cancer survivors, and is commonly used off-label for the treatment of anxiety. Yet, clinical trial evidence to support the use of gabapentin for anxiety symptoms is lacking. In a randomized, double-blinded controlled trial we compared 300 mg gabapentin versus 900 mg gabapentin versus placebo. Subjects were 420 breast cancer patients who had completed all chemotherapy cycles. Anxiety traits and current (state) anxiety were measured using the Speilberger Strait-Trait Anxiety Inventory at baseline, 4 and 8 weeks. Pain was measured at baseline using a 10-point scale. Analyses included analysis of covariance and ordinary least squares regression. At 4 weeks, state anxiety change scores were significantly better for gabapentin 300 and 900 mg (p = 0.005) compared to placebo. The magnitude of improvement was proportional to baseline state anxiety. At 8 weeks, the anxiolytic effects of gabapentin compared to placebo persisted (p < 0.005). We found no significant interactions. The lower dose (300 mg) was associated with the best treatment outcomes for all patients except those with the highest baseline anxiety. Given its similar pharmacology, efficacy in the treatment of hot flashes, and low cost, gabapentin may provide a low cost and parsimonious alternative treatment choice for breast cancer survivors presenting in primary care practices with anxiety symptoms. Gabapentin is effective for hot flashes, and, therefore, may provide therapeutic benefit for both anxiety and hot flashes at a generic drug price. For patients reluctant to take a controlled substance, such as a benzodiazepine, gabapentin may offer an alternative therapy. Similarly, patients with a history of substance use may benefit from gabapentin without risk of addiction or abuse. For cancer survivors experiencing both hot flashes and anxiety, gabapentin may provide a single effective treatment for both and is an alternative therapy for anxiety for patients unwilling to take a benzodiazepine or those with a history of substance use.

    View details for DOI 10.1007/s10549-012-2251-x

    View details for Web of Science ID 000310378700015

    View details for PubMedID 23053645

  • Impact of paroxetine on sleep problems in 426 cancer patients receiving chemotherapy: A trial from the University of Rochester Cancer Center Community Clinical Oncology Program SLEEP MEDICINE Palesh, O. G., Mustian, K. M., Peppone, L. J., Janelsins, M., Sprod, L. K., Kesler, S., Innominato, P. F., Roth, T., Manber, R., Heckler, C., Fiscella, K., Morrow, G. R. 2012; 13 (9): 1184-1190


    Sleep problems are a frequent distressing symptom in cancer patients, yet little is known about their treatment. Sleep problems and depression frequently co-occur, leading healthcare professionals to treat depression with the expectation that sleep problems will also improve. The purpose of this study was to compare the effect of paroxetine to placebo on sleep problems via a secondary data analysis of a RCT designed to compare the effects of paroxetine to placebo on fatigue in cancer patients undergoing chemotherapy. A previously published report found a significant effect of paroxetine on depression in this cohort.A total of 426 patients were randomized following Cycle 2 of chemotherapy to receive either 20mg of paroxetine or placebo. Sleep problems were assessed using questions from the Hamilton Depression Inventory three times during chemotherapy.A total of 217 patients received paroxetine and 209 received placebo. Significantly fewer patients taking paroxetine reported sleep problems compared to patients on placebo (Paroxetine 79% versus Placebo 88%; p<0.05). These differences remained significant even after controlling for baseline sleep problems and depression (p<0.05).Paroxetine had a significant benefit on sleep problems in both depressed and non-depressed cancer patients. However, rates of sleep problems remained high even among those effectively treated for depression with paroxetine. There is a need to develop and deliver sleep-specific interventions to effectively treat sleep-related side effects of cancer treatments. These findings suggest that sleep problems and depression are prevalent and co-morbid. Cancer progression, its response to treatment, and overall patient survival are intricately linked to host factors, such as inflammatory response and circadian rhythms, including sleep/wake cycles. Sleep problems and depression are modifiable host factors that can influence inflammation and impact cancer progression and quality of life. Future research should focus on discovering the pathogenesis of sleep dysregulation and depression in cancer so that better treatment approaches can be developed to ameliorate these symptoms.

    View details for DOI 10.1016/j.sleep.2012.06.001

    View details for Web of Science ID 000311477200012

    View details for PubMedID 22858235

  • Health-related quality of life and biomarkers in breast cancer survivors participating in tai chi chuan JOURNAL OF CANCER SURVIVORSHIP-RESEARCH AND PRACTICE Sprod, L. K., Janelsins, M. C., Palesh, O. G., Carroll, J. K., Heckler, C. E., Peppone, L. J., Mohile, S. G., Morrow, G. R., Mustian, K. M. 2012; 6 (2): 146-154


    Breast cancer survivors experience diminished health-related quality of life (HRQOL). We report on the influence of tai chi chuan exercise (TCC) on HRQOL and explore associations between changes in HRQOL and biomarkers.Breast cancer survivors (N?=?21) were randomly assigned to TCC or standard support therapy (SST) for 12 weeks (three times/week; 60 min/session). Interleukin-6, interleukin-8 (IL-8), insulin-like growth factor-1 (IGF-1), insulin-like growth factor-binding protein (IBFBP)-1, IGFBP-3, glucose, insulin, and cortisol were measured pre- and postintervention. Overall HRQOL and subdomains were assessed at preintervention (T1), midintervention (T2) and postintervention (T3) and biomarkers at T1 and T3.The TCC group improved in total HRQOL (T1-T2:CS?=?8.54, P?=?0.045), physical functioning (T1-T2:CS?=?1.89, P?=?0.030), physical role limitations (T1-T2 CS?=?1.55, P?=?0.023), social functioning (T1-T3:CS?=?1.50, P?=?0.020), and general mental health (T1-T2:CS?=?2.67, P?=?0.014; T1-T3:CS?=?2.44, P?=?0.019). The SST improved in social functioning (T1-T2:CS?=?0.64, P?=?0.043) and vitality (T1-T2:CS?=?0.90, P?=?0.01). There were relationships between changes in IGF-1 and overall HRQOL (r?=?-0.56; P?

    View details for DOI 10.1007/s11764-011-0205-7

    View details for Web of Science ID 000302419700002

    View details for PubMedID 22160628

  • Immune compromization and disparities in cancer type among sexual minority men. 48th Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO) Kamen, C., Gerry, A. A., Andrykowski, M. A., Palesh, O. AMER SOC CLINICAL ONCOLOGY. 2012
  • Psychosocial correlates of sleep architecture in women with advanced breast cancer. 48th Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO) Gerry, A. A., Jo, B., Palesh, O., Zeitzer, J., Neri, E., Spiegel, D. AMER SOC CLINICAL ONCOLOGY. 2012
  • Differential expression of cytokines in breast cancer patients receiving different chemotherapies: implications for cognitive impairment research International Symposium of MASCC/ISOO Janelsins, M. C., Mustian, K. M., Palesh, O. G., Mohile, S. G., Peppone, L. J., Sprod, L. K., Heckler, C. E., Roscoe, J. A., Katz, A. W., Williams, J. P., Morrow, G. R. SPRINGER. 2012: 831?39


    Altered levels of cytokines and chemokines may play a role in cancer- and cancer treatment-related cognitive difficulties. In many neurodegenerative diseases, abnormal concentrations of cytokines and chemokines affect neuronal integrity leading to cognitive impairments, but the role of cytokines in chemotherapy-related cognitive difficulties in cancer patients is not well understood. Patients receiving doxorubicin-based (with cyclophosphamide, or cyclophosphamide plus fluorouracil; AC/CAF) chemotherapy or cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy report experiencing cognitive difficulties; because these regimens work by different modes of action, it is possible that they differentially affect cytokine levels.This study examined the relationships between cytokine levels (i.e., IL-6, IL-8, and MCP-1) and type of chemotherapy among 54 early-stage breast cancer patients receiving AC/CAF or CMF. Cytokine levels were assessed at two time-points: prior to on-study chemotherapy cycle 2 (cycle 2) and after two consecutive chemotherapy cycles (prior to on-study cycle 4; cycle 4).Analyses of variance using cycle 2 levels as a covariate (ANCOVA) were used to determine differences between chemotherapy groups. Levels of IL-6, IL-8, and MCP-1 increased in the AC/CAF group and decreased in the CMF group; the only significant between-group change was in IL-6 (p?

    View details for DOI 10.1007/s00520-011-1158-0

    View details for Web of Science ID 000301525700020

    View details for PubMedID 21533812

  • Few changes observed in polysomnographic-assessed sleep before and after completion of chemotherapy JOURNAL OF PSYCHOSOMATIC RESEARCH Roscoe, J. A., Perlis, M. L., Pigeon, W. R., O'Neill, K. H., Heckler, C. E., Matteson-Rusby, S. E., Palesh, O. G., Shayne, M., Huston, A. 2011; 71 (6): 423-428


    Sleep disturbance is prevalent among patients undergoing chemotherapy and is strongly associated with cancer-related fatigue (CRF). However, little objective evidence has been gathered on the patterns of sleep before and following chemotherapy.Twenty-six patients scheduled to receive chemotherapy were recruited. Sleep parameters were assessed by in-lab polysomnography (PSG) for two consecutive nights prior to first chemotherapy, approximately 3weeks following the patients' last chemotherapy, and 3months following the last treatment. Fatigue was measured on the first night of each of the two-night PSG assessments. We focus on Slow-Wave Sleep (SWS) as we hypothesized that a decrease of this restorative phase of sleep might be implicated in CRF.Repeated-measures analyses examining changes from baseline to the later time points in the proportion of time asleep spent in each of the four sleep architecture stages (Stage 1, Stage 2, SWS, and REM sleep) were non-significant, all Ps>0.41. Canonical correlation analysis showed that the proportion of time spent in SWS was not significantly correlated with any of the three CRF measures at any of the three assessment points, P=0.28.Sleep architecture is not affected by cancer treatment. No evidence of an association between CRF and SWS, or alterations in SWS, was found.

    View details for DOI 10.1016/j.jpsychores.2011.08.003

    View details for Web of Science ID 000297830100010

    View details for PubMedID 22118386

  • Age-related differences in symptoms and their interference with quality of life in 903 cancer patients undergoing radiation therapy JOURNAL OF GERIATRIC ONCOLOGY Mohile, S. G., Heckler, C., Fan, L., Mustian, K., Jean-Pierre, P., Usuki, K., Sprod, L., Janelsins, M., Purnell, J., Peppone, L., Palesh, O., Devine, K. A., Morrow, G. 2011; 2 (4): 225-232


    OBJECTIVES: To evaluate the relationship of age with symptoms and interference with daily function and QOL during RT. DESIGN: A prospective observational study. SETTING: A university-based radiation oncology department. PARTICIPANTS: 903 cancer patients who received radiation therapy (RT). The mean age was 61 yrs (18-92) and 41% were ? 65 yrs. MEASUREMENTS: A symptom inventory was administered pre- and post-RT. Patients rated 10 symptoms and their interference with daily function and QOL on a Likert scale from 0 (not present) to 10 (as bad as possible). A total symptom score was calculated by adding the ratings of individual symptoms. T-tests, Pearson correlation coefficients, and mixed modeling were used to investigate relationships between symptoms and their interference with daily function and QOL. RESULTS: For older and younger patients, the total symptom score worsened during RT (p's < .001). There were no differences in the change in total symptom burden and interference with QOL between older and younger patients during RT. After RT, although younger patients reported significantly worse pain (p = .03), nausea (p <.01), and sleep disturbance (p <.01), symptom interference with walking was more severe in older patients (p = .01). Mixed modeling showed that older age (p=<.001), time of survey (after RT, p<.001), and age*time interaction (p<.001) increased the likelihood of reporting that symptoms interfered with walking. CONCLUSION: The prevalence of symptoms was similar for older and younger patients during RT. Older patients are more likely to report that symptoms interfere with walking after RT.

    View details for DOI 10.1016/j.jgo.2011.08.002

    View details for Web of Science ID 000296545600001

    View details for PubMedCentralID PMC3415272

  • Racial disparities in traumatic stress in prostate cancer patients: secondary analysis of a National URCC CCOP Study of 317 men SUPPORTIVE CARE IN CANCER Purnell, J. Q., Palesh, O. G., Heckler, C. E., Adams, M. J., Chin, N., Mohile, S., Peppone, L. J., Atkins, J. N., Moore, D. F., Spiegel, D., Messing, E., Morrow, G. R. 2011; 19 (7): 899-907


    African American men have the highest rates of prostate cancer of any racial group, but very little is known about the psychological functioning of African American men in response to prostate cancer diagnosis and treatment.In this secondary analysis of a national trial testing a psychological intervention for prostate cancer patients, we report on the traumatic stress symptoms of African American and non-African American men.This analysis includes 317 men (African American: n = 30, 9%; non-African American: n = 287, 91%) who were enrolled in the intervention trial, which included 12 weeks of group psychotherapy and 24 months of follow-up. Using mixed model analysis, total score on the Impact of Events Scale (IES) and its Intrusion and Avoidance subscales were examined to determine mean differences in traumatic stress across all time points (0, 3, 6, 12, 18, and 24 months). In an additional analysis, relevant psychosocial, demographic, and clinical variables were added to the model.Results showed significantly higher levels of traumatic stress for African American men compared to non-African American men in all models independently of the intervention arm, demographics, and relevant clinical variables. African Americans also had a consistently higher prevalence of clinically significant traumatic stress symptoms (defined as IES total score ? 27). These elevations remained across all time points over 24 months.This is the first study to show a racial disparity in traumatic stress specifically as an aspect of overall psychological adjustment to prostate cancer. Recommendations are made for appropriate assessment, referral, and treatment of psychological distress in this vulnerable population.

    View details for DOI 10.1007/s00520-010-0880-3

    View details for Web of Science ID 000291357100005

    View details for PubMedID 20414685

  • Effects of Tai Chi Chuan on Insulin and Cytokine Levels in a Randomized Controlled Pilot Study on Breast Cancer Survivors CLINICAL BREAST CANCER Janelsins, M. C., Davis, P. G., Wideman, L., Katula, J. A., Sprod, L. K., Peppone, L. J., Palesh, O. G., Heckler, C. E., Williams, J. P., Morrow, G. R., Mustian, K. M. 2011; 11 (3): 161-170


    Tai Chi Chuan (TCC) is an integrative medicine mind-body practice with a physical activity component that has positive effects on aerobic capacity, muscular strength, and quality of life among cancer survivors, similar to the effects elicited by other modes of moderate-intensity exercise. Inflammatory cytokines and insulin and insulin-related signaling molecules may contribute to weight gain and affect cancer recurrence rates and survival; exercise can curb cancer- and treatment-related weight gain, increase survival, and reduce levels of insulin and inflammatory cytokines. Despite knowing the beneficial effects of conventional exercise interventions on these mediators, little is known about the physiologic effects of TCC on these pathways in breast cancer survivors.We assessed the effects of a 12-week, moderately intense, TCC intervention (n = 9) compared with a non-physical activity control (n = 10) consisting of psychosocial support therapy (PST), on levels of insulin, insulin-like growth factor (IGF)-1, insulin growth factor-like binding protein (IGFBP)-1, IGFBP-3, and cytokines interleukin (IL)-6, IL-2, and interferon (IFN)-? in breast cancer survivors.Levels of insulin are significantly different in TCC and PST groups; levels remained stable in the TCC group but increased in the PST control group (P = .099). Bivariate analysis revealed novel and significant correlations (all r > 0.45, all P ? .05) of both decreased fat mass and increased fat-free mass with increased IL-6 and decreased IL-2 levels.This pilot study shows that TCC may be associated with maintenance of insulin levels and changes in cytokine levels that may be important for maintenance of lean body mass in breast cancer survivors.

    View details for DOI 10.1016/j.clbc.2011.03.013

    View details for Web of Science ID 000292477500004

    View details for PubMedID 21665136

  • Conducting Cancer Control and Survivorship Research via Cooperative Groups: A Report from the American Society of Preventive Oncology CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Palesh, O., Demark-Wahnefried, W., Mustian, K., Minasian, L., Rowland, J., Sprod, L., Janelsins, M., Peppone, L., Sloan, J., Engquist, K. B., Jones, L., Buist, D., Paskett, E. D. 2011; 20 (5): 1050-1055


    As the number of cancer survivors expands, the need for cancer control and survivorship research becomes increasingly important. The National Cancer Institute (NCI) Cooperative Groups may offer a viable platform to perform such research. Observational, preventive, and behavioral research can often be performed within the cooperative group setting, especially if resources needed for evaluation are fairly simple, if protocols are easily implemented within the typical clinical setting, and if interventions are well standardized. Some protocols are better suited to cooperative groups than are others, and there are advantages and disadvantages to conducting survivorship research within the cooperative group setting. Behavioral researchers currently involved in cooperative groups, as well as program staff within the NCI, can serve as sources of information for those wishing to pursue symptom management and survivorship studies within the clinical trial setting. The structure of the cooperative groups is currently changing, but going forward, survivorship is bound to be a topic of interest and one that perhaps may be more easily addressed using the proposed more centralized structure.

    View details for DOI 10.1158/1055-9965.EPI-11-0176

    View details for Web of Science ID 000290251000044

    View details for PubMedID 21502540

  • Polarity Therapy for Cancer-Related Fatigue in Patients With Breast Cancer Receiving Radiation Therapy: A Randomized Controlled Pilot Study INTEGRATIVE CANCER THERAPIES Mustian, K. M., Roscoe, J. A., Palesh, O. G., Sprod, L. K., Heckler, C. E., Peppone, L. J., Usuki, K. Y., Ling, M. N., Brasacchio, R. A., Morrow, G. R. 2011; 10 (1): 27-37


    Cancer-related fatigue (CRF) is the most frequently reported side effect of cancer and its treatment. In previous research, Polarity Therapy (PT), an energy therapy, was shown to reduce CRF in patients receiving radiation. This study reports on a small randomized clinical trial designed to collect preliminary data on the efficacy of PT compared with an active control (massage) and passive control (standard care) for CRF among cancer patients receiving radiation therapy.Forty-five women undergoing radiation therapy for breast cancer were randomized to 1 of 3 weekly treatment conditions. Patients received standard clinical care, 3 modified massages, or 3 PT treatments. CRF and health-related quality of life (HRQL) were assessed during baseline and the 3 intervention weeks.TResults show CRF ratings were reduced after PT. The effect sizes for PT versus modified massage and versus standard care were small when using the primary measure of CRF (Brief Fatigue Inventory) and large when using the secondary measure of CRF (Daily CRF Diaries).The effect size was medium when assessing the benefit of PT on maintaining HRQL compared with standard care with very little difference between the PT and modified massage conditions. Patients' feedback showed that both the modified massage and PT treatments were deemed useful by radiation patients.The present pilot randomized clinical trial supports previous experimental research showing that PT, a noninvasive and gentle energy therapy, may be effective in controlling CRF. Further confirmatory studies as well as investigations of the possible mechanisms of PT are warranted.

    View details for DOI 10.1177/1534735410397044

    View details for Web of Science ID 000289157000003

    View details for PubMedID 21382958

  • A Comparison of Trauma-Focused and Present-Focused Group Therapy for Survivors of Childhood Sexual Abuse: A Randomized Controlled Trial PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY Classen, C. C., Palesh, O. G., Cavanaugh, C. E., Koopman, C., Kaupp, J. W., Kraemer, H. C., Aggarwal, R., Spiegel, D. 2011; 3 (1): 84-93

    View details for DOI 10.1037/a0020096

    View details for Web of Science ID 000289034000012

  • Exercise, sleep quality, and mediators of sleep in breast and prostate cancer patients receiving radiation therapy. Community oncology Sprod, L. K., Palesh, O. G., Janelsins, M. C., Peppone, L. J., Heckler, C. E., Adams, M. J., Morrow, G. R., Mustian, K. M. 2010; 7 (10): 463-471


    Cancer patients often report impaired sleep quality. Impaired sleep quality may be due to increased levels of sleep-mediating cytokines resulting from cancer treatment. Exercise may have a positive influence on sleep-mediating cytokines, such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-?), and soluble tumor necrosis factor-alpha receptor (sTNF-R), which may improve sleep quality. This two-arm pilot study compared the influence of a home-based exercise intervention with standard care/control on sleep quality and mediators of sleep. Breast and prostate cancer patients (n = 38) beginning radiation therapy were randomized to a 4-week exercise program or no exercise arm. Global sleep quality, subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction were assessed with the Pittsburgh Sleep Quality Index. IL-6, TNF-?, and sTNF-R were measured before and after intervention. There was a greater improvement in sleep quality in the exercise group from pre- to postintervention, although the difference was not significant. Additionally, there were associations between IL-6 and sleep efficiency and duration, suggesting that regulation of sleep-mediating cytokines by exercise may mediate improvements in sleep-quality components.

    View details for PubMedID 21274408

  • Regulation of circadian rhythms and hypothalamic-pituitary-adrenal axis: an overlooked interaction in cancer LANCET ONCOLOGY Innominato, P. F., Palesh, O., Dhabhar, F. S., Levi, F., Spiegel, D. 2010; 11 (9): 816-817

    View details for Web of Science ID 000282412000011

    View details for PubMedID 20816374

  • The efficacy of calcitriol therapy in the management of bone loss and fractures: a qualitative review OSTEOPOROSIS INTERNATIONAL Peppone, L. J., Hebl, S., Purnell, J. Q., Reid, M. E., ROSIER, R. N., Mustian, K. M., Palesh, O. G., Huston, A. J., Ling, M. N., Morrow, G. R. 2010; 21 (7): 1133-1149


    Osteoporosis, a skeletal disorder characterized by a reduction in bone strength, increases fracture risk. Primary osteoporosis is usually a result of reduced bone mineral density as a consequence of natural aging. Secondary osteoporosis is usually a result of a disease, such as cystic fibrosis, or medical treatment, such as corticosteroids or cancer treatment.Currently, ten million Americans are osteoporotic and an additional 34 million have the precursor condition, osteopenia. Osteoporosis leads to 1.5 million fractures and 500,000 hospitalizations annually. Osteoporosis-related fractures increase mortality and reduce quality of life. Calcitriol, the active form of vitamin D, regulates intestinal calcium absorption, among other actions. During the past four decades, many clinical trials investigating the effect of calcitriol on bone loss have been performed.We conducted a systematic qualitative review of clinical trials that assessed calcitriol for the treatment of osteoporosis and bone loss. In these clinical trials, calcitriol was used as a monotherapy and in combination with other therapeutic bone agents.Studies using calcitriol monotherapy, although not conclusive, found that calcitriol slowed the rate of bone loss in a variety of populations. Calcitriol in combination with other therapeutic bone agents was shown to have additional bone-preserving effects when compared to the use of therapeutic bone agents alone. A common side-effect of calcitriol therapy was hypercalcemia and hypercalciuria, but the degree of hypercalcemia was mild. Recent research found that intermittent dosing can reduce hypercalcemia rates. Calcitriol, alone or in combination with other agents, should be considered for the therapy of osteoporosis.

    View details for DOI 10.1007/s00198-009-1136-2

    View details for Web of Science ID 000280137000003

    View details for PubMedID 19960185

  • Effects of a Structured Weight-Bearing Exercise Program on Bone Metabolism Among Breast Cancer Survivors: A Feasibility Trial CLINICAL BREAST CANCER Peppone, L. J., Mustian, K. M., Janelsins, M. C., Palesh, O. G., Rosier, R. N., Piazza, K. M., Purnell, J. Q., Darling, T. V., Morrow, G. R. 2010; 10 (3): 224-229


    Treatments for breast cancer, specifically hormonal therapy, accelerate bone loss (BL) among breast cancer survivors, leading to osteoporosis and an increase in fracture risk. Tai Chi Chuan (TCC) is a moderate form of weight-bearing exercise, equivalent to walking, and it has been shown to improve aerobic capacity and strength among breast cancer survivors and might also be effective in slowing bone loss in breast cancer survivors. This pilot study compared the influence of TCC with that of standard support therapy (ST; exercise control) on BL biomarkers among breast cancer survivors.Randomly assigned breast cancer survivors (N = 16; median age, 53 years; < 30 months after treatment) completed 12 weeks (3 times per week, 60 minutes per session) of TCC or ST. Serum levels of N-telopeptides of type I collagen (NTx), a marker of bone resorption, and bone-specific alkaline phosphatase (BSAP), a marker of bone formation, were determined according to enzyme-linked immunosorbent assay at baseline and after the intervention.Using analysis of covariance, survivors in the TCC group experienced a greater increase in levels of bone formation (BSAP [microg/L]: before, 8.3; after, 10.2; change, 1.9 microg/L and 22.4%), compared with survivors in ST (BSAP [microg/L]: before, 7.6; after, 8.1; change, 0.5 microg/L [6.3%]). Survivors in the TCC group also experienced a significant decrease in bone resorption (NTx [nanomoles bone collagen equivalent; nmBCE]: before, 17.6; after, 11.1; change, -6.5 nmBCE; -36.9%), whereas women in the ST group did not (NTx [nmBCE]: before, 20.8; after, 18.8; change, -2.0 nmBCE; -9.6%).This pilot study suggests that weight-bearing exercise exerts positive effects on BL, through increased bone formation and decreased bone resorption. Further examinations of the influence of TCC on bone health are warranted.

    View details for DOI 10.3816/CBC.2010.n.030

    View details for Web of Science ID 000278020400007

    View details for PubMedID 20497921

  • Social and cultural factors are related to perceived colorectal cancer screening benefits and intentions in African Americans JOURNAL OF BEHAVIORAL MEDICINE Purnell, J. Q., Katz, M. L., Andersen, B. L., Palesh, O., Figueroa-Moseley, C., Jean-Pierre, P., Bennett, N. 2010; 33 (1): 24-34


    Models that explain preventive behaviors, such as colorectal cancer (CRC) screening, do not account for social and cultural factors relevant to African Americans. This exploratory study examined the relationship between socio-cultural factors (e.g., traditional acculturative strategy, group-based medical mistrust, physician ethnicity, and group-level perceptions of susceptibility) and perceived benefits, perceived barriers, and CRC screening intentions among African Americans (N = 198; Age: M = 59.7, SD = 9.9; 65% female; 44% household income $50,000+). Hierarchical multiple regression was used to test the following models with perceived benefits, perceived barriers, and screening intentions as the outcomes: (a) traditional acculturative strategy x medical mistrust; (b) physician's ethnicity x medical mistrust; (c) group susceptibility x medical mistrust; and (d) group susceptibility x traditional acculturative strategy. Results revealed that perceiving high group susceptibility while being both more culturally traditional and less mistrustful was associated with more perception of screening benefits. Greater intention to be screened was associated with perceiving high group susceptibility while having a more traditional cultural orientation and low levels of mistrust in those with African American physicians. These results suggest that it may be beneficial to include these social and cultural factors in behavioral interventions to increase CRC screening among African Americans.

    View details for DOI 10.1007/s10865-009-9231-6

    View details for Web of Science ID 000274088100003

    View details for PubMedID 19876727

  • Prevalence, Demographics, and Psychological Associations of Sleep Disruption in Patients With Cancer: University of Rochester Cancer Center-Community Clinical Oncology Program JOURNAL OF CLINICAL ONCOLOGY Palesh, O. G., Roscoe, J. A., Mustian, K. M., Roth, T., Savard, J., Ancoli-Israel, S., Heckler, C., Purnell, J. Q., Janelsins, M. C., Morrow, G. R. 2010; 28 (2): 292-298


    Sleep disruption is prevalent in patients with cancer and survivors, but the prevalence of insomnia, a distressing sleep disorder, in these populations has yet to be determined in large-scale studies.A total of 823 patients with cancer receiving chemotherapy (mean age, 58 years; 597 female patients) reported on sleep difficulties in a prospective study.During day 7 of cycle 1 of chemotherapy, 36.6% (n = 301) of the patients with cancer reported insomnia symptoms, and 43% (n = 362) met the diagnostic criteria for insomnia syndrome. Patients with cancer younger than 58 years were significantly more likely to experience either symptoms of insomnia or insomnia syndrome (chi(2) = 13.6; P = .0002). Patients with breast cancer had the highest number of overall insomnia complaints. A significant positive association was found between symptoms of insomnia during cycles 1 and 2 of chemotherapy (phi = .62, P < .0001), showing persistence of insomnia during the first two cycles of chemotherapy. Sixty percent of the patient sample reported that their insomnia symptoms remained unchanged from cycle 1 to cycle 2. Those with insomnia complaints had significantly more depression and fatigue than good sleepers (all P < .0001).The proportions of patients with cancer in this sample reporting symptoms of insomnia and meeting diagnostic criteria for insomnia syndrome during chemotherapy are approximately three times higher than the proportions reported in the general population. Insomnia complaints persist throughout the second chemotherapy cycle for the majority of patients with cancer in this study. Insomnia is prevalent, underrecognized, undermanaged, and understudied among patients with cancer receiving chemotherapy.

    View details for DOI 10.1200/JCO.2009.22.5011

    View details for Web of Science ID 000273418000019

    View details for PubMedID 19933917

  • Exercise for the Management of Side Effects and Quality of Life Among Cancer Survivors CURRENT SPORTS MEDICINE REPORTS Mustian, K. M., Sprod, L. K., Palesh, O. G., Peppone, L. J., Janelsins, M. C., Mohile, S. G., Carroll, J. 2009; 8 (6): 325-330


    Physical activity may play an important role in the rehabilitation of cancer survivors during and after treatment. Current research suggests that numerous beneficial outcomes are experienced in cancer survivors undergoing exercise interventions during or after cancer treatment. Exercise not only plays a role in managing side effects but also improves functional capacity and quality of life. The purpose of this article is to provide an overview of the oncology literature supporting the use of exercise as an effective intervention for improving cancer-related fatigue, other side effects, functional capacity, and quality of life among cancer survivors.

    View details for DOI 10.1249/JSR.0b013e3181c22324

    View details for Web of Science ID 000275667500010

    View details for PubMedID 19904073

  • A 4-week home-based aerobic and resistance exercise program during radiation therapy: a pilot randomized clinical trial. The journal of supportive oncology Mustian, K. M., Peppone, L., Darling, T. V., Palesh, O., Heckler, C. E., Morrow, G. R. 2009; 7 (5): 158-167


    During radiation therapy, cancer patients may report cancer-related fatigue (CRF), which impairs aerobic capacity, strength, muscle mass, and, ultimately, quality of life (QOL). The purpose of this pilot clinical trial was to examine the feasibility and initial efficacy of a home-based aerobic and progressive resistance exercise intervention for aerobic capacity, strength, muscle mass, CRF, and QOL. Daily steps walked (DSW), daily minutes of resistance exercise (MRE), and number of resistance exercise days (RED) were assessed to evaluate intervention adherence. Breast and prostate cancer patients (n = 38) beginning radiation therapy were randomized to undergo 4 weeks of exercise or no exercise. Participants in the exercise group demonstrated good adherence to the exercise intervention, with significantly more DSW, MRE, and RED at post intervention and 3 month follow-up than controls. Participants in the exercise intervention exhibited significantly higher QOL and significantly lower CRF post intervention and at 3-month follow-up than controls. Results of this pilot study provide positive preliminary evidence that exercise during radiation may be beneficial for cancer patients.

    View details for PubMedID 19831159

  • Effects of Supportive-Expressive Group Therapy on Pain in Women With Metastatic Breast Cancer 52nd Annual Meeting of the Society-for-Clinical-and-Experimental-Hypnosis Butler, L. D., Koopman, C., Neri, E., Giese-Davis, J., Palesh, O., Thorne-Yocam, K. A., DiMiceli, S., Chen, X., Fobair, P., Kraemer, H. C., Spiegel, D. AMER PSYCHOLOGICAL ASSOC. 2009: 579?87


    To examine whether a group intervention including hypnosis can reduce cancer pain and trait hypnotizability would moderate these effects.This randomized clinical trial examined the effects of group therapy with hypnosis (supportive-expressive group therapy) plus education compared to an education-only control condition on pain over 12 months among 124 women with metastatic breast cancer.Pain and suffering, frequency of pain, and degree of constant pain were assessed at baseline and 4-month intervals. Those in the treatment group also reported on their experiences using the hypnosis exercises.Intention-to-treat analyses indicated that the intervention resulted in significantly less increase in the intensity of pain and suffering over time, compared to the education-only group, but had no significant effects on the frequency of pain episodes or amount of constant pain, and there was no interaction of the intervention with hypnotizability. Within the intervention group, highly hypnotizable participants, compared to those less hypnotizable, reported greater benefits from hypnosis, employed self-hypnosis more often outside of group, and used it to manage other symptoms in addition to pain.These results augment the growing literature supporting the use of hypnosis as an adjunctive treatment for medical patients experiencing pain.

    View details for DOI 10.1037/a0016124

    View details for Web of Science ID 000269832800009

    View details for PubMedID 19751084

  • Sexual Adjustment and Body Image Scale (SABIS): A New Measure for Breast Cancer Patients BREAST JOURNAL Dalton, E. J., Rasmussen, V. N., Classen, C. C., Grumann, M., Palesh, O. G., Zarcone, J., Kraemer, H. C., Kirshner, J. J., Colman, L. K., Morrow, G. R., Spiegel, D. 2009; 15 (3): 287-290


    The purpose of this study was to develop and validate a self-report measure of body image and sexual adjustment in breast cancer patients: the Sexual Adjustment and Body Image Scale (SABIS). Three hundred and fifty three women diagnosed with primary breast cancer that had completed initial surgical treatment completed the SABIS and five measures of psychological, psychosocial, and sexual functioning. Psychometric properties of the SABIS were examined and it was found to be a reliable and valid means of assessing body image and sexuality in breast cancer patients following surgery.

    View details for DOI 10.1111/j.1524-4741.2009.00718.x

    View details for Web of Science ID 000265899300011

    View details for PubMedID 19645784

  • Associations between adult and childhood secondhand smoke exposures and fecundity and fetal loss among women who visited a cancer hospital TOBACCO CONTROL Peppone, L. J., Piazza, K. M., Mahoney, M. C., Morrow, G. R., Mustian, K. M., Palesh, O. G., Hyland, A. 2009; 18 (2): 115-120


    A large percentage of the population continues to be exposed to secondhand smoke (SHS). Although studies have consistently linked active smoking to various pregnancy outcomes, results from the few studies examining SHS exposure and pregnancy difficulties have been inconsistent.Approximately 4800 women who presented to Roswell Park Cancer Institute between 1982 and 1998 and reported being pregnant at least once were queried about their childhood and adult exposures to SHS using a standardised questionnaire. Women were asked to report on selected prenatal pregnancy outcomes (fetal loss and difficulty becoming pregnant).Approximately 11.3% of women reported difficulty becoming pregnant, while 32% reported a fetal loss or 12.4% reported multiple fetal losses. 40% reported any prenatal pregnancy difficulty (fetal loss and/or difficulty becoming pregnant). SHS exposures from their parents were associated with difficulty becoming pregnant (OR = 1.27, 95% CI 1.03 to 1.56) and lasting >1 year (OR = 1.34, 95% CI 1.12 to 1.60). Exposure to SHS in both at home during childhood and at the time of survey completion was also associated with fetal loss (OR = 1.39, 95% CI 1.17 to 1.66) and multiple fetal losses (OR = 1.62, 95% CI 1.25 to 2.11). Increasing current daily hours of SHS exposure as an adult was related to the occurrence of both multiple fetal loss and reduced fecundity (p(trend) < 0.05).Reports of exposures to SHS during childhood and as an adult were associated with increased odds for prenatal pregnancy difficulties. These findings underscore the public health perspective that all people, especially women in their reproductive years, should be fully protected from tobacco smoke.

    View details for DOI 10.1136/tc.2008.027961

    View details for Web of Science ID 000264518700019

    View details for PubMedID 19039010

  • The Cancer and Deity Questionnaire: A New Religion and Cancer Measure JOURNAL OF PSYCHOSOCIAL ONCOLOGY Bowman, E. S., Beitman, J. A., Palesh, O., Perez, J. E., Koopman, C. 2009; 27 (4): 435-453


    We evaluated a new measure, the Cancer and Deity Questionnaire (CDQ), which assesses perceived relations with God after a cancer diagnosis. Based on object relations theory, the 12-item CDQ assesses benevolent and abandoning God representations. Sixty-one older participants with recent cancer diagnoses completed the questionnaire at baseline, and 52 of these participants completed the same questionnaire at follow-up. Internal consistency was excellent for the Benevolence scale (alpha = .97) and good for the Abandonment scale (alpha = .80). Moderate correlations with the Spiritual Well-Being Scale support divergent validity. Correlations between CDQ scales and the Styles of Religious Coping scales support convergent validity. The CDQ is brief, easily scored, practical for psycho-oncology research, and adaptable for use with other illnesses.

    View details for DOI 10.1080/07347330903181913

    View details for Web of Science ID 000270592800004

    View details for PubMedID 19813134

  • Exercise and Cancer-related Fatigue. US oncology Mustian, K. M., Peppone, L. J., Palesh, O. G., Janelsins, M. C., Mohile, S. G., Purnell, J. Q., Darling, T. V. 2009; 5 (2): 20-23


    Cancer-related fatigue is the most common side effect reported by cancer patients during and after treatment. Cancer-related fatigue significantly interferes with a patient's ability to perform activities of daily living and maintain functional independence and quality of life. Cancer-related fatigue can also interfere with a patient's ability to complete treatments. The purpose of this article is to provide an overview of cancer-related fatigue, its pathopsychophysiology, and the role of exercise in the management of this side effect.

    View details for PubMedID 21853012

  • Cancer Survivorship and Aging Moving the Science Forward Society-of-Behavioral-Medicine Preconference on Cancer and Aging - Challenges and Opportunities Across the Cancer Control Continuum Bellizzi, K. M., Mustian, K. M., Palesh, O. G., Diefenbach, M. WILEY-BLACKWELL. 2008: 3530?39


    Given the high incidence and prevalence of cancer in older adults and the anticipated growth of this population over the next few decades, oncologists, geriatricians, and primary care providers will be challenged to provide timely and appropriate post-treatment care to a diverse population of older cancer survivors. To the authors' knowledge to date, few post-treatment epidemiologic or clinical trial studies have investigated the mental, social, and physical health issues among older cancer survivors. For this article, the authors reviewed the behavioral oncology, gerontology, geriatric, and psychology literature on cancer survivorship and aging. This report highlights several methodologic challenges that investigators face when conducting epidemiologic and cancer clinical trial research with older cancer survivors after treatment. These challenges must be considered and overcome to develop an informative body of scientific knowledge to address the post-treatment healthcare needs of this growing population. Future research directions, new models of care, and the need for transdisciplinary approaches are discussed.

    View details for DOI 10.1002/cncr.23942

    View details for Web of Science ID 000261744100007

    View details for PubMedID 19058147

  • Vagal regulation, cortisol, and sleep disruption in women with metastatic breast cancer. Journal of clinical sleep medicine Palesh, O., Zeitzer, J. M., Conrad, A., Giese-Davis, J., Mustian, K. M., Popek, V., Nga, K., Spiegel, D. 2008; 4 (5): 441-449


    To determine the relationship between hypothalamic pituitary axis (HPA) dysregulation, vagal functioning, and sleep problems in women with metastatic breast cancer.Sleep was assessed by means of questionnaires and wrist actigraphy for 3 consecutive nights. The ambulatory, diurnal variation in salivary cortisol levels was measured at 5 time points over 2 days. Vagal regulation was assessed via respiratory sinus arrhythmia (RSA(TF)) during the Trier Social Stress Task.Ninety-nine women (54.6 +/- 9.62 years) with metastatic breast cancer.Longer nocturnal wake episodes (r = 0.21, p = 0.04, N=91) were associated with a flatter diurnal cortisol slope. Sleep disruption was also associated with diminished RSA(TF). Higher RSA baseline scores were significantly correlated with higher sleep efficiency (r = 0.39, p = 0.001, N=68) and correspondingly lower levels of interrupted sleep (waking after sleep onset, WASO; r = -0.38, p = 0.002, N=68), lower average length of nocturnal wake episodes (r = -0.43, p < 0.001, N=68), and a lower self-reported number of hours of sleep during a typical night (r = -0.27, p = 0.02, N=72). Higher RSA AUC was significantly related to higher sleep efficiency (r = 0.45, p < 0.001, N=64), and a correspondingly lower number of wake episodes (r = -0.27, p = 0.04, N=64), lower WASO (r = -0.40, p = 0.001, N=64), and with lower average length of nocturnal wake episodes (r = -0.41, p = 0.001, N=64). While demographics, disease severity, and psychological variables all explained some portion of the development of sleep disruption, 4 of the 6 sleep parameters examined (sleep efficiency, WASO, mean number of waking episodes, average length of waking episode) were best explained by RSA.These data provide preliminary evidence for an association between disrupted nocturnal sleep and reduced RSA the subsequent day, confirming an association between disrupted nocturnal sleep and flattened diurnal cortisol rhythm in women with metastatic breast cancer. They suggest that the stress-buffering effects of sleep may be associated with improved parasympathetic tone and normalized cortisol patterns during the day.

    View details for PubMedID 18853702

  • Supportive-expressive group therapy for primary breast cancer patients: a randomized prospective multicenter trial PSYCHO-ONCOLOGY Classen, C. C., Kraemer, H. C., Blasey, C., Giese-Davis, J., Koopman, C., Palesh, O. G., Atkinson, A., DiMiceli, S., Stonisch-Riggs, G., Westendorp, J., Morrow, G. R., Spiegel, D. 2008; 17 (5): 438-447


    The aim is to evaluate the effectiveness of a manualized 12-week supportive-expressive group therapy program among primary breast cancer patients treated in community settings, to determine whether highly distressed patients were most likely to benefit and whether therapist's training or experience was related to outcome.Three hundred and fifty-three women within one year of diagnosis with primary breast cancer were randomly assigned to receive supportive-expressive group therapy or to an education control condition. Participants were recruited from two academic centers and nine oncology practices, which were members of NCI's Community Clinical Oncology Program (CCOP) and were followed over 2 years.A 2x2x19 analysis of variance was conducted with main effects of treatment condition, cohort, and baseline distress and their interactions. There was no main effect for treatment condition after removing one subject with an extreme score. Highly distressed women did not derive a greater benefit from treatment. Therapist training and psychotherapy experience were not associated with a treatment effect.This study provides no evidence of reduction in distress as the result of a brief supportive-expressive intervention for women with primary breast cancer. Future studies might productively focus on women with higher initial levels of distress.

    View details for DOI 10.1002/pon.1280

    View details for Web of Science ID 000256463200003

    View details for PubMedID 17935144

  • Tai Chi Chuan for breast cancer survivors. Medicine and sport science Mustian, K. M., Palesh, O. G., Flecksteiner, S. A. 2008; 52: 209-217


    Treatment for breast cancer produces side effects that diminish functional capacity and quality of life (QOL) among survivors. Tai Chi Chuan (TCC) is a moderate form of exercise that may improve functional capacity and QOL in these individuals. Women who completed treatment for breast cancer were randomized to receive TCC or psychosocial support therapy for 12 weeks (60 min; three times weekly).The TCC group demonstrated significant improvements in functional capacity, including aerobic capacity, muscular strength, and flexibility, as well as QOL; the psychosocial support therapy group showed significant improvements only in flexibility, with declines in aerobic capacity, muscular strength, and QOL.The TCC group exhibited significant improvements in functional capacity and QOL. These data suggest that TCC may enhance functional capacity and QOL among breast cancer survivors.

    View details for DOI 10.1159/000134301

    View details for PubMedID 18487900

  • Vagal Regulation, Cortisol, and Sleep Disruption in Women with Metastatic Breast Cancer JOURNAL OF CLINICAL SLEEP MEDICINE Palesh, O., Zeitzer, J. M., Conrad, A., Giese-Davis, J., Mustian, K. M., Popek, V., Nga, K., Spiegel, D. 2008; 4 (5): 441-449
  • Les experiences traumatiques chez les enfants et le desir de vivre pendant la vie [History of child sexual abuse and risk of suicide.]. Revue Francophone du Stress & Trauma Spiegel, D., Palesh, O 2008; 8 (3): 197-204
  • Stress history and breast cancer recurrence JOURNAL OF PSYCHOSOMATIC RESEARCH Palesh, O., Butler, L. D., Koopman, C., Giese-Davis, J., Carlson, R., Spiegel, D. 2007; 63 (3): 233-239


    There is mixed evidence regarding the possible association between a history of stressful or traumatic life events and more rapid breast cancer progression.Retrospective reports of past experiences of traumatic life events were assessed among 94 women with metastatic or recurrent breast cancer. A traumatic event assessment was conducted using the event-screening question from the posttraumatic stress disorder (PTSD) module of the Structured Clinical Interview for the DSM-IV-TR (SCID; 2002). Each reported event was judged by two independent raters to determine whether it met DSM-IV-TR PTSD A1 criteria for a traumatic event. Those events that did not meet such criteria were designated "stressful events."Nearly 42% of the women in the sample were judged to have experienced one or more traumatic events; 28.7% reported only stressful events. A Kruskal-Wallis test found significant differences in disease-free interval among the three groups [chi2 (2, N=94)=6.09, P<.05]. Planned comparisons revealed a significantly longer disease-free interval among women who had reported no traumatic or stressful life events (median=62 months) compared to those who had experienced one or more stressful or traumatic life events (combined median=31 months).A history of stressful or traumatic life events may reduce host resistance to tumor growth. These findings are consistent with a possible long-lasting effect of previous life stress on stress response systems such as the hypothalamic-pituitary-adrenal (HPA) axis.

    View details for DOI 10.1016/jjpsychores.2007.05.012

    View details for Web of Science ID 000249309300003

    View details for PubMedID 17719359

  • A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer BIOLOGICAL PSYCHOLOGY Palesh, O. G., Collie, K., Batiuchok, D., Tilston, J., Koopman, C., Perlis, M. L., Butler, L. D., Carlson, R., Spiegel, D. 2007; 75 (1): 37-44


    Sleep disturbances are common among women with breast cancer and can have serious consequences. The present study examined depression, pain, life stress, and participation in group therapy in relation to sleep disturbances in a sample of women with metastatic breast cancer.Ninety-three women with metastatic breast cancer participated in a large intervention trial examining the effect of the group therapy on their symptoms. They completed measures of depression, pain, life stress, and sleep disturbance at baseline, 4, 8 and 12 months.The results showed that higher initial levels of depression at baseline predicted problems associated with getting up in the morning, waking up during the night, and daytime sleepiness. Increases in depression over the course of 12 months were associated with fewer hours of sleep, more problems with waking up during the night and more daytime sleepiness. Higher levels of pain at baseline predicted more problems getting to sleep. Increases in pain predicted more difficulty getting to sleep and more problems waking up during the night. Greater life stress at baseline predicted more problems getting to sleep and more daytime sleepiness.Depression, pain, and life stress scores were each associated with different types of negative change in self-reported sleep disturbances. Depression, especially worsening depression, was associated with the greatest number of types of negative change. The relationships found between sleep disturbance and depression, pain, and life stress suggest specific ways to address the problem of sleep disturbance for women with metastatic breast cancer and show how different types of disturbed sleep may be clinical markers for depression, pain, or life stress in this population.

    View details for DOI 10.1016/j.biopsycho.2006.11.002

    View details for Web of Science ID 000245832000006

    View details for PubMedID 17166646

  • Relationships of depression to child and adult abuse and bodily pain among women who have experienced intimate partner violence JOURNAL OF INTERPERSONAL VIOLENCE Koopman, C., Ismailji, T., Palesh, O., Gore-Felton, C., Narayanan, A., Saltzman, K. M., Holmes, D., McGarvey, E. L. 2007; 22 (4): 438-455


    This study investigates whether depression in women who experienced intimate partner violence is associated with having also experienced childhood sexual and physical abuse, psychological abuse by an intimate partner, recent involvement with the abusive partner, and bodily pain. Fifty-seven women who had left a violent relationship with an intimate partner completed measures assessing their demographic characteristics, experiences of abuse in childhood and in their relationship with their intimate partner, and depressive symptoms. Multiple regression analysis showed that women's depression was significantly greater among those who had experienced childhood physical and sexual abuse, more severe psychological abuse, and greater bodily pain (p<.001), adjusted R(2)=.32. These results suggest characteristics that can help to identify abused women who are most at risk for depression, and they suggest specific issues that may need to be addressed in this population.

    View details for DOI 10.1177/0886260506297028

    View details for Web of Science ID 000244936300005

    View details for PubMedID 17369446

  • Behavioral interventions in treating anticipatory nausea and vomiting. Journal of the National Comprehensive Cancer Network Figueroa-Moseley, C., Jean-Pierre, P., Roscoe, J. A., Ryan, J. L., Kohli, S., Palesh, O. G., Ryan, E. P., Carroll, J., Morrow, G. R. 2007; 5 (1): 44-50


    Anticipatory nausea and vomiting (ANV) is associated with a significant reduction in the quality of life for many chemotherapy patients. The use of 5-hydroxytryptamine type 3 receptor antagonists provides some relief for chemotherapy-induced nausea and vomiting, but does not seem to control ANV. Nonpharmacologic approaches, which include behavioral interventions, may provide the greatest promise in relieving symptoms. Little evidence supports the use of complementary and alternative methods, such as acupuncture and acupressure, in relieving ANV. Behavioral interventions, especially progressive muscle relaxation training and systematic desensitization, should be considered important methods for preventing and treating ANV.

    View details for PubMedID 17239325

  • Scientific study of the dissociative disorders PSYCHOTHERAPY AND PSYCHOSOMATICS Dalenberg, C., Loewenstein, R., Spiegel, D., Brewin, C., Lanius, R., Frankel, S., Gold, S., Van der Kolk, B., Simeon, D., Vermetten, E., Butler, L., Koopman, C., Courtois, C., Dell, P., Nijenhuis, E., Chu, J., Sar, V., Palesh, O., Cuevas, C., Paulson, K. 2007; 76 (6): 400-401

    View details for DOI 10.1159/000107570

    View details for Web of Science ID 000250094100013

    View details for PubMedID 17917478

  • The relationship of child maltreatment and self-capacities with distress when telling one's story of childhood sexual abuse. Journal of child sexual abuse Palesh, O., Classen, C. C., Field, N., Kraemer, H. C., Spiegel, D. 2007; 16 (4): 63-80


    This study examined the impact of telling one's story of childhood sexual abuse and its relationship with the survivor's self-capacities and history of other child maltreatment. The baseline data were collected from 134 female CSA survivors who were participating in a large intervention study. Participants were given 10 minutes to describe their childhood sexual abuse and completed a post-interview questionnaire assessing post-traumatic stress symptoms and their emotional response. The distress in response to their narrative was both predicted and mediated by the survivors' self-capacities and other forms of child maltreatment beyond child sexual abuse.

    View details for PubMedID 18032246

  • Cancer-related fatigue and sleep disorders ONCOLOGIST Roscoe, J. A., Kaufman, M. E., Matteson-Rusby, S. E., Palesh, O. G., Ryan, J. L., Kohli, S., Perlis, M. L., Morrow, G. R. 2007; 12: 35-42


    Sleep disorders, such as difficulty falling asleep, problems maintaining sleep, poor sleep efficiency, early awakening, and excessive daytime sleepiness, are prevalent in patients with cancer. Such problems can become chronic in some patients, persisting for many months or years after completion of cancer therapy. For patients with cancer, sleep is potentially affected by a variety of factors, including the biochemical changes associated with the process of neoplastic growth and anticancer treatments, and symptoms that frequently accompany cancer, such as pain, fatigue, and depression. Fatigue is highly prevalent and persistent in patients with cancer and cancer survivors. Although cancer-related fatigue and cancer-related sleep disorders are distinct, a strong interrelationship exists between these symptoms, and a strong possibility exists that they may be reciprocally related. The majority of studies that have assessed both sleep and fatigue in patients with cancer provide evidence supporting a strong correlation between cancer-related fatigue and various sleep parameters, including poor sleep quality, disrupted initiation and maintenance of sleep, nighttime awakening, restless sleep, and excessive daytime sleepiness. This paper reviews the data from these studies with a view toward suggesting further research that could advance our scientific understanding both of potential interrelationships between sleep disturbance and cancer-related fatigue and of clinical interventions to help with both fatigue and sleep disturbance. Disclosure of potential conflicts of interest is found at the end of this article.

    View details for DOI 10.1634/theoncologist.12-S1-35

    View details for Web of Science ID 000247421300005

    View details for PubMedID 17573454

  • Assessment of cancer-related fatigue: Implications for clinical diagnosis and treatment ONCOLOGIST Jean-Pierre, P., Figueroa-Moseley, C. D., Kohli, S., Fiscella, K., Palesh, O. G., Morrow, G. R. 2007; 12: 11-21


    Cancer-related fatigue (CRF) is a highly prevalent and debilitating symptom experienced by most cancer patients during, and often for considerable periods after, treatment. The recognition of the importance of CRF to patients' psychosocial and cognitive functioning, as well as to their quality of life, has driven the development of a wide range of assessment tools for screening and diagnosis of CRF. Over 20 different measures have been used to assess CRF from either a unidimensional or multi-dimensional perspective. Unidimensional measures are often single-question scales that generally focus on identifying the occurrence and severity of CRF, whereas multidimensional measures may also examine the effect of CRF across several domains of physical, socio-emotional, and cognitive functioning. This paper provides an overview and critique of measures commonly used to assess CRF. Single-question assessment is the most commonly used and the most useful methodology. Strategies to facilitate reliable assessment of CRF are also discussed. Disclosure of potential conflicts of interest is found at the end of this article.

    View details for DOI 10.1634/theoncologist.12-S1-11

    View details for Web of Science ID 000247421300003

    View details for PubMedID 17573452

  • A preliminary study of peritraumatic dissociation, social support, and coping in relation to posttraumatic stress symptoms for a parent's cancer PSYCHO-ONCOLOGY Wong, M., Looney, E., Michaels, J., Palesh, O., Koopman, C. 2006; 15 (12): 1093-1098


    This study examined predictors of posttraumatic stress disorder (PTSD) symptoms in adults who, as children, had a parent diagnosed with cancer. Possible predictors of adulthood PTSD examined were peritraumatic dissociation, satisfaction with social support, coping through denial, behavioral disengagement and self-distraction, and whether or not the parent died. Thirty research participants (20 women and 10 men, ages 18-38) were recruited who were 8-17-years old at the time of a parent's cancer diagnosis. Each participant completed measures of their current PTSD symptoms in response to their parent's cancer, peritraumatic dissociative experiences, demographic characteristics, and satisfaction with social support and use of coping strategies at the time of their parent's cancer diagnosis. Seventeen percent met screening criteria for likely PTSD. As hypothesized, PTSD symptoms were strongly and positively correlated with peritraumatic dissociation. Furthermore, PTSD symptoms were greater among females and were related to greater use of denial and behavioral disengagement and to less satisfaction with social support. These results suggest that health care providers need to recognize symptoms of peritraumatic dissociation in the children of parents who are diagnosed with cancer so that steps can be taken to minimize the children's development of PTSD that may extend into their adult lives.

    View details for DOI 10.1002/pon.1041

    View details for Web of Science ID 000243543500007

    View details for PubMedID 16548023

  • Emotional self-efficacy, stressful life events, and satisfaction with social support in relation to mood disturbance among women living with breast cancer in rural communities BREAST JOURNAL Palesh, O. G., Shaffer, T., Larson, J., Edsall, S., Chen, X. H., Koopman, C., Turner-Cobb, J. M., Kreshka, M. A., Graddy, K., PARSONS, R. 2006; 12 (2): 123-129


    This study evaluated the relationships of emotional self-efficacy, stressful life events, and social support with mood disturbance among women diagnosed with breast cancer who live in rural communities. Eighty-two women completed measures of demographic characteristics, medical status, and psychosocial variables. Using multiple regression analysis, we found that greater mood disturbance was related to having less emotional self-efficacy (p < 0.001) and to having experienced more stressful life events (p = 0.02), while satisfaction with social support was not significantly related to mood disturbance (adjusted R2 = 0.39). Women living with breast cancer in rural communities who have experienced multiple stressful life events may have an increased risk for mood disturbance, whereas having greater emotional self-efficacy may provide resilience against mood disturbance.

    View details for Web of Science ID 000235821000005

    View details for PubMedID 16509836

  • Evidence for a dissociative subtype of post-traumatic stress disorder among help-seeking childhood sexual abuse survivors. Journal of trauma & dissociation Ginzburg, K., Koopman, C., Butler, L. D., Palesh, O., Kraemer, H. C., Classen, C. C., Spiegel, D. 2006; 7 (2): 7-27


    This study examined evidence for a dissociative subtype of post-traumatic stress disorder (PTSD) among women seeking psychotherapy for childhood sexual abuse (CSA). One hundred and twenty-two women seeking treatment for CSA completed a battery of questionnaires assessing PTSD, dissociative symptoms, and child maltreatment. Using signal detection analysis, we identified high and low dissociation PTSD subgroups. A constellation of three PTSD symptoms-hypervigilance, sense of foreshortened future, and sleep difficulties-discriminated between these two subgroups (OR = 8.15). Further evidence was provided by the finding of a nonlinear relationship between severity of childhood maltreatment and dissociation in the women with PTSD. These results provide support for a dissociative subtype of PTSD that may stem from more severe childhood experiences of neglect and abuse.

    View details for PubMedID 16769663

  • The Effects of Watching Michael Moore's Fahrenheit 9/11 on Voting Intentions, Mood, and Beliefs About Why President Bush and His Administration Initiated War in Iraq. Peace and Conflict: Journal of Peace Psychology Koopman, C., Butler, Lisa D.; Palesh , Oxana; McDermott, Rose; Forero-Puerta, Tatiana; Das, Bibi; Poindexter, Tracy; Endress, Patrick 2006; 12 (2): 139-156
  • Sexual revictimization: A review of the empirical literature TRAUMA VIOLENCE & ABUSE Classen, C. C., Palesh, O. G., Aggarwal, R. 2005; 6 (2): 103-129


    This article reviews the literature on sexual revictimization, covering approximately 90 empirical studies and includes a discussion of prevalence, risk factors, and correlates of sexual revictimization. Research suggests that two of three individuals who are sexually victimized will be revictimized. The occurrence of childhood sexual abuse and its severity are the best documented and researched predictors of sexual revictimization. Multiple traumas, especially childhood physical abuse, and recency of sexual victimization are also associated with higher risk. There is preliminary evidence that membership in some ethnic groups or coming from a dysfunctional family places an individual at a greater risk. Revictimization is associated with higher distress and certain psychiatric disorders. People who were revictimized show difficulty in interpersonal relationships, coping, self-representations, and affect regulation and exhibit greater self-blame and shame. Existing research on prevention efforts and treatment is discussed. More longitudinal studies on sexual revictimization are needed.

    View details for DOI 10.1177/1524838005275087

    View details for Web of Science ID 000235490400002

    View details for PubMedID 15753196

  • The effects of expressive writing on pain, depression and posttraumatic stress disorder symptoms in survivors of intimate partner violence JOURNAL OF HEALTH PSYCHOLOGY Koopman, C., Ismailji, T., Holmes, D., Classen, C. C., Palesh, O., Wales, T. 2005; 10 (2): 211-221


    This study examined the effects of expressive writing on depression, posttraumatic stress disorder (PTSD) and pain symptoms among women who have survived intimate partner violence (IPV). Forty-seven women completed baseline and four-month follow-up assessments and were randomly assigned to four writing sessions of either expressive writing focused on traumatic life events or writing about a neutral topic. Main effects were not significant for changes in depression, pain or PTSD symptoms. However, among depressed women, those assigned to expressive writing showed a significantly greater drop in depression. For depressed women with IPV histories, expressive writing may lead to reduced depression.

    View details for DOI 10.1177/1359105305049769

    View details for Web of Science ID 000227154800004

    View details for PubMedID 15723891

  • Internet use and attitudes towards illicit Internet use behavior in a sample of Russian college students CYBERPSYCHOLOGY & BEHAVIOR Palesh, O., Saltzman, K., Koopman, C. 2004; 7 (5): 553-558


    This study assessed Internet use and attitudes toward illicit use of the Internet in a sample of Russian college students. A sample comprised of 198 students was recruited from a university in Moscow. Each participant completed a survey assessing demographic characteristics, Internet use, and attitudes towards engaging in illicit behaviors over the Internet. About half of the students reported that they used the Internet at least several times a year, with 8% reporting daily use of the Internet. Among Internet users, most reported having Internet access either at home or at a friends' home, and 16 % reported having Internet access from work, school, or a computer center. Among Internet users, the main purpose was for school-related activities (60%), followed by e-mail (55%), entertainment (50%), chatting (24%), and searching for pornography (6%). Although most students thought it was inappropriate to read someone else's e-mail, use someone else's password or credit card information without their permission, or break into someone's computer, many students did endorse those illicit behaviors. Over a fifth of the students reported that they knew hackers. Forty three percent of students agreed that people make too much fuss about watching videos, movies or downloading music on the Internet without paying. Males were more likely than females to report using the Internet for entertainment purposes (p = 0.006) and were more likely to agree that it was okay to break into someone's computer (p = 0.04). The results of this study suggest that these Russian college students predominately use the Internet to help with their schoolwork, to communicate with others, and for entertainment. These results also suggest that interventions may be useful to change attitudes endorsing illicit uses of the Internet.

    View details for Web of Science ID 000225030000007

    View details for PubMedID 15667050

  • The effects of a mindfulness-based stress reduction program on stress, mindfulness self-efficacy, and positive states of mind STRESS AND HEALTH Chang, V. Y., Palesh, O., Caldwell, R., Glasgow, N., Abramson, M., Luskin, F., Gill, M., Burke, A., Koopman, C. 2004; 20 (3): 141-147

    View details for DOI 10.1002/smi.1011

    View details for Web of Science ID 000223526100006

  • Relationship between child abuse history, trauma, and dissociation in Russian college students CHILD ABUSE & NEGLECT DALENBERG, C. J., Palesh, O. G. 2004; 28 (4): 461-474


    The research was conducted to determine the relationship between violent trauma, child abuse history, and dissociative symptoms in a Russian population.Three hundred and one undergraduate students from Moscow State Linguistics University participated in the study and completed the Dissociation Continuum Scale, the Violence History Questionnaire, the Traumatic Events Survey (TES), and a demographic measure.Scores on dissociation and its subfactors were significantly higher in the Russian sample compared to the normative US group. The best predictors for dissociation were experiencing a violent trauma, child abuse history, and/or the experience of a fearful event. Those participants with a prior child abuse history were more symptomatic after adult trauma than those with no such history.The relationship between trauma/abuse and dissociation is unlikely to be a result of suggestion by therapists or media exposure, since the correlation appears in a Russian population who are relatively unexposed to these suggestive sources. The validity, reliability, and structure of the dissociation measure were relatively similar in American and Russian samples.

    View details for DOI 10.1016/j.chiabu.2003.11.020

    View details for Web of Science ID 000221366100008

    View details for PubMedID 15120926

  • Spellbound: Dissociation and the movies . Journal of Trauma & Dissociation Butler, L., Palesh, Oxana 2004; 5 (2): 61-88
  • Overview of internet development in Russia. Cyberpsychology & behavior Gronskaya-Palesh, O. 1999; 2 (4): 313-319


    Internet use in Russia has been growing steadily. In the last four years the number of Russian Internet users grew from a few hundred thousand to over one million. Russian websites are diverse, and range from educational-informative to purely entertaining. This paper discusses several interesting and controversial Russian websites and possible implications associated with their use. It aims to understand and analyze a typical Internet user in Russia, by answering questions about their interests and demographics. The paper also discusses several other studies that were conducted in Russia on Internet use and looks at the currently available psychological resources on the Russian Internet.

    View details for DOI 10.1089/cpb.1999.2.313

    View details for PubMedID 19178227

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