My clinical focus is the treatment of cancer survivors coping with late/long-term effects including physical, emotional, and interpersonal difficulties. I have expertise providing counseling that address women's health issues, including sexual and reproductive health, and lead the Women's Sexual Health & Cancer clinic within the Center for Integrative Medicine. My research focuses on improving cancer survivorship through better understanding of late/long-term effects, unmet needs, and preferences for support, and through the development of patient-centered behavioral interventions.

Clinical Focus

  • Psychology

Academic Appointments

Boards, Advisory Committees, Professional Organizations

  • Research Advisor, GRYT Health (2016 - Present)
  • Advisory Council Member, Alliance for Fertility Preservation (2016 - Present)
  • Board Member, Stupid Cancer (2017 - Present)

Professional Education

  • Internship: Rush University Medical Center Psychology Internship (2013) IL
  • PhD Training: University of Miami Office of the Registrar (2013) FL
  • Fellowship: Memorial Sloan Kettering Cancer Center NY
  • BS, Tufts University, Psychology (2005)
  • MS, University of Miami, Clinical Psychology (2010)
  • PhD, University of Miami, Clinical Psychology (2013)
  • Postdoctoral Fellow, Memorial Sloan Kettering Cancer Center, Psycho-Oncology (2015)

Research & Scholarship

Current Research and Scholarly Interests

My research focuses on improving cancer survivorship through better understanding of late/long-term effects, unmet needs, and preferences for support, and through the development of theoretically driven, evidence-based behavioral interventions. The overall goal of my work is to improve adjustment, risk management, and quality of life in survivorship, particularly among young adults affected by cancer. This is an underserved patient population, identified as a health disparity group. Much of my work is guided by a self-regulation theoretical framework and rooted in decision-making science to understand how patients make decisions about health and healthcare under conditions of uncertainty and emotional distress. I have applied this framework to inform intervention development around self-management and adherence, fertility and family-building, and financial toxicity barriers to care. I lead quantitative and qualitative studies examining health outcomes and as a part of a broader research trajectory to build interventions that address the numerous, co-occurring, and long-lasting medical, psychosocial, and financial needs after cancer. This work also overlaps with research focusing on the use of digital health platforms to provide tailored, targeted support, and “real world” impact. I work closely with the developers of a cancer peer-to-peer support app to understand user engagement and both the benefit and potential for harm from peer interactions in a digital space. I collaborate with several young adult cancer patient organizations to support patient-centered research and greater research dissemination to patient communities.

Clinical Trials

  • Pilot Study of a Decision Aid Intervention for Family-building After Cancer Recruiting

    This study tests a web-based decision aid and planning too to help young female cancer survivors manage fertility and family-building issues in post treatment survivorship.

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  • Study to Improve Survivorship Care Related to Fertility and Family-building After Cancer Recruiting

    The goal of this research is to explore how a patient decision aid tool (website) given to patients prior to their survivorship care visits, may impact patient-provider communication about fertility and family-building after cancer; and assess the impact of using the tool on patient reported outcomes. The overall purpose of this research is to improve survivorship care by establishing a multi-disciplinary approach to managing cancer and fertility issues and prompt early referral to supportive and medical care resources.

    View full details


All Publications

  • The Impact of Financial Toxicity on Psychological Well-Being, Coping Self-Efficacy, and Cost-Coping Behaviors in Young Adults with Cancer. Journal of adolescent and young adult oncology Thom, B., Benedict, C. 2019


    PURPOSE: The increase in cost-sharing between patients and payers has resulted in financial toxicity in cancer patients, particularly among young adult (YA) patients and survivors (<40 years of age). This study explored financial toxicity and its impact on psychological well-being, self-efficacy for coping with cancer, and cost-coping behaviors among a sample of YA cancer patients and survivors.METHODS: One hundred forty YAs completed an anonymous online survey. The Comprehensive Score for Financial Toxicity measured financial toxicity and the Cancer Behavior Inventory-Brief measured coping self-efficacy. The Patient Health Questionnaire-4 and items from the Impact of Cancer-Young Adult and the Cancer Needs Questionnaire-Young People assessed psychological well-being. A single item assessed cost-coping behaviors (i.e., skipping or delaying treatment because of its cost). Analyses included Pearson and Spearman correlation matrices and multivariate regression modeling.RESULTS: Worse financial toxicity was associated with lower insurance satisfaction (r=0.52, p<0.001), higher levels of depressive and anxiety symptoms (r=-0.42, p<0.001), greater worry (p<0.001), and lower self-efficacy in coping with cancer (i.e., maintaining independence and a positive attitude, r=0.41, p<0.001; coping and stress management, r=0.43, p<0.001; and managing negative effect, r=0.20, p=0.02). In multivariate modeling, financial toxicity related to skipping or delaying treatment and greater anxiety and depression symptomology, controlling for relevant covariates.CONCLUSION: The findings suggest financial toxicity negatively impacts many facets of the YA cancer experience. There is a need to address the cost of cancer care with patients to ensure they are informed about the financial implications of treatment decisions and to support financial planning as needed.

    View details for PubMedID 30817217

  • Family-building decision aid and planning tool for young adult women after cancer treatment: protocol for preliminary testing of a web-based decision support intervention in a single-arm pilot study. BMJ open Benedict, C. n., Ford, J. S., Schapira, L. n., Simon, P. n., Spiegel, D. n., Diefenbach, M. n. 2019; 9 (12): e033630


    Many young adult female (YA-F) cancer survivors who received gonadotoxic therapy will experience fertility problems. After cancer, having a child will often require assisted reproductive technology (ART), surrogacy or adoption. However, there are significant informational, psychosocial, financial and logistical barriers to pursuing these options. Survivors report high rates of decision uncertainty and distress related to family-building decisions. The aim of this study is to pilot test a web-based decision aid and planning tool for family-building after cancer.The pilot study will use a single-arm trial design to test the feasibility and acceptability (aim 1) and obtain effect size estimates of the decision support intervention (aim 2). The target sample size is 100. Participants will include YA-F survivors (aged 18-45 years) who are post-treatment and have not completed desired family-building. A longitudinal prepost design will be conducted. Participants will complete three psychosocial assessment surveys over a 3-month time period to track decisional conflict (primary outcome) and cognitive, emotional, and behavioural functioning (secondary outcomes). After completing the baseline survey (T1; pre-intervention), participants will have access to the decision aid website. Postintervention surveys will be administered at 1-month (T2) and 3-month (T3) follow-up time points. Feasibility and acceptability metrics will be analysed. Pairwise t-tests will test mean scores of outcome variables from T1 to T2. Effect size estimates (Cohen's d) will be calculated. Google analytics will evaluate user engagement with the website over the study period. Baseline and follow-up data will examine measures of feasibility, acceptability and intervention effect size.This will be the first test of a supportive intervention to guide YA-F cancer survivors in family-building decisions and early planning. Study findings will inform intervention development. Future directions will include a randomised controlled trial to test intervention efficacy over a longer time period.NCT04059237; Pre-results.

    View details for DOI 10.1136/bmjopen-2019-033630

    View details for PubMedID 31888941

  • The Audacity of Engagement: Hearing Directly from Young Adults with Cancer on Their Attitudes and Perceptions of Cancer Survivorship and Cancer Survivorship Research. Journal of adolescent and young adult oncology Benedict, C. n., Victorson, D. n., Love, B. n., Fuehrer, D. n., Lazard, A. n., Saffer, A. J., Linscott, T. n., Zachary, M. n. 2018; 7 (1): 103–11


    Young adult (YA) cancer survivors have been historically under-represented in cancer survivorship research, which has contributed to more disparate health outcomes compared with young and older cancer survivors. Using qualitative methods, this study explored YAs' perceptions of cancer survivorship and identified YA-specific barriers and preferences for participation in cancer survivorship research.Individual interviews and focus groups were conducted with YA cancer survivors (N = 19) attending a patient-focused oncology conference. Grounded theory methodology guided analyses by using an inductive data-driven approach to thematic content analysis.Participants averaged 33 years old (standard deviation [SD] = 5.5), were 10 years postdiagnosis (SD = 2.3), and were primarily female (79%). Key cancer survivorship topics included adjusting to a "new normal," staying connected with cancer peers, and dealing with post-treatment medical care. Perceptions of YA survivorship research were mixed. YAs appreciated and were optimistic about the potential for benefit from research. Specific barriers for participation included perceptions of research being inaccessible, overwhelming, and frustrating; participation as inconvenient and burdensome; and researchers being viewed with skepticism and mistrust. They recommended: (1) making age-appropriate, patient-focused changes (e.g., language and design of study materials); (2) increasing participants' control, flexibility, and convenience of procedures; and (3) creating a back-and-forth dialogue between YAs and researchers.We assessed YA survivors' perceptions of YA cancer survivorship and research. Communication strategies are needed to address negative perceptions and perceived barriers to research participation. This includes tailoring of dissemination efforts and developmentally targeted implementation of YA priorities into the research process. Age-specific, patient-focused research practices may foster trust within the YA cancer survivor community and improve research participation.

    View details for DOI 10.1089/jayao.2017.0038

    View details for PubMedID 29022839

  • Body image and sexual function in women after treatment for anal and rectal cancer PSYCHO-ONCOLOGY Benedict, C., Philip, E. J., Baser, R. E., Carter, J., Schuler, T. A., Jandorf, L., DuHamel, K., Nelson, C. 2016; 25 (3): 316–23


    Treatment for anal and rectal cancer (ARCa) often results in side effects that directly impact sexual functioning; however, ARCa survivors are an understudied group, and factors contributing to the sexual sequelae are not well understood. Body image problems are distressing and may further exacerbate sexual difficulties, particularly for women. This preliminary study sought to (1) describe body image problems, including sociodemographic and disease/treatment correlates, and (2) examine relations between body image and sexual function.For the baseline assessment of a larger study, 70 women completed the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire and Colorectal Cancer-specific Module, including the Body Image subscale, and Female Sexual Function Index. Pearson's correlation and multiple regression evaluated correlates of body image. Among sexually active women (n = 41), hierarchical regression examined relations between body image and sexual function domains.Women were on average 55 years old (standard deviation = 11.6), non-Hispanic White (79%), married (57%), and employed (47%). The majority (86%) reported at least one body image problem. Younger age, lower global health status, and greater severity of symptoms related to poorer body image (p's < 0.05). Poor body image was inversely related to all aspects of sexual function (β range 0.50-0.70, p's < 0.05), except pain. The strongest association was with Female Sexual Function Index Sexual/Relationship Satisfaction.These preliminary findings suggest the importance of assessing body image as a potentially modifiable target to address sexual difficulties in this understudied group. Further longitudinal research is needed to inform the development and implementation of effective interventions to improve the sexual health and well-being of female ARCa survivors.

    View details for PubMedID 25974874

    View details for PubMedCentralID PMC4961045

  • Psychological Symptoms and Patterns of Mobile Application Use for Young Adult Cancer Survivors. Psycho-oncology Ahmad, Z. N., Benedict, C., Hotchkiss, M., Ford, J. S. 2021

    View details for DOI 10.1002/pon.5662

    View details for PubMedID 33646607

  • Initiation and changes in use of social media for peer support among young adults with cancer Lazard, A. J., Collins, M., Hedrick, A., Horrell, L. N., Varma, T., Valle, C. G., Love, B., Benedict, C. WILEY. 2021: 60–61
  • Using social media for support among young adults with cancer Lazard, A. J., Collins, M., Hedrick, A., Varma, T., Love, B., Valle, C. G., Brooks, E., Benedict, C. WILEY. 2021: 86–87
  • Greater fertility distress and avoidance relate to lower decision self-efficacy about family-building after cancer among adolescent and young adult female survivors Benedict, C., Diefenbach, M., Ford, J. WILEY. 2021: 55
  • A Decision Aid Intervention for Family Building After Cancer: Developmental Study on the Initial Steps to Consider When Designing a Web-Based Prototype. JMIR formative research Benedict, C., Dauber-Decker, K. L., King, D., Hahn, A., Ford, J. S., Diefenbach, M. 2021; 5 (1): e20841


    BACKGROUND: An important aspect of patient-centered care involves ensuring that patient-directed resources are usable, understandable, and responsive to patients' needs. A user-centered design refers to an empathy-based framework and an iterative design approach for developing a product or solution that is based on an in-depth understanding of users' needs, values, abilities, and limitations.OBJECTIVE: This study presents the steps taken to develop a prototype for a patient resource for young women who have completed treatment for gonadotoxic cancer to support their decision making about follow-up fertility care and family building.METHODS: User-centered design practices were used to develop Roadmap to Parenthood, a decision aid (DA) website for family building after cancer. A multidisciplinary steering group was assembled and input was provided. Guidelines from the International Patient DA Society and the Ottawa Decision Support Framework were used throughout the development process. In addition, guidelines for developing health DAs with respect to patient diversity and health literacy were also followed.RESULTS: The Roadmap to Parenthood DA website prototype was systematically and iteratively developed. An extensive process of designing and developing solutions from the perspective of the end user was followed. The steps taken included formative work to identify user needs; determining goals, format, and delivery; design processes (eg, personas, storyboards, information architecture, user journey mapping, and wireframing); and content development. Additional design considerations addressed the unique needs of this patient population, including the emotional experiences related to this topic and decision-making context wherein decisions could be considered iteratively while involving a multistep process.CONCLUSIONS: The design strategies presented in this study describe important steps in the early phases of developing a user-centered resource, which will enhance the starting point for usability testing and further design modifications. Future research will pilot test the DA and a planning tool, and evaluate improvement in the decisional conflict regarding family building after cancer. Consistent with a patient-centered approach to health care, the strategies described here may be generalized and applied to the development of other patient resources and clinical contexts to optimize usability, empathy, and user engagement.

    View details for DOI 10.2196/20841

    View details for PubMedID 33480848

  • "Looking at future cancer survivors, give them a roadmap": addressing fertility and family-building topics in post-treatment cancer survivorship care. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Benedict, C., Nieh, J., Hahn, A. L., McCready, A., Diefenbach, M., Ford, J. S. 2020


    PURPOSE: Fertility is an important issue among adolescent and young adult female (AYA-F) cancer survivors. This study examined AYA-F survivors' unmet needs and recommendations for care to address fertility/family-building in post-treatment survivorship.METHODS: Semi-structured interviews (45-60min) explored themes related to fertility and family-building after cancer. Coding categories were derived based on grounded theory methods. Themes were identified through an iterative process of coding and review.RESULTS: Participants (N=25) averaged 29years old (SD=6.2; range, 15-39) were primarily White and well educated, and averaged 5.81years post-treatment (SD=5.43); 32% had undergone fertility preservation (pre- or post-cancer). Six recommendations for improving care were identified: addressing patient-provider communication, need to provide informational, emotional, and peer support, financial information, and decision-making support. AYA-Fs believed the best way to learn about resources was through online platforms or doctor-initiated discussions. Telehealth options and digital resources were generally considered acceptable. Face-to-face interactions were preferred for in-depth information, when AYA-Fs anticipated having immediate questions or distressing emotions, and with concerns about Internet security. Thus, a combined approach was preferred such that information (via web-based communication) should be provided first, with follow-up in-person visits and referrals when needed.CONCLUSION: Informational and support services are needed to better educate patients about gonadotoxic effects and options to have children after cancer treatment is completed. Future work should evaluate how to best support oncology providers in meeting the needs of survivors concerned about fertility and family-building including referral to clinical specialties and supportive resources.

    View details for DOI 10.1007/s00520-020-05731-3

    View details for PubMedID 32889581

  • CLINICIAN AWARENESS OF PARENTING CONCERNS IN PATIENTS WITH CANCER Williams, P., Artusio, D. A., Haruno, L. S., Benedict, C., Shaw, R., Ach, E. L., Rauch, P. K., Schapira, L. OXFORD UNIV PRESS INC. 2020: S29
  • A Randomized Pilot Study of Mindfulness-Based Stress Reduction in a Young Adult Cancer Sample: Feasibility, Acceptability, and Changes in Patient Reported Outcomes. Psycho-oncology Victorson, D., Murphy, K., Benedict, C., Horowitz, B., Meletich, C., Cordero, E., Salsman, J. M., Smith, K., Sanford, S. 2020


    BACKGROUND: The primary purpose of this study was to examine the feasibility and acceptability of participation in a randomized waitlist-controlled intervention of mindfulness-based stress reduction (MBSR) in a young adult cancer sample. A secondary aim was to examine patterns of change in patient reported outcomes (PROs) of physical, social and emotional functioning.METHODS: Participants were enrolled at a large Midwestern comprehensive cancer center and randomized to MBSR or a waitlist control. Feasibility and acceptability were examined through enrollment metrics and a survey. PROs were gathered at baseline, 8-weeks, and 16-weeks. Descriptive statistics and mixed models were used in analyses.RESULTS: Of 597 eligible participants, 151 (26.5%) consented from which 126 (83.4%) completed baseline measures. Sixty-seven participants were randomized to MBSR, and 59 to the waitlist. Immediately following MBSR, the majority of respondents (72-78%) reported their experience with mindfulness was very logical and useful to increasing their wellbeing. Compared to waitlist members, MBSR participant's scores on PROs improved in expected directions.CONCLUSIONS: Our findings suggest that recruitment for an intensive, in-person, multi-week supportive intervention can be challenging with young adults with cancer, similar to other cancer survivor populations; however once enrolled, feasibility and acceptability of MBSR was supported. Further, initial evidence on the role of MBSR on short-term changes in select PROs with this population was also demonstrated. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/pon.5355

    View details for PubMedID 32040222

  • Toward a theoretical understanding of young female cancer survivors' decision-making about family-building post-treatment. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Benedict, C., Hahn, A. L., McCready, A., Kelvin, J. F., Diefenbach, M., Ford, J. S. 2020


    PURPOSE: Family-building after gonadotoxic treatment often requires in vitro fertilization, surrogacy, or adoption, with associated challenges such as uncertain likelihood of success, high costs, and complicated laws regulating surrogacy and adoption. This study examined adolescent and young adult female (AYA-F) survivors' experiences and decision-making related to family-building after cancer.METHODS: Semi-structured interviews explored fertility and family-building themes (N=25). Based on an a priori conceptual model, hypothesis coding and grounded theory coding methods guided qualitative analysis.RESULTS: Participants averaged 29years old (SD=6.2) were mostly White and educated. Four major themes were identified: sources of uncertainty, cognitive and emotional reactions, coping behaviors, and decision-making. Uncertainty stemmed from medical, personal, social, and financial factors, which led to cognitive, emotional, and behavioral reactions to reduce distress, renegotiate identity, adjust expectations, and consider "next steps" toward family-building goals. Most AYA-Fs were unaware of their fertility status, felt uninformed about family-building options, and worried about expected challenges. Despite feeling that "action" was needed, many were stalled in decision-making to evaluate fertility or address information needs; postponement and avoidance were common. Younger AYA-Fs tended to be less concerned.CONCLUSION: AYA-Fs reported considerable uncertainty, distress, and unmet needs surrounding family-building decisions post-treatment. Support services are needed to better educate patients and provide opportunity for referral and early preparation for potential challenges. Reproductive counseling should occur throughout survivorship care to address medical, psychosocial, and financial difficulties, allow time for informed decision-making, and the opportunity to prepare for barriers such as high costs.

    View details for DOI 10.1007/s00520-020-05307-1

    View details for PubMedID 31993754

  • Longitudinal effects of social support and adaptive coping on the emotional well-being of survivors of localized prostate cancer. The journal of supportive oncology Zhou, E. S., Penedo, F. J., Bustillo, N. E., Benedict, C. n., Rasheed, M. n., Lechner, S. n., Soloway, M. n., Kava, B. R., Schneiderman, N. n., Antoni, M. H. ; 8 (5): 196–201


    Survivors of prostate cancer experience treatment-related physical side effects that can compromise emotional well-being for years post-treatment. There is limited research investigating how social support and the use of coping may affect the emotional well-being of this population following treatment. The aim of this study was to investigate how social support and coping impact emotional well-being 2 years after treatment in survivors of localized prostate cancer who have received either radical prostatectomy or radiotherapy. Psychosocial and disease-specific measures were administered to an ethnically and demographically diverse sample of 180 men treated for localized prostate cancer at baseline and at 2-year follow-up. Regression analyses demonstrated that higher levels of social support at baseline predicted better emotional well-being 2 years later. Furthermore, higher levels of adaptive coping at baseline partially mediated the relationship between social support and emotional well-being. Supportive relationships may contribute to improved emotional well-being following treatment by facilitating the use of adaptive coping strategies. Attention should be given to strengthening social support networks and educating survivors of prostate cancer on adaptive coping techniques.

    View details for PubMedID 21086876

    View details for PubMedCentralID PMC3066633

  • Cost of survivorship care and adherence to screening-aligning the priorities of health care systems and survivors. Translational behavioral medicine Benedict, C. n., Wang, J. n., Reppucci, M. n., Schleien, C. L., Fish, J. D. 2020


    Childhood cancer survivors (CCS) experience significant morbidity due to treatment- related late effects and benefit from late-effects surveillance. Adherence to screening recommendations is suboptimal. Survivorship care programs often struggle with resource limitations and may benefit from understanding institution-level financial outcomes associated with patient adherence to justify programmatic development and growth. The purpose of this study is to examine how CCS adherence to screening recommendations relates to the cost of care, insurance status, and institution-level financial outcomes. A retrospective chart review of 286 patients, followed in a structured survivorship program, assessed adherence to the Children's Oncology Group follow-up guidelines by comparing recommended versus performed screening procedures for each patient. Procedure cost estimates were based on insurance status. Institutional profit margins and profit opportunity loss were calculated. Bivariate statistics tested adherent versus nonadherent subgroup differences on cost variables. A generalized linear model predicted the likelihood of adherence based on cost of recommended procedures, controlling for age, gender, race, and insurance. Adherence to recommended surveillance procedures was 50.2%. Nonadherence was associated with higher costs of recommended screening procedures compared to the adherent group estimates ($2,469.84 vs. $1,211.44). Failure to perform the recommended tests resulted in no difference in reimbursement to the health system between groups ($1,249.63 vs. $1,211.08). For the nonadherent group, this represented $1,055.13 in "lost profit opportunity" per visit for patients, which totaled $311,850 in lost profit opportunity due to nonadherence in this subgroup. In the final model, nonadherence was related to higher cost of recommended procedures (p < .0001), older age at visit (p = .04), Black race (p = .02), and government-sponsored insurance (p = .03). Understanding institutional financial outcomes related to patient adherence may help inform survivorship care programs and resource allocation. Potential financial burden to patients associated with complex care recommendations is also warranted.

    View details for DOI 10.1093/tbm/ibz182

    View details for PubMedID 31907549

  • Patterns of social media use and associations with psychosocial outcomes among breast and gynecologic cancer survivors. Journal of cancer survivorship : research and practice Tolby, L. T., Hofmeister, E. N., Fisher, S. n., Chao, S. n., Benedict, C. n., Kurian, A. W., Berek, J. S., Schapira, L. n., Palesh, O. G. 2020


    We sought to characterize the use of social media (SM) among breast and gynecologic cancer survivors, as well as associations between patterns of SM use and psychosocial outcomes.Two hundred seventy-three breast and gynecologic cancer survivors recruited at the Stanford Women's Cancer Center completed the study. Participants completed questionnaires to measure quality of life (FACT-G), functional social support (Duke-UNC FSSQ), distress (PHQ-4), decision regret (DRS), and SM use.In total, 75.8% of the sample reported using SM. There was no difference in quality of life (QOL), functional social support (FSS), distress, or decision regret between SM users and non-users. SM users indicated using SM for social support (34.3%) and loneliness (24.6%) more than for information-seeking (15.9%), coping (18.8%), or self-disclosure (14%). SM use for coping was associated with lower QOL (p < .001), lower FSS (p < .001), and higher decision regret (p = .029). Use for social support was associated with lower FSS (p = .029). Use for information seeking was associated with lower QOL (p = .012). Use of SM when lonely was associated with lower QOL (p < .001), higher distress (p = .007), lower FSS (p < .001), and higher decision regret (p = .020).Associations between SM use and psychosocial outcomes are nuanced and dependent on motivation for use. Further research is needed to better characterize SM use and associations with psychosocial outcomes among cancer survivors.SM is an important potential avenue for understanding and addressing the psychosocial effects associated with cancer survivorship.

    View details for DOI 10.1007/s11764-020-00959-8

    View details for PubMedID 33161562

  • The Impact of Financial Toxicity on Psychological Well-Being, Coping Self-Efficacy, and Cost-Coping Behaviors in Young Adults with Cancer JOURNAL OF ADOLESCENT AND YOUNG ADULT ONCOLOGY Thom, B., Benedict, C. 2019; 8 (3): 236–42
  • Cancer fatalism and adherence to national cancer screening guidelines: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Cancer epidemiology Moreno, P. I., Yanez, B. n., Schuetz, S. J., Wortman, K. n., Gallo, L. C., Benedict, C. n., Brintz, C. E., Cai, J. n., Castaneda, S. F., Perreira, K. M., Gonzalez, P. n., Gonzalez, F. n., Isasi, C. R., Penedo, F. J. 2019; 60: 39–45


    Sociocultural factors, such as health insurance status, income, education, and acculturation, predict cancer screening among U.S. Hispanics/Latinos. However, these factors can be difficult to modify. More research is needed to identify individual-level modifiable factors that may improve screening and subsequent cancer outcomes in this population. The aim of this study was to examine cancer fatalism (i.e., the belief that there is little or nothing one can do to lower his/her risk of developing cancer) as a determinant of adherence to national screening guidelines for colorectal, breast, prostate, and cervical cancer among Hispanics/Latinos.Participants were from the multi-site Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study (N = 5313). The National Cancer Institute (NCI) Health Interview National Trends Survey was used to assess cancer fatalism and receipt of cancer screening. Adherence was defined as following screening guidelines from United States Preventive Services Task Force and the American Cancer Society during the study period.Adjusting for well-established determinants of cancer screening and covariates (health insurance status, income, education, acculturation, age, Hispanic/Latino background), lower cancer fatalism was marginally associated with greater adherence to screening for colorectal (OR 1.13, 95% CI [.99-1.30], p = .07), breast (OR 1.16, 95% CI [.99-1.36], p = .08) and prostate cancer (OR 1.18, 95% CI [.97-1.43], p = .10), but not cervical cancer.The associations of cancer fatalism were small and marginal, underlining that sociocultural factors are more robust determinants of cancer screening adherence among Hispanics/Latinos.

    View details for DOI 10.1016/j.canep.2019.03.003

    View details for PubMedID 30904827

  • Recruitment via social media: advantages and potential biases. Digital health Benedict, C., Hahn, A. L., Diefenbach, M. A., Ford, J. S. 2019; 5: 2055207619867223


    Background: Adolescent and young adult (AYA) cancer survivors are under-represented in research. Social media is increasingly used for recruitment given its ability to reach large audiences. Differences in participant characteristics and potential biases due to recruitment source are not well understood.Purpose: This study aimed to: (a) compare recruitment strategies (hospital-based v. social media) in enrollment metrics, and (b) among enrolled participants, evaluate group differences in patient characteristics and patient reported outcomes (PROs).Methods: Preliminary data from a cancer and fertility study with female AYAs were evaluated. Hospital-based recruitment used electronic medical records (EMR) to identify eligible patients. Social media recruitment involved posting on partner organizations' social media outlets. PROs included validated measures related to the parent study. Descriptive statistics evaluated recruitment metrics. Independent samples t-tests and chi-square identified differences in participant characteristics and PROs based on recruitment.Results: Social media yielded a higher enrollment rate (37%; n=54/146) compared with hospital-based recruitment (7%; n=21/289) and required fewer study resources. Compared with hospital-based recruitment, participants from social media were more likely to be White (p=0.01), with a longer time since treatment (p=0.03); and reported higher levels of reproductive concern (p=0.004) and negative mood (p=0.02), and more negative illness perceptions (ps<0.05).Conclusion: Recruitment via social media may be a more effective and efficient strategy compared with hospital-based methods. However, group differences were identified that could bias findings and limit generalizability. Advantages of social media should be considered with an understanding of how methodology may impact enrollment and results.

    View details for DOI 10.1177/2055207619867223

    View details for PubMedID 31431827

  • Peer-To-Peer Connections: Perceptions of a Social Support App Designed for Young Adults with Cancer. Psycho-oncology Lazard, A. J., Saffer, A. J., Horrell, L. n., Benedict, C. n., Love, B. n. 2019


    Social support is a critical, yet frequently unmet, need among young adults (YAs) with cancer. YAs desire age-appropriate resources to connect with peers. Peer-to-peer mobile apps are promising interventions to provide social support. Peer-to-peer apps will be more effective if development incorporates users' input for whether app designs (look and function) afford meaningful connections.We interviewed 22 YAs to assess perceptions of a peer-to-peer app at a young adult cancer convention in April 2017.Participants were an average age of 29, mostly female (77%), White (73%), and well educated (68% with 4-year college degree or higher). Most participants expressed interested in using an app to connect with YAs, but preferences varied by prevalence or rarity of one's cancer diagnosis. YAs shared trade-offs for profile anonymity versus profiles with more personal information, requests for filter options to connect for varying support needs, and desires for tailored messaging and chat room features (e.g., topic-specific, search capabilities).Findings demonstrate the promise of apps to fulfill YA cancer survivors' unmet peer support needs and provide guidance for app optimization.Peer-to-peer support apps should be designed so users can control their identity and customize features for meaningful connections.

    View details for DOI 10.1002/pon.5220

    View details for PubMedID 31483913

  • "Creating a family after battling cancer is exhausting and maddening": Exploring real-world experiences of young adult cancer survivors seeking financial assistance for family building after treatment PSYCHO-ONCOLOGY Benedict, C., McLeggon, J., Thom, B., Kelvin, J. F., Landwehr, M., Watson, S., Ford, J. S. 2018; 27 (12): 2829–39


    Young adult (YA) cancer survivors who received gonadotoxic therapy are at risk for impaired fertility and/or childbearing difficulties. This study explored the experiences and financial concerns of survivors pursuing family building through assisted reproductive technology (ART) and adoption.Retrospective study of data collected from grant applications for financial assistance with family building. Grounded theory methodology using an inductive data-driven approach guided qualitative data analysis.Participants (N = 46) averaged 32 years old (SD = 3.4) were primarily female (81%) and married/partnered (83%). Four main themes were identified representing the (1) emotional experiences and (2) financial barriers to family building after cancer, (3) perceived impact on partners, and (4) disrupted life trajectory. Negative emotions were pervasive but were balanced with hope and optimism that parenthood would be achieved. Still, the combination of high ART/adoption costs, the financial impact of cancer, and limited sources for support caused extreme financial stress. Further, in the face of these high costs, many survivors reported worry and guilt about burdening partners, particularly as couples failed to meet personal and societal expectations for parenthood timelines.After cancer, YAs face numerous psychosocial and financial difficulties in their pursuits of family building when ART/adoption is needed to achieve parenthood. Survivors interested in future children may benefit from follow-up fertility counseling post-treatment including discussion of ART options, surrogacy, and adoption, as appropriate, and potential barriers. Planning for the financial cost and burden in particular may help to avoid or mitigate financial stress later on.

    View details for PubMedID 30238545

  • The Intersection of Financial Toxicity and Family Building in Young Adult Cancer Survivors CANCER Thom, B., Benedict, C., Friedman, D. N., Kelvin, J. F. 2018; 124 (16): 3284–89

    View details for PubMedID 29924381

    View details for PubMedCentralID PMC6108923

  • Fertility information needs and concerns post-treatment contribute to lowered quality of life among young adult female cancer survivors SUPPORTIVE CARE IN CANCER Benedict, C., Thom, B., Friedman, D. N., Pottenger, E., Raghunathan, N., Kelvin, J. F. 2018; 26 (7): 2209–15


    Cancer treatment may lead to premature menopause and infertility. Young adult female cancer survivors (YAFCS) are often concerned about their fertility and future family-building options, but research is limited on how concerns may affect more general quality of life (QOL) domains. This study examined how fertility factors relate to QOL among YAFCS who received gonadotoxic therapy.A national sample of YAFCS completed an online, anonymous survey. The survey included investigator-designed questions about perceived fertility information needs (five items; Cronbach's α = .83) and general QOL (four items; α = .89), the Reproductive Concerns after Cancer Scale (RCACS) and Decisional Conflict Scale (DCS). Analyses included Pearson's correlation, t tests, and stepwise regression.Participants (N = 314) were an average of 30 years old (SD = 4.1) and 5 years (SD = 5.4) post-treatment; 31% reported being infertile and 19% had undergone fertility preservation (FP). Overall, QOL was relatively high (M = 7.3, SD = 1.9, range 0-10) and did not vary by fertility status (t[272] = .743, p = .46), prior FP (t[273] = .53, p = .55) or sociodemographic/clinical factors (p's > .05) except socioeconomic indicators (p's < .05).In separate models, greater unmet fertility information needs (β = - .19, p = .004) and, among fertile women, greater reproductive concerns (β = - .26, p = .001) related to lower QOL. Among fertile women without prior FP, greater decisional distress about future FP related to lower QOL (β = - .19, p = .03).These preliminary findings suggest that unaddressed fertility information needs, concerns, and decision distress may affect general QOL among post-treatment YAFCS who hope to have children in the future. Future work should identify ways to optimally incorporate fertility counseling and support resources into survivorship care programs, including referrals to reproductive specialists as appropriate.

    View details for PubMedID 29387996

    View details for PubMedCentralID PMC5984121

  • Reduction in social activities mediates the relationship between diarrhea and distress in rectal/anal cancer survivors PSYCHO-ONCOLOGY Benedict, C., DuHamel, K., Nelson, C. J. 2018; 27 (2): 691–94

    View details for PubMedID 28665010

    View details for PubMedCentralID PMC5748015

  • Young Adult Female Cancer Survivors' Concerns About Future Children's Health and Genetic Risk JOURNAL OF ADOLESCENT AND YOUNG ADULT ONCOLOGY Raghunathan, N., Benedict, C., Thom, B., Friedman, D., Kelvin, J. 2018; 7 (1): 125–29


    Betamethasone (BMZ) is commonly administered to patients with fetal growth restriction (FGR) and abnormal umbilical artery Doppler (UAD) velocimetry due to the increased risk of preterm delivery; however, the clinical impact of UAD changes after BMZ exposure is unknown.To test the hypothesis that lack of UAD improvement after BMZ administration is associated with shorter latency and greater neonatal morbidity in patients with FGR.This was a retrospective cohort study of pregnancies complicated by FGR and abnormal UAD between 240 and 336 weeks gestation. Abnormal UAD included the following categories of increasing severity: elevated (pulsatility index >95%), absent end diastolic flow (EDF), or reversed EDF improvement was defined as any improvement in category of UAD within two weeks of BMZ. Sustained improvement was defined as improvement until the last ultrasound before delivery, whereas transient improvement was considered as unsustained. The primary outcome was latency, defined as interval from betamethasone administration to delivery. Secondary outcomes were gestational age at delivery, umbilical artery pH, and a composite of neonatal morbidity (intubation, necrotizing enterocolitis, ionotropic support, intraventricular hemorrhage, total parenteral nutrition, neonatal death). Outcomes were compared between (a) patients with and without UAD improvement and (b) patients with sustained and unsustained improvement, using univariable, multivariable and time-to-event analyses.Of the 222 FGR pregnancies with abnormal UAD, 94 received BMZ and had follow-up ultrasounds. UAD improved in 48 (51.1%), with 27 (56.3%) having sustained improvement. Patients with hypertension and drug use were less likely to have UAD improvement. Patients without UAD improvement had shorter latency (21.5 days [interquartile range (IQR) 8,45] versus 35 [IQR 22,61], p = .02) and delivered at an earlier gestational age (34 weeks [IQR 31,36] versus 37 [IQR 33,37], p < .01) than those with improvement. There were no differences in umbilical artery pH between groups. Composite neonatal morbidity was higher in patients without UAD improvement, but this was not statistically significant after adjusting for confounders (aOR 2.0; 95% CI 0.08-5.1). There were no differences in outcomes between patients with sustained versus unsustained improvement.UAD improved in half of patients following BMZ. Lack of UAD improvement was associated with shorter latency and earlier gestational age at delivery, but no difference in composite neonatal morbidity. UAD response to BMZ may be useful to further risk stratify FGR pregnancies.

    View details for DOI 10.1089/jayao.2017.0050

    View details for Web of Science ID 000423412000001

    View details for PubMedID 29863424

  • Communication and comprehensive cancer control coalitions: lessons from two decades of campaigns, outreach, and training. Cancer causes & control : CCC Love, B. n., Benedict, C. n., Van Kirk Villalobos, A. n., Cone, J. N. 2018; 29 (12): 1239–47


    Comprehensive cancer control (CCC) coalitions and programs have delivered effective models and approaches to reducing cancer burden across the United States over the last two decades. Communication plays an essential role in diverse coalition activities from prevention to survivorship, including organizational and community capacity-building and as cancer control intervention strategies.Based upon a review of published CCC research as well as public health communication best practices, this article describes lessons learned to assist CCC coalitions and programs with systematic implementation of communication efforts as key strategies in cancer control.Communication-oriented lessons include (1) effective communication work requires listening and ongoing engagement with key stakeholders, (2) communication interventions should target multiple levels from interpersonal to mediated channels, (3) educational outreach can be a valuable opportunity to bolster coalition effectiveness and cancer control outcomes, and (4) dedicated support is necessary to ensure consistent communication efforts.External and internal communication strategies can optimize coalition efforts and resources to ultimately help produce meaningful improvement in cancer control outcomes.

    View details for PubMedID 30535669

  • Young Adult Female Cancer Survivors' Concerns About Future Children's Health and Genetic Risk. Journal of adolescent and young adult oncology Raghunathan, N. J., Benedict, C. n., Thom, B. n., Friedman, D. N., Kelvin, J. F. 2018; 7 (1): 125–29


    As young adult female cancer survivors (aged 18-35) make family-building decisions, understanding the specific nature of their concerns is important. We evaluated survivors' concerns about potential health risks to future children including genetic susceptibility for cancer with an internet-based survey study (N = 187). Sixty-five percent reported concern about passing on a genetic cancer risk to their children, and scores did not vary regardless of association with cancer at high risk for genetic transmission. Genetic counseling and education about family-building options may be important to survivors concerned about health risks to offspring to support family-building decisions based on personalized medical information.

    View details for PubMedID 29364765

    View details for PubMedCentralID PMC5813728

  • Examining the impact of a multimedia intervention on treatment decision-making among newly diagnosed prostate cancer patients: results from a nationwide RCT. Translational behavioral medicine Diefenbach, M. A., Benedict, C. n., Miller, S. M., Stanton, A. L., Ropka, M. E., Wen, K. Y., Fleisher, L. G., Mohamed, N. E., Hall, S. J. 2018; 8 (6): 876–86


    Men diagnosed with early stage prostate cancer face multiple treatment options, each with distinctive side effects that have significant implications for post-treatment quality of life. Healing Choices for Men with Prostate Cancer is a multimedia educational and decision aid program. This nation-wide randomized controlled trial evaluated the impact of Healing Choices on reducing decisional conflict and distress. Eligible prostate cancer patients who called the National Cancer Institute's Cancer Information Service (CIS) were invited to participate. After a baseline interview, participants were randomized to usual personalized consultation with a CIS specialist (comparison condition) or CIS personalized consultation plus the Healing Choices program (intervention condition). The Decision Conflict Scale and Impact of Event Scale assessed decisional conflict about prostate cancer treatment and cancer-related distress, respectively. Analyses evaluated group differences at 2 months postenrollment. Hypothesized moderation of intervention effects by demographic and clinical characteristics were evaluated. The final sample consisted of N = 349 participants (intervention: n = 181; comparison n = 168). Men were on average 64 years old, primarily White, and well educated. The difference in total decisional conflict was not significant (DCS total score; F[1,311] = .99, p = .32). The difference in cancer-related distress at 2 months between the intervention and the comparison groups was not significant (F[1,337] = .01, p = .93). Evaluation of specific decision processes indicated a significant effect on levels of perceived decisional support (intervention, M = 34.8, SD = 15.7; comparison, M = 38.3, SD = 16.1; F[1,337] = 3.74, p = .05). The intervention effect was greatest for nonwhite minority participants (b = -9.65, SE = 4.67) and those with lower educational attainment (b = 3.87, SE = 2.21). This interactive, comprehensive education and decision aid program may be most effective for a subset of prostate cancer patients in need of educational and decisional support.

    View details for PubMedID 29982747

    View details for PubMedCentralID PMC6248862

  • Family-building After Breast Cancer: Considering the Effect on Adherence to Adjuvant Endocrine Therapy CLINICAL BREAST CANCER Benedict, C., Thom, B., Teplinsky, E., Carleton, J., Kelvin, J. F. 2017; 17 (3): 165–70


    Adherence to endocrine therapy (ET) is a longstanding problem in breast cancer (BC) survivorship care, particularly among younger women. Younger patients have reported lower ET initiation rates and greater rates of early discontinuation and are considered an "at risk" group for nonadherence. For women who hope to have children in the future, concerns about premature menopause and the implications of postponing childbearing for the 5 to 10 years of ET are widespread. Preliminary evidence suggests that prioritizing fertility, along with concerns about side effects, leads to ET noninitiation and early discontinuation. Clinical efforts to improve adherence might need to consider patients' family-building goals during the course of treatment and to appropriately counsel patients according to their priorities and family-building intentions. Educational materials about family building after cancer are still not consistently available or provided. Helping patients to access trusted informational resources and decision support tools, in conjunction with medical counseling, will promote informed decisions regarding ET adherence and pregnancy that are medically appropriate. Such shared patient-provider decision-making about ET adherence and pregnancy could help to maximize patient autonomy by incorporating their values, preferences, and priorities into decisions, using providers' medical expertise.

    View details for PubMedID 28087390

  • Reply to "Twistin' the Night Away": Fertility Preservation in Young Adult Female Cancer Survivors CANCER Benedict, C., Thom, B., Friedman, D. N., Diotallevi, D., Pottenger, E. M., Raghunathan, N. J., Kelvin, J. F. 2017; 123 (4): 708–9

    View details for PubMedID 27727450

  • Young patients and gastrointestinal (GI) tract malignancies - are we addressing the unmet needs? BMC CANCER Perl, G., Nordheimer, S., Lando, S., Benedict, C., Brenner, B., Perry, S., Shmoisman, G., Purim, O., Amit, L., Stemmer, S. M., Ben-Aharon, I. 2016; 16: 630


    Recent epidemiological studies indicate the rate of gastrointestinal (GI) malignancies among younger patients is increasing, mainly due to colorectal cancer. There is a paucity of data regarding the magnitude of treatment-related symptoms, psychosocial issues and potential unmet needs in this population. We aimed to characterize the needs of this population to evaluate whether unmet needs could be targeted by potential intervention.Female and male patients diagnosed with cancer of the gastrointestinal tract <40y retrospectively completed a questionnaire to evaluate symptoms, daily function and unmet needs at pre-treatment, during and post-treatment. Comparisons were made by gender, disease stage and treatment modality. Multiple linear regression models evaluated effects of demographics, symptoms and needs on multiple domains of health-related-quality-of-life (using Short-Form Health Survey-12 and CARES).Fifty patients were enrolled (52 % female) to a pilot study. Median age at diagnosis was 35.5y (range, 21-40y). The symptoms that significantly increased from baseline to during and post-treatment were: diarrhea (37 %), sleeping disorder (32 %) and sexual dysfunction (40 %). Patients also reported significant deterioration in occupational activities and coping with children compared with baseline. Female patients reported significant unmet need for nutritional counseling and psychosocial support compared to male patients (p < 0.05). Patients treated with multimodality-treatment presented higher rates of unmet needs (p = 0.03).Young patients with GI cancers represent a group with unique characteristics and needs compared with published evidence on other young-onset malignancies. The distinctive symptoms and areas of treatment-related functional impairments indicate there are unmet needs, especially in the area of psychosocial support and nutritional counseling.

    View details for DOI 10.1186/s12885-016-2676-4

    View details for Web of Science ID 000384181200001

    View details for PubMedID 27519697

    View details for PubMedCentralID PMC4983017

  • Young adult female cancer survivors' unmet information needs and reproductive concerns contribute to decisional conflict regarding posttreatment fertility preservation CANCER Benedict, C., Thom, B., Friedman, D. N., Diotallevi, D., Pottenger, E. M., Raghunathan, N. J., Kelvin, J. F. 2016; 122 (13): 2101–9


    Many young adult female cancer survivors (YAFCS) are at risk of experiencing premature menopause. The current study characterized the posttreatment fertility information needs, reproductive concerns, and decisional conflict regarding future options for posttreatment fertility preservation (FP) among YAFCS.Participants completed a Web-based, anonymous survey between February and March 2015. The survey included investigator-designed questions of perceived information needs, the Reproductive Concerns After Cancer Scale, and the Decisional Conflict Scale. Analyses included Pearson correlation coefficients, independent-sample Student t tests, and multiple regression.There was a total of 346 participants with an average age of 29.9 years (SD = 4.1 years) who were 4.9 years from treatment (SD = 5.4 years [range, 0-27 years]). The main analyses focused on a subgroup of YAFCS with uncertain fertility status who had not previously undergone/attempted FP and either wanted future children or were unsure (179 women). Across fertility information topics, 43% to 62% of participants reported unmet information needs. The greatest reproductive concerns were related to fertility potential and the health of future offspring. The regression model controlled for a priori covariates including current age, age at treatment completion, income, relationship status, nulliparity, and prior fertility evaluation. Greater unmet information needs were found to be related to greater decisional conflict (β = .43; p<.001); greater reproductive concerns were associated at the trend level (β = .14, p = .08; F[8,118] = 6.42, p<.001).YAFCS with limited awareness or knowledge of their risk of experiencing premature menopause and FP options reported higher levels of decisional conflict regarding future FP. Posttreatment survivorship care should include comprehensive reproductive health counseling, including posttreatment FP options and family-building alternatives. Cancer 2016;122:2101-9. © 2016 American Cancer Society.

    View details for PubMedID 27213483

    View details for PubMedCentralID PMC4911318

  • Cancer and Fertility Program Improves Patient Satisfaction With Information Received JOURNAL OF CLINICAL ONCOLOGY Kelvin, J. F., Thom, B., Benedict, C., Carter, J., Corcoran, S., Dickler, M. N., Goodman, K. A., Margolies, A., Matasar, M. J., Noy, A., Goldfarb, S. B. 2016; 34 (15): 1780-+


    A cancer and fertility program was established at a large cancer center to support clinicians in discussing treatment-related fertility risks and fertility preservation (FP) options with patients and in referring patients to reproductive specialists. The program provides resources, clinician education, and fertility clinical nurse specialist consultation. This study evaluated the program's impact on patient satisfaction with information received.Retrospective cross-sectional surveys assessed satisfaction before (cohort 1 [C1]) and after (cohort 2 [C2]) program initiation. Questionnaires were investigator-designed, gender-specific, and anonymous.Most C1 (150 males, 271 females) and C2 (120 males, 320 females) respondents were 2 years postdiagnosis; the most frequently reported cancers were testicular, breast, and lymphoma. A significant difference in satisfaction with the amount of information received was seen between C1 and C2. For males, satisfaction with information on fertility risks was high in both cohorts but significantly greater in C2 for information on sperm banking (χ(2) = 9.3, P = .01) and finding a sperm bank (χ(2) = 13.3, P = .001). For females, satisfaction with information was significantly greater in C2 for information on fertility risks (χ(2) = 62.1, P < .001), FP options (χ(2) = 71.9, P < .001), help with decision making (χ(2) = 80.2, P < .001), and finding a reproductive endocrinologist (χ(2) = 60.5, P < .001). Among patients who received and read information materials, 96% of males and 99% of females found them helpful. Among C2 females, fertility clinical nurse specialist consultation was associated with significantly greater satisfaction with information on FP options (χ(2) = 11.2, P = .004), help with decision making (χ(2) = 10.4, P = .006), and finding a reproductive endocrinologist (χ(2) = 22.6, P < .001), with 10% reporting lack of knowledge as a reason for not pursuing FP.Improvements in patient satisfaction with information received demonstrate the potential for fertility programs in cancer care settings to improve the quality of clinician-patient discussions about fertility.

    View details for PubMedID 27044937

    View details for PubMedCentralID PMC4966338

  • Investigation of body image as a mediator of the effects of bowel and GI symptoms on psychological distress in female survivors of rectal and anal cancer SUPPORTIVE CARE IN CANCER Benedict, C., Rodriguez, V. M., Carter, J., Temple, L., Nelson, C., DuHamel, K. 2016; 24 (4): 1795–1802


    Treatment for rectal and anal cancer (RACa) can result in persistent bowel and gastrointestinal (GI) dysfunction. Body image problems may develop over time and exacerbate symptom-related distress. RACa survivors are an understudied group, however, and factors contributing to post-treatment well-being are not well understood. This study examined whether poorer body image explained the relation between symptom severity and psychological distress.Participants (N = 70) completed the baseline assessment of a sexual health intervention study. Bootstrap methods tested body image as a mediator between bowel and GI symptom severity and two indicators of psychological distress (depressive and anxiety symptoms), controlling for relevant covariates. Measures included the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-CR38) Diarrhea, GI Symptoms, and Body Image subscales and Brief Symptom Index Depression and Anxiety subscales.Women averaged 55 years old (SD = 11.6), White (79 %), and were 4 years post-treatment. Greater Depression was related to poorer Body Image (r = -.61) and worse Diarrhea (r = .35) and GI Symptoms (r = .48). Greater Anxiety was related to poorer Body Image (r = -.42) and worse GI Symptoms (r = .45), but not Diarrhea (r = .20). Body Image mediated the effects of bowel and GI symptoms on Depression, but not on Anxiety.Long-term bowel and GI dysfunction are distressing and affect how women perceive and relate to their bodies, exacerbating survivorship difficulties. Interventions to improve adjustment post-treatment should address treatment side effects, but also target body image problems to alleviate depressive symptoms. Reducing anxiety may require other strategies. Body image may be a key modifiable factor to improve well-being in this understudied population. Longitudinal research is needed to confirm findings.

    View details for PubMedID 26446699

    View details for PubMedCentralID PMC4862400

  • Fertility Issues in Adolescent and Young Adult Cancer Survivors JOURNAL OF ADOLESCENT AND YOUNG ADULT ONCOLOGY Benedict, C., Shuk, E., Ford, J. S. 2016; 5 (1): 48–57


    Many adolescent and young adult (AYA) cancer survivors place great importance on fertility. This study explored AYAs' discussions of fertility in the context of discussing their survivorship experiences.Secondary analyses of a qualitative study of young adult survivors of adolescent cancers ("AYA survivors") was performed using semistructured individual interviews and focus groups. Analyses were conducted using grounded theory using thematic content analysis with an inductive data-driven approach.Participants (n = 43) were 16-24 years old, diagnosed with cancer between ages 14 and 18 years, and were at least 6 months post-treatment. Before treatment, 5 males banked sperm and no females preserved fertility. More males (50%) than females (39%) reported uncertainty about their fertility. Three major categories emerged from the data: fertility concerns, emotions raised when discussing fertility, and strategies used to manage fertility concerns. Fertility concerns focused on dating/partner reactions, health risks, and what potential infertility would mean for their life narrative. Emotions included distress, feeling overwhelmed and hopeful/wishful thinking. Females were more likely to feel distressed and overwhelmed than males. Strategies to manage concerns included acceptance/"making do," desire to postpone concerns, and reliance on assisted reproductive technology.Most AYAs in our study reported a number of reproductive concerns and fertility-related distress after treatment, which may affect other areas of psychosocial functioning. Females may be more at-risk for distress than males, particularly in situations of uncertainty and limited knowledge. Future work should explore how to best incorporate fertility-related informational and support services more fully into survivorship care. Implications for survivorship care are discussed.

    View details for PubMedID 26812452

    View details for PubMedCentralID PMC4779291

  • Fertility preservation and cancer: challenges for adolescent and young adult patients CURRENT OPINION IN SUPPORTIVE AND PALLIATIVE CARE Benedict, C., Thom, B., Kelvin, J. F. 2016; 10 (1): 87–94


    With increasing survival rates, fertility is an important quality of life concern for many young cancer patients. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation options and to support them in their reproductive decision-making prior to treatment.Several barriers prevent fertility from being adequately addressed in the clinical context. Providers' and patients' incomplete or inaccurate understanding of infertility risks exacerbate patients' reproductive concerns. For female patients in particular, making decisions about fertility preservation before treatment often leads to decision conflict, reducing the likelihood of making informed, value-based decisions, and posttreatment regret and distress. Recent empirically based interventions to improve provider training around fertility issues and to support patient decision-making about fertility preservation show promise.Providers should be knowledgeable about the infertility risks associated with cancer therapies and proactively address fertility with all patients who might one day wish to have a child. Comprehensive counseling should also include related issues such as contraceptive use and health implications of early menopause, regardless of desire for future children. Although the negative psychosocial impact of cancer-related infertility is now well accepted, limited work has been done to explore how to improve clinical management of fertility issues in the context of cancer care. Evidence-based interventions should be developed to address barriers and provide psychosocial and decision-making support to patients who are concerned about their fertility and interested in fertility preservation options.

    View details for PubMedID 26730794

    View details for PubMedCentralID PMC4752165

  • Young Adult Female Cancer Survivors' Decision Regret About Fertility Preservation JOURNAL OF ADOLESCENT AND YOUNG ADULT ONCOLOGY Benedict, C., Thom, B., Kelvin, J. F. 2015; 4 (4): 213–18


    This study evaluated fertility-related experiences of young adult female cancer survivors (18-39 years). Data were from a retrospective, cross-sectional survey. Women were more likely to undergo pre-treatment fertility preservation (FP) if they received fertility counseling (by a fertility nurse specialist, reproductive endocrinologist, or gynecologist). Compared with women who underwent FP, those who did not had greater decision regret (DR) after treatment (p < 0.001). Multiple reasons for not pursuing FP were reported; lack of time and distress related to more DR and not wanting children in the future related to less DR (p < 0.05). Decision regret may lead to psychosocial morbidity in survivorship.

    View details for PubMedID 26697271

    View details for PubMedCentralID PMC4684663

  • Positive and negative mood in men with advanced prostate cancer undergoing androgen deprivation therapy: considering the role of social support and stress PSYCHO-ONCOLOGY Benedict, C., Dahn, J. R., Antoni, M. H., Traeger, L., Kava, B., Bustillo, N., Zhou, E. S., Penedo, F. J. 2015; 24 (8): 932–39


    Advanced prostate cancer patients often undergo androgen deprivation therapy (ADT). Advanced disease and adverse ADT side effects are often debilitating and negatively impact mood. Social support has been shown to mitigate detrimental effects of stress on mood.This study sought to characterize positive and negative mood in this select patient population and determine whether social support moderated relations between stress and mood.Participants (N = 80) completed the Interpersonal Support Evaluation List, Perceived Stress Scale, and Derogatis Affect Balance Scale at a single time point. Hierarchical regression models evaluated relations among social support, stress, and mood controlling for relevant covariates. Standard moderation analyses were performed.Participants reported higher levels of negative and positive mood compared with published means of localized prostate cancer patients. Overall, mood was more positive than negative. Stress levels were comparable to cancer populations with recurrent disease. Moderated regression analyses showed that social support partially buffered the effects of stress on positive mood; men with high stress and low support reported the lowest levels of positive mood. The model with negative mood as the dependent measure did not support moderation; that is, the relationship between stress and negative mood did not differ by level of social support.Among individuals living with advanced prostate cancer, social support may be an important factor that sustains positive mood in the presence of stress. Future work should examine the extent to which social support prospectively impacts health-related quality of life by promoting positive mood. Limitations include cross-sectional design, which precludes causal inferences.

    View details for PubMedID 25251737

  • Sexual Bother in Men with Advanced Prostate Cancer Undergoing Androgen Deprivation Therapy JOURNAL OF SEXUAL MEDICINE Benedict, C., Traeger, L., Dahn, J. R., Antoni, M., Zhou, E. S., Bustillo, N., Penedo, F. J. 2014; 11 (10): 2571–80


    Men with advanced prostate cancer (APC) undergoing androgen deprivation therapy (ADT) often experience distressing sexual side effects. Sexual bother is an important component of adjustment. Factors associated with increased bother are not well understood.This study sought to describe sexual dysfunction and bother in APC patients undergoing ADT, identify socio-demographic and health/disease-related characteristics related to sexual bother, and evaluate associations between sexual bother and psychosocial well-being and quality of life (QOL).Baseline data of a larger psychosocial intervention study was used. Pearson's correlation and independent samples t-test tested bivariate relations. Multivariate regression analysis evaluated relations between sexual bother and psychosocial and QOL outcomes.The Expanded Prostate Cancer Index Composite sexual function and bother subscales, Center for Epidemiologic Studies Depression Scale, Functional Assessment of Cancer Therapy--General, and Dyadic Adjustment Scale were the main outcome measures.Participants (N = 80) were 70 years old (standard deviation [SD] = 9.6) and reported 18.7 months (SD = 17.3) of ADT. Sexual dysfunction (mean = 10.1; SD = 18.0) was highly prevalent. Greater sexual bother (lower scores) was related to younger age (β = 0.25, P = 0.03) and fewer months of ADT (β = 0.22, P = 0.05). Controlling for age, months of ADT, current and precancer sexual function, sexual bother correlated with more depressive symptoms (β = -0.24, P  = 0.06) and lower QOL (β = 0.25, P = 0.05). Contrary to hypotheses, greater sexual bother was related to greater dyadic satisfaction (β = -0.35, P = 0.03) and cohesion (β = -0.42, P = 0.01).The majority of APC patients undergoing ADT will experience sexual dysfunction, but there is variability in their degree of sexual bother. Psychosocial aspects of sexual functioning should be considered when evaluating men's adjustment to ADT effects. Assessment of sexual bother may help identify men at risk for more general distress and lowered QOL. Psychosocial interventions targeting sexual bother may complement medical treatments for sexual dysfunction and be clinically relevant, particularly for younger men and those first starting ADT.

    View details for PubMedID 25059094

  • SEXUAL BOTHER IN MEN WITH ADVANCED PROSTATE CANCER UNDERGOING HORMONE THERAPY Benedict, C., Traeger, L., Rasheed, M., Zhou, E., Bustillo, N., Kava, B., Soloway, M., Antoni, M., Penedo, F. SPRINGER. 2014: S11
  • QUALITY OF LIFE IN MEN WITH PROSTATE CANCER: LONG-TERM EFFECTS OF A PSYCHOSOCIAL INTERVENTION Benedict, C., Traeger, L., Rasheed, M., Zhou, E., Bustillo, N. E., Kava, B., Soloway, M., Antoni, M., Penedo, F. J. SPRINGER. 2013: S258
  • Identifying how and for whom cognitive-behavioral stress management improves emotional well-being among recent prostate cancer survivors PSYCHO-ONCOLOGY Traeger, L., Penedo, F. J., Benedict, C., Dahn, J. R., Lechner, S. C., Schneiderman, N., Antoni, M. H. 2013; 22 (2): 250–59


    The outcomes of a 10-week cognitive-behavioral stress management (CBSM) group intervention were evaluated in prostate cancer survivors. A model was tested in which CBSM-related improvements in emotional well-being were attained through changes in men's perceptions of their condition, as conceptualized by information processing explanations of self-regulation theory. The model also tested whether life stress and treatment-related side effects moderated intervention effects.Men treated for localized prostate cancer (n = 257) within the past 18 months were randomized to CBSM or a half-day psycho-educational seminar. At pre-intervention and 12-week follow-up, emotional well-being, illness perceptions, life stress, and sexual and urinary function were assessed using validated questionnaires.After controlling for covariates, CBSM participants showed greater improvements in emotional well-being relative to control participants (β = 0.13, p < 0.05). For men reporting higher stress upon study entry, CBSM-related improvements were partially explained by changes in some, but not all, illness perceptions. Sexual and urinary dysfunction did not influence CBSM-related gains.Prostate cancer perceptions may be an important target for enhancing emotional well-being, particularly for men experiencing general life stress. However, interventions that explicitly target mental representations of cancer may be needed to modify perceptions of the disease.

    View details for DOI 10.1002/pon.2074

    View details for Web of Science ID 000314493700003

    View details for PubMedID 21932396

  • Association of stress management skills and perceived stress with physical and emotional well-being among advanced prostrate cancer survivors following androgen deprivation treatment. Journal of clinical psychology in medical settings Penedo, F. J., Benedict, C. n., Zhou, E. S., Rasheed, M. n., Traeger, L. n., Kava, B. R., Soloway, M. n., Czaja, S. n., Antoni, M. H. 2013; 20 (1): 25–32


    Advanced prostate cancer (APC) is associated with disruptions that compromise health related quality of life (HRQOL). Treatment often includes androgendeprivation therapy (ADT), which results in a range of side effects (e.g., fatigue, urinary dysfunction) that further impact HRQOL. Despite these challenges, there are limited evaluations of the impact of stress and stress management skills on HRQOL among APC survivors on ADT. This study evaluated relationships among stress, stress management skills, and HRQOL, and it was hypothesized that better stress management skills would relate to greater physical and emotional well-being by mitigating perceived stress levels. Participants (N = 77) were 69.7 years old (SD = 9.8), 18.6 months post-treatment (SD = 17.5), and ethnically diverse (65 % Non-Hispanic White, 13 % Hispanic, 21 % African-American). Measures included the Measure of Current Status for stress management skills, the Perceived Stress Scale for perceived stress, and the Medical Outcomes Study-Short Form (MOS SF-36; physical functioning and emotional well-being subscales) for HRQOL. Direct effects and mediation models were evaluated to determine the relationships between perceived stress, stress management skills, and HRQOL domains, controlling for relevant covariates. Stress management skills and perceived stress were significantly associated with physical functioning (β = .24, p < .05 and β = -.43, p < .01, respectively) and emotional well-being (β = .35, p < .01 and β = -.64, p < .01, respectively). Regression analyses supported the hypothesis that reduced perceived stress mediated the relationship between stress management skills and both physical functioning and emotional well-being. These results demonstrate that one way stress management skills may impact HRQOL is by lessening ongoing perceptions of stress.

    View details for DOI 10.1007/s10880-012-9308-1

    View details for PubMedID 22739661

  • Millon Behavioral Medicine Diagnostic (MBMD) Predicts Health-Related Quality of Life (HrQoL) Over Time Among Men Treated for Localized Prostate Cancer JOURNAL OF PERSONALITY ASSESSMENT Cruess, D. G., Benedict, C., Lattie, E. G., Molton, I., Kinsinger, D., Kava, B., Manoharan, M., Soloway, M., Penedo, F. J. 2013; 95 (1): 54–61


    Prostate cancer treatment presents multiple challenges that can negatively affect health-related quality of life (HrQoL), and that can be further compromised by maladaptive personality styles and psychological adjustment difficulties. This study examined the utility of a comprehensive psychosocial screening tool to identify psychosocial traits that prospectively predict HrQoL status among men treated for localized prostate cancer. The Millon Behavioral Medicine Diagnostic (MBMD) was administered to 66 men (M age = 68 years, 59% White) treated by either radical prostatectomy or radiotherapy along with standard measures of general and prostate-cancer-specific quality of life assessed at a 12-month follow-up. Higher scores on both summary MBMD Management Guides (Adjustment Difficulties and Psych Referral) and higher scores on personality styles characterized by avoidance, dependency, depression, passive aggressiveness, and self-denigration predicted lower HrQoL (β range = -.21 to -.50). Additionally, higher scores on the MBMD Depression, Tension-Anxiety, and Future Pessimism scales predicted lower HrQoL. Finally, higher scores on the MBMD Intervention Fragility and Utilization Excess scale also consistently predicted poorer mental and physical health functioning over time. These results point to the utility of the MBMD to help screen for potential impairments in mental and physical health functioning in men undergoing treatment for prostate cancer.

    View details for DOI 10.1080/00223891.2012.681819

    View details for Web of Science ID 000312699600006

    View details for PubMedID 22571442

    View details for PubMedCentralID PMC4347933

  • Multilevel Modeling in Psychosomatic Medicine Research PSYCHOSOMATIC MEDICINE Myers, N. D., Brincks, A. M., Ames, A. J., Prado, G. J., Penedo, F. J., Benedict, C. 2012; 74 (9): 925–36


    The primary purpose of this study is to provide an overview of multilevel modeling for Psychosomatic Medicine readers and contributors. The article begins with a general introduction to multilevel modeling. Multilevel regression modeling at two levels is emphasized because of its prevalence in psychosomatic medicine research. Simulated data sets based on some core ideas from the Familias Unidas effectiveness study are used to illustrate key concepts including communication of model specification, parameter interpretation, sample size and power, and missing data. Input and key output files from Mplus and SAS are provided. A cluster randomized trial with repeated measures (i.e., three-level regression model) is then briefly presented with simulated data based on some core ideas from a cognitive-behavioral stress management intervention in prostate cancer.

    View details for DOI 10.1097/PSY.0b013e3182736971

    View details for Web of Science ID 000311131800009

    View details for PubMedID 23107843

    View details for PubMedCentralID PMC3498540

  • PSYCHOSOCIAL CORRELATES OF ANXIETY IN PROSTATE CANCER (PC) SURVIVORS UNDERGOING ACTIVE SURVEILLANCE (AS) Bustillo, N. E., Antoni, M., Lechner, S., Benedict, C., Zhou, E., Rasheed, M., Kava, B., Soloway, M., Penedo, F. SPRINGER. 2012: S281
  • Marital satisfaction of advanced prostate cancer survivors and their spousal caregivers: the dyadic effects of physical and mental health PSYCHO-ONCOLOGY Zhou, E. S., Kim, Y., Rasheed, M., Benedict, C., Bustillo, N. E., Soloway, M., Kava, B. R., Penedo, F. J. 2011; 20 (12): 1353–57


    Coping with the physical and mental side effects of diagnosis and treatment for advanced prostate cancer (APC) is a challenge for both survivors and their spousal caregivers. There is a gap in our current understanding of the dyadic adjustment process on marital satisfaction in this population. The current study sought to: (1) document levels of physical and mental health, and marital satisfaction, and (2) evaluate the relationship between physical and mental health with marital satisfaction in this understudied population.APC survivors who had undergone androgen deprivation therapy within the past year and their spousal caregiver participated in the study (N = 29 dyads). Physical and mental health was assessed using the MOS SF-36 Health Survey and marital satisfaction was evaluated using the Dyadic Adjustment Scale.The Actor-Partner Interdependence Model revealed strong relations between physical and mental health with marital satisfaction for both survivor and caregiver (actor effects). Furthermore, caregiver physical and mental health was related with the survivor's marital satisfaction (partner effect).Levels of mental health and marital satisfaction were comparable to community-based and prostate cancer samples, while physical health was higher. Marital satisfaction between APC survivors and their spousal caregivers may be influenced by both physical and mental health functioning. In particular, APC survivor functioning may affect his marital satisfaction as well as his spousal caregiver's. This has implications for psychosocial interventions for APC dyads. Further evaluation of the complex nature of survivor/caregiver dyadic adjustment in dealing with APC is necessary.

    View details for DOI 10.1002/pon.1855

    View details for Web of Science ID 000298169100013

    View details for PubMedID 20925137

    View details for PubMedCentralID PMC3020233

  • EMOTIONAL WELL-BEING IN MEN WITH PROSTATE CANCER: EFFECTS OF A PSYCHOSOCIAL INTERVENTION USING GROWTH MIXTURE MODELING Benedict, C., Penedo, F. J., Traeger, L., Rasheed, M., Zhou, E., Bustillo, N. E., Kava, B., Soloway, M., Llabre, M., Antoni, M. SPRINGER. 2011: S202
  • Perceived social support as a predictor of disease-specific quality of life in head-and-neck cancer patients. The journal of supportive oncology Penedo, F. J., Traeger, L. n., Benedict, C. n., Thomas, G. n., Dahn, J. R., Krause, M. H., Goodwin, W. J. 2011; 10 (3): 119–23


    Treatment for head-and-neck cancer (HNC) can lead to severe decrements in disease-specific quality of life (DSQOL) due to disfigurement and disability in speech, eating, and/or breathing. Psychosocial factors such as social support may explain individual variance in DSQOL outcomes.The researchers sought to evaluate changes in perceived availability of social support from pretreatment to posttreatment and to determine whether decreases in perceived social support predicted poorer posttreatment DSQOL among HNC patients, controlling for disease- and treatment-related factors.Participants (n = 32) were newly diagnosed with HNC and were awaiting surgery and/or radiation treatment. Measures included the ENRICHD Social Support instrument (ESSI) to assess perceived social support and the Functional Assessment of Cancer Therapy-Head & Neck (FACT-H&N) to assess DSQOL. Paired-samples t-tests and hierarchical regression analyses were conducted to determine relationships between pretreatment and posttreatment perceived social support and DSQOL.Perceived social support decreased significantly from pre- to posttreatment (F[31] = -2.71, P < .01). After adjusting for relevant covariates and pretreatment DSQOL, change in perceived social support remained a significant predictor of posttreatment DSQOL (β = .47, P < .01).This study included a relatively small sample of HNC patients, which limited power to evaluate mechanisms of observed relationships.Increased social isolation may be a risk factor for poorer physical recovery from, or adjustment to, treatment-related side effects. Social support may be an important target for psychosocial interventions for patients who face challenging treatment side effects.

    View details for DOI 10.1016/j.suponc.2011.09.002

    View details for PubMedID 22088826

  • Social support mediates the relationship between stress and quality of life in men treated for localized prostate cancer Zhou, E., Penedo, F., Traeger, L., Rasheed, M., Benedict, C., Schneiderman, N., Antoni, M. JOHN WILEY & SONS LTD. 2008: S303
  • Social support moderates the relationship between declines in physical well-being and increased mood disturbance in prostate cancer (PC) patients Zhou, E. S., Penedo, F. J., Traeger, L., Rasheed, M., Benedict, C. V., Schneiderman, N., Antoni, M. H. SPRINGER. 2008: S78
  • Cognitive adaptation buffers older prostate cancer survivors against age-related declines in subjective well being: A structural equation modeling analysis Traeger, L., Penedo, F., Rasheed, M., Zhou, E., Benedict, C., Antoni, M., Schneiderman, N. SPRINGER. 2008: S17

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