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Spector A, Li Z, He L, Badawy Y, Desai R. The effectiveness of psychosocial interventions on non-physiological symptoms of menopause: A systematic review and meta-analysis. J Affect Disord 2024; 352:460-472. [PMID: 38364979 DOI: 10.1016/j.jad.2024.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Menopause, a crucial transitioning stage for women, can significantly impact mood and wellbeing. We aimed to evaluate the effectiveness of psychosocial interventions on non-physiological symptoms of menopause (depression, anxiety, cognition, and quality of life) through systematic review and meta-analysis. METHODS Five databases were searched from inception to August 2023 for randomized controlled trials. Pre- and post-test means and standard deviations for groups were extracted and used to calculate effect sizes. The effectiveness of Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Interventions (MBI) on depression and anxiety were examined by subgroup analysis. RESULTS Thirty studies comprising 3501 women were included. From meta-analysis, mood symptoms significantly benefited from CBT (anxiety: d = -0.22, 95 % CI = -0.35, -0.10; depression: d = -0.33, 95 % CI = -0.45, -0.21) and MBI (anxiety: d = -0.56, 95 % CI = -0.74, -0.39; depression: d = -0.27, 95 % CI = -0.45, -0.09). Psychosocial interventions were also found to significantly improve cognition (d = -0.23, 95 % CI = -0.40, -0.06) and quality of life (d = -0.78, 95 % CI = -0.93, -0.63). Mean total therapy hours ('dose') was lower for CBT (11.3) than MBI (18.6), indicating reduced costs and burden for women. LIMITATIONS Data regarding menopausal status were not collected, limiting our ability to identify the optimal timing of interventions. Potential longer-term, effects of interventions were not investigated. CONCLUSION Our review highlighted the value of psychosocial interventions in improving non-physiological symptoms (particularly depression and anxiety) during menopause, noting the heterogeneity of findings and importance of implementing effective interventions.
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Affiliation(s)
- Aimee Spector
- Department of Clinical Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom of Great Britain and Northern Ireland.
| | - Zishi Li
- Department of Clinical Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom of Great Britain and Northern Ireland
| | - Lexi He
- Department of Clinical Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom of Great Britain and Northern Ireland
| | - Yasmeen Badawy
- Department of Clinical Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom of Great Britain and Northern Ireland
| | - Roopal Desai
- Department of Clinical Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom of Great Britain and Northern Ireland
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Hymowitz G, Hasan F, Yerramalli G, Cervoni C. Mindfulness-Based Interventions for Surgical Patients and Impact on Postoperative Outcomes, Patient Wellbeing, and Satisfaction. Am Surg 2024; 90:947-953. [PMID: 35940585 DOI: 10.1177/00031348221117025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several psychosocial factors can impact surgical outcomes and overall patient wellbeing following surgery. Although advances in surgical interventions and pain management protocols can reduce surgical trauma and enhance recovery from surgery, additional intervention is warranted to optimize surgical outcomes and patient quality of life (QoL) in the short- and long-term. Research on mindfulness techniques suggests that mindfulness-based interventions (MBI) effectively promote health behaviors, reduce pain, and improve psychological wellbeing and QoL. Thus, there has been an increase in research evaluating the use of MBIs to improve postoperative outcomes and wellbeing in surgical patients. The authors provide a brief overview of psychosocial outcomes of surgery and MBIs and review the literature on the impact of MBIs on postoperative outcomes. The extant literature indicates that MBIs are feasible and acceptable for use in surgical patient populations and provides preliminary evidence of the benefits of mindfulness across a range of surgical patient populations. However, more research is needed to assess the long-term efficacy of MBIs delivered online and in-person across the perioperative continuum.
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Affiliation(s)
| | - Farah Hasan
- Stony Brook University, Stony Brook, NY, USA
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Nebgen DR, Domchek SM, Kotsopoulos J, de Hullu JA, Crosbie EJ, Paramanandam VS, Brood-van Zanten MMA, Norquist BM, Guise T, Rozenberg S, Kurian AW, Pederson HJ, Yuksel N, Michaelson-Cohen R, Bober SL, da Silva Filho AL, Johansen N, Guidozzi F, Evans DG, Menon U, Kingsberg SA, Powell CB, Grandi G, Marchetti C, Jacobson M, Brennan DJ, Hickey M. Care after premenopausal risk-reducing salpingo-oophorectomy in high-risk women: Scoping review and international consensus recommendations. BJOG 2023; 130:1437-1450. [PMID: 37132126 DOI: 10.1111/1471-0528.17511] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/27/2023] [Accepted: 04/06/2023] [Indexed: 05/04/2023]
Abstract
Women at high inherited risk of ovarian cancer are offered risk-reducing salpingo-oophorectomy (RRSO) from age 35 to 45 years. Although potentially life-saving, RRSO may induce symptoms that negatively affect quality of life and impair long-term health. Clinical care following RRSO is often suboptimal. This scoping review describes how RRSO affects short- and long-term health and provides evidence-based international consensus recommendations for care from preoperative counselling to long-term disease prevention. This includes the efficacy and safety of hormonal and non-hormonal treatments for vasomotor symptoms, sleep disturbance and sexual dysfunction and effective approaches to prevent bone and cardiovascular disease.
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Affiliation(s)
- Denise R Nebgen
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan M Domchek
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joanne A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Emma J Crosbie
- Division of Cancer Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Vincent Singh Paramanandam
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Monique M A Brood-van Zanten
- Department of Gynecology, The Netherlands Cancer Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Barbara M Norquist
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Theresa Guise
- Department of Endocrine Neoplasia and Hormone Disorders, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Serge Rozenberg
- Department of Obstetrics and Gynaecology, Universite Libre de Bruxelles, Brussels, Belgium
| | - Allison W Kurian
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Holly J Pederson
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Nese Yuksel
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel Michaelson-Cohen
- Department of Gynaecology and Medical Genetics Institute, Hebrew University Faculty of Medicine, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Sharon L Bober
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nora Johansen
- Department of Gynaecology and Obstetrics, Sørlandet Hospital HF Arendal, Arendal, Norway
| | - F Guidozzi
- Deparment of Obstetrics and Gynaecology, University of Witwatersrand, Johanesburg, South Africa
| | - D Gareth Evans
- University of Manchester, Prevent Breast Cancer Centre, Manchester, UK
| | - Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Sheryl A Kingsberg
- University Hospitals Cleveland Medical Center, Case Western University School of Medicine, Cleveland, Ohio, USA
| | - C Bethan Powell
- Kaiser Permanente Northern California, Hereditary Cancer Program, San Francisco, California, USA
| | - Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Marchetti
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Catholic University Sacred Heart, Rome, Italy
| | - Michelle Jacobson
- Women's College Hospital and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Donal J Brennan
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater University Hospital, Dublin, Ireland
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, Research Precinct, Level 7, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
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Abstract
OBJECTIVE To update the evidence-based Nonhormonal Management of Menopause-Associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society. METHODS An advisory panel of clinicians and research experts in women's health were selected to review and evaluate the literature published since the Nonhormonal Management of Menopause-Associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society. Topics were divided into five sections for ease of review: lifestyle; mind-body techniques; prescription therapies; dietary supplements; and acupuncture, other treatments, and technologies. The panel assessed the most current and available literature to determine whether to recommend or not recommend use based on these levels of evidence: Level I, good and consistent scientific evidence; Level II, limited or inconsistent scientific evidence, and Level III, consensus and expert opinion. RESULTS Evidence-based review of the literature resulted in several nonhormone options for the treatment of vasomotor symptoms. Recommended: Cognitive-behavioral therapy, clinical hypnosis, selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors, gabapentin, fezolinetant (Level I); oxybutynin (Levels I-II); weight loss, stellate ganglion block (Levels II-III). Not recommended: Paced respiration (Level I); supplements/herbal remedies (Levels I-II); cooling techniques, avoiding triggers, exercise, yoga, mindfulness-based intervention, relaxation, suvorexant, soy foods and soy extracts, soy metabolite equol, cannabinoids, acupuncture, calibration of neural oscillations (Level II); chiropractic interventions, clonidine; (Levels I-III); dietary modification and pregabalin (Level III). CONCLUSION Hormone therapy remains the most effective treatment for vasomotor symptoms and should be considered in menopausal women within 10 years of their final menstrual periods. For women who are not good candidates for hormone therapy because of contraindications (eg, estrogen-dependent cancers or cardiovascular disease) or personal preference, it is important for healthcare professionals to be well informed about nonhormone treatment options for reducing vasomotor symptoms that are supported by the evidence.
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A Systematic Review Exploring the Effectiveness of Mindfulness for Sexual Functioning in Women with Cancer. PSYCH 2023. [DOI: 10.3390/psych5010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Sexual intimacy is a basic human need that is associated with quality of life whereby its absence can significantly impact both interpersonal and personal wellbeing. This systematic review aimed to provide an up-to-date evaluation of the available literature on mindfulness treatments for sexual functioning in women diagnosed with cancer. Electronic searches including PubMed, PsycINFO, Web of Science and registered clinical trials yielded 10 studies that met the inclusion criteria. The results showed that treatment intervention designs varied and included mixed methods, randomised clinical trials, single arm non-randomised trials and those with the absence of any control. Furthermore, both brief and longer-term mindfulness interventions were trialled across different sexual domains. Whilst inconclusive, mindfulness-based interventions appear to support sexual function and quality of life in both early- and post-cancer survivors. However, in some instances, there were outcome inconsistencies in sexual desire, arousal and orgasm. This review has identified a current shortage in research on the effectiveness of mindfulness-based treatments for supporting sexual functioning in women with cancer; and so far, no research has been conducted in palliative care. This unmet need in supporting sexual functioning in women with cancer, including palliative care, carries important implications for both psychosexual and oncological healthcare services as sexual intimacy does not end with cancer diagnosis or prognosis.
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Underhill-Blazey M, Rodriguez D, Norton SA. Scoping Review of Nonsurgical, Nonpharmacologic Interventions After Risk Reduction: Improving Quality of Life for Patients With Inherited Cancer Risk. Oncol Nurs Forum 2022; 49:193-200. [PMID: 35446837 DOI: 10.1188/22.onf.193-200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Although risk-reduction interventions for inherited cancer can significantly reduce cancer risk, they may also lead to distressing symptoms. It is not well understood how clinicians support patients in managing such concerns. This scoping review describes nonsurgical, nonpharmacologic interventions for adults with inherited cancer risk who have completed risk reduction. LITERATURE SEARCH Five publications were identified following a database review for English-language articles published from 2015 to 2020. DATA EVALUATION Sample, content, methods, and outcomes of included interventions are summarized. RESULTS The study identified five interventions. IMPLICATIONS FOR NURSING Future research should target a broader variety of heritable cancers to identify effective strategies for addressing challenges with risk-reduction interventions for inherited cancer.
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Gosset A, Susini M, Vidal F, Tanguy-Le-Gac Y, Chantalat E, Genre L, Trémollières F. Quality of life of patients with bilateral oophorectomy before the age of 45 for the treatment of endometriosis. Maturitas 2022; 162:52-57. [PMID: 35561587 DOI: 10.1016/j.maturitas.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/02/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The study aimed to evaluate the quality of life and associated factors among women who underwent bilateral oophorectomy (BO) before the age of 45 for the treatment of deep infiltrating endometriosis (DIE). MATERIALS AND METHODS This cross-sectional study was carried out in 52 women who were treated from January 2014 to December 2019 in 2 public and private DIE surgical centers in Toulouse. All women answered the Menopausal Quality of Life questionnaire (MenQOL). Mean MenQOL scores were compared according to age at BO, smoking, BMI, level of education, delay between BO and the survey and post-BO hormone replacement therapy (HRT) using Mann-Whitney and Anova tests. Spearman's correlation coefficient was used to analyze the correlations between all the MEnQOL domain scores and clinical variables. The variables associated with the outcomes in univariate analyses with p < 0.2 were jointly evaluated using multiple linear regression. RESULTS The mean age at the time of the survey was 43.4 ± 3.4 years while the mean age at BO was 40.5 ± 3.4 years. The mean MenQOL score was 3.96 (± 1.45), with the highest scores in the sexual (4.77) and vasomotor (4.01) domains. BMI and smoking were independently and significantly associated with the mean total MenQOL score, all domain scores being significantly higher in overweight/obese women. A trend towards worse MenQOL scores was found in patients who had BO before the age of 41. We did not find any difference according to whether or not they were taking HRT. CONCLUSION This is a first study evaluating quality of life in a specific population of oophorectomized women under the age of 45 using MenQOL for DIE. While BO is effective in relieving pain in women with severe DIE, the induced premature menopause is associated with a poor quality of life, which deserves further attention.
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Affiliation(s)
- A Gosset
- Centre de Ménopause, Hôpital Paule de Viguier, CHU, Toulouse, France.
| | - M Susini
- Centre de Ménopause, Hôpital Paule de Viguier, CHU, Toulouse, France
| | - F Vidal
- Service de chirurgie gynécologique, Clinique Croix du Sud, Quint-Fonsegrive, France
| | - Y Tanguy-Le-Gac
- Service de chirurgie gynécologique, Hôpital Paule de Viguier, CHU, Toulouse, France
| | - E Chantalat
- Service de chirurgie gynécologique, Hopital Rangueil, CHU, Toulouse, France
| | - L Genre
- Service de chirurgie gynécologique, Clinique Pasteur, Toulouse, France
| | - F Trémollières
- Centre de Ménopause, Hôpital Paule de Viguier, CHU, Toulouse, France
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Şener N, Timur Taşhan S. The effects of mindfulness stress reduction program on postmenopausal women's menopausal complaints and their life quality. Complement Ther Clin Pract 2021; 45:101478. [PMID: 34543872 DOI: 10.1016/j.ctcp.2021.101478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/16/2021] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
Abstract
AIM This study was carried out to define the effect of the Mindfulness Stress Reduction Program (MBSR) applied among postmenopausal women on their menopausal complaints and quality of life. MATERIAL AND METHOD The study was conducted with a quasi-experimental design. The sample consisted of 118 women, including 55 in the experimental group and 63 in the control group. A Personal Information Form, the Mindful Attention Awareness Scale (MAAS), the Menopausal Symptoms Rating Scale (MRS) and the Menopause Specific Quality of Life Questionnaire (MENQOL) were used to obtain the participants' data. An 8-week Mindfulness Stress Reduction Program was applied among the women in the experimental group. After the pretest, both groups completed the midtest at eight weeks and the posttests covering MAAS, MRS and MENQOL at 16 weeks. The data were analyzed by using descriptive statistics, independent-samples t-test, chi-squared test, ANOVA and Cronbach's alpha analysis. FINDINGS It was observed that, in the midtest and posttest, there was a significant difference between the MRS total and psychological complaints domain scores of the women in the experimental and control groups (p < 0.05). In the midtest, there was a significant difference in the vasomotor, psychosocial, sexual domains and scale total scores between the experimental and control groups (p < 0.05). In the posttest of the women in the experimental and control groups, a significant difference was found between these groups in the MENQOL vasomotor area, psychosocial area, physical area domains and scale total scores (p < 0.05). RESULT The MBSR program reduced the menopausal symptoms and increased the quality of life of the postmenopausal women.
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Affiliation(s)
- Nurdilan Şener
- Fırat University, Faculty of Health Sciences, Department of Nursing, Elazığ, Turkey.
| | - Sermin Timur Taşhan
- Inonu University, Faculty of Health Sciences, Department of Nursing, Malatya, Turkey.
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Chen TL, Chang SC, Huang CY, Wang HH. Effectiveness of mindfulness-based interventions on quality of life and menopausal symptoms in menopausal women: A meta-analysis. J Psychosom Res 2021; 147:110515. [PMID: 34034137 DOI: 10.1016/j.jpsychores.2021.110515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Menopause is a normal physiological process experienced by women, but it is often accompanied by physical and emotional symptoms that may negatively affect quality of life. This meta-analysis aimed to evaluate the effectiveness of mindfulness-based interventions on quality of life and menopausal symptoms by examining randomized controlled trials. METHODS A systematic search was conducted across six electronic databases to collect relevant articles published up to June 30, 2020. The articles' quality was assessed using the modified Jadad scale. We performed a meta-analysis with Review Manager 5.3, calculating 95% confidence intervals and standardized mean differences, and conducted sensitivity analyses. RESULTS The meta-analysis of five randomized controlled trials included 475 participants. The results indicated that the mindfulness-based intervention groups showed significant improvements in total quality of life and vasomotor and physical quality of life, compared to control groups (standardized mean differences range: from -0.48 to -0.68, all ps < 0.05). After the sensitivity analyses, evidence of heterogeneity remained. Insufficient data prevented conducting a meta-analysis with the sexual subscale of MENQOL or on vasomotor symptoms of menopause. CONCLUSION For menopausal women, mindfulness-based interventions may improve quality of life (except for psychological and sexual subscales). However, there is insufficient evidence to analyze whether such interventions can reduce vasomotor-related menopausal symptoms. Although heterogeneity should be carefully assessed, mindfulness-based interventions may be a novel approach for improving women's overall quality of life during menopause. However, further research is needed to verify these effects.
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Affiliation(s)
- Tsai-Ling Chen
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Chen Chang
- Department of Nursing, Changhua Christian Hospital, Changhua, Taiwan; College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Chin-Yi Huang
- Medical Education Department, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsiu-Hung Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Warner NZ, Matthews S, Groarke A, McSharry J. A systematic review of psycho-social interventions for individuals with a BRCA1/2 pathogenic variant. J Genet Couns 2021; 30:1695-1706. [PMID: 34060696 DOI: 10.1002/jgc4.1436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022]
Abstract
Women with a pathogenic variant in BRCA1/2 genes have up to an 87% lifetime risk of breast cancer and up to a 68% lifetime risk for ovarian cancer. Common risk-reducing measures include prophylactic surgeries or pharmacological approaches, such as chemoprevention. Psycho-social issues can arise due to this increased risk, often resulting in heightened distress or anxiety. This review examines the efficacy of interventions aimed at improving psychological adjustment in individuals with a pathogenic variant in BRCA1/2. A Public and Patient Involvement (PPI) Panel of six individuals with a BRCA1/2 pathogenic variant provided input on the terminology used and dissemination of the review. Interventions assessing psychological measures in BRCA1/2 pathogenic variant carriers, published in English, were considered eligible for inclusion. A systematic search strategy was carried out on OVID, EBSCO, Cochrane Library, PubMed, Web of Science Core Collections, and Scopus. Two independent reviewers conducted screening, data extraction, risk of bias assessments, and theory coding. Findings were reported through narrative synthesis. Of the 1,024 results from searches, fifteen interventions were eligible. Nine of these were randomized controlled trials, six were quasi-experimental. There was heterogeneity in intervention design, with limited evidence of improvement upon psychological outcome measures. No study was rated as being low risk for bias. Five studies obtained the highest level of risk for bias, the majority of issues arising from problematic outcome measurement. No single study met all criteria on the Theory Coding Scheme, with five studies mentioning a theoretical aspect to intervention design, of which three employed a middle-range theory only. Some studies demonstrated a longitudinal impact on outcomes, however, there is insufficient evidence to draw broad conclusions from this. Further research is needed to better develop interventions to support those with a pathogenic variant in BRCA1/2 throughout their coping experience.
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Affiliation(s)
| | - Soraya Matthews
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - AnnMarie Groarke
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Jenny McSharry
- School of Psychology, National University of Ireland, Galway, Ireland
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Bagherzadeh R, Sohrabineghad R, Gharibi T, Mehboodi F, Vahedparast H. Effect of Mindfulness-Based Stress Reduction Training on Revealing Sexual Function in Iranian Women with Breast Cancer. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09660-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Chavez JL, Porucznik CA, Gren LH, Guan J, Joyce E, Brodke DS, Dailey AT, Mahan MA, Hood RS, Lawrence BD, Spiker WR, Spina NT, Bisson EF. The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Outcomes in Lumbar Spine Degenerative Disease: 3-Month and 12-Month Results of a Pilot Study. World Neurosurg 2020; 139:e230-e236. [PMID: 32278820 DOI: 10.1016/j.wneu.2020.03.186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND We previously reported inpatient and 30-day postoperative patient-reported outcomes (PROs) of a controlled, noncrossover pilot study using preoperative mindfulness-based stress reduction (MBSR) training for lumbar spine surgery. Our goal here was to assess 3-month and 12-month postoperative PROs of preoperative MBSR in lumbar spine surgery for degenerative disease. METHODS Intervention group participants were prospectively enrolled in a preoperative online MBSR course. A comparison standard care only group was one-to-one matched retrospectively by age, sex, surgery type, and prescription opioid use. Three-month and 12-month postoperative PROs for pain, disability, quality of life, and opioid use were compared within and between groups. Regression models were used to assess whether MBSR use predicted outcomes. RESULTS Twenty-four participants were included in each group. At 3 months, follow-up was 87.5% and 95.8% in the comparison and intervention groups, respectively. In the intervention group, mean Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) was significantly higher, whereas mean Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) and Oswestry Disability Index were significantly lower. The change from baseline in mean PROMIS-PF and PROMIS-PI was significantly greater than in the comparison group. At 12 months, follow-up was 58.3% and 83.3% in the comparison and intervention groups, respectively. In the intervention group, mean PROMIS-PI was significantly lower and change in mean PROMIS-PI from baseline was significantly greater. MBSR use was a significant predictor of change in PROMIS-PF at 3 months and in PROMIS-PI at 12 months. No adverse events were reported. CONCLUSIONS Three-month and 12-month results suggest that preoperative MBSR may have pain control benefits in lumbar spine surgery.
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Affiliation(s)
- Juneyoung L Chavez
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
| | - Christina A Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Lisa H Gren
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jian Guan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Evan Joyce
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Darrel S Brodke
- Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Mark A Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Robert S Hood
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Brandon D Lawrence
- Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - William R Spiker
- Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Nicholas T Spina
- Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Erica F Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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Linguistic translation and validation of the Menopause-specific Quality of Life (MENQOL) questionnaire in Greek menopausal women. ACTA ACUST UNITED AC 2020; 27:808-815. [PMID: 32217885 DOI: 10.1097/gme.0000000000001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to translate the Menopause-specific Quality of Life (MENQOL) questionnaire in Greek and validate it for usage in the Greek population both in written and electronic form. METHODS The original English questionnaire MENQOL with 1-month recall period was translated by our team. According to instructions by Mapi Research Trust, the questionnaire was forward and back-translated, followed by patient testing and proofreading. Then it was transcripted electronically. Validation was performed with the following tests: internal consistency (reliability), stability (test-retest reliability) with Cronbach's alpha correlations, independent and paired t tests, and Pearson's correlation coefficients. RESULTS A total of 105 women, the majority recently menopausal, participated in the study. Internal consistency using the Cronbach's alpha showed high reliability ranging between 0.833 (physical domain) and 0.896 (vasomotor domain) for the written, and 0.720 (physical domain) and 0.868 (vasomotor domain) for the online form. Test-retest reliability was also high for both forms. The sexual domain of MENQOL had the higher mean, indicating the highest impact on quality of life (3.80 ± 2.35). CONCLUSIONS The Greek version of MENQOL is a reliable instrument for evaluating menopausal women. Availability of an online form will allow wider dissemination of the questionnaire. Further use of the questionnaire in Greece may lead to better understanding of the bothersome symptoms of menopause; a prerequisite to develop intervention studies for amelioration of quality of life.
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Sexual Health in the Era of Cancer Genetic Testing: A Systematic Review. Sex Med Rev 2020; 8:231-241. [PMID: 31928932 DOI: 10.1016/j.sxmr.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/24/2019] [Accepted: 11/05/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Genetic testing for germline cancer mutations allows individuals to gain specific knowledge of their hereditary cancer risks. Although risk-reducing strategies such as increased screening, prophylactic surgeries, and chemoprevention may be potentially lifesaving, these options can also significantly impact sexual health and function. AIM This study overviews current challenges at the intersection of cancer genetic testing and sexual health and describes a systematic review that summarizes this evidence, identifies methodological limitations, and provides future research directions. METHODS Articles on the intersection of genetic testing and/or family history of cancer, cancer risk, and sexual health were searched in Medline, PsycINFO, and PsycARTICLES databases. MAIN OUTCOME MEASURE The main outcome measure was sexual health in women who pursued risk-reducing surgery. RESULTS On the basis of the inclusion criteria, 32 studies were reviewed. 31 contained empiric data from 3,367 participants; one was a conceptual study. All studies were published between 2000 and 2019. Mean ages ranged from 38 to 51.2. CONCLUSION Given the prevalence of sexual dysfunction after risk-reducing surgery, evidence-based interventions are needed. Furthermore, quality of life that includes sexual health, in at-risk women who pursue preventive surgery, remains an understudied aspect of cancer genetic testing. Yusufov M, Bober SL. Sexual Health in the Era of Cancer Genetic Testing: A Systematic Review. Sex Med Rev 2020;8:231-241.
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Jeffers L, Reid J, Fitzsimons D, Morrison PJ, Dempster M. Interventions to improve psychosocial well-being in female BRCA-mutation carriers following risk-reducing surgery. Cochrane Database Syst Rev 2019; 10:CD012894. [PMID: 31595976 PMCID: PMC6784162 DOI: 10.1002/14651858.cd012894.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Women who carry a pathogenic mutation in either a BRCA1 DNA repair associated or BRCA2 DNA repair associated (BRCA1 or BRCA2) gene have a high lifetime risk of developing breast and tubo-ovarian cancer. To manage this risk women may choose to undergo risk-reducing surgery to remove breast tissue, ovaries, and fallopian tubes. Surgery should increase survival, but can impact women's lives adversely at the psychological and psychosexual levels. Interventions to facilitate psychological adjustment and improve quality of life post risk-reducing surgery are needed. OBJECTIVES To examine psychosocial interventions in female BRCA carriers who have undergone risk-reducing surgery and to evaluate the effectiveness of such interventions on psychological adjustment and quality of life. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase via Ovid, CINAHL, PsycINFO, Web of Science up to April 2019 and Scopus up to January 2018. We also handsearched abstracts of scientific meetings and other relevant publications. SELECTION CRITERIA We included randomised controlled trials (RCT), non-randomised studies (NRS), prospective and retrospective cohort studies and interventional studies using baseline and postintervention analyses in female BRCA carriers who have undergone risk-reducing surgery. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility studies for inclusion in the review. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We screened 4956 records from the searches, selecting 34 unique studies for full-text scrutiny, of which two met the inclusion criteria: one RCT and one NRS. The included studies assessed 113 female BRCA carriers who had risk-reducing surgery, but there was attrition, and outcome data were not available for all participants at final study assessments. We assessed the RCT as at a high risk of bias whilst the NRS did not have a control group. Our GRADE assessment of the studies was very low-certainty due to the paucity of data and methodological shortcomings of the studies. The primary outcome of quality of life was only measured in the RCT and that was specific to the menopause. Both studies reported on psychological distress and sexual function. Neither study measured body image, perhaps because this is most often associated with risk-reducing mastectomy rather than oophorectomy.The RCT (66 participants recruited with 48 followed to 12 months) assessed the short- and long-term effects of an eight-week mindfulness-based stress reduction (MBSR) training programme on quality of life, sexual functioning, and sexual distress in female BRCA carriers (n = 34) in a specialised family cancer clinic in the Netherlands compared to female BRCA carriers (n = 32) who received usual care. Measurements on the Menopause-Specific Quality of Life Questionnaire (MENQOL) showed some improvement at 3 and 12 months compared to the usual care group. At 3 months the mean MENQOL scores were 3.5 (95% confidence interval (CI) 3.0 to 3.9) and 3.8 (95% CI 3.3 to 4.2) for the MBSR and usual care groups respectively, whilst at 12 months the corresponding values were 3.6 (95% CI 3.1 to 4.0) and 3.9 (95% CI 3.5 to 4.4) (1 study; 48 participants followed up at 12 months). However, these results should be interpreted with caution due to the very low-certainty of the evidence, where a lower score is better. Other outcome measures on the Female Sexual Function Index and the Female Sexual Distress Scale showed no significant differences between the two groups. Our GRADE assessment of the evidence was very low-certainty due to the lack of blinding of participants and personnel, attrition bias and self-selection (as only one-third of eligible women chose to participate in the study) and serious imprecision due to the small sample size and wide 95% CI.The NRS comprised 37 female BRCA carriers selected from three Boston-area hospitals who had undergone a novel sexual health intervention following risk-reducing salpingo-oophorectomy (RRSO) without a history of tubo-ovarian cancer. The intervention consisted of targeted sexual-health education, body awareness and relaxation training, and mindfulness-based cognitive therapy strategies, followed by two sessions of tailored telephone counselling. This was a single-arm study without a control group. Our GRADE assessment of the evidence was very low-certainty, and as there was no comparison group in the included study, we could not estimate a relative effect. The study reported change in psychosexual adjustment from baseline to postintervention (median 2.3 months) using measures of Female Sexual Function Index (n = 34), which yielded change with a mean of 3.91, standard deviation (SD) 9.12, P = 0.018 (1 study, 34 participants; very low-certainty evidence). The Brief Symptom Inventory, Global Severity Index yielded a mean change of 3.92, SD 5.94, P < 0.001. The Sexual Self-Efficacy Scale yielded change with a mean of 12.14, SD 20.56, P < 0.001. The Sexual Knowledge Scale reported mean change of 1.08, SD 1.50, P < 0.001 (n = 36). Participant satisfaction was measured by questionnaire, and 100% participants reported that they enjoyed taking part in the psychoeducation group and felt "certain" or "very certain" that they had learned new skills to help them cope with the sexual side effects of RRSO. AUTHORS' CONCLUSIONS The effect of psychosocial interventions on quality of life and emotional well-being in female BRCA carriers who undergo risk-reducing surgery is uncertain given the very low methodological quality in the two studies included in the review. The absence of such interventions highlights the need for partnership between researchers and clinicians in this specific area to take forward the patient-reported outcomes and develop interventions to address the psychosocial issues related to risk-reducing surgery in female BRCA carriers, particularly in this new era of genomics, where testing may become more mainstream and many more women are identified as gene carriers.
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Affiliation(s)
- Lisa Jeffers
- Regional Medical Genetics CentreMedical GeneticsBelfast Health and Social Care TrustLisburn RoadBelfastUKBT9 7AB
| | - Joanne Reid
- Queen's University BelfastSchool of Nursing and Midwifery10 Malone RoadBelfastUKBT9 5BN
| | - Donna Fitzsimons
- Queen's University BelfastSchool of Nursing and Midwifery10 Malone RoadBelfastUKBT9 5BN
| | - Patrick J Morrison
- Regional Medical Genetics CentreMedical GeneticsBelfast Health and Social Care TrustLisburn RoadBelfastUKBT9 7AB
- Queen's University BelfastCentre for Cancer Research and Cell Biology97 Lisburn RoadBelfastUKBT9 7AE
| | - Martin Dempster
- Queen's University BelfastSchool of PsychologyUniversity RoadBelfastNorthern IrelandUKBT7 1NN
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van Driel C, de Bock GH, Schroevers MJ, Mourits MJ. Mindfulness-based stress reduction for menopausal symptoms after risk-reducing salpingo-oophorectomy (PURSUE study): a randomised controlled trial. BJOG 2018; 126:402-411. [PMID: 30222235 PMCID: PMC6587763 DOI: 10.1111/1471-0528.15471] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 11/28/2022]
Abstract
Objective To assess the short‐ and long‐term effects of mindfulness‐based stress reduction (MBSR) on the resulting quality of life, sexual functioning, and sexual distress after risk‐reducing salpingo‐oophorectomy (RRSO). Design Randomised controlled trial. Setting A specialised family cancer clinic of the university medical center Groningen. Population Sixty‐six women carriers of the BRCA1/2 mutation who developed at least two moderate‐to‐severe menopausal symptoms after RRSO. Methods Women were randomised to an 8‐week MBSR training programme or to care as usual (CAU). Main outcome measures Change in the Menopause‐Specific Quality of Life Questionnaire (MENQOL), the Female Sexual Function Index, and the Female Sexual Distress Scale, administered from baseline at 3, 6, and 12 months. Linear mixed modelling was applied to compare the effect of MBSR with CAU over time. Results At 3 and 12 months, there were statistically significant improvements in the MENQOL for the MBSR group compared with the CAU group (both P = 0.04). At 3 months, the mean MENQOL scores were 3.5 (95% confidence interval, 95% CI 3.0–3.9) and 3.8 (95% CI 3.3–4.2) for the MBSR and CAU groups, respectively; at 12 months, the corresponding values were 3.6 (95% CI 3.1–4.0) and 3.9 (95% CI 3.5–4.4). No significant differences were found between the MBSR and CAU groups in the other scores. Conclusion Mindfulness‐based stress reduction was effective at improving quality of life in the short‐ and long‐term for patients with menopausal symptoms after RRSO; however, it was not associated with an improvement in sexual functioning or distress. Tweetable abstract Mindfulness improves menopause‐related quality of life in women after risk‐reducing salpingo‐oophorectomy. Mindfulness improves menopause‐related quality of life in women after risk‐reducing salpingo‐oophorectomy. This paper includes Author Insights, a video abstract available at https://vimeo.com/rcog/authorinsights15471
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Affiliation(s)
- Cmg van Driel
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M J Schroevers
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M J Mourits
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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