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Nicholson WK, Silverstein M, Wong JB, Barry MJ, Chelmow D, Coker TR, Davis EM, Jaén CR, Krousel-Wood M, Lee S, Li L, Mangione CM, Rao G, Ruiz JM, Stevermer JJ, Tsevat J, Underwood SM, Wiehe S. Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2024; 331:1918-1930. [PMID: 38687503 DOI: 10.1001/jama.2024.5534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Importance Among all US women, breast cancer is the second most common cancer and the second most common cause of cancer death. In 2023, an estimated 43 170 women died of breast cancer. Non-Hispanic White women have the highest incidence of breast cancer and non-Hispanic Black women have the highest mortality rate. Objective The USPSTF commissioned a systematic review to evaluate the comparative effectiveness of different mammography-based breast cancer screening strategies by age to start and stop screening, screening interval, modality, use of supplemental imaging, or personalization of screening for breast cancer on the incidence of and progression to advanced breast cancer, breast cancer morbidity, and breast cancer-specific or all-cause mortality, and collaborative modeling studies to complement the evidence from the review. Population Cisgender women and all other persons assigned female at birth aged 40 years or older at average risk of breast cancer. Evidence Assessment The USPSTF concludes with moderate certainty that biennial screening mammography in women aged 40 to 74 years has a moderate net benefit. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of screening mammography in women 75 years or older and the balance of benefits and harms of supplemental screening for breast cancer with breast ultrasound or magnetic resonance imaging (MRI), regardless of breast density. Recommendation The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram. (I statement).
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Affiliation(s)
| | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
| | | | | | | | - Esa M Davis
- University of Maryland School of Medicine, Baltimore
| | | | | | - Sei Lee
- University of California, San Francisco
| | - Li Li
- University of Virginia, Charlottesville
| | | | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- The University of Texas Health Science Center, San Antonio
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Dorfman CS, Fisher HM, Thomas S, Kelleher SA, Winger JG, Mitchell NS, Miller SN, Somers TJ. Breast cancer survivors with pain: an examination of the relationships between body mass index, physical activity, and symptom burden. Support Care Cancer 2023; 31:604. [PMID: 37782420 PMCID: PMC10721211 DOI: 10.1007/s00520-023-08064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Overweight and obesity are common for breast cancer survivors and associated with high symptom burden (i.e., pain, fatigue, depressive symptoms). Physical activity may protect breast cancer survivors with higher body mass indexes (BMI) from increased symptoms. However, the role of physical activity in buffering the relationship between higher BMI and greater symptoms is unclear. METHODS Baseline data from a randomized trial investigating Pain Coping Skills Training among breast cancer survivors (N = 327) with pain were used to examine the relationship between self-reported BMI (kg/m2) and physical activity level (Rapid Assessment of Physical Activity; suboptimal vs. optimal) with pain (Brief Pain Inventory; severity and interference), fatigue (PROMIS-Fatigue short form), and depressive symptoms (Center for Epidemiological Studies Depression Scale). Analyses were conducted in SPSS. Hayes PROCESS macro (Model 1) assessed whether physical activity moderated the relationship between BMI and symptoms. RESULTS Lower BMI (B = .06, p < .01) and optimal physical activity (B = - .69, p < .01) were independently associated with lower pain interference. Lower BMI was also associated with lower pain severity (B = .04, p < .001). Neither BMI nor physical activity was associated with fatigue or depressive symptoms. Physical activity did not moderate the relationship between BMI and symptoms. CONCLUSIONS Among breast cancer survivors experiencing pain, higher BMI and being less physically active were related to greater pain (i.e., severity and/or interference). Physical activity did not buffer the relationships between BMI and pain, fatigue, and depressive symptoms, suggesting that physical activity alone may not be sufficient to influence the strength of the relationships between BMI and symptoms.
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Affiliation(s)
- Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
| | - Hannah M Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Samantha Thomas
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Nia S Mitchell
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Shannon N Miller
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Hu X, Kaplan CM, Martin MY, Walker MS, Stepanski E, Schwartzberg LS, Vidal GA, Graetz I. Race Differences in Patient-Reported Symptoms during Chemotherapy among Women with Early-Stage Hormone Receptor-Positive Breast Cancer. Cancer Epidemiol Biomarkers Prev 2023; 32:167-174. [PMID: 36166516 PMCID: PMC9905215 DOI: 10.1158/1055-9965.epi-22-0692] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Symptom burden differences may contribute to racial disparities in breast cancer survival. We compared symptom changes from before to during chemotherapy among women with breast cancer. METHODS This observational study followed a cohort of Black and White women diagnosed with Stage I-III, hormone receptor-positive breast cancer from a large cancer center in 2007 to 2015, and reported symptoms before and during chemotherapy. We identified patients who experienced a one-standard deviation (SD) increase in symptom burden after starting chemotherapy using four validated composite scores (General Physical Symptoms, Treatment Side Effects, Acute Distress, and Despair). Kitagawa-Blinder-Oaxaca decomposition was used to quantify race differences in symptom changes explained by baseline characteristics (sociodemographic, baseline scores, cancer stage) and first-line chemotherapy regimens. RESULTS Among 1,273 patients, Black women (n = 405, 31.8%) were more likely to report one-SD increase in General Physical Symptoms (55.6% vs. 48.2%, P = 0.015), Treatment Side Effects (74.0% vs. 63.4%, P < 0.001), and Acute Distress (27.4% vs. 20.0%, P = 0.010) than White women. Baseline characteristics and first-line chemotherapy regimens explained a large and significant proportion of the difference in Acute Distress changes (93.7%, P = 0.001), but not General Physical Symptoms (25.7%, P = 0.25) or Treatment Side Effects (16.4%, P = 0.28). CONCLUSIONS Black women with early-stage breast cancer were more likely to experience significant increases in physical and psychological symptom burden during chemotherapy. Most of the difference in physical symptom changes remained unexplained by baseline characteristics, which suggests inadequate symptom management among Black women. IMPACT Future studies should identify strategies to improve symptom management among Black women and reduce differences in symptom burden. See related commentary by Rosenzweig and Mazanec, p. 157.
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Affiliation(s)
- Xin Hu
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cameron M Kaplan
- Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine of USC, Los Angeles, California
| | - Michelle Y Martin
- Center for Innovation in Health Equity Research, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | | | | | - Gregory A Vidal
- West Cancer Center and Research Institute, Germantown, Tennessee.,School of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Mahoney DE, Pierce JD. Ovarian Cancer Symptom Clusters: Use of the NIH Symptom Science Model for Precision in Symptom Recognition and Management. Clin J Oncol Nurs 2022; 26:533-542. [PMID: 36108208 PMCID: PMC9951395 DOI: 10.1188/22.cjon.533-542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the United States, ovarian cancer remains the deadliest gynecologic cancer because most women are diagnosed with advanced disease. Although early-stage ovarian tumors are considered asymptomatic, women experience symptoms throughout disease. OBJECTIVES This review identifies ovarian cancer symptom clusters and explores the applicability of the National Institutes of Health Symptom Science Model (NIH-SSM) for prompt symptom recognition and clinical intervention. METHODS A focused CINAHL® and PubMed® database search was conducted for studies published from January 2000 to May 2022 using combinations of key terms. FINDINGS The NIH-SSM can guide the delivery of precision-focused interventions that address racial disparities and foster equity in symptom- focused care. Enhanced understanding of symptom biology can support clinical oncology nurses in ambulatory and inpatient settings.
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Steineck A, Bradford MC, O'Daffer A, Fladeboe KM, O'Donnell MB, Scott S, Yi-Frazier JP, Rosenberg AR. Quality of Life in Adolescents and Young Adults: The Role of Symptom Burden. J Pain Symptom Manage 2022; 64:244-253.e2. [PMID: 35649460 PMCID: PMC9378571 DOI: 10.1016/j.jpainsymman.2022.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Adolescents and young adults (AYAs) with cancer report worse health-related quality of life (HRQOL) than other age groups. Symptom burden is a modifiable predictor of HRQOL. OBJECTIVES The objective of this study was to identify which symptoms are most burdensome to AYAs with advanced cancer. METHODS In this observational study, English-speaking individuals aged 12-25 years undergoing treatment for advanced cancer completed assessments of symptom burden (Memorial Symptom Assessment Scale) and HRQOL (Pediatric Quality of Life Inventory Generic Form and Cancer Module; minimal clinically important difference 4.4). We dichotomized participants as having low (<7) or high (≥7) symptom prevalence. Mixed regression models estimated HRQOL differences between groups. For individual symptoms, unadjusted mixed models estimated HRQOL reductions. RESULTS N = 58 AYAs completed baseline surveys. The median age was 17 years (IQR 15-19), 58% were male, 59% identified as white, and 44% were diagnosed with leukemia/lymphoma. High symptom prevalence was associated with a mean generic HRQOL 7 points lower (95% CI: -11, -3; P < 0.01) and cancer-specific HRQOL score 12 points lower (95% CI: -17, -7; P < 0.01) than low symptom prevalence. The most prevalent symptoms were fatigue (71%), pain (58%), and difficulty sleeping (58%). Fatigue (-8), difficulty concentrating (-7), and mouth sores (-6) were associated with the greatest generic HRQOL score reductions. Dysphagia (-12), difficulty concentrating (-12), and sadness (-11) were associated with the greatest cancer-specific HRQOL score reductions. CONCLUSION The symptom experience among AYAs with advanced cancer is unique. Separate evaluation of AYA's symptoms may optimize management and improve HRQOL.
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Affiliation(s)
- Angela Steineck
- Seattle Children's Hospital (A.S.), Cancer and Blood Disorders Center, Seattle, Washington, USA; Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington School of Medicine (A.S.), Department of Pediatrics, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA; MACC Fund Center for Cancer and Blood Disorders (A.S.), Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Miranda C Bradford
- Core for Biostatistics (M.C.B.), Epidemiology, and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Alison O'Daffer
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA
| | - Kaitlyn M Fladeboe
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA
| | - Maeve B O'Donnell
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA
| | - Samantha Scott
- Department of Psychology (S.S.), University of Denver, Denver, Colorado, USA
| | - Joyce P Yi-Frazier
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA
| | - Abby R Rosenberg
- Seattle Children's Hospital (A.S.), Cancer and Blood Disorders Center, Seattle, Washington, USA; Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington School of Medicine (A.S.), Department of Pediatrics, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA.
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Hu X, Walker MS, Stepanski E, Kaplan CM, Martin MY, Vidal GA, Schwartzberg LS, Graetz I. Racial Differences in Patient-Reported Symptoms and Adherence to Adjuvant Endocrine Therapy Among Women With Early-Stage, Hormone Receptor-Positive Breast Cancer. JAMA Netw Open 2022; 5:e2225485. [PMID: 35947386 PMCID: PMC9366541 DOI: 10.1001/jamanetworkopen.2022.25485] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Adjuvant endocrine therapy (AET) reduces breast cancer recurrence, but symptom burden is a key barrier to adherence. Black women have lower AET adherence and worse health outcomes than White women. OBJECTIVE To investigate the association between symptom burden and AET adherence differences by race. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using electronic health records with patient-reported data from a large cancer center in the US. Patients included Black and White women initiating AET therapy for early-stage breast cancer from August 2007 to December 2015 who were followed for 1 year from AET initiation. Sixty symptoms classified into 7 physical and 2 psychological symptom clusters were evaluated. For each cluster, the number of symptoms with moderate severity at baseline, and symptoms with 3-point or greater increases during AET were counted. Adherence was measured as the proportion of days covered by AET during the first-year follow-up. Multivariable regressions for patients' adherence adjusting for race, symptom measures, sociodemographic characteristics, and clinical characteristics were conducted. Kitagawa-Blinder-Oaxaca decomposition was used to quantify racial differences in adherence explained by symptoms and patient characteristics. Analyses were conducted from July 2021 to January 2022. EXPOSURES Physical and psychological symptoms at baseline and changes during AET. RESULTS Among 559 patients (168 [30.1%] Black and 391 [69.9%] White; mean [SD] age 65.5 [12.1] years), Black women received diagnoses younger (mean [SD] age at diagnosis, 58.7 [13.7] vs 68.5 [10.0] years old) than White women, with more advanced stages (30 Black participants [17.9%] vs 31 White participants [7.9%] had stage III disease at diagnosis), and lived in areas with fewer adults attaining high school education (mean [SD], 78.8% [7.8%] vs 84.0% [9.3%]). AET adherence in the first year was 78.8% for Black and 82.3% for White women. Black women reported higher severity in most symptom clusters than White women. Neuropsychological, vasomotor, musculoskeletal, cardiorespiratory, distress, and despair symptoms at baseline and increases during the follow-up were associated with 1.2 to 2.6 percentage points decreases in adherence, which corresponds to 4 to 9 missed days receiving AET in the first year. After adjusting for psychological symptoms, being Black was associated with 6.5 percentage points higher adherence than being White. CONCLUSIONS AND RELEVANCE In this cohort study, severe symptoms were associated with lower AET adherence. Black women had lower adherence rates that were explained by their higher symptom burden and baseline characteristics. These findings suggest that better symptom management with a focus on psychological symptoms could improve AET adherence and reduce racial disparities in cancer outcomes.
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Affiliation(s)
- Xin Hu
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | | | - Cameron M. Kaplan
- Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, Los Angeles
| | - Michelle Y. Martin
- Center for Innovation in Health Equity Research, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis
| | - Gregory A. Vidal
- West Cancer Center and Research Institute, Germantown, Tennessee
- Division of Hematology and Oncology, College of Medicine, University of Tennessee Health Science Center, Memphis
| | | | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Mazanec SR, Park S, Connolly MC, Rosenzweig MQ. Factors associated with symptom distress in women with breast cancer prior to initiation of chemotherapy. Appl Nurs Res 2021; 62:151515. [PMID: 34815009 DOI: 10.1016/j.apnr.2021.151515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptom distress in women with breast cancer is associated with early discontinuation of chemotherapy and may influence treatment outcomes. Describing racial differences in prechemotherapy symptom distress and examining contextual variables of the symptom experience may inform our understanding of the complex problem of racial disparities in breast cancer. AIM To determine if perceived social support, healthcare system distrust, and economic hardship predict symptom distress in women with breast cancer prior to their first chemotherapy treatment. DESIGN Descriptive, correlational, cross-sectional. METHODS Baseline data (N = 119) was used from a multisite, longitudinal study comparing the symptom experience and ability to receive chemotherapy of Black and White women with breast cancer (R01MD012245; Rosenzweig, PI). Measures included the Symptom Distress Scale, Interpersonal Support Evaluation List, Health Care System Distrust Scale, and Psychological Sense of Economic Hardship scale. The analysis consisted of multiple regression and a t-test. RESULTS On average, participants reported five symptoms prior to chemotherapy. Black women reported higher symptoms distress than White women; t(68.34) = 2.15, p = 0.035. The model explained 26% of variance in symptom distress; F(5, 112) = 9.01, p < 0.001. While controlling for age and race, greater perceived economic hardship contributed to higher symptom distress (β = 0.36, p = 0.001, 95% CI: 0.34 to 1.34). Race, health care system distrust and social support did not significantly predict symptom distress. CONCLUSION Assessment of perceived financial hardship prior to beginning chemotherapy is critical to identify those patients at risk for greater symptom distress.
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Affiliation(s)
- Susan R Mazanec
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106-4904, United States of America; University Hospitals Seidman Cancer Center, 11100 Euclid Ave., Cleveland, OH 44106, United States of America.
| | - Sumin Park
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106-4904, United States of America.
| | - Mary C Connolly
- School of Nursing, University of Pittsburgh, 3500 Victoria St., Victoria Building, Pittsburgh, PA 15261, United States of America.
| | - Margaret Quinn Rosenzweig
- School of Nursing, University of Pittsburgh, 3500 Victoria St., Victoria Building, Pittsburgh, PA 15261, United States of America; UPMC Hillman Cancer Center, 5115 Centre Ave, Pittsburgh, PA 15232, United States of America.
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