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LeBlanc MR, LeBlanc TW, Yang Q, McLaughlin J, Irish K, Smith SK. A Mobile App to Support Self-Management in Patients with Multiple Myeloma or Chronic Lymphocytic Leukemia: Pilot Randomized Controlled Trial. JMIR Cancer 2023; 9:e44533. [PMID: 37410541 PMCID: PMC10360008 DOI: 10.2196/44533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/20/2023] [Accepted: 05/18/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Patients with blood cancer experience serious physical and emotional symptoms throughout their cancer journey. OBJECTIVE Building on previous work, we aimed to develop an app designed to help patients with multiple myeloma and chronic lymphocytic leukemia self-manage symptoms and test it for acceptability and preliminary efficacy. METHODS We developed our Blood Cancer Coach app with input from clinicians and patients. Our 2-armed randomized controlled pilot trial recruited participants from Duke Health and nationally in partnerships with the Association of Oncology Social Work, Leukemia and Lymphoma Society, and other patient groups. Participants were randomized to the attention control (Springboard Beyond Cancer website) arm or the Blood Cancer Coach app intervention arm. The fully automated Blood Cancer Coach app included symptom and distress tracking with tailored feedback, medication reminders and adherence tracking, multiple myeloma and chronic lymphocytic leukemia education resources, and mindfulness activities. Patient-reported data were collected at baseline, 4 weeks, and 8 weeks for both arms through the Blood Cancer Coach app. Outcomes of interest were global health (Patient Reported Outcomes Measurement Information System Global Health), posttraumatic stress (Posttraumatic Stress Disorder Checklist for DSM-5), and cancer symptoms (Edmonton Symptom Assessment System Revised). Among participants in the intervention arm, satisfaction surveys and usage data were used to evaluate acceptability. RESULTS Among 180 patients who downloaded the app, 49% (89) of them consented to participate and 40% (72) of them completed baseline surveys. Of those who completed baseline surveys, 53% (38) of them completed week 4 surveys (16 intervention and 22 control) and 39% (28) of them completed week 8 surveys (13 intervention and 15 control). Most participants found the app at least moderately effective at helping manage symptoms (87%), feeling more comfortable seeking help (87%), increasing awareness of resources (73%), and reported being satisfied with the app overall (73%). Participants completed an average of 248.5 app tasks over the 8-week study period. The most used functions within the app were medication log, distress tracking, guided meditations, and symptom tracking. There were no significant differences between the control and intervention arms at week 4 or 8 on any outcomes. We also saw no significant improvement over time within the intervention arm. CONCLUSIONS The results of our feasibility pilot were promising in which most participants found the app to be helpful in managing their symptoms, reported satisfaction with the app, and that it was helpful in several important areas. We did not, however, find significantly reduced symptoms or improved global mental and physical health over 2 months. Recruitment and retention were challenging for this app-based study, an experience echoed by others. Limitations included a predominantly White and college educated sample. Future studies would do well to include self-efficacy outcomes, target those with more symptoms, and emphasize diversity in recruitment and retention. TRIAL REGISTRATION ClinicalTrials.gov NCT05928156; https://clinicaltrials.gov/study/NCT05928156.
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Affiliation(s)
- Matthew R LeBlanc
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
- Duke Cancer Institute, Durham, NC, United States
| | - Thomas W LeBlanc
- Duke Cancer Institute, Durham, NC, United States
- School of Medicine, Duke University, Durham, NC, United States
| | - Qing Yang
- School of Nursing, Duke University, Durham, NC, United States
| | | | - Kerry Irish
- AdventHealth Cancer Services, Asheville, NC, United States
- Dempsey Centers for Quality Cancer Care, Lewiston, ME, United States
| | - Sophia K Smith
- Duke Cancer Institute, Durham, NC, United States
- School of Nursing, Duke University, Durham, NC, United States
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Binkley JM, Gabram S, Finley J, Fowler D, VanHoose L, McCullough LE. Racial disparity in breast cancer survivorship: themes from a series of four national healthcare provider live virtual forums. J Cancer Surviv 2023:10.1007/s11764-023-01373-6. [PMID: 37040001 DOI: 10.1007/s11764-023-01373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/25/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Significant disparity exists in the diagnosis, treatment, and survivorship outcomes among Black breast cancer (BC) survivors. Black BC survivors have more significant survivorship issues and a greater burden of illness than White counterparts. Barriers to rehabilitation exist for all BC survivors but are magnified in Black BC survivors. The purpose of this qualitative research was to document patient, clinician, and researchers' perceptions surrounding contributing factors, lived experiences, and potential solutions to racial disparity in BC survivorship. METHODS A narrative approach was utilized to identify themes from a series of four virtual healthcare provider forums that explored lived personal and professional experiences, issues, and potential solutions surrounding racial disparity in BC survivorship. Forums included perspectives of patients, healthcare providers, researchers, and stakeholders in the BC field. An independent thematic analysis was performed by the investigators, all of whom have emic perspectives with respect to race and/or BC. RESULTS Three main themes were identified related to racial disparity in BC survivorship: (1) societal and cultural contributing factors, (2) contribution of healthcare providers and systems, and (3) models of care and research considerations. CONCLUSIONS The findings provide compelling documentation of lived personal and professional experiences of racial disparity in BC survivorship. Potential solutions exist and must be enacted immediately to ensure equitable survivorship outcomes for Black individuals following a BC diagnosis. IMPLICATIONS FOR CANCER SURVIVORS Increased awareness related to racial disparity in BC survivorship among survivors, healthcare providers, and researchers will contribute to health equity and improved outcomes for Black individuals.
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Affiliation(s)
- Jill M Binkley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA.
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA.
| | - Sheryl Gabram
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
- Georgia Center for Oncology Research and Education, Atlanta, GA, USA
| | - Janae Finley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
| | | | - Lisa VanHoose
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
- College of Saint Mary, Omaha, NE, USA
- The Ujima Center, Monroe, LA, USA
| | - Lauren E McCullough
- Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Nolan TS, Ivankova N, Carson TL, Spaulding AM, Dunovan S, Davies S, Enah C, Meneses K. Life after breast cancer: 'Being' a young African American survivor. ETHNICITY & HEALTH 2022; 27:247-274. [PMID: 31642349 DOI: 10.1080/13557858.2019.1682524] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
Objective: In the United States, 26,534 young women (≤45 years) were diagnosed with breast cancer in 2017. Young African American (AA) women have higher incidence and mortality rates than Whites and Hispanics. Yet, few published studies describe survivorship (life after breast cancer diagnosis) experiences among this group. Here, we explore the lived experience of young AA breast cancer survivorship (via quality of life [QOL]).Design: This phenomenological study was framed by the QOL Applied to Breast Cancer model. Fifteen young AA survivors from the Southern U. S. participated in two semi-structured interviews. Methods of transcendental phenomenology were used for data collection and analysis.Results: Five themes emerged from participants' (mean age = 35 years; survivorship = 4 years) descriptions of survivorship experience: (1) actively managing spiritual self, (2) actively managing physical self, (3) actively managing psychological self, (4) actively managing social self, and (5) seeking survivorship knowledge. Participants perceived survivorship as a labile 'new normal' and 'ongoing struggle,' in which spirituality and survivorship knowledge were key to restructuring their lives.Conclusions: Survivorship among young AA survivors was more fluid and complex than the QOL model explained. Findings describe young AA breast cancer survivorship and indicate areas of potential strengths and distress. Healthcare providers and ancillary staff must exercise cultural competence to assess and anticipate young AA survivors' needs and concerns. Implementing targeted survivorship interventions, accounting for cultural contexts (e.g. high spirituality) and need for age-specific survivorship information, may improve QOL among young AA survivors.
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Affiliation(s)
- Timiya S Nolan
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Nataliya Ivankova
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany L Carson
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Shanon Dunovan
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Susan Davies
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Comfort Enah
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen Meneses
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Hastert TA, McDougall JA, Strayhorn SM, Nair M, Beebe-Dimmer JL, Schwartz AG. Social needs and health-related quality of life among African American cancer survivors: Results from the Detroit Research on Cancer Survivors study. Cancer 2020; 127:467-475. [PMID: 33225460 DOI: 10.1002/cncr.33286] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Social needs may affect cancer survivors' health-related quality of life (HRQOL) above and beyond sociodemographic and cancer-related factors. The purpose of this study was to estimate associations between social needs and HRQOL. METHODS Results included data from 1754 participants in the Detroit Research on Cancer Survivors cohort, a population-based study of African American survivors of breast, colorectal, lung, and prostate cancer. Social needs included items related to food insecurity, utility shutoffs, housing instability, not getting health care because of cost or a lack of transportation, and perceptions of neighborhood safety. HRQOL was measured with the validated Functional Assessment of Cancer Therapy-General (FACT-G). Linear regression models controlled for demographic, socioeconomic, and cancer-related factors. RESULTS More than one-third of the survivors (36.3%) reported social needs including 17.1% of survivors reported 2 or more. The prevalence of social needs ranged from 14.8% for food insecurity to 8.9% for utility shutoffs. FACT-G score differences associated with social needs were -12.2 (95% confidence interval [CI] to -15.2 to -9.3) for not getting care because of a lack of transportation, -11.3 (95% CI, -14.2 to -8.4) for housing instability, -10.1 (95% CI, -12.7 to -7.4) for food insecurity, -9.8 (95% CI, -12.7 to -6.9) for feeling unsafe in the neighborhood, -8.6 (95% CI, -11.7 to -5.4) for utility shutoffs, and -6.7 (95% CI, -9.2 to -4.1) for not getting care because of cost. CONCLUSIONS Social needs were common in this cohort of African American cancer survivors and were associated with clinically significant differences in HRQOL. Clinical oncology care and survivorship care planning may present opportunities to screen for and address social needs to mitigate their impact on survivors' HRQOL.
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Affiliation(s)
- Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Jean A McDougall
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Shaila M Strayhorn
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Mrudula Nair
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Jennifer L Beebe-Dimmer
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Ann G Schwartz
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
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Mokhatri-Hesari P, Montazeri A. Health-related quality of life in breast cancer patients: review of reviews from 2008 to 2018. Health Qual Life Outcomes 2020; 18:338. [PMID: 33046106 PMCID: PMC7552560 DOI: 10.1186/s12955-020-01591-x] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 10/01/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Breast cancer still is a topic. This overview of the literature aimed to update the current knowledge on quality of life in breast cancer patients. METHODS A review of literature in MEDLINE, Cochrane Database of Systematic Reviews and Google Scholar were carried out to identify review papers on health-related quality of life in breast cancer during the 2008 to 2018. All publications were screened using the PRISMA guideline. The methodological quality of reviews was assessed using the AMSTAR. The findings were summarized and tabulated accordingly. RESULTS Within over a decade, a total of 974 review papers were identified which according to the study selection criteria finally we have evaluated 82 reviews. Of these about 85% had a reasonable methodological quality. The findings were mainly summarized on several headings including instruments used to measure quality of life, treatment, supportive care, psychological distress, and symptoms. Questionnaires had a good performance to quantify quality of life in breast cancer patients. Most reviews were focused on the impact of treatment including endocrine therapy as well as integrating complementary and alternative medicine into the current practice. According to the reviews, yoga was the most recommended exercise to improve quality of life in breast cancer patients. CONCLUSION Overall, the findings from this overview indicated that quality of life in breast cancer patients enhanced during the last decade. Several simple but effective interventions such as physical activity and psychosocial interventions proved to be effective in improving quality of life in this population. However, management of symptoms such as pain, and lymphedema, issues related to worry, sexual function especially for young patients, and the future outlooks all are among topics that deserve further consideration. Also, this overview indicated that methodological issues in measuring quality of life in breast cancer patients improved greatly, but still there is a long way to go to understand what really matter to patients.
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Affiliation(s)
- Parisa Mokhatri-Hesari
- Integrative Oncology Research Group, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.,Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran. .,Faculty of Humanity Sciences, University of Science and Culture, ACECR, Tehran, Iran.
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Calidad de Vida: a systematic review of quality of life in Latino cancer survivors in the USA. Qual Life Res 2020; 29:2615-2630. [PMID: 32430782 DOI: 10.1007/s11136-020-02527-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cancer is the leading cause of death among Hispanics/Latinos. Thus, understanding health-related quality of life (HRQOL) needs among this diverse racial/ethnic group is critical. Using Ferrell's multidimensional framework for measuring QOL, we synthesized evidence on HRQOL needs among Hispanic/Latino cancer survivors. METHODS We searched MEDLINE/PubMed, EMBASE, CINAHL, and PsycINFO, for English language articles published between 1995 and January 2020, reporting HRQOL among Hispanic/Latino cancer survivors in the USA. RESULTS Of the 648 articles reviewed, 176 met inclusion criteria, with 100 of these studies focusing exclusively on breast cancer patients and no studies examining end-of-life HRQOL issues. Compared with other racial/ethnic groups, Hispanics/Latinos reported lower HRQOL and a higher symptom burden across multiple HRQOL domains. Over 80% of studies examining racial/ethnic differences in psychological well-being (n = 45) reported worse outcomes among Hispanics/Latinos compared with other racial/ethnic groups. Hispanic/Latino cancer survivors were also more likely to report suboptimal physical well-being in 60% of studies assessing racial/ethnic differences (n = 27), and Hispanics/Latinos also reported lower social well-being relative to non-Hispanics/Latinos in 78% of studies reporting these outcomes (n = 32). In contrast, reports of spiritual well-being and spirituality-based coping were higher among Hispanics/Latinos cancer survivors in 50% of studies examining racial/ethnic differences (n = 15). DISCUSSION Findings from this review point to the need for more systematic and tailored interventions to address HRQOL needs among this growing cancer survivor population. Future HRQOL research on Hispanics/Latinos should evaluate variations in HRQOL needs across cancer types and Hispanic/Latino subgroups and assess HRQOL needs during metastatic and end-of-life disease phases.
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Ceballos RM, Hohl SD, Molina Y, Hempstead B, Thompson-Dodd J, Weatherby S, Malen RC. Oncology provider and African-American breast cancer survivor perceptions of the emotional experience of transitioning to survivorship. J Psychosoc Oncol 2020; 39:35-53. [PMID: 32400316 PMCID: PMC8856584 DOI: 10.1080/07347332.2020.1752880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To examine the emotional experience of African American breast cancer survivors (BCS), and the information exchange between providers and patients, during transitioning to post-treatment survivorship. RESEARCH APPROACH We conducted a qualitative study using interviews and focus groups. PARTICIPANTS We sought perspectives of oncology providers (n = 27) and African-American breast cancer survivors (BCS) (n = 45) who provided and received care in three counties in Washington State. METHODS African-American community consultants conducted interviews and focus groups. Thematic coding and constant comparison were applied to identify emergent themes. FINDINGS Participants reported emotional health information and support were needed but not consistently provided, resulting in a sense of survivor isolation. Systemic challenges limited providers' ability to deliver emotional support information. Survivors and providers expressed similar understandings of the emotional impact of transition, but each group highlighted different, yet complementary priorities to address emotional needs of African-American BCS. CONCLUSIONS There is congruence between African-American BCS and oncology providers perceptions of the emotional experience of transitioning to post-treatment survivorship, but patients are not receiving adequate information and resources to help them adequately address their emotional needs. IMPLICATIONS FOR POLICY Improved care continuity, team-based approaches, and partnerships between health systems and community organization partnerships may help patients and providers recognize and address emotional needs during the transition.
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Affiliation(s)
- Rachel M. Ceballos
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Sarah D. Hohl
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Yamile Molina
- School of Public Health, University of Illinois-Chicago, Chicago, Illinois, USA
| | | | | | | | - Rachel C. Malen
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Shakeel S, Tung J, Rahal R, Finley C. Evaluation of Factors Associated With Unmet Needs in Adult Cancer Survivors in Canada. JAMA Netw Open 2020; 3:e200506. [PMID: 32142127 PMCID: PMC7060489 DOI: 10.1001/jamanetworkopen.2020.0506] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Understanding the challenges faced by an increasing number of cancer survivors can guide the development and implementation of effective survivorship care models. OBJECTIVE To identify the physical, emotional, and practical concerns and associated unmet needs reported by cancer survivors. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study obtained data from the Experiences of Cancer Patients in Transitions Study of the Canadian Partnership Against Cancer, in collaboration with cancer agencies in the 10 Canadian provinces, that was disseminated in 2016. This analysis included only adult survivors aged 30 years or older who underwent chemotherapy, radiation therapy, surgical treatment, or a combination of these therapies for breast, prostate, colorectal, melanoma, or hematological cancer within the past 1 to 3 years. Data synthesis and quality assessment were conducted in 2017. Data analysis was completed in July 2019. MAIN OUTCOMES AND MEASURES The outcomes were the (1) quantification of the magnitude and multiplicity of the physical, emotional, and practical concerns of adult survivors of breast, colorectal, prostate, melanoma, or hematological cancer; (2) exploration of the magnitude of associated unmet needs; and (3) identification of patient-, treatment-, and cancer-specific factors associated with the reporting of unmet needs. RESULTS Overall, 10 717 adult respondents were included (5660 [53%] female and 6367 [60%] aged ≥65 years). The median number of concerns per respondent was 6 (interquartile range [IQR], 3-10). Among respondents with concerns, help was sought for a median of 2 (IQR, 0-4) concerns. Unmet needs were reported for a median of 4 (IQR, 2-7) concerns. Emotional concerns were reported by 8330 respondents (78%), physical concerns by 9236 respondents (86%), and practical concerns by 4668 respondents (44%). At least 1 unmet need was reported by 7033 survivors (84%) with emotional concerns, 7475 (81%) with physical concerns, and 3459 (74%) with practical concerns. Age, sex, annual income, marital status, geographic location, language, and treatment type were significant factors associated with unmet needs. Survivors of melanoma cancer had a significantly higher likelihood of reporting unmet emotional needs (odds ratio [OR], 1.75; 95% CI, 1.17-2.61; P = .01), whereas survivors of prostate (OR, 0.60; 95% CI, 0.43-0.84; P < .001) and hematological (OR, 0.70; 95% CI, 0.50-0.99; P = .04) cancers were significantly less likely to report unmet needs for physical concerns when compared with breast cancer survivors. Involvement of the general practitioner combined with the oncologist in providing care was associated with a significantly lower likelihood of reporting unmet emotional (OR, 0.78; 95% CI, 0.62-1.00; P = .05) and practical (OR, 0.72; 95% CI, 0.55-0.94; P = .01) needs. CONCLUSIONS AND RELEVANCE The extent of unmet needs among cancer survivors found in this study suggests the need for enhancements in survivorship care, including better awareness of the realities of survivorship, earlier interventions for emerging concerns among survivors, and greater integration of cancer programs and primary care for more seamless transitions.
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Affiliation(s)
- Saad Shakeel
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jasmine Tung
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Rami Rahal
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Christian Finley
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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Coetzee B, Roomaney R, Smith P, Daniels J. Exploring breast cancer diagnosis and treatment experience among a sample of South African women who access primary health care. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2019. [DOI: 10.1177/0081246319870410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Despite the known impact of a cancer diagnosis and related treatments on quality of life, and the complexity of patient journeys in low-resource settings, there has been little published research into the relevant issues faced by South African women living with breast cancer. In this study, we aimed to understand the experiences of breast cancer diagnosis and treatment among a sample of South African women who access primary health care. A convenience sample of 12 women between the ages of 48 and 66 years attending a primary health care facility took part in our study. Women undergoing breast cancer treatment were invited to take part in face-to-face interviews. The interviews were semi-structured and guided by an interview schedule. Interviews were analysed thematically using ATLAS.ti v 8 computer software. We identified three important themes that explained how women experience diagnosis and treatment, namely, (1) reactions to the diagnosis experience, (2) the importance of faith, and (3) the value in having a sense of agency. Women’s initial reaction to their cancer diagnosis was one of shock and disbelief. Despite these reactions, faith and agency played an important role in how women in this study made sense of their illness experience and how they coped. Our findings demonstrate that women’s experiences of breast cancer diagnosis and treatment were accompanied by some psychological distress for which they need support. Furthermore, supporting women to make positive choices about coping and valuing the role of religion when appropriate should form part of any therapeutic engagement, medical or otherwise.
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Affiliation(s)
| | | | - Paula Smith
- Department of Psychology, University of Bath, United Kingdom
| | - Jo Daniels
- Department of Psychology, University of Bath, United Kingdom
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Yan AF, Stevens P, Holt C, Walker A, Ng A, McManus P, Basen-Enguist K, Weinhardt LS, Underwood SM, Asan O, Wang MQ. Culture, identity, strength and spirituality: A qualitative study to understand experiences of African American women breast cancer survivors and recommendations for intervention development. Eur J Cancer Care (Engl) 2019; 28:e13013. [PMID: 30761637 DOI: 10.1111/ecc.13013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/08/2019] [Accepted: 01/17/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Despite advancements in cancer treatment, racial disparities in breast cancer survival persist, with African American women experiencing lower survival rates and poorer quality of life than non-Hispanic White women. Using a social cognitive model of restorative well-being as a framework, this qualitative study sought: (a) to examine strength- and culture-related factors associated with African American female breast cancer survivors' cancer coping and post-treatment experiences and (b) to make recommendations for culturally sensitive intervention. METHODS Eight focus groups occurred with a total of 40 local African American breast cancer survivors. Focus groups were audiotaped and transcribed verbatim. Framework analyses were used to identify themes. NVivo qualitative analysis software-managed data. RESULTS Two major themes emerged from the focus group discussions: (a) God enables breast cancer survivorship and works every day in our lives and (b) the healthiest thing about us is that we are strong African American women. Recommendations for intervention planning and implementation were made towards intervention structure, content development and language framing in a local context. CONCLUSION Findings suggest a need for community-based participatory survivorship interventions that are culturally and spiritually consonant and peer-based. Such interventions may respond to the cancer-related and personal needs of the target population.
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Affiliation(s)
- Alice F Yan
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, Wisconsin
| | - Patricia Stevens
- Professor Emerita, College of Nursing, University of Wisconsin Milwaukee, Milwaukee, Wisconsin
| | - Cheryl Holt
- Department of Behavioral and Community Health, School of Public Health, University of Maryland College Park, College Park, Maryland
| | - Alonzo Walker
- Cancer Center, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alexander Ng
- Exercise Science Program, College of Health Sciences, Marquette University, Milwaukee, Wisconsin
| | | | - Karen Basen-Enguist
- Department of Behavioral Science, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lance S Weinhardt
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, Wisconsin
| | - Sandra M Underwood
- College of Nursing, University of Wisconsin Milwaukee, Milwaukee, Wisconsin
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, New Jersey
| | - Min Qi Wang
- Department of Behavioral and Community Health, School of Public Health, University of Maryland College Park, College Park, Maryland
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12
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An Integrative Review of Psychosocial Concerns Among Young African American Breast Cancer Survivors. Cancer Nurs 2018; 41:139-155. [DOI: 10.1097/ncc.0000000000000477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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13
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Mayer DK, Nasso SF, Earp JA. Defining cancer survivors, their needs, and perspectives on survivorship health care in the USA. Lancet Oncol 2017; 18:e11-e18. [PMID: 28049573 DOI: 10.1016/s1470-2045(16)30573-3] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/01/2016] [Accepted: 08/12/2016] [Indexed: 12/21/2022]
Abstract
More people are living after a diagnosis of cancer than ever before and now account for around 5% of the US population. The specialty of cancer survivorship has been developing and growing since the mid-1980s, but the term survivor is open to debate by people living with cancer and those caring for them. Regardless of the term used, many ongoing physical, psychological, and social needs affect quality of life for people who are living with cancer and those who have survived the disease. Survivors prefer to have these needs addressed by their oncologist but also want their primary care provider to have a role. However, survivors also believe there are communication and coordination barriers between care providers. The existing method for delivering cancer care is becoming unsustainable and is not adequately configured to deliver high-quality cancer care to this growing population in the USA, especially when confronted with projected health-care shortages by 2020. In this Series paper, we define the term cancer survivor, discuss survivors' ongoing needs and preferences for care over time, and consider the implications for delivering coordinated cancer care in the USA.
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Affiliation(s)
- Deborah K Mayer
- University of North Carolina School of Nursing, University of North Carolina, Chapel Hill, NC, USA; University of North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | | | - Jo Anne Earp
- University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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To be young, Black, and living with breast cancer: a systematic review of health-related quality of life in young Black breast cancer survivors. Breast Cancer Res Treat 2016; 160:1-15. [PMID: 27601138 DOI: 10.1007/s10549-016-3963-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/26/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE Compared with young White women, young Black women are more likely to present with aggressive breast cancer (BC) subtypes that are potentially linked to worse health-related quality of life (HRQOL); however, there is limited consensus regarding HRQOL needs among young Black BC survivors. Employing Ferrell's framework on QOL in BC (i.e., physical, psychological, social, and spiritual well-being), we conducted a systematic review on HRQOL among Black BC survivors aged <50 years and proposed recommendations for advancing HRQOL research and care for this population. METHODS Literature searches were conducted in MEDLINE/PubMed, EMBASE, CINAHL, and PsycINFO to identify relevant articles published from 1995 to 2015. Abstracts and full-text articles were screened using predetermined inclusion/exclusion criteria and evaluated for quality. RESULTS A total of 2533 articles were identified, but six met eligibility criteria. Most studies examined multiple HRQOL domains, with the psychological domain most represented. Compared with their older, White, and BC-free counterparts, young Black BC survivors reported greater fear of dying, unmet supportive care needs, financial distress, and lower physical/functional well-being. However, spiritual well-being appeared favorable for young Black survivors. Research gaps include the absence of longitudinal studies and under-representation of studies examining physical, social, and particularly, spiritual HRQOL in young Black BC survivors. CONCLUSIONS Young Black BC survivors generally experience suboptimal HRQOL after BC diagnosis. As few studies have reported on HRQOL among this group, future research and oncology care should prioritize young Black women in ways that recognize their unique concerns, in order to ensure better HRQOL outcomes both during and after treatment.
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Barsevick AM, Leader A, Bradley PK, Avery T, Dean LT, DiCarlo M, Hegarty SE. Post-treatment problems of African American breast cancer survivors. Support Care Cancer 2016; 24:4979-4986. [PMID: 27543161 DOI: 10.1007/s00520-016-3359-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/18/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE African American breast cancer survivors (AABCS) have a lower survival rate across all disease stages (79 %) compared with White survivors (92 %) and often have more aggressive forms of breast cancer requiring multimodality treatment, so they could experience a larger burden of post-treatment quality of life (QOL) problems. This paper reports a comprehensive assessment of the number, severity, and domains of problems faced by AABCS within 5 years after treatment completion and identifies subgroups at risk for these problems. METHODS A population-based random sample was obtained from the Pennsylvania Cancer Registry of African American females over 18 years of age who completed primary treatment for breast cancer in the past 5 years. A mailed survey was used to document survivorship problems. RESULTS Two hundred ninety-seven AABCS completed the survey. The median number of survivor problems reported was 15. Exploratory factor analysis of the problem scale revealed four domains: emotional problems, physical problems, lack of resources, and sexuality problems. Across problem domains, younger age, more comorbid conditions, and greater medical mistrust were risk factors for more severe problems. CONCLUSIONS The results demonstrated that AABCS experienced significant problem burden in the early years after diagnosis and treatment. In addition to emotional and physical problem domains that were documented in previous research, two problem domains unique to AABCS included lack of resources and sexuality concerns. At risk groups should be targeted for intervention. The study results reported in this manuscript will inform future research to address problems of AABCS as they make the transition from cancer patient to cancer survivor.
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Affiliation(s)
- Andrea M Barsevick
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - Amy Leader
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | | | | | | | - Melissa DiCarlo
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Sarah E Hegarty
- Thomas Jefferson University, 834 Chestnut Street, Philadelphia, PA, 19107, USA
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16
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Dean LT, Brown J, Coursey M, Schmitz KH. Great expectations: racial differences in outcome expectations for a weight lifting intervention among black and white breast cancer survivors with or without lymphedema. Psychooncology 2016; 25:1064-70. [PMID: 27192633 DOI: 10.1002/pon.4175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/26/2016] [Accepted: 05/11/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Black breast cancer survivors are less likely to engage in physical activity than are White survivors. This is unfortunate because physical activity may be especially beneficial given Black breast cancer survivors' higher rates of obesity and adverse treatment effects related to obesity, such as breast cancer-related lymphedema (BCRL). The analysis explored outcome expectations for a weight lifting intervention by sedentary Black or White female breast cancer survivors and assessed the role of BCRL on outcome expectations for exercise. METHODS Chi-squared tests compared mean outcome expectation values for Black and White breast cancer survivors who completed baseline surveys for the Physical Activity and Lymphedema trial (n = 281). With race as the independent variable, multivariable analysis compared results for women without BCRL with those with BCRL, separately. RESULTS Across the entire sample, Black survivors (n = 90) had significantly higher (p < 0.05) outcome expectations than White survivors (n = 191) for improvements in sleep, appearance, mental health, affect, energy, and eating habits, with small to moderate effect sizes. When stratified by BCRL status, differences by race were robust only among those with BCRL. CONCLUSIONS Black cancer survivors had greater expectations than White cancer survivors for how a weight lifting intervention would improve their physical and mental states; these differences were most apparent among women with BCRL. Improving outcomes in Black breast cancer survivors rests on the development of interventions that are appropriately tailored to address the expectations of this population and account for differences in persistent adverse effects of cancer such as BCRL. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Justin Brown
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Morgan Coursey
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn H Schmitz
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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17
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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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18
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Ng CG, Mohamed S, See MH, Harun F, Dahlui M, Sulaiman AH, Zainal NZ, Taib NA. Anxiety, depression, perceived social support and quality of life in Malaysian breast cancer patients: a 1-year prospective study. Health Qual Life Outcomes 2015; 13:205. [PMID: 26715073 PMCID: PMC4696207 DOI: 10.1186/s12955-015-0401-7] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/21/2015] [Indexed: 11/15/2022] Open
Abstract
Background Depression and anxiety are common psychiatric morbidity among breast cancer patient. There is a lack of study examining the correlation between depression, anxiety and quality of life (QoL) with perceived social support (PSS) among breast cancer patients. This study aims to study the level of depression, anxiety, QoL and PSS among Malaysian breast cancer women over a period of 12 months and their associations at baseline, 6 and 12 months. Methods It is a 12 months prospective cohort study. Two hundred and twenty one female patients were included in the study. They were assessed at the time of diagnosis, 6 months and 12 month using Hospital Anxiety and Depression Scale (HADS), Quality-of-Life Questionnaire (QLQ–C30), Version 3.0 of the EORTC Study Group and Multidimensional Scale of Perceived Social Support (MSPSS). The information of age, ethnicity, types of treatment, and staging of cancer were collected. Results The HADS anxiety and depression subscales scores of the subjects were relatively low. The level of anxiety reduced significantly at 6 and 12 months (Baseline – 6 months, p = 0.002; Baseline - 12 months, p < 0.001). There were no changes in the level of depression over the study period. The global status of QoL and MSPSS scores were relatively high. Correlation between the global status of QoL and MSPSS for the study subjects was positive (Spearman’s rho = 0.31–0.36). Global status of QoL and MSPSS scores were negatively correlated with anxiety and depression. Conclusion Malaysian breast cancer women had relatively better QoL with lower level of anxiety and depression. Perceived social support was an important factor for better QoL and low level of psychological distress. It reflects the importance of attention on activities that enhance and maintain the social support system for breast cancer patients.
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Affiliation(s)
- Chong Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia.
| | - Salina Mohamed
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Kuala Lumpur, Malaysia
| | - Mee Hoong See
- Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Faizah Harun
- Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Maznah Dahlui
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia
| | - Nor Zuraida Zainal
- Department of Psychological Medicine, Faculty of Medicine, University Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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