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Jehan M, Azam S, Taimuri MA, Sumbal A, Azhar A, Amir A, Oduoye MO, Zainab A, Ikram A, Ali T. Care for breast cancer survivors in Asian countries: A review of sexual dysfunction. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241237687. [PMID: 38481086 PMCID: PMC10938604 DOI: 10.1177/17455057241237687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/21/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024]
Abstract
Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.
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Affiliation(s)
- Minal Jehan
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Sumran Azam
- Karachi Medical and Dental College, Karachi, Pakistan
| | | | - Anusha Sumbal
- Dow University of Health Sciences, Karachi, Pakistan
| | - Ayesha Azhar
- Dow University of Health Sciences, Karachi, Pakistan
| | - Alina Amir
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Asra Zainab
- Dow University of Health Sciences, Karachi, Pakistan
| | - Areeba Ikram
- Dow University of Health Sciences, Karachi, Pakistan
| | - Tehreem Ali
- Dow University of Health Sciences, Karachi, Pakistan
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Rogers LQ, Courneya KS, Oster RA, Anton PM, Phillips S, Ehlers DK, McAuley E. Physical activity intervention benefits persist months post-intervention: randomized trial in breast cancer survivors. J Cancer Surviv 2023; 17:1834-1846. [PMID: 36723801 DOI: 10.1007/s11764-022-01329-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/30/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Determine durable effects of the 3-month Better Exercise Adherence after Treatment for Cancer (BEAT Cancer) physical activity (PA) behavior change intervention 12 months post-baseline (i.e., 9 months after intervention completion). METHODS This 2-arm multicenter trial randomized 222 post-primary treatment breast cancer survivors to BEAT Cancer (individualized exercise and group education) vs. usual care (written materials). Assessments occurred at baseline, 3, 6, and 12 months, with the 12 months assessment reported here. Measures included PA (accelerometer, self-report), cardiorespiratory fitness, muscle strength, body mass index, Functional Assessment of Cancer Therapy (FACT), SF-36, fatigue, depression, anxiety, satisfaction with life, Pittsburgh Sleep Quality Index (PSQI), lower extremity joint dysfunction, and perceived memory. RESULTS Adjusted linear mixed-model analyses demonstrated statistically significant month 12 between-group differences favoring BEAT Cancer for weekly minutes of moderate-to-vigorous self-report PA (mean between-group difference (M) = 44; 95% confidence interval (CI) = 12 to 76; p = .001), fitness (M = 1.5 ml/kg/min; CI = 0.4 to 2.6; p = .01), FACT-General (M = 3.5; CI = 0.7 to 6.3; p = .014), FACT-Breast (M = 3.6; CI = 0.1 to 7.1; p = .044), social well-being (M = 1.3; CI = 0.1 to 2.5; p = .037), functional well-being (M = 1.2; CI = 0.2 to 2.3; p = .023), SF-36 vitality (M = 6.1; CI = 1.4 to 10.8; p = .011), fatigue (M = - 0.7; CI = - 1.1 to - 0.2; p = .004), satisfaction with life (M = 1.9; CI = 0.3 to 3.5; p = .019), sleep duration (M = - 0.2; CI = - 0.4 to - 0.03, p = .028), and memory (M = 1.1; CI = 0.2 to 2.1; p = .024). CONCLUSIONS A 3-month PA intervention resulted in statistically significant and clinically important benefits compared to usual care at 12 months. IMPLICATIONS FOR CANCER SURVIVORS Three months of individualized and group PA counseling causes benefits detectable 9 months later. TRIAL REGISTRATION ClinicalTrials.gov NCT00929617 ( https://clinicaltrials.gov/ct2/show/NCT00929617 ; registered June 29, 2009).
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Affiliation(s)
- Laura Q Rogers
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave S, MT 614, AL, 35294-4410, Birmingham, USA.
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Robert A Oster
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave S, MT 614, AL, 35294-4410, Birmingham, USA
| | - Philip M Anton
- Department of Kinesiology, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - Siobhan Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane K Ehlers
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, USA
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Ayub F, Khan TM, Baig MR, Amin MU, Tahir H. Quality of life and wellbeing among breast cancer patients in Lahore, Pakistan. Front Oncol 2023; 13:1105411. [PMID: 37456255 PMCID: PMC10341154 DOI: 10.3389/fonc.2023.1105411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/08/2023] [Indexed: 07/18/2023] Open
Abstract
Background Breast cancer has a high incidence rate, emphasizing the necessity of enhanced information on health-related quality of life (HrQOL) in this population of patients. The aim of this study was to identify the factors influencing the QOL experienced by patients in Pakistan. Methods A cross-sectional study was conducted on women with breast cancer, and four instruments were used on a random sample of 130 Pakistani women: FACIT-B Version 4 questionnaire,WHO causality assessment scale, Naranjo's algorithm, and a demographic/clinical characteristics section. Data analysis included descriptive analysis, independent sample t-test, and analysis of variance (ANOVA) test. Results The patients' mean age was 49.10 (standard deviation (SD) 10.89); 98.5% were married. The mean score was 18.34 for physical wellbeing (SD 5.92; interquartile range (IQR) 11), 16.33 for social/family wellbeing (SD 6.3; IQR 11.25), 13.6 for emotional wellbeing (SD 3.55; IQR 6), 17.13 for functional wellbeing (SD 3.73; IQR 6), and 24.86 for breast cancer subscale (SD 3.64; IQR 4). The study found that the age, entitlement, recurrence, marital status, salary, number of doses, duration of cancer treatment, and chemotherapy sessions were significantly related to QOL terms in the assessment of the FACIT-B scale. The WHO causality evaluation scale determined that 78.1% of the responses were "probable" and 20.1% were "possible". According to Naranjo's algorithm assessment scale, 80% of adverse drug reactions (ADRs) were "probable", whereas 18.4% were declared "possible". Chemotherapy-induced anemia was the most often reported ADR in 64.6% of patients, followed by chemotherapy-induced nausea and vomiting (61.5%). Conclusion Healthcare practitioners must acknowledge and take into account the significance of QOL in addition to therapy for breast cancer patients in order to enhance their health. The findings of this study will aid in filling gaps in current unknown knowledge and identifying sites where patients require additional assistance. Because cancer and chemotherapy clearly have a negative impact on individuals' QOL, oncologists must concentrate on strategies that help cancer patients during their sickness and treatment while also enhancing self-care and QOL. Those with cancer will benefit from emotional wellbeing and adaptation to their disease.
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Affiliation(s)
- Fiza Ayub
- Institute of Pharmaceutical Science, University of Veterinary and Animal Science UVAS, Lahore, Pakistan
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Science, University of Veterinary and Animal Science UVAS, Lahore, Pakistan
| | - Mirza Rafi Baig
- Department of Clinical Pharmacy and Pharmacotherapeutics, Dubai Pharmacy College for Girls, Dubai, United Arab Emirates
| | | | - Humera Tahir
- Ruth Pfau College of Nutrition Sciences, Lahore Medical and Dental College, Lahore, Pakistan
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Thompson T, Davis M, Pérez M, Jonson-Reid M, Jeffe DB. "We're in this together": Perceived effects of breast cancer on African American survivors' marital relationships. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2022; 13:789-815. [PMID: 36687398 PMCID: PMC9850417 DOI: 10.1086/713478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Objective We examined married African American breast cancer survivors' perceptions of how cancer affected their marriage, social support from their spouses, and spouses' physical and mental health. Method We conducted a thematic analysis of semi-structured interviews with 15 married African American breast cancer survivors who had participated in a larger randomized controlled trial. Interviews were professionally transcribed and then independently coded by two coders. Results Themes emerged related to the challenges of maintaining mutually supportive relationships. There was variability in the perceived effects of cancer on relationships, as well as uncertainty about cancer's effects on their husbands' emotional and physical health and the adequacy of emotional and tangible support from their husbands. Participants described husbands' key role in promoting wives' positive body image, as well as the challenges of negotiating sexual activity. Participants were receptive to help from medical professionals in dealing with relationship issues. Conclusions Findings show variability in couples' responses to cancer, with some patients and couples adapting well and others needing additional support. During treatment and at follow-up, oncology social workers can assess patients' and family members' social support needs, provide mental health services, and provide patient navigation to help patients and caregivers access health care and community resources.
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Affiliation(s)
- Tess Thompson
- Brown School of Social Work, Washington University in St. Louis
| | - Maxine Davis
- School of Social Work, The University of Texas at Arlington
| | - Maria Pérez
- School of Medicine, Washington University in St. Louis
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Abstract
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.
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Azad AD, Yilmaz M, Bozkurt S, Brooks JD, Blayney DW, Hernandez-Boussard T. Diverse patient trajectories during cytotoxic chemotherapy: Capturing longitudinal patient-reported outcomes. Cancer Med 2021; 10:5783-5793. [PMID: 34254459 PMCID: PMC8419778 DOI: 10.1002/cam4.4124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background High‐value cancer care balances effective treatment with preservation of quality of life. Chemotherapy is known to affect patients’ physical and psychological well‐being negatively. Patient‐reported outcomes (PROs) provide a means to monitor declines in a patients’ well‐being during treatment. Methods We identified 741 oncology patients undergoing chemotherapy in our electronic health record (EHR) system who completed Patient‐Reported Outcomes Measurement Information System (PROMIS) surveys during treatment at a comprehensive cancer center, 2013–2018. PROMIS surveys were collected before, during, and after chemotherapy treatment. Linear mixed‐effects models were performed to identify predictors of physical and mental health scores over time. A k‐mean cluster analysis was used to group patient PROMIS score trajectories. Results Mean global physical health (GPH) scores were 48.7 (SD 9.3), 47.7 (8.8), and 48.6 (8.9) and global mental health (GMH) scores were 50.4 (8.6), 49.5 (8.8), and 50.6 (9.1) before, during, and after chemotherapy, respectively. Asian race, Hispanic ethnicity, public insurance, anxiety/depression, stage III cancer, and palliative care were predictors of GPH and GMH decline. The treatment time period was also a predictor of both GPH and GMH decline relative to pre‐treatment. Trajectory clustering identified four distinct PRO clusters associated with chemotherapy treatment. Conclusions Patient‐reported outcomes are increasingly used to help monitor cancer treatment and are now a part of care reimbursement. This study leveraged routinely collected PROMIS surveys linked to EHRs to identify novel patient trajectories of physical and mental well‐being in oncology patients undergoing chemotherapy and potential predictors. Supportive care interventions in high‐risk populations identified by our study may optimize resource deployment. Novelty and impact This study leveraged routinely collected patient‐reported outcome (PROMIS) surveys linked to electronic health records to characterize oncology patients’ quality of life during chemotherapy. Important clinical and demographic predictors of declines in quality of life were identified and four novel trajectories to guide personalized interventions and support. This work highlights the utility of monitoring patient‐reported outcomes not only before and after, but during chemotherapy to help advert adverse patient outcomes and improve treatment adherence.
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Affiliation(s)
- Amee D Azad
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Melih Yilmaz
- Department of Medicine (Biomedical Informatics, Stanford University School of Medicine, Stanford, California, USA
| | - Selen Bozkurt
- Department of Medicine (Biomedical Informatics, Stanford University School of Medicine, Stanford, California, USA
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Douglas W Blayney
- Department of Medicine, Division of Medical Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Tina Hernandez-Boussard
- Department of Medicine (Biomedical Informatics, Stanford University School of Medicine, Stanford, California, USA.,Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA
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Ooi PS, Draman N, Muhamad R, Yusoff SSM, Noor NM, Haron J, Hadi ISA. Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia. Sex Med 2021; 9:100351. [PMID: 34030061 PMCID: PMC8240344 DOI: 10.1016/j.esxm.2021.100351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Female sexual dysfunction (FSD) is a common complication among breast cancer patients following treatment. AIM To assess the prevalence and factors associated with FSD among breast cancer patients in Kelantan. METHODS This cross-sectional study recruited female patients, aged 18-65, who were married and sexually active with their partner, diagnosed with breast cancer, and had undergone breast surgery. Those with underlying psychiatry disorders, previous pelvic surgery, and husbands with sexual problems were excluded. The questionnaire contained demographic and clinical information, together with the Malay Version of the Breast Impact of Treatment Scale and the Malay Version of Female Sexual Distress Scale-Revised. Their sexual function was evaluated using the Malay Version of the Female Sexual Function Index-6. The data were analyzed with simple and multiple linear regressions. MAIN OUTCOME MEASURES The prevalence and associated factors for FSD in breast cancer patients. RESULTS Ninety-four eligible patients were recruited for this study. In total, 73.4% (n = 69) of the patients reported having sexual dysfunction. A family history of breast cancer (P = 0.040), duration of marriage (P = 0.046), and frequency of sexual intercourse (P = 0.002) were significant factors associated with FSD in breast cancer patients after surgery. CONCLUSION The significant associated factors shown to influence the FSD score include family history of breast cancer, duration of marriage, and frequency of sexual intercourse. About 73.4% of patients have risk of developing FSD after receiving breast cancer treatment. Siang OP, Draman N, Muhamad R, et al. Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia. Sex Med 2021;9:100351.
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Affiliation(s)
- Poh Siang Ooi
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia Kubang Kerian, Kelantan, Malaysia
| | - Nani Draman
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia Kubang Kerian, Kelantan, Malaysia.
| | - Rosediani Muhamad
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia Kubang Kerian, Kelantan, Malaysia
| | - Siti Suhaila Mohd Yusoff
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia Kubang Kerian, Kelantan, Malaysia
| | - Norhayati Mohd Noor
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia Kubang Kerian, Kelantan, Malaysia
| | - Juhara Haron
- Breast Cancer Awareness and Research Unit, Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kelantan, Malaysia
| | - Imi Sairi Ab Hadi
- Department of Surgery, Hospital Raja Perempuan Zainab II, Jalan Hospital, Kota Bharu, Kelantan, Malaysia
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Hu X, Chehal PK, Kaplan C, Krukowski RA, Lan RH, Stepanski E, Schwartzberg L, Vidal G, Graetz I. Characterization of Clinical Symptoms by Race Among Women With Early-Stage, Hormone Receptor-Positive Breast Cancer Before Starting Chemotherapy. JAMA Netw Open 2021; 4:e2112076. [PMID: 34061200 PMCID: PMC8170541 DOI: 10.1001/jamanetworkopen.2021.12076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Race disparities persist in breast cancer mortality rates. One factor associated with these disparities may be differences in symptom burden, which may reduce chemotherapy tolerance and increase early treatment discontinuation. OBJECTIVES To compare symptom burden by race among women with early-stage breast cancer before starting chemotherapy and quantify symptom differences explained by baseline characteristics. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of symptom burden differences by race among Black and White women with a diagnosis of stage I to III, hormone receptor-positive breast cancer who had a symptom report collected before chemotherapy initiation in a large cancer center in the southern region of the US from January 1, 2007, through December 31, 2015. Analyses were conducted from November 1, 2019, to March 31, 2021. Blinder-Oaxaca decomposition was used, adjusting for baseline sociodemographic and clinical characteristics. MAIN OUTCOMES AND MEASURES Four symptom composite scores with a mean (SD) of 50 (10) were reported before starting chemotherapy (baseline) and were derived from symptom items: general physical symptoms (11 items), treatment adverse effects (8 items), acute distress (4 items), and despair (7 items). Patients rated the severity of each symptom they experienced in the past week on a scale of 0 to 10 (where 0 indicates not a problem and 10 indicates as bad as possible). RESULTS A total of 1338 women (mean [SD] age, 54.6 [11.6] years; 420 Black women [31.4%] and 918 White women [68.6%]) were included in the study. Before starting chemotherapy, Black women reported a statistically significantly higher (ie, worse) symptom composite score than White women for adverse effects (44.5 vs 43.8) but a lower acute distress score (48.5 vs 51.0). Decomposition analyses showed that Black patients' characteristics were associated with higher symptom burden across all 4 scores. However, these differences were offset by relatively greater, statistically significant, unexplained physical, distress, and despair symptom reporting by White patients. CONCLUSIONS AND RELEVANCE In this study, before starting chemotherapy, Black patients with early-stage breast cancer reported significantly higher burden for symptoms that may be exacerbated with chemotherapy and lower distress symptoms compared with White patients. Future studies should explore how symptoms change before and after treatment and differ by racial/ethnic groups and how they are associated with treatment adherence and mortality disparities.
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Affiliation(s)
- Xin Hu
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Puneet K. Chehal
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cameron Kaplan
- Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine of University of Southern California, Los Angeles
| | | | - Roy H. Lan
- College of Medicine, University of Tennessee Health Science Center, Memphis
| | | | - Lee Schwartzberg
- West Cancer Center and Research Institute, Germantown, Tennessee
| | - Gregory Vidal
- West Cancer Center and Research Institute, Germantown, Tennessee
- Division of Hematology and Oncology, University of Tennessee Health Science Center, Memphis
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Young M, Voll M, Noll RB, Fairclough DL, Flanagan-Priore C. Bright IDEAS problem-solving skills training for caregivers of children with sickle cell disease: A two-site pilot feasibility trial. Pediatr Blood Cancer 2021; 68:e28822. [PMID: 33355983 PMCID: PMC8665732 DOI: 10.1002/pbc.28822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bright IDEAS problem-solving skills training (BI) is an evidence-based behavioral intervention that has been utilized extensively with caregivers of children recently diagnosed with cancer. Considerable evidence has shown that BI is acceptable to caregivers of children recently diagnosed with cancer, and improvements in problem-solving skills mediate reduced symptoms of distress. PROCEDURES A slightly modified version of BI was offered to caregivers of children with sickle cell disease (SCD) in a two-site pilot feasibility trial. BI was modified to reduce barriers to care, logistical challenges, and stigma associated with receiving behavioral health services. Our goal was to establish high rates of recruitment and retention among caregivers of children with SCD. Recruitment was acceptable (94%; N = 72) and retention reasonable (49%) across both sites with 35 caregivers successfully completing the BI program. RESULTS Results showed that caregivers of children with SCD, who successfully completed the BI program reported, significant improvements in problem-solving skills immediately and three months after intervention completion. Interestingly, initial levels of distress were low with few caregivers reporting clinically significant levels of distress; distress remained low over time. CONCLUSIONS Findings are discussed in the context of psychosocial screening and resilience of caregivers of children with SCD.
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Affiliation(s)
- Melissa Young
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Megan Voll
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert B. Noll
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Diane L. Fairclough
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Cate Flanagan-Priore
- Joint Division of Hematology/Oncology, Oishei Childrens Hospital and Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Prevalence, risk factors, and trajectories of sleep disturbance in a cohort of African-American breast cancer survivors. Support Care Cancer 2020; 29:2761-2770. [PMID: 32995999 DOI: 10.1007/s00520-020-05786-2] [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] [Received: 05/07/2020] [Accepted: 09/16/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Sleep disturbance may be an overlooked modifiable risk factor for health disparities among African-American breast cancer survivors (AABCS). This study aimed to identify the prevalence of and risk factors for sleep disturbance in a cohort of AABCS. METHODS The study was conducted among participants in the Women's Circle of Health Follow-up Study, a longitudinal study of breast cancer in 10 counties in New Jersey. Cases were identified shortly after diagnosis by the New Jersey State Cancer Registry. Self-reported sleep disturbance (Pittsburgh Sleep Quality Index) and other factors (e.g., socioeconomic status, menopausal status) were assessed at pre-diagnosis (n = 637), 10 months post-diagnosis (n = 261), and 24 months post-diagnosis (n = 632). Clinical data were obtained via medical record abstraction, and height and weight were measured by study staff. RESULTS Most AABCS (57%) reported clinically significant sleep disturbance before diagnosis, and this rate remained largely unchanged at 10 months (53%) and 24 months post-diagnosis (61%). Average sleep disturbance scores indicated clinically significant disturbance at all three assessments (M range = 6.67-7.57). Most reported sleeping fewer than the recommended 7 hours per night at each assessment (range 57-65%). Risk factors for sleep disturbance were identified at each assessment, including pre-diagnosis (less education), 10 months post-diagnosis (lack of insurance, treatment with chemotherapy), and 24 months post-diagnosis (younger age, less education, lower income, obesity, and lymphedema). Treatment with endocrine therapy was a protective factor at 10 months post-diagnosis. CONCLUSION Most AABCS report clinically significant sleep disturbance from before diagnosis through 24 months post-diagnosis. These rates appear indicate AABCS experience significant sleep-related disparities.
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Bazargan M, Smith JL, Robinson P, Uyanne J, Abdulrahoof R, Chuku C, Assari S. Chronic Respiratory Disease and Health-Related Quality of Life of African American Older Adults in an Economically Disadvantaged Area of Los Angeles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1756. [PMID: 31108963 PMCID: PMC6571607 DOI: 10.3390/ijerph16101756] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/06/2019] [Accepted: 05/16/2019] [Indexed: 12/14/2022]
Abstract
Background. Most of the attention of policy makers, program planners, clinicians, and researchers in the area of physical health disparities among African American older adults has been traditionally focused on cardiometabolic disease and cancer. Among a long list of chronic medical conditions, chronic respiratory conditions (CRCs), such as asthma, chronic bronchitis, and emphysema, have received less attention. Purpose. This study investigated whether CRCs contribute to physical and mental health-related quality of life (HRQoL) of African American older adults who live in economically disadvantaged urban areas, and whether these effects are due to demographic factors, socioeconomic status (SES), health behaviors, and comorbid medical and mental conditions. Methods. This community-based study recruited 617 African American older adults (age ≥ 65 years) from Service Planning Areas (SPA) 6, an economically disadvantaged area in South Los Angeles. Structured face-to-face interviews were used to collect data on demographic factors (age and gender), SES (educational attainment and financial difficulty), living arrangements, marital status, health behaviors (cigarette smoking and alcohol drinking), health (CRC, number of comorbid medical conditions, depressive symptoms, and pain intensity), and physical and mental HRQoL (Physical and Mental Component Summary Scores; PCS and MCS; SF-12). Linear regressions were used to analyze the data. Results. The presence of CRCs was associated with lower PCS and MCS in bivariate analysis. The association between CRCs and PCS remained significant above and beyond all confounders. However, the association between CRCs and MCS disappeared after controlling for confounders. Conclusion. For African American older adults living in economically disadvantaged urban areas, CRCs contribute to poor physical HRQoL. Evaluation and treatment of CRCs in African American older adults may be a strategy for reduction of disparities in HRQoL in this population. As smoking is the major modifiable risk factor for CRCs, there is a need to increase accessibility of smoking cessation programs in economically disadvantaged urban areas. More research is needed on the types, management, and prognosis of CRCs such as asthma, chronic bronchitis, and emphysema in African American older adults who reside in low-income and resource limited urban areas.
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Affiliation(s)
- Mohsen Bazargan
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
- Departments of Public Health, College of Health and Science, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
- Departments of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - James L Smith
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
| | - Paul Robinson
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
- Departments of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - John Uyanne
- Division of Internal Medicine & Geriatrics, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
| | - Ruqayyah Abdulrahoof
- Departments of Public Health, College of Health and Science, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
| | - Chika Chuku
- Departments of Public Health, College of Health and Science, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
| | - Shervin Assari
- Departments of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
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12
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Carreira H, Williams R, Müller M, Harewood R, Stanway S, Bhaskaran K. Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review. J Natl Cancer Inst 2018; 110:1311-1327. [PMID: 30403799 PMCID: PMC6292797 DOI: 10.1093/jnci/djy177] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/08/2018] [Accepted: 08/31/2018] [Indexed: 01/02/2023] Open
Abstract
Background We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (≥1 year) compared with women with no history of cancer. Methods Studies were identified by searching MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index, and through backward citation tracking. Two researchers selected the studies, extracted data, and assessed the risk of bias. Results Sixty studies were included. Of 38 studies of depression, 33 observed more depression in breast cancer survivors; this was statistically significant in 19 studies overall, including six of seven where depression was ascertained clinically, three of four studies of antidepressants, and 13 of 31 that quantified depressive symptoms. Of 21 studies of anxiety, 17 observed more anxiety in breast cancer survivors, statistically significant in 11 studies overall, including two of four with clinical/prescription-based outcomes, and in eight of 17 of anxiety symptoms. Breast cancer survivors also had statistically significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies), sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatisation (2 of 2 studies), and bipolar and obsessive-compulsive disorders (1 of 1 study each). Studies were heterogeneous in terms of participants' characteristics, time since diagnosis, ascertainment of outcomes, and measures reported. Approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status. Conclusions There is compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. This information can be used to support evidence-based prevention and management strategies. Further population-based and longitudinal research would help to better characterize these associations.
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Affiliation(s)
- Helena Carreira
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachael Williams
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Rhea Harewood
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Susannah Stanway
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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13
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Sheppard VB, Walker R, Phillips W, Hudson V, Xu H, Cabling ML, He J, Sutton AL, Hamilton J. Spirituality in African-American Breast Cancer Patients: Implications for Clinical and Psychosocial Care. JOURNAL OF RELIGION AND HEALTH 2018; 57:1918-1930. [PMID: 29627925 DOI: 10.1007/s10943-018-0611-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Spirituality has been shown to be important to many individuals dealing with a cancer diagnosis. While African-American breast cancer survivors have been reported to have higher levels of spirituality compared to White women, little is known about how levels of spirituality may vary among African-American breast cancer survivors. The aims of this study were to examine factors associated with spirituality among African-American survivors and test whether spirituality levels were associated with women's attitudes about treatment or health care. The primary outcome, spirituality, was nine-item scale (Cronbach's α = .99). Participants completed standardized telephone interviews that captured sociocultural, healthcare process, and treatment attitudes. Medical records were abstracted post-adjuvant therapy for treatment and clinical information. In bivariate analysis, age was not correlated with spirituality (p = .40). Married/living as married women had higher levels of spirituality (m = 32.1) than single women (m = 30.1). Contextual factors that were associated with higher levels spirituality were: collectivism (r = .44; p < 0.0001, Afrocentric worldview (r = .185; p = .01), and self-efficacy scale (r = .17; p = .02). In multivariable analysis, sociodemographic factors were not significant. Collectivism remained a robust predictor (p < 0.0001). Attitudes about the efficacy of cancer treatment were not associated with spirituality. The high levels of spirituality in African-American survivors suggest consideration of integrating spiritual care within the delivery of cancer treatment. Future studies should consider how spirituality may contribute to positive coping and/or behaviors in African-American women with high levels of spirituality.
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Affiliation(s)
- Vanessa B Sheppard
- Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA.
| | | | | | | | - Hanfei Xu
- Georgetown University Medical Center, Washington, DC, USA
| | | | - Jun He
- Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
| | - Arnethea L Sutton
- Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, 830 E Main St, PO Box 980149, Richmond, VA, 23298, USA
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14
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Robertson-Jones TA, Tissue MM, Connolly M, Gallups SF, Bender CM, Rosenzweig MQ. Exploring Racial Differences in Patient Centeredness of Care (PCC) During Breast Cancer (BC) Chemotherapy Clinical Visits. J Racial Ethn Health Disparities 2018; 6:94-100. [PMID: 29971577 DOI: 10.1007/s40615-018-0503-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The communication patterns between clinician and patient, described as the patient centeredness of care (PCC), may be a critically important etiology of breast cancer (BC) racial disparity. The purpose of this prospective, comparative pilot study was to qualitatively explore and code for PCC during the clinical visit of women undergoing BC chemotherapy and compare by race. METHODS Age-matched Black and White women were recruited. Audio recordings of clinical visits conducted prior to any cycle (except first) chemotherapy infusion were obtained and transcribed. Transcripts were blindly reviewed by three independent coders assigning PCC scores, ranging from 1 to 5, with lower scores indicating better PCC. Consensus was reached among reviewers via discussion. RESULTS Dyads consisted of five Black (mean age 47) and five White (mean age 45) women undergoing BC chemotherapy. Twenty-four recordings were analyzed, 13 White and 11 Black. For all 22 PCC items, the mean scores were worse for Black women with significant differences (compared by chi-square analysis) noted for 6/22 items (27%). CONCLUSIONS Qualitatively exploring clinician and patient communication patterns during the chemotherapy clinical visits informs the understanding of racial differences for symptom assessment, reporting, and management. These pilot findings inform future research exploring racial disparity in cancer treatment dose intensity.
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Affiliation(s)
- Tinnikkar Angel Robertson-Jones
- Hampton University School of Nursing, E. Tyler St. & Emancipation Drive, William Freeman Hall, Room 110, Hampton, VA, 23668, USA
| | - Madison M Tissue
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Mary Connolly
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Sarah Frazier Gallups
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Catherine M Bender
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Margaret Quinn Rosenzweig
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA. .,Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15216, USA.
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15
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Morishita S, Tsubaki A, Fu JB, Mitobe Y, Onishi H, Tsuji T. Cancer survivors exhibit a different relationship between muscle strength and health-related quality of life/fatigue compared to healthy subjects. Eur J Cancer Care (Engl) 2018; 27:e12856. [PMID: 29767832 DOI: 10.1111/ecc.12856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 01/22/2023]
Abstract
We investigated the difference in relationship between muscle strength and quality of life (QOL)/fatigue in long-term cancer survivors and healthy subjects. Thirty-six cancer survivors and 29 healthy subjects were assessed for body composition and bone status at the calcaneus using the Osteo Sono Assessment Index. Muscle strength was evaluated via handgrip and knee extensor strength. Health-related QOL was assessed using the Medical Outcome Study 36-item Short-Form Health Survey. Fatigue was measured using the brief fatigue inventory. Cancer survivors exhibited lower QOL scores in the physical functioning, physical role function, bodily pain and general health domains (p < .05). Grip and knee extension muscle strength in cancer survivors was positively correlated with the physical function and bodily pain of QOL (p < .05). The usual fatigue subscale score was only significantly higher in cancer survivors than in healthy subjects (p < .05). However, there were no correlations between muscle strength and fatigue in cancer survivors. Our results showed that muscle strength was an important factor for improving QOL in cancer survivors. We believe that the findings of this study will be relevant in the context of planning rehabilitation for cancer survivors.
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Affiliation(s)
- S Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - A Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - J B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Y Mitobe
- Department of Nursing, Niigata University of Health and Welfare, Niigata, Japan
| | - H Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - T Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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16
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Claridy MD, Ansa B, Damus F, Alema-Mensah E, Smith SA. Health-related quality of life of African-American female breast cancer survivors, survivors of other cancers, and those without cancer. Qual Life Res 2018; 27:2067-2075. [PMID: 29704078 DOI: 10.1007/s11136-018-1862-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to compare differences in health-related quality of life (HRQOL) between African-American female breast cancer survivors, African-American female survivors of other cancers, and African-American women with no history of cancer. METHODS Using data from the 2010 National Health Interview Survey (NHIS), the HRQOL of African-American women aged 35 years or older was compared by cancer status. Physical and mental health items from the Patient-Reported Outcomes Measurement Information System (PROMIS) global health scale were used to assess differences in HRQOL. RESULTS For summary physical and mental health measures, no significant differences were found between breast cancer survivors and women with no history of cancer; survivors of other cancers reported poorer physical and mental health than did women with no history of cancer. Similar differences were found at the item level. When we examined the two African-American female cancer survivor groups, we found that cancer survivors whose cancer was being treated reported substantially poorer physical health and mental health than did those whose cancer was not being treated. Survivors who had private insurance and were cancer free reported better physical and mental health than did those who did not have private insurance and those who were not cancer free. Breast cancer survivors reported slightly better physical and mental health than did survivors of other cancers. CONCLUSIONS Our findings highlight the need for public health agencies to adopt practices to improve the mental and physical health of African-American female survivors of cancer.
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Affiliation(s)
- Mechelle D Claridy
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310-1495, USA.
| | - Benjamin Ansa
- Department of Family Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA, USA
| | - Francesca Damus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310-1495, USA
| | - Ernest Alema-Mensah
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310-1495, USA
| | - Selina A Smith
- Department of Family Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA, USA
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17
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van Driel CM, Stuursma A, Schroevers MJ, Mourits MJ, de Bock GH. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis. BJOG 2018. [PMID: 29542222 PMCID: PMC6585818 DOI: 10.1111/1471-0528.15153] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background During menopause women experience vasomotor and psychosexual symptoms that cannot entirely be alleviated with hormone replacement therapy (HRT). Besides, HRT is contraindicated after breast cancer. Objectives To review the evidence on the effectiveness of psychological interventions in reducing symptoms associated with menopause in natural or treatment‐induced menopausal women. Search strategy Medline/Pubmed, PsycINFO, EMBASE and AMED were searched until June 2017. Selection criteria Randomised controlled trials (RCTs) concerning natural or treatment‐induced menopause, investigating mindfulness or (cognitive‐)behaviour‐based therapy were selected. Main outcomes were frequency of hot flushes, hot flush bother experienced, other menopausal symptoms and sexual functioning. Data collection and analysis Study selection and data extraction were performed by two independent researchers. A meta‐analysis was performed to calculate the standardised mean difference (SMD). Main results Twelve RCTs were included. Short‐term (<20 weeks) effects of psychological interventions in comparison to no treatment or control were observed for hot flush bother (SMD −0.54, 95% CI −0.74 to −0.35, P < 0.001, I2 = 18%) and menopausal symptoms (SMD −0.34, 95% CI −0.52 to −0.15, P < 0.001, I2 = 0%). Medium‐term (≥20 weeks) effects were observed for hot flush bother (SMD −0.38, 95% CI −0.58 to −0.18, P < 0.001, I2 = 16%). [Correction added on 9 July 2018, after first online publication: there were miscalculations of the mean end point scores for hot flush bother and these have been corrected in the preceding two sentences.] In the subgroup treatment‐induced menopause, consisting of exclusively breast cancer populations, as well as in the subgroup natural menopause, hot flush bother was reduced by psychological interventions. Too few studies reported on sexual functioning to perform a meta‐analysis. Conclusions Psychological interventions reduced hot flush bother in the short and medium‐term and menopausal symptoms in the short‐term. These results are especially relevant for breast cancer survivors in whom HRT is contraindicated. There was a lack of studies reporting on the influence on sexual functioning. Tweetable abstract Systematic review: psychological interventions reduce bother by hot flushes in the short‐ and medium‐term. Systematic review: psychological interventions reduce bother by hot flushes in the short‐ and medium‐term.
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Affiliation(s)
- C M van Driel
- Department of Obstetrics & Gynaecology, University Medical Centre Groningen, Groningen, the Netherlands.,Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - A Stuursma
- Department of Obstetrics & Gynaecology, University Medical Centre Groningen, Groningen, the Netherlands.,Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - M J Schroevers
- Department of Health Psychology, University Medical Centre Groningen, Groningen, the Netherlands
| | - M J Mourits
- Department of Obstetrics & Gynaecology, University Medical Centre Groningen, Groningen, the Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
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18
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Symptom Severity and Quality of Life Among Long-term Colorectal Cancer Survivors Compared With Matched Control Subjects: A Population-Based Study. Dis Colon Rectum 2018; 61:355-363. [PMID: 29377871 PMCID: PMC5805591 DOI: 10.1097/dcr.0000000000000972] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data are lacking regarding physical functioning, psychological well-being, and quality of life among colorectal cancer survivors >10 years postdiagnosis. OBJECTIVE The purpose of this study was to examine self-reported physical functioning, quality of life, and psychological well-being in long-term colorectal cancer survivors compared with age- and sex-matched unaffected control subjects. DESIGN Participants completed a cross-sectional survey. SETTINGS The colorectal cancer survivors and unaffected control subjects were recruited from the Ontario Familial Colorectal Cancer Registry. PATIENTS A population-based sample of colorectal cancer survivors (N = 296) and their age- and sex-matched unaffected control subjects (N = 255) were included. Survivors were, on average, 15 years postdiagnosis. MAIN OUTCOME MEASURES Quality of life was measured with the Functional Assessment of Cancer Therapy-General scale, bowel dysfunction with the Memorial Sloan-Kettering Cancer Center scale, urinary dysfunction with the International Consultation on Incontinence Questionnaire-Short Form, fatigue with the Functional Assessment of Chronic Illness Therapy-Fatigue scale, and depression with the Center for Epidemiologic Studies-Depression scale. RESULTS In linear mixed-model analyses adjusting for income, education, race, and comorbid medical conditions, survivors reported good emotional, functional, physical, and overall quality of life, comparable to control subjects. Fatigue and urinary functioning did not differ significantly between survivors and control subjects. Survivors reported significantly higher social quality of life and lower depression compared with unaffected control subjects. The only area where survivors reported significantly worse deficits was in bowel dysfunction, but the magnitude of differences was relatively small. LIMITATIONS Generalizability is limited by moderately low participation rates. Findings are likely biased toward healthy participants. No baseline assessment was available to examine change in outcomes over time. CONCLUSIONS Long-term colorectal cancer survivors appear to have comparable quality of life and, in some areas, better well-being than their unaffected peers. Bowel dysfunction may continue to be an ongoing issue even 15 years after colorectal cancer diagnosis. Overall quality of life can be expected to be good in this group of older survivors. See Video Abstract at http://links.lww.com/DCR/A476.
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19
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Taylor TR, Barrow J, Makambi K, Sheppard V, Wallington SF, Martin C, Greene D, Yeruva SLH, Horton S. A Restorative Yoga Intervention for African-American Breast Cancer Survivors: a Pilot Study. J Racial Ethn Health Disparities 2018; 5:62-72. [PMID: 28411330 DOI: 10.1007/s40615-017-0342-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/09/2017] [Accepted: 01/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data show that yoga is effective for improving health-related outcomes in breast cancer survivors. While breast cancer is the most commonly diagnosed cancer among African-American women (AAW), AAW are less likely to engage in yoga compared to other ethnic groups. The goals of the current study were to assess the feasibility of an 8-week restorative yoga program among African-American breast cancer survivors (AA BCS). Specifically, study aims were to (1) measure changes in study outcomes in a restorative yoga (RY) group compared to a wait list control group, (2) assess adherence to the RY program, and (3) assess program satisfaction among study participants. METHODS Thirty-three AA BCS were randomly assigned to either the RY intervention (n = 18) or wait list control group (n = 15). RY classes met once per week for 8 weeks. Pre- and post-testing assessments were measured at 0 and 8 weeks (immediately post-intervention). RESULTS Depression scores at follow-up were significantly lower in the yoga group (M = 4.78, SD = 3.56) compared to the control group (M = 6.91, SD = 5.86). No significant group differences were observed for sleep quality, fatigue, or perceived stress. Yoga program participants completing baseline assessments demonstrated 61% adherence to the yoga classes. Average rating of the yoga program was "very useful." Recommendations for future yoga programs were provided. CONCLUSIONS This study suggests that yoga has a beneficial effect on depression in AA BCS. There is, however, a need to further explore the benefits of yoga among minority breast cancer survivors using a study with larger sample sizes.
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Affiliation(s)
| | - Judith Barrow
- Community Outreach Associates, P.O. Box 9379, Washington, DC, 20005, USA
| | - Kepher Makambi
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC, USA
| | - Vanessa Sheppard
- Georgetown-Lombardi Comprehensive Cancer Center, Research Building, E501, 3970 Reservoir Road, NW, Washington, DC, 20057, USA
| | - Sherrie Flynt Wallington
- Georgetown-Lombardi Comprehensive Cancer Center, Research Building, E501, 3970 Reservoir Road, NW, Washington, DC, 20057, USA
| | - Chloe Martin
- Department of Psychology, Howard University, Washington, DC, USA
| | - Danyella Greene
- Department of Psychology, Howard University, Washington, DC, USA
| | | | - Sara Horton
- College of Medicine, Howard University, Washington, DC, USA
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20
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Thompson T, Pérez M, Kreuter M, Margenthaler J, Colditz G, Jeffe DB. Perceived social support in African American breast cancer patients: Predictors and effects. Soc Sci Med 2017; 192:134-142. [PMID: 28965004 DOI: 10.1016/j.socscimed.2017.09.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/04/2017] [Accepted: 09/20/2017] [Indexed: 01/13/2023]
Abstract
RATIONALE Social support plays an important role in quality of life and health outcomes after breast cancer diagnosis and treatment. OBJECTIVE To examine changes in perceived social support in African American women during the two years following a new breast cancer diagnosis. METHODS This secondary analysis uses data collected from 2009 to 2015 from 227 newly diagnosed, African American women with breast cancer (mean age 56 [SD = 10], 59% household income < $25,000; 28% married/partnered, 72% early stage) participating in a randomized controlled trial testing the effects of a video-communication intervention on quality-of-life and follow-up care. Participants, all of whom received treatment in one metropolitan area of the Midwestern United States, completed five telephone interviews over 2-year follow-up; demographic, psychosocial, quality of life, and clinical data were collected. Growth curve models were used to examine change in perceived social support (measured by the Medical Outcomes Study Social Support Survey) as well as correlates of baseline levels of social support and predictors of change in individuals' social support. Additional analyses examined whether change in social support over the first year affected depressive symptoms (Center for Epidemiologic Studies Depression Scale) and general health perceptions (RAND SF-36 subscale) at two years. RESULTS Being married, reporting greater spirituality, and reporting fewer depressive symptoms at baseline were significantly associated with higher initial levels of perceived social support. Women whose social support declined during the first year after diagnosis reported more severe depressive symptoms and worse general health perceptions at two years. CONCLUSION Clinicians should periodically assess perceived social support among African American women with breast cancer to help find support resources for those who have low initial social support and for those whose support declines in the first year after diagnosis.
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Affiliation(s)
- Tess Thompson
- Health Communication Research Laboratory, Brown School of Social Work, Washington University in St. Louis, United States.
| | - Maria Pérez
- Washington University School of Medicine, Washington University in St. Louis, United States
| | - Matthew Kreuter
- Health Communication Research Laboratory, Brown School of Social Work, Washington University in St. Louis, United States
| | - Julie Margenthaler
- Washington University School of Medicine, Washington University in St. Louis, United States
| | - Graham Colditz
- Washington University School of Medicine, Washington University in St. Louis, United States
| | - Donna B Jeffe
- Washington University School of Medicine, Washington University in St. Louis, United States
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21
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Fairchild AJ, Heiney SP, Baruth M, Tavakoli A, Parker Hayne PD, McDaniel HL. Mediators of Social Connection in a Group Teleconference Intervention. Res Theory Nurs Pract 2017; 31:121-136. [PMID: 28482993 DOI: 10.1891/1541-6577.31.2.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Social connection has a positive influence on cancer survivorship and has been targeted in intervention work. We examined whether the formation of social connection is influenced by fear, fatalism, and isolation. METHODS We conducted a mediation analysis on data from an intervention study with African American breast cancer survivors to investigate whether fear, fatalism, and isolation conveyed effects on social connection. RESULTS Although results indicated that there were no significant mediated effects of the intervention through these variables, we garnered information about action and conceptual theories underlying the program that inform future work. IMPLICATIONS FOR PRACTICE Our insights can be considered in future interventions conducted for African American women with breast cancer during and following treatment.
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Pinheiro LC, Wheeler SB, Reeder-Hayes KE, Samuel CA, Olshan AF, Reeve BB. Investigating Associations Between Health-Related Quality of Life and Endocrine Therapy Underuse in Women With Early-Stage Breast Cancer. J Oncol Pract 2017; 13:e463-e473. [PMID: 28291383 DOI: 10.1200/jop.2016.018630] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Endocrine therapy (ET) underuse puts women at increased risk for breast cancer (BC) recurrence. Our objective was to determine if health-related quality of life (HRQOL) subgroups were associated with underuse. METHODS Data came from the third phase of the Carolina Breast Cancer Study. We included 1,599 women with hormone receptor-positive BC age 20 to 74 years. HRQOL was measured, on average, 5 months postdiagnosis. Subgroups were derived using latent profile (LP) analysis. Underuse was defined as not initiating or adhering to ET by 36 months postdiagnosis. Multivariable logistic regression models estimated adjusted odds ratios (ORs) between HRQOL LPs and underuse. The best HRQOL LP was the reference. Chemotherapy- and race-stratified models were estimated, separately. RESULTS Initiation analyses included 953 women who had not begun ET by their 5-month survey. Of these, 154 never initiated ET. Adherence analyses included 1,114 ET initiators, of whom 211 were nonadherent. HRQOL was not significantly associated with noninitiation, except among nonchemotherapy users, with membership in the poorest LP associated with increased odds of noninitiation (adjusted OR, 5.5; 95% CI, 1.7 to 17.4). Membership in the poorest LPs was associated with nonadherence (LP1: adjusted OR, 2.2; 95% CI, 1.2 to 4.0 and LP2: adjusted OR,1.9; 95% CI, 1.1 to 3.6). Membership in the poorest LP was associated with nonadherence among nonchemotherapy users (adjusted OR, 2.1; 95% CI, 1.2 to 5.1). CONCLUSION Our results suggest women with poor HRQOL during active treatment may be at increased risk for ET underuse. Focusing on HRQOL, a modifiable factor, may improve targeting of future interventions early in the BC continuum to improve ET initiation and adherence and prevent BC recurrence.
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Affiliation(s)
- Laura C Pinheiro
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cleo A Samuel
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew F Olshan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bryce B Reeve
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Yee MK, Sereika SM, Bender CM, Brufsky AM, Connolly MC, Rosenzweig MQ. Symptom incidence, distress, cancer-related distress, and adherence to chemotherapy among African American women with breast cancer. Cancer 2017; 123:2061-2069. [PMID: 28199006 DOI: 10.1002/cncr.30575] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is a persistent racial survival disparity between African American (AA) and white women with breast cancer. There is evidence that symptom incidence, associated distress, and overall cancer-related distress may be unexplored, important contributing factors. The purpose of the current study was to: 1) describe and compare the number of chemotherapy-related symptoms and associated distress among AA women with breast cancer over the course of chemotherapy at 3 time points (at baseline before initiating chemotherapy, midpoint, and at the completion of chemotherapy); and 2) to describe the relationship between the number of chemotherapy-related symptoms and overall cancer distress compared with the ability to receive at least 85% of the prescribed chemotherapy within the prescribed timeframe. METHODS Descriptive, comparative, and correlational analyses of symptom incidence, symptom distress, cancer-related distress, and prescribed chemotherapy dose received among a cohort of AA women receiving chemotherapy for breast cancer were performed. RESULTS AA women (121 women) experienced worsening symptoms from baseline to midpoint in chemotherapy and then stabilized for the duration of therapy. The inability to receive 85% of the prescribed chemotherapy within a prescribed time point was found to be significantly correlated with midpoint symptom distress. CONCLUSIONS The main findings of the current study were that AA women experience a deterioration in symptom distress over the course of chemotherapy from baseline (before chemotherapy) to the midpoint, which was found to be associated with less adherence to chemotherapy overall. Thus, the incidence and management of physical and emotional symptoms, as measured through a multidimensional symptom measurement tool, may be contributing to breast cancer dose disparity and should be explored further. Cancer 2017;123:2061-2069. © 2017 American Cancer Society.
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Affiliation(s)
- Melissa K Yee
- Department of Medical Oncology at Dana-Farber/Brigham and Women's Cancer Center in clinical affiliation with South Shore Hospital, Harvard University, Cambridge, Massachusetts
| | - Susan M Sereika
- Department of Epidemiology, School of Nursing and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Adam M Brufsky
- Department of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary C Connolly
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Margaret Q Rosenzweig
- Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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Quality of life of older African American breast cancer survivors: a population-based study. Support Care Cancer 2016; 25:1431-1438. [PMID: 27987093 DOI: 10.1007/s00520-016-3539-x] [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: 04/19/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Factors associated with lower health-related quality of life (HRQOL) among older African American (AA) breast cancer survivors (BCS) have not been elucidated. METHODS Using the Surveillance, Epidemiology, and End Results-Medicare Health Outcome Survey linked dataset, all resected AA BCS over 65 were identified. Using the most recent survey after diagnosis, individuals with a VR12 physical (PCS) or mental (MCS) component score 10 points lower than the median were categorized as having poor HRQOL. Univariate and multivariate (MV) analyses identified predictors of poor HRQOL. RESULTS Of 373 AA BCS (median age 74.6), median time from diagnosis to survey was 68.4 months with median follow-up of 138.6 months. Median PCS was 35.9 (IQR 28.5-44.5) with 76 (20.1%) reporting poor PCS. Median MCS was 50.6 (IQR 41.3-59.1) with 101 (27.1%) reporting poor MCS. Predictors of poor PCS included advanced age, larger tumor size, ≥2 comorbidities, inability to perform >2 of 6 activities of daily living (ADLs), modified/radical mastectomy, infiltrating lobular carcinoma, and stage III or IV disease (all p < 0.05). Comorbidities ≥2 and inability to perform >2 of 6 ADLs (p < 0.05) predicted poor MCS. Inability to perform >2 of 6 ADLs was the only independent predictor of poor PCS (OR 10.9, 95% CI 3.0-39.3; p < 0.001) and MCS (OR 7.6, 95% CI 4.3-13.3; p < 0.001). CONCLUSION In elderly AA BCS, poor HRQOL was not associated with socioeconomic status or tumor-specific factors but rather impairment in ADLs. Physical and mental HRQOL in African American breast cancer survivors is not dependent on socioeconomic or tumor-related characteristics, but rather on inability to perform ADLs.
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Pathways between physical activity and quality of life in African-American breast cancer survivors. Support Care Cancer 2016; 25:489-495. [DOI: 10.1007/s00520-016-3427-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
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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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Understanding racial differences in health-related quality of life in a population-based cohort of breast cancer survivors. Breast Cancer Res Treat 2016; 159:535-43. [PMID: 27585477 DOI: 10.1007/s10549-016-3965-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Although racial disparities in health-related quality of life (HRQOL) among women with breast cancer (BC) are well documented, less is known about HRQOL changes over time among women of different races. Our objective was to assess racial differences in HRQOL during active treatment and survivorship phases of BC care. METHODS We used data from the third phase of the Carolina Breast Cancer Study (CBCS-III). CBCS-III enrolled 3000 women in North Carolina aged 20-74 years diagnosed with BC between 2008 and 2013. HRQOL assessments occurred 5 and 25 months post diagnosis, representing distinct phases of care. HRQOL measures included the Functional Assessment of Cancer Therapy for BC and Functional Assessment of Chronic Illness Therapy for Spiritual Well-Being. Analysis of covariance models were employed to assess racial differences in changes in HRQOL. RESULTS The cohort included 2142 Non-Hispanic White (n = 1105) and Black women (n = 1037) who completed both HRQOL assessments. During active treatment, Whites reported physical and functional scores 2-2.5 points higher than Blacks (p < 0.0001). Spiritual HRQOL was 2.1 points higher for Blacks (p < 0.0001). During survivorship, differences persisted. After adjusting for demographic, socioeconomic, tumor, and treatment characteristics, physical and functional HRQOL gaps narrowed, but spiritual HRQOL gaps widened. CONCLUSIONS Racial differences in physical and functional HRQOL during active treatment and survivorship may be largely mediated by socioeconomic factors. However, our results suggest that among Black women, spiritual HRQOL is well supported throughout the BC care continuum. These results inform opportunities for improving the quality and equity of supportive services for women with BC.
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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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Abstract
BACKGROUND Cancer has a great impact on the well-being of affected persons and their caregivers long into survivorship. OBJECTIVE This article reviews the state of science on the survivorship experience of cancer survivors and caregivers, with a focus on symptom burden and quality of life (QOL) after treatment termination. METHODS The primary databases utilized included PubMed and CINAHL. Search results were limited to human participants, English language, and publications from 2008 to 2013. The articles retrieved included studies of prostate, breast, colorectal, and gynecologic cancers during adulthood. RESULTS As many as a third of cancer survivors experienced symptoms after treatment cessation equivalent to those experienced during treatment. Fatigue, depression or mood disturbance, sleep disruption, pain, and cognitive limitation were commonly reported by survivors across various malignancies; depression, anxiety, and sleep disturbance affected some caregivers. The studies indicated residual symptoms that extend into survivorship have a great impact on QOL and are associated with disability and healthcare utilization. Younger age, lower socioeconomic status, and increased comorbidities are associated with poorer QOL and higher symptom distress in cancer survivors. Younger age and lower income are associated with greater distress and poorer QOL in caregivers. CONCLUSIONS Survivors and caregivers struggle with symptom burden and diminished QOL long into survivorship. Longitudinal studies are needed to investigate the persistence and severity of symptom burden over time as well as long-term and late effects of these symptoms. IMPLICATIONS FOR PRACTICE Interventions designed to help alleviate symptom burden in those most affected are needed.
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Chang HY, Jotwani AC, Lai YH, Jensen MP, Syrjala KL, Fann JR, Gralow J. Hot flashes in breast cancer survivors: Frequency, severity and impact. Breast 2016; 27:116-21. [PMID: 27065357 DOI: 10.1016/j.breast.2016.02.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 01/06/2016] [Accepted: 02/27/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSES To (1) determine the frequency and severity of hot flashes, (2) examine the associations between hot flash frequency and severity and quality of life, and (3) identify the predictors of hot flash activity in breast cancer survivors. METHODS The study used a cross-sectional design and mailed survey of 253 breast cancer survivors recruited from a cancer wellness clinic. Participants provided information regarding cancer history, hot flashes, pain intensity, sleep problems, physical functioning, and psychological functioning. RESULTS About half of the survivors reported at least one hot flash in the past 24 h (45%) or past week (52%). The average frequency of hot flashes was 1.9 in the past 24 h and 1.8 in the past week. Hot flash severity was usually mild or asymptomatic. However, participants with hot flashes reported significantly more sleep problems and higher pain severity than those reporting no hot flashes. Moreover, the severity of hot flashes was associated with more sleep problems, higher pain severity, and more psychological dysfunction. History of hormonal suppression therapy and younger age predicted hot flash activity in the study sample. CONCLUSIONS In breast cancer survivors, hot flashes are common and are associated with unpleasant symptoms and poor quality of life. Research is needed to determine if treatments that reduce the frequency and severity of hot flashes in breast cancer survivors also result in improvements in symptoms such as sleep problems, pain, and psychological dysfunction.
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Affiliation(s)
- Hao-Yuan Chang
- School of Nursing, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd., Sec. 1, Taipei, 10051, Taiwan; Department of Nursing, National Taiwan University Hospital, No. 7, Zhong-Shan S. Rd., Taipei, 10002, Taiwan
| | - Aparna C Jotwani
- Rice University, 6100 Main St, MS-760, Houston, TX 77005-1827, United States
| | - Yeur-Hur Lai
- School of Nursing, College of Medicine, National Taiwan University, No. 1, Jen-Ai Rd., Sec. 1, Taipei, 10051, Taiwan; Department of Nursing, National Taiwan University Hospital, No. 7, Zhong-Shan S. Rd., Taipei, 10002, Taiwan
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Box 356490, 325 Ninth Avenue, Seattle, WA, 98104, United States.
| | - Karen L Syrjala
- Biobehavioral Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-220, Seattle, WA, 98109, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, United States
| | - Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, United States
| | - Julie Gralow
- Division of Medical Oncology, University of Washington School of Medicine, 825 Eastlake Ave E., Seattle, WA, 98109-1023, United States; Breast Medical Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave East, G3-630, Seattle, WA, 98109, United States
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Trogdon JG, Ekwueme DU, Chamiec-Case L, Guy GP. Breast Cancer in Young Women: Health State Utility Impacts by Race/Ethnicity. Am J Prev Med 2016; 50:262-9. [PMID: 26775905 PMCID: PMC5841540 DOI: 10.1016/j.amepre.2015.09.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 09/14/2015] [Accepted: 09/24/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Little is known about the effect of breast cancers on health-related quality of life among women diagnosed between age 18 and 44 years. The goal of this study is to estimate the effect of breast cancer on health state utility by age at diagnosis (18-44 years versus ≥45 years) and by race/ethnicity. METHODS The analytic sample, drawn from the 2009 and 2010 Behavioral Risk Factor Surveillance System and analyzed in 2013, included women diagnosed with breast cancer between age 18 and 44 years (n=1,389) and age ≥45 years (n=6,037). Health state utility values were estimated using Healthy Days variables and a published algorithm. Regression analysis was conducted separately by age at diagnosis and race/ethnicity. RESULTS The breast cancer health state utility decrement within 1 year from date of diagnosis was larger for women diagnosed at age 18-44 years than for women diagnosed at age ≥45 years (-0.116 vs -0.070, p<0.05). Within the younger age-at-diagnosis group, Hispanic women 2-4 years after diagnosis had the largest health state utility decrement (-0.221, p<0.01), followed by non-Hispanic white women within 1 year of diagnosis (-0.126, p<0.01). CONCLUSIONS This study is the first to report estimates of health state utility values for breast cancer by age at diagnosis and race/ethnicity from a nationwide sample. The results highlight the need for separate quality of life adjustments for women by age at diagnosis and race/ethnicity when conducting cost-effectiveness analysis of breast cancer prevention, detection, and treatment.
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Affiliation(s)
- Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | | | - Linda Chamiec-Case
- Public Health Economics Program, RTI International, Research Triangle Park, North Carolina
| | - Gery P Guy
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
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Ekwueme DU, Trogdon JG. The Economics of Breast Cancer in Younger Women in the U.S.: The Present and Future. Am J Prev Med 2016; 50:249-54. [PMID: 26775903 PMCID: PMC5850966 DOI: 10.1016/j.amepre.2015.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 11/16/2022]
Affiliation(s)
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Pinheiro LC, Wheeler SB, Chen RC, Mayer DK, Lyons JC, Reeve BB. The effects of cancer and racial disparities in health-related quality of life among older Americans: A case-control, population-based study. Cancer 2014; 121:1312-20. [DOI: 10.1002/cncr.29205] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/24/2014] [Accepted: 11/14/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Laura C. Pinheiro
- Department of Health Policy and Management; Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Stephanie B. Wheeler
- Department of Health Policy and Management; Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Ronald C. Chen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Deborah K. Mayer
- School of Nursing, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Jessica C. Lyons
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Bryce B. Reeve
- Department of Health Policy and Management; Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
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Abu-Helalah M, Al-Hanaqta M, Alshraideh H, Abdulbaqi N, Hijazeen J. Quality of Life and Psychological Well-Being of Breast Cancer Survivors in Jordan. Asian Pac J Cancer Prev 2014; 15:5927-36. [DOI: 10.7314/apjcp.2014.15.14.5927] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Champion VL, Ziner KW, Monahan PO, Stump TE, Cella D, Smith LG, Bell CJ, Von Ah D, Sledge GW. Development and psychometric testing of a breast cancer survivor self-efficacy scale. Oncol Nurs Forum 2014; 40:E403-10. [PMID: 24161644 DOI: 10.1188/13.onf.e403-e410] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe the development of a self-efficacy instrument that measures perceived ability to manage symptoms and quality-of-life problems resulting from the diagnosis and treatment of breast cancer. DESIGN Items were developed and content validity assessed. A 14-item scale was psychometrically evaluated using internal consistency reliability and several types of construct validity. SAMPLE 1,127 female breast cancer survivors (BCSs). METHODS Written consents were mailed to the research office. Data were collected via mail and telephone. MAIN RESEARCH VARIABLES Demographics, symptom bother, communication with healthcare provider, attention function, fear of recurrence, depression, marital satisfaction, fatigue, sexual functioning, trait and state anxiety, and overall well-being. FINDINGS Data demonstrated that the breast cancer self-efficacy scale (BCSES) was reliable, with an alpha coefficient of 0.89, inter-item correlations ranging from 0.3-0.6, and item-total correlation coefficients ranging from 0.5-0.73. Three of 14 items were deleted because of redundancy as identified through high (> 0.7) inter-item correlations. Factor analysis revealed that the scale was unidimensional. Predictive validity was supported through testing associations between self-efficacy and theoretically supported quality-of-life variables, including physical, psychological, and social dimensions, as well as overall well-being. CONCLUSIONS The BCSES demonstrated high internal consistency reliability, unidimensionality, and excellent content and construct validity. This scale should be integrated into interventions that target self-efficacy for managing symptoms in BCSs. IMPLICATIONS FOR NURSING Nurses working with BCSs may use this tool to assess areas in which survivors might need to build confidence to adequately cope with their specific survivorship concerns. KNOWLEDGE TRANSLATION The use of the BCSES can inform nurse researchers about the impact of an intervention on self-efficacy in the context of breast cancer survivorship, improving the ability to deliver effective interventions. The scale is brief and easy to administer. Results of this study demonstrate clear psychometric reliability and validity, suggesting that the BCSES should be put to use immediately in interventions targeting the quality of life of BCSs.
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Use of the metastatic breast cancer progression (MBC-P) questionnaire to assess the value of progression-free survival for women with metastatic breast cancer. Breast Cancer Res Treat 2013; 142:603-9. [PMID: 24218050 PMCID: PMC3855533 DOI: 10.1007/s10549-013-2734-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/12/2013] [Indexed: 11/08/2022]
Abstract
While overall survival (OS) has historically been the primary endpoint for clinical trials in oncology, progression-free survival (PFS) has gained acceptance as a valuable surrogate endpoint. However, there are no known published reports about the value of PFS from the patient’s perspective. We developed a questionnaire that included items regarding quality of life (QoL) and the importance of different treatment outcomes and presented hypothetical scenarios for which respondents were asked to indicate their preferences concerning treatments as they relate to PFS. 282 women with metastatic breast cancer (MBC), ranging in age from 21 to 80 years completed an online version of this questionnaire. The majority of women (66 %) had been diagnosed with MBC within the previous 3 years and 56 % had been told their MBC had progressed. When asked to rank five treatment characteristics from most important to least important, respondents ranked “extending PFS” as the second most important treatment outcome after OS. When presented with a hypothetical scenario of two women receiving different treatments, respondents preferred the treatment that resulted in longer PFS (16 vs. 12 months), even when OS and side effects were assumed to be equal. Specifically, when asked to consider which woman within the hypothetical scenario had better QoL, physical functioning, and emotional well-being, respondents more often chose the woman who experienced longer PFS (QoL: 40 vs. 6 %; physical functioning: 32 vs. 8 %; emotional well-being: 58 vs. 6 %) compared to the woman within the hypothetical scenario who had a shorter time of progression. Respondents rated their own QoL highest after being told their MBC was responding to treatment (mean score 76.6) versus after the initial diagnosis of breast cancer and MBC (68.5 and 60.3). These findings suggest that extending PFS is an important treatment outcome and, from a patient perspective, improves overall QoL, physical functioning, and emotional well-being.
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Sheppard VB, Harper FWK, Davis K, Hirpa F, Makambi K. The importance of contextual factors and age in association with anxiety and depression in Black breast cancer patients. Psychooncology 2013; 23:143-50. [PMID: 24150907 DOI: 10.1002/pon.3382] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 07/12/2013] [Accepted: 07/23/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Limited research exists on correlates of psychosocial distress in Black breast cancer patients. The goals of the study were to describe the prevalence of distress (anxiety and depression) in Black women with breast cancer and to examine the influence of demographic, clinical, contextual (e.g., self-efficacy, medical mistrust), and process of care factors (e.g., patient satisfaction) on women's level of anxiety and depression. METHODS Eighty-two Black women diagnosed with invasive non-metastatic breast cancer were interviewed by phone. Collected data included demographic, clinical, contextual, and process of care factors. Bivariate correlations were used to examine relationships between those variables. Multiple linear regressions were used to examine predictors of anxiety and depression. RESULTS About one-third of the women (32%) met cut-off thresholds for distress. Medical mistrust and positive attitude had significant influences on anxiety levels, whereas age and positive attitude were determinants of levels of depression. Participants with higher medical mistrust reported more anxiety (r = .379; p < .001) and depression (r = .337; p = .002), whereas women with higher self-efficacy reported less anxiety (r = -.401; p < .001) and depression (r = -.427; p < .001). Age was inversely related to both anxiety and depression (r = -.224; r = -.296, respectively; p < .05). CONCLUSIONS Findings support national recommendations for routine distress screening in the delivery of cancer care particularly in younger Black patients. Interventions targeted to boost self-efficacy or reduce medical mistrust through enhanced patient-provider interactions may decrease psychological distress. Psychosocial needs of younger patients warrant particular attention.
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Affiliation(s)
- Vanessa B Sheppard
- Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center, Breast Cancer Program, Washington, DC, USA
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