Helping Patients to Help Themselves after Breast Cancer Treatment

Influence of social networks on cancer survivors' self-management support: A mixed methods study

Objective

The role of social networks, especially weaker ties (e.g. casual acquaintances and hobby groups), in self‐management of long‐term consequences of cancer is unexplored. This study aimed to explore the structure of cancer survivors' social networks and their contribution to self‐management support and health‐related quality of life (HRQoL).

Methods

The study used a sequential, exploratory mixed methods design. Phase 1 surveyed 349 lymphoma, colorectal, breast and prostate cancer survivors. Phase 2 analysed 20 semi‐structured interviews with respondents recruited from Phase 1.

Results

Phase 1 results suggested participants' HRQoL increased if they participated in an exercise group, if their self‐management skills increased, and social distress and negative illness perception decreased (p < 0.0005 adj. R² = 0.631). These findings were explored in Phase 2, identifying underlying mechanisms. Four themes were identified: disrupted networks after cancer treatment; navigating formal support and building individual capacity; peer networks and self‐management knowledge and linking networks to enable adaptation in recovery.

Conclusions

This study suggests engagement with community groups, particularly those not directly related to illness management and social interaction with weak ties, make a valuable contribution to self‐management support, increase HRQoL and enhance well‐being.

Adapting a peer-led self-management program for breast cancer survivors in Switzerland using a co-creative approach

OBJECTIVE

The peer-led Cancer Thriving and Surviving Program (CTS) has demonstrated improved health outcomes for cancer survivors. We describe a co-creative process for adapting the CTS for breast cancer survivors in Switzerland and integrating the program into the clinical pathway of Swiss breast centers.

METHODS

A co-creative approach was employed. Breast cancer survivors and health care professionals (total n = 81) participated in three workshops, an online rating, and a consensus conference. An iterative cycle (evidence, ideas, refining, rating, and synthesis) guided the adaptation process.

RESULTS

Survivors involvement in the adaptation process allowed to tailor the self-management program to the psychosocial needs identified as the highest priority. New contents "Being a woman", "Breast cancer and my (working) life" and "My exercise" were added to the CTS. Program duration was expanded from 6 to 7 weeks. Transition to follow-up care was considered as the optimal time point for program integration into the clinical pathway.

CONCLUSION

The co-creative process may serve as a model in adapting supportive interventions for cancer. A subsequent pilot testing examined the feasibility and preliminary efficacy.

PRACTICE IMPLICATIONS

Combining expertise of health care professionals and patients to co-create a peer-led breast cancer self-management program may enhance acceptability and adoption.

Effectiveness and components of self-management interventions in adult cancer survivors: a protocol for a systematic review and planned meta-analysis

BACKGROUND

Self-management interventions have been proposed as effective strategies to improve health and well-being and promote optimal coping in cancer survivors. Several reviews have shown benefits of self-management interventions on a variety of patient-reported outcomes. Effective self-management strategies in other chronic disease populations are typically based on theories of behavior change, but the extent of theoretical underpinnings in cancer self-management programs has not been evaluated to date. Our aim is to expand on previous reviews by evaluating the effectiveness of self-management interventions in cancer survivors as well as the theoretical components of such interventions.

METHODS

We will conduct a systematic review of self-management interventions for adults who have completed primary treatment for their solid or hematological cancer. Interventions tested using experimental or quasi-experimental methods, with any type of comparator, will be included. A search strategy will be designed with a health sciences librarian and then performed using MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, the Cochrane database of systematic reviews, the National Institutes of Health clinical trials registry, and the Cochrane CENTRAL registry of controlled trials. Data synthesis will include a narrative and tabular summary of the results. Appropriate statistical analysis may include a meta-analysis using random effects methods to determine the effectiveness of self-management interventions and a meta-regression to evaluate how characteristics of the interventions are associated with the intervention effect. Risk of bias will be evaluated using the Cochrane risk of bias tool or the Risk of Bias in Non-randomized studies tool (RoBANS).

DISCUSSION

The results of this systematic review will add to previous reviews and expand the existing knowledge base of the effectiveness and active components of self-management interventions for adult cancer survivors.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018085300.

Women's Free-text Comments on their Quality of Life: An Exploratory Analysis from the UK Standardisation of Breast Radiotherapy (START) Trials for Early Breast Cancer

Aims

Exploratory analysis of patients' unsolicited written comments in the first 2 years of the Standardisation of Breast Radiotherapy (START) trial quality of life study highlighted a potential effect of non-treatment-related problems on the ratings and interpretation of patient self-reported questionnaires. At 5 years of follow-up all eligible subjects were invited to write comments to further explore these findings.

Materials and methods

Using inductive qualitative methods informed by the exploratory analysis, comments were allocated to relevant themes. Key patient-reported outcome measures (PROMs), clinical and demographic factors were collated for patients who did and did not comment at 5 years and comparisons between the groups explored.

Results

Of 2208 women completing baseline PROMs, 482 proffered comments from 0 to 24 months, forming nine distinct themes, including chronic conditions, life events and psychosocial concerns. At 5 years, 1041/1727 (60.3%) women contributed comments, of whom 500 randomly selected participants formed the sample for analysis. Findings revealed comorbidity, impaired physical functioning and psychosocial problems as key themes, with prevalent adverse effects from local and systemic treatments. Eight new themes emerged at 5 years, including ageing, concerns about future cancer and positive aspects of care. Women commenting were better educated, slightly older and more likely to have had chemotherapy compared with non-commenters. They had significantly worse PROM scores for global health and key quality of life domains relevant to the difficulties they revealed.

Conclusions

Difficult personal circumstances and other health concerns affected many women's PROM ratings at 5 years of follow-up, in addition to ongoing cancer treatment effects. Greater attention to multiple sources of distress and adversity could facilitate personalised care and aid interpretation of PROMs.

Patient-Reported Self-Efficacy, Anxiety, and Health-Related Quality of Life During Chemotherapy: Results From a Longitudinal Study

PURPOSE/OBJECTIVES

To explore changes over time in self-efficacy and the predictive ability of changes in state anxiety and health-related quality of life during chemotherapy.
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DESIGN

Secondary analysis of a longitudinal dataset derived from a larger, multicenter study.
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SETTING

Outpatient oncology clinics across eight general hospitals in England, Scotland, and Northern Ireland.
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SAMPLE

137 patients scheduled to receive adjuvant chemotherapy for breast or colorectal cancer.
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METHODS

At the beginning of each of six chemotherapy cycles, participants completed the Strategies Used by People to Promote Health questionnaire, the State-Trait Anxiety Inventory, and the Functional Assessment of Cancer Therapy-Breast or -Colorectal questionnaire. Multilevel model analysis was used to analyze longitudinal data, adjusted for demographic and clinical variables.
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MAIN RESEARCH VARIABLES

Self-efficacy, anxiety, and health-related quality of life.
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FINDINGS

No significant time effects were found for patients' overall perceived self-efficacy or self-efficacy parameters. A trend toward greater self-efficacy was evident as chemotherapy progressed. Self-efficacy was significantly associated with decreased state anxiety throughout chemotherapy. Increases in overall self-efficacy and perceived ability to maintain a positive attitude were significantly associated with over-time increases in physical, emotional, and functional well-being, as well as with fewer cancer-related concerns.
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CONCLUSIONS

Findings highlight the importance of clinical assessments throughout treatment that focus on patients' perceived self-efficacy as a positive regulator of mood and well-being. 
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IMPLICATIONS FOR NURSING

The current study suggests self-efficacy enhancement should be a key component of psycho-behavioral programs designed to support patients with cancer throughout chemotherapy.

Factors related to the experience of menopausal symptoms in women prescribed tamoxifen

INTRODUCTION

Menopausal symptoms are frequent and severe in breast cancer survivors taking tamoxifen; however, treatment options are limited for these patients as hormonal replacement therapy is contraindicated. This study aimed to explore the experience and attribution of menopausal symptoms and identify factors related to the experience of menopausal symptoms in women taking tamoxifen.

METHODS

Women who had been prescribed tamoxifen for a diagnosis of primary breast cancer were recruited from oncology clinics across England and from online advertisements. Seven hundred and forty women completed questionnaires assessing illness perceptions, social support, mood and symptom duration/severity.

RESULTS

Eighty-four percent of women had experienced hot flushes and 80% experienced night sweats; of these, 60% experienced severe symptoms. Symptoms persisted throughout 5 years of treatment and were mainly attributed to tamoxifen. Logistic regressions showed that depressive symptoms, previous chemotherapy and being employed were associated with increased odds of hot flush or night sweat prevalence. Symptom severity was associated with depression, being employed and attributing symptoms to tamoxifen.

DISCUSSION

These findings have clinical implications in terms of targeting women who are more at risk and offering non-hormonal treatment options, such as cognitive behavioural therapy, to help women to develop self-management strategies for coping with menopausal symptoms.