Psychological Resilience as a Protective Factor for the Body Image in Post-Mastectomy Women with Breast Cancer

Social participation of women with breast cancer compared to the general population 5 years after primary surgery-what role do medical data and cancer-related complaints play?

PURPOSE

This study analyzes levels of social participation in patients with breast cancer on average 5 years following primary surgery as compared to women in the general population. In addition, the role of breast cancer-related complaints and medical data as possible influencing factors on levels of patients' social participation is investigated.

METHODS

A total of n = 454 patients after primary surgery (t0) were recruited for a third follow-up study, and n = 372 completed this survey (t3), corresponding to a response rate of 82.2%. For measuring breast cancer-related complaints, participants completed a written questionnaire. Social participation was measured by a questionnaire on different leisure activities that was taken from the Socio-Economic Panel Study. Medical information was extracted from medical reports at t0. A principal component analysis was carried out to identify different dimensions of social participation. Chi2-tests and logistic regression analyses were applied to analyze social participation as compared to the general population and the role of possible medical and diagnosis-related influencing factors thereby.

RESULTS

Compared to the general population, patients show lower levels of social participation in the domains "socio-cultural participation" and "participation in institutions," while no significant differences for "social participation in the private sphere" and "social participation via social media" were found. Psychological symptoms, pain, and a history of mastectomy were most strongly associated with restrictions in social participation.

CONCLUSIONS

Our study suggests that social withdrawal may happen due to disease-related symptoms, preventing some breast cancer patients from participating fully in society. Cancer-related follow-ups should address this issue and support patients' reintegration into society through appropriate therapeutic interventions.

Relationship between dyadic communication and body image among women with breast cancer

PURPOSE

Dyadic communication positively affects marital relationships, good relationships help restore body image, and this study explores the relationship between dyadic communication and body image of breast cancer patients.

METHODS

Cross-sectional correlation design with convenience sampling was used to recruit participants from two outpatient medical centers. Demographic information, medical records, and two questionnaires, dyadic communicative resilience scale (DCRS) and body image scale (BIS), were administered. Participants comprised women with breast cancer and their partners. Multiple regression analysis was performed to control related factors to understand the association between the DCRS of the women with breast cancer and their partners and the women's body image. Analysis of variance (ANOVA) was performed to analyze between three categories of couple's communication status (consistent and good, consistent and poor, and inconsistent) and body image of women with breast cancer.

RESULTS

Data were obtained from 162 women with breast cancer and 90 partners. The study found (1) significant correlation between the women's perception of their communication and body image, (2) humor in partner's perception of their communication was significantly associated with women's body image, and (3) dyadic communication that both patients and partners were consistent and good in the domain of keeping pre-cancer routines and attractiveness was associated with women's body image.

CONCLUSION

The correlation between dyadic communication and the body image of women with breast cancer is significant. Improving communication specific on keeping pre-cancer routines and attractiveness between women with breast cancer and their partners could enhance the women's body image.

Perceived social support mediates cancer and living meaningfully intervention effects on quality of life after breast cancer surgery

Aim: To explore the role of perceived social support in enhancing psychological resilience and quality of life in postoperative breast cancer patients. Materials & methods: The Managing Cancer and Living Meaningfully (CALM) intervention was used to improve indicators such as psychological resilience in breast cancer patients, while the role of perceived social support in this was assessed. Results: The intervention group exhibited significant improvements compared with the control group in psychological resilience (F = 9.059, p < 0.01). The analysis showed that increased social support in the control group partly mediated the link between psychological resilience and quality of life. Conclusion: CALM improves overall well-being, indicating that incorporating it into standard care for post-mastectomy patients can positively impact their mental health.

Group Sex Counseling Based on a Modified "Good Enough Sex" Model: A Randomized Trial on Sexual Health Variables among Breast Cancer Survivors in Iran

A randomized controlled clinical trial conducted in Iran from April 2020-2021 involved 100 eligible breast cancer survivors (BCSs). The study examined the impact of sexual counseling using a modified "Good Enough Sex" (GES) model on BCSs' sexual health variables. The intervention group, consisting of BCSs and their spouses, participated in four weekly group counseling sessions lasting 90-120 min each. The control group attended routine medical checkups. The intervention was designed based on a previous qualitative study assessing sexual needs and concerns in BCSs, as well as the GES model. Sexual satisfaction, function, and communication were evaluated at baseline, two, and three months follow-ups. Most participants (77%) had undergone a mastectomy, with diagnoses typically occurring between ages 39-49 and 5-7 years post-diagnosis. Initially low sexual satisfaction and function significantly improved in the intervention group (p < 0.001), reaching high satisfaction and moderate function levels. After three months, significant differences in sexual health variables were observed between the intervention and control groups (p < 0.001), indicating substantial positive effects, particularly in sexual satisfaction (0.99). Given the challenges in improving sexual function due to cancer complications, sex education based on sexual dialogue and realistic expectations can promote sexual well-being.

RCT Number: IRCT20120609009975N8, dated 2020-04-18, https://en.irct.ir/trial/42030.

The Impact of Newly Diagnosed Early Breast Cancer on Psychological Resilience, Distress Levels, and the Perception of Health

Confronting a breast cancer diagnosis, along with complex and challenging treatment procedures, is an extremely stressful experience. Psychological resilience is the ability to maintain or restore normal functioning while facing adversity. We aimed to explore the impact of an early breast cancer diagnosis on psychological resilience, distress, and perception of health. A cross-sectional study was conducted, including 50 patients newly diagnosed with early breast cancer and 67 healthy women with screening mammograms graded 1 or 2 using a Breast Imaging Reporting and Data System. The levels of distress, perception of health, and psychological resilience were assessed using the depression, anxiety, and stress scale, the SF 36-Item Health Survey 1.0, and the Connor-Davidson RISC-25 scale. Differences between variables were examined using the t-test and chi-square test for interval and categorial variables. The surveys were conducted within four weeks of a breast cancer diagnosis. Patients with breast cancer reported a deterioration of their health relative to the previous year and significantly higher levels of psychological resilience, while there was no significant difference between the groups in levels of stress, anxiety, or depression. The process of diagnosis with early breast cancer may activate psychological dynamic processes which are involved in the effective adaptation to acute stress, leading to higher resilience levels in breast cancer patients compared to healthy controls.

Psychological symptom burden associated with malignant wounds: Secondary analysis of a prospective cohort study

OBJECTIVES

Patients with malignant wounds suffer from physical and psychological symptom burden. Despite psychological support being required, the impact of malignant wounds on patients' psychological distress is poorly investigated. We evaluated psychological distress associated with malignant wounds for patients at their end of life.

METHODS

This study used the secondary analysis of the results of a large prospective cohort study, which investigated the dying process among patients with advanced cancer in 23 palliative care units in Japan. The primary outcome of this study was the prevalence of moderate to severe psychological symptom burden, evaluated by the Integrated Palliative Care Outcome Scale (IPOS)-feeling at peace scores of 2-4. In addition, the factors affecting psychological symptoms were investigated. The quality of death was also evaluated upon death using the Good Death Scale score.

RESULTS

Out of the total 1896 patients, 156 had malignant wounds (8.2%). Malignant wounds were more common in female and young people. The breast, head, and neck were the most prevalent primary sites. More patients with malignant wounds had IPOS-feeling at peace scores of 2-4 than patients without malignant wounds (41.0% vs. 31.3%, p = 0.024). Furthermore, psychological distress was associated with moderate to severe IPOS-pain and the frequency of dressing changes. The presence of malignant wounds did not affect the quality of death.

SIGNIFICANCE OF RESULTS

This study showed increased psychological distress due to malignant wounds. Patients with malignant wounds require psychological support in addition to the treatment of physical symptoms for maintaining their quality of life.

Effects of Music Intervention on Anxiety, Depression Symptoms and Quality of Life in Breast Cancer Patients: A Meta-Analysis

BACKGROUND

Music therapy is often used to relieve anxiety and depression in breast cancer patients, but the clinical effect of music therapy on breast cancer patients is still controversial. This study was a systematic review to investigate the effects of music intervention on anxiety, depression, pain, and quality of life in breast cancer patients.

METHOD

A computer search of PubMed, Embase, Web of Science, and The Cochrane Library repositories was conducted. We searched for randomized controlled trials (RCTs), published in English until October 2023, on the effects of music interventions on anxiety, depressive symptoms, pain levels, and quality of life in breast cancer patients. The Cochrane Manual of Systematic Review 5.3 was used to evaluate the quality of the included references, and Stata15.0 software was selected for meta-analysis of the study indicators.

RESULTS

A total of 10 articles were included in this study, including 593 patients. Meta-analysis showed that music intervention could effectively alleviate anxiety symptoms [standardized mean difference (SMD) = -2.12, 95% confidence interval (CI): -3.17~-1.07], depression symptoms (SMD: -0.77, 95% CI: -1.47~-0.07), and pain degree (SMD: -3.47, 95% CI: -6.45~-0.48). There was no significant difference in the improvement of patients' quality of life (SMD: -0.07, 95% CI: -0.48~0.34).

CONCLUSION

Music intervention can effectively relieve anxiety and depression symptoms in patients with breast cancer, and reduce the degree of pain, but demonstration of its ability to improve the quality of life of patients requires additional research.

Effects of Comprehensive Noise Reduction Management Combined with Reality Therapy on Anxiety and Depression in Hospitalised Patients with Breast Cancer

Objective

This study was conducted to explore the effects of comprehensive noise reduction management combined with reality therapy on anxiety and depression in hospitalised patients with breast cancer.

Methods

The medical records of 166 inpatients with breast cancer in Tongji Hospital affiliated with Tongji Medical College of Huazhong University of Science and Technology from March 2020 to March 2022 were retrospectively analysed. According to different intervention methods, these patients were divided into group A (n = 58, receiving conventional intervention), group B (n = 55, receiving conventional intervention combined with reality therapy) and group C (n = 53, receiving conventional intervention combined with comprehensive noise reduction management and reality therapy intervention). Patients' anxiety and depression, quality of life and satisfaction degree in the three groups were compared.

Results

Before the intervention, the scores of the Hospital Anxiety and Depression Scale (HADS) and Short-From-36 Health Survey (SF-36) scale did not significantly differ amongst the three groups (P > 0.05). After the intervention, we observed a difference in the pairwise comparison of HADS scores amongst the three groups, in which group C had the lowest score and group A had the highest HADS score (P < 0.001). We also noted a difference in the pairwise comparison of SF-36 scores amongst the three groups, in which group C had the highest SF-36 score and group A had the lowest SF-36 score (P < 0.001). The pairwise comparison of satisfaction revealed a difference amongst the three groups, in which group C had the highest satisfaction (92.45%, 94.34% and 94.34%), and group A had the lowest satisfaction (74.14%, 74.14% and 75.86%; P < 0.05).

Conclusion

Comprehensive noise reduction management combined with reality therapy can effectively relieve the negative emotions of inpatients with breast cancer, as well as improve their survival state of patients. It is suggested that it be included in the clinical intervention system for breast cancer.

"My body, my choice": A qualitative study of women's mastectomy with flat closure experiences

This qualitative study aimed to describe and explore the pre and post-mastectomy experiences of women choosing flat closure after a breast cancer diagnosis. Aesthetic flat closure creates a flat contoured chest wall after a mastectomy. There is limited research on women's flat closure experiences. To fill this gap, we interviewed 19 women (Mage = 53, range 31-72) with breast cancer who underwent a bilateral mastectomy with flat closure, examining decision-making, mirror-viewing, and flat closure experiences. Using a hermeneutic phenomenological design, we generated seven themes. Broadly, women choosing flat closure experienced pressure from their clinicians to undergo breast reconstruction. We found flat closure information to be consistently lacking. Mirror-viewing experiences of women obtaining suboptimal flat closure outcomes led to shattered expectations, mirror avoidance, psychological distress, and body image disturbances. Women negotiated their new reality by discovering ways to feel comfortable with their flat bodies. Regardless of surgical outcome, decision satisfaction was high. These findings illustrate the importance of bodily autonomy and supportive healthcare environments for women making flat closure decisions. Providing comprehensive information on all surgical options and addressing post-operative expectations can improve women's decision-making and mirror-viewing experiences and assist women in adapting to their new body image.

How Do Women React to the COVID-19 Pandemic Period? Relationship Between Ego-Resiliency, Anxiety, Alcohol Consumption and Aggression Among Polish Women

Purpose

There are many reports in the literature on the impact of the COVID-19 pandemic on mental health, including the condition of women. Most of these studies refer to a single time point, while there is a lack of studies controlling for selected parameters during different periods of the pandemic. This work aimed to determine the role of ego-resiliency in women's adaptation to the COVID-19 pandemic.

Patients and Methods

The survey was conducted in two stages - all via online forms. A total of 762 Polish women took part in the overall project. The scales used in the study were the Ego-resiliency scale (ER89-R12), Generalized Anxiety Disorder 7 Scale (GAD-7), Alcohol Use Disorders Identification Test (AUDIT), and Buss-Perry Aggression Questionnaire (BPAQ). Statistical analysis was performed using Statistica 13.3.

Results

Women participating in the second study had significantly lower scores on ego-resilience and its components compared to the first study. In the first research, ego-resiliency and optimal regulation were statistically significantly correlated with anxiety, alcohol consumption, generalised aggression, verbal aggression and hostility, while openness to life experiences was correlated with alcohol consumption and hostility. The second part of the project highlighted new significant correlations between ego-resiliency and optimal regulation and physical aggression and anger, but a non-significant correlation of these variables with alcohol consumption. The effect of openness to life experiences on alcohol consumption and anxiety, evident in the first study, was no longer present in the second part of the study.

Conclusion

The lack of a significant effect of openness to life experience on alcohol consumption, lower ego-resiliency and optimal regulation scores are observed in the second part of the research, which might be an expression of adaptation to the COVID-19 pandemic. Ego-resiliency is a protective factor against aggression, while optimal regulation against anxiety among Polish women.

The Effect of Spirituality on Psychological Resilience in Women with Breast Cancer Who Have Received Chemotherapy: A Cross-sectional Study from Turkey

Spirituality involves all of the internal resources of the individual, including religion, the desire to live, and a commitment to life. This study was conducted to determine the effect of spirituality on psychological resilience in women with breast cancer who have received chemotherapy. The study was conducted in a chemotherapy unit between April and June 2022. The sample size of the current cross-sectional study consisted of 85 women who have received chemotherapy. For the measuring of spirituality and psychological resilience, the Spirituality Scale (SS) and the Brief Resilience Scale (BRS), respectively, were completed. In the current study, it was determined that there was a positive weak correlation between the mean SS total score and the mean BRS total score (r = 0.471, p < 0.05). In addition, among women with breast cancer who have received chemotherapy, spirituality accounted for 22% of the variance in psychological resilience (R² = 0.22, p < 0.05). It can also be said that the level of spirituality of women may positively affect their psychological resilience.

Factors Associated with Body Image and Self-Esteem in Mastectomized Breast Cancer Survivors

Body image (BI) and self-esteem (SE) are two fundamental aspects in the evolution of breast cancer (BC), mainly due to surgery, treatment, and the patient's conception of BI. A dissatisfaction with BI and low SE decreases the subject's quality of life and increases the risk of recurrence and mortality by BC. The aim of this study is to find out if there is any degree of association between the sociodemographic data of the sample and their BI and SE. A cross-sectional, descriptive study was conducted with 198 women diagnosed with BC, aged 30-80 years, in Mexico. Women's BI and SE were assessed using two questionnaires, Hopwood Body Image Scale (S-BIS) and Rosenberg Self-Esteem Scale (RSES). The results show significant differences in several items when the variable sense of humor is taken into account, indicating that women with a sense of humor report higher satisfaction with their BI and higher SE. The age also indicates a significantly better BI in women over 50 years of age, as well as the education level variable, where those women who had studied up to secondary reported higher satisfaction with their BI; the family history shows that those women without a family history report better SE. All these data are supported by stepwise regression, which shows that educational level and sense of humor are predictors of BI, and family history along with breast reconstruction and sense of humor are predictors as of SE. In conclusion, it is important to take into account the characteristics of women with BC, particularly age and sense of humor, in order to reduce the impact of the disease on their BI and SE with the help of a multidisciplinary team.

"I listen to my body now": a qualitative exploration of positive body image in breast cancer survivors

OBJECTIVE

Existing research has identified the high prevalence of body image concerns among female breast cancer survivors. However, it has neglected to explore the experience of positive body image among this group, despite its potential utility for intervention development. The present study therefore aimed to explore the experiences of breast cancer survivors who self-identified as experiencing a positive relationship with their post-treatment bodies.

DESIGN

Twenty-two participants (M age = 54, SD = 8.38) were interviewed using a semi-structured approach.

RESULTS

Thematic analysis identified three overarching themes amongst the qualitative data: (1) Resisting appearance pressures, (2) Receiving care, and (3) Self-worth beyond appearance. Findings indicated that women's life experiences had led them to develop a critical awareness of the unrealistic nature of appearance ideals. Their experience of positive body image was also attributed to engaging in self-care and receiving supportive care from others. Finally, women expressed prioritising functionality and health over their physical appearance.

CONCLUSION

The present findings advance the theoretical understanding of positive body image in a breast cancer population. They also provide an opportunity to test theorised models of positive body image.

Resilience among women with breast cancer surviving longer than five years: The relationship with illness perception and body image

PURPOSE

This study aimed to investigate the correlations and identify the relationships between the resilience, perception of illness and body image of women with breast cancer in the 5-year-or-above survivorship.

METHODS

We used convenient sampling to recruit from an outpatient department 106 women with breast cancer. The inclusion criteria were participants aged >20 years currently in a stable condition and were able to understand the Chinese language. Those women with mental health illness were excluded. All participants completed questionnaires on the following: demographic information, revision of illness perception (IPQ-R), body image scale (BIS), Eysenck personality questionnaire (EPQ), and resilience scale (RS). We conducted the structural equation modeling (SEM) to explore the factor structure.

RESULTS

SEM results showed a good fit to the data (comparative fit index = 0.97, Tucker-Lewis index = 0.94). Findings F indicated the existence of significant relationships between resilience and either illness perception or body image. Personality had a direct association with illness perception (β = 0.73, P < 0.05). Body image had an indirect effect on the relationship between resilience and illness perception (coefficient = -2.52; 95% bootstrapping CI = -31.36, -0.62).

CONCLUSIONS

Results indicated that illness perception is a crucial predictor for better resilience as mediated through body image. To provide adequate information to women with breast cancer can improve their perception of breast cancer more positively. Hence, their body image and their way of coping with survival life turn better.

How to measure ego-resiliency in the face of various life-changing crises: Measurement invariance, convergent and discriminant validity and reliability of the Polish version of the Revised Ego-Resiliency Scale (ER89-R12)

This study examines the generalizability of the latent structure of the Polish version of the Ego-Resiliency Scale (ER89-R12), a brief self-report scale that measures ego-resiliency. We investigated the measurement invariance, validity, and reliability of ER89-R12 among three groups of individuals who were facing various major, long-term, life-changing crises (N = 512): parents of children with Down's syndrome, women with breast cancer, and individuals after divorce. The analysis of the measurement invariance confirmed the two-factor structure of the questionnaire and the high reliability of this measure in those studied groups. A multigroup confirmatory factor analysis provided evidence of configural, metric, scalar, and residual invariance across the three groups. Moreover, the correlation patterns were similar across the groups. Ego-resiliency was strongly and consistently positively correlated with mental health: psychological well-being, perceived social support, self-esteem, and post-traumatic growth, and negatively correlated with perceived stress. The presented results indicate the potential usefulness of the ER89-R12 tool in studies on people experiencing various crises in their lives.

Silently Proliferating: Cancer

Cancer is a health problem that has existed for years and frequently affects tissues and organs. Although some standards have been set for its treatment, different treatments and approaches are used for each type of cancer. The treatment process and having to live with cancer drag the individual to a difficult process that affects the individual negatively. Problems such as the severe course of the disease, taking longer than expected treatment, and having many side effects reduce the individual's physical performance and activities of daily living. Therefore, this situation reduces the quality of life and causes the general well-being of the individual to be negatively affected at the psycho-social level. In order to cope with the problems that cancer patients experience, it is important to support them physically, mentally, emotionally, socio-culturally, and spiritually. The decrease in the quality of life of the caregiver also affects the quality of care and therefore the quality of life of the patient. For this reason, it is necessary to determine how patients and caregivers perceive the disease, reduce their psychological anxiety and pain, as well as the factors affecting this perception, and ensure their compliance with treatment.

Associations of body image with depressive symptoms and PTG among breast cancer patients: The mediating role of social support

Background

Cancer diagnosis and treatment usually trigger positive and negative psychological health outcomes. Social support is a coping resource for psychological health outcomes. However, little research is available on the relationships between social support, body image, and overall psychological health outcomes in breast cancer (BC) patients. This study aimed to estimate the prevalence of depressive symptoms and post-traumatic growth (PTG) and examine the mediating roles of social support between body image and depressive symptoms and PTG among BC patients, respectively.

Methods

A cross-sectional study was conducted in the Northeast China from December 2015 to August 2017. All the participants were diagnosed with BC and underwent surgery. This study was conducted with 405 BC patients from the First Affiliated Hospital of China Medical University. Participants completed the Center for Epidemiologic Studies Depression scale, Post Traumatic Growth Inventory, Body Image Scale, and Perceived Social Support Scale. The associations of social support, body image with depressive symptoms, and PTG were examined by hierarchical linear regression analysis. Asymptotic and resampling strategies were used to explore the mediating role of social support.

Results

The prevalence of depressive symptoms was 88.1%, and 67.2% of the patients had moderate-high PTG, 52.84% of the patients had body concerns, and 264 (65.19%) patients had high-level social support. Body image was positively associated with depressive symptoms (β = 0.445, P < 0.001) and social support was negatively associated with depressive symptoms (β = −0.219, P < 0.001). Body image was negatively associated with PTG (β = −0.095, P = 0.023), whereas social support was positively associated with PTG (β = 0.533, P < 0.001). Social support significantly mediated the associations among body image, depressive symptoms (effect size = 0.057), and PTG (effect size = −0.304), respectively.

Conclusions

Social support played mediating role in the relationships between body image and depressive symptoms and PTG. The interventions based on social support and body image should be included in psychological health prevention.

Intimate partner violence in women with breast and gynaecologic cancers: A systematic review

AIM

The current study aimed to systematically review the data obtained from studies on women with breast and gynaecologic cancers subjected to Intimate Partner Violence (IPV).

DESIGN

Systematic review without meta-analysis.

DATA SOURCES

PubMed, ProQuest, Google Scholar, Scopus, Web of Science; databases were searched without time limit.

REVIEW METHOD

The PRISMA model was guided the systematic literature search using Boolean keywords and operators. PICO statement was used to develop a question of this review. Studies examining women with breast and gynaecologic cancers subjected to IPV were included in the study after the quality of the articles was reviewed.

RESULTS

Eight studies that met the inclusion criteria and were conducted between 2000 and 2021 were included in the study.

CONCLUSIONS

Studies confirm the effect of IPV on the severity and consequences of breast and gynaecologic cancers. Having a history of IPV can indirectly lead to breast and gynaecologic cancers. On the other hand, women suffering from IPV are more likely than other women to delay screening or not perform screening for cancer.

IMPACT

The dimensions and nature of violence and the disclosure or non-disclosure of violence in vulnerable women are strongly affected by society's culture. Therefore, researchers need to have sufficient knowledge of the culture and social factors governing the community to achieve reliable findings related to IPV in qualitative, quantitative, and psychometric studies and the design of IPV assessment tools. It is recommended that IPV screening teams, that is, multidisciplinary teams of trained physicians, nurses and social workers, participate in two-way screening programmes: IPV screening for women with gynaecological cancer and screening for gynaecological cancer in women with IPV.

Systematic review and meta-analysis of the efficacy and safety of psychological intervention nursing on the quality of life of breast cancer patients

BACKGROUND

With the increasing incidence of breast cancer, breast cancer patients suffered from psychological problems in different degrees. There was no unified conclusion on whether psychological intervention nursing can improve the quality of life (QOL) of breast cancer patients. This meta-analysis aimed to explore the impact of psychological nursing interventions on the quality of life of breast cancer patients.

METHODS

We retrieved related articles from both English databases (including PubMed, Medline, and Embase) and Chinese databases [including China Biology Medicine DISC (CBMdisc), China National Knowledge Network (CNKI), Wanfang, and China Science and Technology Journal Database (VIP]. All of the databases were searched using a combination of the following search terms: psychological intervention nursing, psychological nursing, psychotherapy, breast loss, radical mastectomy, modified radical mastectomy, and quality of life. The quality of the included literature was assessed using RevMan 5.3 provided by the Cochrane system.

RESULTS

A total of 12 articles were included, and the meta-analysis results showed that the quality of life questionnaire core 30 (QLQ-C 30) was evaluated, and there was heterogeneity among the studies (P<0.00001, I2=92%). There was no statistical difference between the intervention group and the control group [standardized mean difference (SMD) =0.58, 95% confidence interval (CI): -0.11-1.27, P=0.10]. Short Form 36 Questionnaire (SF-36) was evaluated, and there was no heterogeneity among the studies (P=0.40, I2=0%). The fixed effect model was used for Meta-analysis. There were statistical differences between the intervention group and the control group [mean difference (MD) =6.12, 95% CI: 5.17-7.06, P<0.00001]. According to the evaluation of functional assessment of cancer therapy (FACT), there is heterogeneity among the studies (P=0.003, I2=83%). There were statistical differences between the intervention group and the control group (MD =12.74, 95% CI: 6.34-19.14, P<0.0001).

DISCUSSION

Psychological nursing intervention can significantly improve the quality of life of patients with missing breasts undergoing radical mastectomy, which has certain guiding significance for the formulation of clinically effective nursing measures.

Associations between anti-bisexual minority stress and body esteem and emotional eating among bi+ individuals: The protective role of individual- and community-level factors

Bisexual individuals experience prejudice specifically related to their bisexual identity, and these experiences may compound extant risk for disordered eating behaviors and body esteem concerns. However, little is known about how sexual minority stress related to bisexual orientation is associated with emotional eating and body esteem. The current study examined the associations between bisexual-specific minority stress and emotional eating and body esteem in a sample of bisexual plus (bi+) adults (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity), and tested the moderating effects of identity centrality, affirmation, and community connectedness as potential protective factors. This study leveraged data from an online survey of 498 adults (77.46% cisgender women; 79.7% White), ages 18 to 64 years (M = 28.5; SD = 9.59). Bisexual-specific minority stress was associated with more emotional eating (β = 0.15, p = .013) and lower body esteem (β = -0.16, p = .005), while controlling for sociodemographic characteristics, body mass index, and heterosexist minority stress. This finding remained the same when sensitivity analyses were conducted with participants who identified specifically as bisexual. Identity centrality and affirmation and community connectedness did not demonstrate moderating effects but they had main effects, such that they were positively associated with body esteem (β = 0.16, p = .001; β = 0.21, p < .001; β = 0.13, p = .004, respectively). Results suggest that anti-bisexual minority stress has a unique association with bi+ individuals' emotional eating and body esteem, and identified potential individual- and community-level protective factors for body esteem. These findings inform future research and interventions for this understudied population.

Connections Between Perceived Social Support and the Body Image in the Group of Women With Diastasis Recti Abdominis

Background: The psychological features of the body image and the role of perceived social support for women with diastasis recti abdominis (DRAM) is significant for the treatment of this group of patients, but it is difficult to identify research on this topic. We aimed to search for similarities and differences between postpartum women with DRAM in terms of their psychological features of the body image and perceived social support from the partner, family and friends. Methods: Three hundred forty-five Polish women with DRAM were asked to fill the The Multidimensional Body-Self Relations Questionnaire (MBSRQ), The Multidimensional Scale of Perceived Social Support (MSPSS) and The Drawing Self-Assessment Sheet. Data analysis included the stepwise regression analysis and k-cluster analysis. Results: We identified several predictors in the group of women with DRAM. Social support of partner, family, and friends are the predictors of self-assessment of general body appearance. Social support of family is a predictor of self-assessment of the health of the body. Social support of friends is a predictor of self-esteem of weight and fear of gaining weight. Moreover, three clusters of women with DRAM were found. Type 1-women with DRAM with one child and low self-esteem of the general appearance of the body, low self-esteem of health condition of the body, high self-esteem of weight, and fear of weight gain, and low level of social support; Type 2-women with DRAM with three or more children and low self-esteem of the general appearance of the body, low self-esteem of health condition of the body, high self-esteem of weight and fear of weight gain, and high level of social support; and Type 3-women with DRAM with two children and high self-esteem for the general appearance of the body, high level of self-esteem for health of the body, low self-esteem of weight and fear of weight gain, and high levels of social support. Conclusions: Social support is a predictor of body image in women with DRAM, but there are other factors that influence body acceptance more in this group of women. Furthermore the three clusters featured in the study may help in treating women with DRAM.

Psychological resilience of patients with bladder cancer after radical cystectomy and urinary diversion: A cross-sectional study

OBJECTIVE

The aims of this study were to investigate the current state of psychological resilience and identify its associated factors in bladder cancer (BC) patients undergoing radical cystectomy (RC).

METHODS

A cross-sectional study, using convenience sampling was conducted among 248 patients recruited from urology department of a tertiary hospital in Shenyang, China. According to the resilience in illness model, participants were invited to finish a questionnaire included demographic and disease-related information, Connor-Davidson Resilience Scale, Mishel Uncertainty in Illness Scale, Medical Coping Modes Questionnaire, Social Support Rating Scale, Family adaptation, partnership, growth, affection, and resolve Index and Herth Hope Index. Multiple regression analysis was conducted to explore the predictors of resilience.

RESULTS

The average resilience score of 53.45 ± 6.22 among BC patients undergoing RC. Multiple regression showed that the associated factors of resilience of postoperative BC patients were gender (β = -0.142, p = 0.002), living in town (β = -0.103, p = 0.052), living alone (β = 0.118, p = 0.026), almost need to be taken care of (β = 0.094, p = 0.064), illness uncertainty (β = -0.249, p < 0.001), confrontation (β = 0.091, p = 0.077), acceptance-resignation (β = -0.205, p < 0.001), social support (β = 0.122, p = 0.029) and hope (β = 0.350, p < 0.001). These predictors accounted for 56.9% of the total variance in resilience (F = 14.964, p < 0.001).

CONCLUSIONS

Resilience among BC patients undergoing RC needs to be further improved. Hope was the most important variable influencing resilience in BC patients undergoing RC. In the future, we need to pay more attention to the psychological status of patients and encourage them to face the disease with positive emotion and positive coping style to enhance the hope and resilience of patients, so as to improve the quality of life of patients with BC undergoing RC.

BEAUTY and the breast: is adjuvant chemotherapy the right time for a beauty boost? Lessons learned from a large randomized controlled trial

PURPOSE

Beauty care (BTC) is offered at many cancer hospitals having a great uptake among patients. Nevertheless, its benefits in the Quality of life (QoL) of cancer survivors have not been assessed so far.

METHODS

Our study aims to determine whether BTC improves patients' QoL related to their body image measured by the BRBI scale of the QLQ-BR23 questionnaire at the end of adjuvant chemotherapy, after breast cancer (BC) surgery. The BEAUTY study is a prospective, randomized, controlled intervention trial. The following patient-reported outcomes were filled before initiation of chemotherapy (T1) and after their last cycle (T2): EORTC QLQ-C30, QLQ-BR23, and Body Image Scale (BIS). Primary objective was improvement in the BIS of BR23 (BRBI). A qualitative assessment of patients' experience was performed at each cycle through a relevant questionnaire.

RESULTS

In total, 269 (67%) patients filled BRBI at T1 and T2. Mean BRBI scores substantially decreased between T1 and T2 and were not different with or without BTC (p = 0.88). Qualitative assessment suggests impact of BTC in physical well-being and avoids thoughts related to the disease.

CONCLUSION

A substantial proportion of patients have a poor body image and chemotherapy induced a substantial degradation of BRBI scores. Although BTC does not seem to impact BRBI scores, the qualitative assessment suggests some benefit of BTC in other domains. Our study highlights the need to assess patients-perceived body image and build tailored interventions at this critical phase of their disease and generates hypothesis for the impact of BTC among BC patients. Clinical trial registration The study is registered at ClinicalTrials.gov under the NCT01459003 number since October 25, 2011.

The relationship of self-acceptance with decision making duration in cancer patient to perform mastectomy

BACKGROUND

Cancer is a disease caused by abnormal growth of body cells that turn malignant and continue to grow uncontrollably. One of the treatments for breast cancer is mastectomy. The quickness of decision-making determines the survival rate of prognosis patients.

OBJECTIVE

This study aimed to determine the relationship of self-acceptance with decision-making duration in cancer patients to perform a mastectomy.

METHODS

An analytic observation method with cross-sectional design. The samples were taken by purposive sampling method with 50 samples of breast cancer patients. Data collected include age, last level of education, marital status, profession, stage of cancer during mastectomy, self-acceptance score, and decision-making duration to perform a mastectomy.

RESULTS

The data analyzed with the Kruskal-Wallis test. The test showed the relationship of self-acceptance (p = 0.027) with decision-making duration in breast cancer patients to perform a mastectomy.

CONCLUSION

In conclusion, there is a relationship of self-acceptance with decision-making duration in breast cancer patients to perform a mastectomy.

Impact of Mastectomy on Body Image and Sexuality from a LGBTQ Perspective: A Narrative Review

Although mastectomy could lead to a decrease in sexual performance among patients, only a handful of studies focused on the psychological and sexual behavioral aspects after the surgery. Research on post-mastectomy sexuality has focused mainly on female subjects but barely on lesbian, gay, bisexual, transgender, queer (LGBTQ), and male patients. This narrative review aimed to explore the importance of sexuality after mastectomy from a LGBTQ perspective. Each sexual minority group has been addressed individually. In general, sexual and gender minority breast cancer (BC) patients undergoing bilateral mastectomy expect a complex treatment plan in terms of physical and emotional outcomes. Bilateral mastectomy or top surgery for masculinization reasons was reported to be the most popular procedure among transmen, which resulted in a significant improvement in the quality of life. Heterosexual and lesbian female patients are willing to undergo mastectomy after repeated lumpectomies or to avoid radiation, despite potential post-operative somatic and quality-of-life complications. Transwomen would seek gender-affirming surgery to improve physical satisfaction and psychological well-being. There is not enough evidence for non-oncological reasons and consequences of mastectomy in gay men and cisgender heterosexual men. Establishing the awareness of the sexuality impact of mastectomy will allow the implementation of tailored perioperative psychological care.

Medical professionals' knowledge of the use of external breast prostheses among breast cancer patients in China-a cross-sectional study

Background

Breast loss has a negative effect on women physically, psychologically and socially. External breast prostheses can improve patients' figure physically, increase their self-confidence, and thus improve quality of life. Little is known about the knowledge of medical professionals on the use of external breast prostheses in mainland China. This study sought to examine medical professionals' knowledge of the use of external breast prostheses among breast cancer patients in China.

Methods

Self-designed questionnaires were administered to 635 medical professionals specializing in breast cancer in China to examine their knowledge.

Results

Medical professionals who were older in age, those who had higher levels of education and those who had senior professional titles had a broader professional knowledge of external breast prostheses. Medical professionals who were younger in age and those who had junior professional titles thought that the patients were willing to choose direct-adhesive breast prostheses. Medical professionals who were older in age, those who had higher levels of education, those who had senior professional titles and those who had been working for many (but less than 30) years were more likely to think that patients could wear external breast prostheses shortly after surgery, and at all times except when sleeping. More highly educated doctors, head nurses and medical staffs from the East were more likely to think that patients would accept the use of high-priced external breast prostheses.

Conclusions

Medical professionals' knowledge about the wearing of external breast prostheses is lacking. A number of factors, including age, education level, professional title, number of years working years and geographical region have different effects on medical professionals' knowledge. Medical professionals with a good knowledge of external breast prostheses, especially specialist breast nurses, can provide patients with comprehensive information about breast prostheses, assist patients in selecting the appropriate prostheses, understand patients' wearing experiences, and help to reduce patients' physical and mental distress.

Factors related to the resilience and mental health of adult cancer patients: a systematic review

PURPOSE

It has been reported that maintaining the mental health of cancer patients is a critically important issue, and that resilience is related to mental health. This study conducted a systematic literature review in order to fully understand the relationships between resilience and anxiety, depression, and quality of life (QOL) in adult cancer patients, as well as identify factors associated with resilience.

METHODS

The PubMed, CINAHL, Psychology Database, and ICHUSHI Web databases were searched for articles related to resilience in cancer patients published between 2014 and 2019 using the keywords "cancer" and "resilience," connected with "and." The extracted articles that met inclusion criteria were organized using a matrix. To understand the resilience status of adult cancer patients, meta-analyses were performed using resilience scores measured with the most commonly used resilience scale, Connor-Davidson Resilience Scale 25.

RESULTS

Thirty-nine articles were included in the analysis. A higher resilience score is associated with lower anxiety and depression scores and higher QOL scores. Factors related to resilience include personal factors such as age and gender, disease-related factors such as the presence or absence and severity of physical symptoms, and internal factors such as self-efficacy and hopefulness.

CONCLUSIONS

It was found that it is important for cancer patients to improve resilience to maintain mental health and QOL. The findings suggest that providing interventions for factors that will reduce resilience will provide support for patients with cancer.

Resilience in women with breast cancer: A systematic review

PURPOSE

Resilience refers to a dynamic process that promotes a successful adaptation to cancer-related adversity. The aim of this systematic review was to identify the biopsychosocial factors involved in the resilience of women with breast cancer and to integrate evidence on the interventions that can contribute to significantly enhancing it.

METHOD

Three databases were searched. In all, 923 articles were identified and, of these, 39 peer-reviewed articles were included.

RESULTS

Resilience was associated with multiple clinical, sociodemographic, social, psychological and physiological variables, with psychological factors being the most important contributors to the development of resilience. Some protective factors were identified, such as social support, several dimensions of quality of life (QOL) and adaptive coping strategies. Psychological distress was the variable most frequently linked to reductions in resilience, finding a bidirectional relationship between them. Resilience-promoting interventions were found to be effective in improving participants' psychological well-being.

CONCLUSION

Resilience is a relevant factor related with several sociodemographic, clinical, psychosocial and physiological variables in women with breast cancer. However, limitations such as the wide variability of instruments used together with the heterogeneity and small size of the samples restrict the generalizability of our conclusions.

Body Image in Athletes and Nonathletes With Low Back Pain: Avoidance-Endurance-Related Subgroups and Sports Status Play a Role

CONTEXT

Low back pain (LBP) is a serious health problem, both in the general population as well as in athletes. Research has shown that psychosocial aspects, such as dysfunctional pain responses, play a significant role in the chronification of LBP. Recent research supports the relevance of the multidisciplinary concept of body image in the interpretation of LBP.

OBJECTIVE

To examine the differences in 2 psychosocial aspects, body image and pain responses, between athletes and nonathletes with LBP.

DESIGN

Cross-sectional design.

SETTING

The questionnaires were distributed in the course of LBP treatment.

PARTICIPANTS

Data from 163 athletes (mean age = 28.69 [9.6] y) and 75 nonathletes (mean age = 39.34 [12.63] y) were collected.

INTERVENTIONS

Data were collected by questionnaires assessing body image, pain behavior, training activity, and LBP.

MAIN OUTCOME MEASURES

To examine group differences between athletes and nonathletes regarding body image and pain behavior, the authors performed 2-way analyses of variance with Bonferroni post hoc tests.

RESULTS

The results showed (1) a significant main effect regarding pain responses and body image, showing that participants with eustress endurance or adaptive pain behavior revealed a more positive body image in both groups compared with participants with distress endurance or fear-avoidance behavior, and (2) a significant main effect for the factor group in the body image dimension of physical efficacy, indicating a more positive body image for athletes.

CONCLUSION

These results suggest that considering multiple risk factors for LBP, such as body image and dysfunctional pain behavior, as well as subgrouping, might be valuable for research and for broadening therapy options.

Psychometric properties of the Connor-Davidson Resilience Scale in women with breast cancer

The aim was to analyse the psychometric properties of the 10-item version of the Connor-Davidson Resilience Scale (CD-RISC 10©) in breast cancer patients. Method: A sample of 169 Spanish women who had undergone surgery for breast cancer completed the CD-RISC 10©, along with questionnaires assessing life satisfaction, emotional intelligence, self-esteem, and positive and negative affect. Results: Confirmatory Factor Analysis supported a single-factor structure with adequate fit indices. Reliability was analysed by calculating McDonald’s omega coefficient, which yielded a value of .83. Validity evidence based on relationships with other variables was provided by positive and significant correlations between scores on the CD-RISC 10© and scores on emotional intelligence (clarity and repair), life satisfaction, self-esteem and positive affect, and by a negative and significant correlation with negative affect. The majority of these correlations were above |.50|. Conclusions: The CD-RISC 10© has satisfactory psychometric properties and is a suitable tool for measuring resilience in patients with cancer. The instrument is quick and easy to apply and may be used in both clinical and research contexts.

Exploring the relationship between the body self and the sense of coherence in women after surgical treatment for breast cancer

OBJECTIVE

Analysis of the relationship between the body self (BS) and the sense of coherence (SOC) in women after breast surgery due to cancer in comparison with a control group.

METHODS

A cross-sectional study in a group of 78 women using the body-self questionnaire (BS-Q), and the life orientation questionnaire (SOC-29). Statistics based on the IBM SPSS v.25.

RESULTS

Multivariate analysis of variance (MANOVA) has shown significant differences based on groups in experiencing intimacy, manifesting femininity, body acceptance, and manageability. In particular, manifesting femininity and body acceptance showed a big effect size (0.30 < partial ɳ²  < 0.32). Correlation analysis between the BS-Q and SOC-29 subscales and Fisher's r to z transformation determines that the differences between groups were significant in favour of healthy women in two sets of variables: experiencing intimacy/meaningfulness and attitude to food and weight/manageability.

CONCLUSIONS

Breast cancer survivors are at greater risk of developing decreased body acceptance and problems in intimacy, and have less correlation than the healthy control group between manageability and meaningfulness with an appropriate attitude to food and intimate relationship with their partner, respectively. A higher manifestation of femininity in the treated group can be considered a positive but socioculturally conditioned coping strategy.