The effect of anxiety on breast cancer patients

A Qualitative Study on Psychosocial Challenges of Patients With Cancer in Ethiopia Using the Social-Ecological Model

Cancer diagnosis and treatment can be physically arduous, disrupting patients' social and work lives. Understanding the extent of these problems is key to addressing patients' needs, but specific psychosocial challenges have not yet been well studied in resource-limited settings. A qualitative study was conducted in the capital and two regions of Ethiopia with the aim of exploring psychosocial challenges among cancer patients. A total of 14 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were done with cancer patients, health professionals, community representatives, and religious leaders. Four separate interview guides were used to facilitate the interviews and discussions. All transcribed documents, field notes, and reflexive memos were entered into NVivo 12 software, and deductive thematic analysis using the social-ecological model was applied to summarize the main findings. At an individual level, emotional distress, suicidal risk, denial, and refusal of treatment were identified immediately after diagnosis while hopelessness, feeling depressed, and fear of death were commonly reported psychosocial challenges during the course of treatment. Involvement of family members in major treatment decisions was recognized at an interpersonal level. Our result also revealed that cancer patients had strong social support from family members and close friends. In the community, traditional medicine and religious rituals were considered an alternative treatment for cancer. The findings indicate that counselling and psychoeducation are crucial for cancer patients, family members, and close friends. Awareness creation programmes should be delivered through collaboration with religious leaders and traditional healers.

The effect of two different types of music played to cancer patients during chemotherapy on anxiety, nausea, and satisfaction levels

PURPOSE

To investigate the effect of two different types of music on anxiety, nausea, and satisfaction levels in cancer patients receiving chemotherapy (CT) for the first time.

METHODS

The study was conducted as a single-blind, pre-test, post-test, three-group randomized controlled trial in an outpatient CT unit between August 2022 and February 2023. A simple (computer-based) and stratified (age and gender) randomization method was used to assign 75 patients to the relaxing music group (RMG), Turkish classical music group (TCMG), and control group (CG) (n = 25 each). The primary outcome was the change in anxiety levels measured by Spielberger's State Anxiety Inventory before (T0) and after (T1) CT session. Secondary outcomes were the change in the severity of nausea from T0 to T1 and the level of satisfaction at T1.

RESULTS

The groups were similar in terms of baseline sociodemographic and health-related characteristics. Anxiety levels were lower than the baseline in RMG and TCMG in comparison to CG, and repeated measures analysis showed a significant group × time interaction (p = 0.001, F = 210.221, η2 = 0.745). Nausea severity increased from T0 to T1 for CG but decreased for RMG and TCMG with a significant group × time interaction (p = 0.001, F = 100.785, η2 = 0.583). The satisfaction level was significantly higher in TCMG than in CG and RMG (8.64 ± 0.95 vs. 7.88 ± 0.72, and 7.00 ± 0.70, respectively).

CONCLUSION

Music may be an effective non-pharmacologic option to relieve patients' anxiety and nausea during first-time CT. Larger, multicenter studies evaluating the long-term effect of music are needed to confirm these findings.

TRIAL REGISTRATION

clinicaltrials.gov (NCT05687838)/2022-13/18.

Breast conserving surgery versus mastectomy: the effect of surgery on quality of life in breast cancer survivors in Malaysia

BACKGROUND

In the competitive health care environment, patient satisfaction and quality of life (QoL) have become the subject of interest to evaluate the efficacy of therapeutic interventions as we experience improved breast cancer survival in modern times. The knowledge of the long-term effects of surgery on the QoL in breast cancer patients is currently limited in the Asian setting. The purpose of this longitudinal study is to evaluate the QoL of early-stage breast cancer patients undergoing mastectomy and breast-conserving surgery (BCS).

METHODS

In this prospective cohort study, the QoL of 208 patients who underwent mastectomy and the BCS treatment were assessed, using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. The questionnaire was administered at the baseline, 6 and 12 months following diagnosis. One-way ANCOVA was used for statistical analysis.

RESULTS

A total of 208 female survivors of Stage 0-II breast cancer were included, among them 47.1% underwent BCS and 52.9% underwent mastectomy. Older (63.3%), Chinese women (63.6%), and patients with primary education (71.7%) were more likely to undergo mastectomy. At baseline, no significant differences were observed for QoL in both treatment groups. At 6 months, patients who underwent BCS had better social functioning scales( P = 0.006) and worse symptom scales for dyspnoea (P = 0.031), compared to mastectomy patients. One year after diagnosis, the role functioning score of the mastectomy group was significantly higher than the BCS group, specifically among patients who had undergone chemotherapy (P = 0.034).

CONCLUSION

Patients who underwent BCS had better social functioning and worse dyspnoea symptoms compared to patients undergoing mastectomy at six months. During one year, there were only significant improvements in the role functioning among the mastectomy groups compared to the BCS groups. After further stratification, only mastectomy patients who received chemotherapy exhibited improved role functioning compared to patients those who did not undergo chemotherapy. Providing social and physical support postoperatively and monitoring patients for cancer worry, or other symptoms in the long-term survivorship period would be important to ensure optimal QoL.

Breast cancer patients' needs and perspectives on a one-on-one peer support program: quantitative and qualitative analyses

PURPOSE

Although peer support programs as a health resource have become increasingly popular, only limited studies evaluated the added value of one-on-one peer support for breast cancer patients. This study aims to bridge the knowledge gap by focusing on two related research topics. First, we evaluated emotional well-being and (unmet) needs regarding supportive care. Second, we evaluated patients' perspectives on their experiences after having one-on-one peer support.

METHODS

A quantitative analysis was conducted to provide insight in patients' symptoms of anxiety and depression (HADS), quality of life (EORTC-QLQ-C30), and supportive care needs (CaSUN-questionnaire). Furthermore, approximately 1 year after the implementation of a one-on-one peer support program, focus groups were conducted to evaluate patients' perspectives regarding one-on-one peer support.

RESULTS

Two hundred twenty-five of 537 patients diagnosed with breast cancer between 2019 and 2020 completed the questionnaires. Quantitative analysis showed increased symptoms of anxiety and depression among breast cancer patients and lower scores on all EORTC-QLQ-C30 domains compared to the Dutch normative population. Of all patients, 27.6% (95%CI = 0.22-0.34) reported to have unmet needs regarding emotional support and 23.1% (95%CI = 0.18-0.29) reported an unmet need to talk to someone who has experienced breast cancer. For the qualitative analysis, 19 breast cancer patients who were taking part in the one-on-one peer support program participated in three focus groups. Benefits, limitations, and wishes regarding the one-on-one peer support program were discussed.

CONCLUSION

Breast cancer patients showed increased anxiety and depression and lower quality of life, physical, role, emotional, cognitive, and social functioning compared to the Dutch normative population. Almost one-third of breast cancer patients reported unmet needs regarding emotional support and a desire to talk to other breast cancer patients. These (unmet) needs can successfully be met by providing a low-threshold one-on-one peer support program.

Psychosocial factors associated with workability after surgery in cancer survivors: An explorative study

This study aimed to evaluate the work ability and its associated factors in patients with glioma (II, III) and breast cancer after 6 (T0) and 12 (T1) months from surgery. A total of 99 patients were evaluated with self-reported questionnaires at T0 and T1. Correlation and Mann-Whitney tests were used to investigate the association between work ability and sociodemographic, clinical, and psychosocial factors. The Wilcoxon test was used to investigate the longitudinal change in work ability. Our sample showed a decrease in work ability level between T0 and T1. Work ability was associated with emotional distress, disability, resilience, and social support in glioma III patients at T0, and with fatigue, disability, and clinical treatments in patients with breast cancer at T0 and T1. Work ability levels decreased in patients with glioma and breast cancer and were associated with different psychosocial factors after surgery. Their investigation is suggested to facilitate the return to work.

The relationship between anxiety and vaginal-related sexual health in postmenopausal breast cancer survivors on aromatase inhibitors therapies: a cross sectional study

PURPOSE

Sexual health problems and anxiety are disruptive symptoms in breast cancer survivors; however, little is known about these symptoms in postmenopausal breast cancer survivors on aromatase inhibitors therapies. This study aimed to determine the relationship between anxiety and vaginal-related sexual health problems in this population.

METHODS

We analyzed cross-sectional data from a cohort study of postmenopausal women breast cancer survivors receiving aromatase inhibitors. Vaginal-related sexual health problems were assessed with the Breast Cancer Prevention Trial Symptom Checklist. Anxiety was assessed with the anxiety subscale of the Hospital Anxiety and Depression Scale. We used multivariable logistic regression to evaluate relationship between anxiety and vaginal-related sexual health adjusted for clinical and sociodemographic variables.

RESULTS

Among 974 patients, 305 (31.3%) reported anxiety and 403 (41.4%) had vaginal-related sexual health problems. Compared to those without anxiety, patients with borderline and clinically abnormal anxiety reported higher rates of vaginal-related sexual health problems (36.8% vs. 49% and 55.7% respectively, p < 0.001). In multivariate analyses adjusted for clinical and sociodemographic factors, abnormal anxiety was associated with a higher rate of vaginal-related sexual health problems, with adjusted odds ratios of 1.69 (95% CI 1.06-2.70, p = 0.03). Vaginal-related sexual health problems were more frequent among patients who were under 65 years of age, received Taxane-based chemotherapy, reported depression, and were married/living with a partner (p < 0.05).

CONCLUSION

Among postmenopausal breast cancer survivors on aromatase inhibitors therapies, anxiety was significantly associated with vaginal-related sexual health problems. As treatments for sexual health problems are limited, results suggest that psychosocial interventions for anxiety could potentially be adapted to simultaneously address sexual health needs.

Efficacy of a 4-Week Nurse-Led Exercise Rehabilitation Program in Improving the Quality of Life in Women Receiving a Post-Mastectomy Reconstruction Using the Motiva ErgonomixTM Round SilkSurface

We assessed the efficacy of a 4-week nurse-led exercise rehabilitation (ER) program in improving the quality of life (QOL) of breast cancer survivors (BCS) receiving an implant-based breast reconstruction. The eligible patients were equally randomized to either of both groups: the intervention group (n = 30; a 4-week nurse-led ER program) and the control group (n = 30; a 4-week physical therapist-supervised one). Both after a 4-week ER program and at baseline, the patients were evaluated for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Fatigue Severity Scale (FSS) scores. There was a significantly higher degree of increase in global health status/QOL scores, physical functioning scores, role functioning scores, and emotional functioning scores at 4 weeks from baseline in the intervention group as compared with the control group (p = 0.001). However, there was a significantly higher degree of decrease in fatigue scores, nausea/vomiting scores, pain scores, dyspnea scores, and FSS scores in the intervention group as compared with the control group (p = 0.001). In conclusion, our results indicate that a 4-week nurse-led ER program might be effective in the QOL in BCS receiving a post-mastectomy implant-based reconstruction using the Motiva Ergonomix^TM Round SilkSurface.

Changes in Degree Centrality and Functional Connectivity after the First Cycle of Neoadjuvant Chemotherapy in Newly Diagnosed Breast Cancer: A Longitudinal Study

Purpose

To evaluate the longitudinal changes of brain degree centrality (DC) and functional connectivity (FC) in breast cancer patients after the first cycle of neoadjuvant chemotherapy (NAC).

Methods

Thirty-five breast cancer patients were included in the NAC group. Resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological test were performed at baseline before NAC (time point 0, TP0) and after the first cycle of NAC (time point 1, TP1). The healthy controls (HC) included 30 healthy subjects and received the same rs-fMRI scan and neuropsychological test as the above-mentioned NAC group at one time point. DC and FC analyses were conducted to assess brain connectivity of all participants. Receiver operating characteristic (ROC) curve was used to assess the ability of DC and FC in distinguishing patients before and after chemotherapy.

Results

In the NAC group, the Self-Rating Anxiety Scale scores decreased significantly over time. At TP0 and TP1, the Digital Span Test forward score of the NAC group was significantly lower than that of the HC group. In the NAC group, DC in the right middle frontal gyrus and left precentral gyrus/middle frontal gyrus decreased significantly at TP1, and FC between the left precentral gyrus/middle frontal gyrus and bilateral precuneus was significantly reduced at TP1. Through ROC analysis, we found that the area under the curve (AUC) of DC, FC, and the combined model in distinguishing patients in TP0 or TP1 was 0.7886, 0.7665, and 0.8278, respectively.

Conclusions

Brain connectivity, involving executive and motor function related brain areas, changes in the short term after NAC treatment in breast cancer patients.

Examining anxiety and depression in haematology cancer patients in ongoing treatment and under watchful waiting: A systematic review and meta-analysis

INTRODUCTION

The present review aimed to establish prevalence rates of anxiety and depression in adults with haematology cancer, with a focus on the differences between patients under treatment and patients under watchful waiting.

METHOD

Five databases (Scopus, Medline, PsycINFO, EThOS, CINAHL) were searched throughout June 2021. Key search terms included haematology cancer, anxiety, depression, in treatment and watchful waiting. Study and sample characteristics, prevalence rates and mean self-reported scores of anxiety and depression data were extracted.

RESULTS

A total of 18 eligible papers were included in the review. Quality appraisal indicated papers were of adequate standard. Depression data from 2720 participants (14.5% under watchful waiting) and anxiety data from 2520 participants (15.9% under watchful waiting) were analysed through subgroup meta-analyses. The prevalence of anxiety was 34% amongst adults receiving treatment and 24.5% amongst those under watchful waiting. The prevalence of depression amongst adults receiving treatment was 31.3%, significantly higher than 16.1% of adults under watchful waiting.

CONCLUSION

Overall, adults with haematology cancer were at greater risk of experiencing anxiety and depression than the general population, with greatest risk in those under treatment. The findings indicate the need for future research to examine availability and effectiveness of targeted psychological interventions.

Role of sex on psychological distress, quality of life, and coping of patients with advanced colorectal and non-colorectal cancer

BACKGROUND

Patients with advanced gastrointestinal cancer must cope with the negative effects of cancer and complications.

AIM

To evaluate psychological distress, quality of life, and coping strategies in patients with advanced colorectal cancer compared to non-colorectal cancer based on sex.

METHODS

A prospective, transversal, multicenter study was conducted in 203 patients; 101 (50%) had a colorectal and 102 (50%) had digestive, non-colorectal advanced cancer. Participants completed questionnaires evaluating psychological distress (Brief Symptom Inventory-18), quality of life (EORTC QLQ-C30), and coping strategies (Mini-Mental Adjustment to Cancer) before starting systemic cancer treatment.

RESULTS

The study included 42.4% women. Women exhibited more depressive symptoms, anxiety, functional limitations, and anxious preoccupation than men. Patients with non-colorectal digestive cancer and women showed more somatization and physical symptoms than subjects with colorectal cancer and men. Men with colorectal cancer reported the best health status.

CONCLUSION

The degree of disease acceptance in gastrointestinal malignancies may depend on sex and location of the primary digestive neoplasm. Future interventions should specifically address sex and tumor site differences in individuals with advanced digestive cancer.

Negative emotions and personal well-being among incarcerated filicide mothers in Rwanda

Despite the tremendous evidence of the harmful effects of maternal filicide on the lives of offenders, there is a scarcity on studies of their negative emotions and personal wellbeing especially in sub-Saharan Africa. Thus, this study was primarily aimed at assessing the prevalence of negative emotions experienced by filicide mothers and how they were associated with personal wellbeing in Rwanda. With an institutional-based cross-sectional study design, we measured the symptoms of anxiety, anger, shame, guilt, depression and personal well-being in a convenient sample of 55 filicidal mothers (mean age = 26.69; SD = 6.88) who were incarcerated in Nyarugenge prison. SPSS (version 24) was used to compute descriptive, Pearson correlation, independent t-test and regression analyses. The results indicated that the rates of shame were (100%), guilt (98.2%), anxiety (92.7%), depression (92.7%), low happiness and satisfaction with life (81.8%), and anger was (76.4%) in the current sample. Based on age category, there was no significant difference in anger scores, depression, guilt, shame and personal well-being scores between young and adult filicide mothers (p>.05). Young filicide mothers (M = 14.55, SD = 4.03), on the other hand, had higher anxiety scores than adult filicide mothers (M = 11.57, SD = 4.72), t = 2.52, p = .015. Finally, anxiety (β = -.507, t = -3.478, p = .001) and age (β = -.335, t = -2.685, p < .001) were negatively associated with personal well-being. The results emerged from this study highlight that filicide mothers experience substantial negative emotions and poor personal wellbeing regardless of their age category. However, poor personal wellbeing was associated with anxiety and age. Based on these results, mental health professionals should examine their mental state with respect to negative emotions and initiate programs that decrease the emotions as well as increase personal well-being.

Peer support interventions on quality of life, depression, anxiety, and self-efficacy among patients with cancer: A systematic review and meta-analysis

OBJECTIVE

Peer support is a common form of social support that is provided by individuals with the same disease, which is cost-effective and has enhanced health outcomes for patients. This study aimed to determine the effectiveness of peer support interventions on quality of life (QOL), depression, anxiety, and self-efficacy among patients with cancer.

METHODS

A systematic search of seven databases were conducted from inception to January 2021. Studies were screened and assessed by two independent reviewers. Data synthesis was conducted using RevMan 5.3 software, and the standardized mean difference was used to calculate pooled effect sizes.

RESULTS

Seventeen studies were included in current review. The meta-analysis indicated significant beneficial effects of peer support on QOL (SMD = 0.48, 95% CI 0.21-0.75; p < 0.001), depression (SMD = -0.23, 95% CI -0.39 to -0.07; p = 0.005), anxiety (SMD = -0.24, 95% CI -0.45 to 0.03; p = 0.03), and self-efficacy (SMD = 0.22, 95% CI 0.03-0.42; p = 0.03) relative to controls. The subgroup analysis for QOL revealed that peer support delivered in the mixed mode contributed more than peer support delivered in the single mode (e.g., face-to-face or telephone).

CONCLUSION

Peer support has significant effects on improving QOL and self-efficacy as well as alleviating depression and anxiety among patients with cancer. Additional randomized controlled trials with rigorous design and larger sample sizes are warranted in the future.

PRACTICE IMPLICATIONS

Peer support programs might benefit patients with cancer and could be used as a complementary approach to traditional healthcare services during cancer rehabilitation.

A qualitative analysis of negative feelings among incarcerated filicide mothers in Rwanda

BACKGROUND

Most of the research on filicide mothers suggests that they experience negative feelings before they kill their child. However, little is known about whether these negative feelings can be expressed after one-year post-offense among incarcerated filicide mothers with no history of psychiatric problems. In this study, we aimed to conduct a qualitative analysis to (a) understand negative feelings evolving from negative emotions such as anger, guilt, shame, depression, and anxiety among filicide mothers incarcerated in Nyarugenge Prison in Rwanda, (b) identify the impact of experienced negative feelings on their personal wellbeing, and (c) explore their coping strategies.

METHODS

This study adopted a phenomenology research design and face-to-face in-depth interviews to explore the problem among twenty filicide mothers selected from Nyarugenge prison. Data were audio recorded, transcribed verbatim, organized, and analysed by using ATLAS.ti 8 Windows.

RESULTS

Anxious and depressed participants experienced both physical and emotional negative feelings. Social withdrawal and cognitive problems were expressed by anxious participants, while avoidance behaviours were particularly experienced by depressed participants. Intolerance created anger, while self-blame, regret, and acute stress created guilt. In addition, avoidance behaviours and poor self-judgment emerged from shame. Participants felt disconnected from their community and worried about a variety of issues because of their negative feelings. To cope with negative feelings, participants reported that they used abnormal defense, surrender and support from community resources.

DISCUSSION

Our findings highlight the overall negative feelings of incarcerated filicide mothers, which can guide mental health professionals and different stakeholders to respond with appropriate interventions.

The lived experience during the peri-diagnostic period of breast cancer: A scoping review

OBJECTIVES

The aim of this scoping review is to provide an overview of the existing research that investigates the lived experience during the peri-diagnostic period of breast cancer.

METHODS

Nine databases were searched for relevant literature between January 2007 and April 2019. Data were extracted and categorized using deductive and inductive approaches.

RESULTS

A majority of the 66 studies included used qualitative methods to retrospectively explore the treatment decision making process of female breast cancer patients. Patients experienced uncertainty, emotional distress, and a need for more information from providers and relied on social support and family guidance during this period.

CONCLUSIONS

The results of this review show that the burdens experienced during the peri-diagnostic period parallel those in later periods of cancer care. However, these burdens are prompted by different circumstances. More research is needed to explore the lived experience during this period through the use of mixed-methods and by recruiting a diverse sample with regards to role in the breast cancer experience, age, gender, race, and ethnicity.

PRACTICE IMPLICATIONS

Interventions positioned at earlier points in the breast cancer experience should provide informational support, which could be delivered through shared decision making models. Additional support could be facilitated by patient navigation programs and health information technology.

Magnitude and factors associated with anxiety and depression among patients with breast cancer in central Ethiopia: A cross-sectional study

BACKGROUND

Patients with breast cancer are assumed to be susceptible to anxiety and depression, while there is a lack of evidence about the epidemiology and underlying factors in Ethiopia. Hence, we aimed to assess the prevalence and predictors of anxiety and depression among patients with breast cancer in Ethiopia.

METHOD

An institutional-based cross-sectional study was conducted among patients with breast cancer who were attending treatment at the Oncology Center of the Tikur Anbessa Specialized Hospital, the largest referral teaching hospital in Ethiopia. The Hospital Anxiety and Depression Scale (HDAS) was used to evaluate the anxiety and depression status of the participants, and a structured questionnaire was used to collect sociodemographic, socioeconomic, and clinical data from the participants. Medical records of the participants were reviewed to collect and correlate information about the grade and stage of cancer. An analysis was done using STATA 15.1.

RESULTS

The study included 333 randomly selected participants, of which 35.4% were on stage III and 33% on stage II, and 67.9% were on chemotherapy and surgery. The prevalence of anxiety and depression were 60.7 and 58.6%, respectively. Poor patient-provider interaction (adjusted odds ratio [AOR] = 4.5, 95% CI: 2.49, 8.12) and having no financial support (AOR = 2.83, 95% CI: 1.63, 4.91) were the significant predictors of anxiety. Age >49 years (AOR = 0.48, 95% CI: 0.25, 0.90), poor patient-provider interactions (AOR = 3.36, 95% CI: 1.87, 6.02), and having no financial support (AOR = 3.36, 95% CI: 1.95, 5.79) were the significant predictors of depression.

CONCLUSION

In this study, the prevalence of anxiety and depression was high among patients with breast cancer, and the lack of financial support and poor patient-provider interactions were significant predictors of anxiety and depression among these groups of patients. Patients with cancer need regular screening for mental health and better emotional support from their healthcare providers and families to prevent and treat anxiety and depression.

The mental health impacts of receiving a breast cancer diagnosis: A meta-analysis

BACKGROUND

Receiving a breast cancer diagnosis can be a turning point with negative impacts on mental health, treatment and prognosis. This meta-analysis sought to determine the nature and prevalence of clinically significant psychological distress-related symptoms in the wake of a breast cancer diagnosis.

METHODS

Ten databases were searched between March and August 2020. Thirty-nine quantitative studies were meta-analysed.

RESULTS

The prevalence of clinically significant symptoms was 39% for non-specific distress (n = 13), 34% for anxiety (n = 19), 31% for post-traumatic stress (n = 7) and 20% for depression (n = 25). No studies reporting breast cancer patients' well-being in our specific time frame were found.

CONCLUSION

Mental health can be impacted in at least four domains following a diagnosis of breast cancer and such effects are commonplace. This study outlines a clear need for mitigating the impacts on mental health brought about by breast cancer diagnosis. CRD42020203990.

Explaining the Process of Spiritual healing of Critically-ill Patients: A Grounded Theory Study

Background

Spiritual healing is one of the most intriguing category of alternative and complementary medicine. The aim of this study was to explain the process of spiritual healing in patients with refractory diseases in Iran.

Methods

This grounded theory study was conducted in Iran from 2018 to 2019. The participants were 14 patients with refractory diseases and 4 healers whom were first selected through purposeful and then theoretical sampling. Semi-structured interviews were used to collect data on patients and healers. All the interviews were transcribed verbatim. Data were coded and grouped under specific categories and analyzed using the Strauss and Corbin's approach (2008).

Results

Four main categories emerged from data analysis including: I) frustration to initial acceptance II) disbelief to trust III) evaluation to action and IV) doubt to certainty.

Conclusion

The results of our study provide context-specific factors affecting the complex and multifactorial nature of spiritual healing process in patients with refractory diseases. Health care professional can use these findings in designing and implementing appropriate interventions to integrate spiritual healing into their holistic practices of care.

Efficacy of Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy for Anxiety, Depression, and Fatigue in Cancer Patients: A Randomized Clinical Trial

Objective: Cancer is associated with some psychological problems that play an important role in the severity and continuity of cancer. Cancer may lead to maladaptive psychological reactions such as anxiety, depression, and fatigue. Depression and anxiety are highly prevalent in cancer patients. This study aimed to compare the efficacy of mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy (CBT) for anxiety, depression, and fatigue in cancer patients.

Method: The present study was a randomized clinical trial (RCT). Of the 100 patients diagnosed with cancer, 60 patients were eligible to participate in this study according to the inclusion / exclusion criteria. They were randomly assigned into 3 groups: MBCT, CBT, and wait-list group (WLG). Afterward, the experimental groups received 8 weekly treatment sessions. All the participants fulfilled the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Cancer-Related Fatigue Scale (CFS) before and after the intervention. Data were analyzed using SPSS-16 software by Analysis of Covariance (ANCOVA).

Results: The results indicated a significant reduction in depression, anxiety, and fatigue scores in CBT and MBCT groups. There was a significant difference between both treatment groups with WLG in the anxiety and depression, but no significant difference was found between MBCT and CBT groups. Additionally, there was only a significant difference between the CBT group and WLG in terms of fatigue (P = 0.01).

Conclusion: CBT and MBCT performed equally well in decreasing anxiety and depression in cancer patients, and they were significantly better than WLG. It seems that MBCT is a good alternative to CBT for decreasing emotional symptoms in cancer patients. As a result, CBT and MBCT could be considered a good addition to pharmacological treatment of cancer patients with comorbid psychological symptoms. However, CBT was preferable to MBCT in decreasing fatigue.

The study was registered at the irct.ir database under registration number IRCT20180503039509N1.

Mechanisms Supporting the Use of Beta-Blockers for the Management of Breast Cancer Bone Metastasis

Simple Summary

Bone represents the most common site of metastasis for breast cancer and the establishment and growth of metastatic cancer cells within the skeleton significantly reduces the quality of life of patients and their survival. The interplay between sympathetic nerves and bone cells, and its influence on the process of breast cancer bone metastasis is increasingly being recognized. Several mechanisms, all dependent on β-adrenergic receptor signaling in stromal bone cells, were shown to promote the establishment of disseminated cancer cells into the skeleton. This review provides a summary of these mechanisms in support of the therapeutic potential of β-blockers for the early management of breast cancer metastasis.

Abstract

The skeleton is heavily innervated by sympathetic nerves and represents a common site for breast cancer metastases, the latter being the main cause of morbidity and mortality in breast cancer patients. Progression and recurrence of breast cancer, as well as decreased overall survival in breast cancer patients, are associated with chronic stress, a condition known to stimulate sympathetic nerve outflow. Preclinical studies have demonstrated that sympathetic stimulation of β-adrenergic receptors in osteoblasts increases bone vascular density, adhesion of metastatic cancer cells to blood vessels, and their colonization of the bone microenvironment, whereas β-blockade prevented these events in mice with high endogenous sympathetic activity. These findings in preclinical models, along with clinical data from breast cancer patients receiving β-blockers, support the pathophysiological role of excess sympathetic nervous system activity in the formation of bone metastases, and the potential of commonly used, safe, and low-cost β-blockers as adjuvant therapy to improve the prognosis of bone metastases.

Yoga as an Adjuvant for Cancer Patients in India

Though Yoga has originated in India, its scientific use to alleviate the sufferings of cancer patients in India is thin. There are very few published studies on yoga intervention for cancer patients from India. The objective of this review was to analyze the studies that have used yoga as an adjuvant for cancer treatment. Literature searches were made in PubMed, CINAHL, Google Scholar, Proquest and Science Direct for retrieving the related studies. Data were analyzed according to the objective. The compiled results show that yoga and pranayama interventions for cancer patients in India focused mostly on psychological aspects like anxiety and depression. Few studies have explored deep into the mechanisms by which the interventions produce the desired effects. Only very few researchers have analyzed the genetic or biochemical changes that occur in the human body as a result of practicing yoga. Currently, the focus is generally on breast cancer. Researches with yoga and pranayama as an adjuvant for other cancers also need to be experimented.

A randomised controlled trial comparing internet-delivered cognitive behavioural therapy (iCBT) with and without main carer access versus treatment-as-usual for depression and anxiety among breast cancer survivors: Study protocol

BACKGROUND

Depression and anxiety are common problems among breast cancer survivors. Carer support is one of the most important determinants of women's psychological wellbeing. Survivors' distress can be alleviated by giving carers access to survivors' evidence-based treatment, which will help carers understand what survivors have been going through and help survivors feel more supported. Given the limited access to evidence-based treatments, an adapted internet-delivered cognitive behavioural therapy (iCBT) intervention for breast cancer survivors, but also open for carers' access, has the potential to decrease survivors' depression and anxiety symptoms and improve cancer-related communication and relationship quality between survivors and carers.

OBJECTIVES

This study evaluates (1) the effectiveness of a guided iCBT intervention for depression and/or anxiety symptoms among breast cancer survivors with and without main carer access, and (2) the acceptability and satisfaction with the iCBT programme.

METHOD

In this pilot study comparing the effectiveness of an adapted 7-week iCBT without main carer access against the iCBT with main carer access and treatment-as-usual control, 108 breast cancer survivors will be recruited and then randomised to either (1) treatment (n = 72) or (2) treatment-as-usual control group (n = 36) with a 2:1 ratio. The participants in the treatment group will be assigned to either iCBT alone or iCBT with the main carer also having access to the same content based on their preference. The primary outcome measure is the Hospital Anxiety and Depression Scale, and alongside secondary measures such as Cancer-Related Quality of Life, Breast Cancer Worry Scale, Brief COPE, and Medical Outcomes Study Social Support Survey will be completed by the survivors at baseline, post-treatment, and 2-month follow-up. Survivors who have carers will also complete Survivor-Carer Cancer Communication and Relationship Quality measures to provide insights into the effects of carer access. To assess the acceptability and satisfaction with the programme, survivors and their main carers will fill out the Helpful Aspects of Therapy Form (HAT) and Satisfaction with Online Treatment (SAT). Programme effectiveness and the effects of carer access on primary and secondary outcome measures will be evaluated on intention-to-treat and per-protocol basis using Linear-Mixed-Models.

DISCUSSION

This is the first trial comparing the effectiveness and acceptability of iCBT with and without carer access for depression and anxiety among breast cancer survivors. The findings of this study will provide novel data on the acceptability of iCBT programmes for breast cancer survivors and the impact of carer access on them and their carers.

Impact of COVID-19 on anxiety levels among patients with cancer actively treated with systemic therapy

BACKGROUND

Life-threatening diseases have a negative impact on emotional well-being and psychosocial functioning. This study aimed to assess the relationship between the level of anxiety caused by a neoplasm and the threat of coronavirus infection among patients with cancer actively treated with systemic therapy during the COVID-19 pandemic. Additionally, we searched for clinical factors associated with a higher level of anxiety.

METHODS

In this multicentre, prospective, non-interventional study conducted in Poland, we enrolled 306 actively treated patients with cancer and collected their clinical data, including age, gender, cancer type and treatment intention. The fear/anxiety of SARS-CoV-2 were rated in Fear of COVID-19 Scale (SRA-FCV-19S) and Numerical Anxiety Scale (SRA-NAS). The fear and anxiety associated with cancer (CRA) were rated with the NAS (CRA-NAS).

RESULTS

The mean level of SRA-FCV-19S was 18.5±7.44, which was correlated with the SRA-NAS (r=0.741, p<0.001). SRA-FCV-19S was significantly higher in women versus men (20.18±7.56 vs 16.54±6.83; p<0.001) and was tumour type-dependent (p=0.037), with the highest anxiety observed in patients with breast cancer (17.63±8.75). In the multivariate analysis, only the female gender was significantly associated with higher SRA. CRA-NAS was higher in women versus men (7.07±2.99 vs 5.47±3.01; p<0.001), in patients treated with curative versus palliative intention (7.14±3.06 vs 5.99±3.06; p=0.01) and in individuals aged ≤65 years versus >65 years (6.73±2.96 vs 5.66±3.24; p=0.007).

CONCLUSIONS

For an actively treated patient with cancer, cancer remains the main life-threatening disease during the COVID-19 pandemic. The need for more attentive psychological care should be provided especially to female patients, patients with breast cancer, those under 65 years of age and treated with curative intention, as these factors are associated with a higher level of anxiety.

The Relationship between Anxiety and Self-Esteem in Women Suffering from Breast Cancer

Background:

Breast cancer is the most common cancer in women worldwide that has great impact on their lives. Women with breast cancer are at increased risk for anxiety and low self-esteem.

Objective:

The purpose of this study was to explore the relationship between anxiety and self-esteem in women suffering from breast cancer.

Materials and Methods:

In this descriptive correlational study, all 261 women diagnosed with nonmetastatic breast cancer referred to cancer care clinics in winter 2016 were assessed. Data were gathered using demographic information inventory, Spielberger's State–Trait Anxiety Inventory and Rosenberg's Self-Esteem Scale, and were analyzed using SPSS statistical software (version 22). Descriptive statistics, the t-test, ANOVA, the Pearson correlation and the Spearman's correlation were also used.

Results:

The mean ± standard deviation (SD) age of participants in the study was 48.33 ± 10.837 years. The mean score of state and trait anxiety was 46.29 ± 11.745 and 46.61 ± 10.936, respectively. The mean ± SD score of self-esteem was 18.38 ± 5.08. The study results show an indirect correlation between anxiety and self-esteem in women suffering from breast cancer (r = −0.690).

Conclusions:

According to the considerable influences of anxiety and self-esteem on other aspects of physical, psychological, and social health, it is suggested that health-care professionals pay more attention to the self-esteem and psychological state of women diagnosed with breast cancer besides other medical treatments. Screening strategies for detecting psychiatric disorders in breast cancer patients and planning of effective interventions to promote self-esteem and reduce anxiety and its consequences are recommended.

Beyond depression, anxiety and post-traumatic stress disorder symptoms: Qualitative study of negative emotional experiences in hematopoietic stem cell transplant patients

OBJECTIVE

Psychological distress impacts a variety of health outcomes in hematopoietic stem cell transplantation (HSCT). Focused qualitative studies on a wider range of psychological distress in HSCT patients are lacking. However, understanding the subtleties of psychological distress (e.g. fear, guilt, loss of control) in HSCT patients is imperative to optimising the psychological well-being of this vulnerable population. To explore psychological distress after transplantation, we conducted semi-structured interviews with 25 HSCT patients.

METHODS

Interviews were completed in the first 100 days after transplantation. Interview modules explored psychological distress symptoms in the hospital and during the first 100 days after HSCT, along with the perceived impact of these symptoms on their recovery.

RESULTS

Of the negative emotional experiences reported, feeling trapped, fear, guilt, discouragement and powerlessness were frequently expressed. Patients reported that negative emotional states interfered with their motivation to participate in health behaviours important to the transplant recovery.

CONCLUSION

As one of the few qualitative studies broadly characterising the nature of negative emotional experiences after HSCT, these findings add to our understanding of the specific psychological challenges in this growing patient population and can inform development of targeted interventions and overall management of psychological distress during HSCT recovery.

Challenges, Coping Strategies, and Social Support among Breast Cancer Patients in Ghana

Background. Despite the high incidence and mortality rate of breast cancer (BC) in Ghana, little attention has been given to the issue of how adult women cope with having BC. The aim of this study was to explore the challenges, coping strategies, and support systems among women diagnosed with BC in Ghana. Methods. A descriptive cross-sectional study was conducted from February to August 2017 at the Komfo Anokye Teaching Hospital (KATH), Ghana. A systematic random sampling technique was used to select 202 women with a confirmed diagnosis of BC. Coping strategies of women with BC were assessed using the Brief-COPE. The associations between sociodemographic characteristics, social network/support, and coping strategies were assessed using linear regression models. Results. The most and least adopted active coping strategies were religious coping and humors, respectively. Self-distraction and substance use were the most and least adopted avoidant coping strategies, respectively. Spouses and children offered the most support to women with BC; having support from 5 or more sources was associated with higher mean active coping (beta [β] 1.14; 95% CI 0.66 to 1.62) and avoidant coping (β 1.46; 95% CI 0.98 to 1.94), as compared with having <2 sources of social support. Conclusion. This study demonstrates that women diagnosed with BC in Ghana adopt varied coping strategies to deal with these challenges. The forms of coping strategies adopted by women diagnosed with BC are influenced by the extent of social support received. Psychosocial counseling and support should be an integral part of BC management. Exploring and including social networks could play an important role in the management of BC in Ghana.

Treatment of Anxiety Disorders - The Role of Pharmacists

Anxiety disorders represent the group of the most prevalent mental diseases which may have serious negative consequences for mental and social health. Anxiety is generally treated with a combination of the psychotherapeutic treatment and pharmacotherapy. Pharmacotherapy of anxiety implies the use of antidepressants, which are used as basic drugs, and an additional therapy with anxiolytics. This therapeutic approach in the treatment of anxiety disorders is accompanied by significant limitations. Adherence of anxiety patients is often insufficient due to the late onset of the effects of antidepressants, the appearance of adverse effects, the stigmatization of psychiatric patients in society and other reasons. Certain exogenous factors, such as an excessive use of coffee, smoking of marijuana, sleep disorders and personal problems, such as family problems or financial problems, can exacerbate anxiety and make it more difficult to treat it. Prolonged use of benzodiazepines, as an adjunct therapy in the treatment of anxiety, may be accompanied by the development of psycho-physical dependence. Finally, the drugs used to treat anxiety have a serious potential for the drug-drug interactions. All of these limitations may be completely or partially overcome through the active participation of Pharmacists as equal members of collaborative medical teams for the treatment of anxiety disorders.

Perceived cognitive functioning and its influence on emotional vulnerability in breast cancer

We investigated the relationship between perceived cognitive function and emotional vulnerability of breast cancer survivors while examining the moderating effect of various risk factors. Results confirmed that perceived cognitive function predicted emotional vulnerability with grade of breast cancer moderating this relationship. Age at diagnosis exhibited a trend towards significance for emotional vulnerability, and time since diagnosis as well as grade significantly predicted quality of life. Our findings imply that (younger) women with a higher breast cancer grade are at a greater risk for emotional and cognitive vulnerability and can benefit from interventions designed to reduce emotional vulnerability through training cognitive efficiency.

Psychological issues in cancer survivorship

Thankfully, many more women are now surviving cancer due to advances in awareness, surveillance, and treatment. In fact, many oncology clinicians now consider cancer a chronic illness. This has meant that a growing number are living with the physical and psychological consequences of the disease. The psychological impact and emotions experienced by survivors are varied. Some reactions are more common than others, including the onset of depression, anxiety, and sexual dysfunction and feelings of abandonment, isolation, grief, and fear of recurrence. Body image and sexuality are also commonly impacted by cancer, particularly by women who experience treatment-induced menopause. Existential and spiritual concerns can also cause psychological consequences. In time, however, many women adjust to life as a cancer patient and find new meaning and purpose in their lives. The aim of this article is to highlight the key psychological issues faced by women who are in the chronic or survivorship phase of their cancer experience. The article also aims to emphasize the need for ongoing evaluation of the psychological status of these women during regular follow-up appointments. This will ensure that patient-centered supportive care is optimized.

Comparing provider and patient views of issues for low-resourced breast cancer patients

OBJECTIVE

The purpose of this study was to compare provider and patient views from the same clinical settings on issues raised by low-socioeconomic status (SES) breast cancer survivors.

METHODS

We conducted qualitative interviews among two groups: low-SES breast cancer survivors (n = 37) and medical personnel (ie, physicians, nurses, and navigators; n = 8) who interact and serve with these patients from two geographically distinct low-resourced clinical settings. These semistructured qualitative interviews used grounded theory to identify several potential themes, such as finances, resources, and medical care. Transcripts were coded and summarized into themes.

RESULTS

We analyzed each type of interview data separately then compared patient and provider perspectives. From these qualitative interviews, we discovered that low-SES breast cancer survivors reported many unmet needs, including transportation, housing, health literacy, and language, among others. Providers reported that many of these needs are served by the extensive network of supports surrounding these patients.

CONCLUSIONS

These results illustrate that low-SES breast cancer survivors have unique needs that differ from other breast cancer survivors. Many providers feel that these needs are being met, but patients have more diverse experiences. By better addressing the links between resource needs and low-SES breast cancer survivors, quality of life can be improved.

"It is not just any pill"-Women's experiences of endocrine therapy after breast cancer surgery

OBJECTIVE

For patients diagnosed with hormone-receptor-positive breast cancer, endocrine therapy (ET) is usually prescribed to reduce recurrence and mortality rates. Despite the benefits, compliance with treatment varies. The aim of this study was to provide qualitative data about women's experiences with ET after breast cancer surgery.

METHODS

Twenty-five women, treated with Tamoxifen after breast cancer surgery, were interviewed in seven focus groups. Six open-ended questions were used to explore their experiences. The interviews were recorded, transcribed verbatim and analysed using inductive content analysis.

RESULTS

The analysis resulted in three categories that described the women's experiences: the treatment "creates discomfort"; "promotes levels of management"; and "causes feelings of abandonment". Women's experiences of treatment could at first glance be seen as positive, as perceived protection, but after further analysis, a deeper meaning was identified: protection with reservation. When experiencing discomfort, the women tried to manage the situation, although the mode of management sometimes varied. The women reported that they needed support, but when the support did not appear, they felt as though they had been abandoned. Moreover, knowledge about side effects became an obstacle, as it could create fear of more severe symptoms. They also described that their disease was perceived by healthcare professionals as "cancer light".

CONCLUSION

The information needs to be customised specifically to each person.

[Cancer: Communicating the diagnosis and prognosis]

The diagnoses and prognoses that medical professionals have to communicate in cases of cancer come with special problems. Of all fatal diseases, cancer possibly causes most psychological impact on the patient. Although, by nature, medical professionals are aware of this negative impact and take care to be as prudent and human as possible, recent studies have shown that the "psychological factors of the patient" are of direct relevance to the medical factors in cancer, over and above their importance on quality of life during the course of the disease. This direct relevance needs replies that go beyond purely medical knowledge, as well as a specific training as to their application. Interdisciplinary medical-psychological cooperation is probably required. Studies indicate that compliance with both requisites may bring an improvement to clinical results. In Europe, although less than in the United States of America, the necessary inclusion has been the recognition of psychological training in academic pre- and postgraduate training in communicating these cases.

Quality of life: fractionated stereotactic radiotherapy versus enucleation treatment in uveal melanoma patients

PURPOSE

To report the quality of life and visual functioning in uveal melanoma patients treated with enucleation or fractionated stereotactic radiation therapy (fSRT).

METHODS

Uveal melanoma (UM) patients treated with fSRT (n = 65) or enucleation (n = 48) participated in this prospective study. Questionnaires to measure anxiety (State-Trait Anxiety Inventory), subjective distress (Impact of Event Scale) and quality of life (EORTC-QLQ-C30 and National Eye Institute Visual Function Questionnaire (VFQ-25)) were obtained before treatment and 2, 6, 12, 24, 36 and 48 months after treatment.

RESULTS

Less peripheral vision was observed until 3 years (p = 0.026) posttreatment in enucleated patients compared to irradiated patients. From 2 months until 3 years posttreatment irradiated patients increase in role functioning-score (p = 0.005), while enucleated patients decrease in score (p = 0.012). Regardless of their treatment, for all patients we measured a reduction in physical functioning (p = 0.035), insomnia (p < 0.001) and in state anxiety from pretreatment until 2 years posttreatment (p < 0.001). An increase in pain overall (p = 0.023) and in emotional functioning is observed 1 year posttreatment (p < 0.001). At baseline, patients with metastases (independent of their treatment) have more subjective distress (p = 0.037) than patients without metastases. The mean 'global health score' overall, without effect of time, was 76.4 (SD: 13.6).

CONCLUSION

Enucleated patients had more difficulty working or performing household tasks 2 months posttreatment compared to irradiated patients. Enucleated patients had diminished peripheral vision until 3 years compared to irradiated patients. Overall quality of life is not significantly different between both treatment groups.

Highly favorable physiological responses to concurrent resistance and high-intensity interval training during chemotherapy: the OptiTrain breast cancer trial

Background

Advanced therapeutic strategies are often accompanied by significant adverse effects, which warrant equally progressive countermeasures. Physical exercise has proven an effective intervention to improve physical function and reduce fatigue in patients undergoing chemotherapy. Effects of high-intensity interval training (HIIT) in this population are not well established although HIIT has proven effective in other clinical populations. The aim of the OptiTrain trial was to examine the effects of concurrent resistance and high-intensity interval training (RT-HIIT) or concurrent moderate-intensity aerobic and high-intensity interval training (AT-HIIT), to usual care (UC) on pain sensitivity and physiological outcomes in patients with breast cancer during chemotherapy.

Methods

Two hundred and forty women were randomized to 16 weeks of RT-HIIT, AT-HIIT, or UC. Outcomes: cardiorespiratory fitness, muscle strength, body mass, hemoglobin levels, and pressure-pain threshold.

Results

Pre- to post-intervention, RT-HIIT (ES = 0.41) and AT-HIIT (ES = 0.42) prevented the reduced cardiorespiratory fitness found with UC. Handgrip strength (surgery side: RT-HIIT vs. UC: ES = 0.41, RT-HIIT vs. AT-HIIT: ES = 0.28; non-surgery side: RT-HIIT vs. UC: ES = 0.35, RT-HIIT vs. AT-HIIT: ES = 0.22) and lower-limb muscle strength (RT-HIIT vs. UC: ES = 0.66, RT-HIIT vs. AT-HIIT: ES = 0.23) were significantly improved in the RT-HIIT. Increases in body mass were smaller in RT-HIIT (ES = − 0.16) and AT-HIIT (ES = − 0.16) versus UC. RT-HIIT reported higher pressure-pain thresholds than UC (trapezius: ES = 0.46, gluteus: ES = 0.53) and AT-HIIT (trapezius: ES = 0.30).

Conclusion

Sixteen weeks of RT-HIIT significantly improved muscle strength and reduced pain sensitivity. Both exercise programs were well tolerated and were equally efficient in preventing increases in body mass and in preventing declines in cardiorespiratory fitness. These results highlight the importance of implementing a combination of resistance and high-intensity interval training during chemotherapy for women with breast cancer.

An insight into the patient's response to a diagnosis of urological cancer

A cancer diagnosis and the patient's response to the news pertains to all types of cancer, however, in this article, the focus is on urological cancer. Intrinsic to the management of this patient group is the urology multidisciplinary team, in which the role of the cancer nurse specialist (CNS) is pivotal. For most people, a cancer diagnosis is arguably their worst fear. It is therefore prudent that a holistic approach is used when determining care and ensuring that appropriate support is forthcoming. This necessitates an assessment of the physical, psychological/emotional, psycho-social, spiritual and cultural components of the individual's healthcare needs, and accordingly, devising a plan of care to secure the best outcomes. This article concentrates on the psychological/emotional component. It outlines a case study of a patient's response to the consultant's question in the joint consultation clinic, examines the CNS's interpretation and understanding of the events, and her perspective on whether factors such as fear, anxiety and distress influence the individual's response to the diagnosis, their comprehension of information and the messages relayed, and consequently, their ability to manage the ensuing issues. It also looks at the support available to cancer patients following the receipt of a cancer diagnosis and its efficacy in addressing their concerns. Integral to this is effective communication, specifically the timely provision of information by health professionals.

[Anxiety in women undergoing surgical treatment of breast cancer]

AIM

To assess anxiety level and factors contributing to its development in patients undergoing surgical treatment for breast cancer.

MATERIAL AND METHODS

The subjects of the study were 72 women, aged 20-80 years, with the diagnosis of primary breast cancer. The Basic Psycho-Oncological Documentation Scale (PO-BADO), the European Organization for Research, and the Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module (EORTC QLQ-C30; BR-23), the Hospital Anxiety and Depression Scale (HADS) were used.

RESULTS AND CONCLUSION

The anxiety score showed negative correlation with EORTC QLQ-C30 'physical functioning', 'cognitive functioning', 'emotional functioning', 'global health status/quality of life' subscales (p≤0,002). Anxiety is a highly prevalent in women with breast cancer and has a marked negative impact, in particular on younger patients.

The effects on anxiety and quality of life of breast cancer patients following completion of the first cycle of chemotherapy

OBJECTIVES

Breast cancer patients as part of their treatment need to undergo various forms of chemotherapy. This is considered as a burdensome experience for many patients often leading to significant levels of anxiety. The aim of the study was to explore the anxiety levels and any correlations to the quality of life of women with breast cancer that were undergoing chemotherapy.

METHODS

This was a cross-sectional study utilizing an explanatory sequential design. Data were collected from 355 women with breast cancer with the Self Anxiety Scale, the EORTC QLQ-C30, the EORTC QLQ-BR23 and sociodemographic questionnaires. Further insight to patients' experiences was given through 12 in-depth interviews.

RESULTS

Anxiety scores ranged between 24 and 75 (45.7 ± 10.11), with 44% reporting serious or/and intense anxiety. The results revealed statistically significant differences on patients' anxiety levels depending on their source of support. Overall, patients' global health-related quality of life was found to be low to average 55.91 ± 17.94. The results showed low emotional functioning (49.30 ± 29.12), low role functions (56.34 ± 27.50) and low sexual functioning (24.93 ± 20.75). Patients also reported experiencing problems with fatigue (49.04 ± 29.12), insomnia (44.32 ± 32.97), hair loss (48.25 ± 38.32) and arm symptoms (36.53 ± 23.71). Patients being solely supported by the family experienced higher anxiety levels (p < 0.001) and lower quality of life (p < 0.001). There was a statistically significant negative correlation between anxiety and quality of life (r = -0.623, p < 0.001). Statistically significant differences were also found in relation to demographics, anxiety and quality of life. The interviews provided further evidence on the impact of anxiety on patients' lives.

CONCLUSION

The time following the completion of the first cycle of chemotherapy is associated with anxiety and lower quality of life levels in breast cancer patients. Healthcare providers should consider the supportive healthcare needs from the beginning of chemotherapy in patients to optimize their conventional and supportive healthcare outcomes.

Effect of chemotherapy counseling by pharmacists on quality of life and psychological outcomes of oncology patients in Malaysia: a randomized control trial

BACKGROUND

Cancer is now becoming a leading cause of death. Chemotherapy is an important treatment for cancer patients. These patients also need consultation during their treatment to improve quality of life and decrease psychological disorders. The objectives of the study were to develop, implement and evaluate the effectiveness of a chemotherapy counseling module by pharmacists among oncology patients on their quality of life and psychological outcomes in Malaysia.

METHOD

A single-blind randomized controlled trial was carried out among 162 oncology patients undergoing chemotherapy from July 2013 to February 2014 in a government hospital with oncology facilities in Malaysia. Participants were randomized to either the intervention group or the control group. Chemotherapy counseling using the module on 'Managing Patients on Chemotherapy' by Pharmacists was delivered to the intervention group. The outcome measures were assessed at baseline, first follow-up and second follow-up and third follow-up post-intervention. Chi-square, independent samples t-test and two-way repeated measures ANOVA were conducted in the course of the data analyses.

RESULTS

In assessing the impact of the chemotherapy counseling module, the study revealed that the module along with repetitive counseling showed significant improvement of quality of life in the intervention group as compared to the control group with a large effect size in physical health (p = 0.001, partial Ƞ2 = 0.66), psychological (p = 0.001, partial Ƞ2 = 0.65), social relationships (p = 0.001, partial Ƞ2 = 0.30), and environment (p = 0.001, partial Ƞ2 = 0.67) and decrease in the anxiety (p = 0.000; partial Ƞ2 = 0.23), depression (p = 0.000; partial Ƞ2 = 0.40).

CONCLUSION

The module on 'Managing Patients on Chemotherapy' along with repetitive counseling by pharmacists has been shown to be effective in improving quality of life and decreasing anxiety and depression among oncology patients undergoing chemotherapy.

TRIAL REGISTRATION NUMBER

National Medical Research Register (NMRR) of Malaysia and given a registration number NMRR-12-1057-12,363 on 21 December 2012.

Distant metastasis detected by routine staging in breast cancer patients participating in the national German screening programme: consequences for clinical practice

PURPOSE

To determine frequency of routine radiological staging of breast cancer patients diagnosed in a German Breast Cancer Screening Center from 2007 to 2014, the incidence and consequences of distant metastases detected and the resulting implications for clinical routine.

METHODS

Records of 896 patients with primary breast cancer diagnosed in the Screening Centre and treated in five participating hospitals were analyzed retrospectively. Evaluation included frequency and type of staging procedures and results with respect to distant metastasis and their consequences on clinical management.

RESULTS

894/896 Patients (99.8 %) received staging for distant metastases by bone scintigraphy, chest X-ray and liver sonography and/or CT/MRT diagnostics. Distant metastasis was suggested In 6/894 patients but excluded in 3 by further diagnostics or clinical course. Thus, 3 (0.3 %) were clinically verified to have metastatic disease in bone (n = 2; both pT2) or in bone and lung (n = 1; cT4, cN3).

CONCLUSION

Due to the low incidence of verified metastatic disease, the high false positive rate of staging procedures and the unfavorable cost/benefit ratio routine radiological staging should be completely omitted in asymptomatic breast cancer patients diagnosed in a breast cancer screening programme.