Selection of neighborhood controls for a study of factors related to the diagnosis of cervical cancer

How common is fatigue in disease-free breast cancer survivors? A systematic review of the literature

BACKGROUND

There is some debate in the literature as to whether fatigue persists in the long term in women who have completed adjuvant breast cancer treatment.

METHODS

A systematic review was conducted in order to characterise and quantify the phenomenon of post treatment fatigue (PTF).

RESULTS

There was a wide variation in the measures of fatigue used, duration of follow-up and type of comparison made. Overall 18 studies were identified with a follow-up period of between 4 months and 10 years. Fourteen studies demonstrated the presence of continued PTF and/or differences in fatigue levels compared to a reference population up to 5 years after treatment. One short-term study reported no increase in fatigue at 4 months. Three studies (with an average follow up period of longer than 5 years) did not identify overall quality of life differences in breast cancer survivors when compared with a reference population. However there were significant differences in measures of physical functioning and mental fatigue.

CONCLUSION

The authors conclude that there is good evidence of PTF occurring up to 5 years after completion of adjuvant therapy.

Fatigue after treatment for early stage breast cancer: a controlled comparison

BACKGROUND

Evidence suggests that fatigue may be a greater problem for cancer survivors than people without cancer. The present study sought to determine whether fatigue was greater in women who had completed treatment for early-stage breast cancer relative to a demographically matched comparison group of women with no cancer history.

METHODS

As part of a larger study, women with stage 0-II breast cancer were recruited before the start of chemotherapy and radiotherapy (n = 100) or radiotherapy only (n = 121). Fatigue was assessed at the end of treatment and 2, 4, and 6 months later. An age- and geographically matched sample of women with no history of cancer was recruited and assessed for comparison purposes.

RESULTS

Relative to comparison subjects, breast cancer survivors reported more days of fatigue in the past week at all 4 study assessments (P < .05). These differences appeared to be clinically meaningful in that a greater percentage of patients than nonpatients earned scores in the abnormal range on this measure at each assessment (P < .05). Additional analyses indicated that differences in fatigue between patients and comparison subjects were attributable primarily to heightened fatigue in women who received both chemotherapy and radiotherapy.

CONCLUSIONS

Findings suggest that fatigue is a greater problem for breast cancer survivors in the 6 months after completion of chemotherapy than for women with no cancer history. Future research should include longer-term follow-up to determine the persistence of fatigue in this population of survivors.

Variables affecting patient satisfaction in breast surgery: a cross-sectional sample of Turkish women with breast cancer

OBJECTIVE

In Turkey, despite the fact that breast cancer accounts for 24.1% of all cancer in women, a very small number of these patients receive breast reconstruction. This low percentage would seem to indicate that there are several factors affecting the decision of which surgical procedure should be selected. The aim of this study was to establish the demographical, medical, and psychological factors associated with the breast cancer patient's decision-making process, and assess their satisfaction with the type of surgery received.

METHOD

We assessed long-term satisfaction with the type of surgery received; satisfaction with the information process by which the surgery decision is taken; feelings of ambivalence or regret regarding the type of surgery received in both mastectomy (n = 50) and breast reconstruction patients (n = 25). Additionally, breast cancer survivors were compared with age-matched healthy control volunteers (n = 50) in terms of demographics, body image and self-esteem, which could be expected to affect their preferences. We administered a demographical and medical information form, Structured Clinical Interview for DSM-IV, Clinical Version (SCID-I), the Body Cathexis Scale (BCS); and the Rosenberg Self-Esteem Scale (RSE).

RESULTS

In both groups, women with a low income and less education were more likely to experience decision regret or low satisfaction. Moreover, total mastectomy-alone patients had lower self-esteem compared to reconstructive surgery patients and healthy women.

CONCLUSION

Early stage breast cancer is a chronic disease and patients have to live with the consequences of their decision for many years. At the same time, the type of surgery is decided on when patients are in an acute phase and under intense pressure. Therefore, the decision making process needs to be explored more, especially breast cancer patients with less education and low income need better assistance and more detailed explanation of their options.

Surviving cancer: a comparison of 5-year disease-free breast cancer survivors with healthy women

Women with breast cancer are one of the largest groups of cancer survivors. This research examined whether breast cancer has a long-term impact on quality of life (QOL) by comparing 5-year disease-free survivors to age-matched controls and by comparing women who sustained a recurrence to disease-free survivors. Controls were recruited using the neighborhood control methodology. QOL (physical, emotional, social, and spiritual) was assessed during in-person interviews. There were no differences between disease-free survivors (n = 267) and controls (n = 187) on many indicators of QOL. However, survivors reported more difficulties with physical functioning, more physical symptoms, and more faith than did controls (all ps < 0.05). Compared to disease-free survivors, survivors with a recurrence (n = 37) had a worse QOL on most indices, less positive affect, more general fatigue, and more intrusive and avoidant thoughts (all ps < 0.05). There were no differences between the two groups of survivors on indices of marriage, work experiences, or spirituality. These findings suggest that the QOL of long-term survivors who remain disease-free is comparable to that of women their age with the exception of physical functioning. Women who sustain a recurrence suffer an impaired QOL in some, but not all, domains.

Perceived growth and decline following breast cancer: a comparison to age-matched controls 5-years later

Research indicates that individuals who experience stressful life events, such as a diagnosis of cancer, often experience both positive and negative changes as a result of their experiences, but little research has compared these changes with those of a control group who have experienced other stressful life events. We compared 184 5-year breast cancer survivors (Stages: I, II, and III; 95% Caucasian) with 184 age-matched controls in terms of perceived growth and decline that stem from stressful events. Survivors reported on their experience with cancer, whereas controls identified the most stressful event that happened to them 5 years ago. Survivors reported more growth (e.g. appreciation of life) and more decline (e.g. physical side effects) compared with controls. However, there were no group differences in reports of psychological stress. When survivors were compared with controls whose stressor was a personal health problem, many of the differences in growth between the two groups remained, but the differences in decline disappeared. These findings suggest that some growth is unique to breast cancer, but much of the decline associated with breast cancer is similar to the decline associated with other types of health problems.

Five years later: a cross-sectional comparison of breast cancer survivors with healthy women

Although a number of studies have focused on initial adjustment to cancer, less is known about long-term survival issues. The present study compared breast cancer survivors with age-matched healthy controls (N=328) in terms of more subtle indicators of psychological well-being as well as their general quality of life 5 yrs post-diagnosis. Results indicated survivors generally perceive the world as less controllable and more random compared to healthy women. However, survivors perceive the same control over their daily lives as healthy women. Beliefs about personal control are most strongly associated with quality of life in both groups of women. Survivors also indicated that they derived some benefits from their experience with cancer, but these benefits had only a modest impact on quality of life. However, the belief that the experience had lasting harmful effects was associated with poor quality of life for survivors. In both groups, a continued search for meaning in life had a negative impact on quality of life. The strongest and most consistent correlate of quality of life for both survivors and healthy women was having a sense of purpose in life.