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Dai Q, Liu X, Xu X, Fu Y, She Z, Huang Y, Xia Y, Chen Y, Cheng ASK, Feuerstein M. Development of a supportive care framework for breast cancer survivor's unmet needs: A modified Delphi study. J Clin Nurs 2024; 33:1376-1386. [PMID: 38356222 DOI: 10.1111/jocn.16963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/21/2023] [Accepted: 12/04/2023] [Indexed: 02/16/2024]
Abstract
AIM To establish a supportive care framework for addressing unmet needs among breast cancer survivors, providing practical guidance for healthcare providers to assess and manage these needs, ultimately enhancing the health outcomes and quality of life of breast cancer survivors. DESIGN We conducted a two-round Delphi survey to gather expert opinions regarding the unmet needs supportive care framework for breast cancer survivors. METHODS Initial framework identification and inquiry questionnaire creation was achieved via literature search and expert group discussions, which included 15 experts from nursing practice, clinical medicine, nursing management and nursing education was conducted using a Delphi survey. To establish consensus, a two-round Delphi poll was done, using criteria based on the mean (≥4.0), coefficient of variation (CV < 0.25) and percentage for entire score (≥20%). RESULTS Experts reached a consensus, leading to six care modules, and 28 care entries: Tumour Detection Support (three care entries), Management of Complications of Antitumor Therapy (seven care entries), Healthy Lifestyle Management (five care entries), Sexual and Fertility Support (four care entries), Psychosocial Support (four care entries) and Resource and Linkage Support (five care entries). CONCLUSION To address breast cancer survivors' unmet needs, a supportive framework was developed to actively enhance their health outcomes. However, further refinement and feasibility testing using mobile devices or artificial intelligence are required. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE This pioneering framework prioritises addressing unmet needs and equips healthcare providers to assess and manage these needs effectively, facilitating the implementation of programs aimed at improving the well-being of breast cancer survivors. REPORTING METHOD This study was guided by a modified guideline for the Conducting and Reporting of Delphi Studies (CREDES) (Palliative Medicine, 31(8), 684, 2017). PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution. TRIAL AND PROTOCOL REGISTRATION The Delphi study methodology does not require registration.
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Affiliation(s)
- Qian Dai
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Xiangyu Liu
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xianghua Xu
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yulu Fu
- Department of Hematology, Xiangya Third Hospital, Central South University, Changsha, China
| | - Zhengdi She
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Yuansi Huang
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Yimin Xia
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yongyi Chen
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Michael Feuerstein
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Cancer Survivorship, Gaithersburg, Maryland, USA
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Bi L, Zhang X, Wang L, Cai Y, Han J. Subgroups of sleep quality and associated risk factors in patients with cancer undergoing radiotherapy: A cross-sectional study based on latent profile analysis. Eur J Oncol Nurs 2024; 68:102488. [PMID: 38134497 DOI: 10.1016/j.ejon.2023.102488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/26/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To identify latent classes of sleep quality among patients with cancer undergoing radiotherapy, and to examine the predictors of different latent classes. METHODS This cross-sectional study included 238 cancer patients. The assessment instrument included the Pittsburgh Sleep Quality Index, the sleep hygiene awareness and practice scale, the MD Anderson Symptom Inventory, the Distress Thermometer and the Fear of Cancer Recurrence Questionnaire. Latent profile analysis was used to identify different sleep quality subgroups. RESULTS Three latent classes with distinct sleep characteristics were identified: good sleep quality (class 1, 66.8%), moderate sleep disturbance with high hypnotics use (class 2, 9.2%), and high sleep disturbance with low hypnotics use (class 3, 24.0%) classes. Patients who were young (P = 0.022) and diagnosed with cancer stage Ⅲ (P = 0.021) were significantly more likely to be in Class 3 than in Class 1. Patients with a senior middle school were less likely to fall into Class 2, but more likely to fall into Class 1 (P = 0.026). Those with higher sleep hygiene practice scores (P = 0.022; P < 0.001), symptom severity (P < 0.001; P < 0.001), and psychological distress (P = 0.040; P < 0.001) had a significantly higher probability of being classified in Class 2 or Class 3 than in Class 1. CONCLUSIONS Our study revealed the heterogeneity of sleep quality in patients with cancer undergoing radiotherapy; moreover, through our findings, targeted interventions may be developed to promote the sleep quality of these patients.
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Affiliation(s)
- Liuna Bi
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China.
| | - Xian Zhang
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, China.
| | - Linlin Wang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China.
| | - Yanxiu Cai
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China.
| | - Jing Han
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China; Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, China.
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Lello S, Paris I, Cagnacci A, Sartori D, Caruso S, Iop A. Vasomotor symptoms and management of women undergoing treatment for breast cancer: literature review with focus on the therapeutic potential of cytoplasmic pollen extract. Gynecol Endocrinol 2023; 39:2162035. [PMID: 36591791 DOI: 10.1080/09513590.2022.2162035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Effective management of vasomotor symptoms (VMS) in patients undergoing treatment for breast cancer (BC) represents a critical but frequent unmet need. This review summarizes the epidemiology, pathophysiology, and clinical features of VMS in patients with BC and provides a synopsis of the complementary and alternative medicine (CAM) approaches in relieving VMS with a focus on purified cytoplasm of pollen (PCP). METHODS The literature on VMS epidemiology, pathophysiology, clinical burden, and CAM treatment in healthy women and patients with BC was reviewed. RESULTS VMS are common in patients with BC undergoing hormonal treatment and negatively impact quality of life, leading to treatment discontinuation in up to 25% of patients with detrimental impact on risk of BC recurrence and overall survival. CAM approaches to treat VMS in patients with BC include vitamin E, phytoestrogens, and black cohosh, even if there is a lack of solid evidence to guide clinicians in the choice of treatment. PCP, obtained according to standards of good manufacturing practice, has a definite pharmacological mechanism of action, is devoid of estrogen activity, and has shown clinical efficacy on menopause-associated symptoms with a favorable safety profile and high compliance. As such, it appears to represent a valid management option to improve quality of life in patients with pre- and postmenopausal BC. CONCLUSIONS Physicians should actively investigate the presence and impact of VMS in patients receiving therapy for BC. Additional and appropriately sized randomized clinical trials are needed to provide clear evidence on how to best meet the needs of patients with BC suffering from menopause-associated symptoms.
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Affiliation(s)
- Stefano Lello
- Department of Woman and Child Health, Policlinico A. Gemelli Foundation-IRCCS, Rome, Italy
| | - Ida Paris
- Department of Woman and Child Health, Policlinico A. Gemelli Foundation-IRCCS, Rome, Italy
| | - Angelo Cagnacci
- Department of Obstetrics and Gynecology, San Martino Hospital, Genoa, Italy
| | | | - Salvatore Caruso
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Aldo Iop
- University Local Health Authority Giuliano Isontina ASUGI, Trieste,Italy
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Beverly Hery CM, Janse SA, Van Zee KJ, Naftalis EZ, Paskett ED, Naughton MJ. Factors associated with insomnia symptoms over three years among premenopausal women with breast cancer. Breast Cancer Res Treat 2023; 202:155-165. [PMID: 37542630 PMCID: PMC10504151 DOI: 10.1007/s10549-023-07058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE We examined longitudinal trends and factors associated with insomnia over 3 years in a cohort of young breast cancer patients. METHODS Women with stage I-III breast cancer at ≤ 45 years were recruited at five institutions from New York, Texas, and North Carolina, within 8 months of diagnosis (n = 836). Participants completed questionnaires every 6 months for 3 years. Linear mixed-effects models were used to examine insomnia over time, using the Women's Health Initiative Insomnia Rating Scale (WHIIRS). We evaluated the relations of insomnia with demographic (age, race, education, income, employment, marital status), clinical (cancer stage, histologic grade, chemotherapy, radiation, hormone therapy, surgery, tumor size, body mass index, hot flashes), and social/behavioral variables (smoking status, social support, physical activity, depressive symptoms). RESULTS At baseline, 57% of participants met or exceeded the cut-off for clinical insomnia (WHIIRS score ≥ 9). Insomnia symptoms were most prevalent at baseline (p < 0.0001), but decreased significantly throughout follow-up (p < 0.001). However, 42% of participants still experienced insomnia symptoms 3 years after diagnosis. In multivariable models, older age (p = 0.02), hot flashes (p < 0.0001), and depressive symptoms (p < 0.0001) remained significantly associated with insomnia over time. CONCLUSIONS Insomnia symptoms were most frequent closer to breast cancer diagnosis and treatment, but persisted for some women who were older and those reporting higher hot flashes and depressive symptoms. Survivorship care should include assessing insomnia symptoms, particularly during and immediately after primary treatment. Implementing early interventions for sleep problems may benefit young breast cancer survivors and improve their quality of life.
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Affiliation(s)
- Chloe M Beverly Hery
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
| | - Sarah A Janse
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Elizabeth Z Naftalis
- Director of Breast Services, Health Texas Community Health Services Corporate, Dallas, TX, 75001, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Michelle J Naughton
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
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Kapoor E, Faubion SS, Kuhle CL, Kling JM, Miller VM, Fokken S, Mara KC, Moyer AM. The effect of genetic variation in estrogen transportation and metabolism on the severity of menopause symptoms: A study from the RIGHT 10K cohort. Maturitas 2023; 176:107797. [PMID: 37595497 PMCID: PMC10478674 DOI: 10.1016/j.maturitas.2023.107797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE The severity of menopause-related symptoms varies considerably among women. The determinants of this variation are incompletely understood. The aim of this study was to assess the association between genetic variation in estrogen metabolism and transport pathways and the severity of menopause symptoms. METHODS This was a cross-sectional study of 60 peri- and postmenopausal women in the Mayo Clinic RIGHT study (which involved sequencing of genes involved in drug metabolism and transport), who had also been evaluated in the Women's Health Clinic at Mayo Clinic in Rochester, MN. All participants completed the Menopause Rating Scale (MRS) for assessment of menopause symptoms, including hot flashes. The association between severity of menopause symptoms and the variation in genes encoding 8 enzymes and transporters involved in estrogen metabolism was evaluated. RESULTS Lower CYP3A4 activity and higher COMT activity were associated with lower severity of somatic menopause symptoms (p = 0.04 and 0.06, respectively). These associations did not persist after adjustment for hormone therapy use. No differences in MRS scores or hot flash severity were noted among other genetic variant groups. Age at natural menopause was not affected by variations in the genes studied. CONCLUSION The current study did not show an association between genetic variation in estrogen metabolism and transport pathways and the severity of menopause symptoms. Further studies with larger sample sizes may be required to understand this potentially complex association.
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Affiliation(s)
- Ekta Kapoor
- Center for Women's Health, Mayo Clinic, Rochester, MN, USA; Menopause and Women's Sexual Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA; Women's Health Research Center, Mayo Clinic, Rochester, MN, USA.
| | - Stephanie S Faubion
- Center for Women's Health, Mayo Clinic, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Carol L Kuhle
- Center for Women's Health, Mayo Clinic, Rochester, MN, USA; Menopause and Women's Sexual Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juliana M Kling
- Center for Women's Health, Mayo Clinic, Rochester, MN, USA; Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Virginia M Miller
- Emerita Staff, Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Shawn Fokken
- Menopause and Women's Sexual Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kristin C Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Ann M Moyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Cathcart-Rake EJ, Tevaarwerk AJ, Haddad TC, D'Andre SD, Ruddy KJ. Advances in the care of breast cancer survivors. BMJ 2023; 382:e071565. [PMID: 37722731 DOI: 10.1136/bmj-2022-071565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Breast cancer survivors may experience significant after effects from diagnoses of breast cancer and cancer directed therapies. This review synthesizes the evidence about optimal management of the sequelae of a diagnosis of breast cancer. It describes the side effects of chemotherapy and endocrine therapy and evidence based strategies for management of such effects, with particular attention to effects of therapies with curative intent. It includes strategies to promote health and wellness among breast cancer survivors, along with data to support the use of integrative oncology strategies. In addition, this review examines models of survivorship care and ways in which digital tools may facilitate communication between clinicians and patients. The strategies outlined in this review are paramount to supporting breast cancer survivors' quality of life.
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Zhu W, Li W, Gao J, Wang L, Guo J, Yang H. Factors associated with the sleep disturbances of people with breast cancer during chemotherapy in China: A cross-sectional study. Nurs Open 2023. [PMID: 37099665 DOI: 10.1002/nop2.1784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/10/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023] Open
Abstract
AIM The aim of the study was to investigate the incidence of sleep disturbance and its relationship with anxiety and depression symptoms, social support and hope in breast cancer patients in China during chemotherapy. DESIGN A single-centre cross-sectional study. METHODS A total of 329 breast cancer patients were selected via convenience sampling method before they began chemotherapy (n = 115), before the 5th week of chemotherapy (n = 117) or 1 month after chemotherapy ended (n = 97) and administered paper-and-pencil questionnaires to evaluate sleep quality, depression and anxiety symptoms, social support and hope. Risk factors significantly associated with sleep disturbance during bivariate were incorporated in the multivariate analysis. Bivariate analyses showed that age, menopausal status, depression and anxiety symptoms, emotional/informational support, tangible support, affectionate support, positive social interaction and total support were predictors of sleep disturbance. RESULTS Sleep disturbance was prevalent in breast cancer patients before (27.0%), during (32.5%) and after (39.2%) chemotherapy, with 37.4%, 41.9% and 52.6% of participants, respectively, reporting sleeping below the recommended 7 h. Only 8.6%-15.5% of patients reported taking sedative-hypnotic drugs during the chemotherapy. Multivariate analyses found that participants reporting clinically significant anxiety (HADS > 8) were 3.5 times more likely to report sleep disturbance (PSQI > 8) than participants without clinically significant anxiety, and each increment in emotional/informational support was associated with a 9.04% reduced risk of sleep disturbance. Moreover, age was an independent predictor of sleep disturbance during multivariate modelling.
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Affiliation(s)
- Wenjuan Zhu
- Shanxi Medical University, Taiyuan, China
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Wanling Li
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Jinnan Gao
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Linying Wang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Jun Guo
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Hui Yang
- Shanxi Medical University, Taiyuan, China
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Jeong YJ, Choi HR, Kim KS, Shin IH, Park SH. Impact of Acupuncture on Hot Flashes in Breast Cancer Patients Receiving Adjuvant Antiestrogen Therapy with Tamoxifen: A Randomized Controlled Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:241-252. [PMID: 36787483 DOI: 10.1089/jicm.2022.0636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Objectives: The aim of this study was to evaluate the impact of acupuncture on hot flashes in breast cancer patients taking tamoxifen as an adjuvant antiestrogen therapy in Korea. Design: This trial was a randomized, no-treatment-controlled, single-blind, multi-center trial. Participants were randomized 1:1 into the acupuncture group or into the no-treatment control group. Location: This trial was conducted at Daegu Catholic University Hospital and Daegu Haany University Korean Medicine Hospital in Daegu, Republic of Korea. Participants: Patients with moderate to severe symptoms of hot flashes while receiving adjuvant antiestrogen therapy using tamoxifen after surgery for breast cancer were included. Interventions: In the acupuncture group, acupuncture was performed three times a week for 4 consecutive weeks at five predetermined points. The control group received no treatment during the study period. Study Outcome Measures: As a primary outcome, the severity of hot flashes was measured on the visual analogue scale (VAS) and total hot flash score. In addition, the quality of life (QoL) of participants was assessed as a secondary outcome. Results: A total of 30 patients were included in this study, 15 each in the acupuncture group and the control group. The participants in the acupuncture group significantly decreased the severity of hot flashes evaluated with both VAS and total hot flash scores compared with participants in the control group. Also, the acupuncture group showed improved score of a global health status/QoL scale and functional scales assessed with the European Organisation for Research and Treatment of Cancer QoL questionnaire-core questionnaire, compared with those in the control group. This trend was maintained 4 weeks after acupuncture treatment. No adverse events have been reported in this study. Conclusions: Acupuncture was effective and safe in improving hot flashes in Korean breast cancer patients receiving adjuvant antiestrogen therapy with tamoxifen, and it improved the QoL. Clinical Trial Registration: KCT0007829.
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Affiliation(s)
- Young Ju Jeong
- Department of Surgery, School of Medicine, Daegu Catholic University, Daegu, Korea
| | - Hye Ryeon Choi
- Department of Surgery, Eulji Medical Center, Seoul, Korea
| | - Kyung-Soon Kim
- Department of Korean Internal Medicine, College of Korean Medicine, Daegu Haany University, Daegu, Korea
| | - Im Hee Shin
- Department of Medical Statistics, School of Medicine, Daegu Catholic University, Daegu, Korea
| | - Sung Hwan Park
- Department of Surgery, School of Medicine, Daegu Catholic University, Daegu, Korea
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Solikhah S, Perwitasari DA, Rejeki DSS. Cross-cultural adaptation and psychometric properties of the Indonesian version for quality of life among breast cancer patients. Front Public Health 2023; 11:1069422. [PMID: 36926172 PMCID: PMC10011654 DOI: 10.3389/fpubh.2023.1069422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/09/2023] [Indexed: 03/08/2023] Open
Abstract
Background Breast cancer is one of the most important health problems worldwide. Quality of life (QoL) is an important indicator to evaluate symptoms in cancer patients, including those with breast cancer. Culturally suitable, valid, reliable, and appropriate instruments to measure the QoL of breast cancer patients are needed, which is still rare in Indonesia. This study aimed to translate the EORTC QLQ-BR45 instrument into Indonesian and evaluate its psychometrics. Methods A cross-sectional study was performed on 635 patients conveniently selected from the oncology department in referral hospital. The first phase of this study involved translation of the existing EORTC QLQ-BR45 into Indonesian, and in the second phase, we evaluated its psychometric properties. Construct validity was evaluated using confirmatory factor analysis (CFA). Criterion validity was examined according to the association between disease stage and Karnofsky Performance Scale (KPS). Results A total of 635 (99.00%) completed the EORTC QLQ-BR45 successfully. The instrument indicated good readability and high content validity. All Cronbach's alpha coefficients were satisfactory (overall value, 0.87). For construct validity, patients with KPS ≥80% did better than those with KPS ≤70% as did two multi-item scales in functional scales (body image and breast satisfaction) and five multi-item scales in symptom scales (systemic therapy side effects, endocrine therapy, and arm, breast, and endocrine sexual symptoms). Body image score of late-stage patients was significantly higher. CFA indicated that the nine-factor structure of the Indonesian EORTC QLQ-BR45 was a good fit for the data. Conclusion The Indonesian EORTC QLQ-BR45 questionnaire is reliable and valid with good psychometric properties, thus can be used for breast cancer patients in Indonesia.
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Affiliation(s)
- Solikhah Solikhah
- Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | | | - Dwi Sarwani Sri Rejeki
- Department of Public Health, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Indonesia
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Evidence-Based Guidance for Breast Cancer Survivorship. Hematol Oncol Clin North Am 2023; 37:225-243. [PMID: 36435612 DOI: 10.1016/j.hoc.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Breast cancer survivorship care includes management of lingering physical symptoms, supports to address the emotional toll exacted by a cancer diagnosis and cancer therapies, monitoring and optimization of cardiac and bone health, general wellness promotion, reproductive health care, surveillance for cancer recurrence, care coordination, and efforts to mitigate health disparities.
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Khosropanah A, Mehri Ardestani M, Rostami N, Hashemi F, Pasalar M, Hunter J, Heydarirad G. Effects of Chicory and Fumitory on Hot Flashes Among Breast Cancer Survivors: A Randomized, Double-Blind Placebo-Controlled Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:31-41. [PMID: 36219736 DOI: 10.1089/jicm.2022.0624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objectives: Hot flashes are unpleasant long-term complications of breast cancer. This study aimed to evaluate the effects of a traditional Persian medicine containing extracts of Cichorium intybus L. (chicory) and Fumaria parviflora L. (Fumitory) extract syrup (CFS) compared with placebo when used as intended. Design: Randomized, double-blind, placebo-controlled clinical trial. Setting/Location: The Oncology Ward of Shahid Modarres Hospital (Tehran, Iran). Subjects: Breast cancer survivors undergoing hormone deprivation therapy. Interventions: Patients were randomly allocated to receive 5 mL CFS or placebo syrup three times a day, for 4 weeks. Outcome measures: The co-primary outcomes were self-reported daily hot flashes frequency and severity scores assessed using self-reported daily dairies, including 1 week of baseline data. Results: Of the 148 patients screened, 137 were eligible, and 96 were randomly allocated to receive either CFS (n = 48) or placebo (n = 48). All participants who returned their dairies were compliant and analyzed as randomized in the a priori per-protocol analysis. After 4 weeks of treatment, both the mean daily hot flashes frequency and severity score had reduced by 57% in the CFS group and 10% in the placebo group. The overall weekly mean daily hot flashes frequency (effect size ηp2 0.221, p < 0.001, n = 66) and severity scores (effect size ηp2 0.160, p = 0.001, n = 66) were significantly lower in the CFS group compared with the placebo group (one-within one-between repeated-measures analysis of variance adjusted for baseline). CFS was well tolerated, with similar proportions of serious and nonserious adverse events occurring in both groups. Conclusions: This is the first study to report the effects of chicory or fumitory for the treatment of hot flashes. The findings provide preliminary evidence that CFS can improve hot flashes in breast cancer survivors undergoing hormone deprivation therapy. More research is warranted to confirm its effectiveness, safety, and mechanisms of action. Clinical Trial Registration: IRCT20210226050506N1.
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Affiliation(s)
- Alireza Khosropanah
- Department of Internal Medicine, Faculty of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Mojgan Mehri Ardestani
- Department of Persian Medicine, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Nematollah Rostami
- Department of Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hashemi
- Department of Neonatal Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Pasalar
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ghazaleh Heydarirad
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Verma N, Blackford AL, Thorner E, Lehman J, Snyder C, Stearns V, Smith KL. Factors associated with worsening sexual function during adjuvant endocrine therapy in a prospective clinic-based cohort of women with early-stage breast cancer. Breast Cancer Res Treat 2022; 196:535-547. [PMID: 36197536 PMCID: PMC10084786 DOI: 10.1007/s10549-022-06750-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/17/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Sexual function problems are common but under-reported among women receiving adjuvant endocrine therapy for breast cancer. Worsening scores on patient-reported outcomes (PROs) may identify those at risk for sexual function problems during treatment. We performed a secondary analysis of prospectively collected PROs in women receiving adjuvant endocrine therapy to identify factors associated with worsening sexual function. METHODS Women with stage 0-III breast cancer initiating adjuvant endocrine therapy participating in a prospective cohort completed PROs at baseline, 3, 6, 12, 24, 36, 48, and 60 months. Sexual function was evaluated by the MOS-SP measure. Other measures included PROMIS pain interference, fatigue, depression, anxiety, physical function, and sleep disturbance and the Endocrine Symptom Subscale of the FACT-ES. We evaluated associations between score worsening of at least the minimal important difference (MID) in PROMIS T-scores (4 points) and FACT-ES scores (5 points) with score worsening of at least the MID in MOS-SP scores (8 points) using logistic regression. RESULTS Among 300 participants, 45.7% experienced ≥ 8-point worsening of MOS-SP score at any time point compared to baseline. Worsening endocrine symptoms (OR 1.34, 95% CI 1.22-1.49, p < 0.001), worsening physical function (OR 1.09, 95% CI 1.00-1.18, p = 0.06), and prior mastectomy (OR 1.45, 95% CI 0.94-2.23, p = 0.09) were associated with MOS-SP score worsening by at least the MID. CONCLUSION Worsening endocrine symptoms and physical function identified on PROs are associated with worsening sexual function during adjuvant endocrine therapy. Routine assessment of these domains with PROs may identify women at risk for sexual function problems. TRIAL REGISTRATION NUMBER NCT01937052; Date of Registration: 09/09/2013.
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Affiliation(s)
- Neha Verma
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda L Blackford
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Elissa Thorner
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Lehman
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vered Stearns
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Lisa Smith
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Medical Oncology, Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, First Floor, Building B, 5255 Loughboro Road, NW, Washington, DC, 20016, USA.
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13
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Cole KM, Clemons M, McGee S, Alzahrani M, Larocque G, MacDonald F, Liu M, Pond GR, Mosquera L, Vandermeer L, Hutton B, Piper A, Fernandes R, Emam KE. Using machine learning to predict individual patient toxicities from cancer treatments. Support Care Cancer 2022; 30:7397-7406. [PMID: 35614153 PMCID: PMC9385785 DOI: 10.1007/s00520-022-07156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Machine learning (ML) is a powerful tool for interrogating datasets and learning relationships between multiple variables. We utilized a ML model to identify those early breast cancer (EBC) patients at highest risk of developing severe vasomotor symptoms (VMS). METHODS A gradient boosted decision model utilizing cross-sectional survey data from 360 EBC patients was created. Seventeen patient- and treatment-specific variables were considered in the model. The outcome variable was based on the Hot Flush Night Sweats (HFNS) Problem Rating Score, and individual scores were dichotomized around the median to indicate individuals with high and low problem scores. Model accuracy was assessed using the area under the receiver operating curve, and conditional partial dependence plots were constructed to illustrate relationships between variables and the outcome of interest. RESULTS The model area under the ROC curve was 0.731 (SD 0.074). The most important variables in the model were as follows: the number of hot flashes per week, age, the prescription, or use of drug interventions to manage VMS, whether patients were asked about VMS in routine follow-up visits, and the presence or absence of changes to breast cancer treatments due to VMS. A threshold of 17 hot flashes per week was identified as being more predictive of severe VMS. Patients between the ages of 49 and 63 were more likely to report severe symptoms. CONCLUSION Machine learning is a unique tool for predicting severe VMS. The use of ML to assess other treatment-related toxicities and their management requires further study.
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Affiliation(s)
- Katherine Marie Cole
- Department of Medicine, Division of Medical Oncology, The University of Ottawa, Ottawa, Canada
| | - Mark Clemons
- Department of Medicine, Division of Medical Oncology, The University of Ottawa, Ottawa, Canada
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sharon McGee
- Department of Medicine, Division of Medical Oncology, The University of Ottawa, Ottawa, Canada
| | - Mashari Alzahrani
- Department of Medicine, Division of Medical Oncology, The University of Ottawa, Ottawa, Canada
| | | | | | - Michelle Liu
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Lucy Mosquera
- CHEO Research Institute, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Lisa Vandermeer
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ardelle Piper
- University of Ottawa Health Services, Ottawa, ON, Canada
| | - Ricardo Fernandes
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Khaled El Emam
- CHEO Research Institute, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
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14
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Sánchez JMB, Vázquez EC, Picado AL, Crespo MEO, Muela MHDL. Menopausal in breast cancer and the effectiveness of a dietary supplement: Serotomama project. Cir Esp 2022:S2173-5077(22)00199-5. [PMID: 35724874 DOI: 10.1016/j.cireng.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Juana María Brenes Sánchez
- Breast Cancer Unit, Obstetrics and Gynecology, Women's Health Institute, Clíníco San Carlos Hospital, Madrid, Spain.
| | - Elisa Cedeira Vázquez
- Breast Cancer Unit, Obstetrics and Gynecology, Women's Health Institute, Clíníco San Carlos Hospital, Madrid, Spain
| | - Amanda López Picado
- Clinical Trials and Research Unit, IdISSC, Health Department, International University of La Rioja, La Rioja, Spain
| | | | - María Herrera De La Muela
- Breast Cancer Unit, Obstetrics and Gynecology, Women's Health Institute, Clíníco San Carlos Hospital, Madrid, Spain
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15
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Smith KL, Verma N, Blackford AL, Lehman J, Westbrook K, Lim D, Fetting J, Wolff AC, Jelovac D, Miller RS, Connolly R, Armstrong DK, Nunes R, Visvanathan K, Riley C, Papathakis K, Zafman N, Sheng JY, Snyder C, Stearns V. Association of treatment-emergent symptoms identified by patient-reported outcomes with adjuvant endocrine therapy discontinuation. NPJ Breast Cancer 2022; 8:53. [PMID: 35449210 PMCID: PMC9023490 DOI: 10.1038/s41523-022-00414-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/14/2022] [Indexed: 11/08/2022] Open
Abstract
Many patients discontinue endocrine therapy for breast cancer due to intolerance. Identification of patients at risk for discontinuation is challenging. The minimal important difference (MID) is the smallest change in a score on a patient-reported outcome (PRO) that is clinically significant. We evaluated the association between treatment-emergent symptoms detected by worsening PRO scores in units equal to the MID with discontinuation. We enrolled females with stage 0-III breast cancer initiating endocrine therapy in a prospective cohort. Participants completed PROs at baseline, 3, 6, 12, 24, 36, 48, and 60 months. Measures included PROMIS pain interference, fatigue, depression, anxiety, physical function, and sleep disturbance; Endocrine Subscale of the FACT-ES; and MOS-Sexual Problems (MOS-SP). We evaluated associations between continuous PRO scores in units corresponding to MIDs (PROMIS: 4-points; FACT-ES: 5-points; MOS-SP: 8-points) with time to endocrine therapy discontinuation using Cox proportional hazards models. Among 321 participants, 140 (43.6%) initiated tamoxifen and 181 (56.4%) initiated aromatase inhibitor (AI). The cumulative probability of discontinuation was 23% (95% CI 18-27%) at 48 months. For every 5- and 4-point worsening in endocrine symptoms and sleep disturbance respectively, participants were 13 and 14% more likely to discontinue endocrine therapy respectively (endocrine symptoms HR 1.13, 95% CI 1.02-1.25, p = 0.02; sleep disturbance HR 1.14, 95% CI 1.01-1.29, p = 0.03). AI treatment was associated with greater likelihood of discontinuation than tamoxifen. Treatment-emergent endocrine symptoms and sleep disturbance are associated with endocrine therapy discontinuation. Monitoring for worsening scores meeting or exceeding the MID on PROs may identify patients at risk for discontinuation.
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Affiliation(s)
- Karen Lisa Smith
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Neha Verma
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda L Blackford
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Jennifer Lehman
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly Westbrook
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - David Lim
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - John Fetting
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Antonio C Wolff
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniela Jelovac
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert S Miller
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- CancerLinQ, American Society of Clinical Oncology, Alexandria, VA, USA
| | - Roisin Connolly
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Deborah K Armstrong
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raquel Nunes
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kala Visvanathan
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Cancer Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carol Riley
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie Papathakis
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nelli Zafman
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Y Sheng
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vered Stearns
- Johns Hopkins Women's Malignancies Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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16
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Environmental Stressors Suffered by Women with Gynecological Cancers in the Aftermath of Hurricanes Irma and María in Puerto Rico. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111183. [PMID: 34769708 PMCID: PMC8583450 DOI: 10.3390/ijerph182111183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/04/2021] [Accepted: 10/14/2021] [Indexed: 12/23/2022]
Abstract
Background: Hurricanes are the immediate ways that people experience climate impacts in the Caribbean. These events affect socio-ecological systems and lead to major disruptions in the healthcare system, having effects on health outcomes. In September 2017, Puerto Rico (PR) and the United States Virgin Islands (USVI) experienced one of the most catastrophic hurricane seasons in recent history (Hurricane Irma was a Category 5 and Hurricane María was a Category 4 when they hit PR). Objective: This study examines environmental stressors experienced by women with gynecologic (GYN) cancers from PR and USVI who received oncologic cancer care in PR, in the aftermath of the hurricanes. Methods: A descriptive qualitative study design was used to obtain rich information for understanding the context, barriers, knowledge, perspectives, risks, vulnerabilities, and attitudes associated to these hurricanes. We performed focus groups among GYN cancer patients (n = 24) and key-informant interviews (n = 21) among health-care providers and administrators. Interviews were conducted from December 2018–April 2019. Results: Environmental health stressors such as lack of water, heat and uncomfortable temperatures, air pollution (air quality), noise pollution, mosquitos, and rats ranked in the top concerns among cancer patients and key-informants. Conclusions: These findings are relevant to cancer patients, decision-makers, and health providers facing extreme events and disasters in the Caribbean. Identifying environmental secondary stressors and the most relevant cascading effects is useful for decision-makers so that they may address and mitigate the effects of hurricanes on public health and cancer care.
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17
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Relf RL, Lee BJ, Eichhorn G, Flint MS, Beale L, Maxwell N. Thermoregulation is not impaired in breast cancer survivors during moderate-intensity exercise performed in warm and hot environments. Physiol Rep 2021; 9:e14968. [PMID: 34291605 PMCID: PMC8295682 DOI: 10.14814/phy2.14968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to assess how female breast cancer survivors (BCS) respond physiologically, hematologically, and perceptually to exercise under heat stress compared to females with no history of breast cancer (CON). Twenty-one females (9 BCS and 12 CON [age; 54 ± 7 years, stature; 167 ± 6 cm, body mass; 68.1 ± 7.62 kg, and body fat; 30.9 ± 3.8%]) completed a warm (25℃, 50% relative humidity, RH) and hot (35℃, 50%RH) trial in a repeated-measures crossover design. Trials consisted of 30 min of rest, 30 min of walking at 4 metabolic equivalents, and a 6-minute walk test (6MWT). Physiological measurements (core temperature (Tre ), skin temperature (Tskin ), heart rate (HR), and sweat analysis) and perceptual rating scales (ratings of perceived exertion, thermal sensation [whole body and localized], and thermal comfort) were taken at 5- and 10-min intervals throughout, respectively. Venous blood samples were taken before and after to assess; IL-6, IL-10, CRP, IFN-γ, and TGF-β1 . All physiological markers were higher during the 35 versus 25℃ trial; Tre (~0.25℃, p = 0.002), Tskin (~3.8℃, p < 0.001), HR (~12 beats·min-1 , p = 0.023), and whole-body sweat rate (~0.4 L·hr-1 , p < 0.001), with no difference observed between groups in either condition (p > 0.05). Both groups covered a greater 6MWT distance in 25 versus 35℃ (by ~200 m; p = 0.003). Nevertheless, the control group covered more distance than BCS, regardless of environmental temperature (by ~400 m, p = 0.03). Thermoregulation was not disadvantaged in BCS compared to controls during moderate-intensity exercise under heat stress. However, self-paced exercise performance was reduced for BCS regardless of environmental temperature.
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Affiliation(s)
- Rebecca L. Relf
- Environmental Extremes LaboratoryUniversity of BrightonEastbourneUK
| | - Ben J. Lee
- Occupational and Environmental Physiology GroupCoventry UniversityCoventryUK
| | - Gregor Eichhorn
- Environmental Extremes LaboratoryUniversity of BrightonEastbourneUK
| | - Melanie S. Flint
- Cancer Stress LaboratoryUniversity of BrightonMoulsecoombUK
- Centre for Stress and Age‐Related DiseaseBrightonEast SussexUK
| | - Louisa Beale
- Environmental Extremes LaboratoryUniversity of BrightonEastbourneUK
| | - Neil Maxwell
- Environmental Extremes LaboratoryUniversity of BrightonEastbourneUK
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18
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Hutton B, Hersi M, Cheng W, Pratt M, Barbeau P, Mazzarello S, Ahmadzai N, Skidmore B, Morgan SC, Bordeleau L, Ginex PK, Sadeghirad B, Morgan RL, Cole KM, Clemons M. Comparing Interventions for Management of Hot Flashes in Patients With Breast and Prostate Cancer: A Systematic Review With Meta-Analyses. Oncol Nurs Forum 2021; 47:E86-E106. [PMID: 32555553 DOI: 10.1188/20.onf.e86-e106] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PROBLEM IDENTIFICATION Hot flashes are common and bothersome in patients with breast and prostate cancer and can adversely affect patients' quality of life. LITERATURE SEARCH Databases were searched for randomized controlled trials (RCTs) evaluating the effects of one or more interventions for hot flashes in patients with a history of breast or prostate cancer. DATA EVALUATION Outcomes of interest included changes in hot flash severity, hot flash frequency, quality of life, and harms. Pairwise meta-analyses and network meta-analyses were performed where feasible, with narrative synthesis used where required. SYNTHESIS 40 RCTs were included. Findings from network meta-analysis for hot flash frequency suggested that several therapies may offer benefits compared to no treatment, but little data suggested differences between active therapies. Findings from network meta-analysis for hot flash score were similar. IMPLICATIONS FOR RESEARCH Although many interventions may offer improvements for hot flashes versus no treatment, minimal data suggest important differences between therapies. SUPPLEMENTARY MATERIALS CAN BE FOUND BY VISITING&NBSP;HTTPS //bit.ly/2WGzi30.
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19
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Pertyńska-Marczewska M, Pertyński T. Postmenopausal women in gynecological care. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2021; 20:88-98. [PMID: 34321987 PMCID: PMC8297629 DOI: 10.5114/pm.2021.107103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/28/2021] [Indexed: 02/07/2023]
Abstract
Menopause is one of the most important events in the female reproductive life cycle, being a transition from the reproductive to the nonreproductive stage. It is a milestone that may have a negative influence on quality of life and one that brings in several physiological changes that affect the life of a woman permanently. According to a Polish epidemiological forecast, in 2050 the average female life expectancy will be 87.5, which is 6.4 years longer than today. Thus, the life expectancy of women who will be 60 or older in 2050 will also extend. Therefore, strategies need to be optimized to maintain postreproductive health, in part because of increased longevity. The general gynecologist can expect to see more elderly female patients as the population continues to age. Office management of the gynecologic problems of geriatric women requires sensitivity to the special needs of this group. Nowadays, most women spend more than one-third of their lives after menopause; therefore there is plenty of opportunity for gynecologists to cater to the needs of postmenopausal women. It is in their scope of practice to help postmenopausal women through "healthy aging". In this review we look into screenings, early identification, lifestyle modifications and appropriate intervention that may prevent many chronic conditions that cause morbidity and mortality during the postmenopausal years.
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Affiliation(s)
| | - Tomasz Pertyński
- Faculty of Health Science, Mazovian Public University in Plock, Poland
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20
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Rahool R, Haider G, Shahid A, Shaikh MR, Memon P, Pawan B, Beg S, Abbas K, Khalid M. Medical and Psychosocial Challenges Associated with Breast Cancer Survivorship. Cureus 2021; 13:e13211. [PMID: 33717749 PMCID: PMC7943930 DOI: 10.7759/cureus.13211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective To assess the association between common survivorship issues and characteristics of breast cancer survivors presenting at a tertiary care hospital in Karachi, Pakistan. Methodology This study was conducted in the medical oncology department of Jinnah Medical Postgraduate Center from March 27, 2019, to September 27, 2019. A number of 257 females of age group 18-90 years who had either completed their treatment or were undergoing treatment at the time were included using non-probability consecutive sampling techniques. Face-to-face interviews were personally conducted by the researcher, and data regarding the socio-demographics and common survivorship issues faced by breast cancer patients were obtained. The data acquired were entered and analyzed using SPSS version 23 (IBM Corp, Armonk, NY). Results The mean age of the breast cancer survivors were 42.58 ± 10.07 years. Of the main challenges, lack of energy received the highest mean score of 3.44 ± 1.26, followed by fatigue and financial issues. Overall the most common survivorship issue were financial issues (81.3%), followed by fatigue (80.9%), cessation of the menstrual cycle (66.1%), weak social support (59.1%), and cosmetic disfigurement (51.8%). Conclusion Breast cancer survivors have various psychological, medical, and social issues and may require unique attention during follow-up visits.
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Affiliation(s)
- Raja Rahool
- Oncology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Ghulam Haider
- Oncology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Aisha Shahid
- Oncology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | - Paras Memon
- Oncology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Bhunisha Pawan
- Oncology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Shumyla Beg
- Oncology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Kiran Abbas
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Manahil Khalid
- Internal Medicine, Bahria University Medical and Dental College, Karachi, PAK
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21
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Leung K, Shin K, Han F, Jiao J. Ergonomic mastectomy bra design: Effect on core body temperature and thermal comfort performance. APPLIED ERGONOMICS 2021; 90:103249. [PMID: 32889428 DOI: 10.1016/j.apergo.2020.103249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/21/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
The accumulation of sweat and heat between the skin and the prosthesis is one of the common causes of discomfort experienced by post-mastectomy women who wore silicone-type external breast prostheses. This study aimed 1) to investigate the effect of a newly designed heat-reduction mastectomy bra on the thermal responses and thermal comfort performance; and 2) to propose an evaluation protocol for post-mastectomy products. The heat-reduction bra and the conventional bra were made of the same textile materials but the cup of the bra under discussion had a polyurethane cup with a perforated structure along the breast root/inframammary fold. The inframammary fold is often aggravated by heat, sweat, maceration, chafe, and lack of air circulation. Nine healthy male participants were recruited to participate in the study since the women who had undergone double-mastectomy were sensitive about their scars. An ingestible telemetric pill sensor was used to collect the data of core body temperature. Participants performed a 70-min five-phase exercise protocol wearing the heat-reduction bra and the conventional bra together with a silicone prosthesis with ventilation holes on the bottom. Physiological responses (i.e., core body temperature, skin temperature, temperature between bra and prosthesis, skin humidity and humidity between bra and prosthesis) and subjective sensation responses were measured. The results were statistically significant and the conventional mastectomy bra showed a higher core body temperature than that of the heat-reduction mastectomy bra (37.3 ± 0.3 °C to 38.2 ± 0.5 °C vs. 37.2 ± 0.3 °C to 38.0 ± 0.3 °C) starting from the middle of the sitting phase to the running phase and post-exercise resting (F = 164.2, p < 0.001). Both factors, the bra and the phase, have significant effects on the core body temperature (F = 14.5, p < 0.001). The heat-reduction mastectomy bra demonstrated optimum thermal comfort performance in both the temperature and humidity than the conventional mastectomy bra.
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Affiliation(s)
- Kaoru Leung
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Kristina Shin
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Fred Han
- School of System Design and Intelligent Manufacturing, Southern University of Science and Technology, China.
| | - Jiao Jiao
- Dr Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Hong Kong, China.
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22
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Physical activity and menopausal symptoms in women who have received menopause-inducing cancer treatments: results from the Women's Wellness After Cancer Program. ACTA ACUST UNITED AC 2020; 28:142-149. [PMID: 33235033 DOI: 10.1097/gme.0000000000001677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This randomized controlled trial tested a digitally-delivered whole-of-lifestyle program for women previously treated for cancer. We investigated (1) associations between self-reported physical activity (PA) and menopausal symptoms and (2) if the intervention was associated with beneficial changes in PA and menopausal symptoms. METHODS Women were randomized to intervention (n = 142) or control (n = 138). The intervention targeted lifestyle behavior including PA. Self-reported PA (International Physical Activity Questionnaire - Short Form) and menopausal symptom (Green Climacteric Scale, GCS) data were collected at baseline, with measures repeated at 12 weeks (end of intervention) and 24 weeks (to assess sustainability). Generalized estimating equation models explored associations between PA and GCS scores. Mixed-effects generalized equation models analyzed changes within and between groups in PA and GCS scores. RESULTS Total GCS scores were 1.83 (95% CI: 0.11-3.55) and 2.72 (95% CI: 1.12-4.33) points lower in women with medium and high levels of PA, respectively, than in women with low levels of PA. Total average GCS scores were 1.02 (0.21-2.26) and 1.61 (0.34-2.87) points lower in those undertaking moderate or vigorous intensity PA, respectively. Time spent walking, and performing moderate and vigorous PA were not different between intervention and control. The average GCS decrease of 0.66 points (95% CI: 0.03-1.29; p time = 0.03) over 24 weeks was not different between groups. CONCLUSION This exploratory study established a stepwise association between moderate and vigorous PA and a lower total menopausal symptom score. The intervention did not appear to increase self-reported PA in women treated for early stage breast, reproductive, and blood cancers.
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23
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Changes in hot flash experiences and related factors in women with breast cancer. ACTA ACUST UNITED AC 2020; 27:535-542. [PMID: 32068690 DOI: 10.1097/gme.0000000000001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Taiwanese women are younger than women in western countries when diagnosed with breast cancer, and many of them are still menstruating. One of many distressing side effects reported by premenopausal women treated for breast cancer are hot flashes (HFs). The purposes of this study were to identify: (1) the trajectories of hot flash (HF) occurrence, frequency, and interference and (2) potential factors associated with HF changes. METHODS Peri- or premenopausal women newly diagnosed with breast cancer scheduled to receive chemotherapy and hormonal therapy were enrolled. HF frequency, HF interference, and other symptoms were measured six times from prechemotherapy to 24 months after chemotherapy. Data were analyzed using hierarchical linear modeling. RESULTS A total of 90 women were eligible for the study. The prechemotherapy occurrence rate of HFs was 7.9%, but rapidly increased to 42.5% immediately after chemotherapy. The change curve of HF frequency and interference appeared quadratic, increasing first and slightly decreasing later. At any time point, increased body mass index (BMI) was associated with both higher HF frequency (P = 0.020) and HF interference (P = 0.002), whereas anxiety (P < 0.001) and loss of sexual desire (P = 0.038) were associated with higher HF interference. Six months after completing chemotherapy, premenopausal women reported significantly higher HF frequency than perimenopausal women (P = 0.041). CONCLUSION A significant proportion of pre- and perimenopausal women experienced HFs after receiving breast cancer treatment. Our findings on HF trajectories can educate patients newly diagnosed with breast cancer. Special attention should be paid to those with increased body mass index changes and those still regularly menstruating.
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Ferreira MN, Ramseier JY, Leventhal JS. Dermatologic conditions in women receiving systemic cancer therapy. Int J Womens Dermatol 2019; 5:285-307. [PMID: 31909148 PMCID: PMC6938835 DOI: 10.1016/j.ijwd.2019.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/12/2019] [Accepted: 10/13/2019] [Indexed: 12/24/2022] Open
Abstract
As advances in cancer therapies have improved cancer-related survival, novel therapeutics have also introduced a variety of dermatologic toxicities, and an increased number of patients are living with these sequalae. Women with cancer in particular experience a spectrum of dermatologic conditions that affect their skin, hair, nail, and mucosal surfaces. Studies have shown that these toxic effects can significantly affect quality of life and alter a woman's self-image, cultural identity, femininity, sexuality, and mental health. In severe instances, dermatologic toxicities may even disrupt cancer therapy and can therefore affect overall survival and treatment response. In this article, we review the dermatologic adverse effects from traditional chemotherapy, targeted therapy, immune checkpoint inhibitors, and endocrine therapy that disproportionately affect women. The timely diagnosis and management of these dermatologic conditions is crucial in the multidisciplinary care of women with cancer.
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Efficacy of Low-Dose Paroxetine for the Treatment of Hot Flushes in Surgical and Physiological Postmenopausal Women: Systematic Review and Meta-Analysis of Randomized Trials. ACTA ACUST UNITED AC 2019; 55:medicina55090554. [PMID: 31480427 PMCID: PMC6780738 DOI: 10.3390/medicina55090554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Hot flushes and sleep disturbances are the most common vasomotor symptoms (VMS) reported by postmenopausal women. Hormonal treatment is to date referred to as the gold standard approach but not suitable for all the patients. Alternative treatments are needed in case of a contraindication to menopausal hormone therapy (MHT), adverse side effects, and poor compliance. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS. Nonetheless, few trials with low consensus are available about this topic. In this review, we aimed to evaluate the efficacy of low-dose paroxetine therapy in the treatment of vasomotor hot flushes and night sleep disturbances in postmenopausal women. Materials and Methods: We performed an electronic search from the beginning of all databases to July 2019. All results were then limited to a randomized trial. Restrictions for language or geographic location were not utilized. Inclusion criteria were randomized clinical trials of physiological or surgical postmenopausal women experiencing hot flushes and sleep disturbances who were randomized to either low-dose paroxetine or placebo (i.e., formulations without active ingredients). The primary outcome evaluated was the mean weekly reduction of hot flushes. Results: Five randomized clinical trials, including 1482 postmenopausal women, were analyzed. Significant heterogeneity (I2 = 90%) between studies was noted. Hot flushes episodes were significantly reduced in the treatment arm compared to placebo (mean difference (MD) −7.97 [−10.51, −5.92] episodes/week). Results on the improvement on sleep were limited by being reported in only two studies; however, no significant reduction of night-time awakenings was observed (MD, −0.40 awakenings/night [−1.38, 0.58 CI]). Conclusions: Low-dose paroxetine is an effective treatment for vasomotor menopause symptoms, including hot flushes.
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Quantitative comparison of drug efficacy in treating hot flashes in patients with breast cancer. Breast Cancer Res Treat 2018; 173:511-520. [PMID: 30390215 DOI: 10.1007/s10549-018-5029-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/26/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study aimed to quantitatively evaluate drug efficacy and identify relevant factors that affect the relief of hot flashes in patients with breast cancer. METHODS A comprehensive literature search was performed using public databases. Randomized clinical studies on drug therapy for the treatment of hot flashes in patients with breast cancer were identified. A time-effect model was established, and crucial pharmacodynamic parameters, such as maximal efficacy (Emax) and onset time (ET50), were used to reflect the differences in efficacy among the drugs. RESULTS Eighteen studies involving 5178 subjects were included. It was found that the baseline of hot flashes was an important factor for the Emax value of drugs. After correcting the baseline to the level of eight times per day, the Emax values of progesterone, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors (SSRIs/SNRIs), neuroleptic agents, tibolone, phytoestrogen, other types of drugs, and placebo were 8.3(95%CI 6.8, 9.9),5.1(95%CI 4.4, 5.7), 4.4(95%CI 3.6, 5.3), 4.0(95%CI 3.6, 4.3), 3.4(95%CI 2.4, 4.3), 2.5(95%CI 0.8, 4.2), and 2.7(95%CI 2.1, 3.3), respectively. The ET50 of all the drugs were approximately 2-2.5 weeks, which was obviously longer than that of the placebo (1.2 weeks). When compared with the previously reported efficacy characteristics in natural menopausal women, no significant difference was found between the two populations. CONCLUSIONS Progesterone showed the highest efficacy, followed by SSRIs/SNRIs, neuroleptic agents, and tibolone, while phytoestrogen and other types of drugs showed no efficacy advantages. There is a significant association between the baseline of hot flashes and drug efficacy, while there was no significant difference between breast cancer patients and natural menopausal women.
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Kaur N, Gupta A, Sharma AK, Jain A. Survivorship issues as determinants of quality of life after breast cancer treatment: Report from a limited resource setting. Breast 2018; 41:120-126. [PMID: 30029054 DOI: 10.1016/j.breast.2018.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Quality of life (QOL) in breast cancer survivors is affected by various long term sequelae of breast cancer treatment. The present study was conducted with the objectives to estimate prevalence of various survivorship issues, and to identify those which are most predictive of limitations in QOL after completion of primary therapy. MATERIAL &METHODS This study was conducted in 230 breast cancer survivors (BCs) and 112 controls at an academic centre in Northern India. Assessment of QOL was done by SF-36 and FACT-B questionnaires. Survivorship issues were noted from a checklist of 14 commonly reported symptoms. Main outcome measures were (1) frequencies of survivorship issues and QOL scores among three groups of survivors divided on the basis of time elapsed since treatment (<2, 2-5, and >5 year follow up) (2) Issues most predictive of limitations in QOL, identified by stepwise logistic regression analysis. RESULTS Longer term BCs showed higher QOL scores as compared to those in early follow up. However their QOL scores remained poorer compared to healthy women. The most prevalent survivorship issues were fatigue (60%), restriction of shoulder movement (59.6%), body and joint pain (63.5%), chemotherapy induced cessation of menstruation (73.3%) and loss of sexual desire (60%). Issues which had maximum impact on QOL scores were emotional distress (r = -11.375), fatigue (r = -9.27) and premature menopause (r = -2.085) and its related symptoms. CONCLUSION Management of these issues should be priority areas for supportive care, especially in settings with limited resource.
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Affiliation(s)
- Navneet Kaur
- Department of Surgery, UCMS & GTB Hospital, Delhi, India.
| | - Arun Gupta
- Department of Surgery, UCMS & GTB Hospital, Delhi, India.
| | - Arun Kumar Sharma
- Department of Community Medicine, UCMS & GTB Hospital, Delhi, India.
| | - Asmita Jain
- Radiation Oncologist, Delhi State Cancer Institute, India.
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Reeves KW, Pennell M, Foraker RE, Crandall CJ, Stefanick M, Paskett ED. Predictors of vasomotor symptoms among breast cancer survivors. J Cancer Surviv 2018; 12:379-387. [PMID: 29427202 PMCID: PMC5955842 DOI: 10.1007/s11764-018-0677-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 01/26/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Vasomotor symptoms (VMS) are a common side effect of breast cancer treatment, yet modifiable factors that may predict VMS among breast cancer survivors are unknown. METHODS We estimated multivariable-adjusted odds ratios and 95% confidence intervals (aOR, 95% CI) for predictors of VMS among 3595 breast cancer survivors enrolled in the Life and Longevity after Cancer (LILAC) study, an ancillary study of the Women's Health Initiative (WHI). RESULTS VMS post-diagnosis were reported by 790 (22.0%) participants. Risk of VMS after diagnosis was positively associated with prior chemotherapy (aOR 1.80, 95% CI 1.21-2.68) and adjuvant hormone therapy (aOR 2.73, 95% CI 2.08-3.58), postmenopausal hormone therapy use (aOR 1.67, 95% CI 1.30-2.13), prior VMS (aOR 2.20, 95% CI 1.73-2.80), bilateral oophorectomy (aOR 1.77, 95% CI 1.37-2.27), and baseline antidepressant use (aOR 1.49, 1.06-2.09). VMS post-diagnosis were less likely among younger women (aOR 0.94, 95% CI 0.93-0.96), women younger at menopause (aOR 0.98, 95% CI 0.97-1.00), women with more time since diagnosis (aOR 0.92, 95% CI 0.90-0.94), and diabetics (aOR 0.45, 95% CI 0.21-0.95). Metabolic syndrome was not associated with post-diagnosis VMS (aOR 0.76, 95% CI 0.45-1.28). CONCLUSIONS VMS following breast cancer diagnosis was related to a number of modifiable factors, but was unrelated to metabolic syndrome. IMPLICATIONS FOR CANCER SURVIVORS Identification of factors that predispose women to VMS following a breast cancer diagnosis may allow clinicians to recognize and address VMS in the subset of women who are most likely to experience such symptoms.
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Affiliation(s)
- Katherine W Reeves
- Department of Biostatistics and Epidemiology, University of Massachusetts, 411 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA.
| | - Michael Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Randi E Foraker
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Carolyn J Crandall
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Marcia Stefanick
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Electra D Paskett
- The Division of Cancer Prevention and Control, Ohio State University, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Han JA, Choi SY, Lee S. Effects of Menopausal Symptoms and Depression on the Quality of Life of Premenopausal Women With Breast Cancer in Korea. J Transcult Nurs 2018; 30:8-16. [PMID: 29690858 DOI: 10.1177/1043659618771475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION As breast cancer survivors have increased, improving quality of life of the survivors becomes an important issue. The purpose of this study was to examine relationships among menopausal symptoms, depression, and quality of life and to identify the factors affecting the quality of life in premenopausal women with breast cancer. METHOD This was a descriptive, correlational study using structured questionnaires for 90 premenopausal women with breast cancer attending the outpatient clinic of a tertiary hospital in Korea. RESULTS Menopausal symptoms ( r = -0.770, p < .001) and depression ( r = -0.715, p < .001) negatively affected the participants' quality of life. The major factors affecting quality of life were employment ( t = -2.065, p = .042), depression ( t = -2.375, p = .020), and menopausal symptoms ( t = -3.863, p < .001). Menopausal symptoms were the strongest negative factor (β = -.508) affecting quality of life. DISCUSSION AND CONCLUSIONS Developing nursing intervention congruent with the culture of Korean breast cancer women with treatment-induced menopausal symptoms is a high priority.
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Affiliation(s)
- Jeong Ae Han
- 1 Gyeongsang National University Hospital, Jinju, Gyeongnam, Republic of Korea
| | - So Young Choi
- 2 College of Nursing, Gyeongsang National University, Jinju, Gyeongnam, Republic of Korea
| | - Seonah Lee
- 3 College of Nursing, Chonnam National University, Gwangju, Republic of Korea
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Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial. Menopause 2018; 24:517-523. [PMID: 27875389 DOI: 10.1097/gme.0000000000000779] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Sleep disturbance is a major consequence of hot flashes among breast cancer survivors. This study evaluated the effects of electro-acupuncture (EA) versus gabapentin (GP) for sleep disturbances among breast cancer survivors experiencing daily hot flashes. METHODS We analyzed data from a randomized controlled trial involving 58 breast cancer survivors experiencing bothersome hot flashes at least two times per day. Participants were randomly assigned to receive 8 weeks of EA or daily GP (total dose of 900 mg/d). The primary outcome was change in the total Pittsburgh Sleep Quality Index (PSQI) score between groups at week 8. Secondary outcomes include specific PSQI domains. RESULTS By the end of treatment at week 8, the mean reduction in PSQI total score was significantly greater in the EA group than the GP group (-2.6 vs -0.8, P = 0.044). The EA also had improved sleep latency (-0.5 vs 0.1, P = 0.041) and sleep efficiency (-0.6 vs 0.0, P = 0.05) compared with the GP group. By week 8, the EA group had improved sleep duration, less sleep disturbance, shorter sleep latency, decreased daytime dysfunction, improved sleep efficiency, and better sleep quality (P < 0.05 for all) compared with baseline, whereas the GP group improved in duration and sleep quality only (P < 0.05). CONCLUSIONS Among women experiencing hot flashes, the effects of EA are comparable with GP for improving sleep quality, specifically in the areas of sleep latency and efficiency. Larger randomized controlled trials with longer follow-ups are needed to confirm this preliminary finding.
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Bao T, Li Q, DeRito JL, Seluzicki C, Im EO, Mao J. Barriers to Acupuncture Use Among Breast Cancer Survivors: A Cross-Sectional Analysis. Integr Cancer Ther 2018; 17:854-859. [PMID: 29338443 PMCID: PMC6142082 DOI: 10.1177/1534735418754309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction: Increasing evidence suggests that acupuncture may be
helpful to manage common symptoms and treatment side effects among breast cancer
(BC) survivors. Acupuncture usage among BC survivors remains low with little
known about the barriers to its utilization. We evaluated perceived barriers to
acupuncture use among BC survivors and explored the sociodemographic variations
of such barriers. Methods: We conducted a cross-sectional analysis
at an urban academic cancer center on 593 postmenopausal women with a history of
stage I-III hormone receptor-positive BC who were taking or had taken an
aromatase inhibitor. We used the modified Attitudes and Beliefs about
Complementary and Alternative Medicine instrument to evaluate patients’
perceived barriers to acupuncture. Multiple linear regression analysis was
performed to determine sociodemographic factors associated with perceived
barrier scores. Results: The most common barriers were lack of
knowledge about acupuncture (41.6%), concern for lack of insurance coverage
(25.0%), cost (22.3%), and difficulty finding qualified acupuncturists (18.6%).
Compared with whites, minority patients had higher perceived barriers to use
acupuncture (β coefficient = 1.63, 95% confidence interval = 0.3-2.9,
P = .013). Patients with lower education had higher
barriers to use acupuncture (β coefficient = 4.23, 95% confidence interval =
3.0-5.4, P < .001) compared with patients with college
education or above. Conclusion: Lack of knowledge and concerns for
insurance coverage and cost are the common barriers to acupuncture use among BC
survivors, especially among minority patients with lower education. Addressing
these barriers may lead to more equitable access to acupuncture treatment for BC
survivors from diverse backgrounds.
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Affiliation(s)
- Ting Bao
- 1 Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qing Li
- 1 Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Jun Mao
- 1 Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Baker FC, de Zambotti M, Colrain IM, Bei B. Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nat Sci Sleep 2018; 10:73-95. [PMID: 29445307 PMCID: PMC5810528 DOI: 10.2147/nss.s125807] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A substantial number of women experience sleep difficulties in the approach to menopause and beyond, with 26% experiencing severe symptoms that impact daytime functioning, qualifying them for a diagnosis of insomnia. Here, we review both self-report and polysomnographic evidence for sleep difficulties in the context of the menopausal transition, considering severity of sleep complaints and links between hot flashes (HFs) and depression with poor sleep. Longitudinal population-based studies show that sleep difficulties are uniquely linked with menopausal stage and changes in follicle-stimulating hormone and estradiol, over and above the effects of age. A major contributor to sleep complaints in the context of the menopausal transition is HFs, and many, although not all, HFs are linked with polysomnographic-defined awakenings, with HF-associated wake time contributing significantly to overall wakefulness after sleep onset. Some sleep complaints may be comorbid with depressive disorders or attributed to sleep-related breathing or movement disorders, which increase in prevalence especially after menopause, and for some women, menopause, age, and environmental/behavioral factors may interact to disrupt sleep. Considering the unique and multifactorial basis for sleep difficulties in women transitioning menopause, we describe clinical assessment approaches and management options, including combination treatments, ranging from cognitive behavioral therapy for insomnia to hormonal and nonhormonal pharmacological options. Emerging studies suggest that the impact of severe insomnia symptoms could extend beyond immediate health care usage and quality of life issues to long-term mental and physical health, if left untreated in midlife women. Appropriate treatment, therefore, has immediate benefit as well as advantages for maintaining optimal health in the postmenopausal years.
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Affiliation(s)
- Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA.,Brain Function Research Group, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA, USA.,Melbourne School of Psychological Sciences, University of Melbourne
| | - Bei Bei
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University.,Centre for Women's Mental Health, Department of Psychiatry, University of Melbourne, Royal Women's Hospital, Melbourne, VIC, Australia
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Late breast cancer treatment-related symptoms and functioning: associations with physical activity adoption and maintenance during a lifestyle intervention for rural survivors. Breast Cancer Res Treat 2017; 168:755-761. [PMID: 29273954 DOI: 10.1007/s10549-017-4603-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Physical activity may be difficult for survivors with poorer functioning following primary treatment. The study examined whether late symptoms of breast cancer treatment impact PA adoption (0-6 months) and maintenance (6-18 months) during a weight management intervention, and whether late symptoms influence PA when accounting for overall functioning. METHODS Secondary analyses were conducted using a sample of survivors participating in a weight management intervention and who provided valid weight and accelerometer data at baseline and 6 months (N = 176). The Breast Cancer Prevention Trial Symptom Checklist (BCPT) assessed late treatment-related symptoms. SF-12 Physical Component Scale (PCS) and Mental Component Scale (MCS) scores assessed functioning. RESULTS Change in bouted moderate to vigorous physical activity (MVPA) min/week from baseline to 6 months was not associated with BCPT scales (all p values > 0.05). When adding SF-12 scores to the model, change in bouted MVPA min/week was significantly associated with the PCS (p = 0.045). Change in MVPA min/week from 6 to 18 months was significantly associated with cognitive symptoms (p = 0.004), but not musculoskeletal or vasomotor symptoms (p values > 0.05). When adding 6-month SF-12 scores to the model, MVPA min/week was significantly associated with PCS (p = 0.001) and MCS (p = 0.028); however, BCPT cognitive problems score became non-significant (p > 0.05). CONCLUSIONS Poorer physical functioning was associated with lower PA adoption, and poorer mental and physical functioning was associated with lower maintenance of PA, while late symptoms generally were not. Interventionists should consider level of functioning when identifying individual PA goals during weight management interventions.
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Gaitanidis A, Alevizakos M, Pitiakoudis M, Wiggins D. Trends in incidence and associated risk factors of suicide mortality among breast cancer patients. Psychooncology 2017; 27:1450-1456. [PMID: 29055289 DOI: 10.1002/pon.4570] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Breast cancer patients are associated with an increased risk for committing suicide. The purpose of this study was to study the trends in the incidence of suicide mortality and identify pertinent risk factors among patients with breast cancer. METHODS A retrospective examination of the Surveillance Epidemiology and End Results database between years 1973 and 2013 was performed. RESULTS Overall, 474 128 patients were identified of which 773 had committed suicide. There were no significant differences in the incidence of suicide mortality over the last 3 decades (1984-1993: 0.14%, 1994-2003: 0.16%, 2004-2013: 0.17%, P = 0.173). On logistic regression, younger age (<30 y: OR 6.34, 95% CI: 1.98-20.33, P = 0.002; 30-49 y: OR 10.64, 95% CI: 7.97-14.2, P < 0.001; 50-69 y: OR 4.7, 95% CI: 3.64-6.07, P < 0.001), male sex (OR 4.34, 95% CI: 2.57-7.31, P < 0.001), nonwhite-nonblack race (OR 1.39, 95% CI: 1.01-1.91, P = 0.046), marital status (single: OR 1.35, 95% CI: 1.04-1.76, P = 0.024; separated/divorced/widowed: OR 1.25, 95% CI: 1.01-1.55, P = 0.043), undergoing surgery (OR 2.13, 95% CI: 1.23-3.67, P = 0.007), and short-time elapsed from diagnosis (first year: OR 4.67, 95% CI: 3.39-6.42, P < 0.001; second year: OR 2.35, 95% CI: 1.69-3.27, P < 0.001) were independent risk factors of suicide mortality. CONCLUSIONS There have been no identifiable improvements in preventing suicide mortality in the United States. Younger age, male sex, race, marital status, and undergoing surgery are independent risk factors for committing suicide, especially in the first year after diagnosis.
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Affiliation(s)
- Apostolos Gaitanidis
- Department of Surgery, Democritus University of Thrace Medical School, Alexandroupoli, Greece
| | - Michail Alevizakos
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michail Pitiakoudis
- Department of Surgery, Democritus University of Thrace Medical School, Alexandroupoli, Greece
| | - Doreen Wiggins
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Roberts RL, Na H, Yek MH, Elkins G. Hypnosis for Hot Flashes and Associated Symptomsin Women with Breast Cancer. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2017; 60:123-136. [PMID: 28891773 DOI: 10.1080/00029157.2017.1334622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Women with breast cancer experience a host of physical and psychological symptoms, including hot flashes, sleep difficulties, anxiety, and depression. Therefore, treatment for women with breast cancer should target these symptoms and be individualized to patients' specific presentations. The current article reviews the common symptoms associated with breast cancer in women, then examines clinical hypnosis as a treatment for addressing these symptoms and improving the quality of life of women with breast cancer. Clinical hypnosis is an effective, nonpharmaceutical treatment for hot flashes and addressing many symptoms typically experienced by breast cancer patients. A case example is provided to illustrate the use of clinical hypnosis for the treatment of hot flashes with a patient with breast cancer.
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Affiliation(s)
| | - Hyeji Na
- Baylor University, Waco, Texas, USA
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Denlinger CS, Sanft T, Baker KS, Baxi S, Broderick G, Demark-Wahnefried W, Friedman DL, Goldman M, Hudson M, Khakpour N, King A, Koura D, Kvale E, Lally RM, Langbaum TS, Melisko M, Montoya JG, Mooney K, Moslehi JJ, O'Connor T, Overholser L, Paskett ED, Peppercorn J, Rodriguez MA, Ruddy KJ, Silverman P, Smith S, Syrjala KL, Tevaarwerk A, Urba SG, Wakabayashi MT, Zee P, Freedman-Cass DA, McMillian NR. Survivorship, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2017; 15:1140-1163. [PMID: 28874599 PMCID: PMC5865602 DOI: 10.6004/jnccn.2017.0146] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Many cancer survivors experience menopausal symptoms, including female survivors taking aromatase inhibitors or with a history of oophorectomy or chemotherapy, and male survivors who received or are receiving androgen-ablative therapies. Sexual dysfunction is also common in cancer survivors. Sexual dysfunction and menopause-related symptoms can increase distress and have a significant negative impact on quality of life. This portion of the NCCN Guidelines for Survivorship provide recommendations for screening, evaluation, and treatment of sexual dysfunction and menopausal symptoms to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period.
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Sturdee DW, Hunter MS, Maki PM, Gupta P, Sassarini J, Stevenson JC, Lumsden MA. The menopausal hot flush: a review. Climacteric 2017; 20:296-305. [DOI: 10.1080/13697137.2017.1306507] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- D. W. Sturdee
- Department of Gynaecology, Solihull Hospital, Birmingham, UK
| | - M. S. Hunter
- Unit of Psychology, Institute of Psychiatry (at Guy's), King's College London, London, UK
| | - P. M. Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - P. Gupta
- Women's Unit, Solihull Hospital, Birmingham Heartlands & Solihull NHS Trust, Birmingham, UK
| | - J. Sassarini
- Department of Obstetrics & Gynaecology, University of Glasgow, College of Medicine, Western Infirmary, Glasgow, UK
| | - J. C. Stevenson
- National Heart & Lung Institute, Royal Brompton Hospital, London, UK
| | - M. A. Lumsden
- Reproductive and Maternal Medicine, University of Glasgow, Glasgow, UK
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Mustafa Ali M, Moeller M, Rybicki L, Moore HCF. Prevalence and correlates of patient-reported symptoms and comorbidities in breast cancer survivors at a tertiary center. J Cancer Surviv 2017; 11:743-750. [DOI: 10.1007/s11764-017-0612-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/27/2017] [Indexed: 12/28/2022]
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Marsden J. The menopause specialist and breast cancer survivorship. Post Reprod Health 2016; 22:147-154. [PMID: 27633313 DOI: 10.1177/2053369116668738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Due to improvement in survival rates, breast cancer is the most prevalent female malignancy in Europe and hence the management of breast cancer survivorship is garnering significant attention. Most of the health issues associated with treatment result from iatrogenic estrogen deficiency and recognition of this in the recent National Institute for Health and Care Excellence (NICE) menopause guidance has resulted in the recommendation for referral of breast cancer patients to menopause specialists for appropriate counselling about and management of early menopause, estrogen deficiency symptoms and lifestyle risk modification. The latter has significant implications for both all-cause and breast cancer-specific mortality. Extending the role of health professionals with an interest in menopause to provide such service for breast cancer patients is necessary as this is not within the remit or expertise of specialist breast cancer teams; however it will in turn, require menopause specialists to expand and regularly update their knowledge of breast cancer and its treatment.
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Affiliation(s)
- Jo Marsden
- King's College Hospital, NHS Foundation Trust, London, UK
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Poor sleep quality, depression and hope before breast cancer surgery. Appl Nurs Res 2016; 34:7-11. [PMID: 28342628 DOI: 10.1016/j.apnr.2016.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/11/2016] [Accepted: 11/12/2016] [Indexed: 01/04/2023]
Abstract
AIM This study aims to identify the predictors of poor sleep quality and the associations between depression, hope and sleep in a sample of 156 women with breast cancer prior to surgery. BACKGROUND The care and treatment of breast cancer is among the most important scientific challenges in public health. Sleep disturbances and depression are the important complaint of cancer patients. However, they are often neglected. Patients diagnosed with breast cancer also experience prejudice, fear of death, suffering, mutilation, fear of lymphedema, as well as feelings of social devaluation leading to hopelessness Several studies point to hope as an effective strategy to help patients cope with difficulties and achieve their goals, especially patients with cancer. METHODS This is a report of baseline data extracted from a longitudinal study. DATA COLLECTION TOOLS Pittsburgh Sleep Quality Index, Beck Depression Inventory, and the Herth Hope Index. Data were analyzed with the Spearman's Rank Correlation test and Multiple Logistic Regression analysis. RESULTS The majority of women had tumors in initial stages (78.7%), reported poor sleep quality (58.9%), and had moderate to severe or severe depression (27.2%). Significant correlations were found between hope and depression (Spearman r=-0.4341), and between sleep quality and depression (Spearman r=0.3938). Significant associations were found between poor sleep quality and pain, symptoms of menopause and depression. Depression and symptoms of menopause were independent predictors of poor sleep quality. CONCLUSION The evaluation of sleep quality, depression and hope should be implemented in clinical practice. Increased hope lessens depression and may positively affect sleep quality, all of which improves quality of life for women with breast cancer.
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