Evaluation of the Psychometric Properties of the Translated Physical Self-Perception Profile Among Chinese Breast Cancer Survivor

PURPOSE

The purpose of this study was to translate the original English version of the Physical Self-Perception Profile into Cantonese Chinese, while considering linguistic and socio-cultural characteristics, and to evaluate its psychometric properties among Chinese breast cancer survivors in Hong Kong, China, thus providing a valid, culturally relevant tool for assessing physical self-esteem among this population.

METHODS

The 30-item, 5 subscale Physical Self-Perception Profile was translated into Chinese by the combined translation technique. The psychometric properties of the Cantonese version of the Physical Self-Perception Profile were examined in 292 Hong Kong Chinese breast cancer survivors for internal consistency and test-retest reliability. A confirmatory factor analysis was conducted to evaluate the structural validity. A panel of five experts examined its content validity. The concurrent validity was examined by correlating the Physical Self-Perception Profile and a validated global self-esteem measure.

RESULTS

The Cantonese version of the Physical Self-Perception Profile demonstrated satisfactory content validity, also satisfactory internal consistency with Cronbach's α ranging from .64 to .80, as well as good test-retest reliability, with an intraclass correlation coefficient ranging from .77 to .81. The confirmatory factor analysis showed a fairly good fit of the four-factor subdomain structure, namely, physical condition, physical strength, body attractiveness, and sports competence. The concurrent validity of the Chinese version Physical Self-Perception Profile was demonstrated by a significant positive correlation between the physical self-worth domain and four subdomains with global self-esteem. In addition, the four subdomains had statistically significant positive correlations, with the physical self-worth domain indicating the instrument's hierarchical structure.

CONCLUSION

The study translated the Physical Self-Perception Profile from English to Cantonese and demonstrated its desirable psychometric properties among Chinese Hong Kong breast cancer survivors. The linguistical and cultural adaptation of this instrument can serve as a valid and reliable tool for assessing physical self-esteem among breast cancer survivors in Hong Kong, China.

Exercise interventions for self-perceived body image, self-esteem and self-efficacy in women diagnosed with breast cancer: a systematic review with meta-analysis and meta-regressions

PURPOSE

To synthesise the effectiveness of exercise interventions on self-perceived body image, self-esteem and self-efficacy in women diagnosed with breast cancer who are undergoing or have completed primary adjuvant treatments.

METHODS

A systematic review was conducted with meta-analysis and meta-regressions. Five electronic databases were searched from inception to June 2023, and hand searches were performed to explore the reference lists of similar systematic reviews. The established selection criteria were randomised clinical trials that evaluated any type of physical exercise intervention with self-perceived body image, self-esteem and self-efficacy as outcomes. No restrictions were imposed with respect to the control group. Main characteristics were extracted for each study. Meta-analyses, meta-regressions and sensitivity analyses were performed. The certainty of evidence for each outcome was graded using the GRADE approach. The risk of bias was evaluated using the RoB2 Cochrane tool.

RESULTS

Twenty studies, comprising 19 different samples (n = 2030), were included. In general, meta-analysis indicated that physical exercise interventions were not superior to controls for improving self-esteem and body image in women diagnosed with breast cancer. However, subgroup meta-analysis showed a significant difference in self-esteem improvement for resistance exercise (SMD = 0.31; 95% CI = 0.07, 0.55; p = 0.01; I2 = 0%) and supervised exercise (SMD = 0.25; 95% CI = 0.08, 0.42; p = 0.0004; I2 = 0%) compared with controls. Self-efficacy results were scarce and controversial. In addition, serious concerns were mainly detected in terms of the risk of bias and indirectness of the evidence, which caused the certainty of evidence to be very low for all outcomes.

CONCLUSION

Supervised exercise and resistance training appear to be effective exercise modalities for improving self-esteem in women diagnosed with breast cancer. In contrast, exercise interventions are not significantly associated with improvements in body image, while results on self-efficacy are controversial. However, due to the study's limitations, further research is needed.

What is the relationship between body image and the quality of life of women who underwent surgery for breast cancer? A scoping review

PURPOSE

This review aimed to identify, characterize, map, and summarize existing knowledge about the relationship of perceived body image with the quality of life (QoL) of women who have undergone surgical treatment for breast cancer.

METHODS

A scoping review was conducted following the PRISMA-ScR guidelines. PubMed, PsycINFO and Scopus databases were searched, and articles published until August 2022 were included.

RESULTS

The search resulted in 796 records, and 51 articles were included for analysis. A significant negative impact on body image perception and QoL after surgical treatment for breast cancer was found in the majority of studies. Sociodemographic variables such as age, education, socioeconomic status, unstable attachment styles and time after the surgery may have an effect on a worsening of the overall body image and QoL score of women. It was found that there was greater dissatisfaction with body image in women who underwent mastectomy compared to those who underwent conservative surgery.

CONCLUSION

Evidence has shown that breast cancer surgery affects the perceived body image and QoL of patients worldwide. Age, education, socioeconomic status, and the type of surgery are potential factors influencing these outcomes. It is worth noting that the review encompassed articles from various countries, reflecting a significant cultural diversity among the studied populations. However, most of these articles did not delve into an analysis of these cultural disparities. This review also indicated insufficient details regarding the assessment instruments used to assess perceived body image.

Tackling Insomnia Symptoms through Vestibular Stimulation in Patients with Breast Cancer: A Perspective Paper

Insomnia symptoms are common among patients with breast cancer (BC; 20-70%) and are predictors of cancer progression and quality of life. Studies have highlighted sleep structure modifications, including increased awakenings and reduced sleep efficiency and total sleep time. Such modifications may result from circadian rhythm alterations consistently reported in this pathology and known as carcinogenic factors, including lower melatonin levels, a flattened diurnal cortisol pattern, and lower rest-activity rhythm amplitude and robustness. Cognitive behavioral therapy and physical activity are the most commonly used non-pharmacological interventions to counter insomnia difficulties in patients with BC. However, their effects on sleep structure remain unclear. Moreover, such approaches may be difficult to implement shortly after chemotherapy. Innovatively, vestibular stimulation would be particularly suited to tackling insomnia symptoms. Indeed, recent reports have shown that vestibular stimulation could resynchronize circadian rhythms and improve deep sleep in healthy volunteers. Moreover, vestibular dysfunction has been reported following chemotherapy. This perspective paper aims to support the evidence of using galvanic vestibular stimulation to resynchronize circadian rhythms and reduce insomnia symptoms in patients with BC, with beneficial effects on quality of life and, potentially, survival.

The role of exercise for pain management in adults living with and beyond cancer: a systematic review and meta-analysis

BACKGROUND

Pain is a common side effect of cancer or cancer treatment that negatively impacts biopsychosocial wellbeing and quality of life. Exercise is a potential intervention to manage pain that is safe and has multiple benefits. The objective was to determine the role of exercise in cancer pain management.

METHODS

We completed a systematic review and meta-analysis of exercise interventions in adults with any type or stage of cancer by searching Ovid MEDLINE®, Embase, APA PsycInfo, the Cochrane Central Register of Controlled Trials, CINAHL, and SPORTDiscus. We included experimental and quasi-experimental designs where pain was measured as an outcome. Data synthesis included narrative and tabular summary. A meta-analysis was performed on studies powered to detect the effect of exercise on pain. Study quality was evaluated using the Cochrane risk of bias tool and certainty of evidence was evaluated using the GRADE tool.

RESULTS

Seventy-six studies were included. Studies were predominantly conducted in breast cancer and exercise usually included a combination of aerobic and strength training. Ten studies were included in the meta-analysis demonstrating a significant effect for exercise in decreasing pain (estimated average standard mean difference (SMD) was g =  - 0.73 (95% CI: - 1.16 to - 0.30)); however, the overall effect prediction interval was large. Overall risk of bias for most studies was rated as some concerns and the grading of evidence certainty was low.

CONCLUSION

There are limitations in the evidence for exercise to manage cancer-related pain. Further research is needed to understand the role of exercise in a multimodal pain management strategy.

A longitudinal study of physical activity among Malaysian breast cancer survivors

Regular physical activity (PA) after a breast cancer diagnosis is associated with reduced mortality and better quality of life. In this prospective cohort study, we aimed to explore the trends of PA among breast cancer survivors over three years and identify factors associated with low PA. Interviews on 133 breast cancer patients were conducted at baseline, one and three years after the diagnosis of breast cancer at University Malaya Medical Centre in Kuala Lumpur. Physical activity was measured by using the Global Physical Activity Questionnaire. PA was categorised as active (≥ 600 MET-min/week) and inactive (<600 MET-min/week). We used the generalised estimating equation method to examine PA levels and factors affecting PA longitudinally. The survivors' mean age was 56.89 (±10.56) years; half were Chinese (50.4%), and 70.7% were married. At baseline, 48.1% of the patients were active, but the proportion of active patients declined to 39.8% at one year and 35.3% in the third year. The mean total PA decreased significantly from 3503±6838.3 MET-min/week to 1494.0±2679.8 MET-min/week (one year) and 792.5±1364 MET-min/week (three years) (p<0.001). Three years after diagnosis (adjusted odds ratio [AOR]: 1.74, p = 0.021); Malay ethnicity (AOR: 1.86, p = 0.042) and being underweight (AOR: 3.43, p = 0.004) were significantly associated with inactivity. We demonstrated that breast cancer survivors in Malaysia had inadequate PA levels at diagnosis, which decreased over time. Thus, it is vital to communicate about the benefits of PA on cancer outcomes and continue to encourage breast cancer survivors to be physically active throughout the extended survivorship period, especially in the Malay ethnic group and underweight patients.

Role of weight lost in breast cancer-related lymph

OBJECTIVE

Analysis of data collected in routine clinical practice of the combined impact of both physical activity and decrease in body mass index (BMI) on a minor prevalence of lymphedema in post-breast cancer patients.

METHODS

Analysis of data obtained by the specialized rehabilitation unit, from 99 female patients for 18 months, after a specific diet, sports program and complete decongestive therapy (CDT) was indicated. Personal data, affected organ volume, weight, physical activity level and Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4) were collected in follow-up visits.

RESULTS

Although the average of body-mass index showed no change during the assessment period, about 13% of patients in the second follow-up visit and 30% in the third one had lost weight. Women experiencing weight-loss in the third follow-up visit presented a reduced volume of the affected organ [-50 (-248 to 141) ml vs. 130 (-148 to 355) ml, p<0.05] as compared to weight-gaining patients. No relationship was established between physical activity and lymphedema volume changes.

CONCLUSIONS

Apart from the conventional treatment with orthotics and manual lymph drainage, BCRL prevention and treatment needs to focus - right from the start - on weight management or weight-loss in obese patients.

Physical Activity and Health-Related Quality of Life in Women With Breast Cancer: A Meta-Analysis

BACKGROUND

Physical activity (PA) is associated with improved health-related quality of life (HRQoL) among women with breast cancer; however, uncertainty remains regarding PA types and dose (frequency, duration, intensity) and various HRQoL measures. A systematic review and meta-analysis of randomized controlled trials was conducted to clarify whether specific types and doses of physical activity was related to global and specific domains of HRQoL, as part of the Global Cancer Update Programme, formerly known as the World Cancer Research Fund-American Institute for Cancer Research Continuous Update Project.

METHODS

PubMed and CENTRAL databases were searched up to August 31, 2019. Weighted mean differences (WMDs) in HRQoL scores were estimated using random effects models. An independent expert panel graded the evidence.

RESULTS

A total of 79 randomized controlled trials (14 554 breast cancer patients) were included. PA interventions resulted in higher global HRQoL as measured by the Functional Assessment of Cancer Therapy-Breast (WMD = 5.94, 95% confidence intervals [CI] = 2.64 to 9.24; I2 = 59%, n = 12), Functional Assessment of Cancer Therapy-General (WMD = 4.53, 95% CI = 1.94 to 7.13; I2 = 72%, n = 18), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (WMD = 6.78, 95% CI = 2.61 to 10.95; I2 = 76.3%, n = 17). The likelihood of causality was considered probable that PA improves HRQoL in breast cancer survivors. Effects were weaker for physical function and mental and emotional health. Evidence regarding dose and type of PA remains insufficient for firm conclusions.

CONCLUSION

PA results in improved global HRQoL in breast cancer survivors with weaker effects observed for physical function and mental and emotional health. Additional research is needed to define the impact of types and doses of activity on various domains of HRQoL.

Systematic Review of Functional Outcomes in Cancer Rehabilitation

OBJECTIVE

To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains.

DATA SOURCES

PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019.

STUDY SELECTION

Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion.

DATA EXTRACTION

Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV).

DATA SYNTHESIS

Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome.

CONCLUSIONS

These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.

Effectiveness of different types, delivery modes and extensiveness of exercise in patients with breast cancer receiving systemic treatment - A systematic review and meta-analysis

BACKGROUND

Effects of exercise in patients with breast cancer have been thoroughly investigated. The aim was to explore differences in effects regarding type, delivery mode and extensiveness (e.g. intensity; volume) of the interventions.

METHODS

We searched for randomised controlled trials including patients with breast cancer receiving systemic treatment, exercise-based interventions, and measures on patient reported- and objectively measured outcomes.

RESULTS

Exercise showed significant and moderate effects on the primary outcomes quality of life and physical function, Standardised Mean Difference: 0.52 (95 % CI 0.38-0.65) and 0.52 (95 % CI 0.38-0.66), respectively. Type of exercise had little influence on the effects, however combined aerobic- and resistance exercise seemed superior for increasing physical function, compared to aerobic or resistance exercise. Supervised interventions were superior to partly and unsupervised. Extensiveness of the intervention only influenced physical function.

CONCLUSIONS

Supervised interventions, more than type or extensiveness of interventions, seem to increase effects.

Building a biopsychosocial model of cancer-related fatigue: the BIOCARE FActory cohort study protocol

Background

Cancer-related fatigue (CRF) is the most common side effect of cancer and cancer treatment. CRF prevalence is up to 50% in breast cancer patients and can continue several years after cancer remission. This persistent subjective sense of exhaustion is multifactorial. Numerous parameters have been evidenced to be related to CRF across biological, physical, psychological, social and/or behavioral dimensions. Although CRF has been studied for many years, the majority of previous studies focused on only one dimension, i.e., physical function. Moreover, few studies investigated CRF longitudinally with repeated measures. These are the two main obstacles that limit the understanding of CRF mechanisms. The purpose of this study is to create a biopsychosocial model of CRF with simultaneous and longitudinal anthropometric, clinical, biological, physical, psychological and sociological parameters.

Methods

BIOCARE FActory is a multicentric prospective study that will consist of an 18-month follow-up of 200 women diagnosed with breast cancer. Four visits will be scheduled at diagnosis, after treatments, and 12 and 18 months after diagnosis. The same procedure will be followed for each visit. Each session will be composed of anthropometric data collection, a semi-structured interview, cognitive tests, postural control tests, neuromuscular fatigability tests and a cardiorespiratory fitness test. Clinical and biological data will be collected during medical follow-ups. Participants will also complete questionnaires to assess psychological aspects and quality of life and wear an actigraphy device. Using a structural equation modeling analysis (SEM), collected data will build a biopsychosocial model of CRF, including the physiological, biological, psychological, behavioral and social dimensions of CRF.

Discussion

This study aims to highlight the dynamics of CRF and its correlates from diagnosis to post treatment. SEM analysis could examine some relations between potential mechanisms and CRF. Thus, the biopsychosocial model will contribute to a better understanding of CRF and its underlying mechanisms from diagnosis to the aftermaths of cancer and its treatments.

Trial registration

This study is registered at ClinicalTrials.gov (NCT04391543), May 2020.

Anxio-depressive symptoms in Moroccan women with gynecological cancer: Relief factors

INTRODUCTION

Psychosocial determinants can affect the mental health of women who have been diagnosed with gynecological cancer. The aim of this study was to examine how social support and self-esteem are associated with anxiety and depression symptoms in women with gynecological cancer, and who are treated by radical surgery.

METHODS

A cross-sectional study was performed, within the oncology department of Ibn Rochd University Hospital, Casablanca, on 100 Moroccan women. They all had undergone radical surgery for gynecological cancer, hysterectomy and/or oophorectomy.

RESULTS

Our results showed that patients with gynecological cancer treated by radical surgery exhibited high prevalence rates of anxiety (66%) and depression symptoms (59%). Associations showed that age, having children, medical coverage system, area of residence, working status and socioeconomic status were significantly related to the prevalence of anxiety and depression symptoms (P<0.05). The general social support, family support and significant other support besides high self-esteem reduce significantly the risk of getting anxiety and depression symptoms (P-values<0.05).

DISCUSSION

Among patients with gynecological cancer treated by radical surgery, high prevalence of anxiety and depression symptoms was found. Social support and high self-esteem could help improve mental health issues related to this type of cancer.

Enhancing Self-Esteem and Body Image of Breast Cancer Women through Interventions: A Systematic Review

Breast Cancer (BC) is the most common neoplasm in women worldwide, considered a global public health problem. Among BC women, some of the most common psychological symptoms in the adaptation to the disease are reduction in self-esteem and distorted body image (BI). Although there are numerous studies with the goal of promoting different psychological variables, BI and self-esteem are often separately observed despite their relationship and their importance in the process of the illness. Moreover, there have been no reviews that have synthesized the findings related to interventions aimed at enhancing both self-esteem and BI in BC women. Therefore, the objective of this review was to identify and examine the implemented interventions aimed at boosting both variables in this population. For this purpose, a systematic review was implemented following the PRISMA statement. A thorough search was performed on the following databases: Web of Science, PubMed, PsychInfo, PsychArticles, and Scopus. Among 287 records, only eight articles met the eligibility criteria. Interventions were grouped into three types according to their characteristics: Group therapies, Physical activity therapies, and Cosmetic and beauty treatments. The levels of effectiveness of the different interventions varied between them, and within each, in their impact on self-esteem and BI. More interventions focused on developing BI and self-esteem in this population are needed due to their ability to predict psychological functioning and quality of life of women with breast cancer.

Improved self-esteem after mat Pilates method intervention in breast cancer women undergoing hormone therapy: randomized clinical trial pilot study

ABSTRACT The purpose of this randomized clinical trial was to analyze the effects of 16 weeks of mat Pilates method intervention in self-esteem and depressive symptoms in women with breast cancer undergoing hormone therapy. Thirty-four women were randomized in Pilates group (PG) (n=18) and control group (CG) (n=16). The intervention occurs for 16 weeks, three times per week for 60 minutes each session (light to very hard intensity according to BORG scale). The CG received three educational sessions and was invited to maintain their routine activities. The data collection took place at the baseline and post-intervention. A questionnaire was applied including Self-Esteem Scale and the Beck Depression Inventory. Anova Two way with repeated measures and Sydak comparison test was used to analyze the effects in the variables after the 16 weeks intervention. Two types of analysis were performed after the intervention, in the analysis by intention to treat PG (n=18) the self-esteem variable showed a significant result (p=0.011) and in the analysis by PG protocol (n=11) (p=0.013). The depressive symptoms did not demonstrate significant improvements after the intervention. Control group did not present any significant changes during the time of the study. The 16 weeks of PG was an effective intervention to improve self-esteem of women with breast cancer undergoing hormone therapy.

The influence of 12-week dance intervention on sleep quality and pain among women with breast cancer - Pilot study of a non-randomized clinical trial

BACKGROUND

Analyze the effects of a 12-week dance intervention on the sleep quality and the level of pain among women with breast cancer.

METHODS

Non-randomized clinical trial including 21 breast cancer survivors allocated in intervention group (n = 11) or control group (n = 10). Intervention group received a 12-week mix dance intervention and the control group maintained their routine activities. Data collection was realized through the application of a questionnaire before and after 12 weeks, involving pain (VAS) and sleep quality (Pittsburgh Sleep Quality Index). The Two-way ANOVA with repeated measures and Šidák correction, and multiple linear regression was used.

RESULTS

No significant effects were found on sleep quality and pain after the 12-week intervention with a mix dance protocol. Also, no significant difference was found between intervention and control group during post-intervention. The multiple linear regression analysis, controlled by stage of treatment, did not present a significant relationship between sleep quality and pain. Additionally, some spontaneous reports provided by the participants demonstrated a subjective improvement in their social life and general well-being.

CONCLUSION

The 12-week mix dance intervention did not seem to directly influence the sleep quality and pain of breast cancer survivors in this study; however, no adverse events were reported. Perhaps, a dance protocol focusing only in one modality of dance may be more effective for breast cancer survivors on sleep quality and pain.

Physical Activity of Women After Radical Unilateral Mastectomy and Its Impact on Overall Quality of Life

Radical unilateral mastectomy is an acknowledged source of traumatic experience for women, adversely affecting their behavioral and emotional paradigm. The present study aimed to assess the quality of life in physically active and inactive postmastectomy women. Population sample involved 100 women, aged 50 to 60 years, having undergone radical unilateral mastectomy, allocated into 2 groups, upon assumption of undertaking physical activity. The abbreviated version of WHOQOL-BREF questionnaire was a research tool of choice. The data were analyzed with the aid of χ² test, Kruskal-Wallis test, and Mann-Whitney U test. Statistically significant dependence was established between physical activity actually pursued and self-assessment of overall quality of life (P = .014) and overall the self-rated perception of health (P < .001). In the group of physically inactive women, physical health was a variable dependent upon individual level of education (P = .031). The highest scores in this domain were noted in the women boasting secondary education, whereas the lowest in the ones with vocational education. Social domain was the highest rated aspect of quality of life in both the physically active and inactive postmastectomy women, while the physical health domain was rated the lowest. Both in the case of physically active and inactive postmastectomy women, the quality of life in the respective domains, as listed in the WHOQOL-BREF questionnaire, was found independent of the living environment.

Long-Term Effects of Breast Cancer Surgery, Treatment, and Survivor Care

Women are increasingly surviving breast cancer, but up to 90% experience unexpected long-term sequelae as a result of treatment. Symptoms may include physical, functional, emotional, and psychosocial changes that can dramatically alter the quality of life for breast cancer survivors. Primary care clinicians, including midwives, are likely to care for these women and should be familiar with common symptoms, treatment, and best practices to avoid permanent dysfunction. A holistic approach to assessment, treatment, and referral as needed is the most effective strategy. Although women experience significant changes after breast cancer treatment, many fail to receive thorough assessment of their symptoms, education about interventions, and treatment options to optimize health promoting strategies. Disparities exist in treatment availability, options, and survivorship. Long-term physical changes include anatomic changes, chronic pain, phantom breast pain, axillary web syndrome, and lymphedema. In addition, women may have decreased strength, aerobic capacity, mobility, fatigue, and cognitive dysfunction. Emotional and psychosocial changes include depression, anxiety, fatigue, concerns about body image, and issues with sexuality. Treatment should be multifactorial based on thorough assessment of symptoms and can include medication, exercise, counseling, physical and occupational therapy, and alternative and complementary therapies. Primary care and gynecologic clinicians are well positioned to provide thorough evaluation, education, treatment, and referral for the most common sequelae of mastectomy and breast cancer treatments.