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Schou-Bredal I, Sørensen EM, Kraglund KH, Jensen VS, Drageset S. Development of the Breast Cancer Survivors Symptom Checklist for Use in Follow-Up Multidisciplinary Appointments. Patient Relat Outcome Meas 2022; 13:199-208. [PMID: 36238534 PMCID: PMC9552786 DOI: 10.2147/prom.s364625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background Breast cancer survivors are primarily followed up to monitor the effectiveness of treatment and complications and to detect recurrences. Many breast cancer survivors may experience prolonged adverse physical and psychological effects, which should also be addressed at follow-ups. The objective of this study was to develop a brief symptom assessment tool for breast cancer survivors to be used as a guideline for the survivors and all health care professionals conducting the routine follow-up. The second objective was to describe the women's individual experiences with follow-ups. Methods A literature review, a focus group of 6 healthcare professionals using a nominal group technique process, and the experience and feedback via qualitative interviews with 16 breast cancer survivors was used to develop the Breast Cancer Survivors Symptom Assessment Checklist (BCS-SC). Results The BCS-SC consists of a set of 13 symptoms/burdens and one question. On a scale from 0 (no symptom) to 10 (worst imaginable), survivors indicated the extent to which they experience each symptom. All survivors perceived the annual follow-ups as important, but none prepared for them. Eight of the 16 survivors reported that they had 2 or more of the symptoms/burdens listed in the BCS-SC. However, only one of the survivors had mentioned her symptom to the doctor at follow-up. Conclusion The BCS-SC is a comprehensive assessment tool for symptoms/burdens that are common among breast cancer survivors and can aid efforts to optimize their follow-up. Furthermore, the BCS-SC allows for a more patient-initiated and focused consultation, leading to more patient-centered quality care.
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Affiliation(s)
- Inger Schou-Bredal
- Faculty of Medicine, Institute for Health and Science, University of Oslo, Oslo, Norway
| | - Elin Myklebust Sørensen
- Department of Cancer, Unit for Breast and Endocrine Surgery, Oslo University Hospital, Oslo, Norway
| | - Kari Heitmann Kraglund
- Department of Cancer, Unit for Breast and Endocrine Surgery, Oslo University Hospital, Oslo, Norway
| | - Vibeke Schou Jensen
- Department of Cancer, Unit for Breast and Endocrine Surgery, Oslo University Hospital, Oslo, Norway
| | - Sigrunn Drageset
- Faculty of Health Social Sciences, Institute for Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway,Correspondence: Sigrunn Drageset, Faculty of Health Social Sciences, Institute for Health and Caring Sciences, Western Norway University of Applied Sciences, HVL, Postbox 7030, Bergen, 5020, Norway, Tel + 47 55 58 56 32, Email
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Saab M, Han X. Exploring influencing factors in breast cancer survivors’ experience in Lebanon. Front Psychol 2022; 13:965825. [PMID: 36081713 PMCID: PMC9445656 DOI: 10.3389/fpsyg.2022.965825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background The research objective was to investigate social and cultural factors affecting breast cancer survivors’ experiences in Lebanese. Methods A snowball sampling of 20 breast cancer survivors participated in the study. Semi-structured open-ended interviews were used to collect data. Results The results showed that family support and religious beliefs were the primary supporting sources for breast cancer survivors. On the other hand, their body image and children were the major concerns. Thus, family and religious beliefs were needed to overcome breast cancer’s daily burden. Conclusion Women with breast cancer perceived their cancer experience through their social roles, reflecting a concern for image and role preservation.
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How Does Hedonic Aroma Impact Long-Term Anxiety, Depression, and Quality of Life in Women with Breast Cancer? A Cross-Lagged Panel Model Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159260. [PMID: 35954612 PMCID: PMC9368225 DOI: 10.3390/ijerph19159260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022]
Abstract
Depression and anxiety are common symptoms during and after adjuvant chemotherapy treatment for breast cancer (BC), with implications on quality of life (QoL). The present study evaluates the temporal relationship between anxiety, depression, and QoL (primary outcomes), as well as the impact of hedonic aroma (essential oils) on this relationship. This is a secondary analysis of a previously reported randomized controlled trial, with two groups: an experimental group (n = 56), who were subjected to the inhalation of a self-selected essential oil during chemotherapy, and a control group (n = 56), who were only subjected to the standard treatment. The hedonic aroma intervention occurred in the second (T1), third (T2), and fourth (T3) chemotherapy sessions, three weeks apart from each other. The follow-up (T4) assessments took place three months after the end of the treatment. Cross-lagged panel models were estimated in the path analysis framework, using structural equation modeling methodology. Regarding the control group, the cross-lagged panel model showed that anxiety at T1 predicted anxiety at T3, which in turn predicted both QoL and depression at T4. In the experimental group, hedonic aroma intervention was associated with stability of anxiety and QoL over time from T1 to T3, with no longitudinal prediction at T4. For women undergoing standard chemotherapy treatment, anxiety was the main longitudinal precursor to depression and QoL three months after chemotherapy. Thus, essential oils could complement chemotherapy treatment for early-stage BC as a way to improve long-term emotional and QoL-related adjustment.
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Liu J, Wang H, Lin B, Ning L, Liu D, Li J. Mediating Role of Resourcefulness in the Relationship Between Illness Uncertainty and Poststroke Depression. Front Psychol 2022; 13:852739. [PMID: 35645910 PMCID: PMC9133806 DOI: 10.3389/fpsyg.2022.852739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To examine the association between illness uncertainty, resourcefulness, and poststroke depression (PSD) and identifies whether stroke patients' resourcefulness plays a mediating role in the relationship between illness uncertainty and PSD. Methods A cross-sectional study was conducted from September 2020 to April 2021. A convenience sample of 355 stroke patients was recruited. A general characteristic questionnaire, the Mishel Uncertainty in Illness Scale, the Resourcefulness Scale (RS), and the Patient Health Questionnaire-9 (PHQ-9) were used to obtain data. Descriptive analysis, Student's t-test, Mann-Whitney U-test, chi-squared test, hierarchical regression analyses, Pearson correlation analysis, and mediation analysis with the PROCESS macro were used to analyze the data. Results Illness uncertainty, resourcefulness, and PSD were significantly related to each other. Resourcefulness partially mediated the relationship between illness uncertainty and PSD. Conclusion Illness uncertainty and resourcefulness were significantly associated with PSD, and resourcefulness played a mediating role between illness uncertainty and PSD. Interventions designed to reduce illness uncertainty and enhance resourcefulness may contribute to the prevention and improvement of PSD.
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Affiliation(s)
- Jing Liu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Hongxia Wang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Beibei Lin
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liuqiao Ning
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Danman Liu
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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Bektas H, Coskun HS, Arikan F, Ozcan K, Tekeli A, Kondak Y, Sezgin MG, Yangec E, Kalav S. Development and evaluation of the efficacy of a web-based education program among cancer patients undergoing treatment with systemic chemotherapy: a randomized controlled trial. Support Care Cancer 2022; 30:6021-6033. [PMID: 35412076 PMCID: PMC9003166 DOI: 10.1007/s00520-022-07039-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
Purpose The study aimed to develop a web-based education program among cancer patients undergoing treatment with systemic chemotherapy and to evaluate the efficacy of the program on symptom control, quality of life, self-efficacy, and depression. Methods A web-based education program was prepared in line with patient needs, evidence-based guidelines, and expert opinions and tested with 10 cancer patients. The single-blind, randomized controlled study was conducted at a medical oncology unit of a university hospital. Pretests were applied to 60 cancer patients undergoing treatment with systemic chemotherapy, and the patients (intervention: 30, control: 30) were randomized. The intervention group used a web-based education program for 3 months, and they were allowed to communicate with researchers 24/7 via the website. The efficacy of a web-based education program at baseline and after 12 weeks was evaluated. The CONSORT 2010 guideline was performed. Results In the first phase results of the study, it was found that most of the patients with cancer wanted to receive education about symptom management and the side effects of the treatment. Expert opinions on the developed website were found to be compatible with each other (Kendall’s Wa = 0.233, p = 0.008). According to the randomized controlled study results, patients who received web-based education reported significantly fewer symptoms (p = 0.026) and better quality of life (p = 0.001), but there was no statistically significant difference in the self-efficacy and depression levels during the 3-month follow-up period (p˃0.05). The most frequently visited links in the web-based education program by the patients with cancer were the management of chemotherapy-related symptoms (62.6%). Conclusion A web-based education program was found to be efficacy in remote symptom management and improving the quality of life of cancer patients. Trial registration www.clinicaltrials.gov, NCT05076916 (October 12, 2021, retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07039-w.
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Affiliation(s)
- Hicran Bektas
- Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Dumlupinar Bulvari, 07058, Antalya, Turkey.
| | | | - Fatma Arikan
- Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Dumlupinar Bulvari, 07058, Antalya, Turkey
| | - Keziban Ozcan
- Akdeniz University Hospital Medical Oncology Unit, Antalya, Turkey
| | - Aysel Tekeli
- Akdeniz University Hospital Medical Oncology Unit, Antalya, Turkey
| | - Yasemin Kondak
- Akdeniz University Hospital Medical Oncology Unit, Antalya, Turkey
| | - Merve Gozde Sezgin
- Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Dumlupinar Bulvari, 07058, Antalya, Turkey
| | - Elcin Yangec
- Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Dumlupinar Bulvari, 07058, Antalya, Turkey
| | - Simge Kalav
- Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Dumlupinar Bulvari, 07058, Antalya, Turkey
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Dun L, Xian-Yi W, Si-Ting H. Effects of Cognitive Training and Social Support on Cancer-Related Fatigue and Quality of Life in Colorectal Cancer Survivors: A Systematic Review and Meta-Analysis. Integr Cancer Ther 2022; 21:15347354221081271. [PMID: 35225053 PMCID: PMC8891882 DOI: 10.1177/15347354221081271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Few studies have evaluated the effects of cognitive training and social support on cancer-related fatigue and quality of life. We performed a meta-analysis of randomized controlled trials to examine the efficacy of cognitive training and social support in colorectal cancer patients and survivors. Methods: The PubMed, Ovid, EMBASE, Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure databases were searched from database establishment until August 2021 to identify suitable studies according to relevant key words, taking cancer-related fatigue and quality of life as the outcomes. The Jadad scale was used to evaluate the methodological quality of the studies. Stata 15.1 software was used for statistical analyses, and sensitivity analyses were performed. Results: Eleven studies (6 published in English and 5 published in Chinese) involving 980 patients and survivors were included in the meta-analysis. All studies had Jadad scores ≥3. Statistically significant effects of cognitive training and social support were detected for cancer-related fatigue within 14 weeks (SMD = −1.13, P < .001) and after 14 weeks (SMD = −0.56, P < .001), overall quality of life within 14 weeks (SMD = 0.73, P < .001) and after 14 weeks (SMD = 0.54, P = .003). However, no statistically significant effects of the combination intervention were detected on long-term QOL (SMD = 0.50, P = .435). Conclusions: Distinct cognitive interventions and a combination of cognitive and social support interventions can help to alleviate long-term and short-term CRF and short-term QOL. Further studies are needed to examine the mechanisms of cognitive training and social support for cancer-related fatigue and overall quality of life in patients and survivors with colorectal cancer.
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Affiliation(s)
- Liu Dun
- Fujian Medical University, Fuzhou, Fujian, China
| | - Wu Xian-Yi
- Fujian Medical University Affiliated College of oncology clinical medicine and Fujian Cancer Hospital, Fuzhou, Fujian, China
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Lee HJ, Kim YA, Ryu SY, Chun M, Yim CY, Kang HT, Kang JH, Huh JS, Kim JH, Lim KH, Jung SY, Kwon HC, Goh E, Lee YS, Ju HY, Yun EH, Chang YJ. The Positive Effects of Cancer Survivor Support Service on Distress in South Korea: A Nationwide Prospective Study. Front Med (Lausanne) 2022; 9:769221. [PMID: 35237619 PMCID: PMC8882982 DOI: 10.3389/fmed.2022.769221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Aim Cancer survivors are gradually increasing, however, they suffer from various difficulties. We aimed to investigate the characteristics of cancer survivors and the effects of the services of the Korean Cancer Survivorship Center Pilot Project launched by the South Korean government on distress. Methods A prospective observational cohort study was performed on cancer survivors who completed primary treatment. Cancer survivors' distress and symptoms such as fatigue, pain, depressive mood, anxiety, and insomnia were evaluated by well-trained nurses. Regarding their needs, medical and psychosocial support services were provided. Results This study included 1,921 cancer survivors, with a mean age of 57.3 years (68.7% females). Breast cancer was most common, followed by stomach and colorectal cancer. Psychosocial and medical support decreased the percentage of the high-distress group from 50.9 to 30.5% and decreased the percentage of cancer survivors with high scores in fatigue, pain, anxiety, depressive mood, and insomnia. The independent predictors of a low distress level after the use of the services were older age, the relief of fatigue, pain, and insomnia. Conclusion This study showed that psychosocial and medical support is associated with the lower distress and physical and mental symptoms of cancer survivors. Psychosocial and medical support could contribute to distress relief in cancer survivors. Further management strategies for fatigue, pain and insomnia are required.
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Affiliation(s)
- Hyun Jeong Lee
- Division of Cancer Control and Policy, National Cancer Center, Goyang, South Korea
- National Cancer Survivorship Center, National Cancer Center, Goyang, South Korea
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, South Korea
- Department of Psychiatry, Seoul National University, Seoul, South Korea
| | - Young Ae Kim
- Division of Cancer Control and Policy, National Cancer Center, Goyang, South Korea
- National Cancer Survivorship Center, National Cancer Center, Goyang, South Korea
- *Correspondence: Young Ae Kim
| | - Seong Yeob Ryu
- Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Chang-Yeol Yim
- Department of Internal Medicine, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, South Korea
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, South Korea
- Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Jung Hun Kang
- Division of Hematology-Oncology, Department of Internal Medicine, College of Medicine, Gyeong-Sang National University, Jinju, South Korea
- Department of Medicine, Gyeongsang National University Hospital, Jinju, South Korea
| | - Jung-Sik Huh
- Department of Urology, School of Medicine, Jeju National University, Jeju, South Korea
| | - Jong-Heun Kim
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, South Korea
| | - Kyu-Hyoung Lim
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - So-Youn Jung
- Breast Cancer Center, National Cancer Center, Goyang, South Korea
| | - Hyoung-Cheol Kwon
- Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, South Korea
- Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, South Korea
- Department of Radiation Oncology, Chonbuk National University Medical School, Jeonju, South Korea
| | - Eurah Goh
- Department of Family Medicine, Postgraduate College of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Yeon-Seung Lee
- Division of Cancer Control and Policy, National Cancer Center, Goyang, South Korea
| | - Hee Young Ju
- Cancer Survivorship Branch, National Cancer Center, Goyang, South Korea
- Department of Pediatrics, Samsung Medical Center, Seoul, South Korea
| | - E. Hwa Yun
- Division of Cancer Control and Policy, National Cancer Center, Goyang, South Korea
- National Cancer Survivorship Center, National Cancer Center, Goyang, South Korea
- Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, South Korea
| | - Yoon Jung Chang
- Division of Cancer Control and Policy, National Cancer Center, Goyang, South Korea
- National Cancer Survivorship Center, National Cancer Center, Goyang, South Korea
- Center for Cancer Prevention and Detection, National Cancer Center, Goyang, South Korea
- National Hospice Center, National Cancer Center, Goyang, South Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea
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Li J, Liu Y, Jiang J, Peng X, Hu X. Effect of telehealth interventions on quality of life in cancer survivors: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud 2021; 122:103970. [PMID: 34303269 DOI: 10.1016/j.ijnurstu.2021.103970] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND With advances in cancer disease diagnosis and treatment, the trends of cancer survival continue to increase, but cancer survivors usually experience disease- or treatment-related problems (including both physiological and psychological problems) and poorer quality of life. Various types of telehealth interventions have been widespread in the field of medical care and have been shown to be cost-effective, to have high levels of patient satisfaction, and to have high acceptability among health professionals. Currently, there is no definite conclusion about the effectiveness of telehealth interventions on cancer survivors' quality of life. OBJECTIVES To evaluate the effects of telehealth interventions on cancer survivors' quality of life and compare the effectiveness of different types. DESIGN A systematic review and meta-analysis. METHODS A systematic literature search was conducted in six databases (MEDLINE, Embase, the Cochrane Central Register of Controlled trials, CINAHL, PsycINFO, and Web of Science) to identify relevant studies from inception to 14 April 2021. Two reviewers independently screened studies and extracted the data. The Cochrane risk-of-bias tool was used to evaluate the quality of the included studies. Data synthesis was conducted in Review Manager (Version 5.3), and the quality of life scores were calculated by using the standard mean difference (SMD) and 95% confidence intervals (CIs). Sensitivity analysis and subgroup analysis were also conducted. RESULTS Twenty-eight randomized controlled trials (RCTs) published from 2002 to 2020 were included. Meta-analysis revealed significant effects of telehealth interventions on cancer survivors' quality of life (SMD = 0.24, 95% CI: 0.14-0.34, P < 0.00001). Subgroup analysis showed that the most effective method was application-based intervention (SMD = 0.41, 95% CI: 0.17-0.66) and the short-term telehealth intervention was more effective than other durations of intervention (SMD = 0.28, 95% CI: 0.06-0.50). The effects on breast cancer survivors' quality of life were greater than those on the other types of cancer survivors (SMD = 0.30, 95% CI: 0.10-0.51). Sensitivity analysis indicated that the pooled results were robust and reliable. CONCLUSION Telehealth interventions are effective and alternative methods for improving quality of life among cancer survivors. The most effective approach was application-based intervention, the most common approach was website-based intervention, and in terms of intervention durations, the short-term telehealth intervention was the most effective. Most telehealth interventions included breast cancer survivors. More large, well-designed RCTs are needed to confirm the effects of telehealth interventions on quality of life in cancer survivors.
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Affiliation(s)
- Juejin Li
- West China School of Nursing, West China Hospital, Sichuan University, No 37 Guo-xue-xiang Lane, Wuhou District, Chengdu, Sichuan, PR China
| | - Yong Liu
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Jianjun Jiang
- Department of Palliative Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xiaolin Hu
- West China School of Nursing, West China Hospital, Sichuan University, No 37 Guo-xue-xiang Lane, Wuhou District, Chengdu, Sichuan, PR China.
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Wu CY, Chan TF, Shi HY, Kuo YL. Psychiatric problems of anxiety and depression disorder are associated with medical service utilization and survival among patients with cervical cancer. Taiwan J Obstet Gynecol 2021; 60:474-479. [PMID: 33966731 DOI: 10.1016/j.tjog.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There are few nationwide studies regarding the long-term analysis of cervical cancer patients in Taiwan. Thus, this study aimed to evaluate medical service utilization, and survival among cervical cancer patients initially diagnosed with or without anxiety and/or depressive disorders. MATERIALS AND METHODS This was a retrospective longitudinal study using data from the National Health Insurance Research Database from 1996 to 2010. The study subjects were cervical cancer patients identified by ICD-9-CM codes 180.X, while subjects with anxiety and/or depressive disorders were identified using the following codes: 300.0X-300.9X (minus 300.4X) for anxiety disorder, and 296.2X, 296.3X, 300.4, and 311.X for depressive disorder. The cervical patients with anxiety or/and depression disorder were classified as anxiety/depression (AD) group or the non-disorder (ND) group. Propensity score matching (PSM) was used to adjust for differences between the AD and ND groups. T-tests were used to evaluate differences in medical utilization and the Kaplan-Meier method was used to evaluate survival conditions between the two groups. Statistical analyses were performed using SPSS Statistics 20.0. RESULTS A total of 3664 patients were identified, with 862 (23.5%) having anxiety, 149 (4.1%) with depression, and 349 (9.5%) having both anxiety and depression. In total, 1360 cervical cancer patients had anxiety/depression disorders. After PSM, the AD group had significantly more outpatient department (OPD) visits than the ND group (p < 0.001) but the survival status was better in the AD group than the ND group (p < 0.001). CONCLUSIONS Cervical cancer patients with anxiety/depression disorders visited the OPD more frequently than those without anxiety/depression disorders but had better survival status. Gynecologists should also consider cancer patients' mental status during follow-up, referring patients to psychiatric professionals for appropriate psychiatric care if appropriate.
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Affiliation(s)
- Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Te-Fu Chan
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine & Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Ling Kuo
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Gormley M, Knobf MT, Vorderstrasse A, Aouizerat B, Hammer M, Fletcher J, D'Eramo Melkus G. Exploring the effects of genomic testing on fear of cancer recurrence among breast cancer survivors. Psychooncology 2021; 30:1322-1331. [PMID: 33742530 DOI: 10.1002/pon.5679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/06/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is the greatest unmet psychosocial need among breast cancer survivors (BCS). The Oncotype Dx® test predicts the 10-year risk of distant recurrence and benefit of adjuvant chemotherapy among women with early stage hormone receptor-positive breast cancer. Despite the test's clinical utility, psychosocial responses are poorly understood. METHODS A descriptive cross-sectional study was conducted to explore associations between Oncotype Dx® test results (Recurrence Score [RS]) and FCR, health-related quality of life (HRQOL), distress, anxiety, depression, illness representation and perceived risk. Bivariate analyses were used to examine the associations between variables followed by multiple linear regression to examine predictors of FCR. RESULTS Greater FCR was associated with higher distress, anxiety, depression, illness representation and poorer HRQOL. BCS's with a high Oncotype Dx® RS reported higher overall fear (p = 0.013) and greater perceived consequences of their cancer (p = 0.034) compared to BCS's with a low RS. Using multiple linear regression, anxiety ( β = 0.21, p = 0.016), greater emotional response ( β = 0.45, p < 0.001) and perceived consequences ( β = 0.18, p = 0.039) of illness explained 58% of the variance (p < 0.001) in FCR. CONCLUSION BCS's with higher risk of recurrence may experience higher FCR. However, for FCR, modifiable factors such as anxiety and illness representation (greater emotional response and perceived consequences of illness) may be more important than non-modifiable factors such as Oncotype Dx® test results and age. Further research is needed to develop personalized interventions to improve BCS's outcomes.
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Affiliation(s)
- Maurade Gormley
- Rory Meyers College of Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA
| | - M Tish Knobf
- School of Nursing, Yale University School of Nursing, Orange, Connecticut, USA
| | - Allison Vorderstrasse
- College of Nursing, University of Massachusetts Amherst College of Nursing, Amherst, Massachusetts, USA
| | - Bradley Aouizerat
- College of Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Marilyn Hammer
- Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jason Fletcher
- Rory Meyers College of Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Gail D'Eramo Melkus
- Rory Meyers College of Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA
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Do COVID-19-Related Treatment Changes Influence Fear of Cancer Recurrence, Anxiety, and Depression in Breast Cancer Patients? Cancer Nurs 2021; 45:E628-E638. [PMID: 33654008 DOI: 10.1097/ncc.0000000000000937] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The worldwide spread of the coronavirus disease 2019 (COVID-19) has impacted the treatment of cancer patients. Treatment changes can negatively affect patients' prognosis and may be psychologically burdensome. OBJECTIVE The aim of this study was to explore whether COVID-19-related treatment changes (delays, cancellations, changes) influenced fear of cancer recurrence, anxiety, and depression in breast cancer patients. METHODS A convenience sample (n = 154) of patients who were diagnosed with breast cancer no longer than 2 years ago was obtained from an online community and social network site. The survey content included COVID-19-related treatment experiences and psychological status. The data were analyzed using descriptive statistics, χ2 test, independent t test, and analysis of variance. RESULTS Twenty-nine patients (18.8%) had experienced COVID-19-related treatment changes, and changes of the treatment plan had a significant correlation with depression (t = 2.000, P = .047). Fear of cancer recurrence was high (mean score, 84.31 ± 24.23). Fifteen percent had moderate to severe levels of anxiety, and 24.7% had moderate to severe levels of depression. Narrative reports also identified COVID-19-related unforeseen costs. CONCLUSION In the midst of the COVID-19 pandemic, breast cancer patients experienced treatment changes, and changes in treatment plans were significantly associated with depression. Fear of recurrence, anxiety, and depression were found at high levels. IMPLICATIONS FOR PRACTICE Oncology nurses should assess the psychological status of cancer patients in the early survivorship phase who appear to be especially vulnerable during the COVID-19 pandemic. Oncology nurses can also monitor whether patients are receiving timely supportive care to alleviate fears and anxiety and assess financial needs for COVID-19-related costs.
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12
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Melnyk H, Djukic M, Merriman J, Vaughan Dickson V. An integrative review: Women's psychosocial vulnerability in relation to paid work after a breast cancer diagnosis. J Adv Nurs 2020; 77:2144-2154. [PMID: 33368563 DOI: 10.1111/jan.14730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022]
Abstract
AIM The aim of this integrative review was to explore psychosocial vulnerabilities in women after a breast cancer diagnosis that are related to their paid work. DESIGN The review methodology was guided by Whittemore and Knafl. The Mehnert Cancer Survivorship and Work Model provided a lens through which to view vulnerability in working women with a focus on facilitating interventions to improve both recovery and work outcomes. DATA SOURCES PUBMED, CINAHL, Web of Science, and PsycNET databases were searched for English language papers published between January 2014-June 2020. REVIEW METHODS Titles and abstracts were screened. Inclusion/exclusion criteria were then applied to full text screen of the remaining articles following PRISMA guidelines. Thirteen studies meeting the inclusion criteria were critically appraised using the Critical Appraisal Skills Programme (CASP) checklist. A constant comparison approach was used to systematically distil findings into categories and assess their fit within the Mehnert Model subdomains. RESULTS Vulnerabilities coalesced predominantly within the following subdomains: (a) changes in identity and role functioning; (b) social reintegration; (c) coping strategies; and (d) social supports. Patterns and themes within these subdomains were related both positively and negatively to form the contours of a survivor's satisfaction/dissatisfaction with quality of life related to work and breast cancer recovery. CONCLUSION Overall, findings highlight the importance of employment and work environments in bolstering women's psychosocial health after a breast cancer diagnosis. IMPACT Findings from this review support adapting psychosocial distress screening to include vulnerabilities relating to work life. Nurses are ideally positioned to facilitate this screening and engage clinicians in a dialogue surrounding patient's support needs due to nursing's central role on the interdisciplinary team. Nurses may also foster collective accountability for implementing ongoing multidisciplinary survivorship care plans that include a return to work component.
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Affiliation(s)
- Halia Melnyk
- College of Nursing, New York University Rory Meyers, New York, NY, USA
| | - Maja Djukic
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX, USA
| | - John Merriman
- College of Nursing, New York University Rory Meyers, New York, NY, USA
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13
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Shaw S, Atkinson K, Jones LM. Cancer survivors' experiences of an exercise program during treatment and while employed: A qualitative pilot study. Health Promot J Austr 2020; 32 Suppl 2:378-383. [PMID: 33305519 DOI: 10.1002/hpja.447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/07/2020] [Indexed: 11/07/2022] Open
Abstract
ISSUE ADDRESSED This study examined breast cancer survivors' (BCS) views on the role of exercise therapy while they were working in employment during cancer treatment. METHODS Research was undertaken with five participants who undertook an exercise programme as adjuvant care during treatment for breast cancer. Four female and one male client, the only clients who met the criteria for study in the clinic, were interviewed twice each during a two-month period. Participants wrote diaries to supplement the interview data and provide prompts for the second interview. An interpretive paradigm was used to identify themes for analysis. A multiple coding approach was used to interpret the data. The study was conducted at a small breast cancer recovery clinic, situated at a university in the South Island of New Zealand. RESULTS Participants reported that exercise was essential to their ability to work through the active treatment phase and provided positive effects on social, mental and emotional well-being. CONCLUSIONS Exercise therapy is an important element of enabling to work during treatment, for physical, mental and social well-being. SO WHAT?: Future research is required on support for employers to enable exercise therapy for employees; the needs of self-employed patients; tailoring exercise therapy for patients for whom social support is not a primary motivation; and the place of a clinic as a 'middle-ground' between social and emotional support and an exercise clinic.
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Affiliation(s)
- Sally Shaw
- School of Physical Education, Sport & Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Katy Atkinson
- School of Physical Education, Sport & Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Lynnette M Jones
- School of Physical Education, Sport & Exercise Sciences, University of Otago, Dunedin, New Zealand
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14
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Çelik GK, Çakır H, Kut E. Mediating Role of Social Support in Resilience and Quality of Life in Patients with Breast Cancer: Structural Equation Model Analysis. Asia Pac J Oncol Nurs 2020; 8:86-93. [PMID: 33426195 PMCID: PMC7785076 DOI: 10.4103/apjon.apjon_44_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/04/2020] [Indexed: 11/18/2022] Open
Abstract
Objective: This study aimed to investigate the mediating role of social support in the relationship between resilience and quality of life (QoL) among Turkish patients with early-stage breast cancer. Methods: The study used a descriptive and cross-sectional design and was carried out in the oncology ward of a hospital in the Central Anatolia region of Turkey. A demographic-disease survey, the Turkish version of the Connor–Davidson Resilience Scale 25, the Multidimensional Perceived Social Support Scale, the European Organization for Research and Treatment of Cancer QoL Questionnaire Core, and the QoL Questionnaire Breast Cancer 23 were used to interview 113 patients with breast cancer. Results: Social support played a partial mediator role in the relationship between resilience and functional QoL. There was a negative correlation between functional QoL Questionnaire Breast Cancer 23 and psychological resilience and social support (P < 0.005). The mediation effect ratio was 10.2% (R2 = 0.102). Social support was found to not have a mediating role in the relationship between psychological resilience and general QoL (P < 0.05). Conclusions: Patients do not want social support to end, and their weakness in the eyes of others may have a negative impact on their QoL and resilience.
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Affiliation(s)
- Gülden Küçükakça Çelik
- Department of Nursing, Semra and Vefa Kucuk Faculty of Health Sciences, Nevsehir Haci Bektas Veli University, Kayseri, Turkey
| | - Hatice Çakır
- Department of Surgical, Nevsehir, Kayseri City Hospital, Kayseri, Turkey
| | - Engin Kut
- Department of Oncology, Manisa City Hospital, Manisa, Turkey
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15
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van Deuren S, van Dulmen-den Broeder E, Boonstra A, Gielissen M, Blijlevens N, Loonen J, Knoop H. Fatigue-Related Cognitive-Behavioral Factors in Survivors of Childhood Cancer: Comparison with Chronic Fatigue Syndrome and Survivors of Adult-Onset Cancer. J Adolesc Young Adult Oncol 2020; 10:92-99. [PMID: 32857640 DOI: 10.1089/jayao.2020.0094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose: Cancer-related fatigue is a burdensome late effect of cancer treatment. A pilot study showed the effectiveness of cognitive-behavioral therapy (CBT) in fatigued survivors of childhood cancer (CCS). The aim of this study is to investigate whether the six cognitive-behavioral factors that are addressed during CBT differ in CCS compared with patients with chronic fatigue syndrome (CFS) and survivors of adult-onset cancer (ACS). Levels of self-esteem, optimism, and depressive symptoms, variables that are also related to fatigue, were also compared between groups. Methods: Retrospective analyses were performed on 34 CCS (ages 11-42 years), 102 patients with CFS, and 95 ACS who were referred for evaluation of severe fatigue. Fatigue severity, possible cognitive-behavioral fatigue maintaining factors, depressive symptoms, self-esteem, and optimism were assessed using questionnaires and actigraphy. Results: No significant differences were found in the factors coping with the experience of having had cancer, fear of cancer recurrence, physical activity, and in levels of self-esteem and optimism. CCS attributed their fatigue significantly more often to psychosocial causes and reported fewer problems in sleep/rest compared with patients with CFS. Compared with ACS, CCS reported significantly more social support, more problems in sleep/rest, and more depressive symptoms. Conclusions: There is substantial overlap in cognitive-behavioral factors that can maintain fatigue between CCS and CFS patients or ACS. Also differences were found regarding attribution of fatigue, the sleep/rest pattern, social support, and depressive symptoms that might have clinical implications when CBT for fatigue is provided to CCS.
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Affiliation(s)
- Sylvia van Deuren
- Radboudumc Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Pediatric Oncology, VU University, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Amilie Boonstra
- Radboudumc Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacqueline Loonen
- Radboudumc Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Expert Center for Chronic Fatigue, Amsterdam Public Health Research Institute, VU University, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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16
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An Integrative Review on Factors Contributing to Fear of Cancer Recurrence Among Young Adult Breast Cancer Survivors. Cancer Nurs 2020; 45:E10-E26. [DOI: 10.1097/ncc.0000000000000858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Admiraal JM, Hoekstra-Weebers JEHM, Schröder CP, Tuinier W, Hospers GAP, Reyners AKL. Distress, problems, referral wish, and supportive health care use in breast cancer survivors beyond the first year after chemotherapy completion. Support Care Cancer 2020; 28:3023-3032. [PMID: 31511981 PMCID: PMC7256025 DOI: 10.1007/s00520-019-05030-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/06/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE We examined distress levels, problems, referral wish, and supportive health care use in a cross-sectional group of breast cancer survivors at two-time points with a 1-year time interval. Also, factors related to continuing elevated distress were explored. METHODS Breast cancer survivors, 1-5 years after chemotherapy completion, filled in the Dutch Distress Thermometer/Problem List (DT/PL) and questions on background characteristics at study inclusion (T1). DT/PL responses and health care use were discussed during semi-structured interviews. One year later, re-assessment took place (T2). The data were analyzed by descriptive and univariate analyses. Continuing elevated distress was defined as a DT score ≥ 5 at T1 and T2. RESULTS Seventy-three survivors completed all questionnaires (response = 84.6%). Eighteen (25%) experienced continuing elevated distress. Fatigue (T1 N = 48 (66%); T2 N = 41 (56%)) and lack of physical fitness (T1 N = 44 (60%); T2 N = 36 (49%)) were most often reported. Time since diagnosis, health care use, and practical, social, emotional and physical problems were significantly associated with continuing elevated distress. Between diagnosis and T1, N = 49(67%) used supportive healthcare services, mostly a psychologist and/or a physical/lymphedema therapist, and between T1 and T2, 39 (53%) did. At T1, 8 (11%) expressed a referral wish and at T2, 11 (16%) did. CONCLUSIONS Screening and management of distress, problems, and referral wish are important, even years after chemotherapy completion as a substantial proportion of breast cancer survivors continue to report elevated distress and problems. Special attention should be paid to survivors reporting physical problems, especially fatigue and lack of physical fitness, since these problems are most strongly related to continuing elevated distress.
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Affiliation(s)
- J M Admiraal
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - J E H M Hoekstra-Weebers
- University of Groningen, University Medical Center Groningen, Wenckebach Institute, Groningen, The Netherlands
| | - C P Schröder
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - W Tuinier
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - G A P Hospers
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands
| | - Anna K L Reyners
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands.
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18
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Relationships Between Weight Change and Physical and Psychological Distress in Early-Stage Breast Cancer Survivors. Cancer Nurs 2020; 42:E43-E50. [PMID: 29847347 DOI: 10.1097/ncc.0000000000000612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Weight gain and unfavorable changes in body composition are common in a growing population of breast cancer survivors, but the etiology of these changes is poorly understood. OBJECTIVE The aim of this study was to investigate relationships between weight change and symptoms of physical and psychological distress in the first 12 months of completing treatment in women who had completed treatment for breast cancer. METHODS Physical distress and psychological distress were assessed using the Rotterdam Symptom Checklist, the Distress Thermometer, and the Fatigue Symptom Inventory. RESULTS Weight change in 28 women since the completion of treatment (mean, 6.4 ± 4.4 months) ranged from -6.0 kg to +5.2 kg (mean, -0.4 ± 3.2), with 6 women gaining and 7 women losing an average of 3.5 ± 1.0 and 5.1 ± 0.8 kg, respectively. Rotterdam mean scores for physical (17.5 ± 9.0) and psychological distress (27.1 ± 16.9) were similar to previous findings for patients with early-stage breast cancer in active treatment and appear to be markedly higher than distress levels previously reported in cancer-free adults. Distress levels, based on the Distress Thermometer, were moderate to severe in 35% of women. Fatigue was common and associated with interference in daily living for some women. Fatigue duration was negatively correlated with weight change (P = -0.46, P < .05). CONCLUSIONS Symptoms of physical and psychological distress persist for some women in the first year after completing treatment and may associate with weight change. IMPLICATIONS These findings underscore a need for ongoing assessment and supportive care across the breast cancer trajectory and may guide dietary counseling aimed at promoting healthy body weight and overall health in early survivorship.
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19
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de Almeida NG, Knobf TM, de Oliveira MR, Salvetti MDG, Oriá MOB, Fialho AVDM. A Pilot Intervention Study to Improve Sexuality Outcomes in Breast Cancer Survivors. Asia Pac J Oncol Nurs 2020; 7:161-166. [PMID: 32478133 PMCID: PMC7233565 DOI: 10.4103/apjon.apjon_56_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/12/2019] [Indexed: 02/06/2023] Open
Abstract
Objective: The main objective of the study is to assess the efficacy of the Permission, Limited information, Specific Suggestion, and sexual therapy (PLISSIT) model directly with breast cancer survivor (BCS) on sexual function and quality of life (QOL) domains. Methods: A pilot control trial was conducted comparing the PLISSIT model intervention to usual care. The intervention was delivered by two health professionals (nurse and professional sexual therapist) consisted of five sessions on counseling, genitalia anatomy, human sexual response, and sexual function. Data were collected before and 3 months after the intervention using the Female Sexual Function Index and the World Health Organization QOL-BREF questionnaire. Results: The sample consisted of 19 BCS (11 intervention, 8 controls) with a mean age of 54.5 8 years (standard deviation = 7.14) and the majority were married, Black or mixed Brazilian, received chemotherapy, radiation and/or hormonal therapy, and education varied from high school to college. There was significant improvement in physical health (P = 0.031), social relationships (P = 0.046), orgasm (P = 0.055), and pain (P = 0.049) over time and the intervention resulted in improved arousal (P = 0.038). Conclusions: The results suggest that the PLISSIT model may be an effective intervention for BCS in coping with and managing changes in sexuality and sexual function after treatment. It is important that nurses are aware of sexual intimacy concerns for BCS and integrate assessment into their nursing care.
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Affiliation(s)
| | - Tish M Knobf
- School of Nursing, Yale University, New Haven, CT, USA
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20
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Martino ML, Lemmo D, Gargiulo A, Barberio D, Abate V, Avino F, Tortoriello R. Underfifty Women and Breast Cancer: Narrative Markers of Meaning-Making in Traumatic Experience. Front Psychol 2019; 10:618. [PMID: 30984067 PMCID: PMC6448035 DOI: 10.3389/fpsyg.2019.00618] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/06/2019] [Indexed: 02/05/2023] Open
Abstract
A diagnosis of breast cancer is considered a potential traumatic event associated with physical and psychological effects. In literature, an exploration of breast cancer experience in young women is lacking, able to shed light on the narrative processes of meaning-making of the experience in specific phases of treatment, as may be the initial impact with the onset of the cancer. Meaning-making processes are determinant aspects when dealing with traumatic events. The research took place at National Cancer Institute Pascale of Naples. We collected 50 ad hoc narrative interviews to explore the different domains of the experience with under-fifty women at the first phase of the hospitalization. The Narrative Interviews were analyzed through a qualitative methodology constructed ad hoc. Starting from the functions of meaning-making that the narrative mediate we have highlight the different modes to articulate the narrative functions: The Organization of Temporality: chronicled (38%), actualized (26%), suspended (18%), interrupted (16%), and confused (2%). The Search for Meaning: internalized (42%); generalized (24%); externalized (18%); suspended (16%). The Emotional Regulation: disconnected (44%), splitted (28%), pervasive (26%), and connected (2%). The Organization of self-other Relationship: supportive (46%), avoidant (22%), overturned (16%), and sacrificial (16%). The Finding Benefit: revaluating (38%), flattened (34%), and postponed (28%). The Orientation to Action: combative (38%), blocked (36%), and suspended (26%). Findings capture the impact with the onset of the cancer, identifying both risk and resource aspects. The study allows to identify a specific use of narrative device by under-fifty women who impacted with the experience of breast cancer. The ways in which meaning-making functions are articulated highlight the specificity of the first phase of the treatment of the cancer. From a clinical psychology point of view, our findings can be used as clinical narrative markers to grasp, in a diachronic way, the process of meaning-making, integration, and coping during the first phase of breast cancer experience in young women. We consider it valuable to increase longitudinal studies with young women to highlight trajectories of meaning-making during the different phases of the treatment to think about personalized intervention practices diachronically to the experience.
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Affiliation(s)
- Maria Luisa Martino
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Daniela Lemmo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Anna Gargiulo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Daniela Barberio
- Clinical Psychology Unit, National Cancer Institute G. Pascale Foundation (IRCCS), Naples, Italy
| | - Valentina Abate
- Clinical Psychology Unit, National Cancer Institute G. Pascale Foundation (IRCCS), Naples, Italy
| | - Franca Avino
- Breast Surgery, National Cancer Institute G. Pascale Foundation (IRCCS), Naples, Italy
| | - Raffaele Tortoriello
- Breast Surgery, National Cancer Institute G. Pascale Foundation (IRCCS), Naples, Italy
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21
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Arving C, Assmus J, Thormodsen I, Berntsen S, Nordin K. Early rehabilitation of cancer patients—An individual randomized stepped‐care stress‐management intervention. Psychooncology 2018; 28:301-308. [DOI: 10.1002/pon.4940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Cecilia Arving
- Department of Oncology and Medical PhysicsHaukeland University Hospital Bergen Norway
- Department of Public Health and Caring SciencesUppsala University Uppsala Sweden
| | - Jörg Assmus
- Centre for Clinical ResearchHaukeland University Hospital Bergen Norway
| | - Inger Thormodsen
- Department of Oncology and Medical PhysicsHaukeland University Hospital Bergen Norway
| | - Sveinung Berntsen
- Department of Public Health and Caring SciencesUppsala University Uppsala Sweden
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport SciencesUniversity of Agder Kristiansand Norway
| | - Karin Nordin
- Department of Public Health and Caring SciencesUppsala University Uppsala Sweden
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport SciencesUniversity of Agder Kristiansand Norway
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22
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Wu HJ, Tai CJ, Tai CJ, Chien LY. Symptom severity, symptom interference and use of complementary and alternative medicine among survivors of colorectal and breast cancer after curative treatment in Taiwan. Eur J Cancer Care (Engl) 2018; 28:e12925. [DOI: 10.1111/ecc.12925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 03/21/2018] [Accepted: 08/22/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Hsiu-Ju Wu
- Department of Oncology; Sijhih Cathay General Hospital; Taipei Taiwan
| | - Chen-Jei Tai
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine; Taipei Medical University; Taipei Taiwan
- Department of Traditional Chinese Medicine; Taipei Medical University Hospital; Taipei Taiwan
| | - Cheng-Jeng Tai
- Department of Internal Medicine, School of Medicine, College of Medicine; Taipei Medical University; Taipei Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine; Taipei Medical University Hospital; Taipei Taiwan
| | - Li-Yin Chien
- Institute of Community Health Care; National Yang-Ming University; Taipei Taiwan
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23
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Legg M, Hyde MK, Occhipinti S, Youl PH, Dunn J, Chambers SK. A prospective and population-based inquiry on the use and acceptability of peer support for women newly diagnosed with breast cancer. Support Care Cancer 2018; 27:677-685. [PMID: 30056530 DOI: 10.1007/s00520-018-4358-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 07/17/2018] [Indexed: 11/30/2022]
Abstract
The degree to which peer support is used and accepted as a supportive care approach by women with breast cancer is unclear. We examine peer support use across three major modalities (i.e. support groups, online platforms, one-on-one) and identify enablers and barriers to peer support using the beliefs framework of the theory of planned behaviour. A population-based sample of women newly diagnosed with breast cancer (n = 3105) who were on average 54.08 weeks since diagnosis completed mailed surveys at baseline measuring beliefs about peer support and intention. Peer support use was measured via telephone interview at baseline and prospectively at 12-month follow-up (n = 2780). In all, 37% of women had used at least one peer support service since diagnosis (support group = 20%, online = 18%, one-on-one = 10%). A path analysis examined what beliefs enabled or acted as barriers to peer support use at follow-up adjusting for past behaviour (i.e. baseline use), sociodemographic characteristics, and treatment. In order of relative strength, enablers included beliefs that peer support is an outlet for honest expression of feelings (β = .35), a source of empathy (β = .30), approved by doctors (β = .07), and approved by family/partner (β = .04). Barriers were beliefs that it encourages dwelling about breast cancer (β = - .06) and involves exposure to negative stories about this disease (β = - .04). Strategies which communicate the potential emotional support benefits of a shared illness experience and social approval by others, particularly the medical profession, may help to promote acceptance of peer support and encourage service uptake in breast cancer.
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Affiliation(s)
- Melissa Legg
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, 4222, Australia. .,Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia.
| | - Melissa K Hyde
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, 4222, Australia.,Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia
| | - Stefano Occhipinti
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, 4222, Australia
| | - Philippa H Youl
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, 4222, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,University of the Sunshine Coast, Sippy Downs, Australia
| | - Jeff Dunn
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, 4222, Australia.,Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Springfield, Australia.,School of Social Science, University of Queensland, Brisbane, Australia
| | - Suzanne K Chambers
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, 4222, Australia.,Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Springfield, Australia.,Prostate Cancer Foundation of Australia, Sydney, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, Australia
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24
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Wan C, Arès I, Gareau A, Collins KA, Lebel S, Bielajew C. Motherhood and well-being in young breast cancer survivors. BREAST CANCER MANAGEMENT 2018. [DOI: 10.2217/bmt-2017-0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This exploratory study aimed to examine differences in well-being between young breast cancer survivors (BCS) with and without children. Materials & methods: Participants (n = 816) completed an online survey relating to quality of life, illness intrusiveness, fear of cancer recurrence, stress and social support. Results: Exploratory and confirmatory factor analyses revealed similar models of well-being between both groups, but with a stronger relationship between psychological adjustment and illness intrusiveness for BCS with children (r = -0.779, 95% CI: -0.711, -0.848 vs r = -0.525, 95% CI: -0.423, -0.627). Conclusion: Parenting compromises the overall well-being of young BCS with children and they would therefore benefit from interventions and social and oncological support programs, especially for those caring for minor children.
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Affiliation(s)
- Cynthia Wan
- School of Psychology, University of Ottawa, 136 Jean Jacques Lussier Pvt, Ottawa, ON K1N 6N5, Canada
| | - Isabelle Arès
- The Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada
| | - Alexandre Gareau
- School of Psychology, University of Ottawa, 136 Jean Jacques Lussier Pvt, Ottawa, ON K1N 6N5, Canada
| | - Katherine A Collins
- Department of Psychology, Concordia University of Edmonton, 7128 Ada Blvd NW, Edmonton, AB T5B 4E4, Canada
| | - Sophie Lebel
- School of Psychology, University of Ottawa, 136 Jean Jacques Lussier Pvt, Ottawa, ON K1N 6N5, Canada
| | - Catherine Bielajew
- School of Psychology, University of Ottawa, 136 Jean Jacques Lussier Pvt, Ottawa, ON K1N 6N5, Canada
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25
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Villar RR, Fernández SP, Garea CC, Pillado MTS, Barreiro VB, Martín CG. Quality of life and anxiety in women with breast cancer before and after treatment. Rev Lat Am Enfermagem 2017; 25:e2958. [PMID: 29267541 PMCID: PMC5738954 DOI: 10.1590/1518-8345.2258.2958] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/30/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives: to determine the quality of life and anxiety in patients with breast cancer and
the changes they experience after treatments. Method: prospective study. Breast cancer statistics (n=339, confidence=95%, accuracy= ±
5.32%). The quality of life questionnaires (QLQ) used were QLQ C-30 and QLQ Br23,
and the State-Trait Anxiety Inventory (STAI) was used for anxiety. A multivariate
analysis was performed to identify variables associated with baseline quality of
life and anxiety as well as pre- and post-treatment differences. Authorization was
obtained from the Ethics Committee, and informed consent was provided by all
patients. Results: the baseline quality of life dimensions with the lowest score were future
prospects (46.0/100) and sexual enjoyment (55.7/100). The dimensions with the
highest score were body image (94.2/100) and role (93.3/100). The most disturbing
symptoms were insomnia, fatigue and concern about hair loss. After treatment, the
dimensions of physical function, role, body image, financial concerns and
symptomatology worsened, whereas emotional function and future prospects improved.
Severe anxiety presented as a state (48.6%) and as a trait (18.2%). The highest
baseline state anxiety was associated with married-widowed status and anxiolytic
medication. The greatest trait anxiety was associated with an inactive work
situation, anxiolytic medication, breast swelling and advanced stage at diagnosis.
After treatment, anxiety significantly decreased. Conclusions: After treatment, the quality of life score was positively modified, while state
and trait anxiety decreased.
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Affiliation(s)
- Raquel Rey Villar
- Doctoral student, Universidad de A Coruña, A Coruña, A Coruña, Spain. RN, Universidad de A Coruña, A Coruña, A Coruña, Spain
| | | | - Carmen Cereijo Garea
- Doctoral student, Universidad de A Coruña, A Coruña, A Coruña, Spain. RN, Universidad de A Coruña, A Coruña, A Coruña, Spain
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26
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Zhang H, Zhao Q, Cao P, Ren G. Resilience and Quality of Life: Exploring the Mediator Role of Social Support in Patients with Breast Cancer. Med Sci Monit 2017; 23:5969-5979. [PMID: 29248937 PMCID: PMC5744469 DOI: 10.12659/msm.907730] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The diagnosis and treatment of breast cancer can provoke a series of negative emotional changes in patients, further affecting their quality of life. It has been shown that patients with higher resilience have better quality of life. Social support systems are important protective factors that are necessary for the process of resilience to occur. Hence, this study aimed to investigate the role of social support in the relationship between resilience and quality of life among Chinese patients with breast cancer. MATERIAL AND METHODS A demographic-disease survey, the Chinese version of the Connor-Davidson Resilience Scale 25, Medical Outcomes Study Social Support Survey, and Functional Assessment of Cancer Therapy Breast Cancer Version 3 were used to interview 98 patients with breast cancer from a teaching hospital in Chongqing, China. Data analysis was performed by descriptive statistics, independent-sample t test, one-way ANOVA, and regression analyses. RESULTS The mean scores of resilience, social support, and quality of life were 54.68, 61.73, and 80.74 respectively, which were in the moderate range. Participants with stronger social support had higher resilience and better quality of life. Social support played a partial mediator role in the relationship between resilience and quality of life. The mediation effect ratio was 28.0%. CONCLUSIONS Social support is essential for the development of resilience and the improvement of quality of life in Chinese patients with breast cancer. Health professionals should provide appropriate guidelines to help patients seek effective support and enhance their resilience to improve their quality of life after breast cancer.
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Affiliation(s)
- Hailing Zhang
- Department of Nursing, First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Qinghua Zhao
- Department of Nursing, First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Peiye Cao
- Department of Nursing, First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Guosheng Ren
- Department of the Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
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27
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Carter SJ, Hunter GR, Norian LA, Turan B, Rogers LQ. Ease of walking associates with greater free-living physical activity and reduced depressive symptomology in breast cancer survivors: pilot randomized trial. Support Care Cancer 2017; 26:1675-1683. [PMID: 29243165 DOI: 10.1007/s00520-017-4015-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/05/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE We hypothesized exercise training-induced improvements in ease of walking would associate with favorable changes in objectively measured physical activity (PA) and self-reported depressive symptoms following a PA behavior-change intervention in non-metastatic breast cancer survivors (BCS). METHODS Twenty-seven BCS received random assignment to an intervention (INT) or control group (CON). INT included counseling/group discussions coupled with supervised exercise tapered to unsupervised exercise. PA, depressive symptoms, and ease of walking were evaluated pre-/post-intervention using 10-day accelerometry, HADS depression subscale, and indirect calorimetry during a standardized treadmill test, respectively. PA composite score was calculated by converting weekly minutes of moderate-to-vigorous PA and average steps/day to z-scores then dividing the sum by 2. Cardiac efficiency was determined by dividing steady-state oxygen uptake by heart rate to evaluate the volume of oxygen consumed per heartbeat. RESULTS ANCOVA revealed a significant time by group interaction showing the INT group exhibited greater positive changes in the PA composite compared to the CON (INT, + 0.14 ± 0.66 au vs. CON, - 0.48 ± 0.49 au; p = 0.019; η p2 = 0.21). Changes occurring from baseline to follow-up, among all participants, revealed improved ease of walking (less oxygen uptake) associated with increased PA composite (r = - 0.52; p = 0.010) and lower depressive symptomology (r = 0.50; p = 0.012) adjusted for age, race, and months since cancer diagnosis. Increased cardiac efficiency during the standardized treadmill test also associated with less daily sedentary time (r = - 0.52; p = 0.021). CONCLUSIONS These data support the assertion that reducing the physiological difficulty of walking may contribute to greater engagement in free-living PA, less sedentary time, and decreased psychosocial distress among BCS.
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Affiliation(s)
- Stephen J Carter
- Department of Nutrition Sciences, University of Alabama at Birmingham, 1675 University Blvd, Webb Building #248, Birmingham, AL, 35233-2432, USA.
| | - Gary R Hunter
- Department of Nutrition Sciences, University of Alabama at Birmingham, 1675 University Blvd, Webb Building #248, Birmingham, AL, 35233-2432, USA.,Department of Human Studies, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Lyse A Norian
- Department of Nutrition Sciences, University of Alabama at Birmingham, 1675 University Blvd, Webb Building #248, Birmingham, AL, 35233-2432, USA
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Laura Q Rogers
- Department of Nutrition Sciences, University of Alabama at Birmingham, 1675 University Blvd, Webb Building #248, Birmingham, AL, 35233-2432, USA
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28
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Admiraal JM, van der Velden AWG, Geerling JI, Burgerhof JGM, Bouma G, Walenkamp AME, de Vries EGE, Schröder CP, Reyners AKL. Web-Based Tailored Psychoeducation for Breast Cancer Patients at the Onset of the Survivorship Phase: A Multicenter Randomized Controlled Trial. J Pain Symptom Manage 2017; 54:466-475. [PMID: 28711750 DOI: 10.1016/j.jpainsymman.2017.07.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/18/2017] [Accepted: 07/06/2017] [Indexed: 12/29/2022]
Abstract
CONTEXT Many breast cancer patients have unmet informational and psychosocial needs after treatment completion. A psychoeducational intervention may be well suited to support these patients. OBJECTIVES The purpose of this multicenter randomized controlled trial was to examine the effectiveness of a web-based tailored psychoeducational program (ENCOURAGE) for breast cancer patients, which aims to empower patients to take control over prevailing problems. METHODS Female breast cancer patients from two hospitals in The Netherlands who recently completed (neo-)adjuvant chemotherapy were randomly assigned to standard care or 12-week access to the ENCOURAGE program providing fully automated information problem-solving strategies, resources, and services for reported problems. At six and 12 weeks, patients completed self-report questions on optimism and control over the future (primary outcome), feelings of being informed, and acceptance of the illness. At baseline and 12 weeks, distress and quality of life questionnaires were completed. RESULTS About 138 patients were included. Almost all patients (67 of 69) visited ENCOURAGE as requested. No differences between the control and intervention group were observed for primary and secondary outcomes. An unplanned subgroup analysis showed that in clinically distressed patients (N = 57 at baseline; 41%), use of the ENCOURAGE program increased optimism and control over the future at 12 weeks more than in patients in the control group (Cohen's d = 0.65). CONCLUSION Although the effectiveness was not demonstrated, a subgroup of women treated for breast cancer can probably be supported by the program. The results of the present study are a starting point for further development and use of the program.
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Affiliation(s)
- Jolien M Admiraal
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette W G van der Velden
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Medical Oncology, Martini Hospital, Groningen, The Netherlands
| | - Jenske I Geerling
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Grietje Bouma
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annemiek M E Walenkamp
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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29
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Hsiao FH, Jow GM, Kuo WH, Wang MY, Chang KJ, Lai YM, Chen YT, Huang CS. A longitudinal study of diurnal cortisol patterns and associated factors in breast cancer patients from the transition stage of the end of active cancer treatment to post-treatment survivorship. Breast 2017; 36:96-101. [PMID: 28668292 DOI: 10.1016/j.breast.2017.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/23/2017] [Accepted: 06/19/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to examine the changes in diurnal cortisol patterns and its associated factors among breast cancer patients over a 14-month follow up period. MATERIALS AND METHODS A total of 85 breast cancer patients were recruited to participate in this study. Assessments were performed at baseline (T0), T1 (the 2nd month), T2 (the 5th month), T3 (the 8th month), and T4 (the 14th month). Salivary cortisol was measured and the following questionnaires were administered: BDI-II depression scale, European Organization for Research and Treatment of Cancer Core Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer-specific complementary measure (EORTC QLQ-BR23). Patients were grouped into flat and steep groups, according to the median of the diurnal cortisol slopes at the time of the transition period. RESULTS Breast cancer patients in the flatter slope group at transition period demonstrated steeper slopes over the course of recovery from treatment and those in the steeper slope group at transition period continued with steeper slopes over the course of recovery. The greater breast cancer-related symptoms (side-effects, symptoms relating to breast and arm, and hair loss) were associated with the changes in flatter diurnal cortisol slopes during14-month follow up period. CONCLUSION Diurnal cortisol patterns in flatter slope group at the transition period appear to have a trend of recovery with the passage of time over the course of recovery from treatment. Management of breast cancer symptoms could improve dysregulation of diurnal cortisol patterns among survivors.
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Affiliation(s)
- Fei-Hsiu Hsiao
- School of Nursing, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd. Sec. 1, Taipei, Taiwan.
| | - Guey-Mei Jow
- School of Medicine, Fu Jen Catholic University, 510 Zhongzheng Road, Xinzhuang, New Taipei City 24205, Taiwan.
| | - Wen-Hung Kuo
- Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan.
| | - Ming-Yang Wang
- Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan.
| | - King-Jen Chang
- Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan.
| | - Yu-Ming Lai
- School of Nursing, College of Medicine, Chang-Gung University, 259, Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan.
| | - Yu-Ting Chen
- School of Nursing, College of Medicine, Chang-Gung University, 259, Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan.
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taiwan.
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30
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Paulsen JA, Ptacek TS, Carter SJ, Liu N, Kumar R, Hyndman L, Lefkowitz EJ, Morrow CD, Rogers LQ. Gut microbiota composition associated with alterations in cardiorespiratory fitness and psychosocial outcomes among breast cancer survivors. Support Care Cancer 2017; 25:1563-1570. [PMID: 28064384 PMCID: PMC5380600 DOI: 10.1007/s00520-016-3568-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/27/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE In this proof-of-concept pilot study, our purpose was to determine correlations between gut microbiota composition and alterations in cardiorespiratory fitness and psychosocial outcomes among post-primary treatment breast cancer survivors (BCS). METHODS Composition of the gut microbiota in BCS (n = 12) was assessed at baseline (M0) and at the end of 3 months (M3) using Illumina MiSeq DNA Sequencing of the 16S rRNA gene. Gut microbiota composition was analyzed using the QIIME bioinformatics software and represented through diversity metrics and taxa analyses. Cardiorespiratory fitness, fatigue, anxiety, depression, and sleep dysfunction were assessed at M0 and M3 via the submaximal treadmill test, Fatigue Symptom Inventory, Hospital Anxiety and Depression Scale, and Pittsburgh Sleep Quality Index, respectively. RESULTS Increased fatigue interference in BCS was associated with increased mean within-sample Shannon diversity (organism richness and evenness) (p = 0.009). Weighted UniFrac analysis (shifts in taxa relative abundance) revealed significant differences in between-sample (beta) diversity for changes in fatigue interference (p = 0.01) and anxiety (p = 0.022), with a trend observed for fatigue intensity and sleep dysfunction (p < 0.1). Unweighted UniFrac analysis (shifts in taxa types) found significant beta diversity differences for cardiorespiratory fitness (p = 0.026). Prior to false discovery correction (FDR), changes in fitness, fatigue, anxiety, and sleep dysfunction were associated with the frequency of certain gut bacteria genera (e.g., Faecalibacterium, Prevotella, Bacteroides) (p < 0.05). CONCLUSIONS Correlations may exist between alterations in gut microbiota composition and longitudinal changes in cardiorespiratory fitness, fatigue, and anxiety in BCS. Further research examining the role of the microbiota-gut-brain axis in exercise-induced effects on psychosocial outcomes in BCS is warranted.
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Affiliation(s)
- Jesseca A Paulsen
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Travis S Ptacek
- Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen J Carter
- Department of Nutrition Sciences, University of Alabama at Birmingham, Webb 222, 1720 2nd Avenue South, Birmingham, AL, 35294-3360, USA
| | - Nianjun Liu
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ranjit Kumar
- Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - LaKeshia Hyndman
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elliot J Lefkowitz
- Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Casey D Morrow
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laura Q Rogers
- Department of Nutrition Sciences, University of Alabama at Birmingham, Webb 222, 1720 2nd Avenue South, Birmingham, AL, 35294-3360, USA.
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31
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Huang HY, Tsai WC, Chou WY, Hung YC, Liu LC, Huang KF, Wang WC, Leung KW, Hsieh RK, Kung PT. Quality of life of breast and cervical cancer survivors. BMC WOMENS HEALTH 2017; 17:30. [PMID: 28403855 PMCID: PMC5389170 DOI: 10.1186/s12905-017-0387-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 03/30/2017] [Indexed: 12/24/2022]
Abstract
Background Breast and cervical cancer are the most common cancers affecting women. The symptom distresses experienced by cancer survivors are critical factors influencing their quality of life (QOL). This study investigated the QOL of breast and cervical cancer survivors, their physical, psychological and social conditions. Methods The participants were older than 20 years, had been diagnosed with breast or cervical cancer for more than 2 years, and had completed their cancer treatment. The survey incorporated the QOL questionnaires developed by the European Organization of Research and Treatment for Cancer and a self-designed questionnaire. Results The mean age at diagnosis was 48.89 ± 8.53 years for the breast cancer survivors and 49.00 ± 10.30 years for the cervical cancer survivors. The corresponding QOL scores were 75.33 ± 20.25 and 75.56 ± 17.93. The factors influencing QOL of breast cancer survivors were household income, number of comorbidities, stage of cancer, type of cancer treatment and duration of illness, whereas the factor related to QOL of cervical cancer survivors was only household income. Conclusions The QOL of the two groups was similar. Healthcare providers should demonstrate greater concern toward breast and cervical cancer survivors.
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Affiliation(s)
- Huei-Ying Huang
- Department of Anesthesia, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China.,Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung, 413, Taiwan, Republic of China
| | - Wen-Chen Tsai
- Department of Health Service Administration, China Medical University, Taichung, Taiwan, Republic of China
| | - Wen-Yu Chou
- Department of Health Service Administration, China Medical University, Taichung, Taiwan, Republic of China
| | - Yao-Ching Hung
- Department of Gynecologic Oncology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Liang-Chih Liu
- Department of Breast Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Kuo-Feng Huang
- Cancer Center, Chi Mei Hospital, Tainan, Taiwan, Republic of China
| | - Wen-Ching Wang
- Department of General surgery, Chi Mei Hospital, Tainan, Taiwan, Republic of China
| | - Kam-Wing Leung
- Dental Department, Yuan's General Hospital, Kaohsiung, Taiwan, Republic of China
| | - Ruey-Kuen Hsieh
- Division of Hematology and Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung, 413, Taiwan, Republic of China. .,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, Republic of China.
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32
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Interconnection: A qualitative analysis of adjusting to living with renal cell carcinoma. Palliat Support Care 2017; 16:146-154. [PMID: 28262086 DOI: 10.1017/s1478951517000074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:Adjusting to cancer is an ongoing process, yet few studies explore this adjustment from a qualitative perspective. The aim of our qualitative study was to understand how patients construct their experience of adjusting to living with cancer. METHOD Qualitative analysis was conducted of written narratives collected from four separate writing sessions as part of a larger expressive writing clinical trial with renal cell carcinoma patients. Thematic analysis and constant comparison were employed to code the primary patterns in the data into themes until thematic saturation was reached at 37 participants. A social constructivist perspective informed data interpretation. RESULTS Interconnection described the overarching theme underlying the process of adjusting to cancer and involved four interrelated themes: (1) discontinuity-feelings of disconnection and loss following diagnosis; (2) reorientation-to the reality of cancer psychologically and physically; (3) rebuilding-struggling through existential distress to reconnect; and (4) expansion-finding meaning in interconnections with others. Participants related a dialectical movement in which disruption and loss catalyzed an ongoing process of finding meaning. SIGNIFICANCE OF RESULTS Our findings suggest that adjusting to living with cancer is an ongoing, iterative, nonlinear process. The dynamic interactions between the different themes in this process describe the transformation of meaning as participants move through and revisit prior themes in response to fluctuating symptoms and medical news. It is important that clinicians recognize the dynamic and ongoing process of adjusting to cancer to support patients in addressing their unmet psychosocial needs throughout the changing illness trajectory.
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33
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Koutri I, Avdi E. The suspended self: Liminality in breast cancer narratives and implications for counselling. EUROPEAN JOURNAL OF COUNSELLING PSYCHOLOGY 2016. [DOI: 10.5964/ejcop.v5i1.92] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the field of chronic and serious illness, meaning-making with regards to the illness experience has been shown to be a core process for patients. This study focuses on women's narratives of their experiences of living with breast cancer. Within the framework of narrative psychology, illness narratives are considered to provide the main means through which patients make sense of their illness experience and construct its place in their life story. In this paper, we present findings from a narrative study that aimed to explore the different meanings that breast cancer holds for Greek women. In the broader study, four basic narrative types about breast cancer emerged from the analysis. In this paper, we focus on one of these narrative types, in which illness is constructed as an entrance into a state of liminality and where the women's sense of self seems to be “suspended”. The core features of this narrative type are described and arguments are developed regarding its usefulness. We argue that this is a narrative type that deserves further attention, particularly as it seems to reflect a socially non-preferred storyline, which might result in these women's stories being sidestepped or silenced. The implications of this narrative type for healthcare and counselling in cancer care are discussed.
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34
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Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, Tong Y, Wilhelm L, Carpenter JS, Von Ah D, Wagner CD, de Groot M, Schmidt K, Monceski D, Danh M, Alyea JM, Miller KD, Kroenke K. Randomized controlled pilot trial of mindfulness-based stress reduction compared to psychoeducational support for persistently fatigued breast and colorectal cancer survivors. Support Care Cancer 2016; 24:4085-96. [PMID: 27189614 PMCID: PMC5221754 DOI: 10.1007/s00520-016-3220-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Cancer-related fatigue (CRF) is a disruptive symptom for many survivors. Despite promising evidence for efficacy of mindfulness-based stress reduction (MBSR) in reducing CRF, no trials comparing it to an active comparator for fatigued survivors have been published. The purpose of this trial was to compare MBSR to psychoeducation for CRF and associated symptoms. METHODS Breast (n = 60) and colorectal (n = 11) cancer survivors (stage 0-III) with clinically significant CRF after completing chemotherapy and/or radiation therapy an average of 28 months prior to enrollment were randomized to MBSR or psychoeducation/support groups (PES). MBSR focused on mindfulness training; PES focused on CRF self-management. Outcomes included CRF interference (primary), CRF severity and global improvement, vitality, depression, anxiety, sleep disturbance, and pain. Outcomes were assessed at baseline (T1), post-intervention (T2), and 6-month follow-up (T3) using intent-to-treat analysis. RESULTS Between-group differences in CRF interference were not significant at any time point; however, there was a trend favoring MBSR (d = -0.46, p = 0.073) at T2. MBSR participants reported significantly greater improvement in vitality (d = 0.53, p = 0.003) and were more likely to report CRF as moderately to completely improved compared to the PES group (χ2 (1) = 4.1765, p = 0.041) at T2. MBSR participants also reported significantly greater reductions in pain at T2 (d = 0.53, p = 0.014). In addition, both MBSR and PES produced moderate-to-large and significant within-group improvements in all fatigue outcomes, depression, anxiety, and sleep at T2 and T3 compared to T1. CONCLUSION MBSR and PES appear efficacious for CRF and related symptoms. Larger trials including a usual care arm are warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01724333.
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Affiliation(s)
- Shelley A Johns
- Indiana University School of Medicine, Indianapolis, IN, USA.
- Regenstrief Institute, Inc., 1101 West Tenth Street RF-226, Indianapolis, IN, 46202, USA.
| | - Linda F Brown
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathleen Beck-Coon
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Tasneem L Talib
- Regenstrief Institute, Inc., 1101 West Tenth Street RF-226, Indianapolis, IN, 46202, USA
| | | | | | - Yan Tong
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Laura Wilhelm
- West Virginia University School of Medicine, Charleston, WV, USA
| | | | - Diane Von Ah
- Indiana University School of Nursing, Indianapolis, IN, USA
| | | | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Karen Schmidt
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Diane Monceski
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marie Danh
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jennifer M Alyea
- Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Kathy D Miller
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Kurt Kroenke
- Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Inc., 1101 West Tenth Street RF-226, Indianapolis, IN, 46202, USA
- VA HSR&D Center for Health Information and Communication, Indianapolis, IN, USA
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35
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Keesing S, Rosenwax L, McNamara B. A dyadic approach to understanding the impact of breast cancer on relationships between partners during early survivorship. BMC Womens Health 2016; 16:57. [PMID: 27561256 PMCID: PMC5000504 DOI: 10.1186/s12905-016-0337-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 08/18/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The shared impact of breast cancer for women and their male partners is emerging as an important consideration during the experience of a breast cancer diagnosis, particularly during survivorship. This study aimed to explore the experiences of women and their partners during early survivorship and contributes a range of insights into the lives of those intimately affected by breast cancer. METHODS In-depth interviews were completed with Australian women survivors of breast cancer (n = 8) and their partners (n = 8), between six months and five years following cessation of treatment. Questions included a focus on the women and their partners' daily experiences during early survivorship, including the management of ongoing symptoms, engagement in leisure and social interests, returning to work, communicating with each other, maintenance of the current relationship and other important roles and responsibilities. Thematic analysis was employed to determine key themes arising from the dyadic accounts of women and their partners' experiences during early breast cancer survivorship. RESULTS Women and their partners experienced many changes to their previous roles, responsibilities and relationships during early breast cancer survivorship. Couples also reported a range of communication, intimacy and sexuality concerns which greatly impacted their interactions with each other, adding further demands on the relationship. Three significant themes were determined: (1) a disconnection within the relationship - this was expressed as the woman survivor of breast cancer needing to prioritise her own needs, sometimes at the expense of her partner and the relationship; (2) reformulating the relationship - this reflects the strategies used by couples to negotiate changes within the relationship; and (3) support is needed to negotiate the future of the relationship - couples emphasised the need for additional support and resources to assist them in maintaining their relationship during early survivorship. CONCLUSION It can be concluded that the early survivorship period represents a crucial time for both women and their partners and there are currently limited options available to meet their shared needs and preferences for support. Findings indicate that a suitable model of care underpinned by a biopsychosocial framework, access to comprehensive assessment, timely support and the provision of targeted resources are urgently needed to assist women and their partners during this critical time.
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Affiliation(s)
- Sharon Keesing
- School of Occupational Therapy and Social Work, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Lorna Rosenwax
- Deputy Pro Vice-Chancellor, Health Sciences, Curtin University, Perth, WA Australia
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Ahern T, Gardner A, Courtney M. Exploring patient support by breast care nurses and geographical residence as moderators of the unmet needs and self-efficacy of Australian women with breast cancer: Results from a cross-sectional, nationwide survey. Eur J Oncol Nurs 2016; 23:72-80. [PMID: 27456378 DOI: 10.1016/j.ejon.2016.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 04/24/2016] [Accepted: 05/05/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE This study investigated whether use of services of a breast care nurse (BCN) at any time during treatment for breast cancer led to reduced unmet needs and increased self-efficacy among women with breast cancer. A secondary aim was to analyse comparisons between urban and rural and remote dwellers. METHOD Participants were Australian women who completed treatment for breast cancer at least 6 months before the survey date, recruited through two national databases of women diagnosed with breast cancer. The cross-sectional online survey consisted of two well validated measures, the SCNS-SF34 and the CASE-Cancer Scale. Statistical data were analysed using SPSS, with chi-square used to measure statistical significance. RESULTS A total of 902 participants responded to the survey. Unmet needs in the psychological domain were most prominent. Respondents who used the services of a BCN were significantly less likely to report unmet needs regarding tiredness, anxiety; future outlook; feelings about death and dying; patient care and support from medical staff; and provision of health systems and information. Scores of self-efficacy showed women using the services of a BCN had significantly higher self-efficacy when seeking and obtaining information (ρ ≤ 0.001) and understanding and participating in care (ρ = 0.032). Urban dwellers were more likely to have choice of health care service, but overall neither unmet needs nor perceived self-efficacy varied statistically significantly by remoteness. CONCLUSIONS Women with breast cancer experience a range of unmet needs; however those using BCN services demonstrated positive outcomes in terms of decreased unmet needs and increased self-efficacy.
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Affiliation(s)
- Tracey Ahern
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, PO Box 256, Dickson ACT 2602, Australia.
| | - Anne Gardner
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, PO Box 256, Dickson ACT 2602, Australia.
| | - Mary Courtney
- Australian Catholic University, PO Box 456, Virginia QLD 4014, Australia.
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Socio-demographic and clinical variables associated with psychological distress 1 and 3 years after breast cancer diagnosis. Support Care Cancer 2016; 24:4017-23. [PMID: 27129841 DOI: 10.1007/s00520-016-3242-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/24/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE A large group of women (20-30 %) report psychological distress shortly after breast cancer diagnosis, and some experience continued or increased symptoms over time. The aim of this study was to investigate socio-demographic and clinical variables associated with sustained psychological distress in this patient group. METHODS Women with breast cancer (n = 833) completed self-report questionnaires regarding socio-demographic and clinical variables shortly after (T1) and 3 years after diagnosis (T2) while data on illness severity were collected from a quality register. The Hospital Anxiety and Depression Scale was used as a measure of psychological distress at both time points. RESULTS The number of participants who reported elevated levels of anxiety was 231 (28 %) at T1 and 231 (28 %) at T2 while elevated depressive symptoms was reported by 119 (14 %) women at T1 and 92 (11 %) at T2. Despite non-significant differences in mean scores over time, 91 (15 %) participants reported increased anxiety symptoms and 47 (7 %) reported increased depressive symptoms. Poor financial situation, lack of social support, previous psychiatric treatment, and high levels of fatigue were associated with both anxiety and depressive symptoms. Reporting high levels of fatigue was the variable most strongly associated with increased psychological distress over time. CONCLUSION Most participants reported decreased psychological distress over time, but there were subgroups of women who experienced sustained or increased symptoms of anxiety or depression. Participants with poor financial status, previous psychological problems, or high levels of fatigue may be at increased risk of psychological distress. Such individuals may benefit most from psychosocial interventions.
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Turkman YE, Kennedy HP, Harris LN, Knobf MT. "An addendum to breast cancer": the triple negative experience. Support Care Cancer 2016; 24:3715-21. [PMID: 27037812 DOI: 10.1007/s00520-016-3184-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 03/21/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The triple negative breast cancer (TNBC) subtype, known to be aggressive with high recurrence and mortality rates, disproportionately affects African-Americans, young women, and BRCA1 carriers. TNBC does not respond to hormonal or biologic agents, limiting treatment options. The unique characteristics of the disease and the populations disproportionately affected indicate a need to examine the responses of this group. No known studies describe the psychosocial experiences of women with TNBC. The purpose of this study is to begin to fill that gap and to explore participants' psychosocial needs. METHOD An interpretive descriptive qualitative approach was used with in-depth interviews. A purposive sample of adult women with TNBC was recruited. Dominant themes were extracted through iterative and constant comparative analysis. RESULTS Of the 22 participants, nearly half were women of color, and the majority was under the age of 60 years and within 5 years of diagnosis. The central theme was a perception of TNBC as "an addendum" to breast cancer. There were four subthemes: TNBC is Different: "Bottom line, it's not good"; Feeling Insecure: "Flying without a net"; Decision-Making and Understanding: "A steep learning curve"; and Looking Back: "Coulda, shoulda, woulda." Participants expressed a need for support in managing intense uncertainty with a TNBC diagnosis and in decision-making. CONCLUSIONS Women with all subtypes of breast cancer have typically been studied together. This is the first study on the psychosocial needs specifically of women with TNBC. The findings suggest that women with TNBC may have unique experiences and unmet psychosocial needs.
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Affiliation(s)
- Yasemin E Turkman
- University of Virginia School of Nursing, 202 Lancaster Way, Charlottesville, VA, 22903, USA.
| | | | - Lyndsay N Harris
- Division of Hematology/Oncology, Department of Medicine, Case Western University Medical School, Cleveland, OH, 44106, USA
| | - M Tish Knobf
- Yale School of Nursing in West Haven, West Haven, CT, USA
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Wan C, Couture-Lalande MÈ, Narain TA, Lebel S, Bielajew C. Salivary Alpha-Amylase Reactivity in Breast Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:353. [PMID: 27023572 PMCID: PMC4847015 DOI: 10.3390/ijerph13040353] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/09/2016] [Accepted: 03/16/2016] [Indexed: 11/24/2022]
Abstract
The two main components of the stress system are the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal-medullary (SAM) axes. While cortisol has been commonly used as a biomarker of HPA functioning, much less attention has been paid to the role of the SAM in this context. Studies have shown that long-term breast cancer survivors display abnormal reactive cortisol patterns, suggesting a dysregulation of their HPA axis. To fully understand the integrity of the stress response in this population, this paper explored the diurnal and acute alpha-amylase profiles of 22 breast cancer survivors and 26 women with no history of cancer. Results revealed that breast cancer survivors displayed identical but elevated patterns of alpha-amylase concentrations in both diurnal and acute profiles relative to that of healthy women, F (1, 39) = 17.95, p < 0.001 and F (1, 37) = 7.29, p = 0.010, respectively. The average area under the curve for the diurnal and reactive profiles was 631.54 ± 66.94 SEM and 1238.78 ± 111.84 SEM, respectively. This is in sharp contrast to their cortisol results, which showed normal diurnal and blunted acute patterns. The complexity of the stress system necessitates further investigation to understand the synergistic relationship of the HPA and SAM axes.
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Affiliation(s)
- Cynthia Wan
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | | | - Tasha A Narain
- Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada.
| | - Sophie Lebel
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Catherine Bielajew
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
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Saboonchi F, Petersson LM, Wennman-Larsen A, Alexanderson K, Vaez M. Trajectories of Anxiety Among Women with Breast Cancer: A Proxy for Adjustment from Acute to Transitional Survivorship. J Psychosoc Oncol 2016; 33:603-19. [PMID: 26315500 DOI: 10.1080/07347332.2015.1082165] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination. To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within 2 years following BC surgery, survey data from a 2-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and Analysis of Variance. A piece-wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified: High Stable, High Decrease, Mild Decrease, and Low Decrease. Of these, High Stable anxiety showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties. Our results support an emphasis on the transitional nature of the stage that follows the end of primary active treatment and imply a need for supportive follow up care for those who display lack of adjustment at this stage.
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Affiliation(s)
- Fredrik Saboonchi
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,b Department of Medicine and Public Health , Red Cross University College , Stockholm , Sweden
| | - Lena-Marie Petersson
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Agneta Wennman-Larsen
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,c Sophiahemmet University, Stockholm , Sweden
| | - Kristina Alexanderson
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Marjan Vaez
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,d Centre for Occupational and Environmental Medicine , Stockholm County Council , Stockholm , Sweden
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Freysteinson WM, Deutsch AS, Davin K, Lewis C, Sisk A, Sweeney L, Wuest L, Cesario SK. The Mirror Program: Preparing Women for the Postoperative Mastectomy Mirror-Viewing Experience. Nurs Forum 2015; 50:252-257. [PMID: 25130483 DOI: 10.1111/nuf.12108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PROBLEM Preparing women for the experiences they will endure during the breast cancer trajectory improves psychological outcomes and quality of life. Women have found that it may be difficult to view themselves in a mirror after having a mastectomy. Supporting women who have had a mastectomy in mirror-viewing and body image is a relatively new yet important intervention in oncology nursing. METHODS The feasibility of a preoperative mirror program given by oncology nurse navigators to women who were scheduled for a mastectomy was examined in this randomized control study. FINDINGS Pre- and postoperative data on anxiety, body image, depression, emotional well-being, and mirror use were collected from intervention participants (n = 10) and control subjects (n = 9). CONCLUSION This article illustrates the development of the mirror program and the results of the feasibility trial, and provides a discussion with implications for future research.
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Affiliation(s)
| | - Amy S Deutsch
- System Cancer Services, Memorial Hermann Health System, Houston, TX
| | - Karen Davin
- Memorial Hermann Memorial City Hospital, Memorial Hermann Health System, Houston, TX
| | - Carol Lewis
- Memorial Hermann the Woodlands Hospital, Formally of Memorial Hermann Health System, Houston, TX
| | - Angela Sisk
- Memorial Hermann Northwest Hospital, Memorial Hermann Health System, Houston, TX
| | - Lilian Sweeney
- Memorial Hermann Southwest Hospital, Memorial Hermann Health Systems, Houston, TX
| | - Linda Wuest
- Memorial Hermann Northeast Hospital, Memorial Hermann Health Services, Houston, TX
| | - Sandra K Cesario
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, TX
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Blanchin M, Dauchy S, Cano A, Brédart A, Aaronson NK, Hardouin JB. Validation of the French translation-adaptation of the impact of cancer questionnaire version 2 (IOCv2) in a breast cancer survivor population. Health Qual Life Outcomes 2015. [PMID: 26220672 PMCID: PMC4517314 DOI: 10.1186/s12955-015-0301-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The Impact of Cancer version 2 (IOCv2) was designed to assess the physical and psychosocial health experience of cancer survivors through its positive and negative impacts. Although the IOCv2 is available in English and Dutch, it has not yet been validated for use in French-speaking populations. The current study was undertaken to provide a comprehensive assessment of the reliability and validity of the French language version of the IOCv2 in a sample of breast cancer survivors. Methods An adapted French version of the IOCv2 as well as demographic and medical information were completed by 243 women to validate the factor structure divergent/divergent validities and reliability. Concurrent validity was assessed by correlating the IOCv2 scales with measures from the SF-12, PostTraumatic Growth Inventory and Fear of Cancer Recurrence Inventory. Results The French version of the IOCv2 supports the structure of the original version, with four positive impact dimensions and four negative impact dimensions. This result was suggested by the good fit of the confirmatory factor analysis and the adequate reliability revealed by Cronbach's alpha coefficients and other psychometric indices. The concurrent validity analysis revealed patterns of association between IOCv2 scale scores and other measures. Unlike the original version, a structure with a Positive Impact domain consisting in the IOCv2 positive dimensions and a Negative Impact domain consisting in the negative ones has not been clearly evidenced in this study. The limited practical use of the conditional dimensions Employment Concerns and Relationship Concerns, whether the patient is partnered or not, did not make possible to provide evidence of validity and reliability of these dimensions as the subsets of sample to work with were not large enough. The scores of these conditional dimensions have to be used with full knowledge of the facts of this limitation of the study. Conclusions Integrating IOCv2 into studies will contribute to evaluate the psychosocial health experience of the growing population of cancer survivors, enabling better understanding of the multi-dimensional impact of cancer.
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Affiliation(s)
- Myriam Blanchin
- EA4275, Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences, University of Nantes, Nantes, France.
| | - Sarah Dauchy
- Psycho-oncology Unit, Department of Supportive Care, Gustave Roussy, Villejuif, France.
| | - Alejandra Cano
- Psycho-oncology Unit, Department of Supportive Care, Gustave Roussy, Villejuif, France.
| | - Anne Brédart
- Psycho-oncology Unit, Department of Supportive Care - DISSPO, Institut Curie and University Paris Descartes, Psychopathology and Health Process Laboratory LPPS EA 4057, Paris, France.
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Jean-Benoit Hardouin
- EA4275, Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences, University of Nantes, Nantes, France. .,Unit of Methodology and Biostatistics - University Hospital of Nantes, Nantes, France.
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Development and validation of the Female Sexual Function Index adaptation for breast cancer patients (FSFI-BC). Breast Cancer Res Treat 2015. [DOI: 10.1007/s10549-015-3499-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Zhou C, Wu Y, An S, Li X. Effect of Expressive Writing Intervention on Health Outcomes in Breast Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One 2015; 10:e0131802. [PMID: 26151818 PMCID: PMC4494859 DOI: 10.1371/journal.pone.0131802] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 06/05/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Numerous randomized controlled trials (RCTs) have arrived at conflicting conclusions on expressive writing (EW) as an intervention for breast cancer (BC) patients, but there has been no meta-analysis of these studies to assess the effectiveness of EW in BC population. METHODS PubMed, Web of Science, The Cochrane Library, EMBASE, and CINAHL and the www.clinicaltrial.gov database on ongoing clinical trials were searched to identify all the RCTs investigating efficacy of EW on the physical and psychological health in BC patients. The risk of bias of the original studies was assessed using the Cochrane Collaboration's tool. Our primary outcomes for physical and psychological health were respectively negative somatic symptoms and negative mood which were stratified by emotional, benefit-finding and multiple prompts in sub-group analyses. The data were analyzed using Review Manager 5.2 and Stata version 12.0 statistical software. RESULTS Of the 5,232 titles screened, we identified 11 RCTs with a total of 1,178 participants. The pooled results showed a significant effect of EW using either an emotional prompt or a benefit-finding prompt on reducing negative somatic symptoms in BC patients in the ≤3-month follow-up group [Mean Difference (MD), -13.03, 95% CI, -19.23 to -6.83, P<0.0001; MD, -9.18, 95% CI, -15.57 to -2.79, P = 0.005]. There was no significant effect of EW on physical health in the >3-month follow-up group. There were no significant differences regarding psychological health indexes between EW intervention and control groups at any of the follow-up time-points (P>0.05). CONCLUSION This systematic review and meta-analysis reveals that EW intervention may have a significantly positive impact on the physical health but not the psychological health in BC patients, but this benefit may not last long. However, further high-quality studies with more homogeneity are needed to confirm the current findings.
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Affiliation(s)
- Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Shengli An
- Department of Bio-Statistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Xiaojin Li
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
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Alagraa R, Abujaber A, Chandra P, Doughty J. Evaluating psychosocial support needs of female cancer patients in the State of Qatar. Qatar Med J 2015; 2015:4. [PMID: 26535172 PMCID: PMC4614333 DOI: 10.5339/qmj.2015.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 03/23/2015] [Indexed: 12/12/2022] Open
Abstract
Patient perceived perceptions of psychosocial support are increasingly important to understanding appropriate holistic patient-centred care. Information is scarce regarding the attitudes of female cancer patients in Arab and Muslim populations. This study was undertaken in the State of Qatar among female cancer patients. The aim of this study was to investigate what extent women undergoing cancer treatment in the State of Qatar view the importance of psychosocial support? Another aim of this study was to determine which demographic indicators, if any, may predict for certain preferences in support. The authors hypothesized that a majority of female cancer patients will perceive psychosocial support as an important aspect. This study used English and Arabic questionnaires to glean data from female cancer patients attending clinics at the National Centre for Cancer Care and Research in Doha, Qatar. For the purpose of this study, psychosocial support was defined under four categories: 1) family support, 2) religious/spiritual support, 3) support groups 4) physician referred support. Results showed that 88% of female respondents rated psychosocial support categories as important. There was no significance between patient demographics and specific preferences for the support categories in the study. This study may provide some areas for future research that may shape guidelines for improving holistic patient care and in assisting the Supreme Health Council in meeting its targets for the Qatar National Cancer strategy, which states that cancer treatment should be patient-centred focusing on both medical and psychosocial needs of patients.
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Affiliation(s)
- Razzan Alagraa
- MSc. Student, Faculty of Health and Wellbeing, Sheffield Hallam University, UK
| | - Ahmad Abujaber
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Joanne Doughty
- Faculty of Health and Wellbeing, Sheffield Hallam University, UK
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Habitual sleep-wake behaviors and lifestyle as predictors of diurnal cortisol patterns in young breast cancer survivors: a longitudinal study. Psychoneuroendocrinology 2015; 53:60-8. [PMID: 25591116 DOI: 10.1016/j.psyneuen.2014.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/03/2014] [Accepted: 12/19/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of changes in diurnal cortisol patterns during the 8-month follow up period for young breast cancer survivors. Among the potential predictors were tumor size, lymph node metastasis, changes in sleep problems, habitual time of awakening and bedtime, physical activity levels, body mass index (BMI), and depressive levels across 8 months. METHODS The participants were 62 breast cancer women who were aged 40 years and below, and had completed active breast cancer treatment. The longitudinal data were collected at four points: baseline assessment (T0) and three follow-ups after baseline: T1 (in the 2nd month), T2 (in the 5th month), and T3 (in the 8th month). The participants collected their salivary cortisol at home at six time points: upon waking, 30 and 45min after waking, and at 1200h, 1700h, and 2100h. They also completed several questionnaires: the Medical Outcomes Study Sleep scale; the Beck Depression Inventory-II, physical activity levels on a 10-point scale, time of going to bed, time of awakening, and total sleep hours. RESULTS This study found that the main predictors of changes toward flatter diurnal cortisol patterns during the 8-month follow ups were greater tumor sizes, increases of BMI scores, and habitually later times of awakening. CONCLUSIONS While greater tumor sizes represent biological vulnerability of disruption of cortisol circadian rhythm, maintaining an appropriate BMI and good sleep habits could be a protective factor for normal cortisol regulation, which likely helps to reduce early mortality in young breast cancer survivors.
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Park HJ, Kim K, Kim JS. Factors that Influence Korean Breast Cancer Patients to Undergo Cancer Rehabilitation Therapy. ASIAN ONCOLOGY NURSING 2015. [DOI: 10.5388/aon.2015.15.2.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hui-jeong Park
- Department of Nursing, Graduate School of Chung-Ang University, Seoul, Korea
| | - Kyunghee Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Ji-su Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, Wolf E, Peterson JC. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. Altern Ther Health Med 2014; 14:349. [PMID: 25249005 PMCID: PMC4190303 DOI: 10.1186/1472-6882-14-349] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/13/2014] [Indexed: 02/01/2023]
Abstract
Background Among underserved, largely minority women who were breast cancer survivors, this pilot project was designed to evaluate the quality of life outcomes of a 20 week Contemplative Self-Healing Program. Methods Women previously treated for stage I-III breast cancer were assessed before and after the 20 week program with the FACT-G, FACT-B, FACIT-Spirituality, ECOG, and the Impact of Events Scale. They participated in a 20-week intervention involving guided meditation and cognitive-affective-behavioral learning. Results With an average age of 63, 62% of the participants were African-American or Latino. With an average of 5.4 years since the diagnosis of breast cancer, 72% had an ECOG performance status of 1. 57% were currently working. Their baseline FACT-G was 80.5 ± 15.1, and their baseline Impact of Events Scale was 26.3 ± 18.9. The within-patient improvement on the FACT-G was 4.6 ± 10.9 (p = .01); in parallel the FACT-B improved by 2.8 ± 12.8 points (p = .03). The Impact of Events Scale improved by 6.6 ± 15.5 points (p = .01). There was significant within-patient improvement on both the avoidance scale (3.8 ± 9.2) and on the intrusion scale (2.9 ± 7.9). Patients who attended more sessions and conducted more home practice had greater improvements in quality of life. Conclusion Persons receiving a 20-session contemplative self healing intervention showed improved quality of life, with a clinically and statistically significant increase in the FACT-G. In addition, this population showed a significant reduction in post-traumatic stress symptoms assessed by the Impact of Events Scale. Trial registration Clinical Trials Gov NCT00278837.
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Ahern T, Gardner A, Courtney M. Geographical comparisons of information and support needs of Australian women following the primary treatment of breast cancer: a 10-year replication study. Health Expect 2014; 18:2678-92. [PMID: 25131899 DOI: 10.1111/hex.12242] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In 2002, Raupach and Hiller examined the use of and satisfaction with information and support following treatment of breast cancer from a sample of participants in South Australia. In 2013 this study was replicated to include participants Australia wide and analyse comparisons based on geographical location. Statistical comparisons with the original study were also conducted. DESIGN A 10 year replication study using a cross-sectional needs analysis survey. SETTING AND PARTICIPANTS Women aged 18+ years diagnosed with breast cancer between 6 and 30 months ago were sourced from two national databases of women diagnosed with breast cancer. RESULTS A total of 325 participants completed the survey. The Internet was the most commonly used source of information with 70% (n = 229 of 325) of women using the internet for information, a statistically significantly higher percentage compared with the 2002 study. The study found the top four information issues rated as moderately/extremely important by women in 2013 were identical in 2002. A comparison of sources of support used showed that women in outer regional, remote and very remote areas were statistically more likely to use the breast care nurse (BCN) for support (P = 0.044). CONCLUSIONS The study provides useful, up-to-date data about information and support services used by Australian women with breast cancer. Comparisons with the earlier study show some of the needs of women have changed over time, but others have remained the same. Geographic comparisons overall, demonstrate many consistent findings regardless of location, however, the important work of the breast care nurse is an area in need of further research.
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Affiliation(s)
- Tracey Ahern
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
| | - Anne Gardner
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
| | - Mary Courtney
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Australia
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