Contextual variables, emotional state, and current and expected quality of life in breast cancer survivors

Life After Facing Cancer: Posttraumatic Growth, Meaning in Life and Life Satisfaction

Although it is known that facing cancer may be accompanied by a range of chronic and acute stress reactions, it can also contribute to positive psychological changes and influence one's life perception. The aim of this cross-sectional study was to investigate relationship between posttraumatic growth (PTG), meaning in life and life satisfaction to determine whether the presence of meaning or the search for meaning mediated the relationship between PTG and life satisfaction. The study was conducted with 149 cancer survivors who were at least one-month post-completion of all medical cancer therapy. The results indicate positive associations between PTG, the presence of meaning in life, the search for meaning and life satisfaction. Moreover, the relationship between PTG and life satisfaction could be explained by the mediating effect of the presence of meaning in life. Thus, it is important for clinicians to systematically facilitate PTG, meaning in life and life satisfaction as protective factors to one's daily functioning.

The psychosocial determinants of quality of life in breast cancer survivors: a scoping review

Background

Breast cancer care today involves state-of-the-art biomedical treatment but can fail to address the broader psychosocial and quality-of-life (QoL) issues associated with the transition to breast cancer survivorship. This scoping review examines the evidence on the influence of psychosocial determinants on QoL in breast cancer survivors.

Methods

Scoping review methodology was used to: (1) identify the research question(s); (2) identify relevant studies; (3) undertake study selection; (4) extract data; (5) collate, summarise and report the results.

Results

A total of 33 studies met the inclusion criteria. The majority of studies were conducted in the US (n = 22, 67%) and were mainly cross-sectional (n = 26, 79%). Sixteen psychosocial determinants of QoL were identified. Social support (n = 14, 42%), depression (n = 7, 21%) and future appraisal and perspective (n = 7, 21%) were the most frequently investigated determinants. Twelve different QoL measures were used. A range of different measurement tools were also used per psychosocial determinant (weighted average = 6). The 14 studies that measured the influence of social support on QoL employed 10 different measures of social support and 7 different measures of QoL. In general, across all 33 studies, a higher level of a positive influence and a lower level of a negative influence of a psychosocial determinant was associated with a better QoL e.g. higher social support and lower levels of depression were associated with a higher/better QoL. For some determinants such as spirituality and coping skills the influence on QoL varied, but these determinants were less commonly investigated.

Conclusion

Consensus around measures of QoL and psychological determinants would be valuable and would enable research to determine the influence of psychosocial determinants on QoL adequately. Research in other healthcare settings beyond the US is required, in order to understand the influence of organisation and follow-up clinical and supportive care on psychosocial determinants and QoL and to improve the quality of care in breast cancer survivors.

Psychological burden on patients with cancer of unknown primary: from onset of symptoms to initial treatment

OBJECTIVE

Supportive care is a critical issue especially for patients with cancer of unknown primary since they often face serious situations, continuing to seek for relevant diagnosis and treatment with the primary sites unknown. However, there are only few research reports on this subject. The aim of this study was to clarify the experience on patients with cancer of unknown primary until they have their initial treatment and to obtain suggestions of supportive care for them.

METHODS

A qualitative study using semi-structured interviews regarding the experience on patients with cancer of unknown primary was conducted.

RESULTS

Data of the experience of the nine patients with cancer of unknown primary until their initial treatment were collected by semi-structured interviews. Patients' speech at interviews recorded in verbatim reports was assigned with 545 codes, 102 subcategories and 38 categories. Experience of the patients with cancer of unknown primary was categorized into five phases: Phase 1: period of making self-judgment on symptoms; Phase 2: period of suspecting serious disease, and seeking for appropriate medical treatment; Phase 3: period of searching for cause of disease while having painful symptoms and anxiety; Phase 4: period of having fear for death, frustration with unknown cause and denial of unknown state; Phase 5: period of struggling but being determined to face disease.

CONCLUSIONS

Experience of patients with cancer of unknown primary from onset of symptoms to their initial treatment was categorized into five phases, mainly manifesting their psychological burden. These findings will warrant for the future study of supportive care for patients with cancer of unknown primary.

Social constraints and quality of life among Chinese-speaking breast cancer survivors: a mediation model

PURPOSE

Literature has revealed detrimental effects of unsupportive interpersonal interactions on adjustment to cancer. However, no studies have examined this effect and the underlying psychological pathways among Chinese-speaking breast cancer survivors. The study investigated the relationship between social constraints and adjustment to cancer and the underlying psychological pathways among Chinese-speaking breast cancer survivors.

METHODS

Chinese-speaking breast cancer survivors (N = 120) completed a questionnaire package assessing social constraints, intrusive thoughts, affect, and quality of life.

RESULTS

Results revealed a negative relationship between social constraints and quality of life. Such a relationship between social constraints and quality of life was mediated by negative affect and intrusive thoughts, while the association of intrusive thoughts and quality of life were completely mediated by positive and negative affect.

CONCLUSION

Findings highlight the negative association between unsupportive interpersonal interactions and adjustment through cognitive and affective pathways among Chinese-speaking breast cancer survivors.

Affect as a mediator between self-efficacy and quality of life among Chinese cancer survivors in China

Previous studies have shown that self-efficacy influences cancer survivors' quality of life. As most of the relevant findings are based on Caucasian cancer survivors, whether the same relationship holds among Asian cancer patients and through what mechanism self-efficacy influences quality of life are unclear. This study examined the association between self-efficacy and quality of life among Chinese cancer survivors, and proposed affect (positive and negative) as a mediator between self-efficacy and quality of life. A sample of 238 Chinese cancer survivors (75% female, mean age = 55.7) were recruited from Beijing, China. Self-efficacy, affect (positive and negative) and quality of life were measured in a questionnaire package. Self-efficacy was positively associated with quality of life and positive affect, and negatively associated with negative affect. Path analyses revealed the direct effect from self-efficacy to quality of life and the indirect effects from self-efficacy to quality of life through positive affect and negative affect. The beneficial role of self-efficacy in Chinese cancer survivors' quality of life and the mediating role of affect in explaining the relationship between self-efficacy and quality of life are supported. Future interventions should include self-care and affect regulation skills training to enhance cancer survivors' self-efficacy and positive affect, as this could help to improve Chinese cancer survivors' quality of life.

Affect mediates the association between mental adjustment styles and quality of life among Chinese cancer survivors

This study examined the association between mental adjustment styles and quality of life, and affect as a mediator among 238 Chinese cancer survivors. Regression analysis showed that quality of life was positively associated with fighting spirit and negatively associated with fatalism. Path analysis showed that greater fighting spirit was associated with more positive affect, which in turn was associated with higher quality of life. Greater fatalism was associated with less positive affect and more negative affect, which in turn was associated with lower quality of life. Findings suggest that positive affect and negative affect are important in understanding mental adjustment styles and its health implications.

Effects of Chan-Chuang Qigong on Improving Symptom and Psychological Distress in Chemotherapy Patients

The purpose of this study was to explore the effect of Chan-Chuang qigong on symptoms distress and psychological distress of breast cancer patients who underwent chemotherapy. A quasi-experimental design was adopted. Subjects were recruited from breast cancer outpatients receiving chemotherapy at an 1800-bed medical center in Taipei, Taiwan. Of these subjects, 35 were assigned to the control group and 32 to the experimental group in which Chan-Chuang qigong was administered. Assignment was not random. The instruments included a 21-item symptom distress scale and psychological distress with the symptom checklist-90-revised. Data of the symptoms and psychological distress were collected on the day before chemotherapy as baseline values, and also collected on days 8, 15 and 22 of chemotherapy. The results showed that the overall severity of symptom distress in the experimental group was significantly lower than the control group on day 22 ( p < 0.05). The symptoms with significant improvement included pain, numbness, heartburn and dizziness ( p < 0.05). With regard to psychological distress, the difference of overall severity between the two groups was not statistically significant ( p > 0.05). However, the items of "unwillingness to live" ( p < 0.05) and "hopelessness about the future" ( p < 0.05) were significantly improved in the experimental group. In conclusion, Chan-Chuang qigong had the effect of attenuating the symptom distress and probably some part of the psychological distress of chemotherapy patients.

Anxiety, depression and quality of life after cancer diagnosis: what psychosocial variables best predict how patients adjust?

OBJECTIVE

Significant numbers of cancer patients suffer distress, reduced quality of life and various other psychological problems. Evidence regarding psychological predictors of these outcomes is inconsistent. This study explored a range of predictors using an established psychological framework to identify the most important predictors of cancer adjustment, and when these are best assessed for optimal outcome prediction.

METHODS

One hundred sixty newly diagnosed breast, colorectal, lung and prostate cancer patients completed questionnaires after diagnosis and at 3- and 6-month follow-up. Measures included personality, illness cognitions, emotion, coping and outcome (anxiety, depression and quality of life).

RESULTS

Between 47-74% of variance in psychosocial outcome was explained although large proportions were accounted for by clinical factors, demographics and earlier levels of anxiety, depression and quality of life. Of the psychological variables, cognitive appraisals featured more consistently then either emotions or coping.

CONCLUSIONS

There are clear and consistent predictors of negative psychosocial outcome that could be used in clinical practice to risk-assess and monitor patients for adjustment difficulties. The finding that appraisals were more predictive of outcome than emotions and coping may inform the development of psychological interventions for cancer patients.

Well-being, posttraumatic growth and benefit finding in long-term breast cancer survivors

This study evaluates posttraumatic growth, benefit finding and well-being, and their mutual association in a random sample of disease-free 10-year breast cancer survivors. The population-based Eindhoven Cancer Registry (ECR) was used to select all women diagnosed with breast cancer in 1993 in six hospitals. Of the 254 breast cancer survivors, 183 (72%) returned a completed questionnaire. Measures included the Posttraumatic Growth Inventory (posttraumatic growth), the Perceived Disease Impact Scale (benefit finding) and the CentERdata Health monitor (life satisfaction, health status and psychological well-being). Self-reported health status and psychological well-being were similar in survivors compared to general population norms, whereas life satisfaction was significantly higher among survivors. In addition, posttraumatic growth was seen in the following domains: relationships with others, personal strength and appreciation of life. The number of patients reporting benefit finding was high (79%, N = 145). Benefit finding showed a moderately positive correlation with posttraumatic growth. In addition, women who stated that their satisfaction with life was high reported higher levels of posttraumatic growth in comparison to women who did not. Radiotherapy was negatively associated with posttraumatic growth. Women with a higher tumour stage at diagnosis experienced less benefit finding in comparison to women with a lower tumour stage at diagnosis. The above results can help to identify those patients who will probably experience posttraumatic growth and benefit finding after cancer. However, it is important to be aware that the positive effects of cancer on a patient's life do not occur in all cancer patients and all phases of the disease trajectory.

Breast cancer survivors' health-related quality of life : racial differences and comparisons with noncancer controls

BACKGROUND

Small samples with few minority women and/or the absence of comparisons to peers without cancer histories have limited previous research suggesting racial differences in breast cancer survivors' health-related quality of life (HRQoL). This study not only compared HRQoL of African American and white breast cancer survivors, but also compared the HRQoL of these women to that of same-race women with no cancer history.

METHODS

Data from the Women's Health Initiative-Observational Study were used, including 5021 cancer survivors and 88,532 women without a history of cancer. Multivariate regression analyses estimated differences in breast cancer survivors' baseline HRQoL (RAND36), depressive symptoms (CES-D short-form), and sleep quality (WHIIRS).

RESULTS

African American breast cancer survivors reported worse physical functioning and general health compared with white survivors. Among African Americans, survivors reported worse role limitations due to physical health, pain, general health, and vitality than women without a history of cancer. This was most evident in those with more recent diagnoses. Most significant differences between groups were small in magnitude (Cohen d = .21-.36).

CONCLUSIONS

These results add to the increasing knowledge of cancer disparities by showing that African American women have small, but clinically meaningful, decrements in physical HRQoL compared with white survivors and with African American women without cancer. Because African American women also face diagnosis with higher grade tumors and higher breast cancer mortality, more research is needed to examine the physical and psychosocial experiences of African American breast cancer survivors to elucidate the mechanisms leading to poorer outcomes.

Rural and urban breast cancer patients: health locus of control and psychological adjustment

OBJECTIVE

This study examines the moderating influence of rural residence on the associations between health locus of control (HLC) beliefs and psychological well-being.

METHOD

Two hundred and twenty-four breast cancer patients were surveyed.

RESULTS

The results revealed that rurality interacted with HLC beliefs in predicting psychological adjustment. The pattern indicated that, whereas endorsing external forms of locus of control can be detrimental to the psychological well-being of urban breast cancer patients, the same is not true for rural breast cancer patients. For rural breast cancer patients, powerful others locus of control was beneficial for and chance locus of control was unrelated to well-being.

CONCLUSIONS

Implications for future research and medical care are discussed.

The quality of life and self-efficacy of Turkish breast cancer patients undergoing chemotherapy

Self-efficacy has a positive effect on health behaviors, symptom control, compliance with cancer treatment, and quality of life. This study aims to describe the quality of life and self-efficacy of Turkish breast cancer patients undergoing chemotherapy. The sample consisted of 141 patients. Data was gathered using a Patient Information Form, the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B), a scale about Strategies Used by Patients to Promote Health and the Rotterdam Symptom Checklist. All quality of life dimensions were negatively affected at a significant level. Following commencement of chemotherapy, there was an increase in the negative effect on physical well-being, emotional well-being and additional concerns subscales and total FACT-B and their self-efficacy was negatively affected to a moderate degree. However, a significant degree of change did not occur in the self-efficacy. During treatment the physical symptoms and psychological distress increased and the activity level was negatively affected. The quality of life and self-efficacy were influenced by personal and medical characteristics, showing consistency with similar studies. Because there are negative effects of cancer and chemotherapy on patients' quality of life and self-efficacy, nurses need to focus on designing psychosocial interventions to improve their self-efficacy and quality of life.

Positive, negative, and disparate--women's differing long-term psychosocial experiences of bilateral or contralateral prophylactic mastectomy

Because of recent studies showing strong prevention benefit and acceptable psychosocial outcomes, more women may be considering prophylactic mastectomy. A growing literature shows some positive psychosocial outcomes for women with bilateral prophylactic mastectomy, but less is known about women with contralateral prophylactic mastectomy. Several surveys have shown that a large majority of women with prophylactic mastectomy report satisfaction with their decisions to have the procedure when asked in a quantitative, closed-ended format. We sought to explore the nuances of women's satisfaction with the procedure using a qualitative, open-ended format. We included open-ended questions as part of a mailed survey on psychosocial outcomes of prophylactic mastectomy. The research team coded and analyzed these responses using qualitative methods. We used simple descriptive statistics to compare the demographics of the entire survey sample to those women who answered the open-ended questions; the responses to the open- and closed-ended satisfaction questions, and the responses of women with bilateral and contralateral prophylactic mastectomy. Seventy-one percent of women with prophylactic mastectomy responded to the survey and 48% provided open-ended responses about psychosocial outcomes. Women's open-ended responses regarding psychosocial outcomes could be coded into one of three general categories--positive, negative, and disparate. In the subgroup of women with both open- and closed-ended responses, over 70% of women providing negative and disparate comments to the open-ended question simultaneously indicated satisfaction on a closed-ended question. Negative and disparate open-ended responses were twice as common among women with bilateral prophylactic mastectomy (52%) than women with contralateral prophylactic mastectomy (26%). These findings suggest that even among women who report general satisfaction with their decision to have prophylactic mastectomy via closed-ended survey questions, lingering negative psychosocial outcomes can remain, particularly among women with bilateral prophylactic mastectomy. This dichotomy could be an important factor to discuss in counseling women considering the procedure.

The importance of expectations on the recovery period after cancer treatment

The purpose was to study expectations concerning recovery-related changes in life, e.g. beliefs regarding future adjustment back to 'normal' life after curative cancer treatment, whether these expectations were met and their importance for both patients' and their spouses' quality of life and psychological distress. Sixty-two patients and 42 spouses took part in the study. Data on recovery-related expectations, measured using a study-specific questionnaire (RRE), on quality of life using EORTC-QLQ C-30 and on psychological distress using HADS, were collected directly after completion of treatment, four and 16 months later. Optimism was measured using LOT at the last follow-up. The results demonstrate that patients generally had higher recovery-related expectations than did their spouses, and their expectations were also fulfilled to a lesser degree at both follow-ups. However, the expectations, or whether these were met, were generally not associated with their quality of life or psychological distress. The few associations that were made indicated that fulfilled expectations meant higher quality of life and/or less distress. The participants' optimism was associated with both their quality of life and psychological distress. It is concluded that optimism influenced the participants' quality of life and psychological distress to a higher degree than did their recovery-related expectations.

The Long-Term Evolution of Quality of Life for Disease-Free Breast Cancer Survivors

AIM

Little is known about the long-term evolution of Quality of Life (QoL) for breast cancer treated patients. The study aims to describe this evolution of QoL in a group of Belgian breast cancer survivors.

METHODS

We gathered information on treatment, general health, activity problems, disease symptoms, pain, emotions, work, social activities, self-care, housekeeping, sexuality, and meaning of life. One hundred seventy-four disease-free survivors in Flanders (Belgium) participated in this study, which were grouped as being disease free less than one year (39), between one and five years (70) and more than five years (65). The data allowed us to analyse QoL for different dimensions over the three survivor groups.

RESULTS

The longer the survival time, the more QoL of breast cancer treated patients ameliorated and the less breast cancer had a major impact on QoL. Scores for doing intense activities, being tired, emotional health, social activities, and meaning of life were statistically significantly better in the long-term survivor group. The influence of breast cancer was more persistent for sexual QoL items.

CONCLUSION

It is important for patients to know what they may expect after treatment. This kind of patient-reported information on the evolution of QoL is of great value to healthcare workers. Results may be used to encourage patients who are newly diagnosed with breast cancer or for patients who do not believe in further progress for some QoL aspects. When informing breast cancer patients, a fundamental difference has to be made between the several QoL aspects and time over which improvements may be expected.

Profiles of women with breast cancer: who responds to a telephone interpersonal counseling intervention

The purpose of this paper is to discuss the profiles of women with breast cancer for whom a telephone interpersonal counseling intervention (TIP-C) was beneficial for symptom management and quality of life. This analysis was based on 24 participants who completed the telephone counseling intervention and all three measurements over the course of 10-week pilot study. The typical woman with breast cancer was white, in her mid-fifties and married at the time of the study. The majority was Stage II and was receiving chemotherapy as their primary adjuvant treatment. Preliminary findings suggest that women who were in long-term marriages and reported no previous history of depression or cancer benefited most from the intervention. These women reported less depression, negative affect, symptom distress and fatigue, and improved quality of life. Several theories are proposed for these findings and implications for practice are discussed.

Uncertainty Appraisal Coping and Quality of Life in Breast Cancer Survivors

Breast cancer survivors increasingly experience long-term side effects that influence their quality of life. They also experience uncertainty of their future due to recurrence of disease. Descriptive design was conducted. Using convenience sampling, 150 breast cancer survivors of more than 3 years from time of diagnosis were recruited from Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand. Research instruments included Mishel Uncertainty in Illness Scale, Stress Appraisal Index, Ways of Coping Questionnaire, and Quality of Life: Breast Cancer Version Questionnaire and Demographic Data Questionnaire. Results revealed that breast cancer survivors had moderate levels of uncertainty in their illness. Survivors appraised their illness and found high level of challenges, moderate level of threat, and low level of harm. Overall quality of life was found to be moderate. Among Ways of Coping strategies, seeking social support was used the most and confrontive coping was used the least. Using hierarchical multiple regression, variables influencing quality of life were year of survival, uncertainty in illness, and harm appraisal. All 3 variables explained 21.8% variance of quality of life. Uncertainty and harm appraisal influence quality of life in breast cancer survivors. Suggestions and further implications were included.

The Influences of Chan-Chuang Qi-Gong Therapy on Complete Blood Cell Counts in Breast Cancer Patients Treated With Chemotherapy

After surgery, breast cancer patients are offered adjuvant chemotherapy to avoid cancer cell spread. During chemotherapy process, neutrophils could fall relatively, and side effects could spike to the peak. Therefore, the medical care personnel should prevent the progression of the side effects. This study aimed to examine the effects of Chan-Chuang qi-gong therapy on complete blood counts in breast cancer patients treated with chemotherapy. This study used a quasi-experimental design. The experiment group (n = 32) received a 21-day Chan-Chuang qi-gong therapy, whereas the control group (n = 35) did not. White blood cells, platelet, and hemoglobin were measured on the day before chemotherapy and on days 8, 15, and 22 during chemotherapy. According to this study, there were significant differences in white blood cells (F = 115.76, P <.001), platelets (F = 25.29, P <.001), and hemoglobin (F = 15.39, P <.001) over the 3-week therapy between the experiment and control groups. Chan-Chuang qi-gong therapy may decrease leukopenia in breast cancer patients treated with chemotherapy. It is recommended conducting more studies on qi-gong and then introducing it in clinical nursing practice at an appropriate time to promote quality of nursing care and quality of patient life.

Health-related quality of life in women previously treated for early-stage breast cancer

This study describes health-related quality of life (HRQOL) in women previously treated for early stage breast cancer relative to general population and breast cancer norms. It also identifies correlates and multivariate predictors of physical and mental HRQOL. 2582 women who were up to four years post-treatment for early stage breast cancer completed the RAND-36 Health Survey and reported personal and cancer-related information. Participants reported generally high HRQOL that was comparable to norms for women in the general population and other women with breast cancer. In multivariate analyses, better physical HRQOL was associated with fewer psychological symptoms, lower body mass index, better sleep quality, and more physical activity. Better mental HRQOL was associated with better sleep quality, fewer life events, less pain, and fewer gastrointestinal symptoms. Interventions targeting psychosocial symptoms, weight reduction, physical activity, sleep hygiene, and pain could result in improved HRQOL in these women.