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Maroun PS, Gomes R, Silva AD. Breast cancer cultural representations: a scoping review. CIENCIA & SAUDE COLETIVA 2024; 29:e11002023. [PMID: 38896678 DOI: 10.1590/1413-81232024296.11002023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 06/21/2024] Open
Abstract
This article aims to map the global scientific production on social or cultural representations and breast cancer in Public Health and discuss how it is presented in the literature. We conducted a scoping review guided by the question: "How are cultural or social representations in the context of breast cancer described in the global scientific Public Health production?". We searched for works in five scientific literature sources and included 45 studies. The analytical process followed the content analysis technique in the thematic modality. The analyzed collection can be thematized into the following categories: (1) Compromised body image and interactions, (2) Spirituality, (3) Loss of control over life, (4) Going on with life, and (5) Association with ethnic-racial issues. Despite advances in biomedicine, we observed that representations of breast cancer still have metaphors associated with cancer in the last century. We conclude that, among other aspects, care for women with breast cancer cannot be guided only by biomedical and epidemiological approaches since this disease is traversed by knowledge that competes with these approaches.
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Affiliation(s)
- Pedro Senise Maroun
- Instituto Nacional de Câncer. R. Visconde de Santa Isabel até 275/276, Vila Isabel. 20560-120 Rio de Janeiro RJ Brasil.
| | - Romeu Gomes
- Instituto Fernandes Figueira, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro RJ Brasil
| | - Adriano da Silva
- Departamento de Estudos sobre Violência e Saúde Jorge Careli, Escola Nacional de Saúde Pública Sérgio Arouca, Fiocruz. Rio de Janeiro RJ Brasil
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Ye M, Qiu L, Jin Y, Huang Y. Stakeholders' experiences and perceptions of male breast cancer:A qualitative evidence synthesis. Breast 2024; 74:103694. [PMID: 38417232 PMCID: PMC10904996 DOI: 10.1016/j.breast.2024.103694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/06/2023] [Accepted: 02/19/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND The experiences, physical and mental health and needs of women with breast cancer have been studied in some detail, but there is a lack of discussion of the experiences of stakeholder groups such as men with breast cancer, partners and carers and healthcare professionals. The aim of this study was to explore and understand the experiences and perceptions of male breast cancer stakeholders from diagnosis through to survivorship. METHODS We conducted a thematic review of qualitative studies included in a large published scoping review on male breast cancer (reported under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews extension). To be included in a qualitative evidence review, studies had to use qualitative methods for data collection and analysis to capture the perspectives of men with breast cancer, partners or caregivers, and healthcare workers. Key characteristics and findings were extracted and a conceptual coding framework was summarized using thematic analysis. RESULTS Out of a total of 310 studies in the research literature (published research articles and gray literature), 15 studies met the inclusion criteria. These studies reported on the experiences of men with breast cancer, partners or caregivers, and healthcare workers, with participant numbers ranging from 2 to 31. A total of 17 descriptive themes (study outcomes) were identified. From these, four high-level analytic themes emerged: (1) Predicament; (2) Emotion; (3) Support; (4) Coping. CONCLUSIONS The gender stigma that exists at the patient, healthcare system, and family-society levels largely influences the experiences of the male breast cancer stakeholder population. To address gender inequalities in breast cancer care, healthcare organizations and society at large should remain equally attentive to the needs of male and female breast cancer patients. These needs include reducing healthcare and social stigma, providing gender-specific information and emotional support, and access to support groups.
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Affiliation(s)
- Maodie Ye
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Lin Qiu
- Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Yongmei Jin
- Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China.
| | - Yingying Huang
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
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Abboah-Offei M, Bayuo J, Salifu Y, Afolabi O, Akudjedu TN. Experiences and perceptions of men following breast cancer diagnosis: a mixed method systematic review. BMC Cancer 2024; 24:179. [PMID: 38317128 PMCID: PMC10845771 DOI: 10.1186/s12885-024-11911-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Men with breast cancer experience unique physical and emotional challenges. However, a thorough understanding of these experiences including the psychosocial effects and supportive care needs have received less attention. In some settings, men with breast cancer experience stigma within the healthcare system and their care needs are not prioritised. This influences the level of professional support offered, consequently worsening their health and well-being outcomes. This review explored the variabilities in the experiences and treatment modalities of male breast cancer (MBC) across different contexts. METHODS All primary study designs including qualitative, quantitative, and mixed methods studies that reported on the experiences, treatment approaches and outcomes of MBC were included in this systematic review. Six databases (Embase, Medline, PsycINFO, Global Health, CINAHL and Web of Science) were searched for articles from January 2000 to September 2023. A results-based convergence synthesis was used for data analysis and reported using PRISMA guidelines. RESULTS Of the studies screened (n = 29,687), forty-four fulfilled the predetermined criteria and were included. Our findings relating to the experiences and treatment approaches of MBC are broadly themed into three parts. Theme 1-Navigating through a threat to masculinity: describes how males experienced the illness reflecting on detection, diagnosis, coming to terms with breast cancer, and disclosure. Theme 2- Navigating through treatment: captures the experiences of undergoing breast cancer treatment/ management following their diagnosis. Theme 3-Coping and support systems: describes how MBC patients coped with the disease, treatment process, aftercare/rehabilitative care, and the available support structures. CONCLUSIONS Men experience a myriad of issues following a breast cancer diagnosis, especially with their masculinity. Awareness creation efforts of MBC among the public and healthcare practitioners are urgently required, which could change the perception of men in promoting early diagnosis, adherence to treatments, post-treatment monitoring, oncological results and a better quality of life. Considerations for training, education and development of specialised guidelines for healthcare practitioners on MBC would provide the necessary knowledge and skills to enhance their practice through the adoption of person-centred and male-specific care strategies. Professional care intervention and support for MBC should not end after the diagnosis phase but should extend to the entire treatment continuum and aftercare including future research focusing on MBC specific clinical trials. TRIAL REGISTRATION PROSPERO Registration No. CRD42021228778.
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Affiliation(s)
- Mary Abboah-Offei
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Sighthill Campus, Edinburgh, UK
| | - Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, Hongkong, China
| | - Yakubu Salifu
- International Observatory On End of Life Care (IOELC), Faculty of Health and Medicine, Division of Health Research, Lancaster University, Lancaster, LA1 4AT, UK.
| | - Oladayo Afolabi
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, WC2R 2LS, UK
| | - Theophilus N Akudjedu
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Science, Bournemouth University, Bournemouth, UK
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Avila J, Herrick B, Attai DJ, Leone JP. Treatments for breast cancer in men: late effects and impact on quality of life. Breast Cancer Res Treat 2023; 201:489-498. [PMID: 37418032 DOI: 10.1007/s10549-023-07027-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Male breast cancer accounts for approximately 1% of all breast cancer diagnoses. Unfortunately, a lack of information exists regarding late effects of breast cancer treatment in men. METHODS An online survey directed towards male breast cancer patients was distributed via social medial and emails from June to July 2022. Participants were asked about their disease characteristics, treatments and side effects from the disease or treatment. Patients and treatment variables were reported via descriptive statistics. Univariate logistic regression was performed to evaluate associations between different treatment variables and outcomes expressed by odds ratio. RESULTS A total of 127 responses were analyzed. Median age of the participants was 64 years (range 56-71 years). A total of 91 participants (71.7%) revealed they experienced late effects secondary to their cancer or cancer treatment. The most concerning physical and psychological symptoms reported were fatigue and fear of recurrence respectively. Axillary lymph node dissection was associated with swollen arm and with difficulty in arm or shoulder movement. Systemic chemotherapy was related to bothersome hair loss and changes on interest in sex; and endocrine therapy was associated with feeling less masculine. CONCLUSION Our study showed that men suffer several late effects from treatments for breast cancer. Lymphedema, difficulty with arm and shoulder movement, sexual dysfunction and hair loss should be discussed with males as it can be distressing for some patients and decrease their quality of life.
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Affiliation(s)
- Jorge Avila
- Department of Internal Medicine, St. Elizabeth's Medical Center, Boston, MA, USA.
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Beth Herrick
- Department of Radiation Oncology, St. Elizabeth's Medical Center, Boston, MA, USA
- University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Deanna J Attai
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - José Pablo Leone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Male Breast Cancer. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00466-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Hiltrop K. Response to "Re: 'Occupational rehabilitation of male breast cancer patients: Return patterns, motives, experiences, and implications-A qualitative study'". Eur J Cancer Care (Engl) 2022; 31:e13646. [PMID: 35775632 DOI: 10.1111/ecc.13646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/21/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Kati Hiltrop
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
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Breidenbach C, Heidkamp P, Hiltrop K, Pfaff H, Enders A, Ernstmann N, Kowalski C. Prevalence and determinants of anxiety and depression in long-term breast cancer survivors. BMC Psychiatry 2022; 22:101. [PMID: 35139815 PMCID: PMC8827186 DOI: 10.1186/s12888-022-03735-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/26/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is a significant number of long-term breast cancer survivors in Germany. However, research on the psychological challenges of cancer survivors is limited. This analysis describes prevalence, development and determinants of depression and anxiety 5 to 6 years after diagnosis and identifies predictors for an increase of anxiety and depression over time. METHODS Data from 164 women was collected by survey and tumour documentation during post-operative hospital stay, 40 weeks and 5 to 6 years after diagnosis. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale. Sankey-diagrams were created for visual presentation of prevalence over time. Logistic and linear regression models were calculated to identify determinants of anxiety and depression. RESULTS Respondents had higher levels of depression and anxiety 5 to 6 years than 40 weeks after the diagnosis. Lower vocational status and having children were associated with depression, surgery type was correlated with anxiety, and age, as well as comorbidities, were predictors for both anxiety and depression 5 to 6 years after diagnosis. An increase of depression over time was more likely when having children and comorbidities. An increase in anxiety was less likely after cancer recurrence. CONCLUSIONS Findings highlight that anxiety and depression are relevant burdens for breast cancer survivors in Germany. Several sociodemographic and clinical predictors are identified. There is need for psychosocial support after acute treatment and in the long-term. Research on psychological burdens of long-term breast cancer survivors in the identified vulnerable groups is needed.
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Affiliation(s)
- Clara Breidenbach
- grid.489540.40000 0001 0656 7508German Cancer Society, Kuno-Fischer-Straße 8, 14057 Berlin, Germany
| | - Paula Heidkamp
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Kati Hiltrop
- grid.15090.3d0000 0000 8786 803XCenter for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Holger Pfaff
- grid.6190.e0000 0000 8580 3777Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Str. 129, 50933 Cologne, Germany
| | - Anna Enders
- grid.487225.e0000 0001 1945 4553Federal Centre for Health Education (BzgA), Maarweg 149-161, 50825 Cologne, Germany
| | - Nicole Ernstmann
- grid.15090.3d0000 0000 8786 803XCenter for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Christoph Kowalski
- grid.489540.40000 0001 0656 7508German Cancer Society, Kuno-Fischer-Straße 8, 14057 Berlin, Germany
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Hiltrop K, Ernstmann N. Response to 'Response to "Occupational rehabilitation of male breast cancer patients: Return patterns, motives, experiences, and implications-A qualitative study."'. Eur J Cancer Care (Engl) 2021; 30:e13471. [PMID: 34263974 DOI: 10.1111/ecc.13471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/15/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Kati Hiltrop
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
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Campos FAB, Rouleau E, Torrezan GT, Carraro DM, Casali da Rocha JC, Mantovani HK, da Silva LR, Osório CABDT, Moraes Sanches S, Caputo SM, Santana dos Santos E. Genetic Landscape of Male Breast Cancer. Cancers (Basel) 2021; 13:3535. [PMID: 34298749 PMCID: PMC8305894 DOI: 10.3390/cancers13143535] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/20/2022] Open
Abstract
Male breast cancer (MBC) is now considered molecularly different from female breast cancer (FBC). Evidence from studies indicates that common genetic and epigenetic features of FBC are not shared with those diagnosed in men. Genetic predisposition is likely to play a significant role in the tumorigenesis of this rare disease. Inherited germline variants in BRCA1 and BRCA2 account for around 2% and 10% of MBC cases, respectively, and the lifetime risk of breast cancer for men harboring BRCA1 and BRCA2 mutations is 1.2% and 6.8%. As for FBC, pathogenic mutations in other breast cancer genes have also been recently associated with an increased risk of MBC, such as PALB2 and CHEK2 mutations. However, while multigene germline panels have been extensively performed for BC female patients, the rarity of MBC has resulted in limited data to allow the understanding of the magnitude of risk and the contribution of recently identified moderate penetrance genes of FBC for MBC predisposition. This review gathers available data about the germline genetic landscape of men affected by breast cancer, estimated risk associated with these genetic variants, and current guidelines for clinical management.
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Affiliation(s)
| | - Etienne Rouleau
- Department of Medical Biology and Pathology, Gustave Roussy, Cancer Genetics Laboratory, Gustave Roussy, 94805 Villejuif, France;
| | - Giovana Tardin Torrezan
- Genomics and Molecular Biology Group, International Center of Research CIPE, A.C.Camargo Cancer Center, Sao Paulo 01509-010, Brazil; (G.T.T.); (D.M.C.)
- National Institute of Science and Technology in Oncogenomics (INCITO), Sao Paulo 01508-010, Brazil
| | - Dirce Maria Carraro
- Genomics and Molecular Biology Group, International Center of Research CIPE, A.C.Camargo Cancer Center, Sao Paulo 01509-010, Brazil; (G.T.T.); (D.M.C.)
- National Institute of Science and Technology in Oncogenomics (INCITO), Sao Paulo 01508-010, Brazil
| | | | - Higor Kassouf Mantovani
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-881, Brazil; (H.K.M.); (L.R.d.S.)
| | - Leonardo Roberto da Silva
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-881, Brazil; (H.K.M.); (L.R.d.S.)
| | | | - Solange Moraes Sanches
- Deparment of Medical Oncology, A.C.Camargo Cancer Center, Sao Paulo 01509-010, Brazil; (S.M.S.); (E.S.d.S.)
| | - Sandrine M. Caputo
- Department of Genetics, Institut Curie, 75248 Paris, France;
- Institut Curie, PSL Research University, 75005 Paris, France
| | - Elizabeth Santana dos Santos
- Deparment of Medical Oncology, A.C.Camargo Cancer Center, Sao Paulo 01509-010, Brazil; (S.M.S.); (E.S.d.S.)
- Centro de Oncologia, Hospital Sírio Libanês, Sao Paulo 01308-050, Brazil
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Hiltrop K, Heidkamp P, Halbach S, Brock-Midding E, Kowalski C, Holmberg C, Ernstmann N. Occupational rehabilitation of male breast cancer patients: Return patterns, motives, experiences, and implications-A qualitative study. Eur J Cancer Care (Engl) 2021; 30:e13402. [PMID: 33486818 DOI: 10.1111/ecc.13402] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/01/2020] [Accepted: 10/14/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Knowledge regarding the occupational rehabilitation of male breast cancer patients (MBCPs) is currently scarce; however, there may exist unmet needs of men affected by this rare disease. Therefore, this exploratory study investigated the experiences of MBCPs in their return to work (RTW). METHODS Interview data from 14 men with a breast cancer diagnosis were used for qualitative content analysis. Data were collected within the mixed-methods N-MALE project (Male breast cancer: patients' needs in prevention, diagnosis, treatment, rehabilitation, and follow-up care), conducted in Germany from 2016 to 2018. RESULTS The eight identified motives for RTW were desire for normalcy, distraction, need for activity, social contacts, work as a source of pleasure, financial considerations, lack of self-perception of illness, and having a job requiring low physical effort. The participants reported positive experiences with their workplaces from diagnosis through RTW. However, stigmatisation occurred. The aftermath of the disease and treatment led to changes in the interviewees' productivity, for instance due to fatigue. CONCLUSION The findings of this study contribute to a better understanding of RTW processes, as new insights were gained about motives and experiences particular to MBCPs. Support needs after return were apparent and may help to reduce long-term effects that limit productivity.
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Affiliation(s)
- Kati Hiltrop
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Paula Heidkamp
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Sarah Halbach
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Evamarie Brock-Midding
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | | | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
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11
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Weber R, Ehrenthal JC, Brock-Midding E, Halbach S, Würstlein R, Kowalski C, Ernstmann N. Defense Mechanisms and Repressive Coping Among Male Breast Cancer Patients. Front Psychiatry 2021; 12:718076. [PMID: 34955906 PMCID: PMC8703166 DOI: 10.3389/fpsyt.2021.718076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: The concept of defense mechanisms has undergone extensive revision and expansion since Freud first described these processes. Initially formulated as an unconscious repression of unpleasant memories, with further development focusing on the role of defense mechanisms in the regulation of internal conflicts, the concept shifted and evolved to incorporate the adaptation to external demands, including intrapsychic and interpersonal handling of burden of illness. In addition to defense mechanisms, coping provides another perspective on human adjustment to difficult life events. While there is substantial research on both coping and defense mechanisms in various psychiatric and somatic diseases, including cancer, little is known about defensive regulation, coping, and their interaction in male breast cancer patients. Methods: The present study is part of the N-Male project conducted between 2016 and 2018 in Germany (Male breast cancer: patients' needs in prevention, diagnosis, treatment, rehabilitation, and follow-up care). Semi-standardized interviews with 27 male breast cancer patients were analyzed with regard to defense mechanisms. In addition, fear of progression and repressive coping was assessed by self-report. Results: There was considerable variety in levels of defensive functioning as well as repressive coping in our sample. We found no difference in overall levels of defensive functioning between men with vs. without repressive coping. However, patients with repressive coping demonstrated a decopupled association between fear of progression and defensive functioning as compared to patients without repressive coping. Discussion: The study provides the first evidence of disease processing in male breast cancer patients Knowledge of patients' defense patterns and repressive coping seems promising for better planning targeted intervention strategies.
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Affiliation(s)
- Rainer Weber
- Department of Psychosomatic and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Johannes C Ehrenthal
- Department of Psychology, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Evamarie Brock-Midding
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), Bonn, Germany
| | - Sarah Halbach
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), Bonn, Germany
| | - Rachel Würstlein
- Breast Center, Department of Gynecology and Obstetrics (Comprehensive Cancer Center Munich), University Hospital of Munich (Ludwig Maximilian University), Munich, Germany
| | | | - Nicole Ernstmann
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), Bonn, Germany
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12
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Ernstmann N, Kowalski C. Commentary on Nguyen et al. "Living with Male Breast Cancer: A Qualitative Study of Men's Experiences and Care Needs". Breast Care (Basel) 2020; 15:437-438. [PMID: 32982657 DOI: 10.1159/000503778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/26/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Nicole Ernstmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR), University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO) Bonn, Bonn, Germany
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13
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Dippmann AK, Damrau C, Hengelbrock J, Albert US, Lebeau A, Lux MP, Veit C. [Are men and women with breast cancer treated equally in Germany?]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 155:1-10. [PMID: 32861615 DOI: 10.1016/j.zefq.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Within the statutory health insurance system of the Federal Republic of Germany, a system of quality assurance has been implemented and operationalised through the measurement of quality indicators. For breast surgery, these quality indicators are mainly based on recommendations of the German clinical guideline for screening, diagnosis, therapy and follow-up of breast cancer. The 2018 update of this guideline includes a new chapter on breast cancer in men. The aim of this analysis is to examine whether male and female patients with breast cancer are treated equally where appropriate and recommended by the clinical guideline, as measured by the quality indicators. METHOD Data of ten quality assurance indicators were analysed, for each indicator separately, stratified by sex and pooled over a 5-year period to gain statistical power. This dataset constitutes the largest data pool of men with surgical interventions for breast neoplasm in Germany. Indicator results were then compared between male and female cases. Additional subgroup analyses were carried out for two quality indicators with substantial outcome difference between male and female cases in order to detect possible differences in the treatment of breast cancer between different medical departments. RESULTS The database of the ten quality assurance indicators comprised 551,221 patients (546,324 females and 4,897 males) between 2014 and 2018. Pooled data of nine quality indicators (QIs) showed statistically significant outcome differences between male and female cases. In spite of pooling, the male sample size of four QIs was too small to allow for statistically reliable comparisons between male and female patients. Outcome differences in the remaining five QIs may, on the one hand, be explained by anatomical differences and different extent of the surgery, and on the other hand they confirm international data for lower HER2-positivity rates in male breast cancer patients. However, two process indicators, aiming at pretherapeutic biopsy and sentinel lymph node biopsy in invasive breast cancer recommended by the clinical guideline, show substantial differences of more than 6 percentage points between the sexes: although recommended by the clinical guideline, both procedures are carried out less often in male cases. Further analysis regarding the medical departments that recorded the treatment revealed that risk for non-adherence to guideline recommendation was high if treatment took place in non-gynaecological departments. Compared to gynaecological departments, procedures such as pretherapeutic biopsy and sentinel lymph node biopsy were carried out less frequently if cases were documented to be handled by surgery or plastic surgery departments. DISCUSSION AND CONCLUSION Analysis of breast surgery quality indicators reveals a lower level of adherence to guideline recommendations for men with breast cancer compared to women in some aspects of the guideline, as measured by statutory quality indicators in breast surgery. Male breast cancer might be a rare disease, but nevertheless, awareness-rising is needed in diagnostics, treatment and interdisciplinarity in order to avoid inequality between the sexes.
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Affiliation(s)
- Anja Katharina Dippmann
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Deutschland.
| | - Claudia Damrau
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Deutschland
| | - Johannes Hengelbrock
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Deutschland
| | - Ute-Susann Albert
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Annette Lebeau
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf und Gemeinschaftspraxis für Pathologie, Lübeck, Deutschland
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Kinder- und Frauenklinik St. Louise, St. Vincenz-Krankenhaus Paderborn, Paderborn, Deutschland
| | - Christof Veit
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Deutschland
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14
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Berkowitz MJ, Thompson CK, Zibecchi LT, Lee MK, Streja E, Berkowitz JS, Wenziger CM, Baker JL, DiNome ML, Attai DJ. How patients experience endocrine therapy for breast cancer: an online survey of side effects, adherence, and medical team support. J Cancer Surviv 2020; 15:29-39. [PMID: 32804353 PMCID: PMC7430212 DOI: 10.1007/s11764-020-00908-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/14/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Many patients with hormone receptor-positive (HR+) breast cancer do not adhere to endocrine therapy (ET), and treatment-related side effects are often discussed by participants in online breast cancer forums. Our aim was to survey this unique group of patients about their ET-related experiences. METHODS We partnered with patients active in breast cancer social media communities to develop a survey assessing ET-related side effects and medical team communication. Patients with a history of HR+ breast cancer who had received a recommendation to take ET were eligible to participate in the anonymous, online survey. RESULTS Respondents included 2353 women and 54 men. Aromatase inhibitors were the most commonly used medication. Side effects were reported by 91.2%, were more often experienced by women than men (p < 0.001), and were primarily related to medication type. Approximately one-third of respondents discontinued therapy early. While most felt supported by their medical team, 31.5% reported that their side effects were dismissed or minimized. Survey respondents most frequently reported that a healthy diet and exercise, yoga/acupuncture, and vitamins/supplements were helpful in managing ET-related side effects. CONCLUSIONS ET-related side effects are very common, and one-third discontinued treatment early. Lifestyle changes and complementary therapies can be important tools for side effect management. One-third of patients did not feel that their side effects were taken seriously. IMPLICATIONS FOR CANCER SURVIVORS This is the largest survey of ET use by participants in online breast cancer communities. Further research is needed to identify strategies to improve treatment adherence and to better manage ET-related side effects.
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Affiliation(s)
- Maurice J Berkowitz
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Carlie K Thompson
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Laura T Zibecchi
- Department of Nursing, University of California Los Angeles, Los Angeles, USA
| | - Minna K Lee
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Elani Streja
- Department of Medicine, University of California Irvine School of Medicine, Irvine, USA
| | - Jacob S Berkowitz
- Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, USA
| | - Cachet M Wenziger
- Department of Medicine, University of California Irvine School of Medicine, Irvine, USA
| | - Jennifer L Baker
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Maggie L DiNome
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Deanna J Attai
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
- UCLA Health Burbank Breast Care, 191 S. Buena Vista #415, Burbank, CA, 91505, USA.
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15
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Conversano C, Di Giuseppe M, Miccoli M, Ciacchini R, Di Silvestre A, Lo Sterzo R, Gemignani A, Orrù G. Retrospective Analyses of Psychological Distress and Defense Style Among Cancer Patients. CLINICAL NEUROPSYCHIATRY 2020; 17:217-224. [PMID: 34908997 PMCID: PMC8629055 DOI: 10.36131/cnfioritieditore20200403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Psychological distress is common in cancer patients during the diagnostic phase. Research demonstrated that anxiety, depression and defense mechanisms may influence physical and psychological well-being in patients with malignant tumors. The present retrospective study investigated the associations between clinical and psychological characteristics of cancer patients waiting for the diagnosis, focusing on metastatic cancer (MC) and breast cancer (BC). METHOD Patients with a new diagnosis of cancer referring to a Clinical Oncology Unit in Central Italy were interviewed during the 2017 for psychological assessment. Double-blind information about anxiety, depression, sleep disorders, defense style, and cancer diagnosis were available for the 567 patients included in this study. T-test, chi-squared and regression analyses were performed to detect associations between psychological variables and the presence of metastasis (MC) in the whole sample and in the subgroup of breast cancer (BC) patients. RESULTS Female gender and younger age were associated with anxiety, depression, and maladaptive defense style. A significant positive relationship was found between presence of metastasis and symptoms of anxiety. Depression resulted significantly more frequent in BC, while there was a trend close to statistical significance in MC. Immature defense style was widely used by BC women, with a score close to statistical significance. CONCLUSIONS This retrospective study provided empirical evidence of the relationship between psychological functioning and clinical characteristics of cancer. In line with previous research, our findings confirmed the peculiar psychological functioning of BC patients. Further investigations are needed to understand how the diagnosis of cancer may influence the individual psychological functioning and vice versa.
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Affiliation(s)
- Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Italy
| | - Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Rebecca Ciacchini
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Italy
| | | | | | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Italy
| | - Graziella Orrù
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Italy
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16
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Younas A. Epistemic Injustice in Health Care Professionals and Male Breast Cancer Patients Encounters. ETHICS & BEHAVIOR 2020. [DOI: 10.1080/10508422.2020.1756819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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17
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Witzel I. Male Breast Cancer Patients: Lack of Evidence. Breast Care (Basel) 2020; 15:3-4. [PMID: 32231491 PMCID: PMC7098273 DOI: 10.1159/000505636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/27/2019] [Indexed: 03/29/2024] Open
Affiliation(s)
- Isabell Witzel
- Breast Center, Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
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