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Darabos K, Manne SL, Devine KA. The association between neighborhood social and built environment on loneliness among young adults with cancer. J Cancer Surviv 2024:10.1007/s11764-024-01563-w. [PMID: 38499963 DOI: 10.1007/s11764-024-01563-w] [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: 12/11/2023] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Young adults with cancer (YAs, aged 18-39) are at increased risk of experiencing loneliness due to their unique challenges of coping with a cancer diagnosis and treatment during young adulthood. Understanding factors that impact loneliness is critical to improving survivorship outcomes for this vulnerable YA population. Neighborhoods are key determinants of health. However, little is known about how such neighborhood characteristics are associated with loneliness among YA survivors. METHODS YA survivors (N = 181) drawn from the National Institutes of Health All of Us Research Program completed measures of neighborhood social environment (e.g., shared values), aspects of their neighborhood built environment (e.g., access to transit, recreational activities), and loneliness. Two total scores were calculated with higher scores reflecting higher neighborhood social cohesion and higher neighborhood walkability/bikeability (i.e., built environment). Hierarchical linear regression examined associations between the social and built environment on loneliness. RESULTS Higher levels of neighborhood social cohesion (β = - 0.28, 95% confidence interval (CI) = - 0.44, - 0.11) and neighborhood walkability/bikeability (β = - 0.15, 95% CI = - 0.31, - 0.006) were significantly associated with lower levels of loneliness. CONCLUSIONS Findings suggest that living within a cohesive social environment with neighborhood walkability/bikeability to built environment amenities such as green space, grocery stores, and public transportation is protective against loneliness among YA survivors. More longitudinal research is necessary to understand the dynamic changes in loneliness among YA survivors living in diverse social and built environments. IMPLICATIONS FOR CANCER SURVIVORS YA survivors may benefit from cultivating neighbor relationships and living within neighborhoods with walkability/bikeability.
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Affiliation(s)
- Katie Darabos
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, The State University of New Jersey, 683 Hoes Lane West, Rm 327, Piscataway, NJ, 08854, USA.
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA.
| | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Katie A Devine
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
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Fox RS, Armstrong GE, Gaumond JS, Vigoureux TF, Miller CH, Sanford SD, Salsman JM, Katsanis E, Badger TA, Reed DR, Gonzalez BD, Jim HS, Warner EL, Victorson DE, Oswald LB. Social isolation and social connectedness among young adult cancer survivors: A systematic review. Cancer 2023; 129:2946-2965. [PMID: 37489837 PMCID: PMC10584376 DOI: 10.1002/cncr.34934] [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: 04/04/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Social isolation and connectedness are social determinants of health that have demonstrated effects on cancer-related outcomes. These constructs have been systematically evaluated among pediatric and older adult cancer populations. In this review, the authors evaluated the prevalence, correlates, and psychosocial implications of social isolation and connectedness among young adult (YA) cancer survivors aged 18-39 years. METHODS Peer-reviewed articles published in English before June 2021 were identified from database searches and included articles' reference lists according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included articles described studies that assessed social isolation and/or connectedness among YA cancer survivors. RESULTS In total, 5094 unique records were identified; 4143 were excluded after title/abstract screening, and 907 were excluded after full-text review. Forty-four articles were included. Few studies used validated measures or directly assessed social isolation or connectedness. Social isolation was similarly prevalent among YAs and older cancer survivors and noncancer populations. Demographic, clinical, and behavioral risk and protective factors for social isolation were identified. Social isolation was related to worse psychological well-being, whereas social connectedness was often, but not always, related to better psychological well-being. CONCLUSIONS This growing literature underscores the relevance of social isolation and connectedness as important health determinants among YA cancer survivors. The identified risk and protective factors can identify YAs who especially may benefit from screening for social isolation. Future studies are needed that directly, reliably, and validly evaluate social isolation and connectedness to inform the development of interventions to decrease isolation and increase connectedness.
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Affiliation(s)
- Rina S. Fox
- University of Arizona College of Nursing, Tucson, AZ, USA
- University of Arizona Cancer Center, Tucson, AZ, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Grace E. Armstrong
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- The Chicago School of Professional Psychology, Chicago, IL, USA
| | - Julia S. Gaumond
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Corinne H. Miller
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stacy D. Sanford
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - John M. Salsman
- Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Emmanuel Katsanis
- University of Arizona Cancer Center, Tucson, AZ, USA
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Terry A. Badger
- University of Arizona College of Nursing, Tucson, AZ, USA
- University of Arizona Cancer Center, Tucson, AZ, USA
| | | | | | | | - Echo L. Warner
- University of Utah College of Nursing, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - David E. Victorson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
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Thomis S, Devoogdt N, Bechter-Hugl B, Fourneau I. Early Disturbance of Lymphatic Transport as a Risk Factor for the Development of Breast-Cancer-Related Lymphedema. Cancers (Basel) 2023; 15:cancers15061774. [PMID: 36980660 PMCID: PMC10046360 DOI: 10.3390/cancers15061774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Breast-cancer-related lymphedema (BCRL) is a frequently occurring and debilitating condition. When lymphedema is diagnosed late, treatment can be expected to be less effective. Lymphofluoroscopy can provide details about the superficial lymphatic architecture and can detect an early disturbance of lymphatic transport (i.e., dermal backflow) before the lymphedema is clinically visible. The main objective of this study is to investigate whether this early disturbance of lymphatic transport visualized by lymphofluoroscopy is a risk factor for the development of BCRL. Methodology: All patients scheduled for unilateral breast cancer surgery with axillary lymph node dissection or sentinel node biopsy were considered. Patients were assessed at baseline and 1, 3, 6, 9, 12, 18, 24 and 36 months postoperatively. During each visit, a clinical assessment was performed to determine the volume difference between both arms and hands (through circumference measurements and water displacement). Clinical BCRL was defined as a ≥5% increase in relative arm volume difference compared to the baseline value. Variables related to (1) the disturbance of lymphatic transport (through lymphofluoroscopy), (2) the demographics and general health of the patient and (3) the breast cancer and treatment of the patient were collected. Results: We included data of 118 patients in the present study. Thirty-eight patients (39.8%) developed BCRL. Early disturbance of lymphatic transport was identified as a risk factor for the development of clinical BCRL (HR 2.808). Breast-cancer- and treatment-related variables such as axillary lymph node dissection (ALND) (HR 15.127), tumor stage (HR 1.745), mastectomy (HR 0.186), number of positive lymph nodes (HR 1.121), number of removed lymph nodes (HR 1.055), radiotherapy of the axilla (HR 2.715), adjuvant taxanes (HR 3.220) and postsurgical complications (HR 2.590) were identified as significant risk factors for the development of BCRL. In the multivariate analysis, age and ALND were withheld as independent risk factors for the development of BCRL. Conclusion: Lymphofluoroscopy can identify an early disturbance of lymphatic transport after breast cancer treatment. Patients with an early disturbance of lymphatic transport are considered to be a high-risk group for the development of BCRL. This study also confirms that age and ALND are predictors for the development of BCRL. Therefore, a surveillance program of these patients with lymphofluoroscopy could be useful to identify lymphedema in subclinical stages.
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Affiliation(s)
- Sarah Thomis
- Centre for Lymphedema, Department of Vascular Surgery, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
- Research Unit Vascular Surgery, Department of Cardiovascular Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-16346850
| | - Nele Devoogdt
- Centre for Lymphedema, Department of Vascular Surgery, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
| | - Beate Bechter-Hugl
- Centre for Lymphedema, Department of Vascular Surgery, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
| | - Inge Fourneau
- Centre for Lymphedema, Department of Vascular Surgery, UZ Leuven—University Hospitals Leuven, 3000 Leuven, Belgium
- Research Unit Vascular Surgery, Department of Cardiovascular Sciences, KU Leuven—University of Leuven, 3000 Leuven, Belgium
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Sheikh-Wu SF, Anglade D, Downs C. Modèle de survie au cancer appliqué aux soins holistiques et à la recherche. Can Oncol Nurs J 2023; 33:17-30. [PMID: 36789217 PMCID: PMC9894373 DOI: 10.5737/2368807633117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Les progrès réalisés dans la lutte contre le cancer ont augmenté les taux de survie, entraînant un tel changement de paradigme que le cancer est maintenant considéré comme une maladie chronique; il nous faut donc évaluer notre connaissance de la survie au cancer (SC). C’est dans cette optique que les auteurs ont procédé à une recension exhaustive des écrits dans les référentiels CINAHL, MEDLINE et PUBMED de 2000 et 2021. En s’appuyant sur les concepts étudiés dans la littérature, ils ont répertorié les principaux facteurs qui influencent la survie au cancer dans l’ensemble des populations atteintes et ont proposé un modèle. Le présent article décrit ce modèle de survie au cancer (MSC). Le MSC prend en compte les facteurs prédisposant à la survie ainsi que les facteurs d’influence en jeu dans les trois phases de survie (aiguë, prolongée et permanente), à savoir le traitement et le traitement d’entretien (soins médicaux et psychosociaux), le bien-être, et d’autres éléments d’influence (expériences entraînant de profonds changements, incertitude, établissement de priorités, gestion du bien-être et conséquences indirectes) de même que les facteurs liés aux relations sociales qui jouent sur le fardeau des symptômes des survivants ainsi que l’expérience globale de la survie (état de santé et qualité de vie). Une étude de cas a d’ailleurs montré l’utilité du MSC. L’application du modèle est prometteuse pour l’avenir, tant pour améliorer la qualité de la survivance que pour guider la recherche et la pratique clinique en vue de favoriser et d’optimiser la bonne santé des survivants à long terme.
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Affiliation(s)
- Sameena F. Sheikh-Wu
- Auteure-ressource : Sameena F. Sheikh-Wu, École de soins infirmiers et de sciences de la santé, Université de Miami, 5030 Brunson Dr., Coral Gables, FL 33146. Courriel :
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Sheikh-Wu SF, Anglade D, Downs C. A cancer survivorship model for holistic cancer care and research. Can Oncol Nurs J 2023; 33:4-16. [PMID: 36789222 PMCID: PMC9894370 DOI: 10.5737/236880763314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Advancements in cancer have increased survival rates leading to a paradigm shift such that cancer is considered a chronic disease, necessitating an evaluation of our understanding of cancer survivorship (CS). For this purpose, a comprehensive literature search was performed, using CINAHL, MEDLINE, and PUBMED from 2000-2021. Drawing from the concepts in the literature, salient factors that affect CS across cancer populations were identified and a proposed model was developed. This paper describes the Cancer Survivorship Model (CSM). The CSM represents predisposing factors for survivors and survivorship's acute, extended, and long-term phases, influencing factors: treatment and maintenance (medical/ psychosocial care), well-being, influencing aspects (life-changing experience, uncertainty, prioritizing life, wellness management, and collateral damage), and social relationship factors that impact survivors' symptom burdens and overall survivorship experience (health outcomes and quality of life). A case study demonstrates the CSM utility. Future application of the model holds promise for improving the quality of survivorship and informing research and clinical practice to promote and optimize survivors' outcomes throughout the evolving survivorship.
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Affiliation(s)
- Sameena F. Sheikh-Wu
- Corresponding author: Sameena F. Sheikh-Wu, School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr. Coral Gables, FL 33146. E-mail:
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Health-Related Quality of Life in Very Long-Term Cancer Survivors 14-24 Years Post-Diagnosis Compared to Population Controls: A Population-Based Study. Cancers (Basel) 2021; 13:cancers13112754. [PMID: 34206134 PMCID: PMC8199519 DOI: 10.3390/cancers13112754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 01/06/2023] Open
Abstract
Simple Summary Little is known about the health-related quality of life in very long-term cancer survivors 10 and more years post-diagnosis. Therefore, we compared the health-related quality of life of survivors of breast, colorectal, and prostate cancer (14–24 years post-diagnosis) with that of same-aged non-cancer controls, according to age, sex, and disease status (disease-free vs. stage IV, recurrence, metastasis, or second cancer). We found that the overall global health status/quality of life of cancer survivors more than a decade after diagnosis was slightly higher than that of population controls of the same age, but more symptoms and lower functioning were reported. Differences were small but statistically significant. Results differed by age, sex, and disease status. The findings point out the need for a comprehensive survivorship care program in order to monitor and treat potential late and long-term effects after the diagnosis and treatment of cancer. Survivorship care should be risk-adapted to survivors’ needs according to sociodemographic and clinical factors. Abstract (1) Background: Little is known about the health-related quality of life (HRQoL) in very long-term cancer survivors (VLTCS) 10 and more years post-diagnosis. The objective was to compare cancer survivors’ HRQoL 14–24 years post-diagnosis with that of same-aged non-cancer controls, stratified by age, sex, and disease status (disease-free vs. stage IV, recurrence, metastasis, or second cancer). (2) Methods: We recruited 2704 very long-term survivors of breast, colorectal and prostate cancer, and 1765 controls in German multi-regional population-based studies. The HRQoL was assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Differences in the HRQoL were estimated with multiple regression, controlling for age, sex (where appropriate), and education. (3) Results: The overall global health status/quality of life of VLTCS more than a decade after diagnosis was slightly higher than that of population controls of the same age, but more symptoms and lower functioning were reported. Differences were small but statistically significant. Results differed by age, sex, and disease status. (4) Conclusions: The findings point out the need for a comprehensive survivorship care program in order to monitor and treat potential late and long-term effects after the diagnosis and treatment of cancer. Survivorship care should be risk-adapted to survivors’ needs according to sociodemographic and clinical factors.
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Firouzbakht M, Hajian-Tilaki K, Moslemi D. Analysis of quality of life in breast cancer survivors using structural equation modelling: the role of spirituality, social support and psychological well-being. Int Health 2021; 12:354-363. [PMID: 31927594 PMCID: PMC7322199 DOI: 10.1093/inthealth/ihz108] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/29/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To explore and characterize the inter-relationship between psychological well-being, spirituality, social support, comorbidity, demographic and lifestyle factors and quality of life (QoL). METHODS This cross-sectional study was conducted with 305 breast cancer survivors in northern Iran in 2017. The demographic and socio-economic data and physical activity were measured with a standard questionnaire. The standard European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 QoL scale, a system-of-belief inventory questionnaire, the social support scale, the short form of the Hospital Anxiety and Depression Scale and the fatigue severity scale (FSS) were used in data collection. In structural equation modelling analysis, we used the maximum likelihood procedure to estimate the direct and indirect effects of relevant factors on QoL. RESULTS The median age (quartile 1 [Q1], quartile 3 [Q3]) of patients was 50 y (43, 55). The psychological factors designated by anxiety, depression and FSS had a negative significant direct effect on QoL (β=-0.62). Spirituality has a positive direct effect (β=0.089) but a negligible indirect effect (β=0.020) on QoL, while the direct association of social support was almost negligible. CONCLUSIONS The findings emphasized the unifying structure of the determinants of QoL and the mediating negative association of psychological factors with QoL. Thus the supportive education efforts should focus on improving psychological well-being along with standard treatment in breast cancer survivors.
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Affiliation(s)
- Mojgan Firouzbakht
- Social Determinants of Health Research Center, Health Research Institute, Ghang-Afrouz St. Babol University of Medical Sciences, Babol, Iran
| | - Karimollah Hajian-Tilaki
- Department of Biostatistics and Epidemiology, Ghang-Afrouz St. Babol University of Medical Sciences, Babol, Iran
| | - Dariush Moslemi
- Department of Radiotherapy, School of Paramedical Sciences, Ghang-Afrouz St. Babol University of Medical Sciences, Babol, Iran
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Firkins J, Hansen L, Driessnack M, Dieckmann N. Quality of life in "chronic" cancer survivors: a meta-analysis. J Cancer Surviv 2020; 14:504-517. [PMID: 32162194 DOI: 10.1007/s11764-020-00869-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/18/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Cancer survivors are now living longer giving rise to a new concept-chronic cancer as survivors continue to face long-term consequences of cancer and its treatment. For these survivors, QOL becomes a vital consideration in understanding their survivorship and the long-term impact of cancer and its treatment. The primary aim of this review is to describe QOL in cancer survivors two or more years from diagnosis. METHODS A meta-analysis was completed of relevant studies assessing QOL in long-term cancer survivorship using PubMed, CINHAL, and PsycINFO. A total of 64 articles met inclusion criteria and included in the analysis. Standardized effect sizes and errors were calculated using previously published standard QOL pass rates to compare QOL across measurement tools and calculate cumulative effect sizes (CES). Fixed-effect or random-effects models were used based on the presence of significant heterogeneity of ≤ 0.10. RESULTS Physical health (CES = - 0.894; CI, - 1.472, - 0.316), role-physical health (CES = - 2.039; CI, - 2.643, - 1.435), and mental health (CES = - 0.870; CI, - 1.447, - 0.292) had large, negative cumulative effect sizes signifying worse QOL compared with acceptable QOL rates. Tested moderators, cancer type, average age, country of origin, time since diagnosis, or decade of diagnosis, were not significant to explain heterogeneity between included studies. CONCLUSION QOL is significantly impacted 2 to 26 years after cancer diagnosis. More research is needed to determine possible moderators of QOL in long-term cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS QOL continues to be significantly impacted in long-term cancer survivorship. More research is needed to understand the impact of these findings on care needs for survivors with chronic cancer.
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Affiliation(s)
- Jenny Firkins
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA.
| | - Lissi Hansen
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Martha Driessnack
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA
| | - Nathan Dieckmann
- Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Road, Portland, OR, 97239, USA.,Division of Clinical Psychology, Oregon Health & Science University, 3314 SW US Veterans Hospital Road, Portland, OR, 97239, USA
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Late breast cancer treatment-related symptoms and functioning: associations with physical activity adoption and maintenance during a lifestyle intervention for rural survivors. Breast Cancer Res Treat 2017; 168:755-761. [PMID: 29273954 DOI: 10.1007/s10549-017-4603-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Physical activity may be difficult for survivors with poorer functioning following primary treatment. The study examined whether late symptoms of breast cancer treatment impact PA adoption (0-6 months) and maintenance (6-18 months) during a weight management intervention, and whether late symptoms influence PA when accounting for overall functioning. METHODS Secondary analyses were conducted using a sample of survivors participating in a weight management intervention and who provided valid weight and accelerometer data at baseline and 6 months (N = 176). The Breast Cancer Prevention Trial Symptom Checklist (BCPT) assessed late treatment-related symptoms. SF-12 Physical Component Scale (PCS) and Mental Component Scale (MCS) scores assessed functioning. RESULTS Change in bouted moderate to vigorous physical activity (MVPA) min/week from baseline to 6 months was not associated with BCPT scales (all p values > 0.05). When adding SF-12 scores to the model, change in bouted MVPA min/week was significantly associated with the PCS (p = 0.045). Change in MVPA min/week from 6 to 18 months was significantly associated with cognitive symptoms (p = 0.004), but not musculoskeletal or vasomotor symptoms (p values > 0.05). When adding 6-month SF-12 scores to the model, MVPA min/week was significantly associated with PCS (p = 0.001) and MCS (p = 0.028); however, BCPT cognitive problems score became non-significant (p > 0.05). CONCLUSIONS Poorer physical functioning was associated with lower PA adoption, and poorer mental and physical functioning was associated with lower maintenance of PA, while late symptoms generally were not. Interventionists should consider level of functioning when identifying individual PA goals during weight management interventions.
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Levine EG, Yoo G, Aviv C. Predictors of quality of life among ethnically diverse breast cancer survivors. APPLIED RESEARCH IN QUALITY OF LIFE 2017; 12:1-16. [PMID: 28392845 PMCID: PMC5381814 DOI: 10.1007/s11482-016-9447-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/11/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE Few studies have examined predictors of quality of life (QOL) of breast cancer survivors over time. METHODS Breast cancer survivors (n=116) were asked to complete measures of QOL, mood, spirituality, and social support every 6 months from 2-4 years post treatment. RESULTS Overall QOL at 4 years was predicted by previous physical and functional well-being, the breast cancer-specific items, and vigor and current levels of social support (Adj R2=.72, F=30.53, p<.001). Physical QOL was predicted by previous levels of physical and functional well- being and current levels of functional and social/family well-being (Adj R2=.84, F=44.30, p<.001). Functional well- being was predicted by prior levels of physical, functional, and social/family well-being and current levels of physical well-being and vigor (Adj R2=.72, F=3-.53, p<.001). Emotional well-being was predicted by previous levels of emotional well-being and current physical well-being, the breast cancer-specific items, and anxiety (Adj R2=.60, F=26.30, p<.001). Social/family well-being was predicted by previous levels of social/family well-being, social support, and confusion (Adj R2=.71, F=34.18, p<<000). The breast cancer-specific items were predicted by age, previous levels of the breast cancer-specific items, confusion and current levels of emotional and functional well-being and spirituality (Adj R2=.58, F=17.57, p<.001). CONCLUSIONS Over all and specific dimensions of QOL at 4 years were predicted by different combinations of QOL, mood, and spirituality. Interventions should be tailored to which dimensions of QOL are affected and other types of QOL as well as social support, mood, and spirituality as coping mechanisms that influence the specific dimension of QOL affected.
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An evaluation study of the determinants of future perspective and global Quality of Life in Spanish long-term premenopausal early-stage breast cancer survivors. Contemp Oncol (Pozn) 2016; 20:165-70. [PMID: 27358597 PMCID: PMC4925738 DOI: 10.5114/wo.2016.60073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/23/2016] [Indexed: 01/15/2023] Open
Abstract
Aim of the study Quality of life (QL) is important in premenopausal long-term breast cancer survivors. In this study we assessed QL and factors associated with future perspective and global QL in premenopausal early-stage long-term breast cancer survivors from Spain. Material and methods 243 premenopausal stage I-IIIA relapse-free breast cancer patients who had received surgery 5–20 years previously completed EORTC QLQ-C30 and QLQ-BR23 questionnaires once during follow-up. Univariate and multivariate logistic regression analyses were performed. Results QL mean scores were high in most areas (> 80 in functioning; < 20 in symptoms). The main factors for future perspective were emotional and social functioning, fatigue, breast symptom, and body image. The main factors for global QL were fatigue, pain and physical functioning, and emotional and social functioning. The best logistic model to explain future perspective associated high emotional and social functioning and low breast symptoms with a lower risk of low future perspective (R2 = 0.56). Higher scores in physical and emotional functioning and lower scores in fatigue were associated with a lower risk of low global QL (R2 = 0.50). Conclusions Psychological, social, and physical factors were found to be possible determinants of global QL and future perspective. QL in premenopausal early-stage long-term breast cancer survivors may benefit from multidisciplinary treatment.
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Health-Related Quality of Life During the Menopausal Transition: Testing a Theoretical Model. Res Theory Nurs Pract 2016; 30:143-60. [PMID: 27333634 DOI: 10.1891/1541-6577.30.2.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to test the hypothetical model of health-related quality of life (HRQOL) during the menopausal transition. The model was developed to test specific components of the Wilson and Cleary's model for HRQOL. A cross-sectional, correlational study was carried out using self-report questionnaires on a convenience sample of 162 Korean women in the menopausal transition. The model was tested by a path analysis using Analysis of Moment Structure (AMOS) program. The path analysis showed that 5 affecting variables explained 69% of the variance in HRQOL during the menopausal transition. Based on the results, the Wilson and Cleary's model may be useful in explaining HRQOL during the menopausal transition. Symptoms, functional status, and health perceptions mediated the effect of individual and environmental characteristics on HRQOL. However, the results suggest that some paths need to be added or modified in the model. To date, most research using Wilson and Cleary's model has been conducted in the United States, Africa, and Europe (e.g., Austria, Norway, and Spain). This study shows the applicability of the model in Asian people.
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Yamamoto S, Masutani E, Arao H. Effect of persistent menopausal symptoms on the wellbeing of Japanese breast cancer survivors. Nurs Health Sci 2016; 18:379-86. [PMID: 27101769 DOI: 10.1111/nhs.12283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/08/2016] [Accepted: 03/09/2016] [Indexed: 11/28/2022]
Abstract
While more women with breast cancer survive because of advances in cancer treatment including hormonal therapy, they are at a risk of menopausal symptoms, which can threaten their psychological wellbeing. We examined the effect of menopausal symptoms on women's psychological wellbeing during three different phases of breast cancer: short-term (0-1 years since diagnosis), medium-term (2-5 years), and long-term (more than 5 years). In this cross-sectional study, 425 survivors treated with hormonal therapy were recruited from a convenience sample in Japan and completed an anonymous self-administered questionnaire. Multiple regression analysis revealed that menopausal symptoms significantly contributed to psychological wellbeing in all phases. In long-term survivors, menopausal symptoms were significantly milder; however, the negative effect was prolonged. One in three to four survivors was suspected to have poor psychological wellbeing, irrespective of time. Although the effect of menopausal symptoms on psychological wellbeing has been described in short-term survivors, little is known about the long-term effect. This study examines the effect of menopausal symptoms on psychological wellbeing, thereby providing useful information regarding long-term quality of life.
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Affiliation(s)
- Sena Yamamoto
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiko Masutani
- Cancer Education and Research Center, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Harue Arao
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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Jeffe DB, Pérez M, Cole EF, Liu Y, Schootman M. The Effects of Surgery Type and Chemotherapy on Early-Stage Breast Cancer Patients' Quality of Life Over 2-Year Follow-up. Ann Surg Oncol 2015; 23:735-43. [PMID: 26511265 DOI: 10.1245/s10434-015-4926-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND We examined the effects of surgery type and adjuvant chemotherapy on change in early-stage breast cancer patients' quality of life (QOL) over time. METHODS A cohort of 549 patients (33.5% ductal carcinoma in situ, 66.5% stages I/IIA) were interviewed a mean 6.1 weeks (Time1), and 6.2 (Time2), 12.3 (Time3), and 24.4 (Time4) months following definitive breast-conserving surgery (BCS) or mastectomy. QOL was measured using the total Functional Assessment of Cancer Therapy-Breast (FACT-B). Adjusting for demographic, psychosocial, and clinical variables, multiple linear regression models estimated the associations between QOL and each of surgery type, chemotherapy, and their 2-way interaction at each interview. Adjusted generalized estimating equation (GEE) models tested Time1-Time4 change in QOL. RESULTS At Time2, chemotherapy (P < .001) and BCS (P < .001) were independently associated with worse QOL in adjusted linear regression, and the adverse effect of chemotherapy was prominent among patients who received BCS compared with those who received mastectomy (P interaction = .031). In the GEE model, QOL significantly improved over time among patients who received BCS (P trend = .047), mastectomy (P trend = .024), and chemotherapy (P trend < .001), but not among patients who did not receive chemotherapy (P trend = .720). All patients completed adjuvant chemotherapy and radiation by Time3. Regardless of surgery type, patients receiving chemotherapy reported lower QOL following surgery, and QOL improved after completion of adjuvant treatment. CONCLUSIONS Chemotherapy had a short-term negative impact on QOL after definitive surgical treatment regardless of surgery type. QOL rebounded after completion of adjuvant treatment.
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Affiliation(s)
- Donna B Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA. .,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA.
| | - Maria Pérez
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Emily F Cole
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Ying Liu
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Mario Schootman
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
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Chandwani KD, Heckler CE, Mohile SG, Mustian KM, Janelsins M, Peppone LJ, Bushunow P, Flynn PJ, Morrow GR. Hot flashes severity, complementary and alternative medicine use, and self-rated health in women with breast cancer. Explore (NY) 2014; 10:241-7. [PMID: 25037667 DOI: 10.1016/j.explore.2014.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Indexed: 11/12/2022]
Abstract
CONTEXT Hot flashes (HF) are a common distressing symptom in women with breast cancer (BC). Current pharmacologic options are moderately effective and are associated with bothersome side effects. Complementary and alternative medicine is commonly used by cancer patients. However, information on the association of hot flashes severity with such use and self-rated health is lacking. OBJECTIVE To examine the hot flashes severity in women with breast cancer and its association with complementary and alternative medicine use and self-rated health (SRH). DESIGN Longitudinal multicenter study to assess information needs of cancer outpatients. PARTICIPANTS Patients with a diagnosis of breast cancer who were scheduled to undergo chemotherapy and/or radiotherapy. OUTCOME MEASURES Hot flashes severity (0 = not present and 10 = as bad as you can imagine), use of complementary and alternative medicine (yes/no), and self-rating of health (SRH) status post-treatment and six-months thereafter (1-5, higher score = better SRH). RESULTS The majority of women with HF (mean age = 54.4 years) were Caucasian and married, with higher education, and 93% had received surgical treatment for BC. At the end of treatment, 79% women reported experiencing HF [mean severity = 5.87, standard deviation (SD) = 2.9]; significantly more severe HF were reported by younger women with poor SRH, poor performance status, and those reporting doing spiritual practices. At follow-up, 73% had HF (mean severity = 4.86, SD = 3.0), and more severe HF were reported by younger women with poor self-rated health who had undergone chemotherapy plus radiotherapy, used vitamins, and did not exercise. CONCLUSIONS A high percentage of women experienced hot flashes at the end of treatment and at six-month follow-up. A significant association of hot flashes severity with spiritual practice, increased vitamin use, and reduced exercise emphasize the need for future studies to confirm the results. This can facilitate safe use of complementary and alternative medicine and favorable outcomes while managing cancer-related hot flashes.
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Affiliation(s)
- Kavita D Chandwani
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY.
| | - Charles E Heckler
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - Supriya G Mohile
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - Karen M Mustian
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - Michelle Janelsins
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | - Luke J Peppone
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
| | | | | | - Gary R Morrow
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY
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16
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Leung J, Pachana NA, McLaughlin D. Social support and health-related quality of life in women with breast cancer: a longitudinal study. Psychooncology 2014; 23:1014-20. [PMID: 24700668 DOI: 10.1002/pon.3523] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES A breast cancer diagnosis is a distressing event that impacts on physical and psychological functioning. This study examined the longitudinal relationships among a diagnosis of breast cancer, social support, and health-related quality of life (HRQOL). METHODS Participants were 412 women from the 1946-1951 birth cohort of the Australian Longitudinal Study on Women's Health who self-reported a new diagnosis of breast cancer between 1998 and 2007. The three surveys of longitudinal data analyzed included data 3 years before diagnosis, at diagnosis (baseline), and 3 years after diagnosis (follow-up). Social support was measured using the 19-item Medical Outcomes Study Social Support Survey; HRQOL was measured using the Medical Outcomes Study 36-item Short-Form Health Survey. RESULTS Compared with pre-diagnosis HRQOL, women newly diagnosed with breast cancer reported significantly poorer HRQOL in subscales related to pain, physical functioning, and health and vitality. At 3-year follow-up, HRQOL had improved in most domains to levels consistent with pre-diagnosis. Levels of social support remained stable across time. The structural equation model showed that social support was positively predictive of better physical and mental HRQOL at 3-year follow-up. CONCLUSIONS Longitudinal analyses indicate that social support appears to be an important predictor of HRQOL in women diagnosed with breast cancer. In particular, positive emotional and informational support that may normally be provided by a partner is important in maintaining HRQOL. Identification of those lacking social support, especially patients without partners, will enable them to be guided to appropriate support networks and programs.
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Affiliation(s)
- Janni Leung
- The University of Queensland, School of Population Health, Brisbane, Queensland, Australia
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17
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Jeffe DB, Pérez M, Liu Y, Collins KK, Aft RL, Schootman M. Quality of life over time in women diagnosed with ductal carcinoma in situ, early-stage invasive breast cancer, and age-matched controls. Breast Cancer Res Treat 2012; 134:379-91. [PMID: 22484800 PMCID: PMC3448489 DOI: 10.1007/s10549-012-2048-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 03/21/2012] [Indexed: 12/21/2022]
Abstract
Little is known about quality-of-life (QOL) differences over time between incident ductal carcinoma in situ (DCIS) and early-stage invasive breast cancer (EIBC) cases as compared with same-aged women without breast cancer (controls). We prospectively recruited and interviewed 1,096 women [16.8% DCIS, 33.3% EIBC (25.7% Stage I; and 7.6% Stage IIA), 49.9% controls; mean age 58; 23.7% non-white] at mean 6.7 weeks (T1), and 6.2 (T2), 12.3 (T3), and 24.4 months (T4) after surgery (patients) or screening mammogram (controls). We tested two hypotheses: (1) DCIS patients would report lower levels of QOL compared with controls but would report similar QOL compared with EIBC patients at baseline; and (2) DCIS patients' QOL would improve during 2-year follow-up and approach levels similar to that of controls faster than EIBC patients. We tested hypothesis 1 using separate general linear regression models for each of the eight subscales on the RAND 36-item Health Survey, controlling for variables associated with at least one subscale at T1. Both DCIS and EIBC patients reported lower QOL at T1 than controls on all subscales (each P<0.05). We tested hypothesis 2 using generalized estimating equations to examine change in each QOL subscale over time across the three diagnostic groups adjusting for covariates. By T3, physical functioning, role limitations due to physical problems, energy/fatigue, and general health each differed significantly by diagnostic group at P<0.05, because of larger differences between EIBC patients and controls; but DCIS patients no longer differed significantly from controls on any of the QOL subscales. At T4, EIBC patients still reported worse physical functioning (P=0.0001) and general health (P=0.0017) than controls, possibly because of lingering treatment effects. DCIS patients' QOL was similar to that of controls two years after diagnosis, but some aspects of EIBC patients' QOL remained lower.
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Affiliation(s)
- D B Jeffe
- Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, 4444 Forest Park, Suite 6700, St. Louis, MO 63108, USA.
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Kaur JS, Coe K, Rowland J, Braun KL, Conde FA, Burhansstipanov L, Heiney S, Kagawa-Singer M, Lu Q, Witte C. Enhancing life after cancer in diverse communities. Cancer 2012; 118:5366-73. [PMID: 22434384 DOI: 10.1002/cncr.27491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 10/19/2011] [Accepted: 11/10/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although large numbers of cancer survivors exist in every community, including minority communities, there is a significant gap in knowledge about best practices for these patients. METHODS The Community Networks Program, funded by the National Cancer Institute Center to Reduce Cancer Health Disparities, has developed and tested unique services for these communities. These programs have used community-based participatory research techniques under a framework of diffusion of innovation and communications theory. RESULTS This article describes some specifically tailored interventions that may be useful to a wide range of providers working with the underserved. CONCLUSIONS Enhancing life after cancer can be achieved in underserved communities by supplementing local resources.
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Affiliation(s)
- Judith S Kaur
- Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Paskett ED. The Promise of a Cancer-Free World: Where Are We? The Presidential Address from the 35th Annual Meeting of the American Society of Preventive Oncology (ASPO). Cancer Epidemiol Biomarkers Prev 2011; 20:1982-9. [DOI: 10.1158/1055-9965.epi-11-0677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gordon NH, Siminoff LA. Measuring quality of life of long-term breast cancer survivors: the Long Term Quality of Life-Breast Cancer (LTQOL-BC) Scale. J Psychosoc Oncol 2011; 28:589-609. [PMID: 21058158 DOI: 10.1080/07347332.2010.516806] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The authors developed a quality-of-life measure specific to long-term breast cancer survivors. Participants were women diagnosed with early-stage disease ≥ 7 years postdiagnosis. The final scale is the result of an iterative interview process with the 28-item scale administered to 285 participants. Factor analysis demonstrated with seven domains: physical, sexual and cognitive function, body image, coping, social support, and anxiety. Cronbach's alpha is .88. Convergent and divergent validity are also reported. The Long Term Quality of Life-Breast Cancer Scale has domains specific to breast cancer and will be useful to psychosocial and clinical researchers.
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Affiliation(s)
- Nahida H Gordon
- Frances Payne Bolton School of Nursing, Department of Bioethics, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, OH, USA
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22
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Khan SA. Axillary reverse mapping to prevent lymphedema after breast cancer surgery: defining the limits of the concept. J Clin Oncol 2009; 27:5494-6. [PMID: 19826108 DOI: 10.1200/jco.2009.24.3311] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ganz PA, Land SR, Antonio C, Zheng P, Yothers G, Petersen L, Wickerham DL, Wolmark N, Ko CY. Cancer survivorship research: the challenge of recruiting adult long term cancer survivors from a cooperative clinical trials group. J Cancer Surviv 2009; 3:137-47. [PMID: 19526347 PMCID: PMC2714451 DOI: 10.1007/s11764-009-0093-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 06/03/2009] [Indexed: 11/24/2022]
Abstract
Introduction With the growing number of adult cancer survivors, there is increasing need for information that links potential late and long term effects with specific treatment regimens. Few adult cancer patients are treated on clinical trials; however, patients previously enrolled in these trials are an important source of information about treatment-related late effects. Methods Focusing on colorectal cancer survivors, we used the database from five phase III randomized clinical trials from the National Surgical Adjuvant Breast & Bowel Project (NSABP) to recruit and enroll long term survivors in a study of late health outcomes and quality of life. We describe the challenges to recruitment of patients more than 5 –20 years after treatment. Results Sixty-five NSABP treatment sites were invited to enroll patients in the study. Sixty participated with the potential to recruit 2,408 patients. We received registration forms on only 976 patients (41%) of whom 744 (76%) expressed interest in participating and 708 completed interviews (95% of those expressing interest; 29% of total potential sample). There were multiple barriers to recruitment (difficulty locating patients, lack of institutional commitment, lack of patient interest). Conclusions Patients treated on clinical trials are an important potential source for examining the late effects of cancer treatments. Retrospective recruitment has substantial limitations. In the future, mechanisms should be established for prospective long-term follow-up to identify and understand the frequency and type of late effects associated with cancer treatments. Implications for Cancer Survivors As cancer patients are living longer, it will be important to learn from participants in clinical trials whether or not specific treatment regimens are associated with any serious late effects.
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Affiliation(s)
- Patricia A Ganz
- School of Public Health & David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
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Paskett E, Herndon J, Donohue K, Naughton M, Grubbs S, Pavy M, Hensley M, Stark N, Kornblith A, Bittoni M. Health-related quality of life in long-term breast cancer survivors: differences by adjuvant chemotherapy dose in Cancer and Leukemia Group B study 8541. Cancer 2009; 115:1109-20. [PMID: 19170232 DOI: 10.1002/cncr.24140] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Survivor's Health and Reaction (SHARE) study examined health-related quality of life (HRQL) in breast cancer patients who had participated in Cancer and Leukemia Group B Trial 8541 from 1985 to 1991. METHODS In total, 245 survivors (78% of eligible patients) who were 9.4 to 16.5 years postdiagnosis (mean, 12.5 years postdiagnosis) completed HRQL surveys relating to 5 domains. Analyses examined HRQL domains according to 3 different chemotherapy dose levels that were administered in the original treatment trial: low-dose cyclophosphamide, doxorubicin, and fluorouracil (CAF) at 300 mg/m(2), 30 mg/m(2), and 300 x 2 mg/m(2), respectively, over 4 cycles; standard-dose CAF at 400 mg/m(2), 40 mg/m(2), and 400 x 2 mg/m(2), respectively, over 6 cycles; and high-dose CAF at 600 mg/m(2), 60 mg/m(2) and 600 x 2 mg/m(2), respectively, over 4 cycles. RESULTS In univariate analyses, a statistically significant difference was observed on the Medical Outcomes Study 36-item short form Physical Role Functioning subscale by treatment group, with lower mean scores in the standard treatment arm (mean, 65.05) compared with mean scores in the low-dose arm (mean, 74.66) and the high-dose arm (mean, 84.94; P.0001). However, multivariate analysis revealed that treatment arm no longer was statistically significant, whereas the following factors were associated with decreased physical role functioning: age >or=60 years (odds ratio [OR], 3.55; P = .006), increased comorbidity interference total score (OR, 1.64; P = .005), lower vitality (OR, 1.05; P = .0002), and increased menopausal symptoms (OR, 1.04 P = .02). CONCLUSIONS At 9.4-16.5 years after their original diagnosis, differences in physical role functioning among breast cancer survivors who had received 3 different dose levels of chemotherapy were explained by clinical and demographic variables, such as age, fatigue, menopausal symptoms, and comorbidities. Prospective studies are needed to further assess the role of these factors in explaining HRQL and physical role functioning among long-term survivors.
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Affiliation(s)
- Electra Paskett
- College of Public Health and Comprehensive Cancer Center, The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall A356, Columbus, OH 43210-1240, USA.
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Oliveri JM, Day JM, Alfano CM, Herndon JE, Katz ML, Bittoni MA, Donohue K, Paskett ED. Arm/hand swelling and perceived functioning among breast cancer survivors 12 years post-diagnosis: CALGB 79804. J Cancer Surviv 2008; 2:233-42. [PMID: 18792786 PMCID: PMC3910496 DOI: 10.1007/s11764-008-0065-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 08/19/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Lymphedema is an under-reported and debilitating consequence of axillary node dissection among breast cancer survivors. This study describes the characteristics of arm and hand swelling in relation to perceived physical and mental health functioning among breast cancer survivors 9-16 years post-diagnosis who previously participated in a clinical trial coordinated by the Cancer and Leukemia Group B (CALGB 8541). METHODS Eligible survivors of CALGB 8541 completed questionnaires assessing demographics, arm/hand swelling, perceived physical functioning, and mental health. RESULTS Two hundred forty-five women (94% white, mean age = 63, on average 12.4 years post-diagnosis) completed questionnaires (participation rate = 78%). Seventy-five women (31%) reported arm/hand swelling since their surgery. Of these women, 76% reported current swelling and half reported constant swelling, mainly in the upper arm. Swelling was reported as mild or moderate in 88% of the women. Women who reported severe swelling had significantly worse physical functioning and trended toward worse depressive symptoms and poorer mental health (lower mental SF-36 scores) as well. Activity-limiting swelling was also significantly associated with worse physical functioning. Although swelling interfered with wearing clothing (36%) and perceptions about general appearance (32%), only 37% of women sought treatment for swelling. CONCLUSIONS Arm/hand swelling is a chronic problem for a subgroup of long-term survivors of breast cancer, negatively affecting physical functioning. IMPLICATIONS FOR CANCER SURVIVORS Educational efforts are needed as part of a comprehensive survivorship care plan to raise awareness about lymphedema so that survivors may identify this complication, seek treatment early, and potentially improve their physical functioning.
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Affiliation(s)
- Jill M. Oliveri
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, supported by CA77658
| | - Jeannette M. Day
- CALGB Statistical Center, Duke University Medical Center, Durham, NC, supported by CA33601
| | - Catherine M. Alfano
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, supported by CA77658
- College of Public Health, The Ohio State University, Columbus, Ohio
| | - James E. Herndon
- CALGB Statistical Center, Duke University Medical Center, Durham, NC, supported by CA33601
| | - Mira L. Katz
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, supported by CA77658
- College of Public Health, The Ohio State University, Columbus, Ohio
| | - Marisa A. Bittoni
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, supported by CA77658
| | - Kathleen Donohue
- CALGB Statistical Center, Duke University Medical Center, Durham, NC, supported by CA33601
| | - Electra D. Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, supported by CA77658
- College of Public Health, The Ohio State University, Columbus, Ohio
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