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Bargon CA, Mink van der Molen DR, Batenburg MCT, van Stam LE, van Dam IE, Baas IO, Veenendaal LM, Maarse W, Sier M, Schoenmaeckers EJP, Burgmans JPJ, Bijlsma RM, van der Leij F, Doeksen A, Young-Afat DA, Verkooijen HM. Physical and mental health of breast cancer patients and survivors before and during successive SARS-CoV-2-infection waves. Qual Life Res 2023:10.1007/s11136-023-03400-6. [PMID: 37016089 PMCID: PMC10072805 DOI: 10.1007/s11136-023-03400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE During the first SARS-CoV-2-infection wave, a deterioration in emotional well-being and increased need for mental health care were observed among patients treated or being treated for breast cancer. In this follow-up study, we assessed patient-reported quality of life (QoL), physical functioning, and psychosocial well-being during the second SARS-CoV-2-infection wave in a large, representative cohort. METHODS This longitudinal cohort study was conducted within the prospective, multicenter UMBRELLA breast cancer cohort. To assess patient-reported QoL, physical functioning and psychosocial well-being, COVID-19-specific surveys were completed by patients during the first and second SARS-CoV-2-infection waves (April and November 2020, respectively). An identical survey was completed by a comparable reference population during the second SARS-CoV-2-infection waves. All surveys included the validated EORTC-QLQ-C30/BR23, HADS and "De Jong-Gierveld Loneliness" questionnaires. Pre-COVID-19 EORTC-QLQ-C30/BR23 and HADS outcomes were available from UMBRELLA. Response rates were 69.3% (n = 1106/1595) during the first SARS-CoV-2-infection wave and 50.9% (n = 822/1614) during the second wave. A total of 696 patients responded during both SARS-CoV-2-infection waves and were included in the analysis comparing patient-reported outcomes (PROs) during the second SARS-CoV-2-infection wave to PROs during the first wave. Moreover, PROs reported by all patients during the second SARS-CoV-2-infection wave (n = 822) were compared to PROs of a similar non-cancer reference population (n = 241) and to their pre-COVID-19 PROs. RESULTS Patient-reported QoL, physical functioning, and psychosocial well-being of patients treated or being treated for breast cancer remained stable or improved from the first to the second SARS-CoV-2-infection wave. The proportion of emotional loneliness reduced from 37.6 to 29.9% of patients. Compared to a similar non-cancer reference population, physical, emotional, and cognitive functioning, future perspectives and symptoms of dyspnea and insomnia were worse in patients treated or being treated for breast cancer during the second SARS-CoV-2-infection wave. PROs in the second wave were similar to pre-COVID-19 PROs. CONCLUSION Although patients scored overall worse than individuals without breast cancer, QoL, physical functioning, and psychosocial well-being did not deteriorate between the first and second wave. During the second wave, PROs were similar to pre-COVID-19 values. Overall, current findings are cautiously reassuring for future mental health of patients treated or being treated for breast cancer.
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Affiliation(s)
- Claudia A Bargon
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands.
| | - Dieuwke R Mink van der Molen
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marilot C T Batenburg
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Lilianne E van Stam
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Iris E van Dam
- Department of Radiation Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, The Netherlands
| | - Inge O Baas
- Department of Medical Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, The Netherlands
| | | | - Wiesje Maarse
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maartje Sier
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands
- Department of Surgery, Rivierenland Hospital, Tiel, The Netherlands
| | | | | | - Rhodé M Bijlsma
- Department of Medical Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, The Netherlands
| | - Femke van der Leij
- Department of Radiation Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, The Netherlands
| | - Annemiek Doeksen
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - Danny A Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Helena M Verkooijen
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Utrecht University, Utrecht, The Netherlands.
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2
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Velasco L, Gutiérrez L, Alcocer N, Sánchez S, Catalá P, Peñacoba C. Exploring the moderated role of two psychological programs on sexual pleasure from physical symptoms, body image distortion and emotional problems of Hispanic women with breast cancer. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:643-658. [PMID: 36735842 DOI: 10.1080/0092623x.2023.2173111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Decreased sexual pleasure is a common problem in women with breast cancer. The aim of this study was to evaluate the effect of psychoeducation vs. acceptance and commitment therapy to improve sexual pleasure according to the predictive role of physical, cognitive and emotional factors. Results of 139 Hispanic women (Mexico and Spain) diagnosed with breast cancer reveal that only the emotional factor of depression predicts decreased sexual pleasure. Although women who participated in the psychoeducation program presented greater physical symptomatology, body image distortions and emotional distress, the results seem to indicate that psychoeducational guidelines are relevant to improve sexual pleasure in those women who manifest higher levels of previous depression. Future research is required to clarify these issues.
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Affiliation(s)
- Lilian Velasco
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Lorena Gutiérrez
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Natasha Alcocer
- Department of Neurology and Psychiatry, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de México, México
| | - Sofía Sánchez
- Department of Neurology and Psychiatry, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Ciudad de México, México
| | - Patricia Catalá
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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3
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Anderson BM, White JR. Improving the well-being of women with ductal carcinoma in situ: A worthy goal with an unclear route to success. Cancer 2022; 128:1571-1573. [PMID: 35191020 DOI: 10.1002/cncr.34125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/31/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Bethany M Anderson
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Julia R White
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio
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4
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The effects of the COVID-19 pandemic on psychological stress in breast cancer patients. BMC Cancer 2021; 21:1356. [PMID: 34972520 PMCID: PMC8719114 DOI: 10.1186/s12885-021-09012-y] [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: 03/13/2021] [Accepted: 11/15/2021] [Indexed: 01/06/2023] Open
Abstract
Background The majority of breast cancer patients are severely psychologically affected by breast cancer diagnosis and subsequent therapeutic procedures. The COVID-19 pandemic and associated restrictions on public life have additionally caused significant psychological distress for much of the population. It is therefore plausible that breast cancer patients might be particularly susceptible to the additional psychological stress caused by the pandemic, increasing suffering. In this study we therefore aimed to assess the level of psychological distress currently experienced by a defined group of breast cancer patients in our breast cancer centre, compared to distress levels pre-COVID-19 pandemic. Methods Female breast cancer patients of all ages receiving either adjuvant, neoadjuvant, or palliative therapies were recruited for the study. All patients were screened for current or previous COVID-19 infection. The participants completed a self-designed COVID-19 pandemic questionnaire, the Stress and Coping Inventory (SCI), the National Comprehensive Cancer Network® (NCCN®) Distress Thermometer (DT), the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30, and the BR23. Results Eighty-two breast cancer patients were included. Therapy status and social demographic factors did not have a significant effect on the distress caused by the COVID-19 pandemic. The results of the DT pre and during COVID-19 pandemic did not differ significantly. Using the self-designed COVID-19 pandemic questionnaire, we detected three distinct subgroups demonstrating different levels of concerns in relation to SARS-CoV-2. The subgroup with the highest levels of concern reported significantly decreased life quality, related parameters and symptoms. Conclusions This monocentric study demonstrated that the COVID-19 pandemic significantly affected psychological health in a subpopulation of breast cancer patients. The application of a self-created “COVID-19 pandemic questionnaire” could potentially be used to help identify breast cancer patients who are susceptible to increased psychological distress due to the COVID-19 pandemic, and therefore may need additional intensive psychological support. Trial registration DRKS-ID: DRKS00022507. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09012-y.
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5
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Mink van der Molen DR, Bargon CA, Batenburg MCT, Gal R, Young-Afat DA, van Stam LE, van Dam IE, van der Leij F, Baas IO, Ernst MF, Maarse W, Vermulst N, Schoenmaeckers EJP, van Dalen T, Bijlsma RM, Doeksen A, Verkooijen HM. (Ex-)breast cancer patients with (pre-existing) symptoms of anxiety and/or depression experience higher barriers to contact health care providers during the COVID-19 pandemic. Breast Cancer Res Treat 2021; 186:577-583. [PMID: 33598879 PMCID: PMC7889408 DOI: 10.1007/s10549-021-06112-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify factors associated with (perceived) access to health care among (ex-)breast cancer patients during the COVID-19 pandemic. METHODS Cross-sectional study within a large prospective, multicenter cohort of (ex-)breast cancer patients, i.e., UMBRELLA. All participants enrolled in the UMBRELLA cohort between October 2013 and April 2020 were sent a COVID-19-specific survey, including the Hospital Anxiety and Depression Scale (HADS) questionnaire. RESULTS In total, 1051 (66.0%) participants completed the survey. During COVID-19, 284 (27.0%) participants reported clinically relevant increased levels of anxiety and/or depression, i.e., total HADS score ≥ 12. Participants with anxiety and/or depression reported statistically significant higher barriers to contact their general practitioner (47.5% vs. 25.0%, resp.) and breast cancer physicians (26.8% vs. 11.2%, resp.) compared to participants without these symptoms. In addition, a higher proportion of participants with anxiety and/or depression reported that their current treatment or (after)care was affected by COVID-19 compared to those without these symptoms (32.7% vs. 20.5%, resp.). Factors independently associated with symptoms of anxiety and/or depression during COVID-19 were pre-existent anxiety (OR 6.1, 95% CI 4.1-9.2) or depression (OR 6.0, 95% CI 3.5-10.2). CONCLUSION During the COVID-19 pandemic, (ex-)breast cancer patients with symptoms of anxiety and/or depression experience higher barriers to contact health care providers. Also, they more often report that their health care was affected by COVID-19. Risk factors for anxiety and/or depression during COVID-19 are pre-existent symptoms of anxiety or depression. Extra attention-including mental health support-is needed for this group.
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Affiliation(s)
| | - Claudia A. Bargon
- Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
- Department of Surgery, St. Antonius Hospital, Soestwetering, Utrecht, The Netherlands
| | - Marilot C. T. Batenburg
- Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Roxanne Gal
- Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Danny A. Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Lilianne E. van Stam
- Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Iris E. van Dam
- Department of Radiation Oncology, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Femke van der Leij
- Department of Radiation Oncology, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Inge O. Baas
- Department of Medical Oncology, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Miranda F. Ernst
- Department of Surgery, Alexander Monro Clinics, Bilthoven, The Netherlands
| | - Wiesje Maarse
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nieke Vermulst
- Department of Surgery, Rivierenland Hospital, Tiel, The Netherlands
| | | | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Rhodé M. Bijlsma
- Department of Medical Oncology, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Annemiek Doeksen
- Department of Surgery, St. Antonius Hospital, Soestwetering, Utrecht, The Netherlands
| | - Helena M. Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
- Utrecht University, Heidelberglaan, Utrecht, The Netherlands
| | - UMBRELLA study group
- Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
- Department of Surgery, St. Antonius Hospital, Soestwetering, Utrecht, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
- Department of Surgery, Alexander Monro Clinics, Bilthoven, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Surgery, Rivierenland Hospital, Tiel, The Netherlands
- Department of Surgery, Meander Medisch Centrum, Amersfoort, The Netherlands
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
- Utrecht University, Heidelberglaan, Utrecht, The Netherlands
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6
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Gutiérrez Hermoso L, Velasco Furlong L, Sánchez-Román S, Salas Costumero L. The Importance of Alexithymia in Post-surgery. Differences on Body Image and Psychological Adjustment in Breast Cancer Patients. Front Psychol 2020; 11:604004. [PMID: 33391123 PMCID: PMC7775299 DOI: 10.3389/fpsyg.2020.604004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/30/2020] [Indexed: 12/22/2022] Open
Abstract
Breast cancer is a disease that is difficult to face and that often hinders body acceptance. Body changes due to surgery can be very emotionally challenging for those who experience them. The aim of this study is to explore the differences on body image and psychological adjustment on women with breast cancer with high and low alexithymia according to the type of surgery. In this cross-sectional study, 119 women diagnosed with breast cancer (stages I, II, and III) were evaluated with different self-report questionnaires. Afterward, patients were divided into two groups (high and low levels of alexithymia) to analyze dependent variables (body image and psychological adjustment) according to the type of surgery (radical mastectomy or breast conserving therapy). The results of the General Linear Model suggest that when patients show high alexithymia combined with having undergone a radical mastectomy, they show higher levels of Hopelessness. Furthermore, in patients with high alexithymia, higher scores of maladaptive coping styles and greater distortion of body image were found. Alexithymia seems to play an important role in the way in which women cope with their disease, especially in those with radical mastectomy.
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Affiliation(s)
| | | | - Sofía Sánchez-Román
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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7
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Bargon CA, Batenburg MCT, van Stam LE, Mink van der Molen DR, van Dam IE, van der Leij F, Baas IO, Ernst MF, Maarse W, Vermulst N, Schoenmaeckers EJP, van Dalen T, Bijlsma RM, Young-Afat DA, Doeksen A, Verkooijen HM. Impact of the COVID-19 Pandemic on Patient-Reported Outcomes of Breast Cancer Patients and Survivors. JNCI Cancer Spectr 2020; 5:pkaa104. [PMID: 33437925 PMCID: PMC7665619 DOI: 10.1093/jncics/pkaa104] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/10/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic (officially declared on the March 11, 2020), and the resulting measures, are impacting daily life and medical management of breast cancer patients and survivors. We evaluated to what extent these changes have affected quality of life, physical, and psychosocial well-being of patients previously or currently being treated for breast cancer. Methods This study was conducted within a prospective, multicenter cohort of breast cancer patients and survivors (Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaLuAtion). Shortly after the implementation of COVID-19 measures, an extra survey was sent to 1595 participants, including the validated European Organization for Research and Treatment of Cancer (EORTC) core (C30) and breast cancer-specific (BR23) Quality of Life Questionnaire (EORTC QLQ-C30/BR23) and Hospital Anxiety and Depression Scale (HADS) questionnaire. Patient-reported outcomes (PROs) were compared with the most recent PROs collected within UMBRELLA pre-COVID-19. The impact of COVID-19 on PROs was assessed using mixed model analysis, adjusting for potential confounders. Results 1051 patients and survivors (65.9%) completed the survey; 31.1% (n = 327) reported a higher threshold to contact their general practitioner amid the COVID-19 pandemic. A statistically significant deterioration in emotional functioning was observed (mean = 82.6 [SD = 18.7] to 77.9 [SD = 17.3]; P < .001), and 505 (48.0%, 95% confidence interval [CI] = 45.0% to 51.1%) patients and survivors reported moderate to severe loneliness. Small improvements were observed in quality of life and physical, social, and role functioning. In the subgroup of 51 patients under active treatment, social functioning strongly deteriorated (77.3 [95% CI = 69.4 to 85.2] to 61.3 [95% CI = 52.6 to 70.1]; P = .002). Conclusion During the COVID-19 pandemic, breast cancer patients and survivors were less likely to contact physicians and experienced a deterioration in their emotional functioning. Patients undergoing active treatment reported a substantial drop in social functioning. One in 2 reported loneliness that was moderate or severe. Online interventions supporting mental health and social interaction are needed during times of social distancing and lockdowns.
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Affiliation(s)
- Claudia A Bargon
- Division of Imaging and Oncology, University Medical Centre Utrecht, Heidelberglaan, Utrecht, the Netherlands
- Department of Surgery, St Antonius Hospital, Soestwetering, Utrecht, the Netherlands
| | - Marilot C T Batenburg
- Department of Radiation Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
| | - Lilianne E van Stam
- Division of Imaging and Oncology, University Medical Centre Utrecht, Heidelberglaan, Utrecht, the Netherlands
| | | | - Iris E van Dam
- Department of Radiation Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
| | - Femke van der Leij
- Department of Radiation Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
| | - Inge O Baas
- Department of Medical Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
| | - Miranda F Ernst
- Department of Surgery, Alexander Monro Clinics, Bilthoven, the Netherlands
| | - Wiesje Maarse
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Nieke Vermulst
- Department of Surgery, Rivierenland Hospital, Tiel, the Netherlands
| | | | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Rhodé M Bijlsma
- Department of Medical Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, the Netherlands
| | - Danny A Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, Location VUmc, the Netherlands
| | - Annemiek Doeksen
- Department of Surgery, St Antonius Hospital, Soestwetering, Utrecht, the Netherlands
| | - Helena M Verkooijen
- Division of Imaging and Oncology, University Medical Centre Utrecht, Heidelberglaan, Utrecht, the Netherlands
- Utrecht University, Heidelberglaan, Utrecht, the Netherlands
- Correspondence to: Helena M. Verkooijen, MD, PhD, Imaging Division, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands (e-mail: )
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8
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Politi J, Sala M, Domingo L, Vernet-Tomas M, Román M, Macià F, Castells X. Readmissions and complications in breast ductal carcinoma in situ: A retrospective study comparing screen- and non-screen-detected patients. ACTA ACUST UNITED AC 2020; 16:1745506520965899. [PMID: 33076785 PMCID: PMC7594253 DOI: 10.1177/1745506520965899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: Population-wide mammographic screening programs aim to reduce breast cancer
mortality. However, a broad view of the harms and benefits of these programs
is necessary to favor informed decisions, especially in the earliest stages
of the disease. Here, we compare the outcomes of patients diagnosed with
breast ductal carcinoma in situ in participants and non-participants of a
population-based mammographic screening program. Methods: A retrospective cohort study of all patients diagnosed with breast ductal
carcinoma in situ between 2000 and 2010 within a single hospital. A total of
211 patients were included, and the median follow-up was 8.4 years. The
effect of detection mode (screen-detected and non-screen-detected) on breast
cancer recurrences, readmissions, and complications was evaluated through
multivariate logistic regression analysis. Results: In the majority of women, breast ductal carcinoma in situ was screen-detected
(63.5%). Screen-detected breast ductal carcinoma in situ was smaller in size
compared to those non-screen-detected (57.53% < 20 mm versus 78.03%,
p = 0.002). Overall, breast-conserving surgery was the most frequent surgery
(86.26%); however, mastectomy was higher in non-screen-detected breast
ductal carcinoma in situ (20.78% versus 9.7%, p = 0.024). Readmissions for
mastectomy were more frequent in non-screen-detected breast ductal carcinoma
in situ. Psychological complications, such as fatigue, anxiety, and
depression, had a prevalence of 15% within our cohort. Risk of readmissions
and complications was higher within the non-screen-detected group, as
evidenced by an odds ratio = 6.25 (95% confidence interval = 1.95–19.99) for
readmissions and an odds ratio = 2.41 (95% confidence interval = 1.95–4.86)
for complications. Conclusions: Our findings indicate that women with breast ductal carcinoma in situ breast
cancer diagnosed through population-based breast cancer screening program
experience a lower risk of readmissions and complications than those
diagnosed outside these programs. These findings can help aid women and
health professionals make informed decisions regarding screening.
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Affiliation(s)
- Julieta Politi
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Preventive Medicine and Public Health Training Unit, Parc de Salut Mar-Pompeu Fabra University-Agència de Salut Pública de Barcelona (PSMar-UPF-ASPB), Barcelona, Spain
| | - María Sala
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - María Vernet-Tomas
- Breast Surgery, Obstetrics and Gynaecology Department, Hospital del Mar, Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
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9
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Dominici LS, Rosenberg SM. Ductal carcinoma in situ (DCIS): The importance of patient-reported outcomes (PRO). CURRENT BREAST CANCER REPORTS 2020; 12:90-97. [PMID: 32747864 DOI: 10.1007/s12609-020-00363-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose Patient reported outcomes (PROs) are an optimal method for assessing quality of life (QOL), including physical and psychosocial health. This review summarizes PROs frequently assessed in the setting of a DCIS diagnosis. Recent findings Health-related QOL has generally been found to be modestly affected in women with DCIS and similar to women with invasive breast cancer. Several studies reported a substantial negative impact on sexual health and body image, including some differences based on surgery type. Some patients experience pain after treatment, although many physical symptoms resolve. The prevalence of anxiety and depression varied based on assessment timing, with symptoms improving over time. Women with DCIS often overestimate the risks associated both with DCIS and invasive cancer. Summary PROs provide critical information regarding the experiences of women following a DCIS diagnosis. Continued inclusion of PROs in clinical trials is warranted, further informing treatment decisions and adequately preparing patients for what to expect following treatment.
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Affiliation(s)
- Laura S Dominici
- Brigham and Women's Hospital, Boston, MA.,Dana-Farber Cancer Institute, Boston, MA
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10
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Paszat L, Sutradhar R, Rakovitch E. The impact of ductal carcinoma in situ on health services utilization. Breast Cancer Res Treat 2020; 182:159-168. [PMID: 32385793 DOI: 10.1007/s10549-020-05664-9] [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: 01/30/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the intermediate-term impact of diagnosis and treatment of ductal carcinoma in situ of the breast (DCIS) on health services utilization, we compared utilization by cases of DCIS to unaffected controls. METHODS We identified a population-based cohort of Ontario females diagnosed with DCIS between 2010 and 2015. We matched 5 controls without any history of cancer to each case, on the date of diagnosis of the case (the index date), by age, annual mammography history, socioeconomic status, and comorbidity. We identified billing claims and hospital records, during the interval 13 to 60 months prior to, and subsequent to the index date, and computed rates per 100 person-years during both intervals, to conduct a difference-in-differences analysis. We used negative binomial regression to test if the change in rates in health services differed between cases and controls. RESULTS Visits with a breast diagnosis code, and claims for breast surgery and imaging, were significantly increased among cases compared to controls (all p values < 0.0001) after DCIS;however, there was no increase in visits for anxiety or depression (RR 1.13 (95% CI 0.97, 1.32, p = 0.11), visits to psychiatrists (RR 1.07 (95% CI 0.82, 1.40) p = 0.6), or hospital procedures other than breast surgery (RR 1.10 (95% CI 0.88, 1.37) p = 0.4). CONCLUSIONS DCIS is associated with more visits and procedures related to the breast compared to controls following diagnosis and treatment, but other health services utilization and visits related to anxiety and depression were not increased.
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Affiliation(s)
- Lawrence Paszat
- University of Toronto, Sunnybrook Research Institute, T2-156-2075 Bayview Avenue, Toronto, ON, M4N 3M45, Canada.
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, G106 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Eileen Rakovitch
- University of Toronto, Sunnybrook Research Institute, T2-152 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
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Tumor Response After Neoadjuvant Magnetic Resonance Guided Single Ablative Dose Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2020; 106:821-829. [DOI: 10.1016/j.ijrobp.2019.11.406] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/14/2019] [Accepted: 11/17/2019] [Indexed: 12/12/2022]
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Psychological morbidity in women diagnosed with ductal carcinoma in situ compared with women with early breast cancer receiving radiotherapy. Support Care Cancer 2019; 28:2247-2254. [PMID: 31451944 DOI: 10.1007/s00520-019-05034-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/08/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Despite having an excellent prognosis, patients with ductal carcinoma in situ (DCIS) report significant anxiety and depression following diagnosis. This study evaluated psychological morbidity using the Edmonton Symptom Assessment Scale (ESAS) in patients with DCIS compared with women with early-stage invasive breast cancer (EIBC) receiving radiotherapy (RT). METHODS We identified patients diagnosed with DCIS or EIBC (stage I or II breast cancer) from 2011 to 2017 who had at least one ESAS completed pre- and post-RT. Data on systemic treatment, radiation, patient demographics, and disease stage were extracted from existing databases. Psychological morbidity was evaluated through measurement of depression, anxiety, and overall wellbeing within the ESAS. The Wilcoxon rank-sum test or chi-square test was performed for continuous or categorical variables. RESULTS This study included 137 women with DCIS and 963 women with EIBC. ESAS was completed on average 28 days before RT (baseline) and 142 days after RT. Baseline ESAS scores showed significantly higher rates of depression among women with EIBC compared with those with DCIS (p = 0.006). Patients with EIBC also reported higher levels of anxiety and lower overall wellbeing than patients with DCIS, but this difference was not statistically significant. Post-RT ESAS scores showed significantly higher anxiety in patients with EIBC compared with DCIS (p = 0.049). Post-RT measures of anxiety and overall wellbeing were higher in patients with EIBC but differences were not statistically significant. CONCLUSION Women with DCIS experience relatively less psychological morbidity than women with EIBC, pre- and post-RT.
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Liede A, Cai M, Crouter TF, Niepel D, Callaghan F, Evans DG. Risk-reducing mastectomy rates in the US: a closer examination of the Angelina Jolie effect. Breast Cancer Res Treat 2018; 171:435-442. [PMID: 29808287 PMCID: PMC6096880 DOI: 10.1007/s10549-018-4824-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/03/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE In 2013, Angelina Jolie disclosed in the New York Times (NYT) that she had undergone risk-reducing bilateral mastectomy (RRBM) after learning that she was a BRCA1 mutation carrier. We examined the rates of BRCA testing and RRBM from 1997 to 2016, and quantified trends before and after the Jolie op-ed. METHODS This observational study of insurance claims data representative of the commercially-insured US population (Truven MarketScan® database) measured BRCA testing and RRBM rates among females ≥ 18 years. Censoring events were breast cancer or ovarian cancer diagnosis, last follow-up date (September 2016), or death. Interrupted time series analyses were used to quantify trends before and after the op-ed. RESULTS Angelina Jolie's NYT op-ed led to a statistically significant increase in the uptake of genetic testing and in RRBM among women without previous diagnosis of breast or ovarian cancer in the US population, and in women who did not undergo testing for BRCA (P < 0.0001 for both). The rate (slope) of RRBM among women who were previously tested for BRCA (P = 0.70) was unchanged. After excluding women with in-situ tumors, the editorial's effect became less pronounced, suggesting that high-risk women with in-situ breast cancers were most influenced by Jolie's announcement. CONCLUSION The Angelina Effect-a term coined by Time magazine to describe the rise in internet searches related to breast cancer genetics and counseling-represents a long-lasting impact of celebrity on public health awareness as significant increases in genetic testing and mastectomy rates were observed and sustained in subsequent years.
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Affiliation(s)
- Alexander Liede
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Mona Cai
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Tamara Fidler Crouter
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
- SimulStat Incorporated, Solana Beach, CA, USA
| | | | - Fiona Callaghan
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - D Gareth Evans
- Genomic Medicine, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
- Central Manchester University Hospitals NHS Foundation Trust, Saint Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK.
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