Symptom, symptom experiences, and symptom distress encountered by women with breast cancer undergoing current treatment modalities

Investigating the Efficacy and Safety of a Dose-Dense Paclitaxel, Cyclophosphamide With Trastuzumab in Stage I-II Human Epidermal Growth Factor Receptor 2 (HER2) Positive Breast Cancer

BACKGROUND

The evolution of systemic therapies has improved outcomes for patients with human epidermal growth factor receptor 2 positive (HER2+) breast cancer. Nonetheless, the tolerability and safety profile of systemic therapies represent an area for further improvement. Here we report the results of a phase 2 trial evaluating a nonanthracycline, nonplatinum adjuvant treatment regimen for patients following initial surgical resection.

METHODS

We enrolled patients with stage I or II HER2+ breast cancer who underwent upfront surgery to receive adjuvant treatment with 6 cycles of dose-dense Paclitaxel, cyclophosphamide and Trastuzumab (PC-H) every 2 weeks, followed by 13 cycles of maintenance trastuzumab every 3 weeks to complete 52 weeks of treatment (compromising 19 cycles). The primary objective was to determine the safety and feasibility of adjuvant PC-H, measured by the completion rate frequency and the grade of adverse events, using National Cancer Institute Common Terminology Criteria. The secondary objective was to estimate relapse-free survival and overall survival.

RESULTS

Between 2010 and 2019, a total of 39 patients were enrolled. Of those, 34 patients (87.18%) completed the planned treatment. Severe adverse events of grade 3 or 4 occurred in 27 patients (69.23%), including 3 patients (7.69%) with grade 3-4 decrease in ejection fraction. At median follow up of 5.6 years, all 39 patients were alive. The 5-year relapse-free survival was 94.30% (95% CI: 75.3-100).

CONCLUSIONS

PC-H demonstrated overall safety and efficacy, yielding high rates of relapse-free survival among patients with early stage (HER2+) breast cancer.

Inflammatory Breast Cancer: Understanding the Patient Experience

BACKGROUND

Inflammatory breast cancer (IBC) is an aggressive, locally advanced cancer with a 5-year survival rate of approximately 40%. Although patients with IBC likely experience significant and variable symptom burden from diagnosis through survivorship, the description of the symptom burden in this population is limited.

OBJECTIVES

The purpose of this study was to describe the experience of patients with IBC and define the content domain for a patient-reported outcome measure of IBC symptom burden.

METHODS

Twenty patients with IBC described their experience in single qualitative interviews. Content analysis was used to define the symptom burden content domain. Relevance ratings by a panel of experts reduced the number of items for a preliminary patient-reported outcome symptom burden measure.

RESULTS

The mean (SD) participant age was 52.8 (12.0) years; 50.0% had distant metastatic disease, and 85.0% were currently receiving treatment. Content analysis revealed 45 symptoms, with 20 symptoms reported by greater than or equal to 20% of participants. All participants described localized disease-related symptoms. Treatment-related symptoms varied among participants based on the modalities received.

CONCLUSION

Patients with IBC experience symptom burden that is distinct from the symptom burden experienced by patients with non-IBC.

IMPLICATIONS FOR PRACTICE

Differentiating the disease-related symptoms of IBC may assist clinicians in making timely and accurate diagnoses for IBC. A disease- and treatment-specific measure of the symptom burden of IBC should be incorporated in clinical practice to allow for regular assessment and evaluation of symptom burden and implementation of evidence-based interventions for symptom management.

Body image alteration in women with breast cancer: A concept analysis using an evolutionary method

Objective

Women with breast cancer experience changes in body image, a key predictor of overall quality of life. Body image alteration has been recognized in scholarly circles and is actively being researched on; however, a comprehensive conceptualization of body image alteration from an oncological perspective is insufficient. Therefore, this study aimed to analyze the concept of body image alteration in women within the context of breast cancer based on Rodgers' evolutionary method.

Methods

A literature search using a combination of the keywords "breast neoplasms" and "body image" was conducted via PubMed, CINAHL, EMbase, PsycInfo, KISS, and RISS. Peer-reviewed journal articles related to body image alteration in women with breast cancer, published from 2001 to 2020, were included in this study.

Results

Three critical attributes of body image alteration were identified: "dismantling the existing body image," "transitioning to the altered body," and "re-integrating a new body image." Antecedents included "breast cancer and its treatment," "awakening to the sociocultural norms of a feminine body," and "triggering events for reflecting on one's body." The consequences were "psychological well-being or distress," "strengthening or breakdown of intimate relationships," "enhancement or impairment of social functioning," and "adherence or resistance to breast cancer treatment."

Conclusions

This study provides comprehensive conceptualizations that encompass individual, interpersonal, and sociocultural components and cover both negative and positive changes in body image from a long-term perspective. This may offer a useful framework that can be used to develop effective interventions for body image improvement and accelerate further research.

A nurse versus a chatbot ‒ the effect of an empowerment program on chemotherapy-related side effects and the self-care behaviors of women living with breast Cancer: a randomized controlled trial

BACKGROUND

The high levels of unmet needs in relation to provision of self-care information reported by women living with breast cancer suggests that pre-chemotherapy education is suboptimal. Chatbots are emerging as a promising platform to provide education to patients helping them self-manage their symptoms at home. However, evidence from empirical studies on the effect of chatbots education on women living with breast cancer self-care behaviors and symptoms management are scarce.

METHODS

This three-arm randomized controlled trial was performed in a chemotherapy day care center within an oncology center in Egypt. A total of 150 women living with breast cancer were randomly selected and randomized into three groups: the ChemoFreeBot group (n = 50), the nurse-led education group (n = 50), and the routine care group (n = 50). In the ChemoFreeBot group, women were given a link to interact with ChemoFreeBot and ask questions about their symptoms and self-care interventions by typing questions or keywords at any time. On the same day as their first day of chemotherapy, the nurse-led education group received face to face teaching sessions from the researcher (nurse) about side effects and self-care interventions. The routine care group received general knowledge during their chemotherapy session about self-care interventions. The self-care behaviors effectiveness and the frequency, severity and distress of chemotherapy side effects were measured at baseline and postintervention for the three groups. The ChemoFreeBot's usability was assessed.

RESULTS

The mixed design repeated measures ANOVA analyses revealed a statistically significant both group effect and interaction effect of group*time, indicating a significant difference between the three groups in terms of the physical symptoms frequency (F = 76.075, p < .001, F = 147, p < .001, respectively), severity (F = 96.440, p < .001, F = 220.462, p < .001), and distress (F = 77.171, p < .001, F = 189.680, p < .001); the psychological symptoms frequency (F = 63.198, p < .001, F = 137.908, p < .001), severity (F = 62.137, p < .001), (F = 136.740, p < .001), and distress (F = 43.003, p < .001, F = 168.057, p < .001), and the effectiveness of self-care behaviors (F = 20.134, p < .001, F = 24.252, p < .001, respectively). The Post hoc analysis with Bonferroni adjustment in showed that women in the ChemoFreeBot group experienced a statistically significant less frequent, less severe and less distressing physical and psychological symptoms and higher effective self-care behaviors than those in the nurse-led education and routine care groups (p > .001).

CONCLUSION

ChemoFreeBot was a useful and cost-effective tool to improve increase self-care behavior and reduce chemotherapy side effects in women living with breast cancer through the provision of personalized education and the improvement of the accessibility to real-time and high-quality information compared to "one size fits all" approach used by nurses to provide the information. ChemoFreeBot can be an empowering tool to assist nurses to educate women with breast cancer and allow women to take an active role in managing their symptom.

TRIAL REGISTRATION

This study was retrospectively registered in the University hospital Medical Information Network (UMIN) Center, Clinical Trials Registry on 26/09/2022; Registration No:R000055389,Trial ID:UMIN000048955.

Clinical associations for traditional and complementary medicine use among norwegian cancer survivors in the seventh survey of the Tromsø study: a cross-sectional study

BACKGROUND

Cancer survivors are a diverse group with varying needs that are patient-, disease-, and/or treatment-specific. Cancer survivors have reported supplementing conventional anti-cancer treatment with Traditional and Complementary Medicine (T&CM). Although female cancer survivors are reported to have more severe anticancer adverse effects, little is known about the association between anticancer treatment and T&CM use among Norwegian cancer survivors. The aims of this study are therefore to investigate (1) associations between cancer diagnosis characteristics and T&CM utilization and (2) associations between anticancer treatment and T&CM utilization among cancer survivors in the seventh survey of the Tromsø study.

METHODS

Data was collected from the seventh survey of the Tromsø Study conducted in 2015-16 among all inhabitants of Tromsø municipality aged 40 and above (response rate 65%), where inhabitants received online and paper form questionnaires. Data from the data linkage to the Cancer Registry of Norway for cancer diagnosis characteristics was also used. The final study sample was made up of 1307 participants with a cancer diagnosis. Categorical variables were compared using Pearson's Chi-square test or Fisher's exact test while independent sample t-test was used to compare continuous variables.

RESULTS

The use of T&CM the preceding 12 months was reported by 31.2% of the participants with natural remedies as the most reported modality of T&CM (18.2%, n = 238), followed by self-help practices of meditation, yoga, qigong, or tai chi, which was reported by 8.7% (n = 114). Users of T&CM were significantly younger (p = .001) and more likely to be female (p < .001) than the non-users, with higher use of T&CM among female survivors with poor self-reported health and being 1-5 years post-diagnosis. Lower use of T&CM was found among female survivors who received a combination of surgery with hormone therapy and those who received a combination of surgery with hormone therapy and radiotherapy. Similar usage was seen in male survivors, but not at a significant level. For both male and female survivors, T&CM was most frequently used by those with only one cancer diagnosis (p = .046).

CONCLUSION

Our results indicate that the profile of the Norwegian cancer survivor who uses T&M is slightly changing compared to previous findings. Additionally, compared to male survivors, more clinical factors are associated with use of T&CM among female cancer survivors. These results should serve as a reminder to conventional health care providers to discuss the use of T&CM with patients across the entire cancer survivorship continuum to promote safe use, especially among female survivors.

Co-designing a behavioural intervention for reducing the impact of chemotherapy-induced peripheral neuropathy symptoms: An evidence- and theory-driven approach

OBJECTIVE

This study aims to co-design an evidence- and theory-based behavioural intervention to reduce the impact of chemotherapy-induced peripheral neuropathy (CIPN) symptoms on patients' quality of life.

METHODS

Guided by the Medical Research Council Framework for developing and evaluating complex interventions, our intervention development process was guided by (a) findings of systematic reviews, (b) inductive analysis of 39 h of observational fieldwork, 12 patient and 11 clinician interviews, (c) deductive analysis using the Common-Sense Model to develop a Self-Regulation Model of CIPN and (d) 17 patients and 18 clinicians co-designing the intervention.

RESULTS

CIPN perception and coping behaviours were highlighted as processes to target when co-designing an intervention. The processes targeted in our intervention are CIPN perception and coping behaviours, namely, (a) self-monitoring of symptoms, (b) communicating and early reporting of symptoms to clinicians, (c) participating in making chemotherapy dose reduction decisions with their clinicians and (d) engaging in self-management and safety strategies to reduce impact of CIPN symptoms. To address these, a behavioural intervention was deemed suitable.

CONCLUSION

We developed a self-regulation model of CIPN and a logic model for documenting the proposed mechanism of action of our co-designed behavioural intervention for reducing impact of CIPN symptoms.

Symptom burden, family resilience, and functional exercise adherence among postoperative breast cancer patients

Objective

Methods

Results

Conclusions

•

Postoperative breast cancer patients self-report they have a higher level of family resilience.

•

Postoperative breast cancer patients with higher functional exercise adherence have less symptom burden.

•

Family resilience can indirectly alleviate postoperative breast cancer patients' symptom burden.

Pre- and post-operative psychological interventions to prevent pain and fatigue after breast cancer surgery (PREVENT): Protocol for a randomized controlled trial

Background

Breast cancer is the most common cancer type among women worldwide with over a million new cases each year. More than 40% of these women will struggle with chronic pain and fatigue after surgery, regardless of surgical procedure. These consequences are detrimental and result in distress and disability, including work disability. Few attempts have been made to prevent chronic pain and fatigue after surgery by applying a psychological approach, despite psychological risk factors being crucial in the development of both chronic pain and fatigue. In this study, we aim to develop and test an easily implementable strategy of preventing chronic pain and fatigue after breast cancer surgery. The intervention strategy involves a pre-operative hypnosis session and a web-based post-operative Acceptance and Commitment Therapy (ACT). The hypnosis has previously been found effective in alleviating acute post-operative pain and fatigue in breast cancer patients, while ACT is well suited to cancer populations as it offers a model of healthy adaptation to difficult circumstances. Together they form an intervention strategy with both a preventive and a rehabilitative focus.

Methods/Design

This randomized controlled trial aims to estimate the effects of the pre- and post- operative interventions compared to attentional control and treatment as usual (TAU) and will also include a qualitative process evaluation. Participants will be randomized to receive either a pre-operative brief hypnosis session and a post-operative web-based psychological intervention (iACT) or a pre-operative one-session mindfulness through an audio file and post-operative TAU. Self-reported questionnaire data and biomarker data will be assessed pre-surgery, post-surgery and 3 and 12 months after surgery. In addition, we will assess registry data on sick leave and prescriptions until 2-year follow-up. In the qualitative process evaluation, data will be collected from participants from both study arms (through interviews and a diary) and two different analyses performed (socio-narrative and Grounded Theory) with the objective to describe the development of chronic post-surgical pain and fatigue and the potential influence of the interventions on these processes. The study is set-up to demonstrate a minimum difference in pain of 1 point on NRS (0–10) and 3 points on FACIT-F (0–52) between the groups at 3-months follow-up by including 200 breast cancer patients in total.

Discussion

This trial will be the first study to estimate the effect of a combined pre-operative hypnosis with a post-operative iACT to prevent pain and fatigue after breast cancer surgery. The results from our study might i) help the large group of women affected by chronic pain and fatigue after breast cancer surgery, ii) shed light on the mechanisms involved in chronic pain and fatigue development, and iii) serve as a model for other surgical procedures.

Trial registration

Clinicaltrials.gov, registration number NCT04518085. Registered on January 29th, 2020. https://clinicaltrials.gov/ct2/show/NCT04518085.

Development, usability and quality evaluation of the resilient mobile application for women with breast cancer

Introduction

Mental health problems as a consequence of cancer lower the quality of life of cancer patients. Despite increasing studies of breast cancer-focused mobile health applications (m-Health apps), there is less research on breast cancer patients' quality of life or well-being. The purpose of this study is to develop and evaluate the usability and quality of an educational m-Health app aimed at improving the resilience of breast cancer in women.

Methods

This study was conducted in four phases. It included extracting the requirements of the app through the nominal group technique. Based on these results, an m-Health app was developed and evaluated in terms of usability and quality by two scales, System Usability Scale and Mobile App Rating Scale questionnaires, respectively. Finally, the role of patients' age and educational backgrounds in the use of the app was assessed. The relationship between learnability and usability of the app was measured by the T-Test.

Results

The app was developed with three user interfaces. Its usability developed from the patient's point of view scored a remarkable score of 83.20 with a 95% confidence interval. This value was too indicative of high satisfaction with the usefulness and the possibility of recommending it to other cancer survivors. The results of the quality evaluation from an expert's point of view showed that this app had good functionality. Evaluation of the role of demographic information in the use of the app showed that it can be used for all age groups with different levels of education. The app did not differ significantly between learnability and usability.

Conclusion

The development of m-Health apps, based on usability principles that are suitable for all age groups with different levels of education, is welcomed by cancer patients.

The lived experience during the peri-diagnostic period of breast cancer: A scoping review

OBJECTIVES

The aim of this scoping review is to provide an overview of the existing research that investigates the lived experience during the peri-diagnostic period of breast cancer.

METHODS

Nine databases were searched for relevant literature between January 2007 and April 2019. Data were extracted and categorized using deductive and inductive approaches.

RESULTS

A majority of the 66 studies included used qualitative methods to retrospectively explore the treatment decision making process of female breast cancer patients. Patients experienced uncertainty, emotional distress, and a need for more information from providers and relied on social support and family guidance during this period.

CONCLUSIONS

The results of this review show that the burdens experienced during the peri-diagnostic period parallel those in later periods of cancer care. However, these burdens are prompted by different circumstances. More research is needed to explore the lived experience during this period through the use of mixed-methods and by recruiting a diverse sample with regards to role in the breast cancer experience, age, gender, race, and ethnicity.

PRACTICE IMPLICATIONS

Interventions positioned at earlier points in the breast cancer experience should provide informational support, which could be delivered through shared decision making models. Additional support could be facilitated by patient navigation programs and health information technology.

Identification of Breast Cancer Survivors With High Symptom Burden

BACKGROUND

While women diagnosed with breast cancer have increased survival when compared with other cancers, survivorship may include residual symptom burden from treatment and continuing endocrine therapies.

OBJECTIVE

The objective of this study was to identify subgroups of breast cancer survivors experiencing similar symptom severity.

METHODS

Participants were 498 women with breast cancer, not on active treatment. Symptom severity was self-reported using the MD Anderson Symptom Inventory. Target symptoms were included in a latent profile analysis. Factors related to subgroup membership and differences in quality of life (QOL) and functioning were explored using logistic regression.

RESULTS

Mean age was 60.11 (SD, 11.32) years, 86.1% were white, and 79.1% were receiving endocrine therapy. Target symptoms included fatigue (reported at ≥5 by 22.8% of women), sleep disturbance (24.8%), and trouble remembering (17.2%). Two subgroups were identified: low symptom severity (77.0% of women) and high (23.0%). Older women (odds ratio [OR], 0.971; 95% confidence interval [CI], 0.952-0.989) and employed women (OR, 0.621; 95% CI, 0404-0.956) were less likely to be in the high subgroup; women with poorer performance status (OR, 1.653; 95% CI, 1.188-2.299) were more likely to be in the high subgroup. Women in the high subgroup reported lower QOL (P = .000) and greater interference with functioning (P = .000).

CONCLUSIONS

Two subgroups of women with distinct symptom severity were identified.

IMPLICATIONS FOR PRACTICE

Identification of women at risk for high symptoms during survivorship may allow clinicians to intensify their approach to symptom management, thereby mitigating poor outcomes and impairments in QOL.

Network Pharmacology Study and Experimental Confirmation Revealing the Ameliorative Effects of Decursin on Chemotherapy-Induced Alopecia

Decursin, a pyranocoumarin compound from the root of Angelica gigas Nakai as a main constituent, has been reported to have various biological activities, including anti-inflammatory, anticancer, and antioxidant effects. This study aimed to predict and confirm the pharmacological relevance of Decursin on chemotherapy-induced alopecia (CIA) with the underlying molecular mechanisms. Decursin-targeted genes were compared with the gene set of alopecia and investigated through functional enrichment analysis. CIA was induced in C57BL/6J mice by injection of cyclophosphamide, and 1, 10, and 100 μM of Decursin were topically treated to depilated dorsal skin. KGF⁺ expression was detected in the dorsal skin tissues. Based on the predicted results, caspase, PIK3/AKT, and MAPKs protein expressions by Decursin were analyzed in the TNF-α-induced keratinocytes. The Decursin network had 60.20% overlapped genes with the network of alopecia. Biological processes, such as cellular response to chemical stimulus, apoptosis, PI3K-AKT signaling pathway, and MAPK signaling pathway, were derived from the Decursin network. In the Decursin-treated skin, there was morphological hair growth and histological restoration of hair follicles in the CIA mice. The KGF⁺ fluorescence and protein expressions were significantly increased by Decursin treatment. In addition, caspase-3, -7, and -8 expressions, induced by TNF-α, were dose-dependently decreased along with the inhibition of PI3K, AKT, ERK, and p38 expressions in Decursin-treated keratinocytes. These findings indicated that Decursin would be a potent therapeutic option for hair loss, in response to chemotherapy.

Symptom status, body perception, and risk of anxiety and depression in breast cancer patients receiving paclitaxel: a prospective longitudinal study

Background

Paclitaxel regimen which is widely used in clinical treatment causes many negative physical and psychological consequences on women with breast cancer (BC). This longitudinal study firstly aimed to investigate symptom status, body perception changes, and the risk of anxiety and depression in BC patients receiving during paclitaxel regimen.

Materials and methods

This descriptive and prospective study was conducted with 84 BC patients receiving paclitaxel regimen. “Chemotherapy Symptom Assessment Scale (C-SAS),” “Body Perception Scale (BPS),” and “Hospital Anxiety and Depression Scale (HADS)” were applied at five time points (T₁, before the first Paclitaxel infusion; T₂, at the end of first cycle; T₃, at the end of fourth cycle; T₄, at the end of eighth cycle; T₅, at the end of twelfth cycle). Data was analyzed using descriptive statistics, Cochrane Q, and linear mix model regression analysis.

Results

The frequency of needling and numbness in hands and feet, pain, and skin or nail changes significantly increased in the subsequent assessment points (T₂, T₃, T₄, and T₅) compared to the initial assessment (T₁) (p < 0.05). The mean scores of BPS significantly decreased at T₂, T₄, and T₅ compared to T₁ (F = 8.152, p < 0.001). The mean scores of the anxiety subscale of the HADS scale decreased at the T₃, T₄, and T₅ compared to T₁ (F = 6.865, p < 0.001), and the mean scores of the depression subscale significantly increased at the T₅ compared to T₁ (F = 3.708, p = 0.006).

Conclusions

The oncology nurse should comprehensively evaluate the patients who scheduled to receive paclitaxel treatment, and provide counseling to the patients during these specific weeks. Better management of the symptoms that increase with the paclitaxel regimen with repeated interviews under the supervision of the nurse will also prevent the deterioration of body perception. In addition, since the risk of depression increases over time in patients receiving paclitaxel, nurses should periodically screen the risk of depression, and timely consult the patients for the appropriate support.

Severe Reflux and Symptoms of Anxiety and Depression After Esophageal Cancer Surgery

BACKGROUND

Approximately 30% of patients suffer from severe reflux after surgery for esophageal cancer, which may serve as a continuous reminder of the cancer and catalyze fear of recurrence.

OBJECTIVE

The aim of this study was to investigate the association between severe reflux and symptoms of anxiety and depression after esophageal cancer surgery.

METHODS

This was a nationwide prospective cohort study including all Swedish patients who underwent esophageal cancer surgery between 2013 and 2018. Patients reported reflux on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire module for gastroesophageal symptoms and psychological distress on the Hospital Anxiety and Depression Scale at 1 and 2 years after surgery. Repeated-measures logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, body mass index, TNM classification, neoadjuvant therapy, surgery type, postoperative complications, antireflux medication, and elevated headrest at night.

RESULTS

Among 154 included patients, 43 (28%) and 37 (24%) reported severe reflux 1 and 2 years after surgery, respectively. No association between severe reflux and anxiety (OR, 2.1; 95% CI, 0.7-6.3) or depression (OR, 1.2; 95% CI, 0.3-4.6) was found 1 year after surgery. After 2 years, there was still no association between severe reflux and anxiety (OR, 0.9; 95% CI, 0.3-2.8) or depression (OR, 1.2; 95% CI, 0.5-3.3).

CONCLUSIONS

Findings suggest that severe reflux is not associated with anxiety or depression after esophageal cancer surgery.

IMPLICATIONS FOR PRACTICE

For esophageal cancer survivors, other factors than severe reflux may be more important for the psychological recovery.

Scalp cooling for reducing alopecia in gynecology oncology patients treated with dose-dense chemotherapy: A pilot project

•

Scalp cooling may be of benefit to gynecology oncology patients.

•

Cooling may prevent alopecia induced by Carboplatin and weekly Paclitaxel treatment.

•

For Carboplatin with Paclitaxel every three weeks, alopecia is not prevented.

Objective

Determine the efficacy of scalp cooling for the prevention of chemotherapy-induced alopecia in gynecology oncology patients.

Methods

This prospective pilot study included patients diagnosed with a gynecological malignancy that received DigniCap™ scalp cooling. Patients were divided into two groups based on chemotherapy regimen: Carboplatin with area under the curve (AUC) 5–6 every three weeks and (1) conventional Paclitaxel 175 mg/m² every three weeks or (2) Paclitaxel 80 mg/m² weekly. A 1–10 visual analogue scale (1 no hair loss, 10 – complete hair loss) was used to assess degree of hair loss by patients themselves and by a certified dermatologist using photographs. Changes in quality of life and body image were measured using the European Organization for Research and Treatment of Cancer quality of life questionnaire version 3 (EORTC QLQ-C30) and the Body Image Scale (BIS) for cancer patients.

Results

Hair preservation occurred with use of a scalp cooling device for patients receiving weekly Paclitaxel (n = 20), but not conventional every three weeks Paclitaxel (n = 8). Ten of 15 patients (66.7%) in the dose-dense group lost less than 50% of their hair based on self-assessment and 14 of 16 (87.5%) based on dermatologist assessment. No patient in this group acquired a cranial prosthesis (wig). There was no difference between groups in terms of quality of life (QoL) and BIS scores.

Conclusion

Scalp cooling may allow for hair preservation in gynecology oncology patients receiving Carboplatin AUC 5–6 and weekly Paclitaxel 80 mg/m² combination chemotherapy.

Hope and symptom burden of women with breast cancer undergoing chemotherapy: A cross-sectional study

AIM

This research aimed to explore the level of hope and symptom burden of breast cancer women undergoing chemotherapy, and predictive factors of hope were also investigated.

BACKGROUND

Chemotherapy brings physical and psychological stress to breast cancer patients. As an effective coping strategy, hope gives them the courage to overcome difficulties and improve prognosis and survival. Therefore, efforts are needed to raise hope.

DESIGN/METHODS

A total of 450 women who were undergoing breast cancer chemotherapy participated in this cross-sectional study. Sociodemographic data, disease characteristics, and measures of hope and symptom burden were collected using questionnaires. Hope was assessed using the validated Herth Hope Index, and the previously validated Memorial Symptom Assessment Scale was used to assess symptom burden. This paper adhered to the STROBE guidelines.

RESULTS

Chinese breast cancer chemotherapy women hope average scores of 30.15 ± 4.82 were in the medium range of the Hearth Hope Index as specified by Herth to be 24-35. Patients with age ≤45, religious beliefs and lighter symptom burden have a higher level of hope. These variables explained a total of 22.9% of the variation in hope.

CONCLUSIONS

The level of hope for women undergoing breast cancer chemotherapy still needs to be further improved. Symptom burden can negatively predict hope.

RELEVANCE TO CLINICAL PRACTICE

If nurses can decrease breast cancer chemotherapy women symptom burden, there is an impact on increasing levels of hope.

Preferences of Individuals With Cancer for Patient-Reported Outcome Measures

PURPOSE

Symptom monitoring and management using patient-reported outcome (PRO) measures improves outcomes for individuals with cancer. The purpose of the current study was to provide a qualitative assessment of preferences of individuals with cancer for PRO measures.

PARTICIPANTS & SETTING

15 patients receiving systemic therapy at the University of Texas MD Anderson Cancer Center.

METHODOLOGIC APPROACH

Participants completed three PRO measures. Qualitative interviews were conducted, and content analysis was used to identify relevant themes.

FINDINGS

Identified themes were the importance of communicating various aspects of the disease and treatment experience to the oncology team, the importance of systematic PRO assessments, congruence among PRO questionnaires and questions clinicians ask at clinic visits, concerns about the length of PRO questionnaires, the importance of the response options available in PRO questionnaires, and willingness to complete PRO measures frequently.

IMPLICATIONS FOR NURSING

Oncology nurses are critical facilitators of the systematic use of PRO measures across the cancer care continuum.

The physical, psychological and social experiences of alopecia among women receiving chemotherapy: An integrative literature review

PURPOSE

To conduct an integrative scoping review of the physical, psychological and social experiences of women who have experienced chemotherapy-induced alopecia (CIA).

METHOD

An integrative review was undertaken. A systematic search of MEDLINE, CINAHL and PsycInfo identified 23 studies meeting the inclusion criteria. Data relating to women's experiences of alopecia was extracted and synthesized thematically.

RESULTS

Four analytical themes were formed; 'the physical and psychological effect of alopecia', 'more than the loss of hair', 'the complexities of a visual cancer identity' and 'coping with new internal and external relationships'. CIA involves a public and private representation of illness which disrupts women's identity and their acceptance in public, yet this is a highly individualised experience. There is disparity in current evidence regarding the experience of CIA for women among older age groups, with rarer forms of cancer, haematological malignancies and those receiving palliative care or targeted treatment modalities.

CONCLUSIONS

This review highlights the continued pervasive psychosocial implications arising from CIA, however this is not exclusive to scalp hair as alopecia from the face and body has also been found to require adaptation and effective coping. Limited knowledge exists on the experience of alopecia induced by treatment for haematological cancers and rarer-tumour groups and emerging systemic anti-cancer treatment modalities. Healthcare professionals must endeavour to support and discuss the potential risks of alopecia, and provide patients with an opportunity to voice their fears, concerns, and experiences of CIA. Future research should incorporate the identified underserved populations and the experience of newer therapies.

Evaluation of efficacy of QR678® and QR678® Neo hair growth factor formulation in the treatment of persistent chemotherapy-induced alopecia caused due to cytotoxic chemotherapy-A prospective pilot study

BACKGROUND

Cancers are one of the main reasons of morbidity and mortality globally. Chemotherapy-induced alopecia (CIA) is one of the most alarming, terrifying, and traumatic adverse effects. A range of therapeutic measures has been suggested to alleviate CIA, but at present, there is no accepted pharmacological therapy that can assure prevention or management.

AIM

The aim of the present study was to evaluate the efficacy of QR 678 Neo® therapy in the treatment of persistent chemotherapy-induced alopecia in women and men treated with cytotoxic chemotherapy for breast and lung cancers, respectively.

METHODS

A total of 8 male patients with history of lung cancer and 12 female patients with history of breast cancer in the age range of 25-60 years, with WHO classification of grade I and II persistent alopecia who had undergone chemotherapy treatment, were selected for the study. At each visit, 1.5 mL solution of QR 678^® was injected into the scalp skin of patients. A total of 8 sessions were performed at an interval of 3 weeks each. All the patients were evaluated with standard global photography, video microscopic assessment, and patient self-assessment questionnaire at baseline, 6 months, and 1 year.

RESULTS

Marked improvement was seen in the global assessment score at 6 months (mean-8) which was maintained even after 1 year. Mean score increase in hair count at 6 months was 12.71 which further increased at 1 year. High satisfaction score was given by patients for slowing of hair loss (mean = 4.2) and also for overall hair growth. For appearance and growth of hair, the mean value was 3.4 and 3.8, respectively.

CONCLUSION

The formulation of QR 678^® and QR 678^® Neo showed to be significantly safe and efficient for chemotherapy-induced alopecia in both men and women. Improvement in hair growth was maintained even at 1 year of follow-up. No patient had any severe adverse effects, and injections were also easily bearable by most of them.

Management of chemotherapy-induced alopecia (CIA): A comprehensive review and future directions

OBJECTIVES

To review and summarize the available literature on the management of chemotherapy-induced alopecia (CIA) including complementary and alternative medicine (CAM), and to present CIA's effect on quality of life (QoL).

METHODS

Nine databases were searched for CIA-related keywords, including the effect on QoL, and management options. Among 1019 articles found, 54 articles focusing on treatment/prevention or QoL were retrieved. References of selected articles were also checked manually.

RESULTS

CIA was found to negatively affect QoL and body image, regardless of head covering status (i.e., for cultural or religious reasons). Most studies related to treatment/prevention of CIA reported on the use of scalp-cooling. The efficacy of CAM treatments was found to be questionable.

CONCLUSION

A high incidence rate of CIA exists with certain chemotherapies, and it significantly impairs QoL. Preventive and treatment strategies are incompletely effective. Additional literature is needed to explore potential preventive or therapeutic options for CIA.

Symptom Care at Home: A Comprehensive and Pragmatic PRO System Approach to Improve Cancer Symptom Care

INTRODUCTION

There is growing recognition that systematically obtaining the patient's perspective on their health experience, using patient-reported outcomes (PRO), can be used to improve patient care in real time. Few PRO systems are designed to monitor and provide symptom management support between visits. Patients are instructed to contact providers between visits with their concerns, but they rarely do, leaving patients to cope with symptoms alone at home. We developed and tested an automated system, Symptom Care at Home (SCH), to address this gap in tracking and responding to PRO data in-between clinic visits. The purpose of this paper is to describe SCH as an example of a comprehensive PRO system that addresses unmet need for symptom support outside the clinic.

METHODS FOR PRO SCORE INTERPRETATION

SCH uses pragmatic, single-item measures for assessing symptoms, which are commonly used and readily interpretable for both patients and providers. We established alerting values for PRO symptom data, which was particularly important for conserving oncology providers' time in responding to daily PRO data.

METHODS FOR DEVELOPING RECOMMENDATIONS FOR ACTING ON PRO RESULTS

The SCH system provides automated, just-in-time self-management coaching tailored to the specific symptom pattern and severity levels reported in the daily call. In addition, the SCH system includes a provider decision support system for follow-up symptom assessment and intervention strategies.

DISCUSSION

SCH provides PRO monitoring, tailored automated self-management coaching, and alerts the oncology team of poorly controlled symptoms with a provider dashboard that includes evidence-based decision support for follow-up to improve individual patients' symptom care. We particularly emphasize our process for PRO selection, rationale for determining alerting thresholds, and the design of the provider dashboard and decision support. Currently, we are in the process of updating the SCH system, developing both web-based and app versions in addition to interactive voice response phone access and integrating the SCH system in the electronic health record.

Reporting of paclitaxel-induced peripheral neuropathy symptoms to clinicians among women with breast cancer: a qualitative study

PURPOSE

Cases of chemotherapy-induced peripheral neuropathy (CIPN) under-reporting have been sporadically described in the literature, but no studies have focused on actively examining this behavior. Our primary aim was to identify women who purposefully under-reported CIPN, along with reasons for doing so. A secondary aim was to explore factors enabling or hindering communication of CIPN to clinicians.

METHODS

Semi-structured interviews were conducted with women with breast cancer who had received paclitaxel in a prospective observational study. The interview guide was developed based on factors hypothesized to influence side effect disclosure to clinicians. Interviews were recorded, transcribed verbatim, and thematically content analyzed.

RESULTS

Thirty-four women were interviewed. Three main themes emerged from the analysis: (1) enablers of CIPN reporting (e.g., positive relationship with the oncology team, sufficient appointment time, existence of alternative communication channels to office visits, expectation of CIPN as a side effect); (2) deterrents to CIPN reporting (e.g., perception of need to complete the full course of therapy, fear of treatment discontinuation, lack of knowledge of long-term consequences of CIPN); and (3) balancing survival versus functional impairment due to CIPN. Women prioritized efficacy over CIPN until physical functioning was meaningfully affected. No patients reported purposeful CIPN under-reporting, but three women admitted having considered doing so.

CONCLUSIONS

Despite the lack of evidence of CIPN withholding, women considered both the effectiveness and the toxicity of paclitaxel treatment, as well as beliefs about treatment and long-term consequences of CIPN and relationship with the oncology team, when deciding whether to report CIPN symptoms.

Role of stress, age and adjuvant therapy in the cognitive function of patients with breast cancer

According to data largely obtained from retrospective studies, it has been postulated that chemotherapy exerts an aggravating effect on the cognitive function of patients with breast cancer. Potential individual factors related to the effects of chemotherapy on cognitive function have been indicated, such as age-related cognitive dysfunction and stress. Elderly patients differ from non-elderly patients as regards higher cognitive related comorbidities, such as dementia, as well as regarding lower stress levels, indicating that 'chemobrain' may differentially affect these two age groups. The aim of this review was to discuss the effects of stress and chemotherapy on cognitive dysfunction and identify any potential age-related differences in patients with breast cancer treated with adjuvant chemotherapy. For this purpose, a systematic review of the literature was carried out on the PubMed, Scopus and Web of Science databases. The inclusion criteria were original articles published in peer-reviewed journals, elderly and non-elderly patients with breast cancer, reporting on stress and at least one cognitive parameter pre- and/or post-treatment. Eight studies met the preset criteria and were further analyzed. In total, the data of 1,253 women were included, of whom 800 patients with breast cancer were treated with surgery only, systemic treatment only, or both. Although all the studies included a non-elderly breast cancer patient subpopulation, only two of the studies included patients over 65 years of age. All studies indicated a statistically significant association of stress with various domains of cognitive dysfunction in patients, as shown by either self-completed questionnaires, neuropsychological testing or both. An age over 60 years was linked to fewer cognitive difficulties mediated by lower levels of stress. Thus, the evidence supports the association of stress with cognitive deficits in patients with breast cancer, regardless of the type of cancer-related treatment. Therefore, stress should be appropriately addressed. However, further research is required to investigate the association of stress with cognitive function in elderly patients with breast cancer.

The Relationships Among Symptom Distress, Posttraumatic Stress Symptoms, and Depression in Patients With Female-specific Cancers

BACKGROUND

Previous studies have demonstrated that posttraumatic stress symptoms (PTSS) affect women with breast cancer. However, few studies have explored the relationships among PTSS, symptom distress, and depression in association with cancers specific to women in Taiwan.

OBJECTIVE

The aim of this study was to explore the relationships among symptom distress, PTSS, and depression in women given a diagnosis of female-specific cancers.

METHODS

A cross-sectional design was used, and 220 women given a diagnosis of female-specific cancer were recruited from a general hospital in southern Taiwan. The outcome measures included the subjects' scores on a symptom distress scale, the Chinese Davidson Trauma Scale, and the Center for Epidemiologic Studies-Depressive Scale; their personal characteristics; and disease-related variables.

RESULTS

There were significant positive relationships among the frequency of PTSS, the severity of PTSS, symptom distress, and depressive symptoms. Logistic regression analysis demonstrated that educational level, symptom distress, and the frequency of PTSS were significant predictors of depression.

CONCLUSIONS

The study demonstrated a high prevalence of depression in women with female-specific cancer, and the results confirm the relationship between PTSS and depression. In addition, educational level and physical distress were also found to be predictors of depression.

IMPLICATIONS FOR PRACTICE

Screening for depressive symptoms should be a component of routine screening in women with female-specific cancer. Oncology nurses should be aware of the distress symptoms experienced by these women and recognize PTSS in patients who are given a diagnosis of female-specific cancer. Awareness will reduce the multiple risks of posttraumatic stress disorder and depression and decrease the depressive symptoms of women after surviving cancer.

What symptoms are important to patients? Developing a symptom burden measure for women with breast cancer

PURPOSE

The American Cancer Society predicted that 266,120 women would be diagnosed with breast cancer in 2018. Women experience significant symptom burden in response to tumor and treatment-related adverse effects, particularly in advanced disease. Use of valid and reliable patient-reported outcomes (PRO) symptom measures may assist clinicians in systematically monitoring and managing symptoms. The MD Anderson Symptom Inventory (MDASI) is a brief PRO measure of cancer symptom burden; specific symptoms can be added to the core symptoms to produce disease- and treatment-specific modules. The purpose of this study was to describe the patient symptom experience, define the content domain, and generate items for a breast cancer-specific MDASI module for measuring symptom burden in women with breast cancer.

METHODS

Women with breast cancer were qualitatively interviewed about their experiences of disease and treatment. Descriptive exploratory analysis identified symptoms and symptom interference to define the symptom burden of breast cancer. An expert panel rated the relevance of the identified symptoms to patients with breast cancer.

RESULTS

A conceptual model of breast cancer symptom burden was developed from interviews with 36 women (mean age of 57.9 years, 86.1% had stages I-III, and 52.8% were on chemotherapy and/or radiation therapy) across the breast cancer disease and treatment trajectory. Thirty-six symptoms and 6 interference categories were identified. Symptoms specific to treatment modalities and breast cancer met the criteria for inclusion in the provisional instrument for psychometric testing.

CONCLUSIONS

We generated an instrument with content validity for measuring symptom burden specific to women with breast cancer.

Lived experiences and support needs of women who developed chemotherapy-induced peripheral neuropathy following treatment for breast and ovarian cancer

OBJECTIVES

This study explored lived experiences of women who developed chemotherapy-induced peripheral neuropathy (CIPN) following treatment for breast and ovarian cancer. It also explored cancer survivors' perceptions of information and advice offered by clinicians about CIPN and for managing CIPN.

METHODS

The study was advertised through cancer charity websites and social media accounts. Purposeful, convenience sampling was carried out using set eligibility criteria. Individuals with diagnosis of breast or ovarian cancer who experienced or are still experiencing CIPN were recruited. Fifteen semi-structured interviews were conducted. Data were analysed using interpretative phenomenological analysis (IPA).

RESULTS

Similar to previous studies, participants used comparisons to describe their symptoms. Four main themes emerged from the analysis: (a) struggle to process CIPN information, (b) information and trust are key in the treatment decision-making process, (c) experience of symptom reporting and (d) challenges of managing symptoms. Findings suggest interventions to improve understanding of CIPN risk are needed in practice.

CONCLUSION

A better and broader understanding of the patient experience of CIPN could pave the way for improved communication, assessment and management of symptoms. Results suggest the need for interventions to guide cancer survivors to recognise and report CIPN symptoms early and address the impact of CIPN symptoms in their lives.

Critical review of emergency department management of chemotherapy complications in cancer patients

INTRODUCTION

Recent worldwide advances in cancer therapies have resulted in an increased number of people receiving chemotherapy in ambulatory care settings. In Spain, emergency departments are the single point of entry to acute inpatient services and they play a pivotal role in the management of chemotherapy complications. Little research exists in patterns of emergency department utilisation by oncology patients with chemotherapy-related complications. However, it is important for the oncology patients and the healthcare system to gain understanding in the disease pathway and the organisational factors influencing the quality of care.

METHODS

This critical review's main aims were to describe the clinical characteristics of patients who presented to an emergency department after chemotherapy treatment as reported in international literature; to map reported patterns of care in emergency department access; and quality of care exploring the management of febrile neutropenic patients described in the literature, against best practice guidelines.

RESULTS

The search strategy yield 701 articles from MEDLINE, TROVE and SCOPUS and 26 were included. The review combines systematic reviews, observational, cross-sectional case-control studies and randomised control trials.

CONCLUSION

All articles showed areas and opportunities for improvement in the management of this population, especially with regard to time from triage to antibiotic administration in febrile neutropenic patients.

Understanding patient choices regarding breast reconstruction after mastectomy for breast cancer

PURPOSE

In Australia, about 40% of patients undergo mastectomy to treat breast cancer, with negative impacts on body image, sexual function and quality of life. Whilst breast reconstruction is associated with increased patient self-esteem and a greater sense of wholeness and well-being, the national reconstruction rate is low at 18%. This study aimed to compare demographics, treatment factors and information provision about breast reconstruction in women who had and did not have breast reconstruction following mastectomy treatment and identify goals and concerns underpinning women's reconstruction decisions.

METHODS

Female patients who had a mastectomy to treat breast cancer between 2010 and 2014 in a culturally and linguistically diverse (CALD) and socially disadvantaged region participated in a cross-sectional study, completing a questionnaire in their language of choice (English, Vietnamese, Chinese or Arabic).

RESULTS

Completed surveys were returned by 168 women (42% response rate; 77% English-speaking), of whom only 19.0% (n = 32) reported having had breast reconstruction. Reconstruction rates were significantly lower in women who reported speaking a language other than English at home versus only English (37.5% vs 62.5%, p = 0.03). However, all women expressed a desire for more information about breast reconstruction and more support to make their decision about breast reconstruction.

CONCLUSIONS

Patients identified a need for greater information provision on breast reconstruction, highlighting an urgent need for resources specifically about breast reconstruction, particularly for non-English-speaking patients. Greater provision of information prior to mastectomy is critical to underpin breast cancer patients' decisions about breast reconstruction, especially for non-English speaking patients.

Concept domain validation and item generation for the Treatment-Induced Neuropathy Assessment Scale (TNAS)

PURPOSE

Treatment-induced peripheral neuropathy (TIPN) is a difficult problem experienced by patients with cancer that can interfere with their ability to receive optimal therapy. The Treatment-Induced Peripheral Neuropathy Scale (TNAS) is a patient-reported outcome (PRO) measure developed to assess TIPN symptom burden. However, PRO validation is an ongoing process. The aim of this qualitative study was to define the conceptual model, establish content domain validity, and refine items for the TNAS based on patient input.

METHODS

Patients who received bortezomib, oxaliplatin, or platinum-taxane combination therapy reported their experience of TIPN in single qualitative audiotaped interviews. Themes of the TIPN experience were identified by descriptive analysis of the transcribed interviews.

RESULTS

Three groups of 10 patients each who had received bortezomib, oxaliplatin, or platinum-taxane combination therapy, for a total of 30 patients, reported their experiences. Two themes reported by patients were TIPN sensations and functional interference. Five sensations (numbness, tingling, pain, heat or burning, and coldness) and five functional impacts (using hands, walking, maintaining balance or falling, wearing shoes, and sleeping) were reported by at least 20% of patients and were selected for inclusion in the TNAS v3.0 for additional psychometric testing.

CONCLUSIONS

The assessment of TIPN must be convenient, reliable, and practical for patients, who are the most reliable source of information about symptoms. The TNAS, developed with direct patient input, provides an easily administered and conceptually valid method of patient report of TIPN burden for use in research and practice.

Cluster Analysis of Symptoms of Bangladeshi Women with Breast Cancer

Background:

Breast cancer (BC) patients may experience multiple symptoms due to the disease itself, cancer treatment or combination of both.

Aim:

The aim of the present study was to express multiple symptoms experienced by the patients with BC as clusters.

Methods:

This was a retrospective study. We examined symptom profiles of 120 patients with BC who attended the Centre for Palliative Care, Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh, from January 2009 to December 2013. We included all case sheets of BC patients, which had documentation of needed information. Following symptoms were analyzed: pain, nausea, loss of appetite, constipation, weakness, cough, breathlessness, sleeplessness, lymphedema, sadness, anxiety, and depression. Hierarchical cluster analysis was used to identify the natural groupings within the set.

Results:

We could identify three clusters, namely (1) “neuropsychiatric,” (2) “gastro-respiratory,” and (3) “miscellaneous” symptom clusters. The symptoms in cluster 2 comprised of cough, breathlessness, nausea, and constipation. Cluster 1 was characterized by pain, depression, anxiety, weakness, sleeplessness, and loss of appetite. Cluster 2 was comprised of cough, breathlessness, nausea, and constipation. Cluster 3 consisted of two symptoms lymphedema and sadness. The results revealed that the multiple symptoms of patients with BC experienced had been clustered together. Neuropsychiatric symptoms and weakness formed a significant strong relationship with each other.

Conclusion:

Knowledge obtained from this study could be beneficial for better understanding, assessment, and management of symptom clusters in women with BC. It may also help patients to plan ahead for them to seek management of concurrent symptoms to improve their quality of life.

Body image and psychological distress in women with breast cancer: a French online survey on patients' perceptions and expectations

BACKGROUND

Altered body image caused by alopecia, loss of eyebrows or eyelashes, or mastectomy is a major source of psychological distress in women with breast cancer.

OBJECTIVE

To identify and to assess patients' perceptions and expectations regarding altered body image.

METHOD

Opinion survey conducted among patients treated for breast cancer and member of French online support groups. Anonymous online self-administered survey sent to women with breast cancer.

RESULTS

85% of the women interviewed experienced alopecia during treatment and 67% of them loss of eyebrows or eyelashes. About half of patients suffering alopecia and loss of eyebrows or eyelashes reported fearing what others think. Mastectomy was experienced by 84% of the women in our study, but only 32% of them reported fearing what others think. 87% of our study cohort received information about the possibility of adverse events. 70, 56, and 60% of women felt helped by information they received for the management of alopecia, loss of eyebrows or eyelashes, or mastectomy, respectively.

CONCLUSION

This study confirms that altered body image is a critical psychosocial issue for women with breast cancer. Effective information can be a source of reassurance and may constitute one of the most important sources of emotional support.

Development of a mobile application of Breast Cancer e-Support program for women with breast cancer undergoing chemotherapy

BACKGROUND

Women with breast cancer undergoing chemotherapy experience a variety of physical and psychosocial symptoms, which have negative effect on women's quality of life and psychological well-being. Although M-health technologies provides innovative and easily accessible option to provide psychosocial support, mobile phone based interventions remain limited for these women in China.

OBJECTIVE

To develop a new mobile application to offer information as well as social and emotional support to women with breast cancer undergoing chemotherapy to promote their self-efficacy and social support, thus improving symptom management strategies.

METHODS

Basing on previous theoretical framework which incorporated Bandura's self-efficacy theory and the social exchange theory, a new mobile application, called Breast Cancer e-Support Program (BCS) was designed, with the content and functionality being validated by the expert panel and women with breast cancer.

RESULTS

BCS App program has four modules: 1) Learning forum; 2) Discussion forum; 3) Ask-the-Expert forum; and 4) Personal Stories forum. BCS program can be applied on both android mobile phones and iPhones to reach more women.

CONCLUSIONS

This is the first of its kind developed in China for women with breast cancer undergoing chemotherapy. A randomized controlled trial is undertaking to test the effectiveness of BCS program.

‘I’ve got a very dichotomous difference in the way that I perceive myself’: Positive and negative constructions of body image following cancer treatment

This study investigated how women constructed body image following cancer. Four women, aged 32–67 years, who had experienced breast or bowel cancer took part in a 2-hour, in-depth focus group. Discourse analysis revealed that women orientated to positive aspects of the post-treatment body (silhouette, trust, acceptance) while acknowledging that their experiences were also traumatic (hair loss, scarring, sickness, swelling). Bodies and illness were concealed from public judgment, and women developed new trust in their bodies due to overcoming cancer; post-cancer bodies were accepted despite opportunities for normalisation. Implications for those wanting to support women during and after cancer are discussed.

Optimizing post-acute care in breast cancer survivors: a rehabilitation perspective

Breast cancer (BC) is the most common malignancy and a leading cause of morbidity and mortality in women worldwide. Therapeutic advances and improved survival rates of women with BC have implications for long-term impact on disability, psychological function and quality of life (QoL), which may be amenable to rehabilitation. The focus of rehabilitation is on managing disability, reducing sequelae and symptoms, and enhancing participation and societal reintegration, to achieve the highest possible independence and the best QoL. Rehabilitation interventions should be considered early for maintaining functional capacity and reducing the risk of losing important abilities or independence and should be individualized depending on disease phase, functional deficits, personal requirements and specific goals. A number of interventions have been trialled to support rehabilitation input for women with BC, which include physical therapy, psychological interventions (psychotherapy, cognitive behavioral training) and others. Multidisciplinary rehabilitation and uni-disciplinary interventions such as physical therapy have been shown to be beneficial in reducing disability, and improving participation and QoL. There is a need for comprehensive assessment of health domains in BC patients using a standardized framework and a common language for describing the impact of disease at different levels, using the International Classification of Functioning, Disability and Health core sets. This will provide more detailed information on the needs of these patients, so more efficient and targeted rehabilitation interventions can be provided.

Women Treated for Breast Cancer Experiences of Chemotherapy-Induced Pain: Memories, Any Present Pain, and Future Reflections

BACKGROUND

Breast cancer survivors make up a growing population facing treatment that poses long-standing adverse effects including chemotherapy-related body function changes and/or pain. There is limited knowledge of patients' lived experiences of chemotherapy-induced pain (CHIP).

OBJECTIVE

The aim of this study was to explore CHIP and any long-standing pain experiences in the lifeworld of breast cancer survivors.

METHODS

Fifteen women participated in a follow-up interview a year after having experienced CHIP. They were interviewed from a lifeworld perspective; the interviews were analyzed through guided phenomenology reflection.

RESULTS

A past perspective: CHIP is often described in metaphors, leads to changes in a patient's lifeworld, and impacts lived time. The women become entirely dependent on others but at the same time feel isolated and alone. Existential pain was experienced as increased vulnerability. Present perspective: Pain engages same parts of the body, but at a lower intensity than during CHIP. The pain creates time awareness. Expected normality in relationships/daily life has not yet been achieved, and a painful existence emerges in-between health and illness. Future perspective: There are expectations of pain continuing, and there is insecurity regarding whom to turn to in such cases. A painful awareness emerges about one's own and others' fragile existence.

CONCLUSIONS

Experiencing CHIP can impact the lifeworld of women with a history of breast cancer. After CHIP, there are continued experiences of pain that trigger insecurity about whether one is healthy.

IMPLICATIONS FOR PRACTICE

Cancer survivors would likely benefit from communication and information about and evaluation of CHIP.

The experience of chemotherapy-induced peripheral neuropathy in adult cancer patients: a qualitative thematic synthesis

The aim of this review was to systematically identify, appraise and synthesise qualitative research evidence on the experience of adult cancer patients living with chemotherapy-induced peripheral neuropathy (CIPN). A systematic search of the literature was performed in September 2015. Qualitative studies were included if they investigated CIPN and patient experience. Quality of the articles was appraised using an adapted version of the Critical Appraisal Skill Programme Checklist for Qualitative Research (CASP 2014). Themes were identified using the thematic synthesis approach proposed by Thomas and Harden [BMC Medical Research Methodology 8 (2008) 45]. Five articles presented findings generated by 88 patients who had all received neurotoxic chemotherapy. Sample sizes from included studies varied from 1 to 28 patients; all studies originated from America and were published between 2005 and 2015. Four analytical themes emerged: (1) CIPN is an unclear experience, (2) a less important risk, (3) impact on quality of life and (4) a feature of cancer survivorship. In conducting this synthesis, the lack of qualitative evidence in this specific condition is evident. Further studies are needed outside of America, to focus on CIPN risk communication approaches by healthcare professionals, patient understanding and perception of CIPN risk and interventions to promote early detection of CIPN including effective reporting and assessment.

Psychological interventions for women with non-metastatic breast cancer

BACKGROUND

Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer.

OBJECTIVES

To assess the effects of psychological interventions on psychological morbidities, quality of life and survival among women with non-metastatic breast cancer.

SEARCH METHODS

We searched the following databases up to 16 May 2013: the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO; and reference lists of articles. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) search portal and ClinicalTrials.gov for ongoing trials in addition to handsearching.

SELECTION CRITERIA

Randomised controlled trials that assessed the effectiveness of psychological interventions for non-metastatic breast cancer in women.

DATA COLLECTION AND ANALYSIS

Two review authors independently appraised and extracted data from eligible trials. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcome.

MAIN RESULTS

Twenty-eight randomised controlled trials comprising 3940 participants were included. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. A wide range of interventions were evaluated, with 24 trials investigating a cognitive behavioural therapy and four trials investigating psychotherapy compared to control. Pooled standardised mean differences (SMD) from baseline indicated less depression (SMD -1.01, 95% confidence interval (CI) -1.83 to -0.18; P = 0.02; 7 studies, 637 participants, I(2) = 95%, low quality evidence), anxiety (SMD -0.48, 95% CI -0.76 to -0.21; P = 0.0006; 8 studies, 776 participants, I(2) = 64%, low quality evidence) and mood disturbance (SMD -0.28, 95% CI -0.43 to -0.13; P = 0.0003; 8 studies, 1536 participants, I(2) = 47%, moderate quality evidence) for the cognitive behavioural therapy group than the control group. For quality of life, only an individually-delivered cognitive behavioural intervention showed significantly better quality of life than the control with an SMD of 0.65 (95% CI 0.07 to 1.23; P = 0.03; 3 studies, 141 participants, I(2) = 41%, very low quality evidence). Pooled data from two group-delivered studies showed a non-significant overall survival benefit favouring cognitive behavioural therapy compared to control (pooled hazard ratio (HR) 0.76, 95% CI 0.25 to 2.32; P = 0.63; 530 participants, I(2) = 84%, low quality evidence). Four studies compared psychotherapy to control with one to two studies reporting on each outcome. The four studies were assessed as high risk of bias and provided limited evidence of the efficacy of psychotherapy. Adverse events were not reported in any of the included studies.

AUTHORS' CONCLUSIONS

A psychological intervention, namely cognitive behavioural therapy, produced favourable effects on some psychological outcomes, in particular anxiety, depression and mood disturbance. However, the evidence for survival improvement is still lacking. These findings are open to criticism because of the notable heterogeneity across the included studies and the shortcomings of the included studies.

Adherence to intravenous chemotherapy in African American and white women with early-stage breast cancer

BACKGROUND

Adherence to intravenous chemotherapy offers survival and recurrence-free benefits for women diagnosed with early-stage breast cancer. However, previous studies have found that African American women are more likely to discontinue intravenous chemotherapy early, thus shortening their survival. Yet the existence of racial differences and predictors of adherence to chemotherapy treatment between African American and white women are largely understudied or inconsistent.

OBJECTIVE

The purposes of this study were to examine factors that influence the decision to adhere to chemotherapy in African American and white women diagnosed with early-stage breast cancer and to test for racial differences that may exist in this sample.

INTERVENTIONS/METHODS

The study recruited a convenience sample of 99 African American and white women. Factors examined were sociodemographic variables (age, race, access to healthcare), social support, religious coping, chemotherapy adverse effects, depression, breast cancer knowledge, health beliefs, cancer fatalism, and days from diagnosis to treatment. Data analyses included logistic regression modeling.

RESULTS

No racial differences in adherence to intravenous chemotherapy between African American and white women were found (χ = 2.627, P = .10). Days to treatment (odds ratio [OR], 0.982, P = .058), health insurance (OR, 0.121; P = .016), change in depression (OR, 0.935; P = .118), and symptom severity (OR, 0.950; P = .038) were independently associated with nonadherence to chemotherapy.

CONCLUSIONS

This study provides emerging evidence of factors that may be potentially modified with interventions at the clinical setting.

IMPLICATIONS FOR PRACTICE

The findings can be used to spearhead future intervention studies that improve treatment decision making to chemotherapy adherence.

Patient-reported stressful events and coping strategies in post-menopausal women with breast cancer

The objective of this paper was to explore what stressful events post-menopausal women with primary or recurrent breast cancer experience, how bothersome these events were and which coping strategies these women used. Data were collected from 131 patients diagnosed with primary or recurrent breast cancer. The Daily Coping Assessment was used. Thematic analysis was applied to form themes of stressful events. Six types of stressful events were extracted. The most frequently experienced events for women with primary cancer and those with recurrent cancer were 'distressing bodily symptoms'. The most bothersome event among primary cancer was 'everyday concerns' and in the recurrent group, 'distressing psychological reactions'. The most commonly used strategies were 'acceptance', 'distraction' and 'relaxation'. This study shows that women in different parts of the cancer trajectory differ in what they perceive to be stressful events when reporting them in their own words in a diary. The differences have an impact on the subsequent coping strategies they used.