Psychosocial issues experienced by young women with breast cancer: the minority group with the majority of need

What contributes to promote sexual health in cancer palliative care? A realist review

INTRODUCTION

Sexuality is an important determinant of the overall health of a population and remains so at the end of life and in patients with advanced cancers. Despite the abundant literature on sexuality and intimacy, these topics have been rarely discussed in the context of cancer palliative care, and very few interventions to promote sexual health in patients undergoing cancer palliative care have been explored.

OBJECTIVES

In this study we sought to identify which factors and mechanisms contribute to promoting sexual health in cancer palliative care.

METHODS

A realist review was performed according to the guidelines of the realist and meta-narrative evidence synthesis method guidelines. Articles published between January 2010 and June 2021 were searched in 4 databases. Records were screened for their relevance regarding a predefined list of context-mechanism-outcome (CMO) configurations. Abstracts were independently screened by 2 authors before the data were extracted from the full-text articles selected for inclusion. With the use of abductive and retroductive reasoning techniques, each article was examined for evidence of its contribution to one of the CMO configurations, which could be refined when relevant. The data were summarized according to the final CMO configurations.

RESULTS

Of the 2056 articles identified, 38 articles were included in the review. The data reported in these articles contributed to 7 CMO hypotheses: (1) improving communication skills, (2) healthcare provider training, (3) reorganizing the patient environment in care settings or at home, (4) managing sexual symptoms and also general symptoms, (5 and 6) patient-centered counseling or couple counseling, and (7) lifting the taboo.

CONCLUSIONS

The findings reported here highlight various ways to improve sexual health for patients in cancer palliative care but are limited to genital cancers. Further research should consider all types of cancer rather than being restricted to genital cancers.

Psychosocial and supportive care concerns of young women living with advanced breast cancer: baseline findings from a prospective virtual support intervention study

PURPOSE

Adolescent and young adults (AYAs) with metastatic breast cancer (MBC) experience high physical and psychosocial burdens compounded by a disrupted life trajectory. We sought to determine the psychosocial and supportive care concerns of this population to better understand and address unmet needs.

METHODS

AYAs diagnosed with MBC (18-39 years) participating in a prospective interventional study (Young, Empowered, and Strong) at Dana-Farber Cancer Institute completed an electronic survey following enrollment. Measures evaluated sociodemographics, health behaviors, quality of life, and symptoms, among others. We used two-sided Fisher's exact tests to determine associations between concerns (e.g., cancer progression, side effects, lifestyle, finances, fertility) and demographic variables.

RESULTS

Among 77 participants enrolled from 9/2020-12/2022, average age at MBC diagnosis and survey was 35.9 (range: 22-39) and 38.3 years (range: 27-46), respectively. Most were non-Hispanic white (83.8%) and 40.3% reported their diagnosis caused some financial problems. Many were concerned about fertility (27.0%), long-term treatment side effects (67.6%), exercise (61.6%), and diet (54.1%). Select concerns varied significantly by age, race/ethnicity, and education. Younger women at survey reported greater concern about familial cancer risk (p = 0.028). Women from minority racial/ethnic groups more frequently reported issues talking about their cancer to family/friends (p = 0.040) while those with more education were more frequently concerned with long-term effects of cancer on their health (p = 0.021).

CONCLUSION

Young women living with MBC frequently report psychosocial, health, and cancer management concerns. Tailoring supportive care and communications to address prevalent concerns including disease progression and treatment side effects may optimize wellbeing.

Clinicopathological features, psychological status, and prognosis of 33 patients with occult breast cancer

BACKGROUND

Occult breast cancer (OBC) has traditionally been considered to be a carcinoma of unknown primary origin with a favorable prognosis and can be treated as stage II-III breast cancer. Due to the small number of cases and limited clinical ex-perience, treatments vary greatly around the world and no standardized treat-ment has yet been established.

AIM

To investigate the clinicopathological features, psychological status and prog-nostic features of patients with OBC.

METHODS

The clinicopathological data of 33 OBC patients diagnosed and treated in the Affiliated Hospital of Xuzhou Medical University and Xuzhou Central Hospital from November 2015 to November 2022 were retrospectively analyzed. The psychological status of OBC patients was evaluated by the Self-rating Anxiety Scale and Self-rating Depression Scale. Patients' emotions, stress perception and psychological resilience were evaluated by the Positive and Negative Affect Schedule, the Chinese Perceived Stress Scale, and the Connor-Davidson Resilience Scale (CD-RISC), respectively. Patient survival was calculated using the Kaplan-Meier method, and survival curves were plotted for analysis with the log-rank test. Univariate and multivariate survival analyses were performed using the Cox regression model.

RESULTS

The 33 OBC patients included 32 females and 1 male. Of the 33 patients, 30 (91%) had axillary tumors, 3 (9%) had a neck mass as the primary symptom; 18 (54.5%) had estrogen receptor-positive tumors, 17 (51.5%) had progesterone receptor-positive tumors, and 18 (54.5%) had Her-2-positive tumors; 24 (72.7%) received surgical treatment, including 18 patients who underwent modified radical mastectomy, 1 patient who underwent breast-conserving surgery plus axillary lymph node dissection (ALND), and 5 patients who underwent ALND alone; 12 patients received preoperative neoadjuvant therapy. All 30 patients developed anxiety and depression, with low positive affect scores and high negative affect scores, accompanied by a high stress level and poor psychological resilience. There were no differences in the psychological status of patients according to age, body mass index, or menopausal status. The overall survival and disease-free survival (DFS) of all the patients were 83.3% and 55.7%, respectively. Univariate analysis demonstrated that the initial tumor site (P = 0.021) and node stage (P = 0.020) were factors that may affect patient prognosis. The 5-year DFS rate of OBC patients who received radiotherapy was greater (P < 0.001), while the use of different surgical methods (P = 0.687) had no statistically significant effect on patient outcomes. Multivariate analysis revealed that radiotherapy (P = 0.031) was an independent prognostic factor. Receiving radiotherapy had a significant effect on the CD-RISC score (P = 0.02).

CONCLUSION

OBC is a rare breast disease whose diagnosis and treatment are currently controversial. There was no significant difference in the efficacy of other less invasive surgical procedures compared to those of modified radical mastectomy. In addition, radiotherapy can significantly improve patient outcomes. We should pay attention to the psychological state of patients while they receive antitumor therapy.

Latent classes of health-promoting lifestyle in breast cancer patients undergoing chemotherapy in China: A cross-sectional survey

AIM

To identify the latent classes of a health-promoting lifestyle and examine the associations of latent class profile with individual characteristics of breast cancer undergoing chemotherapy in China in order to provide some insights and recommendations for targeted and individualized health education of health-promoting lifestyle.

DESIGN

A descriptive cross-sectional survey design was used for this work.

METHODS

A total of 197 patients with breast cancer undergoing chemotherapy recruited from the Breast Cancer Outpatient Chemotherapy Clinic of a Grade 3A hospital were surveyed. Health-promoting lifestyle was measured using the Health Promotion Lifestyle Profile-II: Chinese Version Short (HPLP-IICR). Latent class analysis was used to examine respondents' health-promoting lifestyle patterns. Associations between the latent class membership and individual characteristics were examined using multinomial logistic regression.

RESULTS

Four latent classes were identified: Class 1-Good Nutrition and Poor Physical Activity, Class 2-Poor Health Responsibility and Nutrition, Class 3-Active Health-Promoting Lifestyle, and Class 4-Medium Spiritual Growth and Poor Other Dimensions. Younger respondents and respondents with a higher score in anxiety and depression were more likely to be classified in Class 4 rather than Class 1 or 3. Respondents with low exercise self-efficacy were more likely to be classified in Class 4 than the others. Respondents in Class 4 had more chemotherapy symptom severity and interference, and cases of menopause were fewer in Class 4 rather than Class 3. Those in Class 4 were more likely to have been diagnosed with cancer within 3 months than those in Class 1.

Optimizing sexuality of young women with breast cancer: how can the breast clinic help?

BACKGROUND

Breast cancer treatment can lead to sexual dysfunction which, in general, impacts younger women more. Being well informed and having good social support are important elements in dealing with this dysfunction.

AIMS

This study aims to explore how specialized breast clinics can help young women with questions or problems regarding their sexual health by fulfilling their information and social support needs.

METHOD

A thematic analysis was used for 16 interviews with young women (18-45 years) diagnosed with breast cancer, in Belgium.

RESULTS

Participants report a lack of information on sexual issues and find the information insufficiently tailored to young women. The empathy of healthcare providers and their communication skills play an important role in whether sexual issues can be discussed. Finally, they indicate that more attention should be paid to their partner (relationship).

CONCLUSION

The breast clinic might help young women by giving more specific advice on what is sexually allowed (or not) during treatment, by informing them about lubricants and sex toys, by adapting brochures and information sessions to young women, by investing in the partner's well-being and their relationship, and by training healthcare providers better.

Examining engagement in a self-in-relationship observation exercise by couples coping with breast cancer: A qualitative analysis of text-based feedback

Young women with breast cancer (BC) and their partners generally face greater psychosocial difficulties relative to older couples, justifying the need for targeted support for this group. Toward this end, we examined how couples facing BC responded to participating in a self-in-relationship observation exercise intended to improve the relationship. Participants (N = 60) were 30 women and 30 male partners who, over the course of a week, observed and textually described/reported their "turning-towards-and-away-behaviors" deemed to contribute to relationship closeness/distance. Text-based feedback on the exercise was thematically analyzed. Findings suggest an online exercise promoting in vivo awareness of relationship interactions was feasible and acceptable to the majority of couples. Language accounts reflected acting with and through the shared "turning-towards-and-away-framework" with the intention of increasing closeness with one's partner. We discuss differences in exercise engagement and how participants reported changes in their attending, understanding, and acting in relationship, primarily for the better.

Reproductive concerns among young adult women with breast cancer: a systematic review protocol

INTRODUCTION

Reproductive concerns refer to worries about impaired or lost reproductive ability due to disease or/and treatment. Many young female patients with breast cancer experience reproductive concerns because they still desire to have children at the time of diagnosis. Reproductive concerns can impact patients' treatment decision-making as well as their psychological health and quality of life. Understanding the situation, contributing factors and health-related consequences of reproductive concerns among patients with breast cancer is essential to minimise their impacts.

METHODS AND ANALYSIS

A systematic review will be conducted. We will search five English databases (PubMed, Embase, CINAHL, Web of Science and APA PsycInfo) and four Chinese databases (Wang Fang database, VIP, CBM and CNKI) for pertinent studies. Other relevant studies will be identified from the reference lists of included studies. Two reviewers will independently perform study selection, data extraction and quality appraisal. Any discrepancies between the two reviewers will be resolved through consultation and discussion with the senior reviewer. A formal narrative synthesis will be performed to summarise the findings of individual studies. This review aims to improve understanding of the level of reproductive concerns, factors associated with reproductive concerns and health-related consequences of reproductive concerns among patients with breast cancer. The findings can contribute to the development of tailored interventions to alleviate reproductive concerns of patients with breast cancer, enhancing their psychological health and quality of life.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review, as it will be based on published studies. The findings will be disseminated by publishing in a journal.

PROSPERO REGISTRATION NUMBER

CRD42022375247.

Experiences of peer support activities and the need for a metaverse-based program in young women with breast cancer: A qualitative study

Objective

This study aimed to explore young breast cancer survivors' experiences of peer support activities and their need for a metaverse-based peer support program.

Methods

This qualitative content analysis study involved 15 young women with breast cancer under the age of 40. Participants with diverse experiences in peer support activities were purposefully selected. Data were collected in March 2023 through three focus group interviews and three additional individual interviews. Saturation was reached when no new themes emerged from the interviews. The interviews were transcribed verbatim and analyzed using conventional content analysis. This study ensured the trustworthiness of the data based on criteria including truth value, applicability, consistency, and neutrality.

Results

Four categories emerged: advantages, disadvantages, preferences for peer support activities, and the need for metaverse-based peer support programs. Participants valued peer support activities for exchanging information, nurturing empathy, and encouraging healthy behaviors. Challenges included information confusion, peer conflict, isolation, and stigma. Preferences for group composition, size, and medium varied; however, all participants agreed on the importance of operational guidelines. Participants expected a metaverse-based peer support program to provide safe and enjoyable experiences despite concerns about unfamiliar platforms.

Conclusions

This study highlights the unique needs and preferences of young breast cancer survivors regarding peer support activities. Well-organized and tailored peer support can significantly enhance their quality of life. These findings provide valuable insights for developing effective metaverse-based peer support programs to meet the needs of young women with breast cancer.

Unmet supportive care needs of breast cancer survivors: a systematic scoping review

BACKGROUND

Breast cancer is the most common type of cancer in women worldwide. Though improved treatments and prolonged overall survival, breast cancer survivors (BCSs) persistently suffer from various unmet supportive care needs (USCNs) throughout the disease. This scoping review aims to synthesize current literature regarding USCNs among BCSs.

METHODS

This study followed a scoping review framework. Articles were retrieved from Cochrane Library, PubMed, Embase, Web of Science, and Medline from inception through June 2023, as well as reference lists of relevant literature. Peer-reviewed journal articles were included if USCNs among BCSs were reported. Inclusion/exclusion criteria were adopted to screen articles' titles and abstracts as well as to entirely assess any potentially pertinent records by two independent researchers. Methodological quality was independently appraised following Joanna Briggs Institute (JBI) critical appraisal tools. Content analytic approach and meta-analysis were performed for qualitative and quantitative studies respectively. Results were reported according to the PRISMA extension for scoping reviews.

RESULTS

A total of 10,574 records were retrieved and 77 studies were included finally. The overall risk of bias was low to moderate. The self-made questionnaire was the most used instrument, followed by The Short-form Supportive Care Needs Survey questionnaire (SCNS-SF34). A total of 16 domains of USCNs were finally identified. Social support (74%), daily activity (54%), sexual/intimacy (52%), fear of cancer recurrence/ spreading (50%), and information support (45%) were the top unmet supportive care needs. Information needs and psychological/emotional needs appeared most frequently. The USCNs was found to be significantly associated with demographic factors, disease factors, and psychological factors.

CONCLUSION

BCSs are experiencing a large number of USCNs in fearing of cancer recurrence, daily activity, sexual/intimacy, psychology and information, with proportions ranging from 45% to 74%. Substantial heterogeneity in study populations and assessment tools was observed. There is a need for further research to identify a standard evaluation tool targeted to USCNs on BCSs. Effective interventions based on guidelines should be formulated and conducted to decrease USCNs among BCSs in the future.

ESO-ESMO fifth international consensus guidelines for breast cancer in young women (BCY5)

We dedicate this manuscript in memory of a dear friend and colleague Bella Kaufman. The fifth International Consensus Symposium for Breast Cancer in Young Women (BCY5) took place virtually in October 2020, organized by the European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY4 with incorporation of new evidence to inform the guidelines. Areas of research priorities as well as specificities in different geographic and minority populations were identified. This manuscript summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).

Gender Socialization as a Predictor of Psychosocial Well-Being in Young Women with Breast Cancer

This study aimed to explore the relationship between gender socialization and psychosocial well-being among young women diagnosed with and treated for breast cancer. A total of 113 women between the ages of 18-49 completed a one-time questionnaire package. Four key measures of gender socialization were included: Gender Role Socialization Scale (GRSS), Objectified Body Consciousness Scale (OBCS), Mental Freedom Scale (MFS), and Silencing the Self Scale (SSS). Two measures of psychosocial well-being were included: Functional Assessment of Cancer Therapy-Breast (FACT-B) and Experience of Embodiment Scale (EES). Correlational and regression analyses were conducted to assess the relationship between gender socialization variables and well-being. In multiple regression models, GRSS and MFS added significant increments to the prediction of variance of the FACT-B (R² = 23.0%). In contrast, the OBCS and MFS added significant increments to the prediction of variance of the EES (R² = 47.0%). Findings suggested that women with greater endorsements to proscribed gender socialization were associated with poor well-being scores. Women who endorsed a critical stance, resisting traditional gender-role expectations, objectification pressures, and other social discourses, were associated with greater well-being scores. Future studies are needed to examine the impact of gender socialization on the well-being of young people with breast cancer.

Sleep health in young women with breast cancer: a narrative review

PURPOSE

The purpose of this narrative review was to synthesize the evidence on sleep health in young women with breast cancer and provide recommendations for clinical practice and research.

METHODS

Multiple databases were searched (OVID Medline, OVID PsycINFO, OVID Embase, and Scopus) using the search terms "breast neoplasm", "young women", "sleep", "sleep disturbance", "sleep problems", "sleep deficiency", and "insomnia". There were 467 titles and abstracts screened, and 82 full-text papers were reviewed, yielding 11 research publications for inclusion.

RESULTS

Sleep problems are prevalent among young women with breast cancer and are associated with vasomotor symptoms of menopause and psychological symptom distress. The evidence, however, is weak due to methodological and design aspects of the studies.

CONCLUSIONS

Poor sleep health in women with breast cancer is a clinically relevant problem that persists after treatment. As sleep is multidimensional and multifactorial, future research should evaluate sleep with objective sleep measures as well as self-reports; consider longitudinal designs; include factors that potentially contribute to poor sleep quality, such as physical and psychological symptom distress, family stressors, and competing life demands for this age group; and explore the perspective of this younger population of survivors on sleep. For clinical practice, survivorship visits should incorporate sleep assessment for all breast cancer survivors, especially younger women.

Psychological Benefits of a Sport-Based Program for Female Cancer Survivors: The Role of Social Connections

In the context of sports-based interventions for improving health and quality of life in chronic patients, participants could develop meaningful social relationships that affect their well-being as much as intervention activities. In this study, 80 female cancer survivors participated in a running-based group intervention (2 sessions/week; 1.5 h), while 51 acted as controls. The intervention lasted approximately 5 months. Unfortunately, the length of the intervention was reduced and sport activities were altered by the COVID-19 pandemic and lockdown mid-intervention, while the shared therapy sessions continued online. This possibly altered the results, as anxiety, depression, and physical aspects did not show significant differences between the experimental and control groups after the intervention. Participants reported positive comments on the experience as a whole, especially regarding the positive influence of the newly developed social connections. This was corroborated by significant correlations between group perceived cohesion and anxiety, depression, self-efficacy, and positive experience with the group psychological support. Overall, it is possible to suggest that in the program an important role was played by social connections and support, peer influence and the group experience, preserving positive experiential qualities of the intervention even if it was altered by external circumstances.

Couplelinks online intervention for young couples facing breast cancer: A randomised controlled trial

OBJECTIVE

Young women with breast cancer and their partners are more distressed than couples who are affected later in life. While dyadic interventions in the context of cancer are promising, there are access barriers, particularly for younger couples. This study evaluated Couplelinks, a professionally facilitated, web-based program designed to help couples improve their conjoint coping.

METHOD

This randomised controlled trial employed a waitlist control evaluation of the program. Outcomes included dyadic coping, relationship adjustment, depression, and anxiety.

RESULTS

Seventy-five couples consented to participate and were randomised. The final analysis included 31 couples in the treatment group and 36 couples in the waitlist group. Modest improvements were found in positive dyadic coping but effects were not maintained at 3-month follow-up. No effect was seen on overall relationship adjustment.

CONCLUSIONS

Our findings inform the rapidly expanding field of online programming for couples in general, and those affected by BC in particular. Intervention timing, 'dose', low overall relational distress, and the mainly enrichment rather than problem-focus of Couplelinks may help explain the lack of change on relationship adjustment.

Young, Empowered and Strong: A Web-Based Education and Supportive Care Intervention for Young Women With Breast Cancer Across the Care Continuum

PURPOSE

Patient-centered digital interventions may help empower young women to self-manage symptoms and psychosocial concerns and support informational needs often unaddressed in clinic.

METHODS

Young, Empowered and Strong (YES) is an interactive web-based intervention designed to engage young women with personalized education and symptom self-management resources on the basis of responses to patient-reported outcome-based questionnaires. We piloted YES among young women (< 45 years) with newly diagnosed early breast cancer (EBC) or metastatic breast cancer (MBC) and breast cancer survivors (BCSs). Assessments were deployed weekly (EBC and MBC) or every 4 weeks (BCSs) over 12 weeks. At study completion, use, feasibility, and acceptability of YES were evaluated via a survey and semistructured interview.

RESULTS

Thirty women were enrolled between April and June 2019: 10 EBC, 10 BCSs, and 10 MBC. The mean age at diagnosis and enrollment was 36 (range 25-44) and 39 (range 31-44) years, respectively. Most participants were actively treated (96%, 27 of 28) with endocrine therapy (54%, 15 of 28) or chemotherapy (43%, 12 of 28). Overall, 61% (180 of 296) of assessments were completed (EBC: 70%, BCSs: 63%, and MBC: 52%). Of 37 patient-reported outcome and need domains, the most frequently triggered were sexual health (EBC: 90%, BCSs: 90%, and MBC: 90%), anxiety (EBC: 80%, BCSs: 90%, and MBC: 90%), stress and mindfulness (EBC: 80%, BCSs: 90%, and MBC: 90%), and fatigue (EBC: 90%, BCSs: 80%, and MBC: 90%). On postpilot survey, participants reported that YES helped them to learn (50%, 7 of 14), monitor (43%, 6 of 14), and manage (57%, 8 of 14) their symptoms.

CONCLUSION

YES is a feasible and acceptable digital intervention to support young women across the breast cancer care continuum. The nearly universal triggering of sexual and mental health needs suggests suboptimal management in the clinical setting and the potential for self-management through a digital platform.

A review of psychological impact of breast cancer in women below 50 years old

A breast cancer diagnosis is a critical event with a potentially traumatic nature. In recent years there has been an increase of this illness in women aged under-fifty, a group of particular scientific interest. In this article the authors review the recent scientific literature on psychological impact of breast cancer experiences in under-50 women. Our results highlight three trajectories: clinical psychological risks; feminine-specific concerns; resources between individual and relational aspects. This overview illustrates the complexity of the effects of breast cancer in under-50women allowing to think about theoretical and psychosocial models to provide support for under-50 women during the illness experience.

Young Women With Breast Cancer: Treatment, Care, and Nursing Implications

BACKGROUND

Young women with breast cancer (YWBC) are more likely to have aggressive disease, carry mutations for hereditary cancer genes, and experience higher mortality. They also may face reduced fertility because of the toxicity of chemotherapy.

OBJECTIVES

This article aims to present a review of YWBC treatments, sequelae of treatment, and psychosocial challenges.

METHODS

The authors performed a review of guideline-supported treatment options, patient resources, and nursing implications.

FINDINGS

Because of high-risk cancers and a lack of specific treatment guidelines, healthcare providers may consider aggressive treatments for younger patients. However, studies indicate that the foundation for treatment decisions for YWBC are best based on disease stage and National Comprehensive Cancer Network guidelines.

Distress Thermometer in breast cancer: systematic review and meta-analysis

Objective

This meta-analysis aimed to reach a summarised estimate of distress prevalence screened by Distress Thermometer (DT) among patients with breast cancer and compare different pooled prevalence estimated between different subgroups.

Methods

Two independent interviewers conducted a systematic search from PubMed, EMBASE, Ovid and Cochrane Library and checked related reviews and meta-analyses for eligible studies. The studies that identified distress of patients with breast cancer with DT were included. After extracting demographic characteristics and distress prevalence, the pooled analysis and the forest plot were completed by using STATA V.12.0 software. We conducted a subgroup analysis based on demographic and methodological characteristics of the studies. The publication bias was estimated by funnel plot.

Results

Seventeen studies describing 3870 patients with breast cancer were included in this meta-analysis. The distress prevalence of patients with breast cancer varied from 25.3% to 71.7% among these studies. The pooled distress prevalence was 50% (95% CI 49% to 52%) for the overall sample. The pooled distress prevalence rates in DT ≥7, DT ≥5 and DT ≥4 subgroups were 37% (95% CI 35% to 40%), 45% (95% CI 40% to 49%) and 62% (95% CI 60% to 65%), respectively. The distress prevalence had statistically significant differences between subgroups, which were differentiated by the initial time of distress identified, papers’ publication time, patients’ average age and country. There was no publication bias among the included studies.

Conclusion

The distress prevalence was high among patients with breast cancer. Routine and timely screening of distress for patients with breast cancer is of great significance in oncology management.

Multicentre prospective cohort study of unmet supportive care needs among patients with breast cancer throughout their cancer treatment trajectory in Penang: a PenBCNeeds Study protocol

INTRODUCTION

Proper assessment of unmet supportive care needs of patients with breast cancer and its influencing factors at different treatment intervals will improve the rehabilitation of patients with breast cancer. Therefore, this study aims to determine the prevalence of unmet supportive care needs, changes of needs over time and associated factors during the treatment period.

METHODS AND ANALYSIS

This multicentre, prospective cohort study will be conducted in three governmental hospitals and one tertiary cancer institute in Penang, Malaysia. Adult women diagnosed with primary or recurrent tumour, node, metastases stage I-IV breast cancer based on pathological biopsy will be eligible for this study. At least 281 samples are required for this study. Participants will undergo follow-up at three time intervals: T1 at breast cancer diagnosis; T2 at 3 months after diagnosis and T3 at 6 months after diagnosis. Patients will complete a set of questionnaires at each time. The primary outcome of this study includes the changes in supportive care needs over three time points, followed by the secondary outcome examining patients' characteristics, coping behaviours and positive psychological components as they affect changes in unmet supportive care needs over time.

ETHICS AND DISSEMINATION

The study has received ethics approval from the Medical Research and Ethics Committee, Ministry of Health Malaysia (NMRR-19-268-45809 IIR) and the Human Research Ethics Committee of Universiti Sains Malaysia (USM/JEPeM/17100443). The results of the prospective study will be submitted for publication in a peer-reviewed journal.

The Efficacy of Psychological Intervention on Body Image in Breast Cancer Patients and Survivors: A Systematic-Review and Meta-Analysis

The experience of breast cancer and related treatments has notable effects on women's mental health. Among them, the subjective perception of the body or body image (BI) is altered. Such alterations deserve to be properly treated because they augment the risk for depression and mood disorders, and impair intimate relationships. A number of studies revealed that focused psychological interventions are effective in reducing BI issues related to breast cancer. However, findings are inconsistent regarding the dimension of such effects. This meta-analysis synthesizes and quantifies the efficacy of psychological interventions for BI in breast cancer patients and survivors. Additionally, since sexual functioning emerged as a relevant aspect in the BI distortions, we explored the efficacy of psychological interventions on sexual functioning related to BI in breast cancer patients and survivors. The literature search for relevant contributions was carried out in March 2020 through the following electronic databases: Scopus, PsycINFO, and ProQUEST. Only articles available in English and that featured psychological interventions for body image in breast cancer patients or survivors with controls were included. Seven articles with 17 dependent effect sizes were selected for this meta-analysis. Variables were grouped into: Body Image (six studies, nine dependent effect sizes) and Sexual Functioning Related to the Body Image in breast cancer patients and survivors (four studies, eight dependent effect sizes). The three-level meta-analysis showed a statistically significant effect for Body Image [g = 0.50; 95% CI (0.08; 0.93); p < 0.05] but no significant results for Sexual Functioning Related to Body Image [g = 0.33; 95% CI (−0.20; 0.85); p = 0.19]. These results suggest that psychological interventions are effective in reducing body image issues but not in reducing sexual functioning issues related to body image in breast cancer patients and survivors. Future review efforts may include gray literature and qualitative studies to better understand body image and sexual functioning issues in breast cancer patients. Also, high-quality studies are needed to inform future meta-analyses.

An Improved Stress-Scale Specifically Designed to Measure Stress of Women with Newly Diagnosed Breast Cancer

Most breast cancer patients are middle-aged women actively involved in establishing a family, developing a career, or raising children. With the exception of the Newly Diagnosed Breast Cancer Stress Scale (NDBCSS), few stress scales have been designed for women with breast cancer. This study checked the dimensionality of the NDBCSS by confirmatory factor analysis (CFA) and the results showed a poor fit, indicating an urgent need for improvement. Exploratory factor analysis (EFA) using the varimax rotation method was performed to improve the model, the revised NDBCSS (NDBCSS-R), which showed a good Kaiser-Meyer-Olkin value, Bartlett’s test of sphericity, and internal consistency reliability. The NDBCSS-R showed improved indices compared with NDBCSS, including: chi-square fit statistics/degree of freedom (CMIN/DF), goodness-of-fit index (GFI), adjusted goodness of fit index (AGFI), normed fix index (NFI), relative fit index (RFI), incremental fix index (IFI), Tucker–Lewis index (TLI), comparative fix index (CFI), root mean square error of approximation (RMSEA), root mean square residual (RMR), parsimonious goodness-fit-index (PGFI), and parsimonious normed fit index (PNFI). In conclusion, the improved NDBCSS-R can provide health professionals with an early understanding of the stress levels of women with breast cancer so that they can provide immediate medical intervention to prevent vicious cycles in a timely manner.

Unmet Supportive Care Needs Among Women With Breast and Gynecological Cancer: Relevance of Attachment Anxiety and Psychological Distress

OBJECTIVE

Attachment anxiety and avoidance are known risk factors for the development of unmet needs and poor well-being among patients with chronic diseases. Few studies have addressed this in individuals with cancer. We aimed to explore the relationship between supportive care needs, attachment styles and distress in women with breast and gynecological cancer.

METHODS

Using a cross-sectional paper-pencil (n = 157) and online survey (n = 614), a total of 771 patients with breast or gynecological cancer completed a set of validated questionnaires. From September 2013 to January 2014, consecutive inpatients and outpatients of the university hospital Tuebingen were included in the study. Further, participants were recruited through social media, patient internet platforms, self-help group leaders and patient networks. We used the Supportive Care Needs Survey (SCNS-SF-34) with the need dimensions: health system, patient care, psychological, physical, and sexual needs, as well as the Experiences in Close Relationships-Revised Questionnaire, and the Distress Thermometer. A multiple linear regression model was used to analyze the influence of attachment styles (anxiety and avoidance) on the SCNS-SF-34 dimensions. A moderation analysis was used to explore the influence of the interaction between attachment anxiety and distress for all SCNS-SF-34 dimensions.

RESULTS

Attachment anxiety was a significant determinant and led to higher unmet supportive care needs in all dimensions, whereas attachment avoidance was not significant. Distress did moderate the relationship between attachment anxiety and psychological and health system needs and led to a higher unmet needs development. For the other SCNS-SF-34 dimensions, distress was not confirmed as a moderator.

CONCLUSION

Our findings highlight attachment anxiety as a risk factor for the development of unmet supportive care needs and potentially impaired psychological adjustment to cancer. Further studies are needed to elucidate the interactions between attachment styles, distress and supportive care needs among cancer patients.

The prevalence of altered body image in patients with primary brain tumors: an understudied population

Purpose

Body image (BI) is an important issue for cancer patients, as patients with BI concerns are susceptible to depression, anxiety, difficulty coping, and poor quality of life (QoL). While this concern has been documented in patients with other malignancies, no data exists of this QoL issue in patients with primary brain tumors (PBT).

Methods

A cross-sectional survey of 100 PBT patients was conducted on an IRB approved prospective protocol using structured questionnaires. Participants completed the body image scale (BIS), Appearance Scheme Inventory Revised (ASI-R), MD Anderson Symptom Inventory Brain Tumor (MDASI-BT), and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression, Anxiety, and Psychosocial Impact Positive measures.

Results

The prevalence of clinically significant body image dissatisfaction (BIS ≥ 10) was 28% (95% CI 19–37%), median BIS score was 5 (range 0–27). The median ASI-R composite score was 2.9 (range 1.5–4.7). BIS was significantly correlated with the ASI-R (r = 0.53, 95% CI 0.37 to 0.65). The mean PROMIS Depression score was 48.4 (SD = 8.9), PROMIS Anxiety score was 49.4 (SD = 9.9), and PROMIS Psychosocial Illness Impact Positive score was 48.9 (SD = 9.7). BIS was significantly correlated with age, and trended with BMI and sex. The PROMIS Psychosocial Illness Impact Positive and PROMIS Anxiety scores were the most strongly related to BIS.

Conclusions

This study, the first to explore altered body image in PBT patients, revealed clinically significant body image dissatisfaction in nearly 1/3 of patients, similar to other malignancies. These findings underscore the potential contribution of disease and treatment-related body image concerns on psychosocial wellbeing in patients with PBT.

Electronic supplementary material

The online version of this article (10.1007/s11060-020-03433-8) contains supplementary material, which is available to authorized users.

Longitudinal effect of emotional processing on psychological symptoms in women under 50 with breast cancer

Breast cancer is a potential traumatic event associated with psychological symptoms, but few studies have analysed its impact in under-50 women. Emotional processing is a successful function in integrating traumatic experiences. This work analysed the relationship between emotional processing and psychological symptoms during three phases of treatment (before hospitalization, counselling after surgery and adjuvant therapy) in 50 women under the age of 50 with breast cancer. Mixed-effects models tested statistical differences among phases. There were significant differences in symptoms during the treatments: the levels of anxiety decrease from T1 to T3 (0.046), while those of hostility increase (<0.001). Emotional processing is a strong predictor of all symptoms. Clinical implications are discussed.

Evaluation of Illness Perception of Women with Breast Cancer in Turkey

Objective

The aim of this study is to examine the illness perceptions of women with breast cancer and possible relationships between these perceptions and descriptive characteristics such as sociodemographic and clinical characteristics in Turkey.

Materials and Methods

The study was conducted in compliance with correlational, descriptive research principles. Three hundred eighty women with breast cancer who were treated in various hospitals in seven regions of the country were included in the study. A sociodemographic and clinical characteristics form, and The Illness Perception Questionnaire were used for data collection.

Results

The mean age of the patients with breast cancer was 49.8±11.5, among them, 83.95% were married, 37.37% were at stage 2 breast cancer, and 67.11% experienced mastectomy. It was found that the patients perceived higher personal control over illness (20.88±4.76). The patients perceived most common risk factors as the cause of the illness (19.42±6.38). This study show that variety sociodemographic and clinical characteristics of the patients affected their perceptions of illness.

Conclusion

The meaning of illness from the perspective of patient with breast cancer should be assessed. The care, education and counselling programs should be planned according to the patient's illness perceptions.

Underfifty Women and Breast Cancer: Narrative Markers of Meaning-Making in Traumatic Experience

A diagnosis of breast cancer is considered a potential traumatic event associated with physical and psychological effects. In literature, an exploration of breast cancer experience in young women is lacking, able to shed light on the narrative processes of meaning-making of the experience in specific phases of treatment, as may be the initial impact with the onset of the cancer. Meaning-making processes are determinant aspects when dealing with traumatic events. The research took place at National Cancer Institute Pascale of Naples. We collected 50 ad hoc narrative interviews to explore the different domains of the experience with under-fifty women at the first phase of the hospitalization. The Narrative Interviews were analyzed through a qualitative methodology constructed ad hoc. Starting from the functions of meaning-making that the narrative mediate we have highlight the different modes to articulate the narrative functions: The Organization of Temporality: chronicled (38%), actualized (26%), suspended (18%), interrupted (16%), and confused (2%). The Search for Meaning: internalized (42%); generalized (24%); externalized (18%); suspended (16%). The Emotional Regulation: disconnected (44%), splitted (28%), pervasive (26%), and connected (2%). The Organization of self-other Relationship: supportive (46%), avoidant (22%), overturned (16%), and sacrificial (16%). The Finding Benefit: revaluating (38%), flattened (34%), and postponed (28%). The Orientation to Action: combative (38%), blocked (36%), and suspended (26%). Findings capture the impact with the onset of the cancer, identifying both risk and resource aspects. The study allows to identify a specific use of narrative device by under-fifty women who impacted with the experience of breast cancer. The ways in which meaning-making functions are articulated highlight the specificity of the first phase of the treatment of the cancer. From a clinical psychology point of view, our findings can be used as clinical narrative markers to grasp, in a diachronic way, the process of meaning-making, integration, and coping during the first phase of breast cancer experience in young women. We consider it valuable to increase longitudinal studies with young women to highlight trajectories of meaning-making during the different phases of the treatment to think about personalized intervention practices diachronically to the experience.

Dyadic Coping Across the Lifespan: A Comparison Between Younger and Middle-Aged Couples With Breast Cancer

The association between dyadic coping and adjustment to cancer has been well-established. However, a significant gap in the literature is the understanding of how the life stage of couples may influence their dyadic coping and the accompanying quality of life. Although younger couples have been identified at higher risk for poor coping because of less collaborative behaviors and higher vulnerability to stress, only a limited number of studies have addressed younger women's coping with breast cancer in the context of close relationships. The present study addressed the differential impact of the illness on the quality of life and dyadic coping behaviors of younger and middle-aged dyads and the influence of relational mutuality on couples' coping in the two groups. A sample of 86 couples participated in a cross-sectional study; 35 younger couples were compared to 51 middle-aged dyads. Patients and partners completed measures of quality of life, dyadic coping, and mutuality. Independent-samples t-tests were used to examine differences in the two groups, while the Actor-Partner Interdependence Model (APIM) identified actor and partner effects of relational mutuality on dyadic coping. Younger women and their partners reported statistically significant worse quality of life and dyadic coping scores than the middle-age group. For younger couples, positive and negative coping styles were the result of both actor and partner effects of mutuality. The study highlighted the more negative impact of breast cancer on the quality of life of younger patients and partners. It also revealed a stronger influence of each partner's relational mutuality compared to the middle-age group in predicting both adaptive and maladaptive coping behavior. Future studies should continue to examine the developmental trajectory of dyadic coping across the lifespan in order to develop psychosocial interventions to promote younger dyads' coping efforts.

What Young Women with Breast Cancer Get Versus What They Want in Online Information and Social Media Supports

Purpose: Young women are high users of social media (SM), but information is lacking on whether online supports including SM meet the needs of young women (<40 years) with breast cancer (YWBC). YWBC are a vulnerable population who experience many psychosocial challenges alongside cancer diagnosis and treatment. This study aimed to gather data on what YWBC get versus what they want in online support. Methods: Semi-structured interviews explored YWBC's perceptions and use of online information/SM, including visions for ideal support. YWBC between the ages of 18-40 were recruited via two urban oncology clinics. Recruitment continued until redundancy of responses was achieved. Results: Thirteen YWBC participated in the study. Some reported benefits of online supports included connection with similar others, emotional support and ease of use. These benefits were balanced by drawbacks, such as a lack of appropriate/credible information and/or distressing information. Respondents spontaneously mentioned coping strategies such as managing information exposure and regulating SM use to mitigate against harms of online supports. Collectively, participants described nine facets of an ideal online support hub, which could function as a one stop shop for informational, practical and emotional supports for YWBC. Conclusion: Developing a multifunction online support hub may help women to find credible and useful information, rapidly, and address current limitations of online supports.

The impact and incidence of altered body image in patients with head and neck tumors: a systematic review

Body image dissatisfaction is a common issue among patients with cancer and is associated with difficulty coping, anxiety, and depression. Patients with tumors involving the head and neck are at increased risk of body image dissatisfaction due to the visible disfigurement that can occur from their illness and its treatment. Patients with primary central nervous system (CNS) malignancies often face similar tumor-related and treatment-related effects, yet there is limited research conducted in this population. Our aim was to perform a systematic review of the literature on body image in patients with tumors of the head and neck, and identify factors associated with body image alterations during treatment, with the intention of applying these approaches to those with CNS disease. A systematic search of PubMed and EMBASE was performed using predefined criteria. Nine studies met the inclusion criteria and were selected for review. The literature collected showed a relationship between body image and age, depressive symptoms, and tumor grade or stage. In addition, body image disturbance had an impact on patients' daily functioning and psychosocial indices including anxiety, coping, and body reintegration. Evaluation of the impact of body image alterations in patients with CNS tumors is needed to direct clinical care, explore research opportunities, and improve patient quality of life.

Comparison of the lived experiences of family caregivers of patients with dementia and of patients with cancer in Indonesia

ABSTRACTBackground:Dementia, even more than cancer, demands long-term care. While in Indonesia cancer is accepted as a disease requiring caregiving, dementia is still considered "a normal condition." These differences might affect the experiences of caregivers, especially those relating to social health, the subject of our study. We aim to describe and compare the lived experiences of family caregivers of patients with cancer (PWC) with those of patients with dementia (PWD) in Yogyakarta, Indonesia, and to explore the role of their social health in these experiences.

METHOD

A qualitative design was applied. In-depth face-to-face interviews were conducted with PWC and PWD caregivers in two outpatient clinics of a tertiary hospital. The constant comparative method was applied to analyze the data that were interpreted using the concept of social health to explore the experiences of the caregivers. We used Atlas.ti software.

RESULTS

Three themes were identified: problems with caregiving, dealing with problems, and beliefs in caregiving. We found more similarities than differences in the experiences of caregivers in both groups. Half of the categories were related to social health: challenges, consequences, hiding, social support, and the caregiver's approach. The organization of dementia care is characterized by simplicity and direct ties between medical specialists, PWD, and caregivers, whereas cancer care encounters coordination problems.

CONCLUSIONS

Family caregivers of both groups mostly had similar experiences of the caregiving process. Gaining a better understanding of the specific experiences of caregivers, and their social health, opens new avenues for interventions to improve their quality of life.

Psychosocial needs of young breast cancer survivors in Mexico City, Mexico

Objective

Young breast cancer survivors in Mexico face distinct psychosocial challenges that have not been characterized. This study aims to describe the psychosocial needs of young breast cancer survivors in Mexico at 5 or more years of survivorship, identifying areas of focus for early interventions.

Methods

Breast cancer patients diagnosed at age 40 or prior with 5 or more years since diagnosis were invited to participate in one-on-one 30–60 minute semi-structured audio-recorded interviews at the Instituto Nacional de Cancerología in Mexico City. Transcripts were coded using thematic analysis with NVivo software.

Results

25 women participated. Five major phenomena emerged from analysis: (1) minimization of fertility concerns; (2) persistence of body image disturbance over time; (3) barriers to employment during survivorship; (4) impact on family relationships and social networks; & (5) unmet psychological care and informational needs.

Conclusions

Early interventions with a focus on fertility loss education, access to reconstructive surgery and body image support, guidance during return-to-work, assistance with childcare, integration of psychological care and the fulfillment of informational needs could ameliorate long-term psychological and social distress for young breast cancer survivors in Mexico.

Disentangling the determinants of interest and willingness-to-pay for breast cancer susceptibility testing in the general population: a cross-sectional Web-based survey among women of Québec (Canada)

OBJECTIVES

To identify common and specific individual factors that favour or impede women's interest in and willingness-to-pay (WTP) for breast cancer susceptibility testing (BCST) and to identify the most impactful factors on both outcome measures.

DESIGN AND METHODS

This study used a self-administered cross-sectional Web-based questionnaire that included hypothetical scenarios about the availability of a new genetic test for breast cancer.

PARTICIPANTS

French-speaking women of the general population of Québec (Canada), aged between 35 and 69 years, were identified from a Web-based panel (2410 met the selection criteria, 1160 were reached and 1031 completed the survey).

MEASURES

The outcomes are the level of interest in and the range of WTP for BCST. Three categories of individual factors identified in the literature were used as potential explanatory factors, that is, demographic, clinical and psychosocial.

RESULTS

Descriptive statistics indicated that the vast majority of sampled women are interested in BCST (90%). Among those, more than half of them are willing-to-pay for such a test (57%). The regression models pointed out several factors associated with both outcomes (eg, age, income, family history, locus of control-powerful others) and marginal effects were used to highlight the most impactful factors for each outcome.

CONCLUSION

The results of this study provide a proxy of the readiness of women of the general population to use and to pay for BCST. They also offer insights for developing inclusive and specific strategies to foster informed decision-making and guide the services offered by health organisations corresponding to women's preferences and needs.

The narrow treatment road to survival: Everyday life perspectives of women with breast cancer from Iraq and the former Yugoslavia undergoing radiation therapy in Sweden

This study aimed at exploring how women from Iraq and the former Yugoslavia, diagnosed with breast cancer and living in Sweden, experience their everyday life during radiation therapy. A qualitative research design was used comprising interviews with ten women, five originating from Iraq and five from the former Yugoslavia. Striving to survive, the women experienced their everyday life during radiation therapy as extremely challenging. This experience can be placed into three categories: strategies for survival, keeping up appearances and staying in control. Because of these specific challenges, immigrant women may need additional information and guidance in conjunction with the diagnosis, which may enable them to identify possible sources of support from those closest to them. Also, greater attention should focus on acknowledging the woman behind the diagnosis, regardless of her origin, to develop an individualised support programme to help her cope with everyday life during radiation therapy.

Demands and Needs for Psycho-Oncological eHealth Interventions in Women With Cancer: Cross-Sectional Study

Background

Over the last decade, a growing body of studies regarding the application of eHealth and various digital interventions has been published and are widely used in the psycho-oncological care. However, the effectiveness of eHealth applications in psycho-oncological care is still questioned due to missing considerations regarding evidence-based studies on the demands and needs in cancer-affected patients.

Objective

This cross-sectional study aimed to explore the cancer-affected women’s needs and wishes for psycho-oncological content topics in eHealth applications and whether women with cancer differ in their content topics and eHealth preferences regarding their experienced psychological burden.

Methods

Patients were recruited via an electronic online survey through social media, special patient Internet platforms, and patient networks (both inpatients and outpatients, University Hospital Tuebingen, Germany). Participant demographics, preferences for eHealth and psycho-oncological content topics, and their experienced psychological burden of distress, quality of life, and need for psychosocial support were evaluated.

Results

Of the 1172 patients who responded, 716 were included in the study. The highest preference for psycho-oncological content topics reached anxiety, ability to cope, quality of life, depressive feelings, and adjustment toward a new life situation. eHealth applications such as Web-based applications, websites, blogs, info email, and consultation hotline were considered to be suitable to convey these content topics. Psychological burden did not influence the preference rates according to psycho-oncological content and eHealth applications.

Conclusions

Psycho-oncological eHealth applications may be very beneficial for women with cancer, especially when they address psycho-oncological content topics like anxiety, ability to cope, depressive feelings, self-esteem, or adjustment to a new life situation. The findings of this study indicate that psycho-oncological eHealth applications are a promising medium to improve the psychosocial care and enhance individual disease management and engagement among women with cancer.

Budget Impact Analysis of Biosimilar Trastuzumab for the Treatment of Breast Cancer in Croatia

BACKGROUND AND OBJECTIVE

Breast cancer is the most common cancer in women and has considerable impact on healthcare budgets and patients' quality of life. Trastuzumab (Herceptin^®) is a monoclonal antibody directed against the human epidermal growth factor receptor (HER2) for the treatment of breast cancer. Several trastuzumab biosimilars are currently in development. In 2015, trastuzumab was the drug with the highest financial consumption among all drugs in Croatia. This model estimates the 1-year budget impact of the introduction of biosimilar trastuzumab in Croatia.

METHODS

A budget impact model, based on approvals for trastuzumab treatment in 2015, was developed for the introduction of biosimilars. Two biosimilar scenarios were developed: biosimilar scenario 1, based on all approvals in 2015, and biosimilar scenario 2, based on approvals after February 2015 and the reimbursement of the subcutaneous formulation of trastuzumab in Croatia. Only trastuzumab-naïve patients and drug-acquisition costs were used in the model. Uptake of biosimilar was assumed at 50 %. Scenarios were calculated with price discounts of 15, 25 and 35 %. The robustness of the model was tested by extensive sensitivity analyses.

RESULTS

The projected drug cost savings from the introduction of biosimilar trastuzumab range from €0.26 million (scenario 2, 15 % price discount) to €0.69 million (scenario 1, 35 % price discount). If budget savings were reinvested to treat additional patients with trastuzumab, 14 (scenario 2, 15 % price discount) to 47 (scenario 1, 35 % price discount) additional patients could be treated. Sensitivity analyses showed that the incidence of breast cancer had the highest impact on the model, with a 10 % decrease in incidence leading to an 11.3 % decrease in projected savings.

CONCLUSION

The introduction of biosimilar trastuzumab could lead to significant drug cost savings in Croatia.

The closer 'We' are, the stronger 'I' am: the impact of couple identity on cancer coping self-efficacy

The present study tested the supposition that greater levels of couple identity (or we-ness) increase a woman's coping self-efficacy in relation to breast cancer, which, in turn, predicts better psychosocial adjustment. Women (N = 112) in committed relationships completed surveys assessing their levels of couple identity, cancer coping self-efficacy, and aspects of their psychosocial adjustment (specifically, depression, anxiety and functional well-being) during one of their outpatient visits to the cancer centre. As predicted, the more women identified with their relationships, the lower their levels of depression and anxiety were and the greater their functional well-being was. This relationship was mediated by coping self-efficacy: greater identification with one's relationship predicted greater confidence in one's ability to cope, which, in turn, predicted better adjustment. The role intimate relationships play in women's adjustment to breast cancer, as well as directions for further research, are discussed.

A Model of Engagement Promotion in a Professionally Facilitated Online Intervention for Couples Affected by Breast Cancer

Professionally facilitated web-based interventions for couples affected by an illness such as cancer are growing in popularity. Attrition rates for such online programs, however, are substantially higher than what is observed in face-to-face therapeutic contexts, and lower levels of participant engagement are associated with poorer outcomes. In the present investigation, a task analysis was employed to develop a model of engagement promotion in an online intervention for couples affected by breast cancer called "Couplelinks." Results indicated that facilitators utilized a variety of meta-processes, such as humanizing the technology, and associated "eBehaviors," to maintain three relationships involved in promoting online engagement: (a) between the facilitator and couple; (b) between the intervention and couple; and (c) between the partners within the couple.

Lessons Learned for Online Health Community Moderator Roles: A Mixed-Methods Study of Moderators Resigning From WebMD Communities

Background

Online health community (OHC) moderators help facilitate conversations and provide information to members. However, the necessity of the moderator in helping members achieve goals by providing the support they need remains unclear, with some prior research suggesting that moderation is unnecessary or even harmful for close-knit OHCs. Similarly, members’ perceptions of moderator roles are underexplored. Starting January of 2013, WebMD moderators stopped working for WebMD communities. This event provided an opportunity for us to study the perceived role of moderators in OHCs.

Objective

We examine the OHC members’ perception on OHC moderators by studying their reactions toward the departure of moderators in their communities. We also analyzed the relative posting activity on OHCs before and after the departure of moderators from the communities among all members and those who discussed moderators’ departures.

Methods

We applied a mixed-methods approach to study the posts of all 55 moderated WebMD communities by querying the terms relating to discussions surrounding moderators’ disappearance from the WebMD community. We performed open and axial coding and affinity diagramming to thematically analyze patients’ reactions to the disappeared moderators. The number of posts and poster groups (members and moderators) were analyzed over time to understand posting patterns around moderators’ departure.

Results

Of 821 posts retrieved under 95 threads, a total of 166 open codes were generated. The codes were then grouped into 2 main themes with 6 total subthemes. First, patients attempted to understand why moderators had left and what could be done to fill the void left by the missing moderators. During these discussions, the posts revealed that patients believed that moderators played critical roles in the communities by making the communities vibrant and healthy, finding solutions, and giving medical information. Some patients felt personally attached with moderators, expressing they would cease their community participation. On the other hand, patients also indicated that moderators were not useful or sometimes even harmful for peer interactions. The overall communities’ posting activity, which was already in decline, showed no significant difference before and after the moderators’ departure. In fact, the overall posting activities of the communities were declining well before the moderators’ departure. These declining posting activities might be the reason why WebMD removed the moderators.

Conclusion

Compassionate moderators who provide medical expertise, control destructive member posts, and help answer questions can provide important support for patient engagement in OHCs. Moderators are in general received positively by community members and do not appear to interfere with peer interactions. Members are well aware of the possibility of misinformation spreading in OHCs. Further investigation into the attitudes of less vocal community members should be conducted.