[Psychosocial impact of breast cancer in long-term survival: proposal of an integral follow-up care for survivors]

Psychosocial Care Needs of Women with Breast Cancer: Body Image, Self-Esteem, Optimism, and Sexual Performance and Satisfaction

As breast cancer is on the rise, it is essential to understand the consequences of the diagnosis for patients. This article investigates whether there are differences in different psychosocial variables in Spanish women with breast cancer according to the type of surgery the patients underwent and in comparison with a control group. A study was carried out in the north of Spain in which 54 women participated (27 women were the control group, and 27 women who had been diagnosed with breast cancer). The results of the study indicate that women with breast cancer have lower self-esteem and worse body image, sexual performance, and sexual satisfaction than women in the control group. No differences were found in optimism. These variables do not differ according to the type of surgery the patients underwent. The findings confirm the need to work on these variables in women diagnosed with breast cancer in psychosocial intervention programs.

Are Nursing Interventions Effective in Improving Quality of Life in Cancer Survivors? A Systematic Review

BACKGROUND

Cancer survivors (CSs) have needs that can negatively impact their quality of life (QoL). Oncology nurses play a key role in providing comprehensive care in cancer survivorship, although little is known about their impact on health outcomes.

OBJECTIVE

The aim of this study was to determine the effectiveness of nursing interventions to improve QoL and satisfaction with care of CSs.

METHODS

A systematic review was conducted. PubMed, CINAHL, PsycINFO, and Cochrane databases were searched for experimental studies. The Joanna Briggs Institute Checklist for Randomized Controlled Trials was used to verify the quality of the studies (Prospero reference: CRD42020148294).

RESULTS

Of the 8 clinical trials eligible for inclusion, 5 demonstrated that interventions conducted by nurses improved the overall QoL or some of its domains in CSs. The included studies focused on short-term survival; no studies in long-term CSs were identified. Two studies assessed satisfaction with care of survivors, obtaining positive results.

CONCLUSIONS

Nursing interventions seem to improve the QoL of short-term CSs. However, because of the low number of studies identified, the findings of this systematic review should be interpreted with caution.

IMPLICATIONS FOR PRACTICE

Further studies are necessary to strengthen the implementation of effective nursing intervention in cancer practice. Research should particularly be conducted with long-term CSs as there is lack of data on this specific stage of cancer.

Quality of life in women treated with chemotherapy for breast cancer in Cali, Colombia

Introduction: Breast cancer is a serious neoplasm that originates in mammary tissues whose treatment with chemotherapy seems to generate significant changes in the quality of life. Objective: To determine the risk factors associated with health-related quality of life in women with breast cancer under chemotherapy in Cali, Colombia. Materials and methods: We conducted an observational, cross-sectional study with analytical components in a sample of 80 female patients using the QLQ-C30 questionnaire for cancer, and the QLQ-BR23 for breast cancer, as well as sociodemographic and clinical information. We performed a logistic regression analysis to determine associated risk factors through adjusted OR and 95% CI; the quality of life was classified using the QLQ-BR23. Results: The most relevant symptoms were fatigue, insomnia, and hair loss. Physical functionality, feelings of pleasure, and sexual activity were reduced. The factors associated with low quality of life were mammary symptoms (adjusted OR= 5.5; 95% CI: 1.2-24.8; p = 0.038), systemic therapy side effects (adjusted OR = 7.3; IC95%: 2.6-22.1; p = 0.012), lower sexual pleasure (adjusted OR = 1.8; IC95%: 1.2-11.8; p = 0.027) and reduction of expectations about the future (adjusted OR = 4.2; IC95%: 1.1-17.8; p = 0.045). Conclusions: The quality of life in women with breast cancer and under chemotherapy was mainly affected by the side effects of the therapy; the most relevant signs and symptoms identified were hair loss, insomnia, and fatigue besides breast symptoms, lower physical functionality, and decreased sensation of sexual pleasure. We recommend intervention strategies aimed at improving the quality of life and the physical and emotional care of these patients.

Breaking paradigms, new breast cancer rehabilitation methods from occupational therapy: case report

Introducción. El cáncer de mama es una enfermedad recurrente en el mundo y en Colombia. Miles de mujeres que la padecen se someten a tratamiento, sobreviven y necesitan una oportuna, y sobre todo holística, intervención desde la terapia ocupacional. Se presenta un estudio de caso de rehabilitación en concordancia al modelo biopsicosocial y centrado en la persona. Presentación del caso. Mujer de 64 años remitida al servicio de terapia ocupacional con diagnóstico de cáncer ductal infiltrante de mama izquierda con neoadyuvancia por radioterapia, posterior a mastectomía radical modificada y linfedema etapa III, quien presenta restricciones en la participación y desempeño ocupacional, en específico en actividades de la vida diaria con alteraciones psicosociales y socioemocionales relevantes. Se planteó una intervención centrada en la persona, con enfoque biopsicosocial, en donde se aplicaron diferentes estrategias en actividades de tipo restaurativo, potenciación y mantenimiento de destrezas ocupacionales implicadas en actividades de la vida diaria. Se hizo énfasis en las áreas socioemocional, de biomecánica ocupacional y de educación con especial cuidado de involucrar los intereses de la mujer. Conclusiones. La rehabilitación del cáncer de mama no solo implica atención biomédica, sino también abordaje de aspectos psicosociales que en ocasiones tienen que ser resueltos con antelación para conseguir resultados que se evidencien en la salud. En este caso la elaboración de una prótesis de mama por y para la persona vinculó toda clase de estrategias que respondían a ejes biomédicos y comprendían en su totalidad el bienestar y la salud.

Evaluation of the psychological and biological changes of patients diagnosed with benign and malignant breast tumors

Purpose

Posttraumatic stress disorder (PTSD) is a severe anxiety disorder developed by exposure to any incident or circumstance that results in psychological trauma. In this study we compared the psychological and physiological changes between patients with malignant and benign breast tumors.

Methods

We selected 150 Chinese women with a breast mass, aged 20 to 45 years, from the Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital between 2009 and 2011 for this study; 30 healthy participants were enrolled into the control group. All subjects were examined and had their tumor mass aspirated for diagnosis. Equal numbers of patients with benign and malignant tumors were recruited. Patients with malignant tumors presented with low grade, minimal tumor invasion and non-involved lymph nodes. Questionnaires regarding anxiety, depression and PTSD were conducted 2 hours before getting the diagnostic result and 1 month after the diagnosis. Serum levels of IL-6, TNF-, cortisol and high-sensitivity C-reactive protein before and after diagnosis were investigated and compared. The number of occurrences of oral ulcerative mucositis was also recorded.

Results

All patients experienced a certain degree of anxiety and their biomarkers were elevated compared with the normal reference range before the pathological report was disclosed. However, 1 month after the operation, the benign tumor group showed significantly lower levels of biomarkers and anxiety scores than patients with a malignant breast tumor. The results were consistent throughout 12 months of study.

Conclusion

Study subjects with a benign tumor returned to their normal condition after being diagnosed, while patients with a malignant tumor suffered from a certain degree of PTSD or depression.

Effects of warm acupuncture on breast cancer-related chronic lymphedema: a randomized controlled trial

BACKGROUND

Effective treatment for breast cancer-related chronic lymphedema (bcrl) remains a clinical challenge. Acupuncture and moxibustion treatments have been shown to be beneficial and safe for treating bcrl. In the present randomized controlled trial, we compared the effectiveness of combined acupuncture and moxibustion ("warm acupuncture") with that of diosmin in bcrl.

METHODS

Breast cancer patients who met the inclusion and exclusion criteria (n = 30) were randomized to experimental and control groups (15 per group). On alternate days, patients in the experimental group received 30 minutes of acupuncture at 6 acupoints, with 3 of the needles each being topped by a 3-cm moxa stick. The control treatment was diosmin 900 mg 3 times daily. The control and experimental treatments were administered for 30 days. Outcome measures included arm circumferences (index of effectiveness), range of motion [rom (shoulder joint function)], quality of life, clinical safety, and adverse events.

RESULTS

Measured by the index of effectiveness, bcrl improved by 51.46% in the experimental group and by 26.27% in the control group (p < 0.00001). Effects were greatest at 10 cm above the elbow and at the wrist, where the warm needling was provided. Impairments in shoulder joint rom were minimal at baseline in both treatment groups. However, the roms of rear protraction, abduction, intorsion, and extorsion in the experimental group improved significantly; they did not change in the control group. Self-reported quality of life was significantly better with warm acupuncture than with diosmin. No adverse effects were reported during the treatment period, and laboratory examinations for clinical safety fell within the normal ranges.

CONCLUSIONS

Compared with diosmin, warm acupuncture treatment can effectively reduce the degree of bcrl at the specific acupoints treated and can promote quality of life. Warm acupuncture showed good clinical safety, without any adverse effects on blood or the cardiovascular system.

[Journey to what is essentially invisible: pysochosocial aspects of disease]

Physicians may be well equipped for the biological aspects of disease, but not for its psychosocial dimensions, an issue that has been absent in family medicine. The psychosocial aspects of the disease are the factors involved in how patients react to the disease, play a role in the expression of symptoms and disease, and have implications on the lives of patients. Moreover, the biological effects (specific) and psychosocial effects (non-specific) are not simply additive but interactive. Physicians should be aware of this hidden, essentially invisible patient psychosocial morbidity, and must incorporate bio-psychosocial interventions into routine medical care to be more effective. In addition, to consider these aspects in the context of care contributes to the distinctive elements of family medicine.