"An addendum to breast cancer": the triple negative experience

Anxiety and depression among Black breast cancer survivors: Examining the role of patient-provider communication and cultural values

OBJECTIVE

Breast cancer survivors frequently experience anxiety and depression post-treatment. Patient-provider communication and cultural values may impact these psychological outcomes. We examined the impact of patient-provider communication and cultural values on anxiety and depression among Black breast cancer survivors.

METHODS

Using an observational, cross-sectional design, 351 survivors self-reported patient-provider communication (quality, confidence), cultural values (religiosity, collectivism, future time orientation), anxiety, and depression. Patients were categorized into high, moderate, and low levels of communication and cultural values. Separate linear regressions examined the effect of levels of communication and cultural values on anxiety and depression, controlling for sociodemographic variables.

RESULTS

A subset of breast cancer survivors reported clinically significant symptoms of anxiety (40%) and depression (20%). Communication was associated with anxiety (β = -0.14, p = 0.01) and depression (β = -0.10, p = 0.04). Specifically, women reporting higher levels of communication quality/confidence reported lower levels of anxiety and depression. There was a trend towards a significant association between cultural values and depression (β = -0.09, p = 0.06).

CONCLUSIONS

Black breast cancer survivors experience poor psychological functioning. Effective patient-provider communication may reduce anxiety and depression post-treatment.

PRACTICE IMPLICATIONS

Patient-provider relationships and patient empowerment may be key components of cancer survivorship. Special attention should be paid to patient-centered communication for Black breast cancer survivors.

What Is Important When Making Treatment Decisions in Metastatic Breast Cancer? A Qualitative Analysis of Decision-Making in Patients and Oncologists

BACKGROUND

Metastatic breast cancer (MBC) is an ideal environment for shared decision-making because of the large number of guideline-based treatment options with similar efficacy but different toxicity profiles. This qualitative analysis describes patient and provider factors that influence decision-making in treatment of MBC.

MATERIALS AND METHODS

Patients and community oncologists completed in-person interviews. Academic medical oncologists participated in focus groups. Interviews and focus groups were audio-recorded, transcribed, and analyzed using NVivo. Using an a priori model based on the Ottawa Framework, two independent coders analyzed transcripts using a constant comparative method. Major themes and exemplary quotes were extracted.

RESULTS

Participants included 20 patients with MBC, 6 community oncologists, and 5 academic oncologists. Analysis of patient interviews revealed a decision-making process characterized by the following themes: decision-making style, contextual factors, and preferences. Patient preference subthemes include treatment efficacy, physical side effects of treatment, emotional side effects of treatment, cognitive side effects of treatment, cost and financial toxicity, salience of cutting-edge treatment options (clinical trial or newly approved medication), treatment logistics and convenience, personal and family responsibilities, treatment impact on daily activities, participation in self-defining endeavors, attending important events, and pursuing important goals. Physician decisions emphasized drug-specific characteristics (treatment efficacy, side effects, cost) rather than patient preferences, which might impact treatment choice.

CONCLUSION

Although both patients with MBC and oncologists considered treatment characteristics when making decisions, patients' considerations were broader than oncologists', incorporating contextual factors such as the innovative value of the treatment and life responsibilities. Differences in perspectives between patients and oncologists suggests the value of tools to facilitate systematic communication of preferences in the setting of MBC.

IMPLICATIONS FOR PRACTICE

Both patients with metastatic breast cancer (MBC) and oncologists emphasized importance of efficacy and physical side effects when making treatment decisions. However, other patient considerations for making treatment decisions were broader, incorporating contextual factors such as the logistics of treatments, personal and family responsibilities, and ability to attend important events. Furthermore, individual patients varied substantially in priorities that they want considered in treatment decisions. Differences in perspectives between patients and oncologists suggest the value of tools to facilitate systematic elicitation of preferences and communication of those preferences to oncologists for integration into decision-making in MBC.

Addition of triple negativity of breast cancer as an indicator for germline mutations in predisposing genes increases sensitivity of clinical selection criteria

Background

Breast cancer is the most common cancer in women. 12–15% of all tumors are triple-negative breast cancers (TNBC). So far, TNBC has been mainly associated with mutations in BRCA1. The presence of other predisposing genes seems likely since DNA damage repair is a complex process that involves several genes. Therefore we investigated if mutations in other genes are involved in cancer development and whether TNBC is an additional indicator of mutational status besides family history and age of onset.

Methods

We performed a germline panel-based screening of 10 high and low-moderate penetrance breast cancer susceptibility genes (BRCA1, BRCA2, ATM, CDH1, CHEK2, NBN, PALB2, RAD51C, RAD51D and TP53) in 229 consecutive individuals affected with TNBC unselected for age, family history or bilateral disease. Within this cohort we compared the number of mutation carriers fulfilling clinical selection criteria with the total number of carriers identified.

Results

Age at diagnosis ranged from 23 to 80 years with an average age of 50.2 years. In 57 women (24.9%) we detected a pathogenic mutation, with a higher frequency (29.7%) in the group manifesting cancer before 60 years. Deleterious BRCA1 mutations occurred in 14.8% of TNBC patients. These were predominantly recurrent frameshift mutations (24/34, 70.6%). Deleterious BRCA2 mutations occurred in 5.7% of patients, all but one (c.1813dupA) being unique.

While no mutations were found in CDH1 and TP53, 10 mutations were detected in one of the six other predisposition genes. Remarkably, neither of the ATM, RAD51D, CHEK2 and PALB2 mutation carriers had a family history. Furthermore, patients with non-BRCA1/2 mutations were not significantly younger than mutation negative women (p = 0.3341). Most importantly, among the 57 mutation carriers, ten (17.5%) would be missed using current clinical testing criteria including five (8%) with BRCA1/2 mutations.

Conclusions

In summary, our data confirm and expand previous studies of a high frequency of germline mutations in genes associated with ineffective repair of DNA damage in women with TNBCs. Neither age of onset, contralateral disease nor family history were able to discern all mutation positive individuals. Therefore, TNBC should be considered as an additional criterion for panel based genetic testing.

"Being connected" The experience of African American women with breast cancer: A community-based participatory research project: Part I

The objective was to understand the breast cancer experience of African American (AA) women using a community-based participatory research framework. Qualitative data were collected from five focus groups with 29 participants in four urban cities. "Being Connected" was the major theme that explained the importance of people in their lives as they coped with the diagnosis, treatment, and life after therapy. Faith, talking, information, support, and living with changes were important factors in the process. The breast cancer experience was situated with the AA culture and community and unique aspects were identified for clinical practice in the care of these women.