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Woolley A, Hadjiconstantinou M, Bodicoat DH, Khunti K, Davies MJ, Seidu S. A cross-sectional time series of cardiometabolic health education format preferences across sociodemographic groups. Diabet Med 2024:e15404. [PMID: 38994926 DOI: 10.1111/dme.15404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 06/07/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024]
Abstract
AIMS Health education is integral to cardiometabolic disease (CMD) management. This study aimed to assess whether and how education preferences have changed over time, and whether trends differ by sociodemographic characteristics (education status, age, ethnicity, and sex). METHODS A cross-sectional questionnaire was deployed across five counties in the East Midlands, UK between 2017 and 2022 to adults with CMD (type 2 diabetes, cardiovascular disease or cerebrovascular disease). Respondent demographic data were collected alongside health education preferences. Statistical analyses ascertained whether demographic characteristics influenced preferences. The distribution of preferences over time was charted to identify trends. RESULTS A total of 4301 eligible responses were collected. Face-to-face one-to-one education was preferred (first choice for 75.1% of participants) but popularity waned over the five-year period. Trends were similar amongst demographic groups. Online education showed a U-shaped trend: In 2017, 44% of respondents ranked it as acceptable, peaking at 53% in 2019, but declining again, to below base line, 43%, by 2022. This modality was more popular with participants aged younger than 65 years, but popularity in people older than 65 years increased over the study period. The popularity of printed information also declined over time across all demographic groups except those of South Asian ethnicity, for whom it remained static. CONCLUSIONS The overwhelming preference for face-to-face one-to-one health education from a doctor or nurse highlights the importance of preserving access to this modality, even in the face of current NHS pressures and trends towards digitalisation. Trends are changing, and should continue to be monitored, including between different sociodemographic groups.
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Affiliation(s)
- Angharad Woolley
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Kim M, Ali B, Graziano FD, Colvin K, Boe LA, Allen RJ, Nelson JA, Disa J. Analyzing mastectomy and reconstruction weight in immediate autologous breast reconstruction: A preliminary study. J Surg Oncol 2024; 129:1466-1474. [PMID: 38637992 DOI: 10.1002/jso.27647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND This study aims to explore the ideal breast size by assessing the relationship between mastectomy to free flap weight ratio and complications as well as patient-reported outcomes in autologous breast reconstruction (ABR). METHOD A retrospective review of patients undergoing bilateral immediate ABR with mastectomy and flap weights available was completed. Patients were divided into three groups based on the ratio of mastectomy to flap weights. The patients were grouped as "maintained" if the flap weight was within 10% of the mastectomy weight. Patients with a weight difference greater than 10% were used to declare "downsized" or "upsized." Outcomes included complications and four domains of the BREAST-Q at 1-year postoperatively. RESULTS Three hundred and fifty-nine patients were included in the analysis, of which 112 were downsized, 91 maintained, and 156 upsized, respectively. Presence of complications did not significantly differ among the groups. At 1-year postoperatively, Sexual Well-being significantly differed (p = 0.033). Between preoperative and 1 year, patients who upsized experienced an improvement in Satisfaction with Breasts by 16 points (p < 0.001), while patients who downsized experienced a decline in Physical Well-being of the Chest by 7 points (p = 0.016). Multivariable linear regression model showed that Sexual Well-being was 13 points lower in the downsized cohort than in the maintained cohort (β = -13, 95% confidence interval: -21 to -5.4; p = 0.001). CONCLUSION Although complication rates do not significantly differ between the three cohorts, patients who downsize may have lower Sexual Well-being postoperatively. Surgeons should consider our preliminary findings to counsel patients preoperatively about the predicted breast size and the impact of downsizing on sexual health.
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Affiliation(s)
- Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Barkat Ali
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Francis D Graziano
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kate Colvin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lillian A Boe
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Kim M, Carter J, Tadros AB, Abuhdra N, Nelson JA, Stern CS. A guide for addressing sexual health in breast cancer patients. J Surg Oncol 2024; 129:1034-1040. [PMID: 38385690 DOI: 10.1002/jso.27602] [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: 01/10/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Sexual health concerns are common in breast cancer surgery but often overlooked. Yet, breast cancer patients want more sexual health information from their providers. We aimed to share ways for providers to address sexual health concerns with their breast cancer patients at different stages of the treatment process. METHODS Experts in breast cancer treatments, surgeries, and sexual health at Memorial Sloan Kettering Cancer Center assembled to review the literature and to develop the recommendations. RESULTS Providers should provide sexual health information for their breast cancer patients throughout the continuum of care. Conversations should be initiated by the providers and can be brief and informative. Whenever appropriate, patients should be referred to Sexual Medicine experts and/or psychosocial support. There are various recommendations and tools that can be utilized at diagnosis, endocrine and chemotherapy, and breast surgery to identify patients with sexual health concerns and to improve their sexual functioning. CONCLUSION In this paper, we sought to provide providers with some insights, suggestions, and tools to address sexual health concerns. We encourage healthcare providers to initiate the conversation throughout the continuum of care beginning as early as diagnosis and refer patients to additional services if available.
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Affiliation(s)
- Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jeanne Carter
- Gynecology Service, Department of Psychiatry, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nour Abuhdra
- Breast Oncology, Department of MedicineMemorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carrie S Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Hunter W, Pettigrew J, Carpenter KM, Worly B, Coons HL. Improving Sexual Health Across the Life Span Through Integrated Care in Obstetrics and Gynecology. Clin Obstet Gynecol 2024; 67:233-246. [PMID: 38173321 DOI: 10.1097/grf.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Sexual health is a vital part of physical, emotional, and relational well-being among adults across the life span. While patients are reluctant to discuss their sexual concerns, Obstetrics and Gynecology providers are especially well positioned to improve sexual functioning and satisfaction through screening, education, prevention and early intervention, treatment, and integrating behavioral health and sexual medicine services in their clinical practices. This article sets out to provide applied information and perspectives to foster the development of interprofessional sexual medicine services in Obstetrics and Gynecology practices in hospital and community settings.
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Affiliation(s)
- Winnifred Hunter
- Women's Behavioral Health & Wellness Service, University of Colorado School of Medicine/Anschutz Medical Campus, Aurora
| | | | - Kristen M Carpenter
- Department of Psychiatry & Behavioral Health, Psychology, Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Brett Worly
- Department of OB/GYN, The Ohio State University Wexner Medical Center
| | - Helen L Coons
- Women's Mental Health Associates & Health Psychology Solutions, Denver, Colorado
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Rojas K, Spring LM, O'Riordan L, Weiss A. Endocrine Therapy for Surgeons: Practical Pearls for Managing Menopausal, Bone Loss and Sexual Adverse Effects. Ann Surg Oncol 2023; 30:5951-5961. [PMID: 37495843 DOI: 10.1245/s10434-023-13907-4] [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: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023]
Abstract
Breast cancer patients are living longer than ever before and as such the population of breast cancer survivors continues to grow. Approximately 80% of breast cancers are hormone receptor-positive (HR+) and most patients will receive neoadjuvant or adjuvant estrogen blockade, referred to as endocrine therapy. Although endocrine therapy reduces HR+ breast cancer recurrence by 30-50%, significant adverse effects pose a threat to treatment adherence. These adverse effects include vasomotor symptoms, colloquially referred to as hot flashes, bone loss, joint arthralgias, genitourinary syndrome of menopause (GSM), previously referred to as vaginal atrophy, and low libido. This review will present the evidence-based treatments available for each of these adverse effects, including clear treatment algorithms for GSM, which is often experienced by patients but overlooked by providers. The most important takeaway is to ask open-ended questions, encourage reporting of these symptoms, and refer patients to specialty providers as needed. Surgeons may be the first to encounter these symptoms, therefore it is critical to remain informed of the treatment options.
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Affiliation(s)
- Kristin Rojas
- Dewitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, MUSIC™ Sexual Health After Cancer Program, Miami, FL, USA
| | - Laura M Spring
- Harvard Medical School, Boston, MA, USA
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Anna Weiss
- Division of Surgical Oncology, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
- Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA.
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Shi M, Meltzer KJ, Dunker AM, Hall BC. Point-of-care assessment of sexual concerns among young adult oncology active patients and survivors. Support Care Cancer 2023; 31:556. [PMID: 37665432 DOI: 10.1007/s00520-023-08026-5] [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: 05/26/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Adolescent and young adult (AYA) oncology populations have unique sexual health concerns that deserve more attention. Our study aimed to describe sexual health and related concerns in young adults (YAs) to move toward integrating sexual health into routine care. METHODS A total of 127 YAs (ages 19-39) in active treatment and survivorship from three outpatient oncology clinics provided demographic and clinical information. They completed versions of the NCCN Distress Thermometer and Problem List (AYA-POST; AYA-SPOST) developed specifically for AYAs as part of an ongoing needs assessment study. RESULTS Over one quarter (27.6%) of the total sample (Mage = 31.96, SD = 5.33) - 31.9% in active treatment (n = 72) and 21.8% in survivorship (n = 55) - reported at least one sexual health concern (i.e., sexual concern, loss of libido (desire for sex), pain with sex, and unprotected sex). Those undergoing active treatment with sexual concerns had significantly higher distress than those without sexual concerns, whereas this pattern was nonsignificant for those in survivorship. Both genders often endorsed general sexual concerns and loss of libido. CONCLUSION The current study adds to the important and burgeoning literature on sexual health concerns of YAs oncology populations. The prevalence of sexual concerns, differences between treatment status and between those with and without sexual concerns highlight the utility and need to embed screening that includes sexual health items at point of care. This can facilitate discussion of these sensitive and multifaceted needs throughout the cancer continuum.
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Affiliation(s)
- Molin Shi
- Department of Psychiatry, Division of Psychology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Karen J Meltzer
- Department of Psychiatry, Division of Psychology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Alexandra M Dunker
- Moncrief Cancer Institute, The University of Texas Southwestern Medical Center, 400 West Magnolia Ave, Fort Worth, TX, 76104, USA
- Fort Worth Adolescent Young Adult Oncology Coalition, 080 S Hulen St Ste 360, PMB, Fort Worth, TX, 299, USA
| | - Brittany C Hall
- Department of Psychiatry, Division of Psychology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Moncrief Cancer Institute, The University of Texas Southwestern Medical Center, 400 West Magnolia Ave, Fort Worth, TX, 76104, USA
- Fort Worth Adolescent Young Adult Oncology Coalition, 080 S Hulen St Ste 360, PMB, Fort Worth, TX, 299, USA
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Shi M, Meltzer KJ, Dunker A, Hall BC. Point of Care Assessment of Sexual Concerns among AYA Oncology Active Patients and Survivors. RESEARCH SQUARE 2023:rs.3.rs-2986799. [PMID: 37398255 PMCID: PMC10312983 DOI: 10.21203/rs.3.rs-2986799/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Purpose Adolescent and young adults (AYAs) oncology populations have unique sexual health concerns that deserve more attention. The current study aimed to describe the prevalence and characteristics of sexual health and related concerns in AYAs in active treatment and survivorship to move toward integrating sexual health in routine care. Methods A total of 127 AYAs (ages 19-39) in active treatment and survivorship were recruited from three outpatient oncology clinics. In addition to providing demographic and clinical information, they completed an adapted version of the NCCN Distress Thermometer and Problem List (AYA-POST; AYA-SPOST) as part of an ongoing needs assessment study. Results Over one quarter (27.6%) of the total sample ( M age = 31.96, SD = 5.33) - 31.9% of active treatment, and 21.8% in survivorship - reported at least one sexual health concern (i.e., sexual concern, loss of libido, pain with sex, and unprotected sex). The most frequently endorsed concerns differed between active treatments and survivorship. Both genders often endorsed general sexual concerns and loss of libido. Conclusion The literature on sexual concerns in the AYA population is sparse and inconclusive, especially accounting for gender and other types of concerns. The current study highlights the need for further examination between treatment status, psychosexual concerns, emotional distress, and demographic and clinical factors. Given the prevalence of sexual concerns in AYAs in active treatment and survivorship, providers should consider integrating assessment and discussion of these needs at onset of diagnosis and as part of monitoring.
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Affiliation(s)
- Molin Shi
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Division of Psychology
| | - Karen J Meltzer
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Division of Psychology
| | - Alexandra Dunker
- The University of Texas Southwestern Medical Center, Moncrief Cancer Institute
| | - Brittany C Hall
- The University of Texas Southwestern Medical Center, Department of Psychiatry, Division of Psychology
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Fisher CS, Teshome M, Blair SL. 23rd Annual Meeting of the American Society of Breast Surgeons: Back to In-Person Scientific Exploration. Ann Surg Oncol 2022; 29:6087-6089. [PMID: 35902494 PMCID: PMC9333076 DOI: 10.1245/s10434-022-12263-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Carla S Fisher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah L Blair
- Department of Surgery, University of California San Diego, San Diego, CA, USA.
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