Four days after Mother's Day, May 15, 2003, my dear friend Marcy Dempsey passed away. Her personal reflection, “A Toolbox for Living: Cancer Reflections” can be read within the current issue of Palliative and Supportive Care (P&SC). I do wish she were still here, not so much just to see this piece come out, but to grace us longer with her gentle spirit, boundless energy, and sage wisdom.

Objective: This study aimed to clarify which older adults benefit most from a control-enhancing intervention; in particular, whether cognitive functioning or locus of control might moderate the benefit derived.

Methods: Nursing home residents were randomly assigned to two conditions: (1) a control-enhanced condition that provided the option of caring for a plant (n = 10), and (2) a comparison condition that monitored any change under the standard of care (n = 10). Comparison group participants were subsequently offered the intervention, which led to a total of 17 intervention participants.

Results: Cognitive function and locus of control were found to significantly moderate the effects of the control-enhancing intervention on residents' perceived health competency, but not depression or life satisfaction.

Significance of results: Interventions for nursing home residents could be tailored to fit specific needs. Screening for cognitive function and locus of control may help predict who is likely to benefit from control-enhancing interventions.

Objective: The purpose of this article is to evaluate an 8-week pilot intervention based on Social Cognitive Theory to improve quality of life for women with breast cancer.

Methods: A total of 32 breast cancer patients were randomized to either the intervention or standard care. Outcome variables included quality of life, mood, self-efficacy, outcome expectations, and self-regulation.

Results: Effect sizes were calculated to examine the impact of the intervention, with moderate to large effect sizes found for several subscales of the outcome expectations variable: learning about cancer and treatment (d = 0.85), having a positive attitude (d = 0.54), talking about cancer (d = 1.02), engaging in relaxation (d = 0.62), and setting goals (d = 1.58).

Significance of results: A nonparametric sign test was conducted, indicating that women in the intervention condition either improved more or showed less decline than the women in standard care, p = .034, two-tailed. Implications and suggestions for the content and delivery of future psychosocial interventions with cancer patients are reviewed.

Objective: The multidimensional aspect of pain suggests the use of multimodal interventions. The Memorial Sloan-Kettering Cancer Center has recently utilized the art therapy modality to help patients communicate the painful side of their illness in such a way that they can feel understood and respected. In this paper we describe a simple innovative art therapy intervention that we have developed within the Art Therapy Service in the Psychiatric Department of Memorial Sloan-Kettering Cancer Center.

Method: The patients work with a Body Outline as a starting template, together with the art therapist, in sessions lasting approximately 45 minutes. They are encouraged to fill the space inside and outside the Body Outline. They can use colored pastels, markers, or watercolor or cut out images for a collage.

Results: Seventy hospitalized adult cancer patients, 60 women and 10 men, used this intervention between January 1999 and May 2000. We have analyzed the variety of responses from the 70 patients, and three main groups have emerged, which have focused on the following issues: (1) visualization of physical pain, (2) communication of emotions, and (3) search for meaning/spirituality.

Significance of results: The results suggest that because of its abstract symbolic feature, the Body Outline is a very flexible therapeutic intervention. It must be offered within the relationship with the art therapist, and it may fulfill quite a variety of expressive needs, from the description of physical pain to the elaboration of spiritual longings.

Objective: Spirituality has been neglected when assessing the well-being of cancer patients. Traditionally, researchers have focused on areas such as physical, social, and emotional functioning. However, there is a potential for spirituality to have a large impact on quality of life in patients with cancer. The current study was conducted to investigate the relationship between spirituality and boredom, constraint, social contact, and depression.

Methods: A total of 100 oncology patients completed several assessment instruments, including the Purposelessness, Under-stimulation, and Boredom (PUB) Scale, Functional Assessment of Cancer Therapy Scale–Anemia, Brief Zung Self-Rating Depression Scale (BZSDS), Cancer Behavior Inventory, Systems of Belief Inventory, and Eastern Cooperative Oncology Group Performance Status Scale.

Results: The average age of the sample was 62.37 years (SD = 13.43) and was comprised of 60 women (60%) and 40 men (40%). A regression analysis conducted to explore the impact of the variables on quality of life found only the BZSDS (R2Δ = .650, F = 180.392, p < .001) and the PUB Scale (R2Δ = .077, F = 26.885, p < .001) were significant predictors of quality of life. Another set of regression analyses were conducted to explore whether spirituality had a mediating effect on this relationship, but the mediated model was not supported.

Significance of results: We conclude that spirituality and boredom are difficult concepts to define, operationalize, and measure, but crucial to our understanding of quality of life in advanced cancer. More research is needed to clarify the nature of the interrelationships between these important concepts.

Objective: The aim of this paper is to delineate the particular nature of the end-of-life care experience from the perspective of family members and friends. Ideas drawn from feminist analyses of caring and the sociology of death and dying are used to illuminate study respondents' accounts.

Methods: Qualitative study with people who cared for a family member or friend who died of breast cancer. Two interviews were conducted with each of 12 study participants, and one carer responded by letter to a series of questions drawn from the interview guide. Accounts were analyzed with reference to grounded theory methods.

Results: The analysis presented here suggests that anticipating the death of an ill relative or friend generates imperatives to care, imperatives that are both “felt” and linked to wider social structures and processes. The value assigned to closeness with the ill person can be seen to reflect cultural injunctions toward a “good death,” and to shape informal carers' perceptions of their labor. Also discussed in this paper are the complex negotiations undertaken by relatives and friends, for the life and death of someone with advanced cancer.

Significance of results: This paper offers insight into the social processes of caregiving, revealing how care may be shaped in particular ways by an awareness of approaching death.

Objective: To investigate differences between African American and White family caregivers in self-reported health, use of social support and external resources, and emotional and financial strain in the context of their care of a family member with advanced cancer.

Methods: Sixty-nine patient-designated family caregivers of patients with advanced lung or colon cancer interviewed between December 1999 and July 2001.

Results: Most African American and White family caregivers were able to identify someone else who was helping them in the care of their family member. Few caregivers used outside resources (e.g., home-based medical care, meal delivery, pastoral care, outside social support visitor) to assist in the support and care of the patient. At baseline, White caregivers were more likely to agree that caregiving caused work adjustments (ρ = .28, p = .02) and emotional difficulties (ρ = .32, p = .008) and that caregiving had been completely overwhelming (ρ = .19, p = .12) than were African American caregivers. At follow-up, among family caregivers of patients who had died, 44% reported having to quit work to provide personal care for the patient. Twenty-five percent of family caregivers reported using most or all of the family's saving in caring for the patient.

Significance of results: Caregivers of patients at end of life experience substantial emotional and financial difficulties related to caregiving. Family caregiving is a private undertaking with little use of outside resources to mitigate the burden.

Objective: An increasing number of patients are cared for at home and the presence of next of kin is often a prerequisite for successful home care. The aim of this study was to describe and interpret the construct of meaningfulness in next of kin of cancer patients who are in advanced palliative home care.

Methods: The perspective of Antonovsky's salutogenic framework of sense of coherence was applied in the analysis. Using a hermeneutic approach, 19 next of kin were interviewed (n = 30 interviews) during ongoing palliative home care.

Results: Elements that facilitated meaningfulness included comfort, retaining everyday life, action, commitment, and hope, which were of great importance for creating a perception of self-transcendence and that the best possible was done.

Significance of results: The findings are discussed in relation to the concepts of meaning-based coping, tragic optimism, and existentialism. Clinical implications are suggested.

Articles from the last decade that have propelled the field of palliative care are reviewed. The areas of depression, anxiety, substance abuse, delirium, and grief are represented by seminal articles that define, explore, or thoroughly review these topics.

Growing up on New York City's Lower East Side of the 1950s there were no other Breitbarts to be found, so it was not surprising that I would be drawn to the heroic legend of my famous ancestor and namesake, Siegmund (Zishe) Breitbart. My parents were survivors of the Holocaust, born in Turka, a small shtetl in Galicia, Poland, not far from the Lodz birthplace of the “greatest Jewish strongman—the modern Samson.” Being related to the famous Jewish “Iron King” was, for me, a proud link to a legacy of strength, courage, and defiance in an environment scarred by the profound losses and overwhelming grief of my generation of “children of survivors.” In 1994, I attended the International AIDS Congress in Berlin, and was the first Breitbart, to my knowledge, to visit Zishe's grave site in a small Jewish cemetery in the former East Berlin. Zishe Breitbart was a looming figure of strength in my subconscious.

The surgeon has offered me a chair, tightly fitted in the corner of her office. She proceeds with what seems like a foreign language, and relays the news. Absorbing the minimum, I learn that I have breast cancer.

Literature abstracts.

Calendar of events.

On page 93, paragraph 2, sentence 2 should have read:“in a lifelong friendship of eighteen months, he had been my colleague, my mentor, my fellow-performer, my friend”. We inadvertently eliminated the phrase “of eighteen months” which did not accurately reflect Dr. Mount's intention of communicating the intense experience of getting to know Philip Simmons over a relatively short period of time, yet still have the sense of being a lifelong friend.