Prevalence of pain in patients with breast cancer post-treatment: A systematic review

Returning to Work after Breast Cancer: A One-Year Mixed-Methods Study

Breast cancer (BC) is the most common invasive neoplasm and affects many women of working age. The return to work (RTW) of female survivors (BCSs) is associated with a better quality of life and longer survival. A tailored intervention to promote RTW was launched in 2022. A year later, the women were contacted to find out if RTW had occurred regularly and what their health conditions were compared to the baseline. BCSs reported excessive fatigue, poor sleep quality, anxiety, depression and reduced work ability; these parameters had not improved significantly compared to the baseline. Thematic analysis of the interviews confirmed the presence of personal, company, and societal factors that could hinder or favor RTW. The interviews demonstrated that, even in an economically developed country that has provided numerous benefits for BCSs, protection is not always effective. Personalized intervention seems necessary to complete the process of reintegrating BCSs into their future working careers.

Breast Cancer Surgery: A Qualitative Exploration of Concerns Over Time

INTRODUCTION

As outcomes for breast cancer patients improve, addressing the side effects and distress of treatment can optimize survivorship. Although distress in breast cancer is well known in literature, there is a lack of information on how these concerns change through the phases of the cancer care continuum. Therefore, this study investigates the longitudinal trajectory of worry in patients with nonmetastatic breast cancer.

METHODS

Female patients with newly diagnosed stage I-III breast cancer comprised a mixed-methods, longitudinal study at a cancer center from June 2019 to June 2023. Patients completed an open-ended survey regarding their top three concerns. Responses were obtained before surgery and two weeks, three, six, nine months, and one year postoperatively. Responses were qualitatively coded and analyzed to determine themes of cancer-related distress.

RESULTS

Participants (n = 262) were aged an average 57.53 y (±12.54), 65.8% had stage I disease at diagnosis, and 91.1% were White. Responses revealed that patients' top three sources of concerns varied by treatment phase. Overall, patients were worried about their cancer diagnosis and the risk of recurrence. Preoperatively, patients were worried about treatment timeline, while postoperative concerns transitioned to physical appearance and surgical side effects.

CONCLUSIONS

Breast cancer patients consistently reported worries about cancer diagnosis, recurrence, and metastasis as well as the side effects and fear of treatments. However, patient worry appeared to be intrinsically linked with their treatment phase. Therefore, support and interventions should be catered to reflect the changing patterns of patients' sources of distress to optimize breast cancer patients' quality of life.

Effectiveness of Virtual Reality in the Management of Anxiety and Pain Peri-Treatment for Breast Cancer: A Systematic Review and Meta-Analysis

BACKGROUND

Breast cancer is the second most common cancer in humans. Its therapy procedures such as breast biopsy can cause anxiety and persistent pain in patients. Virtual reality (VR) has been applied to promote comfort in various populations. However, the effectiveness of VR in relieving pain and anxiety in patients undergoing breast cancer treatment is unclear.

PURPOSE

This study was designed to examine the effect of VR on anxiety and pain in people undergoing treatment for breast cancer.

METHODS

PubMed, Cochrane, Embase, Scopus, Web of Science, and MEDLINE databases were searched for studies involving VR, pain, and anxiety in patients with breast cancer published up to March 2022. The Cochrane Handbook for Systems quality evaluation standard 6.3.0 was followed to assess risk of bias in the identified studies, with the results reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Subsequently, a meta-analysis of the included data was conducted using RevMan 5.3 software.

RESULTS

Six randomized controlled trials and one quasi-experimental study were included. The strength of the evidence ranged from moderate to high. Although VR was found to ameliorate anxiety in patients with breast cancer, only three studies showed statistically significant changes. All of the included studies reported statistically significant improvement in pain levels. In addition, two of the studies reported cybersickness symptoms as a common side effect of VR.

CONCLUSIONS

VR has an important role to play in alleviating pain in patients with breast cancer. However, evidence demonstrating VR's importance in alleviating anxiety symptoms in this population is insufficient. Studies conducted with larger sample sizes and high-quality research methodologies will be necessary to clarify this issue. Clinical nurses should address the potential side effects of VR.

Cognitive impairment following breast cancer treatments: an umbrella review

OBJECTIVES

Cancer-related cognitive impairment (CRCI) refers to a cognitive decline associated with cancer or its treatments. While research into CRCI is expanding, evidence remains scattered due to differences in study designs, methodologies, and definitions. The present umbrella review aims to provide a comprehensive overview of the current evidence regarding the impact of different breast cancer therapies on cognitive functioning, with a particular focus on the interplay among objective cognitive deficits (ie, measured with standardized tests), subjective cognitive concerns, (ie, self-reported), and other mediating psycho-physical factors.

METHODS

The search was made in Pubmed, Embase, and Scopus for articles published until July 2023, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis protocol.

RESULTS

Chemotherapy and endocrine therapy appear consistently associated with CRCI in patients with breast cancer, primarily affecting memory, attention/concentration, executive functioning, and processing speed. Subjective cognitive concerns were often found weakly or not associated with neuropsychological test results, while overall CRCI seemed consistently associated with psychological distress, fatigue, sleep quality, and inflammatory and biological factors.

CONCLUSION

Current evidence suggests that CRCI is common after chemotherapy and endocrine therapy for breast cancer. However, heterogeneity in study designs and the scarcity of studies on more recent treatments such as targeted therapies and immunotherapies, highlight the need for more systematic and harmonized studies, possibly taking into account the complex and multifactorial etiology of CRCI. This may provide valuable insights into CRCI's underlying mechanisms and potential new ways to treat it.

Optimizing exercise prescription during breast cancer rehabilitation in women: Analysis of the load-velocity relationship in the box squat exercise

The aims of this study were to assess (i) the load-velocity relationship during the box squat exercise in women survivors of breast cancer, (ii) which velocity variable (mean velocity [MV], mean propulsive velocity [MPV], or peak velocity [PV]) shows stronger relationship with the relative load (%1RM), and (iii) which regression model (linear [LA] or polynomic [PA]) provides a greater fit for predicting the velocities associated with each %1RM. Nineteen women survivors of breast cancer (age: 53.2 ± 6.9 years, weight: 70.9 ± 13.1 kg, and height: 163.5 ± 7.4 cm) completed an incremental load test up to one-repetition maximum in the box squat exercise. The MV, MPV, and the PV were measured during the concentric phase of each repetition with a linear velocity transducer. These measurements were analyzed by regression models using LA and PA. Strong correlations of MV with %1RM (R2 = 0.903/0.904; the standard error of the estimate (SEE) = 0.05 m.s-1 by LA/PA) and MPV (R2 = 0.900; SEE = 0.06 m.s-1 by LA and PA) were observed. In contrast, PV showed a weaker association with %1RM (R2 = 0.704; SEE = 0.15 m.s-1 by LA and PA). The MV and MPV of 1RM was 0.22 ± 0.04 m·s-1, whereas the PV at 1RM was 0.63 ± 0.18 m.s-1. These findings suggest that the use of MV to prescribe relative loads during resistance training, as well as LA and PA regression models, accurately predicted velocities for each %1RM. Assessing and prescribing resistance exercises during breast cancer rehabilitation can be facilitated through the monitoring of movement velocity.

Personal Resources and Total Pain: Exploring the Multiple Mediation of Fear of Recurrence, Meaning-Making, and Coping in Posttreatment Cancer Patients

BACKGROUND

People with cancer who have completed treatment still experience negative effects, such as an increased risk of experiencing cancer-related pain. Psychological factors tend to influence cancer patients' ability to cope with pain in various dimensions. Although personal resources are an important factor in buffering total pain, still little is known about the intervening variables and underlying mechanisms.

PURPOSE

The current study examined the relationship between psychological flexibility, self-esteem, and total pain, while considering fear of recurrence, meaning-making, and coping as potential mediating factors.

METHODS

Adults (N = 304) who completed medical treatment (radiotherapy, chemotherapy, and combined therapy) participated in this study. They completed questionnaires measuring the aforementioned variables. Structural equation models were used to examine mediation effects.

RESULTS

Psychological flexibility, and partly self-esteem, were negatively related to the dimensions of total pain. However, to a large extent, these relationships were serially and parallelly mediated by fear of recurrence, meaning-making, and emotion-oriented coping.

CONCLUSIONS

Consistent with the meaning-making model, cognitive (meaning-making), and affective (fear of recurrence and emotional coping) factors may be potential mechanisms underlying the association between psychological flexibility, self-esteem, and total pain in posttreatment cancer patients. In this study, they tended to interact in the area of physiological and psychosocial experiences of cancer-related pain.

The Effect of Spiritual Emotional Freedom Technique (SEFT) on Pain Intensity of Advanced Breast Cancer Patients in X Hospital Tangerang

This study aimed to analyze the effect of spiritual emotional freedom techniques (SEFTs) on pain intensity of advanced breast cancer patients. The study used a quasi-experiment design with one pre-posttest group. The sample was selected using a consecutive sampling technique with total of 45 respondents. The respondents were given SEFT intervention for 3 (three) days using set-up, tune-in, and tapping techniques. The evaluation was carried out on the third day after the intervention by measuring the pain intensity using Brief Pain Inventory (BPI). This research used Wilcoxon and ordinal logistic regression for data analysis. The results showed a difference in pain intensity before and after SEFT intervention in patients with advanced breast cancer with a p-value of .001 (p < .05) with a change in intensity from severe to mild pain. This study's novelty is that SEFT intervention can be used as a nonpharmacological therapy for pain management in patients with advanced breast cancer. The limitations are only limited to measuring the patient's pain and less analysis related to the patient's emotional and spiritual problems. The application of SEFT intervention is recommended as a nurse's independent intervention in the management of advanced breast cancer pain.

Exercise Across the Phases of Cancer Survivorship: A Narrative Review

Exercise has long been recognized as an important component of treatment for various diseases. However, the benefits and risks of exercise interventions must be carefully evaluated to ensure the former outweighs the latter. As cancer patients undergo diverse treatment modalities with distinct objectives, a systematic approach partitioning the cancer journey into distinct phases is necessary to inform tailored exercise prescriptions. This narrative review summarizes exercise benefits and mechanisms for cancer patients and survivors across four distinct survivorship periods-before surgery, after surgery and before adjuvant treatment, during nonsurgical treatment (adjuvant and neoadjuvant), and during extended survival. In summary, exercise reduces the risks of complications and declines in physical functioning while improving fatigue, quality of life, and the ability to manage treatment effects. Although additional research is warranted, existing evidence is sufficient to integrate exercise into clinical oncology practice and cancer survivorship programs.

Investigation of the analgesic effects of rhomboid intercostal and pectoral nerve blocks in breast surgery

PURPOSE

The objective of this study was to examine the hypothesis that the opioid consumption of patients who receive a rhomboid intercostal block (RIB) or a pectoral nerve (PECS) block after unilateral modified radical mastectomy (MRM) surgery is less than that of patients who receive local anesthetic infiltration.

METHODS

Eighty-one female patients aged 18-70 years who underwent unilateral MRM surgery with general anesthesia were randomly allocated to three groups. The first group received an RIB with 30 ml of 0.25% bupivacaine on completion of the surgery, and the second received a PECS block with the same volume and concentration of local anesthetic. In the third (control) group, local infiltration was applied to the wound site with 30 ml of 0.25% bupivacaine at the end of the surgery. The patients' total tramadol consumption, quality of recovery (QoR), postoperative pain scores, and sleep quality were evaluated in the first 24 h postoperatively.

RESULTS

Both the RIB (58.3 ± 22.8 mg) and PECS (68.3 ± 21.2 mg) groups had significantly lower tramadol consumption compared to the control group (92.5 ± 25.6 mg) (p < 0.001 and p = 0.002, respectively). Higher QoR scores were observed in the RIB and PECS groups than the control group at 6 h post-surgery. The lowest pain values were observed in the RIB group. The sleep quality of the patients in the RIB and PECS groups was better than that of the control group (p < 0.001).

CONCLUSION

Compared to local anesthetic infiltration, the RIB and PECS blocks applied as part of multimodal analgesia in MRM surgery reduced opioid consumption in the first 24 h and improved the quality of recovery in the early period.

Pain in Long-Term Cancer Survivors: Prevalence and Impact in a Cohort Composed Mostly of Breast Cancer Survivors

Cancer survival is becoming more common which means that there is now a growing population of cancer survivors, in whom pain may be common. However, its prevalence has hardly been addressed systematically. We aimed to assess the prevalence and explore the pathophysiology and impact of pain on health outcomes in cancer survivors. We conducted a retrospective-prospective cohort study in cancer-free patients diagnosed with cancer at least five years before the study start date. We used multivariable regression to establish the association of patients' cancer characteristics with pain, and then the association of patients' pain features with health outcomes and related symptoms. Between March and July 2021, 278 long-term cancer survivors were evaluated. Almost half of them (130/278, 46.8%) had pain, of whom 58.9% had a probable neuropathic component, but only 18 (13.8%) were taking specific drugs for neuropathic pain. A history of surgery-related pain syndrome in breast cancer patients was more than twice as frequent in the pain cohort. Post-chemotherapy and post-radiotherapy pain syndromes were uncommon. Pain was associated with lower QoL, emotional functioning, professional performance, and disability scores. Pain is a frequent health determinant in cancer survivors. Referral to specialised pain services may be a reasonable move in some cases.

Effects of nonpharmacological interventions on symptom clusters in breast cancer survivors: A systematic review of randomized controlled trials

Objective

To summarize nonpharmacological interventions and assess their effects on symptom clusters and quality of life (QoL) in breast cancer (BC) survivors.

Methods

Seven English and three Chinese electronic databases and three clinical trial registries were searched from January 2001 to August 2023. A narrative approach was applied to summarize the data. The primary outcome was symptom clusters measured by any patient-reported questionnaires, and the secondary outcomes were QoL and intervention-related adverse events.

Results

Six published articles, one thesis, and one ongoing trial involving 625 BC survivors were included. The fatigue-sleep disturbance-depression symptom cluster was the most frequently reported symptom cluster among BC survivors. The nonpharmacological interventions were potentially positive on symptom clusters and QoL among the BC survivors. However, some of the included studies exhibited methodological concerns (e.g., inadequate blinding and allocation concealment). The intervention protocols in only two studies were developed following a solid evidence-based approach. Adverse events related to the targeted interventions were reported in six included studies, with none performing a causality analysis.

Conclusions

The nonpharmacological interventions could be promising strategies for alleviating symptom clusters in BC survivors. Future studies should adopt rigorously designed, randomized controlled trials to generate robust evidence.

Systematic review registration

INPLASY202380028.

Percutaneous electrical nerve stimulation in post-mastectomy neuropathic pain: A case report

Post-mastectomy pain syndrome (PMPS) is a type of chronic postsurgical pain that can be severe, debilitating and frequently encountered in clinical practice. Multiple studies have focused on prevention, identifying risk factors and treating this condition. Nonetheless, PMPS remains a complex condition to treat effectively. In this case report, we describe the use of percutaneous electrical nerve stimulation in a breast cancer patient who experienced PMPS refractory to conventional treatments.

The use of written guides to empower breast cancer survivors in their management of chronic pain: A realist evaluation

OBJECTIVE

Many breast cancer survivors experience long-term complaints following treatment, such as pain, which are often not addressed in a sufficient way. To empower survivors in talking about their pain and related complaints and in searching for appropriate support when needed, we developed two written guides. With this study, we aimed to pilot test the guides and gain insight into the implementation process and influencing mechanisms through the perspective of a realist evaluation.

METHODS

Nine survivors were interviewed at two time points (i.e., post-intervention and at three-month follow-up). The data were thematically analysed and categorized into a context-implementation-mechanisms-outcomes hypothesis.

RESULTS

The guides empowered the participants to discuss pain with medical specialists and initiate support-seeking behaviour through underlying mechanisms such as awareness, acknowledgment, hope, reduced isolation, and motivation. Nonetheless, mechanisms and outcomes differed according to a survivor's unique context.

CONCLUSION

Written guides can offer a feasible way to empower survivors in their management of chronic pain. However, a one-size-fits-all approach is not desirable and other strategies might be necessary.

PRACTICE IMPLICATIONS

It is pivotal to engage survivors as well as professionals in adopting new interventions. As such, the role of nurses in introducing and endorsing the guides should be further explored.

Apigenin promotes apoptosis of 4T1 cells through PI3K/AKT/Nrf2 pathway and improves tumor immune microenvironment in vivo

The 2022 US Cancer Statistics show that breast cancer is one of the most common cancers in women. Epidemiology has shown that adding flavonoids to the diet inhibits cancers that arise in particular women, such as cervical cancer, ovarian cancer, and breast cancer. Although there have been research reports on apigenin (API) and breast cancer, its anti-tumor effect and potential mechanism on breast cancer have not yet been clarified. Therefore, in this study, we used 4T1 cells and a 4T1 xenograft tumor mouse model to investigate the antitumor effect of API on breast cancer and its underlying mechanism. In vitro, we used MTT, transwell, staining, and western blotting to investigate the inhibitory effect of apigenin on 4T1 and the underlying molecular mechanism. In vivo by establishing a xenograft tumor model, using immunohistochemistry, and flow cytometry to study the inhibitory effect of apigenin on solid breast tumors and its effect on the tumor immune microenvironment. The results showed that API can induce breast cancer cell apoptosis through the PI3K/AKT/Nrf2 pathway and can improve the tumor immune microenvironment in mice with breast tumors, thereby inhibiting the growth of breast cancer. Thus, API may be a promising agent for breast cancer treatment.

Effect of perceived injustice-targeted pain neuroscience education compared with biomedically focused education in breast cancer survivors: a study protocol for a multicentre randomised controlled trial (BCS-PI trial)

INTRODUCTION

Current treatments for pain in breast cancer survivors (BCSs) are mostly biomedically focused rather than biopsychosocially driven. However, 22% of BCSs with pain are experiencing perceived injustice, which is a known predictor for adverse pain outcomes and opioid prescription due to increased maladaptive pain behaviour. Educational interventions such as pain neuroscience education (PNE) are suggested to target perceived injustice. In addition, motivational interviewing can be an effective behavioural change technique. This trial aims to examine whether perceived injustice-targeted PNE with the integration of motivational interviewing is superior to biomedically focused pain education in reducing pain after 12 months in BCS with perceived injustice and pain. In addition, improvements in quality of life, perceived injustice and opioid use are evaluated, and a cost-effectiveness analysis will finally result in a recommendation concerning the use of perceived injustice-targeted PNE in BCSs with perceived injustice and pain.

METHODS AND ANALYSIS

This two-arm multicentre randomised controlled trial will recruit female BCS (n=156) with pain and perceived injustice. Participants will be randomly assigned to perceived injustice-targeted PNE or biomedically focused pain education in each centre. Both interventions include an online session, an information leaflet and three one-to-one sessions. The primary outcome (pain), secondary outcomes (quality of life, perceived injustice and outcomes for cost-effectiveness analysis) and explanatory outcomes (pain phenotyping, sleep, fatigue and cognitive-emotional factors) will be assessed at baseline and at 0, 6, 12 and 24 months postintervention using self-reported questionnaires online. Treatment effects over time will be evaluated using linear mixed model analyses. Additionally, a cost-utility analysis will be done from a healthcare payer and societal perspective.

ETHICS AND DISSEMINATION

The ethical agreement was obtained from the Main Ethics Committee (B.U.N.1432020000068) at the University Hospital Brussels and all other participating hospitals. Study results will be disseminated through presentations, conferences, social media, press and journals.

TRIAL REGISTRATION NUMBER

NCT04730154.

The Effects of Massage Therapy in Decreasing Pain and Anxiety in Post-Surgical Patients With Breast Cancer: A Systematic Review and Meta-Analysis

Background

Massage therapy is an effective non-pharmacological intervention in treating pain and anxiety of patients with cancer. Prior studies have reviewed the benefits of massage therapy in patients with breast cancer undergoing chemotherapy, radiation, and other patient-specific cancer treatments. What has yet to be examined is the effects of massage therapy on the pain and anxiety of patients with breast cancer after surgery.

Objective

: The purpose of this systematic review and meta-analysis was to examine the effect of massage therapy on post-surgical pain and anxiety in patients with breast cancer.

Methods

Systematic searches were performed using databases PubMed, CINAHL, and Medline (EBSCO), with no date constraint through September 30, 2023, to identify randomized control trials, randomized pilot, and quasi-experimental studies. The database searches retrieved 1205 titles, and after screening, 7 studies were chosen for full analysis using Cohen's d, 95% Confidence Interval (CI), and effect size. The heterogeneity of the studies was calculated in the meta-analysis using Cochran's Q equation.

Results

Massage therapy techniques reported were massage therapy, classic massage, reflexology, myofascial release, and myofascial therapy, and were performed at day 0 up to 16 weeks post-surgery. Massage therapy decreased pain and anxiety for patients in the massage group. Analyses showed a positive effect size using massage therapy as an intervention for pain and anxiety in women with breast cancer post-surgery. Overall effect size for pain was 1.057 with a P-value of <.0001, and overall effect size for anxiety was .673 with a P-value of <.0001.

Conclusion

The current evidence in this study reflects that massage therapy is effective as a non-pharmacological tool in decreasing post-surgical pain and anxiety in women with breast cancer.

Burden of late effects in a nationwide sample of long-term breast cancer survivors

BACKGROUND

Long-term breast cancer survivors (BCSs) may experience several late effects (LEs) simultaneously. This study aimed to identify subgroups of 8-year BCSs with higher burden of LEs who could benefit from closer survivorship care, explore variables associated with higher symptom burden, and describe how symptom burden may affect general functioning.

METHODS

All Norwegian women aged 20 to 65 years when diagnosed with stage I-III breast cancer in 2011 and 2012 were invited (n = 2803). The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire/BR23, the Fatigue Questionnaire, Assessment of Survivor Concerns, and Scale for Chemotherapy Induced Long-term Neurotoxicity were used to assess 10 common LEs and general functioning. Using latent class analysis, subgroups of BCSs with similar burden of LEs were identified. Multinominal regression analysis were performed to examine variables associated with higher symptom burden.

RESULTS

The final sample consisted of 1353 BCSs; 46% had low, 37% medium, and 17% high symptom burden. Younger age, short education, axillary dissection, higher systemic treatment burden, higher body mass index, and physical inactivity were associated with higher symptom burden. General functioning scores were lower, and the proportion on disability pension were higher among BCSs in the two most burdened subgroups compared with those in the low burden subgroup.

CONCLUSION

More than half of long-term BCSs suffered from medium or high symptom burden and experienced impaired general functioning compared with BCS with low symptom burden. Younger age and systemic treatment were important risk factors for higher symptom burden. BCSs at risk of higher symptom burdens should be identified and offered closer and extended survivorship care.

Pain associated with breast cancer: etiologies and therapies

Pain associated with breast cancer is a prevalent problem that negatively affects quality of life. Breast cancer pain is not limited to the disease course itself but is also induced by current therapeutic strategies. This, combined with the increasing number of patients living with breast cancer, make pain management for breast cancer patients an increasingly important area of research. This narrative review presents a summary of pain associated with breast cancer, including pain related to the cancer disease process itself and pain associated with current therapeutic modalities including radiation, chemotherapy, immunotherapy, and surgery. Current pain management techniques, their limitations, and novel analgesic strategies are also discussed.

Comparative effect of different patient education modalities on quality of life in breast cancer survivors: A systematic review and network meta-analysis

PURPOSE

To assess the comparative effect of patient education modalities (online, telephonic, mixed, in-person meetings) on the improvement of quality-of-life in breast cancer survivors.

METHODS

A search was conducted in different databases, being only included randomised controlled trials. The methodological quality and the risk of bias were assessed following the criteria of PEDro and Cochrane Rob-2 tools, respectively. The certainty of the evidence was judged using the GRADE tool. These evaluations were performed by two independent reviewers. When possible, data was pooled in a network meta-analysis (95% confidence interval [CI]).

RESULTS

Fourteen studies were included in the qualitative synthesis (1632 participants) and 11 in the quantitative (1482 participants). Network comparisons revealed that mixed educational modality was the highest ranked intervention at short (MD = 0.62; 95% CI [-0.35, 1.6]) and long -term (MD = 1.1; 95% CI [-1.5, 3.8); the control condition was the last in both cases, with a good convergence of the model observed. However, comparisons did not show significant differences.

CONCLUSIONS

Health policies could benefit from mixed modalities of patient education as it is expected to generate socio-economical savings and promote patient self-management. Probably, online mixed modalities, i.e. virtual face to face meetings, could be a more up-to-date option that fit best to nowadays patients' lifestyle. However, the limitations of this review force us to interpret our results with caution.

Understanding advanced practice registered nurse perspectives on providing care to people with a history of breast cancer

BACKGROUND

People with a history of breast cancer (PHBC) face a lifelong risk of treatment-related sequelae affecting their quality of life. Stakeholders advocate for improving breast cancer survivorship outcomes by increasing clinicians' knowledge of cancer survivorship issues. In Missouri, advanced practice registered nurses (APRNs) in nononcology settings provide routine survivorship care to PHBC; however, little is known about how they approach survivorship care planning for PHBC.

PURPOSE

Examine perspectives of Missouri APRNs practicing in nononcology settings about providing survivorship care to PHBC.

METHODS

A combination of grounded theory and thematic analysis techniques was used for focus groups and semistructured interviews. The interviews were audio-recorded, transcribed, and analyzed using grounded theory coding methods.

RESULTS

Nineteen nononcology Missouri-based APRNs (18 NPs, 1 CNS/DNP) shared their perspectives about managing care for PHBC. We identified four major themes. Our participants (1) attuned their baseline assessment techniques to a history of breast cancer; (2) were prepared to order additional evaluations; (3) were willing to proactively figure out next best steps for PHBC beyond theneed for breast cancer recurrence surveillance; and (4) suggest that streamlining cancer survivorship care resources would benefit both clinicians and PHBC.

CONCLUSIONS

Our findings shed light on how APRNs approach care planning for PHBC and the needs of nononcology APRNs for managing PHBC.

IMPLICATIONS FOR PRACTICE

Advanced practice registered nurses are well-positioned to improve cancer survivorship care. Increasing knowledge of cancer survivorship care guidelines could improve long-term health outcomes of PHBC. Access to cancer survivorship resources or experts via telehealth/technology for both APRNs and patients could improve survivorship care and overall health of PHBC.

Home-Based Treatment for Chronic Pain Combining Neuromodulation, Computer-Assisted Training, and Telemonitoring in Patients With Breast Cancer: Protocol for a Rehabilitative Study

BACKGROUND

Chronic pain is a disabling symptom frequently reported in patients with breast cancer with a prevalence ranging from 25% to 60%, representing a major health issue. It has negative consequences on health status, causing psychological distress and affecting quality of life. Furthermore, the clinical management of chronic pain is often inadequate, and many patients do not benefit from the administration of pharmacological treatments. Alternative therapeutic options have been implemented to improve the psychophysical well-being of patients, including neuromodulation and complementary interventions.

OBJECTIVE

We aimed to investigate the effectiveness of a home care strategy combining computerized rehabilitation, transcranial direct current stimulation (tDCS), and remote telemonitoring via a web-based platform in patients with breast cancer suffering for chronic pain.

METHODS

A web-based structured survey aimed at monitoring chronic pain and its effect on psychological functions will be delivered to patients with breast cancer through social media and email. In total, 42 patients with breast cancer affected by chronic pain will be recruited during the medical screening visit. The patients will be randomly divided into 3 treatment groups that will carry out either tDCS only, exercise therapy only, or a combination of both over a 3-week period. All the treatments will be delivered at the patients' home through the use of a system including a tablet, wearable inertial sensors, and a tDCS programmable medical device. Using web-based questionnaires, the perception of pain (based on the pain self-efficacy questionnaire, visual analogue scale, pain catastrophizing scale, and brief pain inventory) and psychological variables (based on the hospital and anxiety depression scale and 12-item short form survey) will be assessed at the beginning of treatment, 1 week after the start of treatment, at the end of treatment, 1 month after the start of treatment, and 3 months after the start of treatment. The system's usability (based on the mobile app rating scale and system usability scale) and its involvement in the decision-making process (based on the 9-item shared decision-making questionnaire) will be also evaluated. Finally, at the end of the treatment, a digital focus group will be conducted with the 42 patients to explore their unexpressed needs and preferences concerning treatment.

RESULTS

The study project is scheduled to start in June 2023, and it is expected to be completed by August 2025.

CONCLUSIONS

We expect that the combination of tDCS and telemedicine programs will reduce pain perceived by patients with breast cancer and improve their mental well-being more effectively than single interventions. Furthermore, we assume that this home-based approach will also improve patients' participation in routine clinical care, reducing disparities in accessing health care processes. This integrated home care strategy could be useful for patients with breast cancer who cannot find relief from chronic pain with pharmacological treatments or for those who have limited access to care due to poor mobility or geographical barriers, thus increasing the patients' empowerment and reducing health care costs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/49508.

Anti HER-2 aptamer functionalized gold nanoparticles of dasatinib for targeted chemo-radiotherapy in breast cancer cells

In the present study, gold nanoparticles functionalized with anti HER-2 aptamer were designed for effective targeted delivery of dasatinib (DSB) to breast cancer cells. Anti HER-2 aptamer attached to porous or plain gold nanoparticles were compared for dasatinib delivery. Activated drug with succinic anhydride and L-cysteine linker was used for conjugation of DSB to gold nanoparticles. The loading efficiency of the activated drug on plain and porous gold nanoparticles was 52 and 68 %, respectively, which was significantly more than the loading of free DSB in gold nanoparticles (1-2.5 %). The anti HER-2 aptamer was conjugated to porous gold nanoparticles loaded with the activated drug. Various characterization techniques such as FESEM, TEM, AFM, zeta potential and ICP-MS were used to confirm the binding of the drug to gold nanoparticles. 1HNMR and FTIR spectroscopic analyses were employed to examine the structural characteristics of the conjugated drug. These analytical techniques confirmed the successful incorporation of succinyl and thiol groups onto the drug molecule. The amount of aptamer binding to different types of gold nanoparticles was obtained from the intensity of the light emitted from the bands observed in electrophoresis gel and due to the presence of porosity in porous gold nanoparticles, the amount of aptamer conjugation on porous gold nanoparticles increased compared to plain ones. Cell cytotoxicity and cellular uptake were evaluated by MTT assay and TEM in BT-474 and MCF-7 cells. Aptamer-functionalized porous gold nanoparticles containing activated dasatinib showed higher cytotoxicity and cellular uptake than modified DSB-loaded nanoparticles and un-activated DSB. The combination of radiation therapy with the modified dasatinib attached to porous gold nanoparticles and aptamer demonstrated a notable reduction in the IC50 values for both the BT-474 and MCF-7 cell lines. Specifically, the IC50 value for the BT-474 cells decreased from 6.95 μM (for unmodified dasatinib) to 2.57 μM, while for the MCF-7 cells, it decreased from 13.97 μM to 8.57 μM. These findings indicate a significant improvement in the efficacy of the modified dasatinib compared to its unmodified counterpart when used in conjunction with radiation therapy.

Non-Surgical Site Pain in Women following Breast Cancer Surgery: A Systematic Review and Meta-Analysis

Background

Chronic pain after breast cancer surgery affects up to 60% of patients. Evidence supports the fact that pain outwith the surgical site is a significant issue. This systematic review and meta-analysis sought to evaluate the prevalence of non-surgical site pain (NSSP) in women after breast cancer surgery at 6 months post-operatively.

Methods

Adult women with a confirmed breast cancer diagnosis who had undergone breast cancer surgery were identified. The outcome pursued was pain outwith the surgical site measured on either NRS/VRS or VAS rating scale. CENTRAL, Embase, PubMed, MEDLINE, CINAHL, PsycInfo, Web of Science, and Scopus were searched to identify studies that examined NSSP after breast cancer surgery at 6 months. Data were gathered via pre-piloted Excel forms and analysed both quantitively and qualitatively. Meta-analysis was carried out using a random-effects model to assess risk difference with 95% confidence interval (CI).

Results

A total of sixteen studies were identified for inclusion. Eleven studies failed to provide sufficient data and consequently were analysed qualitatively. Five studies were adequate for quantitative analysis, including a total of 995 patients. Meta-analysis identified a risk difference of 18% (95% CI: 5-31%) between patients who had breast cancer surgery and a reference, however, this is low-quality evidence.

Conclusion

This review has highlighted that breast cancer surgery increases the risk of pain outwith the surgical site postoperatively. It was additionally identified that NSSP data are often gathered in research yet rarely presented in results or highlighted as a primary outcome. As the quality of evidence was low, research specifying NSSP as a primary outcome is required to provide more certainty.

The American Society of Breast Surgeons classification system for oncoplastic breast conserving surgery independently predicts the risk of delayed wound healing

INTRODUCTION

Oncoplastic breast conserving surgery (OBCS) aims to provide safe and satisfying surgery for breast cancer patients. The American Society of Breast Surgeons (ASBrS) classification system is based on volumetric displacement cut-offs (level I for <20% of breast volume; level II for 20-50%). It aims to facilitate communication among treating physicians and patients. Here, we investigate whether the extent of OBCS as classified by ASBrS independently predicts postoperative complications.

MATERIALS AND METHODS

This retrospective analysis of a prospectively maintained database included patients with stage I-III breast cancer who underwent OBCS between 03/2011 and 12/2020 at a Swiss university hospital. Outcomes included short-term (≤30 days) complications and chronic (>30 days) pain after surgery. Multivariate logistic regression models were used to identify independent predictors.

RESULTS

In total, 439 patients were included, 314 (71.5%) received ASBrS level I surgery, and 125 (28.5%) underwent ASBrS level II surgery. ASBrS level II was found to be an independent predictor of delayed wound healing (odds ratio [OR] 9.75, 95% confidence intervals (CI) 2.96-32.10). However, ASBrS level did not predict chronic postoperative pain (incidence rate ratio [IRR] 1.20, 95%CI 0.85-1.70), as opposed to age (IRR 1.19, 95%CI 1.11-1.27 per 5 years decrease), and weight disorders (underweight [BMI <18.5] vs. normal weight [BMI 18.5 < 25]: IRR 4.02, 95%CI 1.70-9.54; obese [BMI ≥30] vs. normal weight: IRR 2.07, 95%CI 1.37-3.13).

CONCLUSION

ASBrS level II surgery predicted delayed wound healing, warranting close clinical follow-up and prompt treatment to avoid delays in adjuvant therapy.

Cost-Effectiveness Analysis Evaluating Delivery Strategies for Pain Coping Skills Training in Women With Breast Cancer

Pain coping skills training (PCST) is efficacious in patients with cancer, but clinical access is limited. To inform implementation, as a secondary outcome, we estimated the cost-effectiveness of 8 dosing strategies of PCST evaluated in a sequential multiple assignment randomized trial among women with breast cancer and pain (N = 327). Women were randomized to initial doses and re-randomized to subsequent doses based on their initial response (ie, ≥30% pain reduction). A decision-analytic model was designed to incorporate costs and benefits associated with 8 different PCST dosing strategies. In the primary analysis, costs were limited to resources required to deliver PCST. Quality-adjusted life-years (QALYs) were modeled based on utility weights measured with the EuroQol-5 dimension 5-level at 4 assessments over 10 months. A probabilistic sensitivity analysis was performed to account for parameter uncertainty. Implementation of PCST initiated with the 5-session protocol was more costly ($693-853) than strategies initiated with the 1-session protocol ($288-496). QALYs for strategies beginning with the 5-session protocol were greater than for strategies beginning with the 1-session protocol. With the goal of implementing PCST as part of comprehensive cancer treatment and with willingness-to-pay thresholds ranging beyond $20,000 per QALY, the strategy most likely to provide the greatest number of QALYs at an acceptable cost was a 1-session PCST protocol followed by either 5 maintenance telephone calls for responders or 5 sessions of PCST for nonresponders. A PCST program with 1 initial session and subsequent dosing based on response provides good value and improved outcomes. PERSPECTIVE: This article presents the results of a cost analysis of the delivery of PCST, a nonpharmacological intervention, to women with breast cancer and pain. Results could potentially provide important cost-related information to health care providers and systems on the use of an efficacious and accessible nonmedication strategy for pain management. TRIALS REGISTRATION: ClinicalTrials.gov: NCT02791646, registered 6/2/2016.

Supporting Return to Work after Breast Cancer: A Mixed Method Study

Breast cancer (BC) is the most common invasive cancer in the world. Most BC survivors (BCSs) continue working while dealing with cancer-related disabilities. BCSs' return-to-work (RTW) after cancer treatment is an important stage of their recovery and is associated with a higher survival rate. In this study, we addressed the RTW of BCSs with the intention of facilitating this process through direct action in the workplace. Thirty-two women who requested assistance from January to December 2022 were enrolled in the study. Semi-structured interviews and medical examinations were conducted by a team of three physicians. Interviews were analyzed using Thematic Analysis. Moreover, a quantitative cross-sectional study was conducted to compare the health status of BCSs with that of a control group of 160 working women, using standardized questionnaires on work ability, fatigue, sleep problems, anxiety, depression, and happiness. BCSs were also asked to rate the level of organizational justice they perceived at work prior to their illness. From the qualitative analysis emerged three facilitating/hindering themes: (1) person-related factors, (2) company-related factors, and (3) society-related factors. In the quantitative analysis, BCSs had significantly higher scores for anxiety, depression, sleep problems and fatigue, and lower levels of happiness than controls. The RTW of BCSs entails adapting working conditions and providing adequate support. The work-related analysis of each case made it possible to highlight the measures that need to be taken in the workplace to promote RTW. The treatment of cancer should be paired with advice on the best way to regain the ability to work.

Cancer-related post-treatment pain and its impact on treatment satisfaction with medication in women with breast cancer: a cross-sectional study from Palestine

BACKGROUND

Pain after therapy is an important clinical problem in patients with breast cancer. Unfortunately, cancer patients have a lower quality of life due to inadequate treatment of posttreatment pain; therefore, improving medication management plans and palliative care has become one of the most important targets of cancer therapy. Therefore, the current study aimed to examine the impact of posttreatment pain on medication satisfaction in patients with various stages of breast cancer in Palestine.

METHODS

A cross-sectional analytical study was conducted et al.-Watani Hospital and An-Najah National University Hospital in the Nablus area. Using the Brief Pain Inventory (BPI), the intensity and interference of pain were evaluated. In addition, patients' satisfaction with cancer management medications was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM).

RESULTS

Two hundred fifty-four patients were included in this study. All were women, with a mean ± SD age of 53.1 ± 10.7 years. The median score for pain severity was 7.0. Pain in the lower extremities was the most reported location. There was a negative association between the global satisfaction domain and the presence of posttreatment pain (p < 0.001). Furthermore, significant differences and negative correlations were found between global satisfaction and posttreatment pain on the day of the interview (p = 0.001), pain medication (p < 0.001), paracetamol use (p < 0.001), and the presence of side effects (p = 0.003). There were significant negative correlations (p < 0.05) between pain severity and interference with effectiveness (r = -0.258, -0.319, respectively), side effects (r = -0.414, -0.514, respectively), convenience (r = -0.274, -0.307, respectively), and global satisfaction domain scores (r = -0.293, -0.287, respectively). Exposure to chemotherapy was the only significant positive correlation with global satisfaction (p = 0.007). The regression analysis results indicated an independent association between chemotherapy use and a higher global satisfaction score (p = 0.011).

CONCLUSIONS

Patients with posttreatment pain, side effects, and greater interference of pain with their functioning had lower satisfaction scores. Therefore, better management of their treatment medications, side effects, and pain medications is recommended to enhance their satisfaction and quality of life. Several aspects of palliative care should be organized to improve the patient's satisfaction and quality of life in addition to conducting longitudinal studies to evaluate the pain and satisfaction of different types of cancers.

Examining the Role of Resilience, Posttraumatic Growth, and Quality of Life in Women with Breast Cancer: A Serial Multiple Mediator Model Approach

OBJECTIVES

It is unclear how resilience and posttraumatic growth help women with breast cancer face cancer-related symptom distress. This study included both resilience and posttraumatic growth as mediators in a serial multiple mediator model to examine changes in the relationship between symptom distress and quality of life among women with breast cancer.

DATA SOURCES

We conducted the descriptive, cross-sectional study in Taiwan. Data were collected using a survey that assessed symptom distress, resilience, posttraumatic growth, and quality of life. A serial multiple mediator model examined one direct and three specific indirect effects of symptom distress on quality of life through resilience and posttraumatic growth. All 91 participants reported the presence of symptom distress and moderate levels of resilience. Quality of life was significantly associated with symptom distress (b = -1.04), resilience (b = 0.18), and posttraumatic growth (b = 0.09). The indirect effect of symptom distress on quality of life through resilience alone was statistically significant (b = -0.23, 95% CI -0.44 to -0.07) and statistically greater than the specific indirect effect through resilience and posttraumatic growth combined (b = -0.21, 95% CI -0.40 to -0.05).

CONCLUSION

Resilience plays a unique role in reducing the impact of symptom distress on the quality of life among women with breast cancer.

IMPLICATIONS FOR NURSING PRACTICE

Given the importance of resilience to quality of life, oncology nurses can assess the resilience of women with breast cancer and help identify available internal, external, and existential resources to strengthen their resilience.

Emotional Processing, Coping, and Cancer-Related Sickness Symptoms in Breast Cancer Survivors: Cross- Sectional Secondary Analysis of the REPAT Study

Purpose

The study aims to provide a better understanding of the relationship between emotional processing, coping, and cancer-related sickness symptoms.

Methods

The study used a cross-sectional, secondary analysis of data from 179 Israeli Jewish women who were breast cancer survivors (BCS) 3 to 18 months after completing primary treatment and who participated in a larger randomized controlled trial (REPAT study). Data were collected at baseline. Participants completed questionnaires measuring emotion acceptance, situational approach, avoidance coping, and cancer-related sickness symptoms (depression, fatigue, and pain) and a performance measure of emotional awareness. Hierarchical linear regressions were performed, controlling for background variables.

Results

Participants experienced significant clinical depression (51.7%), cancer-related fatigue (CRF, 78.8%), pain interference (78%), and pain intensity (66%) levels. There were strong correlations between cancer-related symptoms. After controlling for confounders, emotional processing (acceptance) was negatively associated with depression, and avoidance coping was positively associated with depression, CRF, and pain interference (i.e., higher use of avoidance related to higher cancer-related symptoms; higher acceptance was associated with lower depression). Emotional awareness and coping by approaching emotions were not related to cancer-related symptoms.

Conclusions

The BCS posttreatment period presents the challenge of dealing with elevated cancer-related symptoms. Regardless, BCS who used high emotional processing levels-especially acceptance of emotion and lower reliance on avoidance to cope-experienced fewer cancer-related symptoms.

Implications for Cancer Survivors

Professionals should recognize the potential role of emotional processing and avoidant coping relative to cancer-related symptoms and recognize their patterns in posttreatment patients.

Pain-related and psychological factors mediate the effect of personality on health-related quality of life. A study in breast cancer survivors with persistent pain

Introduction

Personality characteristics affect the long-term well-being and health-related quality of life (HrQoL) of breast cancer (BC) survivors. Persistent pain significantly affects psychosocial well-being and HrQoL in this patient group. We studied the effects of temperament and character via pain-related and psychological factors on dimensions of HrQoL in BC survivors.

Methods

We studied 273 patients who had been treated for BC and who reported persistent pain at any site of the body in Brief Pain Inventory. The patients were recruited from a longitudinal cohort of patients 4-9 years after surgery for BC. Short-Form-36 inventory was used to assess physical and mental dimensions of HrQoL and Temperament and Character Inventory to assess dimensions of temperament and character. We used parallel mediation modeling for studying effects of temperament and character on physical and mental HrQoL.

Results

A significant total effect was found for harm avoidance (HA) temperament (β_total = -0.665, p < 0.001) and character dimensions self-directedness (SD) (β_total = 0.609, p = 0.001) and cooperativeness (CO) (β_total = 0.584, p = 0.028) on physical and mental HrQoL. Additionally, different combinations of pain-related and psychological variables fully mediated the indirect effects of HA, SD, and CO on physical and mental HrQoL.

Discussion

HA temperament is a potential emotional vulnerability factor for psychological burden and impaired HrQoL in BC survivors. Character dimensions SD and CO may protect from the negative effect of mood on HrQoL. The results provide new insights about the risk-and target-factors for clinical interventions and effective pain management to improve psychosocial well-being and HrQoL in BC survivors.

Effect of Pain Coping Skills Training on Pain and Pain Medication Use for Women With Breast Cancer

CONTEXT

Pain is distressing for women with breast cancer. Pain medication may not provide full relief and can have negative side-effects. Cognitive-behavioral pain intervention protocols reduce pain severity and improve self-efficacy for pain management. These interventions' impact on pain medication use is less clear. Intervention length and coping skills use might play a role in pain outcomes.

OBJECTIVES

Secondary analysis to examine differences in pain severity, pain medication use, pain self-efficacy, and coping skill use after five- and one-session cognitive-behavioral pain intervention protocols. Pain self-efficacy and coping skills use were assessed as mediators of intervention effects on pain and pain medication use.

METHODS

Women (N = 327) with stage I-III breast cancer were enrolled in a randomized trial comparing individually-delivered, five- and one-session pain coping skills training (PCST). Pain severity, pain medication use, pain self-efficacy, and coping skills use were assessed preintervention and five to eight weeks later (postintervention).

RESULTS

Pain and pain medication use significantly decreased, while pain self-efficacy increased pre-post for women randomized to both conditions (P's <.05). Five-session PCST participants demonstrated less pain (P =.03) and pain medication use (P =.04), and more pain self-efficacy (P =.02) and coping skills use (P =.04) at postintervention compared to one-session PCST participants. Pain self-efficacy mediated the relationship of intervention condition with pain and pain medication use.

CONCLUSION

Both conditions led to improvements in pain, pain medication use, pain self-efficacy, and coping skills use, and 5-session PCST showed the greatest benefits. Brief cognitive-behavioral pain intervention improve pain outcomes, and pain self-efficacy may play a role in these effects.

Measurement of rat and human tissue optical properties for improving the optical detection and visualization of peripheral nerves

Peripheral nerve damage frequently occurs in challenging surgical cases resulting in high costs and morbidity. Various optical techniques have proven effective in detecting and visually enhancing nerves, demonstrating their translational potential for assisting in nerve-sparing medical procedures. However, there is limited data characterizing the optical properties of nerves in comparison to surrounding tissues, thus limiting the optimization of optical nerve detection systems. To address this gap, the absorption and scattering properties of rat and human nerve, muscle, fat, and tendon were determined from 352-2500 nm. The optical properties highlighted an ideal region in the shortwave infrared for detecting embedded nerves, which remains a significant challenge for optical approaches. A 1000-1700 nm hyperspectral diffuse reflectance imaging system was used to confirm these results and identify optimal wavelengths for nerve imaging contrast in an in vivo rat model. Optimal nerve visualization contrast was achieved using 1190/1100 nm ratiometric imaging and was sustained for nerves embedded under ≥600 µm of fat and muscle. Overall, the results provide valuable insights for optimizing the optical contrast of nerves, including those embedded in tissue, which could lead to improved surgical guidance and nerve-sparing outcomes.

Label-free intraoperative nerve detection and visualization using ratiometric diffuse reflectance spectroscopy

Iatrogenic nerve injuries contribute significantly to postoperative morbidity across various surgical disciplines and occur in approximately 500,000 cases annually in the US alone. Currently, there are no clinically adopted means to intraoperatively visualize nerves beyond the surgeon's visual assessment. Here, we report a label-free method for nerve detection using diffuse reflectance spectroscopy (DRS). Starting with an in vivo rat model, fiber- and imaging-based DRS independently identified similar wavelengths that provided optimal contrast for nerve identification with an accuracy of 92%. Optical property measurements of rat and human cadaver tissues verify that the source of contrast between nerve and surrounding tissues is largely due to higher scattering in nerve and differences in oxygenated hemoglobin content. Clinical feasibility was demonstrated in patients undergoing thyroidectomies using both probe-based and imaging-based approaches where the nerve were identified with 91% accuracy. Based on our preliminary results, DRS has the potential to both provide surgeons with a label-free, intraoperative means of nerve visualization and reduce the incidence of iatrogenic nerve injuries along with its detrimental complications.

Effect of Total Breast Reconstruction With Autologous Fat Transfer Using an Expansion Device vs Implants on Quality of Life Among Patients With Breast Cancer: A Randomized Clinical Trial

Importance

There is a need for a new, less invasive breast reconstruction option for patients who undergo mastectomy in their breast cancer treatment.

Objective

To investigate quality of life (QoL) among patients undergoing a new breast reconstruction technique, autologous fat transfer (AFT), compared with that among patients undergoing implant-based reconstruction (IBR).

Design, Setting, and Participants

The BREAST trial was a randomized clinical trial conducted between November 2, 2015, and October 31, 2021, performed in 7 hospitals across the Netherlands. Follow-up was 12 months. Referrals could be obtained from general practitioners and all departments from participating or nonparticipating hospitals. The patients with breast cancer who had undergone mastectomy and were seeking breast reconstruction were screened for eligibility (radiotherapy history and physique) by participating plastic surgeons. Patients receiving postmastectomy radiotherapy were excluded.

Interventions

Breast reconstruction with AFT plus expansion or 2-phased IBR. Randomization was done in a 1:1 ratio.

Main Outcomes and Measures

The statistical analysis was performed per protocol. The predefined primary outcome was QoL at 12 months after final surgery. This was measured by the BREAST-Q questionnaire, a validated breast reconstruction surgery questionnaire. Questions on the BREAST-Q questionnaire are scored from 0 to 100, with a higher score indicating greater satisfaction or better QoL (depending on the scale). Secondary outcomes were breast volume and the safety and efficacy of the techniques.

Results

A total of 193 female patients (mean [SD] age, 49.2 [10.6] years) 18 years or older who desired breast reconstruction were included, of whom 91 patients in the AFT group (mean [SD] age, 49.3 [10.3] years) and 80 in the IBR group (mean age, 49.1 [11.0] years) received the allocated intervention. In total, 64 women in the AFT group and 68 women in the IBR group completed follow-up. In the IBR group, 18 patients dropped out mainly due to their aversion to implant use while in the AFT group 6 patients ended their treatment prematurely because of the burden (that is, the treatment being too heavy or tiring). The BREAST-Q scores were higher in the AFT group in all 5 domains and significantly higher in 3: satisfaction with breasts (difference, 9.9; P = .002), physical well-being: chest (difference; 7.6; P = .007), and satisfaction with outcome (difference, 7.6; P = .04). Linear mixed-effects regression analysis showed that QoL change over time was dependent on the treatment group in favor of AFT. The mean (SD) breast volume achieved differed between the groups (AFT: 300.3 [111.4] mL; IBR: 384.1 [86.6] mL). No differences in oncological serious adverse events were found.

Conclusions and Relevance

This randomized clinical trial found higher QoL and an increase in QoL scores over time in the AFT group compared with the IBR group. No evidence was found that AFT was unsafe. This is encouraging news since it provides a third, less invasive reconstruction option for patients with breast cancer.

Trial Registration

ClinicalTrials.gov Identifier: NCT02339779.

Patient reported symptom burden amongst immigrant and Canadian long-term resident women undergoing breast cancer surgery

PURPOSE

Immigrants are susceptible to marginalization due to social isolation, economic disadvantage and systemic bias. Our goal was to compare symptom burden between immigrant and long-term resident women undergoing breast cancer surgery in Ontario, Canada.

METHODS

A population-level retrospective cohort-study using administrative databases was conducted. Women who underwent surgery for newly diagnosed breast cancer and were treated at regional cancer centers between 2010 and 2016 were included. The primary outcome was a moderate or severe (≥ 4) symptom score on the Edmonton Symptom Assessment System Scale (ESAS).

RESULTS

There were 12,250 (87.2%) long-term Canadian residents and 1,806(12.8%) immigrants. Immigrants were younger (mean age 53 vs. 61 years); had a higher proportion residing in a lowest income quintile neighbourhood (22.2% vs 15.4%); were less often on a primary-care physician roster (83.7% vs. 90.4%); and were less often diagnosed with Stage I/II disease (80.9% vs. 84.6%) (all p < 0.01). The proportion of women with scores ≥ 4 was significantly higher amongst immigrant women for 7/9 symptom categories; with the largest differences for depression (24.9% vs. 20.2%, p < 0.01) and pain (28.0% vs. 22.4%, p < 0.01). On multivariable regression analysis, immigration status was associated with scores ≥ 4 for pain (OR 1.13, 95% CI 1.02-1.23). There was an association between moderate/severe pain and region of origin, but not length of stay in Canada or immigration class.

CONCLUSIONS

This is the first study comparing symptom burden amongst immigrant and non-immigrant women with breast cancer at a population-level. Immigrant women with breast cancer undergoing surgery were found to have a higher burden of pain.

Research Progress on Serratus Anterior Plane Block in Breast Surgery: A Narrative Review

Breast surgery, especially radical mastectomy, is often accompanied by moderate to severe acute pain, which significantly reduces postoperative quality of life. Effective pain management can accelerate patient recovery. Serratus anterior plane block (SAPB) is a new type of fascial plane block technique, which can better target the nerve network innervating the chest wall and breast and provide good analgesia in the anterolateral chest wall. Current clinical research evidence indicates that SAPB has significant benefits in breast surgery. Further research avenues for this technology include optimal local anesthetic dosing strategy, the type of SAPB which is more suitable for breast surgery, comparison of SAPB and pectoral nerve block II (PECS II) in breast surgery, and high-quality randomized controlled study with outcomes of chronic pain or cancer prognosis.

Effect of exercise on rehabilitation of breast cancer surgery patients: A systematic review and meta-analysis of randomized controlled trials

AIM

To determine the effective exercise methods for different complications of breast cancer patients after surgery.

DESIGN

Systematic review and meta-analysis.

METHODS

A comprehensive electronic search was carried out with no time limit until May 2020. Studies must have been randomized controlled trials of patients after breast cancer surgery, without limit to the way of exercise. Literature quality was evaluated by the modified Jadad scale. The meta-analysis was conducted with CMA2.0 software.

RESULTS

Aerobic exercise reduced the intensity of the pain (MD = -1.043), improved shoulder flexion (MD = 3.398) and internal rotation range (MD = 3.868), lessened upper limb dysfunction (MD = -5.231) and improved muscle strength during flexion (MD = 1.076) and abduction (MD = 0.991). Shoulder elbow movement improved the range of shoulder external rotation (MD = 2.691) and reduced the incidence of arm lymphedema (RR = 0.343). Anti-resistance exercise also lessened upper limb dysfunction (MD = - 4.094).

Psychosocial Interventions for Pain Management in Breast Cancer Survivors: A RE-AIM Evaluation

Psychosocial interventions for breast-cancer-related pain are effective, yet over 45% of survivors continue to struggle with this often-chronic side effect. This study evaluated multilevel indicators that can influence successful translation of interventions into clinical practice. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was applied to evaluate reporting of individual and setting/staff-level intervention indicators. A systematic search and multi-step screening process identified 31 randomized controlled trials for psychosocial interventions for breast cancer-related pain. Average reporting of indicators for individual-level dimensions (Reach and Effectiveness) were 65.2% and 62.3%, respectively. Comparatively, indicators for setting/staff-level dimensions were reported at a lower average frequency (Implementation, 46.8%; Adoption, 15.2%; Maintenance, 7.7%). Low reporting of setting/staff-level dimensions suggests gaps in the sustained implementation of psychosocial interventions. Implementation science methods and frameworks could improve trial design and accelerate the translation of psychosocial interventions for breast cancer-related pain into clinical practice.

Prospective Study of Pain Outcomes Associated With Breast Surgery in Women With Nonhereditary Breast Cancer

OBJECTIVE

To assess pain severity and interference with life in women after different types of breast cancer surgery and the demographic, treatment-related, and psychosocial variables associated with these pain outcomes.

SUMMARY OF BACKGROUND DATA

Data are conflicting regarding pain outcomes and quality of life (QOL) among women who undergo different types of breast surgery.

METHODS

Women with nonhereditary breast cancer completed the brief pain inventory before surgery and at 1, 6, 12, and 18 months postsurgery. We assessed associations between pain outcomes and CPM status and mastectomy status using multivariable repeated measures models. We assessed associations between pain outcome and QOL and decision satisfaction.

RESULTS

Of 288 women (mean age 56 years, 58% non-Hispanic White), 50 had CPM, 75 had unilateral mastectomy, and 163 had BCS. Mean pain severity scores were higher at one (2.78 vs 1.9, P = 0.016) and 6 months (2.79 vs 1.96, P = 0.031) postsurgery in women who had CPM versus those who did not, but there was no difference at 12 and 18 months. Comparing mastectomy versus BCS, pain severity was higher at 1 and 12 months. There was a significant interaction between pain severity and time point for CPM ( P = 0.006), but not mastectomy status ( P = 0.069). Regardless of surgery type, Black women had higher pain severity ( P = 0.004) than White women. Higher pain interference was associated with lower QOL ( P < 0.001) and lower decision satisfaction ( P = 0.034).

CONCLUSIONS

Providers should counsel women considering mastectomy about the potential for greater acute pain and its impact on overall well-being. Racial/ethnic disparities in pain exist and influence pain management in breast surgical patients.

Development of an intervention aimed at the prevention and treatment of chronic pain in breast cancer survivors: An intervention mapping approach

OBJECTIVE

Pain is prevalent among breast cancer survivors and can persist for years, impeding quality of life. Both prevention and pain treatment are important. However, this requires an interdisciplinary approach and complex models of care. We report on the design and implementation of an intervention that follows a step-wise care model, aimed at timely and adequate pain follow-up among breast cancer survivors.

METHODS

We used intervention mapping to guide our planning process. The intervention was developed in co-design with relevant stakeholders, such as breast cancer survivors and healthcare providers.

RESULTS

An e-learning training was developed aimed at changing healthcare providers' knowledge, beliefs, and interprofessional behaviour regarding pain follow-up. Second, guides were produced to empower patients in talking about pain and stimulate referral to other disciplines.

CONCLUSION

To achieve change in pain follow-up, multiple levels should be addressed. Additionally, the implementation and adoption of an intervention opposes challenges. Intervention mapping can serve as a theory-based and data-driven approach for decision-making during planning.

PRACTICE IMPLICATIONS

This study can inform others about how to prepare for the development and implementation of an intervention. The developed intervention can also be adapted according to the target population and context, and used for other cancer populations.

Predictors of persistent post-surgical pain intensity and interference at 1 year after breast cancer surgery: assessing central sensitization, central sensitivity symptoms, and psychological factors

BACKGROUND

Persistent post-surgical pain (PPSP) is associated with upper limb dysfunction and decreased quality of life and causes long-term suffering for breast cancer survivors after surgery. However, the predictors of PPSP remain unclear. The purpose of this study was to examine predictors of PPSP intensity and interference at 1 year postoperatively, focusing on treatment-related factors, pre- and postoperative central sensitization (CS), CS-related symptoms (e.g., muscle stiffness, fatigue, sleep disturbances), and psychological factors.

METHODS

Eighty-eight women with planned unilateral breast cancer surgery were included in this longitudinal study. CS, CS-related symptoms, and psychological factors were assessed preoperatively, 1 month postoperatively, and 1 year postoperatively. Analysis of covariance was used to compare the groups with and without PPSP, accounting for treatment-related factors. Multiple regression analysis was performed to identify predictors of PPSP intensity and interference at 1 year postoperatively.

RESULTS

Even after adjusting for covariates, preoperative and 1-month postoperative Central Sensitization Inventory scores in the PPSP group were significantly higher than scores in the group without PPSP. Multiple regression analysis showed that axillary lymph node dissection (ALND) and 1-month postoperative CS-related symptoms were independent predictors of PPSP intensity and interference at 1 year postoperatively (p < 0.01).

CONCLUSION

We found that ALND and 1-month postoperative CS-related symptoms were predictors of PPSP intensity and interference at 1 year postoperatively.

Microneedles for Efficient and Precise Drug Delivery in Cancer Therapy

Cancer is the leading cause of death, acting as a global burden, severely impacting the patients’ quality of life and affecting the world economy despite the expansion of cumulative advances in oncology. The current conventional therapies for cancer which involve long treatment duration and systemic exposure of drugs leads to premature degradation of drugs, a massive amount of pain, side effects, as well as the recurrence of the condition. There is also an urgent demand for personalized and precision-based medicine, especially after the recent pandemic, to avoid future delays in diagnosis or treatments for cancer patients as they are very essential in reducing the global mortality rate. Recently, microneedles which consist of a patch with tiny, micron-sized needles attached to it have been quite a sensation as an emerging technology for transdermal application to diagnose or treat various illnesses. The application of microneedles in cancer therapies is also being extensively studied as they offer a myriad of benefits, especially since microneedle patches offer a better treatment approach through self administration, painless treatment, and being an economically and environmentally friendly approach in comparison with other conventional methods. The painless gains from microneedles significantly improves the survival rate of cancer patients. The emergence of versatile and innovative transdermal drug delivery systems presents a prime breakthrough opportunity for safer and more effective therapies, which could meet the demands of cancer diagnosis and treatment through different application scenarios. This review highlights the types of microneedles, fabrication methods and materials, along with the recent advances and opportunities. In addition, this review also addresses the challenges and limitations of microneedles in cancer therapy with solutions through current studies and future works to facilitate the clinical translation of microneedles in cancer therapies.

Survivors' perceptions regarding the follow-up of pain complaints after breast cancer treatment: Distinct coping patterns

Introduction

After finishing cancer treatment, breast cancer survivors often experience both physical and psychosocial symptoms such as pain. In some, pain can persist for months or even years. Pain is a complex experience. Its occurrence and maintenance are explained through interactions between multiple factors, which are biological/physiological, psychological, and social in nature. Unaddressed needs related to this problem - such as insufficient pain relief, limited validation of the problem, and minimal physical and psychological support - may cause severe disability and negatively impact well-being and quality of life. This study investigated how breast cancer survivors perceive their (chronic) pain complaints to be addressed during follow-up care. Furthermore, we explored how they coped with the way their trajectories happened to unfold.

Methods

We conducted four focus groups with a total of thirty-one breast cancer survivors. Each focus group consisted of an asynchronous part with an online discussion platform and a synchronous part through video calls. Data analysis was guided by the Qualitative Analysis Guide of Leuven.

Results

Narratives revealed the unmet needs of survivors and showed variability in the lived experiences of having to deal with pain. Some survivors tend to ignore the pain, while others look for solutions to reduce pain. A third coping pattern is accepting pain and its impact. Furthermore, how survivors cope with pain is influenced by intrapersonal, interpersonal, and societal processes. For example, pain-related beliefs and prejudices among healthcare providers, family, friends, colleagues, other cancer survivors, and society could possibly steer a survivor towards a certain way of coping. In these processes, the role of healthcare providers seems pivotal. For instance, when survivors do not feel heard or taken seriously by healthcare providers, their acceptance of pain can be impeded.

Discussion

To conclude, a person's way of coping with pain and the associated needs is dynamic and influenced by factors at multiple levels such as the intrapersonal, interpersonal and societal level. To sufficiently address the problem of pain among cancer survivors, we therefore also need actions that tackle the health care system and its stakeholders, as well as the public debate concerning cancer follow-up care.

Sexuality after breast cancer, how to provide a global and contemporary approach

Patients' sexuality is one of the major and most neglected impact of breast cancer (BC) and its treatment. Even though research is ongoing on the subject, sexuality issues are rarely taken into account and efficiently dealt with in clinical practice. The objective is to review the impact of BC and its treatment on modern women sexuality. In the literature, a heterogeneous level of advancement is notable in the different publishing countries depending on the cultural background; some countries simply do not publish on the matter, others mainly discuss the male partners and practicians experience, and lastly, the most progressive countries have moved up to studying niches of patients such as sexual and gender minorities. A multidisciplinary approach, including pharmacologic and nonpharmacologic management, appears most efficient. There is a need for greater inclusion of partners and for providing a specific training to first-line health care providers. This review provides a general contemporary worldwide overview of the state of the art in sexuality issues in BC patients and survivors.

High-rate breakthrough cancer pain and tumour characteristics - literature review and case series

Cancer pain requires careful comprehensive patient evaluation and an appropriate and personalized clinical approach by a trained multidisciplinary team. The proper assessment of breakthrough cancer pain (BTcP) is part of an all-inclusive multidimensional evaluation of the patient. The aim of this narrative review is to explore the relationship between high-rate BTcP, which strongly impacts health- related quality of life and tumour characteristics, in the face of novel approaches that should provide guidance for future clinical practice. The presentation of short, emblematic clinical reports also promotes knowledge of BTcP, which, despite the availability of numerous therapeutic approaches, remains underdiagnosed and undertreated. This article is part of the Management of breakthrough cancer pain Special Issue: https://www.drugsincontext.com/special_issues/management-of-breakthrough-cancer-pain.

Role of self-efficacy for pain management and pain catastrophizing in the relationship between pain severity and depressive symptoms in women with breast cancer and pain

PURPOSE

This study evaluated the relationship between pain and depressive symptoms through pain self-efficacy and pain catastrophizing in breast cancer patients with pain.

DESIGN

Secondary analysis of a randomized trial investigating a cognitive-behavioral pain management protocol.

SAMPLE

Females (N = 327) with stage I-III breast cancer and report of at least moderate pain.

METHODS

Pain severity, pain self-efficacy, pain catastrophizing, and depressive symptoms were measured. The proposed model was assessed using structural equation modeling.

RESULTS

Higher pain severity was significantly related to lower pain self-efficacy and higher pain catastrophizing. Lower pain self-efficacy and higher pain catastrophizing were significantly related to more depressive symptoms. Higher pain severity was significantly associated with more depressive symptoms through lower pain self-efficacy and higher pain catastrophizing. The association between pain severity and depressive symptoms was not significant when specified as a direct effect.

CONCLUSION

Pain severity related to depressive symptoms in breast cancer patients via pain self-efficacy and pain catastrophizing.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

Measurement of pain self-efficacy and pain catastrophizing should be incorporated into comprehensive pain assessments for women with breast cancer, as these variables may be relevant therapeutic targets. Psychosocial symptom management interventions should include strategies that increase pain self-efficacy and decrease pain catastrophizing because these pain-related cognitive variables appear to drive the relationship between pain severity and depressive symptoms.

Does Digital Rubbing Massage-Pain Relief (DRM Pain Relief) Affect Breast Cancer Patients' Pain, Comfort, and Quality of Life?

Introduction

The incidence of breast cancer in Indonesia is the highest among types of cancer in women, with an estimated pain prevalence of 40%-89%. More than 50% of cancer patients suffer from pain that has not been resolved. Cancer pain's impact will affect the comfort level and quality of life.

Objectives

The purpose of this study was to analyze the effectiveness of DRM Pain Relief on the degree of pain, comfort, and quality of life among breast cancer patients.

Methods

The research was a true experimental study with pre-test and post-test designs with a control group. The population was all breast cancer patients attending hospitals in Semarang and Pekalongan Districts. The research subjects were 64 respondents who met the inclusion and exclusion criteria. Respondents were selected randomly and divided into two groups, namely 32 in the treatment group (DRM Pain Relief application) and 32 in the control group (only received drugs as conventional therapy in the hospital). Data were analyzed using a multivariate test.

Results

The application of DRM Pain Relief was effective in reducing the degree of pain (p < .001), and effectively increasing comfort (p < .001), as well as improving the quality of life of breast cancer patients in the components of improvement in symptom status, functional status, and global quality of life with p-value <.001, .003,  < .001, respectively.

Conclusion

The DRM Pain Relief effectively reduces the degree of pain, increases comfort, and improves the quality of life of breast cancer patients.

Feasibility and potential effects of breathing exercise for chronic pain management in breast cancer survivors: study protocol of a phase II randomised controlled trial

INTRODUCTION

Chronic pain is a common symptom significantly affecting the quality of life of breast cancer survivors. Despite the achievement of pharmacological interventions, the barriers associated with this approach such as inaccessibility, misuse and side effects drive research into effective non-pharmacological interventions to improve chronic pain management, quality of life, anxiety and depression. Breathing exercise (BE) can be a promising option, but research evidence is sparse. This pilot study aims to examine the feasibility and preliminary effect of using an evidence-based BE intervention for chronic pain management in breast cancer survivors.

METHOD AND ANALYSIS

This study will be a two-parallel-arm, open-labelled, phase II randomised controlled trial with 1:1 allocation. Seventy-two participants will be recruited from a tertiary hospital in China and randomly allocated to either a BE intervention group (n=36) or a control group (n=36). The participants in the intervention group will receive the usual care, a pain information booklet and a 4-week self-administered BE intervention; the participants in the control group will receive the usual care and the pain information booklet only. The assessment will be conducted at three time points: baseline (week 0), immediately after the intervention completion (week 5) and 4 weeks after the intervention completion (week 9). The primary outcomes will be the acceptability and feasibility assessment of the study protocol and methodological procedures. The secondary outcomes will be the effects of BE on pain, quality of life, anxiety and depression in breast cancer survivors. Descriptive statistics will be applied to present the primary outcomes and the Generalised Estimating Equation Model will be utilised to analyse the clinical outcomes.

ETHICS AND DISSEMINATION

This study has received ethical approvals from the Human Research Ethics Committee at Charles Darwin University (H21089) and the Clinical Trial Ethics Committee at the Affiliated Hospital of Southwest Medical University (KY2022107). Findings from this study will be presented at academic conferences and submitted to peer-reviewed journals for publication.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov: NCT05257876.