Pain and Cognition of Breast Cancer Survivors Treated with Chemotherapy: The Mediating Role of Depression

OBJECTIVES

While chemotherapy is the primary contributor to cancer-related cognitive impairment (CRCI), interindividual differences in CRCI are not well-understood. Studies suggest that breast cancer (BC) survivors who are in pain are more likely to experience depression, which in turn contributes to CRCI, although this hypothesis is not yet tested. Therefore, this study aimed to investigate the relationship between pain and CRCI among BC survivors and the mediation effect of depression on this relationship.

METHODS

As a secondary analysis of a descriptive cross-sectional study investigating fatigue and preferred types of fatigue self-management in BC survivors recruited from five tertiary hospitals in South Korea; of the 229 participants, data on 186 who received chemotherapy were analyzed. Study participants were aged between 20 and 69 years, diagnosed with stage I to III, and treated with chemotherapy and/or radiation therapy. Measurement was done with Korean versions of the Cognitive Failure Questionnaire (to assess CRCI), Brief Pain Inventory (for pain severity and interference on daily functioning), and C-ESD (for depression). To assess bivariate relationships between pain, depression, and CRCI, Pearson correlation was used. A mediation analysis was used to examine the effect of depression on CRCI.

RESULTS

Significant associations were found among pain, depression, and CRCI (all P < 0.01). Furthermore, a mediation effect of depression was found on the association between pain and CRCI (severity, β = 1.26, SE = 0.38, 95% confidence intervals [0.60, 2.08]; interference, β = 1.53, SE = 0.32, 95% confidence intervals [0.95, 2.20]).

CONCLUSION

Findings indicate that among BC survivors, those with higher pain tend to show higher depression and consequently had lower cognitive function.

IMPLICATION FOR NURSING PRACTICE

Oncology nurses may need to identify BC survivors with higher pain, and screening those survivors could be a strategy to identify those at higher risk for CRCI. Also, nurses should focus on managing depression to prevent and/or treat CRCI in BC survivors.

The Role of Attachment Styles on Quality of Life and Distress Among Early-Stage Female Breast Cancer Patients: A Systematic Review

Cancer patients' quality of life (QoL) and distress are affected by dispositional factors such as attachment anxiety or avoidance. In this review, we aimed to provide a thorough overview of the relationship between attachment dimensions and QoL and distress among early-stage breast cancer patients. Following PRISMA guidelines, we conducted a systematic search using PubMed, PsycINFO, Scopus, Cinahl, Google Scholar, and PMC Europe. We reviewed 8 eligible studies describing 1180 patients. Insecure attachment appeared to be related to poorer QoL and higher distress levels. Avoidant attachment was more frequent and was more often associated with more negative outcomes. Healthcare providers should consider investigating modifiable personality traits in the immediate post diagnosis period to identify patients more vulnerable to mental health problems, deliver personalized care, and reduce emotional burden.

Informational Needs of Surgical Oncology Patients: A Cross-Sectional Patient Survey

INTRODUCTION

Patients newly diagnosed with cancer often seek information prior to being seen by a specialist. Little is known about the type of information desired and the sources used. We asked how patients find information about their new cancer diagnoses to improve information provision.

METHODS

An anonymous seven-question survey was provided to new patients in the surgical and medical oncology clinics at a comprehensive cancer center from February 2021 to June 2021.

RESULTS

Of 503 consecutive patients, 405 (81%) returned surveys; 49% female, 57% aged 51-75 y, and 71% Caucasian. Many (74%) sought information before their visit. Most (57%) relied on prior medical providers and 77% reported them as a trusted source. Nearly 80% of patients used at least one nonvalidated resource; 21% friends and relatives, 20% nongovernment or hospital resources, and 12% social media. Importantly, 23% found conflicting information. Respondents desired information on cancer treatment (58%), alternative therapies (35%), and nutrition and supplements (31%).

CONCLUSIONS

Patients with cancer trust information from medical providers but seek information from a variety of sources that can provide conflicting information. These data support encouraging patients to use validated sources, providing robust organization-based resources, and engaging patients on topics such as alternative therapies and nutrition.

Is rumination associated with psychological distress after a cancer diagnosis? A systematic review

Objective: The aim of this work was to review evidence on the association between psychological rumination and distress in those diagnosed with cancer. Methods: Six databases were searched for studies exploring rumination alongside overall assessments of psychological distress, depression, anxiety, or stress. Results: Sixteen studies were identified. Rumination was associated with distress cross-sectionally and longitudinally. However, once baseline depression was controlled for, the association was no longer seen. The emotional valence of ruminative thoughts and the style in which they were processed, rather than their topic, was associated with distress. Brooding and intrusive rumination were associated with increased distress, deliberate rumination had no association, and reflection/instrumentality had mixed findings. Conclusions: This review highlights that it is not necessarily the topic of content, but the style and valence of rumination that is important when considering its association with distress. The style of rumination should be the target of clinical intervention, including brooding and intrusion.

Facteurs associés à la symptomatologie anxiodépressive chez des femmes tunisiennes atteintes d’un cancer du sein

Objectifs : L’étude avait pour objectif d’estimer la prévalence de la dépression et de l’anxiété dans une population de femmes tunisiennes suivies pour un cancer du sein et de relever les données sociodémographiques, cliniques et de vie de couple qui leur sont associées.

Matériels et méthodes : Une étude transversale auprès de 100 patientes suivies pour un cancer du sein a été réalisée. Un questionnaire portant sur les caractéristiques sociodémographiques, cliniques, thérapeutiques, sur la vie conjugale et sur la sexualité du couple a été administré. L’échelle HADS (Hospital Anxiety and Depression Scale) a été utilisée pour le dépistage des symptômes anxieux et dépressifs.

Résultats : Un score clinique a été retrouvé dans 48 % des cas pour l’anxiété et 37 % des cas pour la dépression. Les patientes qui ont vécu une réaction négative de leur conjoint face à leur maladie et dont la relation de couple et la relation sexuelle ont été altérées présentaient des scores significativement plus élevés de symptomatologie anxieuse et dépressive. Une relation sexuelle non altérée était retrouvée comme facteur protecteur de l’anxiété et de la dépression.

Conclusion : Les résultats de cette étude mettent en évidence l’importance de développer des mesures spécifiques pour améliorer la communication et promouvoir la santé sexuelle au sein du couple en Tunisie.

Association of cognitive impairment and breast cancer survivorship on quality of life in younger breast cancer survivors

Purpose

Younger breast cancer survivors (BCS) often report cognitive impairment and poor quality of life (QoL), which could be interrelated. The purpose of this study was to examine the association of cognitive impairment and breast cancer status (BCS versus healthy control (HC)), with QoL, which included psychological (depressive symptoms, well-being, perceived stress, and personal growth) and physical well-being (physical functioning and fatigue).

Methods

Four hundred ninety-eight BCS (≤45 years at diagnosis) who were 3 to 8 years post-chemotherapy treatment and 394 HC completed subjective questionnaires and a one-time neuropsychological assessment, including tests of attention, memory, processing speed, and verbal fluency. For each test, cognitive impairment was defined as scoring 1.5 and 2.0 standard deviations below the mean of the HC group. Separate linear regression models for each outcome were ran controlling for known covariates.

Results

BCS reported significantly more memory problems than HC (p < 0.0001), with up to 23% having significant impairment. Cognitive performance did not differ significantly between BCS and HCs. BCS vs. HCs had greater depression and fatigue, yet more personal growth. Objective and subjective cognitive impairment were significantly related to greater depressive symptoms and perceived stress and lower well-being and physical functioning; whereas, objective impairment was related to less personal growth and subjective impairment was related to greater fatigue.

Conclusions

Younger BCS report significant cognitive impairment years after treatment which may relate to greater decrements in QoL.

Implications to Cancer Survivors

Assessment and interventions to address cognitive concerns may also influence QoL outcomes in younger BCS.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11764-021-01075-x.

Quality of life of women with breast cancer undergoing treatment and follow-up at King Salman Armed Forces Hospital in Tabuk, Saudi Arabia

Background: Assessment of quality of life can significantly impact the diagnosis and treatment course of breast cancer, resulting in a better prognosis among patients. However, very limited data are available regarding quality of life among breast cancer patients in Saudi Arabia.

Objective: To determine the quality of life of women with breast cancer referred to the Surgery Department of King Salman Armed Forces Hospital for treatment and follow-up.

Materials and methods: This cross-sectional study used a questionnaire to assess the quality of life of 96 adult Saudi female patients diagnosed with breast cancer from January 2016 to September 2017.

Results: One-third of the surveyed patients (31.3%) were >48 years of age, and 29.2% were in the 18- to 27-year age group. Regarding marital status, 35.4% of the women were married and 8.3% were single. The highest score was observed for the physical well-being subscale (7.65±071), followed by the spiritual well-being subscale (7.19±0.66), psychological well-being scale (7.09±0.30) and social concerns subscale (7.02±0.41). Age, marital status and cancer stage differed remarkably (P=0.00) for the physical well-being subscale scores. Meanwhile, employed women differed significantly (P=0.01) in terms of psychological well-being compared to those who were not employed. The social well-being subscale score of single and married women was significantly higher than that of widowed and divorced women. Women who underwent radiation and immunotherapy had significantly higher scores for the spiritual well-being subscale.

Conclusions: Scores were determined for the physical, spiritual, psychological and social well-being scales. Age, marital status and cancer stage significantly influenced the physical well-being scale; the occupation status of the patients significantly impacted the psychological well-being scale. Social well-being can be predicted by marital status, and chemotherapy and radiation significantly impacted the spiritual well-being scale.

What information do patients want across their cancer journeys? A network analysis of cancer patients' information needs

Background

Patients want information across their cancer journeys. We investigated what sort of information they want and at what stage in the cancer journey by examining English patients’ satisfaction derived from ratings of their care.

Methods

Using patient experience data from 209 Clinical Commission Groups (CCGs) involving 72 788 respondents in 2016, overall patient satisfaction ratings and information needs questions were extracted. Novel network analysis techniques were used to construct an undirected weighted concentration network to assess the relationship between information needs and patient satisfaction.

Results

From the network analysis, we found that patients value information early in the pathway; there were higher associations between patient satisfaction and when information needs are met in earlier phases of the cancer journey. Across the stages of the cancer journey, strong associations between information needs and patient satisfaction emerged during diagnostic testing and also at those points when patients received information provided by the clinical nurse specialists. A mixture of strong and weak associations between patient satisfaction and information needs was found during later phases of the cancer journey, specifically when patients move from treatment to home care. Our study identified that meeting needs for information related to supportive care may be a weaker factor in patient satisfaction than meeting needs for information related to the patient's disease, its treatment and the side effects of treatment.

Conclusion

If patients have their information needs met, especially during stages within the cancer journey when information needs are highest, they are more likely to be satisfied with their care. Our study has implications for information giving and improving patient satisfaction in cancer care.

Quality of Life and Body Image as a Function of Time from Mastectomy

BACKGROUND

We sought to determine the impact of time after surgery on quality of life (QoL) and body image in breast cancer patients undergoing mastectomy.

METHODS

Female patients with unilateral breast cancer who had undergone mastectomy were surveyed regarding their body image (Body Image After Breast Cancer Questionnaire; BIBCQ) and QoL (FACT-B). Data were analyzed using nonparametric statistics (SPSS version 24).

RESULTS

Ninety-four of the 109 patients approached completed both surveys (86.2% response rate). Median patient age at the time of surgery was 49.5 (range 29-82); the survey was administered at a median of 14.2 months postoperatively (range 0.3-192.1 months). Seventy-four patients (78.7%) had reconstruction, and 52 patients (55.3%) chose to undergo contralateral prophylactic mastectomy. Patients who reported an above average overall body image perception on the BIBCQ tended to be further out from their surgery than those who reported a below average perception (median 20.9 vs. 8.1 months, respectively, p = 0.009). Patients who reported above average QoL also tended to be further out from their surgery compared with those with below average overall QoL (median 21.8 vs. 6.4 months, respectively, p = 0.004). Receipt of reconstruction, contralateral prophylactic mastectomy, disease stage, patient race, education, insurance type, income, marital status, employment status, and age at surgery did not significantly affect body image nor QoL in this cohort.

CONCLUSIONS

Better body image perception and higher QoL were associated with being further out from surgery. These findings suggest that body image and QoL may improve with time, as patients acclimatize to their "new normal."

Changes in depression status during the year after breast cancer surgery and impact on quality of life and functioning

OBJECTIVE

Although breast cancer patients' depression changes over time, most longitudinal studies have assessed the influence of only baseline depression on quality of life (QoL). Therefore, this study investigated the influence of changes in depression status on QoL in the year after surgery.

METHODS

Participants were interviewed at 2-5days and at 1year after surgery. Depression was diagnosed at both time points, and participants were classified into four groups: no, recovered, incident, and persistent depression. QoL-related functioning and symptoms were evaluated with the EORTC QLQ-C30 questionnaire and the interaction of depression and QoL was analyzed using a repeated-measures analysis of covariance (RMANCOVA).

RESULTS

Of the 306 participants, 247 were evaluated at 1year after surgery; 165 had no depression, 40 had recovered from depression, 24 had incident depression, and 18 had persistent depression. The RMANCOVA revealed significant time-by-group interactions; the no-depression group exhibited better recovery in general QoL and functioning, whereas the persistent-depression group showed the worst recovery. QoL and functioning improved in the recovered depression group, but worsened in the group with incident depression.

CONCLUSIONS

The different impacts of changes in depression status on QoL highlight the importance of periodic screening for depression.

Quality of Life Determinants in Breast Cancer Patients in Central Rural India

Introduction:

Breast cancer is the most frequently diagnosed cancer among women throughout world, with incidence rates increasing in India. Improved survival in breast cancer patients has resulted in their quality of life (QOL) becoming an important issue. Identifying determinants for QOL may provide insights into how to improve their living conditions. This study aimed to assess socio-demographic and clinical factors, as well as the role of self-efficacy, in relation to QOL among women with breast cancer in rural India.

Methods:

A total of 208 female patients with infiltrating carcinoma of the breast participated in the study. A questionnaire was administered that included sections for socio-demographic characteristics, clinical stage of the cancer and patient delay in seeking health care. A standardized instrument to measure self-efficacy was applied. To assess QOL, the WHOQOL – BREF instrument was used.

Results:

The overall mean score for QOL was 59.3. For domain 1 (physical health) the mean score across all groups was 55.5, for psychological health 58.2, for social relationships 63.2 and for environmental factors, 60.4. The environmental domain in QOL was negatively associated with lower education. Being divorced/widowed/unmarried had a negative association with the psychological health and social relationship dimensions, whereas higher income was positively associated with QOL parameters such as psychology, social relationships and environmental factors. Self-efficacy was positively associated with all four domains of QOL.

Conclusions:

The present study demonstrated a moderate QOL in women with breast cancer in rural India. Young age, lack of education and being without a partner were negatively related to QOL, and employment as casual and industrial workers, high monthly family income and higher self-efficacy were positively associated with QOL. A comprehensive public health initiative is required, including social, financial and environmental support, that can provide better QOL for breast cancer survivors.

Symptom-Management Self-efficacy Mediates the Effects of Symptom Distress on the Quality of Life Among Taiwanese Oncology Outpatients With Breast Cancer

BACKGROUND

Theory has suggested that self-efficacy plays an important role in facilitating health behaviors and, in turn, promoting healthy outcomes. However, limited research has focused on the mechanisms through which symptom-management self-efficacy acts as a mediator between symptom distress and quality of life (QOL) for patients with breast cancer who have undergone chemotherapy.

OBJECTIVE

The purpose of this study is to examine the association between symptom distress and QOL among Taiwanese oncology outpatients with breast cancer and proposed symptom-management self-efficacy as a mediator between symptom distress and QOL.

METHODS

This cross-sectional study included 201 oncology outpatients in 1 teaching hospital in the Taipei area of Taiwan. The research instruments included the Symptom-Management Self-Efficacy Scale-Breast Cancer, the symptom distress scale, and the European Organization for Research and Treatment of Cancer Quality of Life Group Questionnaire. Bootstrapping was used to statistically assess the possible mediating effects of self-efficacy on QOL.

RESULTS

Symptom-management self-efficacy mediated the association between symptom distress and global QOL (indirect effect, -6.33; 95% confidence interval [CI], -9.63 to -3.74), functional QOL (indirect effect, -4.47; 95% CI, -7.05 to -2.36), and symptom QOL (indirect effect, 2.59; 95% CI, 1.07-4.83). All of the 95% CIs were significant. The lower symptom distress that patients experienced was indirectly associated with better QOL through higher self-efficacy.

CONCLUSIONS

Symptom management self-efficacy may be a crucial mechanism through which symptom distress influences patients' QOL.

IMPLICATIONS

Clinicians may incorporate strategies focused on improving patients' self-efficacy in relation to managing their symptoms caused by chemotherapy to improve patients' QOL.

Symptom incidence, distress, cancer-related distress, and adherence to chemotherapy among African American women with breast cancer

BACKGROUND

There is a persistent racial survival disparity between African American (AA) and white women with breast cancer. There is evidence that symptom incidence, associated distress, and overall cancer-related distress may be unexplored, important contributing factors. The purpose of the current study was to: 1) describe and compare the number of chemotherapy-related symptoms and associated distress among AA women with breast cancer over the course of chemotherapy at 3 time points (at baseline before initiating chemotherapy, midpoint, and at the completion of chemotherapy); and 2) to describe the relationship between the number of chemotherapy-related symptoms and overall cancer distress compared with the ability to receive at least 85% of the prescribed chemotherapy within the prescribed timeframe.

METHODS

Descriptive, comparative, and correlational analyses of symptom incidence, symptom distress, cancer-related distress, and prescribed chemotherapy dose received among a cohort of AA women receiving chemotherapy for breast cancer were performed.

RESULTS

AA women (121 women) experienced worsening symptoms from baseline to midpoint in chemotherapy and then stabilized for the duration of therapy. The inability to receive 85% of the prescribed chemotherapy within a prescribed time point was found to be significantly correlated with midpoint symptom distress.

CONCLUSIONS

The main findings of the current study were that AA women experience a deterioration in symptom distress over the course of chemotherapy from baseline (before chemotherapy) to the midpoint, which was found to be associated with less adherence to chemotherapy overall. Thus, the incidence and management of physical and emotional symptoms, as measured through a multidimensional symptom measurement tool, may be contributing to breast cancer dose disparity and should be explored further. Cancer 2017;123:2061-2069. © 2017 American Cancer Society.

Psychological treatments to improve quality of life in cancer contexts: A meta-analysis

This study aimed to analyze the effects of psychological treatments on quality of life among cancer patients and survivors. Additionally, it was explored the moderating influence of some medical- and treatment-related features on these effects. Scientific studies published between 1970 and 2012 were analyzed. Seventy-eight studies were included in a meta-analysis. Concerns related to samples, interventions, and standard of methodological evidence were explored across the studies. A significant overall effect size of psychological interventions was revealed (g = .35). Clinical state and use of adjuvant psychological treatment for managing medical side effects moderated this result (p < .05). Furthermore, a meta-regression model was showed significant (R 2  = .30) so as to explain the quality of life change associated with psychological interventions. The psychotherapeutic benefits on depressive symptomatology were included as a moderating factor. To sum up, quality of life is improved by psychological interventions, especially when patients have to cope with medical treatment or with adjustment after the disease is treated. Psychological treatments tend to promote better outcomes when depressive symptomatology is managed. These findings support that providing psychological treatments should be considered as crucial for the patient's health in cancer contexts.

Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence

OBJECTIVE

Although cancer care guidelines recommend screening for distress among cancer patients and offering psychological support when indicated, many patients decline offers of such support. This study aimed to quantify uptake and adherence to psychological support and to identify predictors of each.

METHODS

Searches were conducted in Embase, Medline, PsychInfo and Scopus to identify studies reporting uptake or adherence rates for individual psychological interventions targeting distress, anxiety or depression for cancer patients or survivors.

RESULTS

Across the 53 included studies reporting uptake and/or adherence rates for 12 323 cancer patients, the uptake and adherence rates were 60.1% and 90.4%, respectively. Patients screened and identified as distressed were less likely to accept intervention than unselected patients (50.3% compared with 66.3%, Q(1) = 4.66, P = 0.031). Uptake of therapy was higher for interventions delivered by telephone rather than face-to-face (71.2% compared with 53.8%, Q(1) = 4.91, P = 0.027) and when therapy was offered prior to medical treatment compared with later (72.9% compared with 56.8%, Q(1) = 5.60, P = 0.018). Patients were more likely to accept intervention from nurses than other allied health professionals (68.3% compared with 50.5%, Q(1) = 5.76, P = 0.016).

CONCLUSIONS

Patients appeared more receptive to interventions offered near diagnosis, over the telephone and by nurses. Although this suggests higher acceptability of such interventions, evidence of their greater efficacy is lacking, and this merits further investigation. Research is needed to understand barriers to acceptance of psychological support, particularly because uptake rates were lower for distressed patients. Copyright © 2016 John Wiley & Sons, Ltd.

Indicators of distress in newly diagnosed breast cancer patients

Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life.

Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment.

Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress.

Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient’s knowledge (β = − 0.22), which, in turn, was positively associated with both attitudes toward breast cancer (β = 0.39) and coping self-efficacy (β = 0.36). Self-efficacy was then directly related to psychological distress (β = − 0.68).

Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress.

Decreased Cortisol and Pain in Breast Cancer: Biofield Therapy Potential

Breast cancer is one of the leading causes of cancer death among women of all races. Pain is a common symptom associated with cancer; 75–90% of cancer patients experience pain during their illness and up to 50% of that pain is undertreated. Unrelieved pain leads to increased levels of the stress hormone cortisol. The purpose of this study was to examine the impact of bioenergy on fecal cortisol levels for mice injected with murine mammary carcinoma 4T1 in two separate pilot studies. Using a multiple experimental group design, six to eight week old female BALB/c mice were injected with tumor and randomly assigned, in groups of 10, to daily treatment, every other day treatment, and no treatment groups. Five days after tumor cell injection, bioenergy interventions were begun for a period of ten consecutive days. Fecal samples were collected for each study and ELISA analysis was conducted at the end of both studies. For both studies, cortisol levels were decreased in the every other day treatment groups but remained high in the no treatment groups. Future studies utilizing bioenergy therapies on cortisol levels in a murine breast cancer model can begin to describe pain outcomes and therapeutic dose.

Positive psychology group intervention for breast cancer patients: a randomised trial

This study assessed the effects of a psychological group intervention based on positive psychology in women with breast cancer. 175 women were randomly assigned either to an experimental group, receiving the 14-session intervention (n = 87), or to a wait list group (n = 88) that did not receive any type of intervention. For treatment, a group intervention was applied, based on improving psychological strengths and enhancing positive psychology-based styles of coping. Strength-related outcomes, self-esteem, well-being, and happiness were assessed before and after the intervention. The experimental group showed higher scores on all of the study variables after the intervention. Participants reported improved self-esteem, emotional intelligence-related abilities, resilience, and optimism, as well as positive affectivity, well-being, and happiness. The results show a beneficial effect of this psychological intervention based on positive psychology on female breast cancer patients' psychological health.