The current study was a longitudinal study of psychosocial health outcomes (distress, coping and QoL) in male GI cancer patients participating in an ongoing men-only GI cancer SEGT intervention. Data was collected between May 2015- February 2016. Participants were assessed for their mood states, coping, and health-related quality of life (QoL) at baseline (i.e. before or near the beginning of group attendance (T1) and after three months (T2) and six months (T3) of participation in the group. The aim was to evaluate the patient-reported changes over time in mood, coping and quality of life in these patients.
The study was conducted in the Department of Psychosocial Oncology of the Tom Baker Cancer Centre (TBCC) in Calgary, Alberta, Canada. The TBCC is a large tertiary cancer centre that serves the population of Southern Alberta, with a catchment area of approximately 1.6 Million.
Participants and procedure
All men who were attending the ongoing men-only GI cancer SEGT at TBCC.
Men who were (1) ≥ 18 years with any GI cancer diagnosis (2) able to communicate in English, (3) attending the ongoing men’s cancer SEGT, were eligible to participate in this study. There were no restrictions on the treatment stage, time since diagnosis, phase of illness, or stage/severity of the disease. Men in the study could be either on or off treatment.
Inability to converse or read/write in English.
Study participants were recruited from the ongoing men’s GI cancer SEGT at TBCC that was open to all GI cancer patients of the centre, delivered through the Department of Psychosocial Oncology. Men were referred to this group in the usual manner, which included self-referral, health care team referral, word of mouth and through pamphlets posted in the cancer centre treatment areas. Men potentially eligible for the group were also approached in clinic waiting areas by a Research Assistant, and asked to complete “consent to contact” forms so that a team member could contact them and discuss the group and accompanying optional study.
New patients who joined the group between May 2015 and February 2016 were eligible to participate in the current study and were recruited through convenience sampling. A total of 219 men were invited to participate by the RA and/or filled out the consent to contact form, of which 213 were eligible and 6 were excluded because they did not have adequate English language skills. Of the eligible men, 177 declined to participate for reasons such as: not interested in the study; did not feel the need for the group; had enough social support; were busy, had pre-scheduled out of town visits; inconvenient time and/or location; poor health; or no specific reasons. Of the 36 remaining patients, five dropped out before the study commenced and 31 completed (response rate = 14.2%) the quantitative assessments at baseline.
Study participation was voluntary and independent of group enrollment, attendance, or entitlement to other psychosocial services at TBCC. Consenting participants were given a package of quantitative assessments to complete at baseline (before starting the group). After attending the group for three months, the participants filled out the same questionnaire package. The same procedures were followed six months after group entry.
The men’s GI cancer SEGT is the only known professionally-led group of its kind, running in Alberta (and beyond) since 2010. The Department of Psychosocial Resources established the SEGT at the TBCC within the GI tumour group in response to an increased number of referrals of distressed GI male cancer patients to the Psychosocial Department, and requests for such a group from male GI patients themselves. Through other formats of psychosocial interventions, GI male cancer patients expressed interest in engaging together in a forum that aims at facilitating information acquisition, provision of emotional support, and development of coping strategies.
The group has been running continually every two weeks for 90 min since its inception, with an average attendance of 12 to 15 men per session. The group adopted a supportive-expressive focus, guided by the principles of SEGT, emphasizing emotional support and shared experiences amongst male GI cancer patients at different stages in their cancer journey. The group is professionally led in dyads by three clinical psycho-oncologists (one female and two male). The group aims to: (1) reduce psychosocial morbidity, (2) facilitate coping/adaptation, and (3) improve quality of life. The structure of the groups was drop-in and ongoing, with the rolling addition of new members and graduation of old members when they no longer wished to attend. Attendance was voluntary and was determined by individual patients as per their needs. The facilitators moderated the discussions and encouraged the participants to talk about their existential concerns.
The Profile of Mood States (POMS)  is a 65-item scale that assesses six dimensions of mood: anger, confusion, depression, fatigue, tension, and vigour, as well as total mood disturbance. The scale has a good internal consistency for various dimensions (Cronbach α = 0.84–0.90) as well as good concurrent and discriminant validity .
The Ways of Coping Questionnaire- Cancer Version (WOC)  is a 53- item questionnaire that assesses coping with regards to five factors: seeking social support (e.g. talked to someone to find out more about the situation or to someone who could do something concrete about the problem, getting professional help, accepting sympathy from someone), focusing on positive (e.g. grew as a person, found a new faith, prayed, inspired to do something creative), distancing (e.g. making light of the situation, went on as if nothing happened, didn’t let it get to them, tried to forget the whole thing, or looked at the silver lining), cognitive escape-behavioural (e.g. avoided being with people, came up with different solutions, took a chance and did something risky, criticized or lectured themselves, tried not to act too hastily), and cognitive escape-avoidance (e.g. hoped a miracle would happen, took it out on others, wished that situation would go away, use of drugs, smoking, or medication to make themselves feel better, went along with fate). The reliability estimates for these factors have been moderate to high (α ranging from 0.74 to 0.86 for all the factors) . We also conducted a post-hoc analysis to analyze changes over time for each of the individual items of the WOC questionnaire to determine which contributed to the overall change in the subscale over time.
Quality of life
Functional Assessment of Cancer Therapy-General  is a 27-item scale that assesses four domains of QoL or wellbeing: Physical, Social/family, Emotional, Functional, and overall QoL. The scale has good internal consistency (all Cronbach α ≥ 0.77), test–retest reliability (r = 0.70) as well as construct validity .
Statistical data analysis
The sample size was limited to men joining the group over the study period. Participants’ demographic and clinical characteristics were reported using descriptive statistics. To determine the change in the outcomes (mood states, coping and QoL) from baseline to three months and six months of group participation, linear mixed models (LMM) were used. In LMM, time (categorically coded) was included as fixed effect while random intercepts, as well as random slopes, were included as random effects. Unstructured covariance matrix was used. Statistical significance was set at p ≤ 0.05. Mixed-level models are appropriate for analysis of this type of data as there is a lack of independence between observations obtained at each time point. In addition, these models are more robust to missing data and unbalanced designs. Chi-square tests were performed to compare the difference in participants who completed the questionnaires at each timepoint with those who completed the baseline but later dropped out at three months and six months. Data were analyzed using SPSS v. 25.