The transition from breast cancer ‘patient’ to ‘survivor’

Symptoms and need for individualised support during the first year after primary treatment for breast cancer-A qualitative study

BACKGROUND

The survival rate among patients with breast cancer is high. It is well described that after primary treatment patients may experience symptoms and concerns but the needs and resources during the first year to manage everyday life are not well described.

AIM

To describe experiences of symptom distress, needs and support during the first year after primary treatment for breast cancer from the perspectives of patients and healthcare professionals.

DESIGN

Qualitative descriptive.

METHODS

Data collection through individual interviews with patients (n = 17) and a focus group interview with healthcare professionals (n = 7). Data was analysed using thematic analysis and resulted in three themes.

RESULTS

The first theme, 'Struggling with symptoms and changes in everyday life' shows how symptoms and concerns interfered with the everyday life of patients and in some situations even impeded them. Patients try to adapt to their new situation by creating new routines and managing symptoms through self-care. The second theme, 'Adaption in a period of uncertainty' describes thoughts about cancer recurrence and doubts about continuing with the endocrine therapy if symptoms prolong. In the third theme, 'Support and need for individualized follow-up care' healthcare professionals described that they provide support by being available and by giving both verbal and written information. Patients expressed that the information could be too general and voiced a need for more individually tailored support.

CONCLUSION

During the first year after primary treatment, patients with breast cancer describe how they try to manage by themselves, but express both unmet needs and a wish for extended and more individually tailored support. The healthcare professionals recognised that patients lack a structured plan for the first year and the need for continued support. This stresses a need for development of care models with special consideration towards individualised support after breast cancer treatment.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public involvement in the design or conduct of the study. The interview study was not considered to benefit from involving patients or healthcare professionals when designing the interview guides as they were developed through literature and previous research of patients treated for breast cancer.

Protective Factors against Fear of Cancer Recurrence in Breast Cancer Patients: A Latent Growth Model

The current study aimed to examine the fear of cancer recurrence (FCR) trajectory and protective predictors in women coping with breast cancer (BC). The study's model investigated whether a higher coping self-efficacy and positive cognitive-emotion regulation at the time of the BC diagnosis would lead to reduced levels of FCR at six months and in later stages (12 and 18 months) post-diagnosis. The sample included 494 women with stages I to III BC from Finland, Italy, Portugal, and Israel. They completed self-report questionnaires, including the Fear of Cancer Recurrence Inventory (FCRI-SF), the Cancer Behavior Inventory-Brief Version (CBI-B), the Cognitive-Emotion Regulation Questionnaire (CERQ short), and medical-social-demographic data. Findings revealed that a higher coping self-efficacy at diagnosis predicted lower FCR levels after six months but did not impact the FCR trajectory over time. Surprisingly, positive cognitive-emotion regulation did not predict FCR levels or changes over 18 months. FCR levels remained stable from six to 18 months post-diagnosis. This study emphasizes the importance of developing specific cancer coping skills, such as coping self-efficacy. Enhancing coping self-efficacy in the first six months after BC diagnosis may lead to lower FCR levels later, as FCR tends to persist in the following year.

Emotional Processing, Coping, and Cancer-Related Sickness Symptoms in Breast Cancer Survivors: Cross- Sectional Secondary Analysis of the REPAT Study

Purpose

The study aims to provide a better understanding of the relationship between emotional processing, coping, and cancer-related sickness symptoms.

Methods

The study used a cross-sectional, secondary analysis of data from 179 Israeli Jewish women who were breast cancer survivors (BCS) 3 to 18 months after completing primary treatment and who participated in a larger randomized controlled trial (REPAT study). Data were collected at baseline. Participants completed questionnaires measuring emotion acceptance, situational approach, avoidance coping, and cancer-related sickness symptoms (depression, fatigue, and pain) and a performance measure of emotional awareness. Hierarchical linear regressions were performed, controlling for background variables.

Results

Participants experienced significant clinical depression (51.7%), cancer-related fatigue (CRF, 78.8%), pain interference (78%), and pain intensity (66%) levels. There were strong correlations between cancer-related symptoms. After controlling for confounders, emotional processing (acceptance) was negatively associated with depression, and avoidance coping was positively associated with depression, CRF, and pain interference (i.e., higher use of avoidance related to higher cancer-related symptoms; higher acceptance was associated with lower depression). Emotional awareness and coping by approaching emotions were not related to cancer-related symptoms.

Conclusions

The BCS posttreatment period presents the challenge of dealing with elevated cancer-related symptoms. Regardless, BCS who used high emotional processing levels-especially acceptance of emotion and lower reliance on avoidance to cope-experienced fewer cancer-related symptoms.

Implications for Cancer Survivors

Professionals should recognize the potential role of emotional processing and avoidant coping relative to cancer-related symptoms and recognize their patterns in posttreatment patients.

Treatment burden in individuals living with and beyond cancer: A systematic review of qualitative literature

BACKGROUND

Individuals with cancer are being given increasing responsibility for the self-management of their health and illness. In other chronic diseases, individuals who experience treatment burden are at risk of poorer health outcomes. Less is known about treatment burden and its impact on individuals with cancer. This systematic review investigated perceptions of treatment burden in individuals living with and beyond cancer.

METHODS AND FINDINGS

Medline, CINAHL and EMBASE databases were searched for qualitative studies that explored treatment burden in individuals with a diagnosis of breast, prostate, colorectal, or lung cancer at any stage of their diagnostic/treatment trajectory. Descriptive and thematic analyses were conducted. Study quality was assessed using a modified CASP checklist. The review protocol was registered on PROSPERO (CRD42021145601). Forty-eight studies were included. Health management after cancer involved cognitive, practical, and relational work for patients. Individuals were motivated to perform health management work to improve life-expectancy, manage symptoms, and regain a sense of normality. Performing health care work could be empowering and gave individuals a sense of control. Treatment burden occurred when there was a mismatch between the resources needed for health management and their availability. Individuals with chronic and severe symptoms, financial challenges, language barriers, and limited social support are particularly at risk of treatment burden. For those with advanced cancer, consumption of time and energy by health care work is a significant burden.

CONCLUSION

Treatment burden could be an important mediator of inequities in cancer outcomes. Many of the factors leading to treatment burden in individuals with cancer are potentially modifiable. Clinicians should consider carefully what they are asking or expecting patients to do, and the resources required, including how much patient time will be consumed.

Person-centred communication with cancer survivors: Exploring the meaning of follow-up coaching conversations

AIM

The aim of this study was to explore the meaning of a coaching intervention for cancer survivors.

BACKGROUND

Cancer survivors often experience existential concerns and worries after adjuvant treatment. A number of "care transition interventions" have been developed to improve person-centred care by empowering patients. Several of these interventions include a "care transition coach". A coaching approach to communication used in health care communication have among others shown to assists in establishing confidential relationships between health professionals, increase the patient's well-being and support the patient's experience of being met and viewed as a whole person.

DESIGN

This is a qualitative study using semi-structured interviews to explore the meaning of a coaching intervention. In analyzing and interpreting the qualitative interviews Ricoeur's theory of interpretation was applied.

METHOD

The intervention consisted of two parts: (1) a two-day training program in coaching for nurses and (2) a specially developed communication intervention for cancer survivors.

RESULTS AND DISCUSSION

The analysis of the transcribed interview material led to the development of two themes: (1) Support in moving forward in life, and (2) An opportunity to talk about existential thoughts and worries. Our results show how the experience of cancer, even when cured, leaves the survivors with profound existential worries. The cancer survivors described how coaching conversations allowed them to express their current concerns and provided them with an opportunity to discuss wider issues than treatment, symptoms, and after-effects, which had been the main focus during treatment.

CONCLUSION

The time immediately after the end of adjuvant treatment can be challenging, with many existential concerns and opposing emotions. We found that the follow-up coaching conversations performed helped the cancer survivors to process many of these difficult thoughts and feelings.

Patients' perceived challenges, competencies, and supportive care needs during acute clinical treatment of breast or gynecological cancer

OBJECTIVE

This study aimed to examine challenges, competencies, and supportive care needs (SCN) of women with breast or gynecological cancer during acute cancer treatment and associations to other health-related variables.

METHODS

We surveyed 120 patients with breast or gynecological cancer at the end of acute cancer treatment, either directly after surgery or during adjuvant chemotherapy. We assessed challenges, subjective competencies, and SCN using a self-developed measure comprising 25 items referring to coping tasks assigned to six domains. In addition, patients' competencies and health literacy (HL) were assessed.

RESULTS

Most patients felt at least moderately challenged by coping tasks concerning psychological distress (e.g., dealing with fears and insecurities, 70.2%; coping with cancer diagnosis, 69.6%) and physical complaints (e.g., dealing with a reduced physical capacity, 56.6%). About 42.5%-71.4% of patients who evaluated coping tasks as highly challenging felt competent to deal with these challenges themselves. Less than half of patients reported SCN, mainly regarding psychological concerns. The extent of challenging coping tasks, patients' perceived ability to overcome challenges themselves, and SCN showed associations to patient competencies and HL.

CONCLUSIONS

SCN regarding psychological concerns and health behavior should be addressed in acute cancer care and rehabilitation programs. In addition, promoting HL might be essential in strengthening patients' subjective competencies related to various coping tasks.

How Does Hedonic Aroma Impact Long-Term Anxiety, Depression, and Quality of Life in Women with Breast Cancer? A Cross-Lagged Panel Model Analysis

Depression and anxiety are common symptoms during and after adjuvant chemotherapy treatment for breast cancer (BC), with implications on quality of life (QoL). The present study evaluates the temporal relationship between anxiety, depression, and QoL (primary outcomes), as well as the impact of hedonic aroma (essential oils) on this relationship. This is a secondary analysis of a previously reported randomized controlled trial, with two groups: an experimental group (n = 56), who were subjected to the inhalation of a self-selected essential oil during chemotherapy, and a control group (n = 56), who were only subjected to the standard treatment. The hedonic aroma intervention occurred in the second (T1), third (T2), and fourth (T3) chemotherapy sessions, three weeks apart from each other. The follow-up (T4) assessments took place three months after the end of the treatment. Cross-lagged panel models were estimated in the path analysis framework, using structural equation modeling methodology. Regarding the control group, the cross-lagged panel model showed that anxiety at T1 predicted anxiety at T3, which in turn predicted both QoL and depression at T4. In the experimental group, hedonic aroma intervention was associated with stability of anxiety and QoL over time from T1 to T3, with no longitudinal prediction at T4. For women undergoing standard chemotherapy treatment, anxiety was the main longitudinal precursor to depression and QoL three months after chemotherapy. Thus, essential oils could complement chemotherapy treatment for early-stage BC as a way to improve long-term emotional and QoL-related adjustment.

Breast Cancer Survivorship: the Role of Rehabilitation According to the International Classification of Functioning Disability and Health-a Scoping Review

Purpose of Review

The population of breast cancer (BC) survivors is growing due to earlier diagnosis and effective combined treatments. A scoping review was performed to explore the role of rehabilitation in BC survivorship and the major issues in BC survivors with International Classification of Functioning Disability and Health (ICF) perspective.

Recent Findings

The authors searched PubMed from January 1, 2018, up until November 9, 2021. The 65 selected publications were analyzed with the Comprehensive ICF BC Core Set (CCS) perspective and assigned to the categories of the CCS components along with the 3 areas of health (physical, mental, and social health). The multidimensional aspects of BC survivor disability are evident, whereas the topics of the articles concern several categories of the ICF BC CCS and all 3 areas of health. However, the current ICF BC CCS does not include certain categories related to emerging issues of BC survivorship recurring in the papers.

Summary

Rehabilitation is crucial in BC survivorship management to give personalized answers to women beyond BC, and the ICF BC CCS remains an essential tool in rehabilitation assessment for BC survivors although it needs updating.

Evaluation of the Pathways for Survivors Program to Address Breast Cancer Survivorship-Associated Distress: Survey Study

Background

Patients with breast cancer frequently experience escalation of anxiety after completing curative treatment.

Objective

This study evaluated the acceptability and psychological impact of a 1-day workshop to emphasize behavioral strategies involving intention and self-efficacy.

Methods

Breast cancer survivors who attended a 1-day Pathways for Survivors workshop provided feedback and completed electronic quality of life (QOL) questionnaires at baseline, 1 and 6 weeks, and 6 months after the workshop. Attendees’ baseline QOL scores were compared to follow-up (FUP) scores. Scores from patients receiving routine FUP care were also compiled as a reference population.

Results

In total, 77 patients attended 1 of 9 workshops. The mean satisfaction score was 9.7 out of 10 for the workshop and 9.96 out of 10 for the moderator. Participants’ baseline mean Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scores were 57.8 (SD 6.9) and 55.3 (SD 7.5), respectively, which were significantly higher than those of patients receiving routine FUP care (49.1, SD 8.3 and 47.3 SD 8.0, respectively). PROMIS anxiety and depression scores decreased, and the Happiness Index Profile (HIP-10) score—measuring intention and resiliency—increased significantly at 1- and 6-week FUPs.

Conclusions

The Pathways for Survivors program was favorably received. Anxiety and depression decreased significantly at 1- and 6-weeks after the workshop and remained below baseline at 6 months. Increased HIP-10 scores suggest that patients acquired and implemented skills from the workshop. A 1-day workshop led by a lay moderator significantly improved several psychological measures, suggesting that it may be a useful and time-efficient strategy to improve QOL in breast cancer survivors. We are investigating whether an abbreviated “booster” of the intervention at a later date could further improve and maintain QOL gains.

Evaluating a Pilot Culturally Sensitive Psychosocial Intervention on Posttraumatic Growth for Chinese American Breast Cancer Survivors

This study investigated the potential benefit of a pilot culturally sensitive group support intervention, named Joy Luck Academy (JLA), in fostering posttraumatic growth among Chinese American breast cancer survivors. Eighty-six Chinese American breast cancer survivors participated in an eight-week single-arm pre-/post-test trial of an intervention program, which included educational lectures and peer mentor support. The JLA participants were compared with an independent sample of 109 Chinese American breast cancer survivors who went through routine care. Both groups completed baseline and eight-week follow-up assessments of the five facets of posttraumatic growth (meaningful interpersonal relationships, finding new possibilities in life, personal strength, appreciation of life, and spirituality). From baseline to follow-up, the JLA participants displayed significant improvements in the total score of posttraumatic growth, meaningful interpersonal relationships, appreciation of life, finding new possibilities in life, and personal strength. In contrast, the routine care participants showed no significant change in any of these outcome variables. The findings suggest the potential benefit of a culturally sensitive group support intervention in facilitating posttraumatic growth for Chinese American breast cancer survivors, indicating the need for a randomized controlled trial. The educational lectures and peer mentor support may be adapted to tailor the needs of other ethnic minority cancer patients.

'It's always in the back of my mind': understanding the psychological impact of recovery following pancreaticoduodenectomy for cancer: a qualitative study

OBJECTIVES

Ten per cent of patients diagnosed with pancreatic cancer undergo pancreaticoduodenectomy. There is limited previous research focusing on psychological well-being; unmet support needs impact negatively on quality of life. This paper reports the psychological impact of a pancreatic cancer diagnosis and subsequent pancreaticoduodenectomy, exploring how patients' lives alter following surgery and how they seek support.

DESIGN

Inductive qualitative study involving in-depth semistructured interviews with 20 participants who had undergone pancreaticoduodenectomy for pancreatic or distal biliary duct cancer. Interviews were audiorecorded, transcribed and anonymised, and thematic analysis used principles of constant comparison.

SETTING

Single National Health Service Trust in Northwest England.

PARTICIPANTS

Patients were eligible for inclusion if they had had pancreaticoduodenectomy for head of pancreas cancer, periampullary cancer or distal cholangiocarcinoma between 6 months and 6 years previously, and had completed adjuvant chemotherapy.

RESULTS

Analysis identified the following main themes: diagnosis and decision making around surgery; recovery from surgery and chemotherapy; burden of monitoring and ongoing symptoms; adjusting to 'a new normal'; understanding around prognosis; support-seeking. Participants seized the chance to have surgery, often without seeming to absorb the risks or their prognosis. They perceived that they were unable to control their life trajectory and, although they valued close monitoring, experienced anxiety around their appointments. Participants expressed uncertainty about whether they would be able to return to their former activities. There were tensions in their comments about support-seeking, but most felt that emotional support should be offered proactively.

CONCLUSIONS

Patients should be made aware of potential psychological sequelae, and that treatment completion may trigger the need for more support. Clinical nurse specialists (CNSs) were identified as key members of the team in proactively offering support; further training for CNSs should be encouraged. Understanding patients' experience of living with cancer and the impact of treatment is crucial in enabling the development of improved support interventions.

Identifying women with increased risk of breast cancer and implementing risk-reducing strategies and supplemental imaging

Breast cancer (BC) is the second most common cancer in women, affecting 1 in 8 women in the United States (12.5%) in their lifetime. However, some women have a higher lifetime risk of BC because of genetic and lifestyle factors, mammographic breast density, and reproductive and hormonal factors. Because BC risk is variable, screening and prevention strategies should be individualized after considering patient-specific risk factors. Thus, health care professionals need to be able to assess risk profiles, identify high-risk women, and individualize screening and prevention strategies through a shared decision-making process. In this article, we review the risk factors for BC, risk-assessment models that identify high-risk patients, and preventive medications and lifestyle modifications that may decrease risk. We also discuss the benefits and limitations of various supplemental screening methods.

Behavioural, physical, and psychological predictors of cortisol and C-reactive protein in breast cancer survivors: A longitudinal study

Background

Breast cancer survivors (BCS) can exhibit a dysregulation of cortisol and elevated C-reactive protein (CRP) levels post-treatment, which increase the risk of diverse health outcomes. Certain behavioural, physical, and psychological variables may help to predict cortisol and CRP levels post-treatment. The aims of this study were to: (1) describe naturally occurring changes in absolute diurnal cortisol and CRP levels over a period of 1.5 years post-treatment among BCS, (2) assess if absolute diurnal cortisol and CRP levels change in tandem, and (3) assess behavioural, physical, and psychological variables as predictors of absolute diurnal cortisol levels and CRP levels.

Methods

Capillary blood and saliva samples were collected from 201 BCS, on average, 3.5 months post-treatment (T1) and again 3, 6, 9, and 12 months later (T2−T5). At each time point, five saliva samples were collected on two nonconsecutive days: at awakening, 30 ​min after awakening, 2:00 p.m., 4:00 p.m., and at bedtime. At each time point, participants also completed self-report questionnaires and wore an accelerometer for seven consecutive days. Data were analyzed using multilevel modeling.

Results

Absolute diurnal cortisol levels did not change significantly over time. CRP levels decreased across time points (B_linear ​= ​−0.31, p ​= ​.01), though the rate of decrease slowed over time (B_quadratic ​= ​0.05, p ​= ​.03). Generally, greater sedentary time predicted higher overall absolute diurnal cortisol levels (B ​< ​0.01, p ​= ​.01); whereas higher physical activity (B ​= ​−0.004, p ​< ​.01), lower body mass index (B ​= ​0.10, p ​< ​.01), and lower health- and cancer-related stress (B ​= ​0.24, p ​= ​.04) predicted lower overall CRP levels. Also, lower absolute diurnal cortisol levels were evident when participants engaged in more sedentary time, as compared to their own average sedentary time (B ​= ​−0.01, p ​< ​.01).

Conclusions

Results offer insight into the nature of change in diurnal cortisol and CRP levels among BCS from treatment completion onwards and offer clinical implications. Helping BCS manage their weight, reduce stress, increase physical activity participation, and decrease sedentary time as soon as possible after treatment may help to reduce physiological dysregulations, thereby lowering the risk of adverse health outcomes in this population. Further research investigating specific intervention parameters such as type, context, frequency, and intensity are warranted for the development of the most optimal interventions.

Online Support Seeking and Breast Cancer Patients: Changes in Support Seeking Behavior following Diagnosis and Transition off Cancer Therapy

Transitions in breast cancer care are associated with significant increases in stress and anxiety, and this stress can negatively impact mental and physical health. Social support has been shown to alleviate such distress, but whether, how, and how often social support is accessed through existing support networks is unclear. Our study examines changes in social media use following breast cancer diagnosis and treatment, using hand-coded longitudinal data from 30 breast cancer survivors' Facebook pages for the 6 months surrounding cancer diagnosis and for the 6 months surrounding transition off cancer therapy. Results revealed that following diagnosis, there was a significant increase in posting behavior and self-disclosure. However, this increase in posts did not correspond to an increase in support requests. In addition, while participants' primary support requests were for resources, support provided tended to be lower-cost emotional support. Finally, temporal maps indicated that participants started off increasing their engagement but withdrew over time. Our findings suggest that Facebook offered participants a platform for continued social engagement and self-disclosure - but showed several indications that support was principally low-effort, limited quality, and ill-fitting.

Changes after cancer diagnosis and return to work: experience of Korean cancer patients

Background

Cancer patients’ return to work is a growing aspect of survivorship care, yet limited studies have been conducted in Korea to understand the work-related experience of cancer patients. The purpose of this study was to understand the unmet needs of cancer patients and identify the necessary factors to develop a vocational intervention program based on cancer patients’ work-related experience after cancer diagnosis.

Methods

Semi-structured individual in-depth interviews were conducted with 50 cancer patients who were working at the time of diagnosis at a university hospital in Seoul, South Korea from July to September of 2017. Interview data were analyzed using qualitative content analysis.

Results

‘The changes patients experienced after cancer diagnosis’ were categorized into Personal and socio-environmental changes. ‘Personal changes’ were changes within the patient that were further divided into ‘physical’, ‘psychological’ and ‘spiritual’ changes while ‘socio-environmental changes’ were changes in either ‘attitude’ and ‘relationship’ of other people cancer patients encountered. In addition to these post-diagnosis changes, the following 4 major factors related to return-to-work were identified to affect patients’ experience: ‘fear of cancer recurrence’, ‘financial status’, ‘informational support’, and ‘job-related work environment’.

Conclusion

Cancer patients’ working status was determined by personal and socio-environmental changes after the cancer diagnosis which as well as psychological distress and practical issues such as fear of cancer recurrence, financial burden, and work environment. Educational materials and intervention programs informing patients on these changes and factors may facilitate their return-to-work after diagnosis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-07812-w.

A Patient's Perspective: Bridging the Transition Following Radiation Therapy for Patients with Breast Cancer

INTRODUCTION

As the number of women surviving breast cancer grows, it becomes increasingly important to investigate their unique psychosocial and physical needs in the post-treatment period. The period of transition from patient to survivor is a time fraught with physical and emotional challenges. This qualitative study was conducted to gain insight into the perspective of breast cancer patients transitioning to survivorship after receiving RT in Alberta.

METHODS

Ten patients receiving radiation therapy (RT) for breast cancer in Alberta participated in an open-ended telephone interview two to three weeks following the cessation of treatment. The data was analyzed using a qualitative interpretive phenomenological approach. Data was clustered and categorized, and emerging themes were examined.

RESULTS

Though participants reported to be satisfied with the care and information they received, a need for more robust and detailed skin care education was identified. Patients expressed a sense of anxiety around returning to normalcy following RT, and described feeling lonely, and unsure of themselves in the post-treatment period. A post-treatment phone call may allow Radiation Therapists (RTTs) to mitigate the ongoing needs of patients in the period between their last day of treatment and their first follow-up visit.

CONCLUSION

This project has given us an opportunity to hear the voice of the patient, thus laying the groundwork to allow for a more patient-centred approach to the transition of care following RT. The data gathered suggests possible areas for development of interventions and supports for breast cancer patients as they transition into survivorship.

An investigation into socio-demographic-, health-, and cancer-related factors associated with cortisol and C-reactive protein levels in breast cancer survivors: a longitudinal study

BACKGROUND

Breast cancer survivors (BCS) may exhibit dysregulated patterns of cortisol and C-reactive protein (CRP). The aims of this study were to describe BCS' cortisol and CRP levels over a 1-year period after treatment, and assess how levels relate to socio-demographic- (age, education level, marital status), health- (body mass index [BMI] category, menopausal status), and cancer-related factors (cancer stage, chemotherapy exposure, time since diagnosis).

METHODS

Participants (N = 201) provided data at 3 months post-treatment (T1) and again 3, 6, 9, and 12 months later (T2-T5). At T1, participants completed self-report questionnaires and had their weight and height measured by a trained technician. At T1-T5, they provided five saliva samples at awakening, 30 min after awakening, 2:00 pm, 4:00 pm, and before bedtime on two nonconsecutive days to measure diurnal cortisol, and provided capillary whole blood to measure CRP. Data were analyzed using repeated-measure analyses of variance (ANOVAs) and mixed-design ANOVAs.

RESULTS

Diurnal cortisol and CRP levels fluctuated over time. In univariate models, older age and post-menopausal status were associated with higher cortisol and CRP levels, higher cancer stage and chemotherapy were associated with lower cortisol levels, and higher BMI category was associated with higher CRP levels. In adjusted models, age was no longer associated with CRP levels and shorter time since diagnosis was significantly associated with higher CRP levels.

CONCLUSIONS

Socio-demographic-, health-, and cancer-related factors may help identify BCS at risk of physiological dysregulation who need intervention. Identifying modifiable factors associated with cortisol and CRP will inform cancer care interventions.

Effects of Internet-based psycho-educational interventions on mental health and quality of life among cancer patients: a systematic review and meta-analysis

PURPOSE

To systematically review evidence regarding the benefits of Internet-based psycho-educational interventions among cancer patients.

METHODS

We performed a systematic review with meta-analysis and qualitative evidence synthesis. Systematic searches for published studies in English or Chinese identified eligible randomized and clinical controlled trials. The following databases were searched: Medline, Embase, CINAHL, PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Proquest Digital Dissertations, Foreign Medical Retrieval System, China National Knowledge Infrastructure, China Science and Technology Journal Database, China Wanfang Database, and Taiwanese Airiti Library. We also searched the gray literature and reviewed reference lists from relevant articles. Studies were scored for quality using the Cochrane Risk of Bias Tool.

RESULTS

Seven eligible studies (1220 participants) were identified that used three intervention tools: website programs (n = 5), e-mail counseling (n = 1), and a single-session psycho-educational intervention (n = 1). The quality of all studies was moderate. The meta-analysis showed that Internet-based psycho-educational interventions had a significant effect on decreasing depression (standardized mean difference (SMD) - 0.58, 95% confidence interval (CI) (- 1.12, - 0.03), p = 0.04) and fatigue (mean difference (MD) - 9.83, 95% CI (- 14.63, - 5.03), p < 0.01). However, there was no evidence for effects on distress (SMD - 1.03, 95% CI (- 2.63, 0.57), p = 0.21) or quality of life (MD 1.10, 95% CI (- 4.42, 6.63), p = 0.70).

CONCLUSION

Internet-based psycho-educational interventions reduce fatigue and depression in cancer patients. More rigorous studies with larger samples and long-term follow-up are warranted to investigate the effects of these interventions on cancer patient quality of life and other psychosocial outcomes.

Health care use and remaining needs for support among women with breast cancer in the first 15 months after diagnosis: the role of the GP

BACKGROUND

The number of women with breast cancer in general practice is rising. To address their needs and wishes for a referral, GPs might benefit from more insight into women's health care practices and need for additional support.

OBJECTIVE

To examine the prevalence of health care use and remaining needs among women with breast cancer in the first 15 months after diagnosis.

METHODS

In this multicentre, prospective, observational study women with breast cancer completed a questionnaire at 6 and 15 months post-diagnosis. Medical data were retrieved through chart reviews. The prevalence of types of health care used and remaining needs related to medical, psychosocial, paramedical and supplementary service care (such as home care), was examined with descriptive analyses.

RESULTS

Seven hundred forty-six women completed both questionnaires. At both assessments patients reported that they had most frequent contact with medical and paramedical providers, independent of types of treatment received. Three to fifteen percent of the patients expressed a need for more support. Prominent needs included a wish for more frequent contact with a physiotherapist, a clinical geneticist and a psychologist. Patients also wanted more help for chores around the house, particularly in the early post-treatment phase.

CONCLUSION

A small but relevant percentage of women with breast cancer report having unmet needs. GPs may need to be particularly watchful of their need for more support from specific providers. Future research into the necessity of structural needs assessment among cancer patients in general practice is warranted.

Risk factors of unmet needs among women with breast cancer in the post-treatment phase

OBJECTIVE

Unmet health care needs require additional care resources to achieve optimal patient well-being. In this nationwide study we examined associations between a number of risk factors and unmet needs after treatment among women with breast cancer, while taking into account their health care practices. We expected that more care use would be associated with lower levels of unmet needs.

METHODS

A multicenter, prospective, observational design was employed. Women with primary breast cancer completed questionnaires 6 and 15 months post-diagnosis. Medical data were retrieved from medical records. Direct and indirect associations between sociodemographic and clinical risk factors, distress, care use, and unmet needs were investigated with structural equation modeling.

RESULTS

Seven hundred forty-six participants completed both questionnaires (response rate 73.7%). The care services received were not negatively associated with the reported levels of unmet needs after treatment. Comorbidity was associated with higher physical and daily living needs. Higher age was associated with higher health system-related and informational needs. Having had chemotherapy and a mastectomy were associated with higher sexuality needs and breast cancer-specific issues, respectively. A higher level of distress was associated with higher levels of unmet need in all domains.

CONCLUSIONS

Clinicians may use these results to timely identify which women are at risk of developing specific unmet needs after treatment. Evidence-based, cost-effective (online) interventions that target distress, the most influential risk factor, should be further implemented and disseminated among patients and clinicians.

Codifying Online Social Support for Breast Cancer Patients: Retrospective Qualitative Assessment

BACKGROUND

Social media has emerged as the epicenter for exchanging health-related information, resources, and emotional support. However, despite recognized benefits of social media for advancing health-promoting support exchange, researchers have struggled to differentiate between the different ways social support occurs and is expressed through social media.

OBJECTIVE

The objective of this study was to develop a fuller understanding of social support exchange by examining the ways in which breast cancer patients discuss their health needs and reach out for support on Facebook and to develop a coding schema that can be useful to other social media researchers.

METHODS

We conducted a retrospective qualitative assessment of text-based social support exchanges through Facebook among 30 breast cancer survivors. Facebook wall data were systematically scraped, organized, coded, and characterized by whether and which types of support were exchanged. Research questions focused on how often participants posted related to cancer, how often cancer patients reached out for support, and the relative frequency of informational, instrumental, or socioemotional support requests broadcast by patients on the site.

RESULTS

A novel ground-up coding schema applied to unwieldy Facebook data successfully identified social support exchange in two critical transitions in cancer treatment: diagnosis and transition off cancer therapy. Explanatory coding, design, and analysis processes led to a novel coding schema informed by 100,000 lines of data, an a priori literature review, and observed online social support exchanges. A final coding schema permits a compelling analysis of support exchange as a type of peer community, where members act proactively to buffer stress effects associated with negative health experiences. The coding schema framed operational definitions of what support meant and the forms each type of support could take in social media spaces.

CONCLUSIONS

Given the importance of social media in social interaction, support exchange, and health promotion, our findings provide insight and clarity for researchers into the different forms informational, resource, and emotional support may take in Web-based social environments. Findings support broader continuity for evaluating computer-mediated support exchange.

Values of cancer survivors and the supportive role of recreational video games

Value-affirming activities have been linked to positive health outcomes and improved ability to cope. For cancer survivors who regularly play video games, might the games have potential to affirm values? We surveyed gameplaying survivors and included an open-ended question asking about values and the extent to which they perceived gameplaying as supporting values. A content analysis of responses (N = 533) using Schwartz's value typology revealed that a majority perceived gameplaying as supporting values or offering other benefits. Self-transcendence followed by openness to change were the most frequently coded higher-order categories. The results contribute to a richer understanding of survivors who gameplay.

Passion among breast cancer survivors: A 12-month prospective study

We examined the prospective relationship between harmonious passion and post-treatment health outcomes among female breast cancer survivors. Participants reported passion toward a favorite activity, physical pain symptoms, and mental health after their final breast cancer treatment (Time 1, N = 188). Twelve months later (Time 2, N = 148), participants reported their physical pain symptoms and mental health. Harmonious passion at Time 1 predicted fewer physical pain symptoms and higher levels of mental health at Time 2. These results show that breast cancer survivors benefit from being harmoniously passionate toward a meaningful activity following treatment.

The use of the concept of transition in different disciplines within health and social welfare: An integrative literature review

AIMS

To continuing the quest of the concept of transition in nursing research and to explore how the concept of transition is used in occupational therapy, oral health and social work as well as in interdisciplinary studies in health and welfare, between 2003-2013.

DESIGN

An integrative literature review.

METHODS

PubMed, CINAHL, PsycINFO, DOSS, SocIndex, Social Science Citation Index and AMED databases from 2003-2013 were used. Identification of 350 articles including the concept of transition in relation to disciplines included. Assessment of articles are in accordance to Meleis' typologies of transition by experts in each discipline. Chosen key factors were entered into Statistical Package for the Social Sciences (SPSS).

RESULTS

Meleis' four typologies were found in all studied disciplines, except development in oral health. The health-illness type was the most commonly explored, whereas in social work and in occupation therapy, situational transitions dominated.

Revision of the fear of cancer recurrence cognitive and emotional model by Lee-Jones et al with women with breast cancer

BACKGROUND

Fear of cancer recurrence (FCR) is among the top unmet concerns reported by breast cancer survivors. Despite the sizable literature on FCR, few theoretical models have been empirically tested. One of the most cited is the FCR model.

AIM

This study seeks to understand the nature of women's cognitive and emotional issues from FCR using specific guidance from the model by Lee-Jones and to provide suggestions for modifications to the model based on empirical results from the reported experiences of women living with breast cancer.

METHODS AND RESULTS

A qualitative descriptive study using semi-structured interviews was conducted at an urban hospital. Recruited by convenience sampling, 12 breast cancer survivors concerned with FCR and who had recently completed active treatment participated in the study. Seven thematic categories emerged from the women's descriptions of their cognitive and emotional experiences with FCR: (a) FCR is always there; (b) beliefs about risk of recurrence; (c) beliefs about eradication of cancer; (d) preferences not to seek information about recurrence; (e) derailment of normal life; (f) worries related to recurrence; and (g) need for support. Adjustments to the model by Lee-Jones et al¹ specifically to women living with breast cancer include the addition of new variables-the fear is always present, a preference not to seek information, and the need for support beyond treatment-and the merging of two variables, anxiety and worry, as participants viewed these concepts as interchangeable and experienced in similar ways. Lastly, participants did not report any remorse related to not opting for more aggressive treatments.

CONCLUSION

The refinement of a more comprehensive FCR theoretical model, such as through the modifications derived from this study, provides a deeper understanding of breast cancer survivors' experiences with FCR and can more effectively guide health care professionals to develop appropriately tailored interventions aimed at decreasing FCR levels.

The implications of women's activity limitations and role disruptions during breast cancer survivorship

Early survivorship is a time of critical transition for women survivors of breast cancer as they attempt to resume functional activities and important life roles. This study aimed to explore the challenges of women and their partners as they attempted to resume activities and roles, identify unmet needs and make recommendations regarding a suitable framework to support women and partners to recommence valued activities and important roles during early survivorship. Qualitative methods utilising in-depth interviews of women (n = 18) and their partners (n = 8), and two focus groups (n = 10) were completed in Perth, Western Australia, between June 2014 and April 2015. These methods were used to facilitate women and partners' views regarding the resumption of previously meaningful activities and important life roles during early survivorship. Questions addressed their individual and shared experiences concerning self-care, leisure, social and productive activities and important roles. Thematic analysis was employed to determine themes. Women and partners reported significant impact on their ability to engage in valued activities, resulting in changes to participation in meaningful roles. Three themes were determined: (1) ambiguity regarding survivorship prevents resumption of activities and previous roles, (2) breast cancer continues to impact a couples' relationship during survivorship, and (3) support is needed to assist women and partners to resume activities and important roles. This research provides evidence suggesting that the ongoing symptoms of breast cancer treatment continue to impact many women and their partners, as they attempt to resume functional activities and important life roles during early survivorship. Disruption to these valued activities and roles may influence women and their partner's health and well-being during early survivorship and extend beyond this period. Rehabilitation following cessation of treatment could be offered as required to facilitate access to multi-disciplinary services and supports for both individuals and couples.

Fear of cancer recurrence: A qualitative systematic review and meta-synthesis of patients' experiences

Fear of cancer recurrence (FCR) is a significant issue for most cancer survivors, with nearly half of cancer survivors reporting it at moderate to high levels of intensity. We aimed to further explore the experience of having FCR from the point of view of patients by systematically reviewing qualitative studies. Following PRISMA guidelines, 87 qualitative studies were selected. All participants' quotes about FRC were extracted, then analysed using a conceptual framework based on the emotion-focused therapy theory of emotion schemes, which consist of experienced/implicit emotions, along with perceptual-situational, bodily-expressive, symbolic-conceptual and motivational-behavioral elements. According to participant descriptions, FCR was found to be an intense, difficult, multi-dimensional experience. Considering the diversity of experiences identified, it is useful to look at FCR as an emotional experience that extends along a continuum of adaptive and maladaptive responses. For some participants, FCR was described in trauma-like terms, including forms of re-experiencing, avoidance, negative thoughts and feelings, and arousal or reactivity related to cancer-related triggers or memories. Vivid metaphors expressing vulnerability and conflict also reflect the strong impact of FCR in patients' lives and can help therapists empathize with their clients.

Looking beyond Disfigurement: The experience of Patients with Head and Neck Cancer

Despite the frequent occurrence of head and neck cancer (HNC) disfigurement, little is known about its psychosocial impact on patients. This study aimed to understand the lived experience of disfigurement in HNC and explore what patients considered to be its influences. Fourteen disfigured HNC patients participated in a 45-to-120-minute in-depth, semi-structured interview, which was analyzed qualitatively using interpretive phenomenology. A majority of participants (64 percent) were considered to be at an advanced cancer stage (stage III or stage IV). Patients’ experiences revolved around the concept of a ruptured self-image (a discontinuity in sense of self). Forces triggering this ruptured self-image created a sense of “embodied angst”, in which disfigurement served as a constant reminder of the patient's cancer and associated foundational malaise. Other influences fostered a sense of normalcy, balance, and acceptance. Participants oscillated between these two states as they grew to accept their disfigurement. This study's findings could guide supportive interventions aimed at helping patients face head and neck surgery.

Hidden voices: an interpretative phenomenological analysis of the experience of surviving breast cancer in Saudi Arabia

Background

Women with breast cancer often have difficulties in making sense of and understanding their experiences, specifically the ways in which cultural sensitivities impact on and shape their lifeworlds.

Aims

The aim of this study is to explore the experience of being a breast cancer survivor in Saudi Arabia.

Methods

Qualitative, in-depth, semi-structured interviews were conducted with 18 Saudi breast cancer survivors aged between 30 and 50 years who had finished treatment 6-47 months before data collection. The data were transcribed verbatim, translated from Arabic into English and analysed using interpretative phenomenological analysis.

Results

Three themes emerged: the meaning of cancer; hidden survival; and the cultural meaning of survival. For women in Saudi, breast cancer has a cultural stigma linked to death. It changes the sense of self and of society, leading some women to hide their diagnosis from the public and their families. The meaning of survival in a Muslim context has a cultural and religious base, linked to God's will, normality and resumption of activities.

Conclusions

The study helps give Saudi women a 'voice' through the understanding of their experiences of surviving breast cancer. The unique cultural perspectives provide new insights, which can guide healthcare practice and inform the development of programmes to support women who survive breast cancer.

A biopsychosocial model of resilience for breast cancer: A preliminary study in mainland China

PURPOSE

Patients diagnosed with breast cancer exhibited critical biopsychosocial functions following surgery or adjuvant treatment; therefore, it is important that they exhibit resilience. A Resilience Model for Breast Cancer (RM-BC) was developed using Chinese breast cancer patients to increase our understanding of how resilience outcomes are positively and negatively affected by protective and risk factors, respectively.

METHODS

Chinese women with breast cancer completed the questionnaires within 1 week of beginning treatment. Exploratory Structural Equation Modeling was used to evaluate the RM-BC using a sample size of 342 patients.

RESULTS

RM-BC suggested satisfactory goodness-of-fit indices and 67 percents of variance for resilience was explained. The Fit Indices for the measurement model were as follows: CFI = 0.909, GFI = 0.911, IFI = 0.897, NFI = 0.922, PNFI = 0.896, PCFI = 0.884, and RMSEA = 0.031. Three risk factors - emotional distress, physical distress, and intrusive thoughts - and four protective factors - self-efficacy, social support, courage-related strategy, and hope - were recognized.

CONCLUSION

The resilience model allows for a better understanding of Chinese breast cancer patients' resilience integration while undergoing treatment and provides an effective structure for the development of resilience-focused interventions that are grounded in their experiences. A randomized trial has provided evidences of feasibility in Chinese women with breast cancer and the resilience model could be used as a useful framework for more resilience intervention in the future.

To support and to be supported. A qualitative study of peer support centres in cancer care in Norway

OBJECTIVE

To explore what peer supporters, patients and their relatives want and gain from peer support in cancer care.

METHODS

Focus group interviews with peer supporters, and in-depth interviews with peer supporters, patients and relatives (N=38) and observations of daily activities in a Vardesenter ("Cairn Centre").

RESULTS

Peer supporters helped cancer patients and relatives with coping in and outside the hospital in several ways: (1) conveying hope and providing ways to cope in situations where despair would often be prevalent, thus protecting against unhealthy stress; (2) being someone who had the same experiences of disease and treatment, and thus providing a framework for positive social comparisons; and (3) to be an important supplement to family and health care providers. To be working as a peer supporter was also found to be positive and important for the peer supporters themselves.

CONCLUSION

The peer support program represented a valuable supplement to informal support from family and friends and healthcare providers, and gave the peer supporters a new role as "professionally unprofessional".

PRACTICE IMPLICATIONS

Organised peer support represents a feasible intervention to promote coping for cancer survivors.

Does emotional talk vary with fears of cancer recurrence trajectory? A content analysis of interactions between women with breast cancer and their therapeutic radiographers

Fears of cancer recurrence (FCR) in patients with breast cancer are hypothesised to develop over the period from diagnosis, through treatment and thereafter. A crucial point may be the contact that patients have with their therapeutic radiographer in review appointments. The study aimed to (1) describe and categorise the content of the identified emotional talk, and (2) consider the evidence for an association of content with FCR trajectory.

METHODS

A concurrent mixed methods approach was applied as part of a larger investigation (FORECAST) of breast cancer patients (n=87). Patients completed a daily diary during their radiotherapy treatment. Audio recordings were collected of review appointments. The Verona Coding Definitions of Emotional Sequences (VR-CoDES) system was used to code patient emotional cues and concerns (CCs). Purposeful sampling of the daily diary ratings identified 12 patients (30 consultations) with an increasing (n=6) or decreasing (n=6) FCR trajectory. The emotional talk of these patients at their weekly reviews was content analysed.

RESULTS

Four themes were identified from 185 CCs: Physical Symptoms, Factors External to Hospital, Treatment, and Labelling Cancer. FCR decreasing trajectory group consultations were longer (p<0.02), expressed twice as many CCs as the increasing trajectory group (p<0.001), and were more likely to refer to cancer directly (p<0.05).

CONCLUSIONS

The emotional content expressed matched features outlined in the Lee-Jones et al. (1997) FCR model, and showed evidence of avoidance in increasing FCR trajectory patients.

'I know I'm not invincible': An interpretative phenomenological analysis of thyroid cancer in young people

Objective

Thyroid cancer is one of the most common cancers affecting young people and carries an excellent prognosis. Little is known about the psychosocial issues that face young people diagnosed with a treatable cancer. This study explored how young people experienced diagnosis, treatment, and how they made sense of an experience which challenged their views on what it means to have cancer.

Method

Semi‐structured interviews were conducted with eight young people diagnosed with either papillary or follicular thyroid cancer, and analysed with interpretative phenomenological analysis (IPA).

Results

Two inter‐related aspects of their experience are discussed: (1) the range of feelings and emotions experienced including feeling disregarded, vulnerability, shock and isolation; (2) how they made sense of and ascribed meaning to their experience in the light of the unique nature of their cancer. A thread running throughout the findings highlights that this was a disruptive biographical experience.

Conclusions

Young people experienced a loss of youthful immunity which contrasted with a sense of growth and shift in life perspective. Having a highly treatable cancer was helpful in aiding them to reframe their situation positively but at the same time left them feeling dismissed over a lack of recognition that they had cancer. The young peoples’ experiences point to a need for increased understanding of this rare cancer, more effective communication from health care professionals and a greater understanding of the experiential impact of this disease on young people. Suggestions to improve the service provision to this patient group are provided.

The Affect Regulation in Cancer framework: Understanding affective responding across the cancer trajectory

Affective dimensions of cancer have long been a central concern in the field of psycho-oncology. Recent developments in the field of affective science suggest the value of incorporating insights from the burgeoning literature on affect regulation. Accordingly, the objective of this article is to build on prior work in this area by applying a process-oriented affect regulation framework to the various phases of the cancer trajectory. The Affect Regulation in Cancer framework is adapted from Gross' process model of emotion regulation, and its aim is to integrate recent advances in affective science with work in the field of psycho-oncology. The basic elements of the affect generative and affect regulatory processes are outlined across the various phases of the cancer trajectory. Our proposed model provides a useful heuristic framework in advancing research on the ways people manage their affective responses throughout the cancer trajectory.

Web-Based Tailored Psychoeducation for Breast Cancer Patients at the Onset of the Survivorship Phase: A Multicenter Randomized Controlled Trial

CONTEXT

Many breast cancer patients have unmet informational and psychosocial needs after treatment completion. A psychoeducational intervention may be well suited to support these patients.

OBJECTIVES

The purpose of this multicenter randomized controlled trial was to examine the effectiveness of a web-based tailored psychoeducational program (ENCOURAGE) for breast cancer patients, which aims to empower patients to take control over prevailing problems.

METHODS

Female breast cancer patients from two hospitals in The Netherlands who recently completed (neo-)adjuvant chemotherapy were randomly assigned to standard care or 12-week access to the ENCOURAGE program providing fully automated information problem-solving strategies, resources, and services for reported problems. At six and 12 weeks, patients completed self-report questions on optimism and control over the future (primary outcome), feelings of being informed, and acceptance of the illness. At baseline and 12 weeks, distress and quality of life questionnaires were completed.

RESULTS

About 138 patients were included. Almost all patients (67 of 69) visited ENCOURAGE as requested. No differences between the control and intervention group were observed for primary and secondary outcomes. An unplanned subgroup analysis showed that in clinically distressed patients (N = 57 at baseline; 41%), use of the ENCOURAGE program increased optimism and control over the future at 12 weeks more than in patients in the control group (Cohen's d = 0.65).

CONCLUSION

Although the effectiveness was not demonstrated, a subgroup of women treated for breast cancer can probably be supported by the program. The results of the present study are a starting point for further development and use of the program.

[Mental disorders in patients with breast cancer: a differentiated approach to the study of nozogeny]

AIM

To study mental disorders in patients with breast cancer (BC) at different stages of the disease taking into account premorbid characteristics and psychosomatic correlations in their development.

MATERIAL AND METHODS

The study included 82 patients with histologically confirmed BC. The first group consisted of 30 patients (mean age 49.7±11.1 years) with the first established diagnosis of BC and mental disorders caused by somatic disease (ICD-10 F40-F48, stress-related neurotic and somatoform disorders). The second group included 52 patients (mean age 56.8±6.7 years) with illness duration and follow-up ≥3 years (17 years in some cases) with signs of personality disorder (PD) according to ICD-10 F62. Clinical/pschopathological, follow-up and statistical methods were used.

RESULTS AND CONCLUSION

Mental disorders are represented by two nosologic categories: nosogenic reactions and pathological personality. Manifestation of a nozogeny reaction is closely correlated with premorbid personality characteristics. Anxious - depressive nozogenic reaction (n=17) is strongly correlated with the anxious type of personality accentuation and weakly correlated with personality characteristics of the affective (bipolar) range. Anxious-nozogenic dissociative response (n=9) was characteristic of hysterical and expansive schizotypal PD with a significant direct correlation with constitutional hyperthymia. Anxiety - hypomanic nozogeny response (n=4) was observed in schizotypal PD correlated with symptoms of persistent hyperthymia. Five types of PD are formed in the follow-up period: hypochondriacal dysthymia, 'paranoia struggle', 'aberrant hypochondria', hypomanic endoform response with the phenomenon of post-traumatic growth and 'new life'.

A longitudinal study of diurnal cortisol patterns and associated factors in breast cancer patients from the transition stage of the end of active cancer treatment to post-treatment survivorship

OBJECTIVES

The aim of this study was to examine the changes in diurnal cortisol patterns and its associated factors among breast cancer patients over a 14-month follow up period.

MATERIALS AND METHODS

A total of 85 breast cancer patients were recruited to participate in this study. Assessments were performed at baseline (T0), T1 (the 2nd month), T2 (the 5th month), T3 (the 8th month), and T4 (the 14th month). Salivary cortisol was measured and the following questionnaires were administered: BDI-II depression scale, European Organization for Research and Treatment of Cancer Core Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer-specific complementary measure (EORTC QLQ-BR23). Patients were grouped into flat and steep groups, according to the median of the diurnal cortisol slopes at the time of the transition period.

RESULTS

Breast cancer patients in the flatter slope group at transition period demonstrated steeper slopes over the course of recovery from treatment and those in the steeper slope group at transition period continued with steeper slopes over the course of recovery. The greater breast cancer-related symptoms (side-effects, symptoms relating to breast and arm, and hair loss) were associated with the changes in flatter diurnal cortisol slopes during14-month follow up period.

CONCLUSION

Diurnal cortisol patterns in flatter slope group at the transition period appear to have a trend of recovery with the passage of time over the course of recovery from treatment. Management of breast cancer symptoms could improve dysregulation of diurnal cortisol patterns among survivors.

The suspended self: Liminality in breast cancer narratives and implications for counselling

In the field of chronic and serious illness, meaning-making with regards to the illness experience has been shown to be a core process for patients. This study focuses on women's narratives of their experiences of living with breast cancer. Within the framework of narrative psychology, illness narratives are considered to provide the main means through which patients make sense of their illness experience and construct its place in their life story. In this paper, we present findings from a narrative study that aimed to explore the different meanings that breast cancer holds for Greek women. In the broader study, four basic narrative types about breast cancer emerged from the analysis. In this paper, we focus on one of these narrative types, in which illness is constructed as an entrance into a state of liminality and where the women's sense of self seems to be “suspended”. The core features of this narrative type are described and arguments are developed regarding its usefulness. We argue that this is a narrative type that deserves further attention, particularly as it seems to reflect a socially non-preferred storyline, which might result in these women's stories being sidestepped or silenced. The implications of this narrative type for healthcare and counselling in cancer care are discussed.

'Am I really gonna go sixty years without getting cancer again?' Uncertainty and liminality in young women's accounts of living with a history of breast cancer

Although much research has examined the experience of breast cancer, the distinctive perspectives and lives of young women have been relatively neglected. Women diagnosed with breast cancer under the age of 45, and who had completed their initial treatment, were interviewed, and social constructionist grounded theory methods were used to analyse the data. The end of initial treatment was accompanied by a sense of unease and uncertainty in relation to recurrence and survival, and also fertility and menopausal status. The young women's perceptions about the future were altered, and their fears about recurrence were magnified by the possibility of many decades ahead during which breast cancer could recur. The implications for the young women's life course, in terms of whether they would be able to have children, would not become clear for several years after initial treatment. This resulted in a liminal state, in which young women found themselves neither cancer-free nor cancer patients, neither pre- nor post-menopausal, neither definitively fertile nor infertile. This liminal state had a profound impact on young women's identities and sense of agency. This extends previous understanding of life after cancer, exploring the age-related dimensions of liminality.

French women's representations and experiences of the post-treatment management of breast cancer and their perception of the general practitioner's role in follow-up care: A qualitative study

Background

In France, the Cancer Plan II 2009‐2013 was launched to improve post‐cancer management and promote greater involvement of general practitioners (GPs) in follow‐up care.

Objectives

We investigated how women experienced the post‐treatment management of breast cancer and perceived the role of the GP in follow‐up care.

Design

We conducted a qualitative study based on semi‐structured interviews with women with breast cancer in remission. The interviews were transcribed and analysed in accordance with the principles of thematic analysis.

Setting and participants

We interviewed 21 patients aged between 30 and 86. Eighteen breast cancer survivors were recruited from GP practices and five from a patients’ association.

Results

Four themes emerged from the thematic analysis: that breast cancer is a life‐changing event; how patients managed the effects of treatment; how patients viewed the future; and patients’ expectations of their GP.

Discussion and conclusion

French survivors of breast cancer perceived the physical changes caused by their illness to impact their womanhood, leading to difficulties with sexual relations, a diminished sense of self and fears for the future. They felt abandoned at the end of treatment and desired support. They appreciated the ease of contacting their GP but considered follow‐up care outside their remit. They agreed to be followed up by their GP, provided that they co‐operated closely with a cancer specialist. This is in accordance with the French Cancer Plan II 2009‐2013, which recommends greater involvement of GPs in a monitoring protocol shared with cancer specialists.

Mindfulness and Quality of Life in Cancer Survivors: The Mediating Role of Self-Kindness and Alexithymia

The purpose of this study was to understand the relationship among mindfulness, self-kindness, alexithymia and quality of life in post-treatment breast cancer survivors and to examine whether self-kindness and alexithymia mediate the relationship between mindfulness and quality of life. Results suggested that the overall model accounted for significant variance in quality of life and that alexithymia partially mediated the relationship between mindfulness and quality of life. Implications for practice and further research are discussed.

Understanding the Essential Meaning of Measured Changes in Weight and Body Composition Among Women During and After Adjuvant Treatment for Breast Cancer: A Mixed-Methods Study

BACKGROUND

Changes in weight and body composition among women during and after adjuvant antineoplastic treatment for breast cancer may influence long-term survival and quality of life. Research on factual weight changes is diverse and contrasting, and their influence on women's perception of body and self seems to be insufficiently explored.

OBJECTIVE

The aim of this study was to expand the understanding of the association between changes in weight and body composition and the women's perception of body and selves.

METHODS

A mixed-methods research design was used. Data consisted of weight and body composition measures from 95 women with breast cancer during 18 months past surgery. Twelve women from this cohort were interviewed individually at 12 months. Linear mixed model and logistic regression were used to estimate changes of repeated measures and odds ratio. Interviews were analyzed guided by existential phenomenology.

RESULTS

Joint displays and integrative mixed-methods interpretation demonstrated that even small weight gains, extended waist, and weight loss were associated with fearing recurrence of breast cancer. Perceiving an ambiguous transforming body, the women moved between a unified body subject and the body as an object dissociated in "I" and "it" while fighting against or accepting the body changes.

CONCLUSIONS

Integrating findings demonstrated that factual weight changes do not correspond with the perceived changes and may trigger existential threats.

IMPLICATIONS FOR PRACTICE

Transition to a new habitual body demand health practitioners to enter a joint narrative work to reveal how the changes impact on the women's body and self-perception independent of how they are displayed quantitatively.

A dyadic approach to understanding the impact of breast cancer on relationships between partners during early survivorship

BACKGROUND

The shared impact of breast cancer for women and their male partners is emerging as an important consideration during the experience of a breast cancer diagnosis, particularly during survivorship. This study aimed to explore the experiences of women and their partners during early survivorship and contributes a range of insights into the lives of those intimately affected by breast cancer.

METHODS

In-depth interviews were completed with Australian women survivors of breast cancer (n = 8) and their partners (n = 8), between six months and five years following cessation of treatment. Questions included a focus on the women and their partners' daily experiences during early survivorship, including the management of ongoing symptoms, engagement in leisure and social interests, returning to work, communicating with each other, maintenance of the current relationship and other important roles and responsibilities. Thematic analysis was employed to determine key themes arising from the dyadic accounts of women and their partners' experiences during early breast cancer survivorship.

RESULTS

Women and their partners experienced many changes to their previous roles, responsibilities and relationships during early breast cancer survivorship. Couples also reported a range of communication, intimacy and sexuality concerns which greatly impacted their interactions with each other, adding further demands on the relationship. Three significant themes were determined: (1) a disconnection within the relationship - this was expressed as the woman survivor of breast cancer needing to prioritise her own needs, sometimes at the expense of her partner and the relationship; (2) reformulating the relationship - this reflects the strategies used by couples to negotiate changes within the relationship; and (3) support is needed to negotiate the future of the relationship - couples emphasised the need for additional support and resources to assist them in maintaining their relationship during early survivorship.

CONCLUSION

It can be concluded that the early survivorship period represents a crucial time for both women and their partners and there are currently limited options available to meet their shared needs and preferences for support. Findings indicate that a suitable model of care underpinned by a biopsychosocial framework, access to comprehensive assessment, timely support and the provision of targeted resources are urgently needed to assist women and their partners during this critical time.

Survivorship care and support following treatment for breast cancer: a multi-ethnic comparative qualitative study of women's experiences

BACKGROUND

As the number of breast cancer survivors continues to rise, Western populations become more ethnically and socially diverse and healthcare resources become ever-more stretched, follow-up that focuses on monitoring for recurrence is no longer viable. New models of survivorship care need to ensure they support self-management and are culturally appropriate across diverse populations. This study explored experiences and expectations of a multi-ethnic sample of women with breast cancer regarding post-treatment care, in order to understand potential barriers to receiving care and inform new models of survivorship care.

METHODS

A phenomenological qualitative research design was employed. In-depth interviews were conducted with women from diverse socio-demographic backgrounds in England, who completed treatment for breast cancer in the 12 months prior to the study. Data were analysed using Framework Analysis.

RESULTS

Sixty-six women participated and reported expectations and needs were unmet at follow-up. Whilst there were more commonalities in experiences, discernible differences, particularly by ethnicity and age, were identified relating to three key themes: emotional responses on transition to follow-up; challenges communicating with healthcare professionals at follow-up; and challenges finding and accessing information and support services to address unmet needs.

CONCLUSIONS

There are cultural differences in the way healthcare professionals and women communicate, not necessarily differences in their post-treatment needs. We do not know if new models of care meet survivors' needs, or if they are appropriate for everyone. Further testing and potential cultural and linguistic adaptation of models of care is necessary to ensure their appropriateness and acceptability to survivors from different backgrounds. New ways of providing survivorship care mean survivors will need to be better prepared for the post-treatment period and the role they will have to play in managing their symptoms and care.

Effect of a multidiscipline mentor-based program, Be Resilient to Breast Cancer (BRBC), on female breast cancer survivors in mainland China-A randomized, controlled, theoretically-derived intervention trial

To reduce the risk of adjustment problems for breast cancer patients in mainland China, we examined the efficacy of a multidiscipline mentor-based program, Be Resilient to Breast Cancer (BRBC), delivered after breast surgery to (a) increase protective factors of social support, hope for the future, etc.; (b) decrease risk factors of Physical and Emotional Distress; and (c) increase outcomes of Resilience, Transcendence and Quality of Life (QOL). A multisite randomized controlled trial was conducted at 6 specialist cancer hospitals. 101 and 103 breast cancer patients were allocated to intervention group (IG) and control group (CG), respectively, and 112 general females (without breast cancer) were allocated to the norm group (NG). Participants completed measures that were related to latent variables derived from the Resilience Model for Breast Cancer (RM-BC) at baseline (T1), 2 months (T2), 6 months (T3), and 12 months (T4) after intervention. At T2, the IG reported significantly lower Depression (ES = 0.65,P = 0.0019) and Illness Uncertainty (ES = 0.57, P = 0.004), better Hope (ES = 0.81, P < 0.001) and QOL (ES = 0.60, P = 0.002) than did the CG. At T3, the IG reported significantly lower Anxiety (ES = 0.74, P < 0.001), better Social Support (ES = 0.51,P = 0.009), Transcendence (ES = 0.87, P < 0.001), and Resilience (ES = 0.83, P < 0.001) compared with the CG. At T4, the IG reported better Resilience though not significant (P = 0.085) and better Transcendence (P = 0.0243) than did the NG. The BRBC intervention improves the positive health outcomes and decreases the risk factors of illness-related distress of breast cancer patients during the high-risk cancer treatment.