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Werutsky G, Lopes M, de Jesus RG, Gazola AA, Pellegrini RA, Rebelatto TF, Freitas LVW, Heck AP, da Silva AF, Rodrigues MF, Gössling G, Giacomazzi J, Rocha MS, Rosa DD, Barrios CH, Cronemberger EH, Queiroz GS, Bines J, Simon SD, Fay AP. The impact of a breast cancer diagnosis on marital outcomes and factors associated with divorce and separation. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo60. [PMID: 38994465 PMCID: PMC11239212 DOI: 10.61622/rbgo/2024rbgo60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/26/2024] [Indexed: 07/13/2024] Open
Abstract
Objective To analyze marital outcomes, divorce or separation, and its association with demographic, socioeconomic, and clinicopathological factors among breast cancer (BC) survivors after 2-years of diagnosis. Methods We performed a retrospective analysis of marital status at baseline and at years 1 and 2 of follow-up of women aged ≥ 18 years diagnosed with invasive BC participating in the AMAZONA III (GBECAM0115) study. The BC diagnosis occurred between January 2016 and March 2018 at 23 institutions in Brazil. Results Of the 2974 women enrolled in AMAZONA III, 599 were married or living under common law at baseline. Divorce or separation occurred in 35 (5.8%) patients at 2 years of follow-up. In the multivariate analysis, public health insurance coverage was associated with a higher risk of marital status change (8.25% vs. 2.79%, RR 3.09, 95% CI 1.39 - 7.03, p = 0.007). Women who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation (8.1% vs. 4.49%, RR 1.97, 95 CI 1.04 - 3.72, p = 0.0366) than those who underwent breast-conserving surgery. Conclusion Women covered by the public health system and those who underwent mastectomy, adenomastectomy or skin-sparing mastectomy were associated with a higher risk of divorce or separation. This evidence further supports the idea that long-term marital stability is associated with a complex interplay between socioeconomic conditions and stressors, such as BC diagnosis and treatment. ClinicalTrials Registration: NCT02663973.
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Affiliation(s)
- Gustavo Werutsky
- Latin American Cooperative Oncology GroupPorto AlegreRSBrazilLatin American Cooperative Oncology Group, Porto Alegre, RS, Brazil.
| | - Mahira Lopes
- Latin American Cooperative Oncology GroupPorto AlegreRSBrazilLatin American Cooperative Oncology Group, Porto Alegre, RS, Brazil.
| | - Rafaela Gomes de Jesus
- Latin American Cooperative Oncology GroupPorto AlegreRSBrazilLatin American Cooperative Oncology Group, Porto Alegre, RS, Brazil.
| | - Antonia Angeli Gazola
- Pontifícia Universidade Católica do Rio Grande do SulPorto AlegreRSBrazilPontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Rodrigo Azevedo Pellegrini
- Pontifícia Universidade Católica do Rio Grande do SulPorto AlegreRSBrazilPontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Taiane Francieli Rebelatto
- Latin American Cooperative Oncology GroupPorto AlegreRSBrazilLatin American Cooperative Oncology Group, Porto Alegre, RS, Brazil.
| | - Laura von Wallwitz Freitas
- Department of Medical OncologyHospital São LucasPontifícia Universidade Católica do Rio Grande do SulPorto AlegreRSBrazilDepartment of Medical Oncology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Ana Paula Heck
- Department of Medical OncologyHospital São LucasPontifícia Universidade Católica do Rio Grande do SulPorto AlegreRSBrazilDepartment of Medical Oncology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Arthur Ferreira da Silva
- Department of Medical OncologyHospital São LucasPontifícia Universidade Católica do Rio Grande do SulPorto AlegreRSBrazilDepartment of Medical Oncology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Matheus Füehr Rodrigues
- Pontifícia Universidade Católica do Rio Grande do SulPorto AlegreRSBrazilPontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Gustavo Gössling
- Latin American Cooperative Oncology GroupPorto AlegreRSBrazilLatin American Cooperative Oncology Group, Porto Alegre, RS, Brazil.
| | - Juliana Giacomazzi
- Latin American Cooperative Oncology GroupPorto AlegreRSBrazilLatin American Cooperative Oncology Group, Porto Alegre, RS, Brazil.
| | - Matheus Soares Rocha
- Latin American Cooperative Oncology GroupPorto AlegreRSBrazilLatin American Cooperative Oncology Group, Porto Alegre, RS, Brazil.
| | - Daniela Dornelles Rosa
- Grupo Brasileiro de Estudos em Câncer de MamaPorto AlegreRSBrazilGrupo Brasileiro de Estudos em Câncer de Mama, Porto Alegre, RS, Brazil.
| | - Carlos Henrique Barrios
- Latin American Cooperative Oncology GroupPorto AlegreRSBrazilLatin American Cooperative Oncology Group, Porto Alegre, RS, Brazil.
| | - Eduardo Henrique Cronemberger
- Centro Regional Integrado de OncologiaFortalezaCEBrazilCentro Regional Integrado de Oncologia, Fortaleza, CE, Brazil.
| | - Geraldo Silva Queiroz
- Associação de Combate ao Câncer em GoiásHospital Araújo JorgeGoiâniaGOBrazilAssociação de Combate ao Câncer em Goiás, Hospital Araújo Jorge, Goiânia, GO, Brazil.
| | - José Bines
- Instituto Nacional do CâncerRio de JaneiroRJBrazilInstituto Nacional do Câncer, Rio de Janeiro, RJ, Brazil.
| | - Sérgio Daniel Simon
- Grupo OncoclínicasSão PauloSPBrazilGrupo Oncoclínicas, São Paulo, SP, Brazil.
| | - Andre Poisl Fay
- Latin American Cooperative Oncology GroupPorto AlegreRSBrazilLatin American Cooperative Oncology Group, Porto Alegre, RS, Brazil.
- Department of Medical OncologyHospital São LucasPontifícia Universidade Católica do Rio Grande do SulPorto AlegreRSBrazilDepartment of Medical Oncology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Sommer JL, Reynolds K, Hebbard P, Smith MSD, Mota N, Mutch WAC, Maples-Keller J, Roos L, El-Gabalawy R. Preoperative Virtual Reality to Expose Patients With Breast Cancer to the Operating Room Environment: Feasibility and Pilot Case Series Study. JMIR Form Res 2024; 8:e46367. [PMID: 38231570 PMCID: PMC10831694 DOI: 10.2196/46367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. OBJECTIVE This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. METHODS Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants' impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. RESULTS Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, "It was realistic to my past surgical experiences"), impacting their degree of preparedness and expectations for surgery (eg, "The sounds and sights and procedures give you a test run; they prepare you for the actual day"), and having a calming or relaxing effect (eg, "You feel more relaxed for the surgery"). CONCLUSIONS This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Pamela Hebbard
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
| | | | - Natalie Mota
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - W Alan C Mutch
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jessica Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Leslie Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
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Fayanju OM, Greenup RA, Zafar SY, Hyslop T, Hwang ES, Fish LJ. Modifiable Barriers and Facilitators for Breast Cancer Care: A Thematic Analysis of Patient and Provider Perspectives. J Surg Res 2023; 284:269-279. [PMID: 36610386 PMCID: PMC10020986 DOI: 10.1016/j.jss.2022.11.074] [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: 08/24/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We sought to examine patient and provider perspectives regarding modifiable contributors to breast cancer treatment and to assess perceptual alignment between these two groups. MATERIALS Participants were women≥18 y with stage 0-IV breast cancer who received all oncologic care in a single health system and physicians and advanced practice providers who provided medical, radiation, or surgical oncology care for breast cancer. All completed ∼45-min semistructured interviews that were recorded and transcribed verbatim. A 5-stage approach to thematic analysis was conducted, with emergent themes and exemplar quotes placed into clinical, psychological, social/logistical, financial, and lifestyle categories using a multilevel conceptual framework. RESULTS Eighteen patients (9 Black, 9 White, and median age 60 y) and 10 providers (6 physicians and 4 advanced practice providers) were interviewed from May to November 2018. Both patients and providers perceived suboptimal communication, parking and transportation, and competing family-caregiving responsibilities as modifiable barriers to care. Treatment costs were cited by patients as barriers that were inadequately addressed even with referrals to financial counselors, but providers did not raise the issue of cost unless prompted by patients and did not feel prepared to discuss the topic when it arose. Providers cited obesity as a barrier to treatment, a view not shared by patients. CONCLUSIONS Several modifiable factors were recognized by both patients and providers as either promoting or detracting from treatment receipt, but there was also significant incongruence and asymmetry. Alignment of provider and patient perceptions regarding contributors to guideline-concordant care receipt could mitigate disparities in breast cancer treatment and outcomes.
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Affiliation(s)
- Oluwadamilola M Fayanju
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Forge, Duke University, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina.
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - S Yousuf Zafar
- Duke Cancer Institute, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina; Change Healthcare, Nashville, Tennessee
| | - Terry Hyslop
- Duke Cancer Institute, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina
| | - Laura J Fish
- Duke Cancer Institute, Durham, North Carolina; Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina
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Lacourt TE, Koncz Z, Tullos EA, Tripathy D. A detailed description of the distress trajectory from pre- to post-treatment in breast cancer patients receiving neoadjuvant chemotherapy. Breast Cancer Res Treat 2023; 197:299-305. [PMID: 36383306 DOI: 10.1007/s10549-022-06805-y] [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: 07/11/2022] [Accepted: 11/03/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To characterize the distress trajectory in patients with newly diagnosed, non-metastatic breast cancer from pre-neoadjuvant chemotherapy until 12 months after onset of treatment and to identify demographic and clinical predictors of distress in these patients. METHODS In a retrospective, longitudinal study, chart review data were abstracted for 252 eligible patients treated at a comprehensive cancer care center. The center screens for distress at least monthly with the distress thermometer; the highest distress score per month was included in the analyses. The growth trajectory was established using mixed modeling and predictors were added to the initial growth model in subsequent models. RESULTS Distress showed a cubic growth trajectory with highest distress prior to treatment onset followed by a steep decline in the first three months of treatment. A slight increase in distress was apparent over months 6-10. Being Hispanic was associated with a stronger increase in distress in the second half of the year (p = 0.012). NACT was associated with lower distress and surgery with higher distress (both: p < 0.001). CONCLUSION Distress is at its peak prior to treatment onset and rapidly decreases once treatment has started. Oncologist should be aware that both completion of NACT and undergoing surgery are associated with increases in distress and Hispanic patients may be more at risk for an increase in distress at these times; this suggests that careful monitoring of distress during the treatment trajectory and in Hispanic patients in particular in order to provide timely support.
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Affiliation(s)
- Tamara E Lacourt
- Department of Psychiatry, The University of Texas MD Anderson Cancer Center, Unit 1454, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA.
| | - Zsuzsa Koncz
- Faculty of Medicine, Institute of Behavioral Sciences, Semmelweis University, 26, Ulloi Ut, Budapest, Hungary
| | - Emily A Tullos
- Department of Psychiatry, The University of Texas MD Anderson Cancer Center, Unit 1454, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1354, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
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Mundy LR, Stukes B, Njoroge M, Fish LJ, Sergesketter AR, Wang SM, Worthy V, Fayanju OM, Greenup RA, Hollenbeck ST. Community collaboration to improve access and outcomes in breast cancer reconstruction: protocol for a mixed-methods qualitative research study. BMJ Open 2022; 12:e064121. [PMID: 36344000 PMCID: PMC9644344 DOI: 10.1136/bmjopen-2022-064121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Breast reconstruction plays an important role for many in restoring form and function of the breast after mastectomy. However, rates of breast reconstruction in the USA vary significantly by race, ethnicity and socioeconomic status. The lower rates of breast reconstruction in non-white women and in women of lower socioeconomic status may reflect a complex interplay between patient and physician factors and access to care. It remains unknown what community-specific barriers may be impacting receipt of breast reconstruction. METHODS AND ANALYSIS This is a mixed-methods study combining qualitative patient interview data with quantitative practice patterns to develop an actionable plan to address disparities in breast reconstruction in the local community. The primary aims are to (1) capture barriers to breast reconstruction for patients in the local community, (2) quantitatively evaluate practice patterns at the host institution and (3) identify issues and prioritise interventions for change using community-based engagement. ETHICS AND DISSEMINATION Ethics approval was obtained at the investigators' institution. Results from both the quantitative and qualitative portions of the study will be circulated via peer-review publication. These findings will also serve as pilot data for extramural funding to implement and evaluate these proposed solutions.
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Affiliation(s)
- Lily R Mundy
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bryanna Stukes
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Moreen Njoroge
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Laura Jane Fish
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - Amanda R Sergesketter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Sabrina M Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Valarie Worthy
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA
- Triangle Chapter, Sisters Network, Raleigh-Durham, North Carolina, USA
| | | | - Rachel A Greenup
- Department of Surgery, Yale University, New Haven, Connecticut, USA
| | - Scott T Hollenbeck
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA
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Yu H, Li H, Zuo T, Cao L, Bi X, Xing H, Cai L, Sun J, Liu Y. Financial Toxicity and psychological distress in Adults with Cancer: A Treatment-based Analysis. Asia Pac J Oncol Nurs 2022; 9:100069. [PMID: 35669288 PMCID: PMC9166374 DOI: 10.1016/j.apjon.2022.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate disparities in financial toxicity and psychological distress in patients with cancer as a function of treatment and reveal the relationship between financial toxicity and psychological distress. Methods This was a multicenter cross-sectional study. Patients were recruited from March 2017 to October 2018, and questionnaires were completed regarding their demographics, financial toxicity, and psychological distress. A multiple linear regression model was used to examine factors associated with financial and psychological distress. Results Significant financial toxicity and psychological distress occurred in 47.9% and 56.5% of patients, respectively. Financial toxicity (P = 0.032) and psychological distress (P < 0.001) were statistically different among the single chemotherapy, adjuvant therapy, and surgery groups. Multivariable analysis revealed that patients aged 50–59 years (P = 0.035), 60–69 years (P = 0.007), and 70 years or older (P = 0.002) had higher the Comprehensive Score for financial Toxicity (COST) scores compared with patients less than 50 years old. Patients with personal annual income > 40,000 CNY reported higher COST scores than those who had < 20,000 CNY (P < 0.001). Patients who had Urban Resident Basic Medical Insurance (URBMI) (P = 0.030) or New Rural Cooperative Medical Scheme (NRCMS) (P = 0.006) compared with Urban Employee Basic Medical Insurance (UEBMI) presented lower COST scores than patients with UEBMI. The multiple analysis model of psychological distress showed that an age of more than 70 years (P = 0.010) was significantly associated with low the Distress Thermometer (DT) scores, and patients with colorectal cancer (P = 0.009), the surgery group (P < 0.001) and adjuvant therapy group (P < 0.001) were significantly associated with high DT scores. The correlations between financial toxicity and psychological distress were mild but statistically significant in the chemotherapy-related treatment groups. Conclusions The research highlights the high rates of financial and psychological distress in adult patients. Multidimensional distress screening and psychosocial interventions should be provided for patients with cancer according to related factors.
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Taurisano P, Abbatantuono C, Verri V, Pepe I, Stucci LS, Taurino A, Moschetta M, De Caro MF, Antonucci LA. Pre-surgery supportive and goal-oriented strategies are associated with lower post-surgery perceived distress in women diagnosed with breast cancer. BMC Psychol 2022; 10:2. [PMID: 34980291 PMCID: PMC8725323 DOI: 10.1186/s40359-021-00714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psycho-oncology literature pointed out that individual health outcomes may depend on patients' propensity to adopt approach or, conversely, avoidant coping strategies. Nevertheless, coping factors associated with postoperative distress remain unclear, unfolding the lack of tailored procedures to help breast cancer patients manage the psychological burden of scheduled surgery. In view of this, the present study aimed at investigating: 1. pre-/post-surgery distress variations occurring among women diagnosed with breast cancer; 2. the predictivity of approach and avoidant coping strategies and factors in affecting post-surgery perceived distress. METHODS N = 150 patients (mean age = 59.37; SD = ± 13.23) scheduled for breast cancer surgery were administered a screening protocol consisting of the Distress Thermometer (DT) and the Brief-COPE. The DT was used to monitor patients' distress levels before and after surgery (± 7 days), whereas the Brief-COPE was adopted only preoperatively to evaluate patients' coping responses to the forthcoming surgical intervention. Non-parametric tests allowed for the detection of pre-/post-surgery variations in patients' perceived distress. Factor analysis involved the extraction and rotation of principal components derived from the Brief-COPE strategies. The predictivity of such coping factors was investigated through multiple regression (Backward Elimination). RESULTS The Wilcoxon Signed-Rank Test yielded a significant variation in DT mean scores (TW = -5,68 < -zα/2 = -1,96; p < .001) indicative of lower perceived distress following surgery. The four coping factors extracted and Varimax-rotated were, respectively: 1. cognitive processing (i.e., planning + acceptance + active coping + positive reframing); 2. support provision (i.e., instrumental + emotional support); 3. emotion-oriented detachment (i.e., self-blame + behavioral disengagement + humor + denial); 4. goal-oriented detachment (i.e., self-distraction). Among these factors, support provision (B = .458; β = - .174; t = - 2.03; p = .045), encompassing two approach coping strategies, and goal-oriented detachment (B = .446; β = - .176; t = - 2.06; p = .042), consisting of one avoidant strategy, were strongly related to post-surgery distress reduction. CONCLUSION The present investigation revealed that the pre-surgery adoption of supportive and goal-oriented strategies led to postoperative distress reduction among breast cancer patients. These findings highlight the importance of timely psychosocial screening and proactive interventions in order to improve patients' recovery and prognosis.
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Affiliation(s)
- Paolo Taurisano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Chiara Abbatantuono
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Veronica Verri
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Ilaria Pepe
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | | | - Alessandro Taurino
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Via Scipione Crisanzio 42, 70122, Bari, Italy
| | - Marco Moschetta
- Department of Emergency and Organ Transplantations (D.E.T.O.), Breast Care Unit, University of Bari Aldo Moro, Bari, Italy
| | - Maria F De Caro
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Linda A Antonucci
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Via Scipione Crisanzio 42, 70122, Bari, Italy.
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Fayanju OM, Ren Y, Stashko I, Power S, Thornton MJ, Marcom PK, Hyslop T, Hwang ES. Patient-reported causes of distress predict disparities in time to evaluation and time to treatment after breast cancer diagnosis. Cancer 2021; 127:757-768. [PMID: 33175437 PMCID: PMC7897266 DOI: 10.1002/cncr.33310] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/13/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND We examined whether the National Comprehensive Cancer Network distress thermometer (DT), a patient-reported outcome measure, could be used to identify levels and causes of distress associated with racial/ethnic disparities in time to care among patients with breast cancer. METHODS We identified women aged ≥18 years with stage 0-IV breast cancer who were diagnosed in a single health system between January 2014 and July 2016. The baseline visit was defined as the first postdiagnosis, pretreatment clinical evaluation. Zero-inflated negative binomial (ZINB) regression (modeling non-zero DT scores and DT scores = 0) and logistic regression (modeling DT score ≥ 4, threshold for social services referral) were used to examine associations between baseline score (0 = none to 10 = extreme) and types of stressors (emotional, familial, practical, physical, spiritual) after adjustment for race/ethnicity and other characteristics. Linear regression with log transformation was used to identify predictors of time to evaluation and time to treatment. RESULTS A total of 1029 women were included (median baseline DT score = 4). Emotional, physical, and practical stressors were associated with distress in both the ZINB and logistic models (all P < .05). Black patients (n = 258) were more likely to report no distress than Whites (n = 675; ZINB zero model odds ratio, 2.72; 95% CI, 1.68-4.40; P < .001) despite reporting a similar number of stressors (P = .07). Higher DT scores were associated with shorter time to evaluation and time to treatment while being Black and having physical or practical stressors were associated with delays in both (all P < .05). CONCLUSIONS Patient-reported stressors predicted delays in time to care, but patient-reported levels of distress did not, with Black patients having delayed time to care despite reporting low levels of distress. We describe anticipatory, culturally responsive strategies for using patient-reported outcomes to address observed disparities.
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Affiliation(s)
- Oluwadamilola M. Fayanju
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Women’s Cancer Program, Duke Cancer Institute, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Forge, Duke University, Durham, North Carolina
- Department of Surgery, Durham VA Medical Center, Durham, North Carolina
| | - Yi Ren
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, North Carolina
| | - Ilona Stashko
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, North Carolina
| | - Steve Power
- Department of Quality and Outcomes, Duke Cancer Institute, Durham, North Carolina
| | | | - P. Kelly Marcom
- Women’s Cancer Program, Duke Cancer Institute, Durham, North Carolina
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Terry Hyslop
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - E. Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Women’s Cancer Program, Duke Cancer Institute, Durham, North Carolina
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Li J, Gao W, Yang Q, Cao F. Perceived stress, anxiety, and depression in treatment-naïve women with breast cancer: a case-control study. Psychooncology 2020; 30:231-239. [PMID: 32969126 DOI: 10.1002/pon.5555] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Women with breast cancer face elevated risk for psychological problems. We aimed to examine to what extent treatment-naïve women with breast cancer are at higher risk for perceived stress and symptoms of anxiety and depression, compared with matched women with benign breast disease and healthy women, and explore the contribution of perceived stress in the association between breast cancer and symptoms of anxiety and depression. METHODS The study included 360 women (120 per group). Perceived stress and symptoms of anxiety and depression were assessed using self-report questionnaires. We conducted linear and logistic regressions to assess increased risk and mediation analyses to test the role of perceived stress. RESULTS After adjusting for potential confounders, perceived stress in women with breast cancer was 0.71 and 1.58 points higher than in patients with benign breast disease (p = 0.029) and healthy controls (p < 0.001), respectively; they were 1.85-2.44 times more likely to experience anxiety than either control group (p< 0.05) and 3.57 times more likely to experience depression than healthy controls (p < 0.001). The indirect effect of perceived stress between breast cancer and anxiety and depressive symptoms was 0.19-0.47 (p < 0.05). CONCLUSIONS This study demonstrates the high risk of perceived stress and symptoms of anxiety and depression in treatment-naïve patients with breast cancer, and the association between breast cancer and increased anxiety and depressive symptoms through elevated perceived stress. It underscores the need to assess psychological status in pretreatment period and conduct stress-targeted prehabilitation interventions.
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Affiliation(s)
- Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wei Gao
- Department of Breast Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qianqian Yang
- School of Nursing, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fenglin Cao
- School of Nursing, Cheeloo College of Medicine, Shandong University, Jinan, China
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