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Arraras JI, Illarramendi JJ, Manterola A, de la Cruz S, Zarandona U, Ibañez B, Salgado E, Visus I, Barrado M, Teiejira L, Martinez MI, Martinez E, Vera R. Quality of life in Spanish postmenopausal breast cancer patients with localized disease who finish endocrine treatment: a prospective study. Menopause 2023; 30:613-620. [PMID: 37022296 DOI: 10.1097/gme.0000000000002178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
OBJECTIVE In this article, the quality of life (QOL) of Spanish postmenopausal early-stage breast cancer patients who have finished endocrine therapy (ET), QOL changes after endocrine therapy cessation, and the differences between two endocrine therapy modalities (tamoxifen or aromatase inhibitor [AI]) are studied. More QOL information after endocrine therapy cessation is needed. METHODS A prospective cohort study was performed. Participating in the study were 158 postmenopausal patients who had received tamoxifen or AI for 5 years. In some cases, endocrine therapy may have changed during those 5 years.Patients completed the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR45 questionnaires at baseline, after 6 months, and after 1 year of follow-up. Patients older than 65 years also completed the QLQ-ELD14. Linear mixed-effect models were used to evaluate longitudinal changes in QOL and differences in QOL between endocrine therapy modalities. RESULTS QOL scores for the whole sample throughout follow-up were high (>80/100 points) in most QOL areas. Moderate limitations (>30 points) occurred in the QLQ-BR45 in sexual functioning and sexual enjoyment, future perspective, and joint symptoms. Moderate limitations also occurred in the QLQ-ELD14 in worries about others, maintaining purpose, joint stiffness, future worries, and family support. In those who had finished endocrine therapy, pain was reduced in all three assessments conducted during the 1-year follow-up period in both groups. Tamoxifen patients showed better QOL in functioning (role functioning, global QOL, financial impact), symptoms (pain), and emotional areas (future perspective and worries about others) than AI patients but worse QOL in skin mucosis symptoms. CONCLUSIONS The results of this study show that postmenopausal early-stage breast cancer patients adapted well to their disease and endocrine therapy treatment. QOL improvements in the 1-year follow-up period appeared in one key area: pain. Differences between endocrine therapy modalities suggested QOL was better in the tamoxifen group than in the AI group.
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Affiliation(s)
| | - Jose Juan Illarramendi
- From the Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ana Manterola
- Radiotherapeutic Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Susana de la Cruz
- From the Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Berta Ibañez
- Navarrabiomed, RICAPPS, Unidad de Metodología, Pamplona, Spain
| | - Esteban Salgado
- From the Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ignacio Visus
- Radiotherapeutic Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Marta Barrado
- Radiotherapeutic Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Lucia Teiejira
- From the Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - María Isabel Martinez
- Radiotherapeutic Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Enrique Martinez
- Radiotherapeutic Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ruth Vera
- From the Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
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Cáceres MC, Nadal-Delgado M, López-Jurado C, Pérez-Civantos D, Guerrero-Martín J, Durán-Gómez N. Factors Related to Anxiety, Depressive Symptoms and Quality of Life in Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3547. [PMID: 35329232 PMCID: PMC8955820 DOI: 10.3390/ijerph19063547] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 03/15/2022] [Indexed: 12/15/2022]
Abstract
Breast cancer (BC) is a major public health problem internationally. Although illness survival rates have improved, patients usually suffer multiple symptoms, both physical and psychological, which can affect their quality of life (QoL). The main aim of this study was to evaluate depressive symptoms, anxiety and the QoL of people with BC. An observational, cross-sectional study was carried out at Badajoz University Hospital (Spain). A total of 200 women with BC were included. EORTC QLQ-C30 and QLQ-BR23 questionnaires were used to assess QoL. Patients were screened for depressive symptoms using the Beck Depression Inventory (BDI) and for state anxiety and trait anxiety using the State Anxiety Inventory (STAI). Thirty-eight percent of the patients in the sample had moderate to severe anxiety, which was related to the time of diagnosis, advanced stage of illness and surgical treatment. We found that 28% of patients had depressive symptoms, related mainly with time of diagnosis, adjuvant therapy and number of cycles of chemotherapy (CT). Patients with the longest time since diagnosis, in stage III, and in treatment with CT, especially those with the greatest number of cycles, had the worst scores in QoL. We found a positive association between depressive symptoms and anxiety with QoL in patients with BC.
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Affiliation(s)
- Macarena C. Cáceres
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (C.L.-J.); (J.G.-M.); (N.D.-G.)
| | | | - Casimiro López-Jurado
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (C.L.-J.); (J.G.-M.); (N.D.-G.)
| | - Demetrio Pérez-Civantos
- Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura Hospital Universitario de Badajoz, 06006 Badajoz, Spain;
| | - Jorge Guerrero-Martín
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (C.L.-J.); (J.G.-M.); (N.D.-G.)
| | - Noelia Durán-Gómez
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain; (C.L.-J.); (J.G.-M.); (N.D.-G.)
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Lagendijk M, Mittendorf E, King TA, Gibbons C, Pusic A, Dominici LS. Incorporating Patient-Reported Outcome Measures into Breast Surgical Oncology: Advancing Toward Value-Based Care. Oncologist 2019; 25:384-390. [PMID: 31848315 DOI: 10.1634/theoncologist.2019-0355] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
Value in health care is defined as the health outcome achieved per unit of cost. For health care systems, improving value means achieving better outcomes at lower costs. Improving outcomes, including patient-reported outcomes (PROs), as well as more established metrics such as mortality and complication rates, ensures high-quality care. This is particularly true in breast cancer surgery, where survival and recurrence rates are comparable across different surgical approaches. Outcomes reflecting survivorship quality may therefore better inform decision making regarding surgical approaches. PROs can be assessed using validated instruments known as patient-reported outcome measures (PROMs). They are obtained directly from patients reflecting their health-related quality of life (HRQOL). Ongoing initiatives strive to define PROMs that accurately reflect HRQOL and demonstrate value, with the goal of establishing benchmarks for quality of care. Clinicians caring for patients with breast cancer are well positioned to be involved in defining meaningful measures of value-based breast cancer care. This article reviews value-based breast cancer care in the context of locoregional therapy, with attention paid to the work done by the International Consortium of Health Outcome Measures in which a "standard set" of value-based patient-centered outcomes for breast cancer for international use is defined. In addition, an overview is provided of relevant PROMs and previously reported scores. Recommendations and future challenges for implementation of routine collection of PROs are also discussed. IMPLICATIONS FOR PRACTICE: Opportunity exists to act as early adopters of the routine collection of longitudinal patient-reported outcome data for breast cancer, allowing transition of current care to value-based cancer care.
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Affiliation(s)
- Mirelle Lagendijk
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - Elizabeth Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Christopher Gibbons
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrea Pusic
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Laura S Dominici
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
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Calderon C, Carmona-Bayonas A, Jara C, Beato C, Mediano M, Ramón Y Cajal T, Carmen Soriano M, Jiménez-Fonseca P. Emotional functioning to screen for psychological distress in breast and colorectal cancer patients prior to adjuvant treatment initiation. Eur J Cancer Care (Engl) 2019; 28:e13005. [PMID: 30761638 DOI: 10.1111/ecc.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 09/04/2018] [Accepted: 01/17/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective was to analyze the usefulness of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) EF subscale to detect emotional problems in patients with breast (BC) and colorectal cancer (CRC). METHODS A prospective, observational, cross-sectional study was conducted. Participants completed the Brief Symptom Inventory (BSI) and EORTC-QLQ-C30. The following psychometric properties were calculated: accuracy, sensitivity, positive predictive value, specificity and negative predictive value. RESULTS The sample analyzed included 445 patients: 202 with BC and 243 with CRC. In total, 129 BC patients (64%) and 104 CRC patients (43%) suffered psychological distress according to the BSI. The accuracy of EORTC-QLQ-C30 EF in detecting psychological distress was 77% and 82% in BC and CRC respectively. Specificity rates for BC and CRC were 81% and 82%, and sensitivity was 75% and 82% respectively. Positive predictive value was 87% and 77%, and negative predictive value was 65% and 86% in BC and CRC respectively. The mean AUC for BC was 0.83 and 0.88 for CRC. CONCLUSIONS The EORTC-QLQ-C30 EF is useful for rapid screening. The systematic application of this scale would allow patients with cancer and emotional problems to be easily identified in clinical practice.
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Affiliation(s)
- Caterina Calderon
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Spain
| | | | - Carlos Jara
- Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Madrid, Spain
| | - Carmen Beato
- Department of Medical Oncology, Grupo Hospitalario Quirón, Sevilla, Spain
| | - Marilo Mediano
- Department of Medical Oncology, Grupo Hospitalario Quirón, Sevilla, Spain
| | - Teresa Ramón Y Cajal
- Department of Medical Oncology, Hospital Universitario Santa Creu y San Pau, Barcelona, Spain
| | - Mª Carmen Soriano
- Department of Medical Oncology, Hospital Virgen de La Luz, Cuenca, Spain
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology. Hospital, Universitario Central de Asturias, Oviedo, Spain
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Álvarez-Salvago F, Galiano-Castillo N, Arroyo-Morales M, Cruz-Fernández M, Lozano-Lozano M, Cantarero-Villanueva I. Health status among long-term breast cancer survivors suffering from higher levels of fatigue: a cross-sectional study. Support Care Cancer 2018; 26:3649-3658. [PMID: 29730714 DOI: 10.1007/s00520-018-4240-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/26/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE The aims of this study were to evaluate the health status of long-term breast cancer survivors (LTBCS) suffering from higher levels of fatigue, to highlight their needs, and to establish the key points of intervention support programs. METHODS A cross-sectional observational study was conducted at the Sport and Health Joint University Institute (iMUDS) between September 2016 and July 2017 with 80 LTBCS that were classified into non-fatigued (≤ 3.9) or fatigued (≥ 4) according to the Piper Fatigue Scale (PFS) total score. The instruments used were the European Organization for Research and Treatment of Cancer Core 30 and its breast cancer (BC) module, the Visual Analog Scale (VAS), the Brief Pain Inventory (BPI), the Scale for Mood Assessment (EVEA), the International Fitness Scale (IFIS), and the Charlson Comorbidity Index. RESULTS The analysis revealed that 41.2% of LTBCS were considered moderately fatigued and showed significantly higher levels for the categories of "nausea and vomiting" (P = .005), "pain," "dyspnea" and "insomnia" (P < .001), "appetite loss" (P = .002), "financial difficulties" (P = .010), "systemic therapy side effects" (P < .001), "breast symptoms" and "arm symptoms" (P = .002), and "upset by hair loss" (P = .016). In addition, LTBCS presented significantly higher levels of pain in the affected and non-affected arm, "sadness-depression." "anxiety," "anger/hostility" (All: P < .001), and lower general physical fitness (P < .001). The rest of the variables did not show significant differences. CONCLUSION LTBCS suffering from higher levels of fatigue had lower QoL, higher level of pain, worse mood state, and lower physical fitness.
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Affiliation(s)
| | - Noelia Galiano-Castillo
- Department of Physiotherapy, University of Granada, Granada, Spain.
- Biohealth Research Institute in Granada (ibs.GRANADA), University Hospital Complex of Granada/University of Granada, Granada, Spain.
- Sport and Health Joint University Institute (iMUDS), Granada, Spain.
| | - Manuel Arroyo-Morales
- Department of Physiotherapy, University of Granada, Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), University Hospital Complex of Granada/University of Granada, Granada, Spain
- Sport and Health Joint University Institute (iMUDS), Granada, Spain
| | | | - Mario Lozano-Lozano
- Department of Physiotherapy, University of Granada, Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), University Hospital Complex of Granada/University of Granada, Granada, Spain
| | - Irene Cantarero-Villanueva
- Department of Physiotherapy, University of Granada, Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), University Hospital Complex of Granada/University of Granada, Granada, Spain
- Sport and Health Joint University Institute (iMUDS), Granada, Spain
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