Factors Related to Anxiety, Depressive Symptoms and Quality of Life in Breast Cancer

Exploring the broad-spectrum pharmacological activity of two less studied Australian native fruits: chemical characterisation using LCMS-driven metabolomics

Australian fruits such as native currant (Acrotriche depressa) and lemon aspen (Acronychia acidula) are under-examined in terms of their therapeutic potential. In this study, the in vitro antiproliferative activity of native currant and lemon aspen extracts (water and ethanol) against MCF7 breast adenocarcinoma cells was determined using the Alamar blue assay. The most potent extracts (native currant water, NC-W; native currant ethanol, NC-Et; lemon aspen ethanol, LA-Et) were further evaluated using flow cytometry to detect the potential induction of apoptosis in MCF7 cells whereas 2',7'-dichlorodihydrofluorescein diacetate (H2DCFDA) assay was implemented to understand the impact of the extracts on the intracellular reactive oxygen species (ROS) levels in MCF7 cells. Furthermore, the antioxidant activity of the extracts was assessed using ABTS [2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonate)], and CUPRAC (cupric reducing antioxidant capacity) assays. The antimicrobial susceptibility testing of NC-W, NC-Et, and LA-Et was carried out against Gram-positive (Staphylococcus aureus), Gram-negative (Escherichia coli), and yeast (Candida albicans) strains using a resazurin-based assay. Additionally, potential metabolites in the NC-W and NC-Et extracts were analysed with liquid chromatography-mass spectrometry (LC-MS) driven metabolomics and chemometrics to spot differential and major metabolites. A dose-dependent antiproliferative activity was conferred by the NC extracts against MCF7 cells. Of the two LA extracts, only LA-Et showed a dose-dependent antiproliferative activity at higher concentrations. Both NC extracts and LA-Et induced apoptosis in MCF7 cells. None of the extracts increased the production of ROS significantly in MCF7 cells compared to the untreated control. A dose-dependent antioxidant activity was observed in both antioxidant assays. Both NC and LA extracts showed a similar minimum inhibitory concentration (MIC) value against S. aureus. Only LA-Et showed activity against E. coli, while NC-W and NC-Et were less active. All extracts showed MIC values of >1500 μg mL-1 against C. albicans. The metabolomics analysis revealed an abundance of flavonoids, fatty acyl derivatives, carbohydrates, carboxylic acids and their derivatives, and alkaloid compounds as potential bioactive metabolites in the NC extracts. In conclusion, both NC and LA showed antiproliferative (against MCF7 breast adenocarcinoma cells through the induction of apoptosis), strong antioxidant and minimal antimicrobial properties.

A systematic review of rehabilitation programs for cognitive impairment related to breast cancer: Different programs at different times?

BACKGROUND

"Cancer Related Cognitive Impairment" (CRCI) defines cognitive disorders related to cancer and its treatments. Many people with breast cancer experience signs of CRCI (incidence between 20 and 30 %) and, although several intervention options exist, there is no established standard of care. Our main objective was to provide a detailed description of the methods and results of randomized controlled trials of interventions for CRCI in breast cancer survivors, paying particular attention to the timing of the interventions within the care pathway.

METHODS

We conducted a systematic literature review following the PRISMA guidelines from 01 to 01-2019 to 16-07-2023 and included randomized controlled trials of interventions for CRCI after breast cancer with at least one objective cognitive assessment as a primary or secondary outcome.

RESULTS

Among 228 identified studies, 35 (including 2821 participants) were retained for inclusion. The interventions were classified into 4 categories: cognitive rehabilitation, physical activity, complementary therapy and pharmacological treatment. Our analysis revealed that pharmacological interventions have no effect, whereas physical activity interventions proposed in the months following the initial cancer treatment improve Quality of Life and Speed of Information Processing while interventions proposed later improve Memory and Attention (Cognitive Rehabilitation) and Perceived Cognitive Function and Depression/Anxiety/Mood (Complementary Therapies).

CONCLUSION

CRCI is multifactorial and affected individuals frequently experience high levels of fatigue, pain, anxiety and depression and are most likely to benefit from holistic approaches that include cognition, physical activity, relaxation, psychoeducation, group support and/or psychological counselling. Thus, rehabilitation programs should be designed on multi-modal approaches, using innovative, cost-effective delivery methods that increase access to treatment, and intervention outcomes should be evaluated using measures of participation.

DATABASE REGISTRATION

The review was recorded on Prospero (01-03-2020), with the registration number 135,627.

Risk of obstetric and perinatal complications in women presenting with breast cancer during pregnancy and the first year postpartum in Sweden 1973-2017: A population-based matched study

INTRODUCTION

For women presenting with breast cancer during pregnancy, treatment guidelines were historically restricted to only surgical treatment. Over the past decades, chemotherapy administered during pregnancy has been gradually introduced. Although breast cancer treatments during ongoing pregnancy have been deemed safe, detailed information on potential obstetric risks is lacking. We aimed to assess the risk of adverse obstetric and perinatal outcomes of breast cancer in pregnancy and within 1 year postpartum and in relation to trimester at breast cancer diagnosis, tumor stage, and cancer treatment during pregnancy.

MATERIAL AND METHODS

Population-based matched study. Women diagnosed with breast cancer during pregnancy in 1973-2017 were identified in the Swedish Cancer Register and the Medical Birth Register, with additional information from the National Quality Register for Breast Cancer. Each birth with maternal breast cancer (n = 208 pregnant, n = 672 postpartum) was matched by age, calendar year, and birth order to 10 unexposed births from cancer-free women in the population (n = 2080 and n = 6720). Adjusted conditional logistic and multinomial regression models were used to estimate odds ratios and relative risk ratios, commonly denoted relative risks (RR) with 95% confidence intervals (CI), of adverse obstetric and perinatal outcomes.

RESULTS

Breast cancer during pregnancy was associated with higher risks of preterm birth, both planned (RR 67.1, 95% CI 33.2-135.6) and spontaneous preterm birth (RR 3.8, 95% CI 2.0-7.5), and low birthweight (<2500 g: RR 7.5, 95% CI 4.9-11.3). The associated risks were higher if the breast cancer was diagnosed in the second trimester, and of similar magnitude irrespective of stage and treatment groups. There was a higher risk of low birthweight for gestational age (<25th centile) if breast cancer was diagnosed in the first trimester (RR 2.8, 95% CI 1.1-7.3). Risks of other pregnancy complications were similar to those of unexposed women, as were risks of neonatal mortality and malformations. Postpartum breast cancer was only associated with bleeding during pregnancy (RR 1.6, 95% CI 1.0-2.8).

CONCLUSIONS

Preterm birth and related adverse outcomes were more common in women diagnosed with breast cancer during pregnancy. Reassuringly, breast cancer was not associated with other maternal pregnancy complications or adverse outcomes in children.

Female cancer survivors: sexual function, psychological distress, and remaining fertility

PURPOSE

Improved survivorship in cancer patients leads to new challenging issues including potential impairment of quality of life, sexual function, and fertility. The aim of this study was to assess sexual dysfunction (SD) and psychological distress in female cancer survivors who underwent fertility preservation in the past in comparison to reviewed healthy control data from other published studies. Additionally, our focus was on the difference in SD between women with current desire to get pregnant and already completed family planning.

METHODS

In this prospective study, 53 female cancer survivors who underwent fertility preservation at time of cancer diagnosis between 2010 and 2020 were invited to a gynecological exam, laboratory assessment, and two questionnaires (Female Sexual Function Index (FSFI) and Hospital anxiety and depression scale (HADS)) in 2022. These scores were compared to results in the literature of healthy controls and depending on anti-Mullerian-hormone (AMH) levels, current desire to have a child, and age.

RESULTS

After a mean follow-up time of 70 ± 50 months, SD was detected in 60.4% (n = 32) of the 53 included patients. Normal results regarding HADS-D/anxiety and HADS-D/depression were found in 88.7% and 94.3% of patients, respectively. At time of follow-up, 69.9% (n = 40) regained regular menstrual cycles, 52.6% (n = 20) < 40 years showed a diminished ovarian reserve with AMH levels < 1.1 ng/ml and 28.3% (n = 15) suffered from infertility.

CONCLUSION

Female cancer survivors may be at risk for SD. Cancer patients should be informed about possible sexual dysfunction already at the start of cancer treatment and during follow-up. In addition, contraception needs to be addressed if regular cycles occur as more than two-thirds of the women regained regular menstrual cycles.

Health-related quality of life, psychological issues and concerns among sarcoma survivors: a mixed method study

Purpose

We aimed to explore the health-related quality of life (HRQoL), psychological issues and concerns among sarcoma survivors in India and assess their satisfaction with nursing care.

Methods

This study employed a sequential mixed-methods design, enrolling 100 sarcoma survivors from July to December 2021, with data collected using standardised questionnaires for HRQoL, depression, anxiety, stress, cognitive impairment and self-structured satisfaction with nursing care. Qualitative data were gathered through focused group discussions.

Results

The mean global health score among sarcoma survivors was 79.48 ± 16.26. A significant number of survivors had symptoms of mild-to-moderate depression (30%), severe anxiety (12%), stress (16%) and mild cognitive impairment (5%). Significant mean rank differences were observed between anxiety and financial difficulty (p < 0.05), emotional functioning (p < 0.001), cognitive functioning (p < 0.001), pain (<0.05), insomnia (p < 0.001), fatigue (p < 0.001), anorexia (p < 0.05) and nausea/vomiting (p < 0.001). Educational qualification had a significant association with depression and anxiety while family history of cancer emerged as a significant factor associated with anxiety and stress among survivors. Qualitative analysis revealed themes related to body image, societal discrimination, socio-economic impact, marriage concerns and fertility issues. Survivor satisfaction with nursing care was good.

Conclusion

A substantial number of sarcoma survivors had an average HRQoL and experienced depression, anxiety and stress. Our study emphasizes the importance of holistic survivorship care, involving nurses in post-treatment support, and addressing societal discrimination and psychosocial concerns to enhance their quality of life.

Implications for cancer survivors

Our study calls for a holistic approach to sarcoma survivor care and emphasizes the importance of personalised survivorship care plans led by nurses to address the diverse needs of sarcoma survivors in India. Such plans should encompass strategies for managing depression, anxiety and stress, along with addressing body image concerns and social support.

Home-based lifestyle intervention for breast cancer survivors: A surprising improvement in the quality of life during the first year of COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic induced an extraordinary impact on public mental health to a degree not completely understood, especially in vulnerable populations such as breast cancer (BC) survivors. In this study, we described the short- (after 3-month) and long- (after 12-month) term effects of a multidisciplinary home-based lifestyle intervention in Italian women BC survivors during the first year of COVID-19 pandemic.

MATERIALS AND METHODS

In total, 30 Italian BC survivors with risk factors for recurrence took part in the ongoing MoviS trial (protocol: NCT04818359). Between January 2020 and January 2021, a 3-month lifestyle intervention based on psychological counseling, nutrition, and exercise was carried out. Participants were asked to fill out psychological questionnaires for the assessment of quality of life (QoL) indicators (European Organization for Research and Treatment of Cancer QoL, EORTC-QLQ-C30) and psychological health measures such as fatigue (Brief Fatigue Inventory, BFI), distress (Distress Thermometer, DT and Psychological Distress Inventory, PDI), cancer-related fatigue (Verbal Rating Scale, VRS), and mood states (Profile of Mood States Questionnaire, POMS). IBM SPSS Statistical Software version 27.0 and R Project for Statistical Computing version 4.2.1 were used to process data. All participants were assessed at four time points: T0 (baseline), T1 (3-month), and follow-up at T2 and T3 (6- and 12-month, respectively) to measure primary (quality of life indicators) and secondary (psychological health) outcomes. Friedman non parametric test and Wilcoxon signed rank test (with Bonferroni correction) were conducted to investigate the statistically significant differences in psychometric scores and between assessment times.

RESULTS

Compared to baseline (T0), at T1 most of the QoL indicators (i.e., symptoms of fatigue and general health) were improved (p < 0.017) with the exception of a worsening in participants' social functioning ability. Also, perception of severity of fatigue, distress, cancer-related fatigue, depression, and anger enhanced. Compared to baseline (T0), at T3 we mainly observed a stable condition with T0-T1 pairwise comparison, however other secondary outcomes (i.e., fatigue mood state, confusion, and anxiety) significantly improved.

DISCUSSION

Our preliminary findings support the proposal of this lifestyle intervention for BC survivors. Despite the home-confinement due to the COVID-19 pandemic, the intervention surprisingly improved QoL indicators and psychological health of the participants.

Prevalence of Psychoneurological Symptoms and Symptom Clusters in Women with Breast Cancer Undergoing Treatment: Influence on Quality of Life

OBJECTIVES

To identify subgroups of psychoneurological symptoms (PNS) and their relationship to different clinical variables in a sample of women with breast cáncer (BC) with different type of treatment, and the possible influence of these on quality of life (QoL), using a factorial principal components analysis.

DATA SOURCES

Observational, cross-sectional, non-probability study (2017-2021) at Badajoz University Hospital (Spain). A total of 239 women with BC receiving treatment were included.

RESULTS

68% of women presented fatigue, 30% depressive symptoms, 37.5% anxiety, 45% insomnia, and 36% cognitive impairment. The average score obtained for pain was 28.9. All the symptoms were related between themselves, and within the cluster of PNS. The factorial analysis showed three subgroups of symptoms, which accounted for 73% of variance: state and trait anxiety (PNS-1), cognitive impairment, pain and fatigue (PNS-2), and sleep disorders (PNS-3). The depressive symptoms were explained equally by PNS-1 and PNS-2. Additionally, two dimensions of QoL were found (functional-physical and cognitive-emotional. These dimensions correlated with the three PNS subgroups found. A relationship was found between chemotherapy treatment and PNS-3, and its negative impact on QoL.

CONCLUSIONS

A specific pattern of grouped symptoms in a psychoneurological cluster with different underlying dimensions has been identified which negatively influences QoL of survivors of BC.

IMPLICATION FOR NURSING PRACTICE

It is important to raise awareness among professionals and patients about the existence of a cluster of PNS, the patient's profile, as well as the factors that exacerbate them. This will allow them to be treated more effectively and comprehensively.

Comparison of Quality of Life in Breast Cancer Survivors with and without Persistent Depressive Symptoms: A 12-Month Follow-Up Study

Although breast cancer treatments reduce mortality, their adverse effects can increase depression which impacts one's quality of life (QoL). Physical activity (PA) seems to improve the QoL of breast cancer survivors (BCS). However, an unanswered question is the influence of PA on the QoL in BCS with depressive symptoms. Thus, we analyzed the influence of PA on the QoL in BCS with persistent depressive symptoms during 12 months of follow-up. The sample included 70 female BCS. Depression and QoL domains (i.e., functional capacity, physical limitations, body pain, general health status, vitality, social and emotional aspects, and mental health) were assessed at baseline and follow-up periods by the Hospital Anxiety and Depression Scale and SF-36, respectively. Habitual PA was assessed by Baecke's questionnaire. Our results indicate a prevalence of 17.1% of depressive symptoms. Non-depressives BCS improved their physical limitations and general health status domains over time, but there were no observed differences in depressive BCS. BCS with persistent depressive symptoms (baseline and follow-up) showed worse QoL scores than non-depressives in all domains, regardless of confounding factors. When adjusted for PA, the difference between BCS depressives and non-depressives lost its significance in the functional capacity domain. In conclusion, habitual PA practice positively influenced the functional capacity domain of the QoL in BCS.

Living experiences of people with advance cancer with low socioeconomic status: A systematic review of qualitative evidence

BACKGROUND

The number of patients with advanced cancer is rapidly increasing, and the subgroup of this population with low socioeconomic status has suffered more disease burden than others. However, there is no recent qualitative synthesis of primary research studies into advanced cancer patients with low socioeconomic status.

OBJECTIVE

To synthesise qualitative research findings into advanced cancer patients' experiences with low socioeconomic status, and then to help provide targeted and effective strategies to improve their quality of life.

DESIGN

A systematic review and meta-synthesis of qualitative evidence (PROSPERO: CRD42021250423).

DATA SOURCES

PubMed, Web of Science Core Collection (ISI Web of Science), Cochrane Library, Embase, OVID LWW, CINAHL Complete (EBSCO), PsycINFO (EBSCO) and MEDLINE (ISI Web of Science), China National Knowledge Infrastructure (CNKI), WangFang, and Vip databases were systematically searched from their original dates to July 2022. Qualitative data were appraised using the Joanna Briggs Institute (JBI) qualitative assessment.

FINDINGS

The findings were synthesised into the following three analytical themes: (1) multi-dimensional disease distresses; (2) barriers in coping with disease distresses; and (3) strategies for dealing with disease distresses.

CONCLUSIONS

Patients with advanced cancer with low socioeconomic status experienced complicated and interactional distresses, unique life barriers, and a wide range of adaptation strategies. These findings will provide a comprehensive perspective to promote individual-centred health care systems and services to help these vulnerable people deal with the challenges of disease and improve their quality of life.

Prevalence of psychological distress among cancer patients in Southeast Asian countries: A systematic review

Psychological distress (including depression and anxiety) is common in the first years of cancer diagnosis but can differ by country and region. The aim of the present paper was to review the prevalence of psychological distress among cancer patients in the Southeast Asia (SEA) region. A systematic literature search was carried out using several databases (i.e., PubMed, PsychARTICLES, Embase, CINAHI, Web of Sciences, Plus, Scopus, and AHMED). Papers originally published in English language were taken into consideration if they (i) were published from 2010 to 2021 and (ii) reported the prevalence of psychological distress among patients with different types of cancer. A total of 23 studies met the inclusion criteria. The most frequently employed psychometric instrument for anxiety and depression screening was the Hospital Anxiety and Depression Scale (HADS). The prevalence of anxiety (ranging from 7% to 88%) was wider than that of depression (ranging from 3% to 65.5%) among patients with different types of cancer and living in various countries in the SEA region. The overall prevalence rate of psychological distress among cancer patients from the SEA region was not fundamentally very different from that of general populations. These findings provide useful information for health professionals and cancer patients to understand the negative role of psychological distress in quality of life and health. The research findings demonstrate the importance of counselling for psychological distress among cancer patients as means of effectively resolving their psychological problems and ultimately improving the quality of oncology medical care. Clinical recommendations for cancer management should incorporate the early identification of (and therapy for) psychological distress, as well as their monitoring during treatment.