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Marzorati C, Masiero M, Pravettoni G. "Perspective: An integrated vision of the quality of life in breast cancer survivorship trajectory". Breast 2024; 77:103785. [PMID: 39208546 PMCID: PMC11401158 DOI: 10.1016/j.breast.2024.103785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/12/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Affiliation(s)
- Chiara Marzorati
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.
| | - Marianna Masiero
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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Pagan E, Ruggeri M, Bianco N, Bucci EO, Graffeo R, Borner M, Giordano M, Gianni L, Rabaglio M, Freschi A, Cretella E, Seles E, Farolfi A, Simoncini E, Ciccarese M, Rauch D, Favaretto A, Honecker F, Berardi R, Franzetti-Pellanda A, Gelber S, Partridge AH, Goldhirsch A, Bagnardi V, Pagani O, Ribi K. Factors influencing 5-year persistence to adjuvant endocrine therapy in young women with breast cancer. Breast 2024; 77:103765. [PMID: 39002281 PMCID: PMC11301370 DOI: 10.1016/j.breast.2024.103765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 06/14/2024] [Accepted: 06/30/2024] [Indexed: 07/15/2024] Open
Abstract
PURPOSE Although younger age has been negatively associated with persistence to adjuvant endocrine therapy (ET), factors contributing to non-persistence remain poorly understood. We assessed factors associated with non-persistence to ET and described the 5-year trajectories of quality of life (QoL) and symptoms in young women (≤40 years) with hormone receptor-positive breast cancer (BC). METHODS We retrieved data on clinical characteristics and non-persistence from the medical annual records in the European cohort of the "Helping Ourselves, Helping Others: The Young Women's BC Study" (IBCSG 43-09 HOHO). Women completed surveys at baseline, biannually for three years, and annually for another seven years. Data collection included sociodemographic information, QoL aspects assessed by the Cancer Rehabilitation Evaluation System-Short Form and symptoms assessed by the Breast Cancer Prevention Trial symptom scales. Cox regression models were applied to identify factors associated with non-persistence. RESULTS The cumulative risk of interrupting ET within 5 years was 27.7 % (95 % CI, 21.5-35.2). The QoL subscale scores remained stable over 5 years, with slight improvements in the physical subscale. Hot flashes decreased (p < 0.001), while vaginal problems intensified (p < 0.001) over time. Being married without children and having difficulties interacting and communicating with the medical team were significantly associated with non-persistence. CONCLUSIONS Discussing the desire to conceive with partnered childless women and establishing a good relationship with the medical team may be important in addressing the non-persistence in young BC survivors. As recent data suggests the safety of pausing ET to conceive, this approach may be a reasonable future option to limit non-persistence.
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Affiliation(s)
- Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Monica Ruggeri
- Program for Young Patients, International Breast Cancer Study Group, a Division of ETOP IBCSG Partners Foundation, Bern, Switzerland
| | - Nadia Bianco
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Rossella Graffeo
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Markus Borner
- Division of Oncology (Oncocare), Klinik Engeried, Lindenhofgruppe, Bern, Switzerland
| | | | - Lorenzo Gianni
- Department of Medical Oncology, Ospedale Infermi, Rimini, AUSL Della Romagna, Italy
| | - Manuela Rabaglio
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Andrea Freschi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081, Aviano, Italy
| | - Elisabetta Cretella
- Department of Medical Oncology, Azienda Sanitaria Dell'Alto Adige, Bolzano, Italy
| | - Elena Seles
- Department of Medical Oncology, Ospedale Degli Infermi, Biella, Italy
| | - Alberto Farolfi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Edda Simoncini
- Breast Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Adolfo Favaretto
- Medical Oncology Unit, Azienda ULSS2, Marca Trevigiana, Treviso, Italy
| | | | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica Delle Marche, A.O.U. Delle Marche, Ancona, Italy
| | | | - Shari Gelber
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aron Goldhirsch
- International Breast Cancer Study Group, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Olivia Pagani
- Geneva University Hospitals, Lugano University, Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - Karin Ribi
- Quality of Life Office, International Breast Cancer Study Group, a division of ETOP IBCSG Partners Foundation, Bern, Switzerland; Careum School of Health, Part of the Kalaidos University of Applied Sciences, Zurich, Switzerland.
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3
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Duzova US, Duzova M, Altinel B. The effect of sleep quality on attitudes toward death in breast cancer survivors. Support Care Cancer 2024; 32:666. [PMID: 39287817 DOI: 10.1007/s00520-024-08865-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 09/07/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE The aim of this study was to determine the levels of sleep quality and attitudes toward death among breast cancer survivors and to examine the impact of sleep quality on attitudes toward death. METHODS This descriptive and correlational study was conducted with 117 patients who had been treated for breast cancer in radiation oncology. Data were collected using a Demographic Information Form, the Pittsburgh Sleep Quality Index, and the Death Attitude Profile-Revised Scale. RESULTS The mean score for sleep quality among breast cancer survivors was 15.17 ± 3.96, while the mean score for the Death Attitude Profile-Revised was 137.65 ± 30.74. Sleep quality was associated with marital status, place of residence, perception of economic status, presence of social support, time since diagnosis, body mass index, and other factors (p < 0.05). Attitudes toward death were associated with age, educational level, occupation, place of residence, perception of economic status, comorbidity, histopathological stage, chemotherapy status, type of breast surgery, and other factors (p < 0.05). Additionally, a moderately positive correlation was found between sleep quality and attitudes toward death among women undergoing breast cancer treatment (r = 0.368, p < 0.001). It was determined that patients' sleep quality, education status, and comorbidity had a significant effect on attitudes toward death and the variables explained 29.4% of the variance (R2 = 0.294) (p < 0.001). CONCLUSION This study shows that there is a significant relationship between sleep quality and attitudes toward death in cancer patients and that sleep quality affects attitudes toward death. In addition, when evaluating the sleep quality and attitudes toward death of women treated for breast cancer, taking into account their sociodemographic characteristics and treatment characteristics may contribute positively to the recovery process and quality of life.
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Affiliation(s)
- Ulku Saygili Duzova
- Department of Internal Medicine Nursing, Faculty of Nursing, Selcuk University, Konya, Turkey.
| | - Mursel Duzova
- Department of Radiation Oncology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Busra Altinel
- Faculty of Nursing, Public Health Nursing, Selcuk University, Konya, Turkey
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Liu Y, Yin S, Lu G, Du Y. The intersection of the nervous system and breast cancer. Cancer Lett 2024; 598:217132. [PMID: 39059572 DOI: 10.1016/j.canlet.2024.217132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
Breast cancer (BC) represents a paradigm of heterogeneity, manifesting as a spectrum of molecular subtypes with divergent clinical trajectories. It is fundamentally characterized by the aberrant proliferation of malignant cells within breast tissue, a process modulated by a myriad of factors that govern its progression. Recent endeavors outline the interplay between BC and the nervous system, illuminate the complex symbiosis between neural structures and neoplastic cells, and elucidate nerve dependence as a cornerstone of BC progression. This includes the neural modulations on immune response, neurovascular formation, and multisystem interactions. Such insights have unveiled the critical impact of neural elements on tumor dynamics and patient prognosis. This revelation beckons a deeper exploration into the neuro-oncological interface, potentially unlocking novel therapeutic vistas. This review endeavors to delineate the intricate mechanisms between the nervous system and BC, aiming to accentuate the implications and therapeutic strategies of this intersection for tumor evolution and the formulation of innovative therapeutic approaches.
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Affiliation(s)
- Yutong Liu
- Department of Breast Surgery, General Surgery Center, The First Hospital of Jilin University, No.71Xinmin Street, Changchun, Jilin, China
| | - Shiqi Yin
- Anhui University of Science and Technology Affiliated Fengxian Hospital, 6600 Nanfeng Road, Shanghai, China
| | - Guanyu Lu
- Cancer Center, The First Hospital of Jilin University, No.71Xinmin Street, Changchun, Jilin, China
| | - Ye Du
- Department of Breast Surgery, General Surgery Center, The First Hospital of Jilin University, No.71Xinmin Street, Changchun, Jilin, China.
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5
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Yao H, Xiong M, Cheng Y, Zhang Q, Luo Y, Ding X, Zhang C. The relationship among body image, psychological distress, and quality of life in young breast cancer patients: a cross-sectional study. Front Psychol 2024; 15:1411647. [PMID: 39233880 PMCID: PMC11372716 DOI: 10.3389/fpsyg.2024.1411647] [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: 04/03/2024] [Accepted: 07/26/2024] [Indexed: 09/06/2024] Open
Abstract
Purpose The aim of this study is to explore the interrelationships among body image perception, levels of psychological distress, and the quality of life (QOL) experienced by young breast cancer patients. Methods This study analyzed data from 339 young female breast cancer patients aged between 18 and 40 years (mean age was 33.47 years) from August 2023 to February 2024. Data on demographic characteristics, psychological distress, body image, medical coping, and QOL of young breast cancer patients were collected. Psychological distress, body image, medical coping, and QOL were measured using the Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), Body Image Scale (BIS), Medical Coping Modes Questionnaire (MCMQ), and Functional Assessment of Cancer Therapy-Breast (FACT-B), respectively. Multiple regression analysis was conducted to examine factors influencing QOL. Results After adjusting for covariates, significant predictors of QOL in young survivors included psychological distress (β = -3.125; p = 0.002), anxiety and depression (β = -4.31; p < 0.001), cognitive dimension of body image (β = -0.218; p = 0.027), behavioral dimension of body image (β = 0.579; p = 0.047), and confrontational dimension of medical coping (β = -0.124; p = 0.01). Conclusion The findings suggest that higher levels of body image concerns and psychological distress are associated with poorer QOL among young female breast cancer patients. Furthermore, breast cancer patients facing with more positive medical coping strategies predicted a higher QOL.
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Affiliation(s)
- Hongmei Yao
- Nursing Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Meidi Xiong
- Medical Department, Yangtze University, Jingzhou, China
- Nursing Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuping Cheng
- Nursing Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qingyuan Zhang
- Nursing Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying Luo
- Beihu Community Health Service Center, Wuhan, China
| | - Xiegang Ding
- Nursing Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chunhua Zhang
- Nursing Department, Zhongnan Hospital of Wuhan University, Wuhan, China
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Rosenkranz KM, Boughey JC. Locoregional Management of Multiple Ipsilateral Breast Cancers: A Review. Clin Breast Cancer 2024; 24:473-480. [PMID: 38845236 DOI: 10.1016/j.clbc.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/25/2024] [Accepted: 04/16/2024] [Indexed: 07/28/2024]
Abstract
The incidence of preoperatively diagnosed multiple ipsilateral breast cancer (MIBC) is increasing due to improved sensitivity of screening and preoperative staging modalities including digital breast tomosynthesis (3D breast mammography) and magnetic resonance imaging (MRI). The surgical management of MIBC remains controversial. Many surgeons continue to recommend mastectomy due to high local recurrence rates in patients with MIBC undergoing breast conservation therapy reported in historic, retrospective studies. More recent retrospective studies report acceptable rates of local recurrence. Yet concerns persist due to a paucity of prospective data regarding recurrence as well as concerns for margin positivity, cosmetic outcomes and the feasibility of adequate and safe delivery of radiation following breast conserving surgery. Breast conservation has emerged as the preferred surgical strategy for eligible patients with unifocal disease. Benefits include improved quality of life, body image and sexual function and lower surgical complication rates. A recent prospective clinical trial has corroborated a large body of retrospective data confirming the safety of breast conserving therapy and adjuvant radiation in women with MIBC with good oncologic control, low rates of conversion to mastectomy and satisfactory patient-reported cosmetic outcomes. With the current rise in MIBC diagnoses, it is imperative that surgeons understand the existent evidence in order to guide shared decision-making conversations with patients diagnosed with MIBC. This comprehensive review synthesizes the best available data and offers current recommendations for management of both the primary sites of disease as well as management of the axilla in patients with MIBC.
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Affiliation(s)
- Kari M Rosenkranz
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
| | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN
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Zhang Y, Yan J, He H, Zhang L, Chen L, Li N, Li H, Zhang X, Zhang N, Sun S, Zhang B, Zhang M. The trajectories of psychosocial adjustment among young to middle-aged women with breast cancer: A prospective longitudinal study. Eur J Oncol Nurs 2024; 71:102617. [PMID: 38865852 DOI: 10.1016/j.ejon.2024.102617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 05/08/2024] [Accepted: 05/18/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE This study aims to explore heterogeneous trajectories of psychosocial adjustment among young to middle-aged women with breast cancer and determine the predictive factors influencing these trajectories. METHODS This study was conducted from October 2019 to October 2022 across two hospitals in Guangzhou. Demographic and disease characteristics, psychosocial adjustment, self-efficacy, social support, and coping modes were collected at baseline. Follow-up evaluations of psychosocial adjustment occurred at 1, 3, and 6 months post-surgery. Latent class growth modeling identified distinct patterns of psychosocial adjustment trajectories. Logistic regression analysis determined the predictive factors. RESULTS A total of 377 young to middle-aged women with breast cancer participated in this study, with 289 participants completing the 6-month follow-up. Three distinct trajectories of psychosocial adjustment were identified including a "sustained severe maladjustment" trajectory, comprising 22.5% of participants, a "sustained moderate maladjustment" trajectory, comprising 50.4% of participants, and a "well-adjusted class" trajectory, comprising 27.1% of participants. Predictors of psychosocial adjustment trajectories included affected side, surgical type, chemotherapy, self-efficacy, social support, and coping modes. CONCLUSIONS This study revealed three distinct trajectories of psychosocial adjustment among young to middle-aged women with breast cancer. Those with right-sided breast cancer, undergoing total mastectomy, receiving chemotherapy, low self-efficacy, limited social support, and relying on confrontation or avoidance coping modes may experience sustained maladjustment.
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Affiliation(s)
- Yiheng Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jingwen Yan
- Sun Yat-sen memorial hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Haiyan He
- Sun Yat-sen memorial hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lijuan Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lili Chen
- Sun Yat-sen memorial hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Na Li
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Huan Li
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | | | - Ni Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shihao Sun
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Baoyi Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Meifen Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Liu X, Alipour GH, Shao C, Burcu M, Bortnichak E, Vo T, Yu CL. The Comparison of Newly Diagnosed Invasive Breast Patient Cohorts in Genomics Evidence Neoplasia Information Exchange Biopharma Collaborative (GENIE-BPC) and Other Real-World Databases. Pharmacoepidemiol Drug Saf 2024; 33:e5851. [PMID: 39090803 DOI: 10.1002/pds.5851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/09/2024] [Accepted: 05/28/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Oncology databases that integrate genomic and clinical data have become valuable resources for precision medicine. However, the generalizability of these databases has not been comprehensively assessed. OBJECTIVES To describe the demographics, clinical characteristics, treatments, and overall survival of breast cancer cohorts in GENIE-BPC and three other databases. METHODS This study utilized GENIE-BPC, SEER, SEER-Medicare, and Merative MarketScan Research Databases. Women with invasive breast cancer were identified through EHR, cancer registries or ICD-9/10-CM codes. The ages were 18+ years or per database requirement. Treatments were based on EHR or HCPCS/NDC codes in claims. Overall survival was estimated as time from diagnosis to death. RESULTS Of female breast cancer patients in GENIE-BPC (n = 775), SEER (n = 548 336), SEER-Medicare (n = 68 914), and Marketscan (n = 109 499) databases, the median ages at initial diagnosis were 44, 62, 74, and 57 years, respectively. A greater proportion of patients in GENIE-BPC, compared to SEER/SEER-Medicare, had higher nuclear grades (%III-%IV: 57% vs. 26%/24%), advanced disease stage (%IV: 25.3% vs. 5%/3.6%), percent of triple negative breast cancer (19.7% vs. 10.2%/8.5%), and receipt of chemotherapy (85.0% vs. NA/22.3%). The 1-, 3-, and 5-year overall survival rates were lower in GENIE-BPC (78.5%, 60.5%, 55.5%) than in SEER (95.8%, 89.5%, 85.5%) and SEER-Medicare (91.6%, 81.4%, 75.0%). CONCLUSION Breast cancer patients in GENIE-BPC were younger, had more advanced disease, had a higher proportion of triple negative breast cancer and recipients of chemotherapy, and had poorer overall survival. Researchers must use statistical adjustment when extrapolating results (e.g., biomarker prevalence) from GENIE-BPC to the larger breast cancer population.
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Affiliation(s)
- Xinyue Liu
- Epidemiology, Biostatistics and Research Decision Sciences, Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Golnoosh Haris Alipour
- Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Changxia Shao
- Epidemiology, Biostatistics and Research Decision Sciences, Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Mehmet Burcu
- Epidemiology, Biostatistics and Research Decision Sciences, Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Edward Bortnichak
- Epidemiology, Biostatistics and Research Decision Sciences, Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Thao Vo
- Epidemiology, Biostatistics and Research Decision Sciences, Merck & Co., Inc., West Point, Pennsylvania, USA
| | - Chu-Ling Yu
- Epidemiology, Biostatistics and Research Decision Sciences, Merck & Co., Inc., West Point, Pennsylvania, USA
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Redondo-Sáenz D, Solano-López AL, Vílchez-Barboza V. Body image, illness uncertainty and symptom clusters in surgically treated breast cancer survivors: An exploratory factor analysis and correlational study. Eur J Oncol Nurs 2024; 72:102662. [PMID: 39053380 DOI: 10.1016/j.ejon.2024.102662] [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: 06/14/2023] [Revised: 06/19/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To determine the relationship among body image, illness uncertainty, and symptom clusters in surgically treated breast cancer survivors. METHODS A correlational, descriptive study was conducted in a convenience sample of 60 women surgically treated breast cancer survivors recruited in a private hospital and a survivor center. A questionnaire of sociodemographic characteristics, MUIS-C Scale, and QLQ-C30 and Module BR-23 were used. Variable characteristics and associations were analyzed with descriptive statistics and Pearson correlation coefficient, and exploratory factor analysis using unweighted least squares and Promax rotation was used for symptom clustering. RESULTS A three-factor structure was found: an anxiety symptom cluster, a breast symptom cluster, and an arm symptoms, depression, and fatigue symptom cluster, explaining 46,47% of the variance. Significant correlations were found among body image and illness uncertainty (r = -0,390, p < 0,01), body image and the anxiety symptom cluster (r = 0,613, p < 0,01), illness uncertainty and the anxiety symptom cluster (r = -0,421, p < 0,01), the breast symptom cluster (r = -0,425, p < 0,01), and the arm symptoms - depression - fatigue symptom cluster (r = -0,443, p < 0,01). CONCLUSION The relationships among all variables were statistically significant. Nurses providing care to BC survivors need to address the multidimensionality of the symptom experience and its correlates to better assist their patients. Further research is needed to elucidate the biopsychosocial underpinnings of those relationships.
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Affiliation(s)
- Diego Redondo-Sáenz
- School of Nursing, University of Costa Rica, Costa Rica; School of Medicine, University of Costa Rica, Costa Rica.
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Adler JM, Hesse-Biber S, Seven M, Dwyer AA. "Identity theft" in BRCA1/2: impact of positive genetic test results and risk-reducing interventions. Front Genet 2024; 15:1380637. [PMID: 39050256 PMCID: PMC11267581 DOI: 10.3389/fgene.2024.1380637] [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: 02/01/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024] Open
Abstract
Individuals harboring breast cancer gene 1/2 (BRCA1/2) pathogenic variants are at increased lifetime risk for developing cancer. Learning one's BRCA1/2 carrier status is a watershed moment that can result in psychological distress, anxiety, and depression, as well as feelings of vulnerability and stigma. However, emotional and coping responses to learning one's BRCA1/2 carrier status and after risk-reducing interventions (i.e., preventative bilateral mastectomy) are variable, and existing literature reveals mixed and sometimes contradictory results. Drawing on the concept of narrative identity from the field of psychology, we sought to examine if "identity theft" (the sudden overtaking of one's narrative agency by an external force) may help explain the heterogeneity of emotional and coping responses following the revelation of BRCA carrier status and the subsequent medical intervention one may receive. This Perspective explores BRCA related identity theft using two case studies. Narrative analysis of qualitative interviews uncover the ways that patients experience the disintegration (theft) of their identity as well as their efforts to build and reintegrate a new BRCA carrier identity. This initial qualitative exploration provides preliminary support for the relevance of narrative identity and identity theft to hereditary cancer. We posit that applying the lens of identity theft may hold promise as a unifying concept, integrating across the variable emotional and coping responses among BRCA carriers. Employing a lens of identity theft may help inform the development of tailored narrative interventions as part of precision healthcare to support active coping and psychosocial wellbeing.
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Affiliation(s)
- Jonathan M. Adler
- Department of Psychology, Olin College of Engineering, Needham, MA, United States
| | | | - Memnun Seven
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
| | - Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
- P50 Massachusetts General Hospital–Harvard Center for Reproductive Medicine, Boston, MA, United States
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Rosenberg SM, Zheng Y, Ruddy K, Poorvu PD, Snow C, Kirkner GJ, Meyer ME, Tamimi RM, Schapira L, Peppercorn J, Come S, Borges VF, Warner E, Gelber S, Collins L, Winer EP, Partridge AH. Helping ourselves, helping others: the Young Women's Breast Cancer Study (YWS) - a multisite prospective cohort study to advance the understanding of breast cancer diagnosed in women aged 40 years and younger. BMJ Open 2024; 14:e081157. [PMID: 38951008 PMCID: PMC11218027 DOI: 10.1136/bmjopen-2023-081157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/29/2024] [Indexed: 07/03/2024] Open
Abstract
PURPOSE Compared with older women diagnosed with breast cancer, younger women are more likely to die of breast cancer and more likely to suffer psychosocially in both the short-term and long term. The Young Women's Breast Cancer Study (YWS) is a multisite prospective cohort study established to address gaps in our knowledge about this vulnerable and understudied population. PARTICIPANTS The YWS enrolled 1302 women newly diagnosed with stages 0-IV breast cancer at age 40 years or younger at 13 academic and community sites in North America between 2006 and 2016. Longitudinal patient-reported outcome data are complemented by clinical data abstraction and biospecimen collection at multiple timepoints. FINDINGS TO DATE Key findings related to fertility include that nearly 40% of participants were interested in pregnancy following diagnosis; of those who reported interest, 10% pursued fertility preservation. Overall, approximately 10% of YWS participants became pregnant in the first 5 years after diagnosis; follow-up is ongoing for pregnancies after 5 years. Studies focused on psychosocial outcomes have characterised quality of life, post-traumatic stress and fear of recurrence, with findings detailing the factors associated with the substantial psychosocial burden many young women face during and following active treatment. Multiple studies have leveraged YWS biospecimens, including whole-exome sequencing of tumour analyses that revealed that select somatic alterations occur at different frequencies in young (age≤35) versus older women with luminal A breast cancer, and a study that explored clonal hematopoiesis of indeterminate potential found it to be rare in young survivors. FUTURE PLANS With a median follow-up of approximately 10 years, the cohort is just maturing for many relevant long-term outcomes and provides outstanding opportunities to further study and build collaborations to address gaps in our knowledge, with the ultimate objective to improve care and outcomes for young women with breast cancer. TRIAL REGISTRATION NUMBER NCT01468246.
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Affiliation(s)
- Shoshana M Rosenberg
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Yue Zheng
- Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kathryn Ruddy
- Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip D Poorvu
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Craig Snow
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gregory J Kirkner
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Meghan E Meyer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rulla M Tamimi
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Lidia Schapira
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, California, USA
| | - Jeffrey Peppercorn
- Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steven Come
- Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Virginia F Borges
- Medical Oncology, University of Colorado Denver, Denver, Colorado, USA
| | - Ellen Warner
- Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Shari Gelber
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Laura Collins
- Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Eric P Winer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Yale University Yale Cancer Center, New Haven, Connecticut, USA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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12
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Liu X, Ma Z, Chu H, Nie W, Sun G, Zhao K, Zou X. Long-term oncologic outcomes following breast cancer surgery in adolescents and young adults: a single-center retrospective analysis. Front Oncol 2024; 14:1364608. [PMID: 38978734 PMCID: PMC11228172 DOI: 10.3389/fonc.2024.1364608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/28/2024] [Indexed: 07/10/2024] Open
Abstract
Background Breast cancer (BC) in adolescents and young adults (AYAs, aged 15-39 years), remains inadequately understood. The incidence of BC in AYAs has been steadily increasing, making it the second leading cause of cancer-related mortality among females aged 0-39 globally. This study aimed to elucidate the clinical characteristics and long-term outcomes of AYAs and older adults (OAs, aged > 39 years) with BC who underwent surgery. Methods From January 2011 to June 2017, BC patients who underwent surgery were enrolled in this study and divided into AYA group and OA group. Clinical characteristics, recurrence-free survival (RFS), and overall survival (OS) were compared between these two groups, both before and after propensity score matching (PSM). Univariate and multivariate Cox proportional hazard regression analyses were performed to assess the influence of age on OS and RFS. Results Compared to the OA group, the AYA group exhibited a younger age at menarche (p < 0.001), a lower prevalence of menopausal status (p < 0.001), a reduced occurrence of comorbid conditions (p < 0.001), fewer instances of undergoing mastectomy (p = 0.031), a higher incidence of Triple-Negative Breast Cancer (TNBC) (p = 0.046), and elevated Ki-67 levels (p = 0.036). In terms of prognostic outcomes, within the study cohort, AYAs had a higher mortality rate and poorer long-term survival compared to OAs, both before and after PSM. In the PSM cohort, AYAs experienced a significantly shorter median OS (p < 0.001) and RFS (p < 0.001). Young age (15-39 years) emerged as an independent risk factor for OS (HR 2.659, 95% CI 1.385-5.106, p = 0.003) and RFS (HR 3.235, 95% CI 2.085-5.022, p < 0.001) in BC patients following surgery. Conclusion Significant differences were identified in the clinicopathological characteristics between AYA and OA patients with BC. In comparison to OA patients, AYA patients exhibited a less favorable long-term prognosis, with young age emerging as an independent prognostic risk factor for both OS and RFS in BC patients following surgery. Further investigations are warranted to develop age-specific therapeutic approaches for AYA BC patients.
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Affiliation(s)
- Xin Liu
- Qingdao Medical College, Qingdao University, Qingdao, China
| | - Zengyan Ma
- Department of Pathology, Qingdao Central Hospital, Qingdao, China
| | - Hongwu Chu
- Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Weihong Nie
- Qingdao Medical College, Qingdao University, Qingdao, China
| | - Guoxin Sun
- Qingdao Medical College, Qingdao University, Qingdao, China
| | - Kaihua Zhao
- Department of Breast Surgery, Qingdao Central Hospital, Qingdao, China
| | - Xiao Zou
- Department of Breast Surgery, Xiangdong Hospital Affiliated to Hunan Normal University, Liling, China
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13
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Myers SP, Laws A, Dominici LS, Lagendijk M, Grossmith S, Mittendorf EA, King TA. Arm morbidity and financial difficulty in breast cancer survivors. J Cancer Surviv 2024:10.1007/s11764-024-01628-w. [PMID: 38896173 DOI: 10.1007/s11764-024-01628-w] [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: 05/20/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Long-term upper extremity symptoms after breast cancer treatment may impact patient-reported financial difficulty. In this cross-sectional investigation, we hypothesized that severity of arm symptoms would be associated with greater financial difficulty. METHODS Stage 0-III breast cancer patients treated at our institution from 2002 to 2012 were recruited for a 2018 survey study appraising disease-specific patient-centered outcomes using EORTC-QLQ-BR23 and EORTC-QLQ-C30 questionnaires. The association between Arm Symptom (AS) score and Financial Impact (FI) score was assessed, adjusting for clinically relevant variables. RESULTS Of 1126 interested participants, 882 (78%) responded to surveys. Three hundred fourteen (36%) with incomplete responses were excluded. Median time from surgery was 9 years; 181 (32%) and 117 (21%) had mastectomy with or without reconstruction, 126 (22%) received postmastectomy radiation (PMRT), and 221 (39%) underwent axillary lymph node dissection. 76 (13%) reported some degree of financial difficulty; 10 (2%) the highest degree of difficulty. Of 217 (38%) patients experiencing arm symptoms, 60 (28%) had severe symptoms. Seven (70%) of those with highest degree of financial difficulty had severe arm symptoms. Younger age at surgery (p = .029), mastectomy with reconstruction (p = 0.003), Hispanic ethnicity (p < 0.001), PMRT (p = 0.027), recurrence (p < 0.001), and higher AS score (p < 0.001) were associated with greater financial difficulty. On multivariable analysis, AS score, younger age, Hispanic ethnicity, and recurrence remained associated with financial difficulty. CONCLUSION In this study, younger age, Hispanic ethnicity, and arm morbidity were associated with increased risk for financial difficulty. Clarifying how treatment-related adverse events such as arm morbidity increase financial hardship may guide interventions to mitigate this burden.
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Affiliation(s)
- Sara P Myers
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, 450 Brookline Ave, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Alison Laws
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, 450 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Division of General Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Laura S Dominici
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, 450 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Mirelle Lagendijk
- Department of Surgery, Erasmus Medical Center, Rotterdam, NL, Netherlands
| | - Samantha Grossmith
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, 450 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, 450 Brookline Ave, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
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14
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Vuong B, Jacinto AI, Chang SB, Kuehner GE, Savitz AC. Contemporary Review of the Management and Treatment of Young Breast Cancer Patients. Clin Breast Cancer 2024:S1526-8209(24)00148-4. [PMID: 38972829 DOI: 10.1016/j.clbc.2024.06.001] [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: 12/15/2023] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024]
Abstract
Approximately 11% of all new breast cancer cases annually are diagnosed in young women, and this continues to be the leading cause of death in women age 20 to 49. Young, premenopausal breast cancer patients present with more advanced stages and with a higher proportion of aggressive subtypes such as triple negative and HER2-enriched tumors. Recently, the United States Preventive Services Task Force (USPSTF) lowered the age threshold to initiate screening mammograms to age 40 to aid in earlier detection. Young age at diagnosis increases the likelihood for a pathogenic mutation, and genetic testing is recommended for all patients age 50 and younger. This population is often underrepresented in landmark clinical trials, and data is extrapolated for the treatment of young women with breast cancer. Despite there being no survival benefit to more extensive surgical treatments, such as mastectomy or contralateral prophylactic mastectomy, many patients opt against breast conservation. Young patients with breast cancer face issues related to treatment toxicities, potential overtreatment of their disease, mental health, sexual health, and fertility preservation. This unique population requires a multidisciplinary care team of physicians, surgeons, genetic counselors, fertility specialists, mental health professionals, physical therapists, and dieticians to provide individualized, comprehensive care. Our aim is to (1) provide a narrative review of retrospective studies, relevant society guidelines, and clinical trials focused on the contemporary treatment and management of YBC patients and (2) discuss important nuances in their care as a guide for members of their multidisciplinary treatment team.
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Affiliation(s)
- Brooke Vuong
- Department of Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA.
| | - Ana I Jacinto
- Department of Surgery, University of California, Davis, Sacramento, CA
| | - Sharon B Chang
- Department of Surgery, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA
| | - Gillian E Kuehner
- Department of Surgery, Kaiser Permanente Vallejo Medical Center, Vallejo, CA
| | - Alison C Savitz
- Department of Surgery, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA
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15
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Jiang L, Xu J, Wu Y, Liu Y, Wang X, Hu Y. Effects of the "AI-TA" Mobile App With Intelligent Design on Psychological and Related Symptoms of Young Survivors of Breast Cancer: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e50783. [PMID: 38833298 PMCID: PMC11185911 DOI: 10.2196/50783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/28/2024] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Young women often face substantial psychological challenges in the initial years following cancer diagnosis, leading to a comparatively lower quality of life than older survivors. While mobile apps have emerged as potential interventions, their effectiveness remains inconclusive due to the diversity in intervention types and variation in follow-up periods. Furthermore, there is a particular dearth of evidence regarding the efficacy of these apps' intelligent features in addressing psychological distress with these apps. OBJECTIVE This study aims to evaluate the effectiveness of a mobile app with intelligent design called "AI-TA" on cancer-related psychological health and ongoing symptoms with a randomized controlled design. METHODS Women aged 18 to 45 years diagnosed with breast cancer were randomly assigned to the intervention or control group. The intervention was AI-TA, which included 2-way web-based follow-up every 2 weeks. Both intention-to-treat (ITT) and per-protocol (PP) analyses employed repeated measurement analysis of variance. The participants' background features, primary outcomes (psychological distress and frequency, self-efficacy, and social support), and secondary outcomes (quality of life) were measured using multiple instruments at 3 time points (baseline, 1-month intervention, and 3-month intervention). RESULTS A total of 124 participants were randomly allocated to the control group (n=62, 50%) or intervention group (n=62, 50%). In total, 92.7% (115/124) of the participants completed the intervention. Significant improvements in psychological symptoms (Memorial Symptom Assessment Scale-Short Form) were observed in the ITT group from baseline to 1-month intervention relative to the control group (ITT vs control: 1.17 vs 1.23; P<.001), which persisted at 3-month follow-up (ITT vs control: 0.68 vs 0.91; P<.001). Both the ITT and PP groups exhibited greater improvements in self-efficacy (Cancer Behavior Inventory-Brief Version) than the control group at 1-month (ITT vs PP vs control: 82.83 vs 77.12 vs 65.35; P<.001) and 3-month intervention (ITT vs PP vs control: 92.83 vs 89.30 vs 85.65; P<.001). However, the change in social support (Social Support Rating Scale) did not increase significantly until 3-month intervention (ITT vs control: 50.09 vs 45.10; P=.002) (PP vs control: 49.78 vs 45.10; P<.001). All groups also experienced beneficial effects on quality of life (Functional Assessment of Cancer Therapy-Breast), which persisted at 3-month follow-up (P<.001). CONCLUSIONS The intelligent mobile app AI-TA incorporating intelligent design shows promise for reducing psychological and cancer-related symptoms among young survivors of breast cancer. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200058823; https://www.chictr.org.cn/showproj.html?proj=151195.
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Affiliation(s)
- Lulu Jiang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jiehui Xu
- Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanwei Wu
- Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanyan Liu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Xiyi Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Yun Hu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
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16
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Ma T, Ma T, Wang L, Wang H. Neoadjuvant Chemotherapy Is Effective in Those Infected With SARS-CoV-2: The Real-World Experience of a Large Chinese Breast Cancer Center. J Breast Cancer 2024; 27:176-186. [PMID: 38769687 PMCID: PMC11221209 DOI: 10.4048/jbc.2023.0299] [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: 12/27/2023] [Revised: 02/27/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE During the major shift in China's policies on coronavirus disease 2019 (COVID-19), many residents will be infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) over a short period, including a few patients with breast cancer undergoing neoadjuvant chemotherapy (NAC). Moreover, it is unknown whether this comorbidity affects the efficacy of NAC for breast cancer and the patient's psychological state and quality of life (QOL). This study aims to answer these questions. METHODS The clinical data of 2,793 patients with breast cancer who received NAC at The Affiliated Hospital of Qingdao University were retrospectively collected. The infected and non-infected groups were divided according to whether they were infected with COVID-19 during NAC. Propensity score matching was used to reduce patient selection bias. The effectiveness, psychological well-being, and QOL of the two groups were compared. RESULTS No discernible differences were observed in the pathological complete response rates (p = 0.307) and major histological responses rate (p = 0.398) between the infected and non-infected groups. Following the full course of NAC, the Functional Assessment of Cancer Treatment General (p < 0.001) and Functional Assessment of Cancer Therapy for Breast Cancer (p < 0.001) were lower in the infected group than the non-infected group, the Hospital Anxiety and Depression Scale (HADS) anxiety scale (p < 0.001) and HADS depression scale (p < 0.001) were considerably higher in the infected group than the non-infected group. CONCLUSION With timely treatment and effective medical management, SARS-CoV-2 does not appear to affect the efficacy of NAC; however, it can significantly affect the QOL of patients and increase their psychological distress. Therefore, in addition to a timely assessment of the efficacy of NAC, it is necessary to dynamically understand the patient's psychological state and QOL.
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Affiliation(s)
- Teng Ma
- Breast Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tianyi Ma
- Breast Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lulu Wang
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haibo Wang
- Breast Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China.
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17
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Wang X, Wang X, Cai L, Zhang C, Li Y. Clinical characteristics and prognostic analysis of metachronous bilateral breast carcinoma: a retrospective study based on propensity score matching. Clin Transl Oncol 2024:10.1007/s12094-024-03528-y. [PMID: 38801511 DOI: 10.1007/s12094-024-03528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND To investigate clinical characteristics, treatment, outcomes, and prognostic risk factors of metachronous bilateral breast carcinoma (MBBC) and provide a theoretical basis for clinical management of MBBC. METHODS This was a retrospective study. From January 1, 2010 to March 31, 2022, a total of 23,010 patients with breast cancer underwent surgical treatment at the Breast Center of the Fourth Hospital of Hebei Medical University, including 386 patients with MBBC. Propensity score matching (PSM) was performed on MBBC patients and unilateral breast cancer (UBC) patients in a 1:1 ratio, and 210 UBC patients and 210 MBBC patients were finally matched. Clinical medical records of all patients were collected, including age of onset, family history of breast cancer, tumor size, lymph node status, TNM stage, mode of surgery, menstruation, pathological type, immunohistochemical (IHC) typing, treatment, disease-free survival (DFS), and overall survival (OS). RESULTS The result showed that age of onset of the second primary cancer (SPC) was significantly older than that of the first primary cancer (FPC) (P = 0.024). Baseline data from MPPC patients showed that the tumor size of FPC was significantly larger than that of SPC (P = 0.043), and the proportion of PR ( +) in FPC is significantly higher than that in SPC (P = 0.045). Among MBBC patients with FPC for estrogen receptor (ER) or progesterone receptor (PR) ( +) and Her-2 (-), clinical characteristics and treatment results showed that the proportion of PR ( +) in the drug-resistant group was significantly lower than that in the non-drug-resistant group. The 2-year OS rate of SPC in the drug-resistant group was significantly shorter than those of the non-drug-resistant group (78.9% vs 100%, P < 0.05). The result of PSM-based comparison between MBBC patients and UBC patients showed significantly lower proportion of MBBC patients with SPC received chemotherapy compared to UBC patients (P = 0.026), and there was no significant difference in OS and DFS between SPC course of MBBC patients and UBC patients (P > 0.05). The univariate analysis showed that high TNM stage was a risk factor for death and disease progression in MBBC patients, with the risk of death in stage III MBBC patients being about 5 times higher than that in stage I MBBC patients (HR = 4.97, 95%CI = 1.42-17.31, P = 0.012), and the risk of disease recurrence being about 3.5 times higher than that in stage I MBBC patients (HR = 3.55, 95%CI = 1.07-11.81, P = 0.039). CONCLUSION In summary, this study presented clinical characteristics, treatment options, and outcomes of MBBC patients and patients with MBBC who were resistant to endocrine therapy have a worse SPC survival prognosis. The course of SPC in MBBC patients was similar to that of UBC in terms of prognosis and survival, which suggested that SPC can be treated according to UBC treatment regimen. High TNM stage was a prognostic risk factor for SPC patients.
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Affiliation(s)
- Xinle Wang
- Breast Disease Diagnosis and Treatment Center, The Fourth Hospital of Hebei Medical University, No. 169 Tianshan Avenue, ShijiazhuangShijiazhuang, 050011, Hebei, China
| | - Xinrui Wang
- Breast Disease Diagnosis and Treatment Center, The Fourth Hospital of Hebei Medical University, No. 169 Tianshan Avenue, ShijiazhuangShijiazhuang, 050011, Hebei, China
| | - Lijing Cai
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Cong Zhang
- Scientific Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuntao Li
- Breast Disease Diagnosis and Treatment Center, The Fourth Hospital of Hebei Medical University, No. 169 Tianshan Avenue, ShijiazhuangShijiazhuang, 050011, Hebei, China.
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18
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Carretti G, Dabraio A, Manetti M, Marini M. Biofeedback-Based Proprioceptive Training to Improve Functional Prerequisites of Dragon Boating in Breast Cancer Survivors. Eur J Investig Health Psychol Educ 2024; 14:1351-1368. [PMID: 38785587 PMCID: PMC11120340 DOI: 10.3390/ejihpe14050089] [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: 03/28/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Breast cancer (BC)-related sequelae drastically impact the psychophysical functioning and quality of life of affected women. Adapted physical activity (APA) has proved to effectively counteract these impairments in a non-medicalized framework. In particular, dragon boats are able to promote body functionality, social interaction, and quality of life in BC survivors, but the literature on specific motor gestures is scarce and practice is still based more on a re-educative perspective than a performative one. In this context, the present longitudinal study investigated the benefits of an adapted biofeedback-based sensorimotor training intervention on upper body functionality in a team of dragon ladies. The 8-week intervention was conceived as integrated dry workout sessions led by an APA kinesiologist and applied a novel sensorized proprioceptive device, such as a Libra board. Post-protocol evaluation revealed a significant improvement in bilateral upper limb mobility, core endurance, and trunk stability along with a distress decrease and quality of life enhancement through validated assessment tools. Our findings suggest that integrating biofeedback-based workout sessions can effectively promote upper body functionality in BC survivors practicing dragon boating. Furthermore, our innovative approach could help spread methodological hints able to boost exercise adherence in this target population, thus counteracting cancer recurrence while promoting overall well-being.
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Affiliation(s)
| | | | | | - Mirca Marini
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, University of Florence, 50134 Florence, Italy; (G.C.); (A.D.); (M.M.)
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19
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Torras I, Cebrecos I, Castillo H, Mension E. Evolution of breast conserving surgery-current implementation of oncoplastic techniques in breast conserving surgery: a literature review. Gland Surg 2024; 13:412-425. [PMID: 38601289 PMCID: PMC11002492 DOI: 10.21037/gs-23-454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/18/2024] [Indexed: 04/12/2024]
Abstract
Background and Objective De-escalation in breast cancer surgery has been a natural evolution since breast conserving surgery (BCS) was introduced in the early 1980s. From Halsted mastectomies to wide local excisions, we are facing nowadays the next trend in form of oncoplastic breast surgery. Oncoplastic breast surgery combines oncological principles with plastic surgery techniques to preserve the breast shape and appearance. The aim of this work is to review recent oncological and quality of live outcomes derived from oncoplastic techniques as well as offer a perspective about its implementation in breast cancer units. Methods A literature review was conducted to explore the landscape of oncoplastic breast surgery. Key terms related to oncoplastic techniques and breast cancer were used in searches across databases such as PubMed, Embase and Cochrane Library. Inclusion criteria focused on recent articles discussing oncological and quality of life (QoL) outcomes, as well as perspectives on the role of oncoplastic surgery. Key Content and Findings The research aims to contribute valuable insights into the efficacy and impact of oncoplastic surgery in the context of breast cancer treatment. In this new era of precision medicine, it is more than just healing patients; it is about improving their well-being. We ought to consider specific oncoplasty role in leading this paradigm shift. It is also relevant to define whether these new technical-demanding surgical options can be applied to all patients and if professional training performs adequately to current demands of personalized treatments. Conclusions The global adoption of oncoplastic BCS is recommended due to its oncological safety and improvement in QoL compared to standard procedures. Emphasizing the need for skilled surgeons in complex cases, collaboration between breast surgeons and scientific societies is urged to certify ongoing educational training in oncoplastic techniques.
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Affiliation(s)
| | | | - Helena Castillo
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Eduard Mension
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, Barcelona, Spain
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20
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Tsutsumi T, Nakagomi D, Kobayashi K, Hanai S, Kobayashi Y, Ito R, Ishii T, Okuma H, Uchinuma H, Ichijo M, Tsuchiya K. Moon-like Facies by Glucocorticoid Is Associated With the Development of Diabetes and Body Image Disturbance. J Endocr Soc 2024; 8:bvae036. [PMID: 38481602 PMCID: PMC10928504 DOI: 10.1210/jendso/bvae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 04/07/2024] Open
Abstract
Context Moon-like facies (MLF) are a typical side effect of glucocorticoid (GC) therapy; however, its predisposing factors, relationship with GC-induced complications, and effects on body image are not well understood. Objective This study aimed to determine the predisposing factors for MLF during GC therapy; its association with GC-induced diabetes, hypertension, and dyslipidemia; and its effects on body image. Methods This prospective observational study spanned 24 weeks and targeted patients who received GC therapy at the University of Yamanashi Hospital from June 2020 to August 2022. The MLF was defined based on the following 3 factors: (1) an increase in facial measurement lengths, (2) subjective facial changes by patients' self-assessment using a visual analog scale; (3) objective and qualitative facial changes assessed by physicians. We examined the predisposing factors for MLF and the association of MLF with GC-induced diabetes, hypertension, dyslipidemia, and body image. Results The cumulative incidence rate of MLF at 24 weeks was 37.6%. Predisposing factors for MLF were an initial oral prednisolone dosage of ≥ 30 mg/day [odds ratio (OR) 63.91, 95% confidence interval (CI) 5.82-701.81] and female (OR 6.66, 95% CI 1.35-32.79). MLF showed a significant association with the onset of GC-induced diabetes (OR 6.58, 95% CI 1.25-34.74). MLF was also an independent factor contributing to body image disturbance (β = -18.94, P = .01). Conclusion MLF contributes to body image disturbance and is associated with the development of GC-induced diabetes; therefore, it is clinically important as a physical manifestation of GC therapy.
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Affiliation(s)
- Takahiro Tsutsumi
- Department of Diabetes and Endocrinology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Daiki Nakagomi
- Department of Rheumatology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Kei Kobayashi
- Department of Rheumatology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Shunichiro Hanai
- Department of Rheumatology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Yoshiaki Kobayashi
- Department of Rheumatology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Ryosuke Ito
- Department of Rheumatology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Toshihisa Ishii
- Department of Nephrology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Hideyuki Okuma
- Department of Diabetes and Endocrinology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Hiroyuki Uchinuma
- Department of Diabetes and Endocrinology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Masashi Ichijo
- Department of Diabetes and Endocrinology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Kyoichiro Tsuchiya
- Department of Diabetes and Endocrinology, Graduate School of Interdisciplinary Research, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
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21
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Laws A, Lagendijk M, Grossmith S, Hughes M, Lin NU, Mittendorf EA, Eliassen AH, King TA, Dominici LS. Long-Term Patient-Reported Arm Symptoms in Breast Cancer Survivors. Ann Surg Oncol 2024; 31:1623-1633. [PMID: 38071708 DOI: 10.1245/s10434-023-14711-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/19/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Understanding long-term arm symptoms in breast cancer survivors is critical given excellent survival in the modern era. METHODS This cross-sectional study included patients treated for stage 0-III breast cancer at our institution from 2002 to 2012. Patient-reported arm symptoms were collected from the EORTC QLQ-BR23 questionnaire. We used linear regression to evaluate adjusted associations between locoregional treatments and the continuous Arm Symptom (AS) score (0-100; higher score reflects more symptoms). RESULTS A total of 1126 patients expressed interest in participating and 882 (78.3%) completed the questionnaire. Mean time since surgery was 10.5 years. There was a broad distribution of locoregional treatments, including axillary lymph node dissection (ALND) in 37.1% of patients, mastectomy with reconstruction in 36.5% of patients, and post-mastectomy radiation in 38.2% of patients. Overall, 64.3% (95% confidence interval [CI] 61.1-67.4%) of patients reported no arm symptoms, 17.0% (95% CI 14.7-19.6%) had one mild symptom, 9.4% (95% CI 7.7-11.5%) had two or more mild symptoms, and 9.3% (95% CI 7.6-11.4%) reported one or more severe symptoms. Adjusted AS scores were significantly higher with ALND versus sentinel node biopsy (β 3.5, p = 0.01), and with autologous reconstruction versus all other breast/reconstructive surgery types (β 4.5-5.5, all p < 0.05). There was a significant interaction between axillary and breast/reconstructive surgery, with the greatest effect of ALND in those with mastectomy with implant (β 9.7) or autologous (β 5.7) reconstruction. CONCLUSIONS One in three patients reported arm symptoms at a mean of 10 years from treatment for breast cancer, although rates of severe symptoms were low (<10%). Attention is warranted to the arm morbidity related to both axillary and breast surgery during treatment counseling and survivorship.
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Affiliation(s)
- Alison Laws
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mirelle Lagendijk
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Samantha Grossmith
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Melissa Hughes
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Nancy U Lin
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura S Dominici
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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22
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Mustață LM, Peltecu G, Gică N, Botezatu R, Iancu G, Gheoca GD, Cigăran R, Iordăchescu DA. Evaluation of quality of life and socio-emotional impact of oncological treatment among patients with breast cancer. J Med Life 2024; 17:341-352. [PMID: 39044938 PMCID: PMC11262597 DOI: 10.25122/jml-2024-0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 07/25/2024] Open
Abstract
Breast cancer is the most frequent cancer in women worldwide. Quality of life (QoL) is significantly affected by both surgical and oncological treatment. The aim of this study was to assess and compare QoL, resilience and depression scores among women who had breast cancer treatment. We assessed 170 patients diagnosed with breast cancer in a non-experimental, descriptive study through anonymized questionnaires from January to March 2024. Patients were invited to fill in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Breast Cancer Module (EORTC QLQ-BR23) questionnaire, the Depression Anxiety Stress Scale, the CD-RISC 10 questionnaire, and the MOS Social Support Survey. Clinical information and demographical data were obtained and statistical analysis was conducted to evaluate factors that affect QoL, resilience and depression scores. QoL was significantly influenced by chemotherapy and surgery. Women with higher resilience scores had lower anxiety and depression scores and reported a better QoL. Women with strong social support and high resilience reported a better QoL during and after breast cancer treatment. The results of our study show that breast cancer surgery and chemotherapy have an important impact on patients' QoL. Moreover, the results reflect the importance of both medical treatment and social support as resilience-building strategies in managing and improving the QoL of patients.
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Affiliation(s)
| | - Gheorghe Peltecu
- Department of Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Nicolae Gică
- Department of Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Radu Botezatu
- Department of Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - George Iancu
- Department of Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Ruxandra Cigăran
- Department of Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
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23
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Huang D, Yang L, Peng N, Wang R. Effect of systemic family psychotherapy on quality of life in patients undergoing postoperative chemotherapy for breast cancer. Asian J Surg 2024; 47:1113-1114. [PMID: 38036370 DOI: 10.1016/j.asjsur.2023.10.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Dan Huang
- Department of Cadres Health Care, Jingmen Central Hospital, 168 Xiangshan Avenue, Jingmen, 448001, China.
| | - Lixia Yang
- Department of Clinical Psychology, Jingmen Central Hospital, 168 Xiangshan Avenue, Jingmen, 448001, China.
| | - Na Peng
- Department of Cadres Health Care, Jingmen Central Hospital, 168 Xiangshan Avenue, Jingmen, 448001, China.
| | - Rui Wang
- Department of Oncology, Jingmen Central Hospital, 168 Xiangshan Avenue, Jingmen, 448001, China.
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24
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Griffin C, Fairhurst K, Stables I, Brunsden S, Potter S. Outcomes of Women Undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry: A Systematic Review. Ann Surg Oncol 2024; 31:303-315. [PMID: 37749407 PMCID: PMC10695874 DOI: 10.1245/s10434-023-14294-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/29/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Breast reconstruction (BR) is routinely offered to restore symmetry after mastectomy for breast cancer. Not all women, however, may want reconstructive surgery. A contralateral mastectomy (CM) to achieve "flat symmetry" can be an excellent alternative, but surgeons are often reluctant to offer this procedure. This systematic review aimed to summarize the available evidence regarding the outcomes of CM as the first step to developing guidelines in this area. METHODS PubMed, MEDLINE, CINAHL and PsycINFO were searched to identify primary research studies, published in English between 1 January 2000 and 30 August 2022, evaluating clinical or patient-reported outcomes for women who underwent a CM without reconstruction after a mastectomy for unilateral breast cancer. Simple descriptive statistics summarized quantitative data, and content analysis was used for qualitative data. RESULTS The study included 15 studies (13 quantitative, 1 qualitative, and 1 mixed-methods) evaluating outcomes for at least 1954 women who underwent a bilateral mastectomy without reconstruction (BM) after unilateral breast cancer. The risk of surgical complications after BM was higher than after unilateral mastectomy without reconstruction (UM) but significantly less than after BR. Satisfaction with the decision for BM was high in all the studies. Key themes relating to flat denial, stigma, and gender-based assumptions were identified. CONCLUSION Women electing to undergo BM reported high levels of satisfaction with their decision and complication rates similar to those for UM. Further study is needed to comprehensively explore the outcomes for women seeking BM, but these data should give surgeons confidence to offer the procedure as an alternative option for symmetry after unilateral mastectomy for breast cancer. REGISTRATION This systematic review was prospectively registered on the PROSPERO database (CRD42022353689).
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Affiliation(s)
- Cora Griffin
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Imogen Stables
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Shelley Potter
- Bristol Medical School, University of Bristol, Bristol, UK.
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK.
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25
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Liu S, Huang R, Li A, Yu S, Yao S, Xu J, Tang L, Li W, Gan C, Cheng H. Effects of the CALM intervention on resilience in Chinese patients with early breast cancer: a randomized trial. J Cancer Res Clin Oncol 2023; 149:18005-18021. [PMID: 37980293 DOI: 10.1007/s00432-023-05498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE Resilience is an important regulating factor for anxiety and depression in breast cancer. The Managing Cancer and Living Meaningfully (CALM) intervention has been confirmed to improve anxiety and depression in patients, but the role of resilience is still unclear. This study explores this issue. METHODS In this study, a cohort of 124 patients diagnosed with breast cancer was recruited and randomly assigned to either the intervention group (IG) or the control group (CG). In addition, we enrolled a group of cancer-free women (regular control group) and assessed their resilience. All patients were evaluated using the Connor-Davidson Resilience Scale (CD-RISC), Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy (FACT-B) and Perceived Stress Scale (PSS) at different time points. The primary outcomes were resilience, quality of life, anxiety, depression, and perceived stress. A repeated measures ANOVA was used to compare the scores of the IG and CG groups. The relationship between resilience and quality of life was analyzed using Pearson's correlation test. The paired-sample t-test was used to compare the changes in each score at different time points. RESULTS The intervention group showed significant differences in resilience, adamancy, optimism, tenacity, anxiety, depression, perceived stress and QOL scores before and after 6, 12, and 24 weeks (F = 17.411, F = 226.55, F = 29.096, F = 50.67, F = 82.662, F = 105.39, F = 62.66, F = 72.43, F = 34.561, respectively; P < 0.001). Compared to the control group, the intervention group demonstrated significant improvement in resilience and quality of life (t = -11.517, p < 0.001; t = - 4.929, p < 0.001), as well as a significant reduction in anxiety, depression, and perceived stress scores (t = 5.891, p < 0.001; t = 2.654, p < 0.001; t = 4.932, p < 0.001). In the intervention group, a significant positive correlation was observed between resilience in breast cancer survivors and quality of life (QOL) scores. (before CALM treatment: r = 0.3204, P = 0.0111; after 6 weeks: r = 0.3619, P = 0.0038; after 12 weeks: r = 0.3355, P = 0.0077; after 24 weeks: r = 0.2801, P = 0.0274). CONCLUSIONS A positive impact of the CALM intervention can be seen in improved resilience and reduced anxiety and depression, supporting its use as an effective psychological management tool and intervention strategy in the early stages of long-term breast cancer recovery.
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Affiliation(s)
- Shaochun Liu
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Runze Huang
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Anlong Li
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Sheng Yu
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Senbang Yao
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Jian Xu
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Lingxue Tang
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Wen Li
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Chen Gan
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China
| | - Huaidong Cheng
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, Anhui, China.
- Shenzhen Clinical Medical School of Southern Medical University, Guangzhou, China.
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China.
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26
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Diao K, Lei X, He W, Jagsi R, Giordano SH, Smith GL, Caudle A, Shen Y, Peterson SK, Smith BD. Patient-reported Quality of Life After Breast-conserving Surgery With Radiotherapy Versus Mastectomy and Reconstruction. Ann Surg 2023; 278:e1096-e1102. [PMID: 37232937 PMCID: PMC10592600 DOI: 10.1097/sla.0000000000005920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To compare long-term quality of life (QOL) outcomes in breast cancer survivors who received breast-conserving surgery with radiotherapy (BCS+RT) with those who received a mastectomy and reconstructive surgery (Mast+Recon) without radiotherapy and identify other important factors. BACKGROUND The long-term differences in patient-reported QOL outcomes following BCS+RT and Mast+Recon are not well understood. METHODS We identified patients from the Texas Cancer Registry with stage 0-II breast cancer diagnosed in 2009-2014 after BCS+RT or Mast+Recon without radiotherapy. Sampling was stratified by age and race and ethnicity. A paper survey was sent to 4800 patients which included validated BREAST-Q and PROMIS modules. Multivariable linear regression models were implemented for each outcome. Minimal clinically important difference for BREAST-Q and PROMIS modules, respectively, was 4 points and 2 points. RESULTS Of 1215 respondents (25.3% response rate), 631 received BCS+RT and 584 received Mast+Recon. The median interval from diagnosis to survey completion was 9 years. In adjusted analysis, Mast+Recon was associated with worse BREAST-Q psychosocial well-being (effect size: -3.80, P =0.04) and sexual well-being (effect size: -5.41, P =0.02), but better PROMIS physical function (effect size: 0.54, P =0.03) and similar BREAST-Q satisfaction with breasts, physical well-being, and PROMIS upper extremity function ( P >0.05) compared with BCS+RT. Only the difference in sexual well-being reached clinical significance. Older (≥65) patients receiving BCS+RT and younger (<50) patients receiving autologous Mast+Recon typically reported higher QOL scores. Receipt of chemotherapy was associated with detriments to multiple QOL domains. CONCLUSIONS Patients who underwent Mast+Recon reported worse long-term sexual well-being compared with BCS+RT. Older patients derived a greater benefit from BCS+RT, while younger patients derived a greater benefit from Mast+Recon. These data inform preference-sensitive decision-making for women with early-stage breast cancer.
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Affiliation(s)
- Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Weiguo He
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Sharon H. Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grace L. Smith
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Abigail Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan K. Peterson
- Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Benjamin D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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27
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Beverly Hery CM, Janse SA, Van Zee KJ, Naftalis EZ, Paskett ED, Naughton MJ. Factors associated with insomnia symptoms over three years among premenopausal women with breast cancer. Breast Cancer Res Treat 2023; 202:155-165. [PMID: 37542630 PMCID: PMC10504151 DOI: 10.1007/s10549-023-07058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE We examined longitudinal trends and factors associated with insomnia over 3 years in a cohort of young breast cancer patients. METHODS Women with stage I-III breast cancer at ≤ 45 years were recruited at five institutions from New York, Texas, and North Carolina, within 8 months of diagnosis (n = 836). Participants completed questionnaires every 6 months for 3 years. Linear mixed-effects models were used to examine insomnia over time, using the Women's Health Initiative Insomnia Rating Scale (WHIIRS). We evaluated the relations of insomnia with demographic (age, race, education, income, employment, marital status), clinical (cancer stage, histologic grade, chemotherapy, radiation, hormone therapy, surgery, tumor size, body mass index, hot flashes), and social/behavioral variables (smoking status, social support, physical activity, depressive symptoms). RESULTS At baseline, 57% of participants met or exceeded the cut-off for clinical insomnia (WHIIRS score ≥ 9). Insomnia symptoms were most prevalent at baseline (p < 0.0001), but decreased significantly throughout follow-up (p < 0.001). However, 42% of participants still experienced insomnia symptoms 3 years after diagnosis. In multivariable models, older age (p = 0.02), hot flashes (p < 0.0001), and depressive symptoms (p < 0.0001) remained significantly associated with insomnia over time. CONCLUSIONS Insomnia symptoms were most frequent closer to breast cancer diagnosis and treatment, but persisted for some women who were older and those reporting higher hot flashes and depressive symptoms. Survivorship care should include assessing insomnia symptoms, particularly during and immediately after primary treatment. Implementing early interventions for sleep problems may benefit young breast cancer survivors and improve their quality of life.
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Affiliation(s)
- Chloe M Beverly Hery
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
| | - Sarah A Janse
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Elizabeth Z Naftalis
- Director of Breast Services, Health Texas Community Health Services Corporate, Dallas, TX, 75001, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Michelle J Naughton
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
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28
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Pak LM, Matar-Ujvary R, Verdial FC, Haglich KA, Sevilimedu V, Nelson JA, Gemignani ML. Long-Term Patient-Reported Outcomes Comparing Oncoplastic Breast Surgery and Conventional Breast-Conserving Surgery: A Propensity Score-Matched Analysis. Ann Surg Oncol 2023; 30:7091-7098. [PMID: 37556008 PMCID: PMC10996134 DOI: 10.1245/s10434-023-13962-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/03/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Oncoplastic breast surgery (OBS) combines plastic surgery techniques with conventional breast-conserving surgery (BCS) and expands BCS eligibility. Limited data are available on patient-reported outcomes (PROs) after OBS. Here we compare long-term PROs after OBS and BCS utilizing the BREAST-Q. PATIENTS AND METHODS Women undergoing OBS or BCS between 2006 and 2019 who completed ≥ 1 long-term BREAST-Q survey 3-5 years postoperatively were identified. Baseline characteristics were compared between women who underwent OBS/BCS. Women who underwent OBS were paired with those who underwent BCS using 1:2 propensity matching [by age, body mass index (BMI), race, T stage, and multifocality]. BREAST-Q scores were compared preoperatively and 3-5 years postoperatively. RESULTS A total of 297 patients were included for analysis (99 OBS/198 BCS). Women who underwent OBS were younger (p < 0.001) and had higher BMI (p = 0.005) and multifocal disease incidence (p = 0.004). There was no difference between groups in nodal stage, re-excision rates, axillary surgery, chemotherapy, endocrine therapy, or radiotherapy. After propensity matching preoperatively, women who underwent OBS reported lower psychosocial well-being (63 versus 100, p = 0.039) but similar breast satisfaction and sexual well-being compared with women who underwent BCS; however, only three patients who underwent BCS had preoperative BREAST-Q scores available for review. In long-term follow-up, women who underwent OBS reported lower psychosocial scores (74 versus 93, p = 0.011) 4 years postoperatively, but not at 5 years (76 versus 77, p = 0.83). There was no difference in long-term breast satisfaction or sexual well-being. CONCLUSIONS Women who undergo OBS present with a larger disease burden and may represent a group of non-traditional BCS candidates; they reported similar long-term breast satisfaction and sexual well-being compared with women who undergo BCS. While women who underwent OBS reported lower psychosocial well-being scores preoperatively and during a portion of the follow-up period, this difference was no longer seen at 5 years postoperatively.
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Affiliation(s)
- Linda M Pak
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Regina Matar-Ujvary
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Francys C Verdial
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Kathryn A Haglich
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
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29
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Lipsyc-Sharf M, Partridge AH. Fertility and Sexual Health in Young Women with Early-Stage Breast Cancer. Surg Oncol Clin N Am 2023; 32:747-759. [PMID: 37714641 DOI: 10.1016/j.soc.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Fertility and sexual health may be impaired by early breast cancer treatment in young women, and these issues should be addressed at diagnosis and through survivorship. Future fertility interest and risk should be considered and communicated, and early referral made to an infertility specialist for those interested. Data regarding safety of fertility preservation options as well as pregnancy after breast cancer are overall reassuring. Patients should be counseled about the impact of systemic therapies and breast surgeries on sexual health outcomes and educated about and referred as needed for available strategies for prevention and management of impairment.
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Affiliation(s)
- Marla Lipsyc-Sharf
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Yawkey 1238, Boston, MA 02215, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Dana 1608-A, Boston, MA 02215, USA.
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30
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Knelson LP, Rosenberg S, Snow C, Rigby K, Lynch J, Sella T, Morgans A, Partridge AH. Survivorship Navigation for Young Women With Early-Stage Breast Cancer. Clin Breast Cancer 2023; 23:746-751.e1. [PMID: 37625925 DOI: 10.1016/j.clbc.2023.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Young women treated for breast cancer experience unique concerns in follow-up. We developed a program to direct young breast cancer survivors to a dedicated survivorship visit and evaluated their experience. MATERIALS AND METHODS Early-stage breast cancer patients diagnosed under age 45 within 1 year of completing breast surgery, chemotherapy and/or radiation therapy were systematically referred for a survivorship visit. Patients completed a one-time, post-visit survey about their experience. RESULTS Sixty-nine out of 89 (78%) eligible patients attended a survivorship visit, and 40 of those 69 (58%) completed the post-visit survey. Most respondents learned about the survivorship clinic after completing treatment (30/40; 75%) and reported the survivorship visit occurred at an appropriate time in their follow-up care (26/40; 65%). Of the 34 respondents who reported receiving a treatment summary and survivorship care plan, 30 indicated it would be helpful when visiting their primary care provider (88.2%). Participants reported gaining valuable knowledge about cancer treatment (28/38; 73.7%), side effects (32/39; 82.1%), and cancer surveillance (30/40; 75%), and discussed emotional health (32/40; 80%), exercise (38/40; 95%), and ongoing cancer surveillance (32/37; 86.5%). Several reported intentions to make changes to their follow-up oncology care (8/20; 40%), exercise routines (16/30; 53.3%), and emotional health care (15/22; 68.2%). DISCUSSION Survivorship visit navigation is feasible for young breast cancer patients. These visits can influence knowledge gained and intended future health plans and behaviors. Systematic approaches to survivorship care may improve the physical and mental health of cancer survivors. Future health care delivery research focused on survivorship is warranted.
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Affiliation(s)
| | - Shoshana Rosenberg
- Weill Cornell Medicine, Sandra and Edward Meyer Cancer Center, New York, NY
| | - Craig Snow
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Tal Sella
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - Alicia Morgans
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA.
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Johnson MK, Cortina CS, Hsu TL, Huang S, Frebault J, Huang CC, Kong AL. National Trends in "Going Flat" After Mastectomy. Ann Surg Oncol 2023; 30:6374-6382. [PMID: 37458947 DOI: 10.1245/s10434-023-13845-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/28/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION The "Going Flat" movement became widely publicized in 2016 and provides information and support to women who choose to forego post-mastectomy breast reconstruction (PMBR). The objectives of this study were to evaluate temporal trends in PMBR to ascertain the potential impact of this movement and assess which factors are associated with going flat. METHODS A retrospective cohort analysis was performed using the NCDB of women with non-metastatic breast cancer who underwent mastectomy between 2004 and 2019. Trends in going flat after mastectomy were examined and stratified by age (< 50, 50-69, ≥ 70). A multivariate logistic regression model was used to identify factors associated with going flat. RESULTS 650,983 patients met the inclusion criteria: 244,201 (37.5%) underwent PMBR and 406,782 (62.5%) went flat. Among women < 70, rates of going flat steadily decreased from 2004 to 2015 and then stabilized after 2015, coinciding with the rise of the "Going Flat" movement. In multivariate analysis, non-White race, older age, increasing comorbidities, government provided insurance, treatment at a community program, radiotherapy, and adjuvant chemotherapy were associated with a higher likelihood of going flat (p < 0.001). CONCLUSION In the first 2 years after the "Going Flat" movement, the number of women going flat after mastectomy has stabilized in women < 70 for the first time in over a decade. These trends suggest that the social and cultural impact of this movement may have contributed to the stabilization of PMBR rates.
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Affiliation(s)
- Morgan K Johnson
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- MCW Cancer Center, Milwaukee, WI, USA
| | - Tzu-Lun Hsu
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Shane Huang
- Department of Statistics, University of Wisconsin-Madison, Madison, WI, USA
| | - Julia Frebault
- Department of Surgery, Hennepin Healthcare, Minneapolis, MN, USA
| | - Chiang-Ching Huang
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Amanda L Kong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
- MCW Cancer Center, Milwaukee, WI, USA.
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Huang H, Wei T, Zhang A, Zhang H, Kong L, Li Y, Li F. Comparison of Survival Outcomes in Young Patients With Breast Cancer Receiving Contralateral Prophylactic Mastectomy Versus Unilateral Mastectomy. Clin Breast Cancer 2023; 23:752-762.e7. [PMID: 37586925 DOI: 10.1016/j.clbc.2023.07.010] [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: 04/21/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Contralateral prophylactic mastectomy (CPM) has been performed for several decades in patients with unilateral breast cancer (BC). However, the survival benefits of CPM are controversial, particularly in young women. MATERIALS AND METHOD In this retrospective study, the clinical total of 69,000 young female patients (age ≤ 40 years) who were diagnosed to have unilateral BC and underwent unilateral mastectomy (UM) or CPM between January 1, 2000 and December 31, 2019 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to minimize selection bias and overcome differences in tumor characteristics between the CPM and UM groups. Overall survival (OS) and BC-specific survival (BCSS) were assessed using Kaplan-Meier curves and compared across groups using log-rank test. Multivariable Cox proportional hazards regression analysis was performed to estimate hazard ratios (HRs). RESULTS A total of 36,528 patients (21,600 and 14,928 patients in the UM and CPM groups, respectively) were included in follow study. The CPM group showed a higher 5-year OS rate (82.1% vs. 75.8%) and a higher 5-year BCSS rate (83.5% vs. 77.7%) than the UM group. Multivariate Cox analysis after PSM (n = 13,089) showed that CPM significantly decreased 25% risk of all-cause mortality (OS, HR: 0.75, 95% confidence interval [CI]: 0.70-0.80; P < .001) and 25% risk of BC-specific mortality (BCSS, HR: 0.75, 95% CI: 0.70-0.80; P < .001) in young BC patients as compared to UM. CONCLUSION This study suggests that CPM improved OS and BCSS benefits in young BC patients as compared to UM. Randomized clinical trials with a larger sample size are required in the future to confirm these results.
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Affiliation(s)
- Hongbo Huang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tingting Wei
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Aijie Zhang
- Department of Health Management Center, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Heng Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingquan Kong
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunhai Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Fan Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Farewell JT, Perez K, Henderson S, Crook J, Hunter M, Zhang AY. Psychological impact of the COVID-19 pandemic on breast cancer patients. J Plast Reconstr Aesthet Surg 2023; 84:313-322. [PMID: 37390540 PMCID: PMC10257321 DOI: 10.1016/j.bjps.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/06/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE The COVID-19 pandemic uniquely impacted patients with breast cancer as mastectomies were allowed to proceed, yet breast reconstruction surgeries were halted. The purpose of this study was to examine the effect of the COVID-19 pandemic on the rates of breast reconstruction and patients' well-being. METHODS A chart review included all patients who underwent mastectomy from December 2019 to September 2021. Patients were contacted by a member of the research team and asked to participate in a COVID-19-specific survey and to complete the Hospital Anxiety and Depression Scale (HADS). Patients were then grouped into "surge" or "nonsurge" groups based on the date of mastectomy. RESULTS Two hundred and fifty-nine patients were included in this study. During the study period, 42% (n = 111) of the patients underwent breast reconstruction. The "surge" group included 106 patients whereas the "nonsurge" group included 153 patients. Fewer patients began breast reconstruction during the surge period compared with the nonsurge period (34.0% vs. 49.0%, p = 0.017). Eighty-six patients participated in the COVID-19 survey. Forty-one percent (n = 35) of the patients felt that their care was disrupted because of COVID-19. Eighty-three patients completed the HADS survey. Overall, 16.8% and 15.7% of the respondents fell into the moderate to severe ranges for both anxiety and depression scales, respectively. CONCLUSIONS Patients with breast cancer have faced increased difficulties with access to breast reconstruction throughout the COVID-19 pandemic. Our institution demonstrated decreased rates of breast reconstruction and an increase in anxiety and depression. The positive benefits of breast reconstruction cannot be overlooked when determining resource allocation in the future.
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Affiliation(s)
- Jordyn T Farewell
- University of Texas Southwestern, Department of Plastic Surgery, 1801 Inwood Road, Dallas, TX, USA
| | - Kevin Perez
- University of Texas Southwestern, Department of Plastic Surgery, 1801 Inwood Road, Dallas, TX, USA
| | - Silas Henderson
- Baylor College of Medicine, Department of Surgery, Houston, TX, USA
| | - Jennifer Crook
- University of Texas Southwestern, Department of Plastic Surgery, 1801 Inwood Road, Dallas, TX, USA
| | - Madysen Hunter
- University of Texas Southwestern, Department of Plastic Surgery, 1801 Inwood Road, Dallas, TX, USA
| | - Andrew Y Zhang
- University of Texas Southwestern, Department of Plastic Surgery, 1801 Inwood Road, Dallas, TX, USA.
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Tyner TE, Freysteinson WM, Evans SC, Woo J. "My body, my choice": A qualitative study of women's mastectomy with flat closure experiences. Body Image 2023; 46:419-433. [PMID: 37573764 DOI: 10.1016/j.bodyim.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023]
Abstract
This qualitative study aimed to describe and explore the pre and post-mastectomy experiences of women choosing flat closure after a breast cancer diagnosis. Aesthetic flat closure creates a flat contoured chest wall after a mastectomy. There is limited research on women's flat closure experiences. To fill this gap, we interviewed 19 women (Mage = 53, range 31-72) with breast cancer who underwent a bilateral mastectomy with flat closure, examining decision-making, mirror-viewing, and flat closure experiences. Using a hermeneutic phenomenological design, we generated seven themes. Broadly, women choosing flat closure experienced pressure from their clinicians to undergo breast reconstruction. We found flat closure information to be consistently lacking. Mirror-viewing experiences of women obtaining suboptimal flat closure outcomes led to shattered expectations, mirror avoidance, psychological distress, and body image disturbances. Women negotiated their new reality by discovering ways to feel comfortable with their flat bodies. Regardless of surgical outcome, decision satisfaction was high. These findings illustrate the importance of bodily autonomy and supportive healthcare environments for women making flat closure decisions. Providing comprehensive information on all surgical options and addressing post-operative expectations can improve women's decision-making and mirror-viewing experiences and assist women in adapting to their new body image.
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Affiliation(s)
- Tracy E Tyner
- College of Nursing, Texas Woman's University, P.O. Box 425498, ASB 216, Denton, TX 76204-5498, USA.
| | - Wyona M Freysteinson
- Nelda C. Stark College of Nursing, Texas Woman's University, 6700 Fannin Street, Houston, TX 77030-2897, USA
| | - Stephanie C Evans
- Houston J. and Florence A. Doswell College of Nursing, Texas Woman's University, 5500 Southwestern Medical Avenue, Dallas, TX 75235-7299, USA
| | - Jennifer Woo
- Houston J. and Florence A. Doswell College of Nursing, Texas Woman's University, 5500 Southwestern Medical Avenue, Dallas, TX 75235-7299, USA
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Liu G, Kong X, Dai Q, Cheng H, Wang J, Gao J, Wang Y. Clinical Features and Prognoses of Patients With Breast Cancer Who Underwent Surgery. JAMA Netw Open 2023; 6:e2331078. [PMID: 37624596 PMCID: PMC10457722 DOI: 10.1001/jamanetworkopen.2023.31078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
Importance Breast cancer (BC) remains a pervasive malignant neoplasm worldwide, with increasing incidence. However, there are a scarcity of studies examining the clinical characteristics and prognosis of Chinese patients with BC who have undergone surgery. Objective To evaluate overall survival (OS) and disease-free survival (DFS) in patients with surgically treated BC in China, focusing on histopathology and surgical approach. Design, Setting, and Participants This cohort study included a retrospective review of the medical records of patients with unilateral BC who underwent surgery between January 2009 and September 2017, with a median follow-up time of 7.69 years. Clinical features were extracted from these records, and survival analysis was performed. Data analysis was conducted in March 2023. Main Outcomes and Measures Patients' OS and DFS. Results The study included 14 782 patients (14 724 [99.6%] female patients; mean [SD] age, 51.6 [10.9] years). Invasive ductal carcinoma (IDC) was the most prevalent type, observed in 12 671 patients (85.6%). Stages 0, I, II, III, and IV accounted for 6.4% (919 patients), 32.0% (4579 patients), 40.5% (5791 patients), 20.2% (2896 patients), and 0.9% (126 patients) of cases, respectively. Hormone receptor (HR) positivity was observed in 10 241 patients (75.1%), and 3665 (29.1%) tested positive for ERBB2 (formerly HER2/neu). The HR-negative-ERBB2-negative, HR-negative-ERBB2-positive, HR-positive-ERBB2-negative, and HR-positive-ERBB2-positive subtypes constituted 13.3% (1666 patients), 12.7% (1595 patients), 57.8% (7251 patients), and 16.2% (2034 patients) of cases, respectively. Breast-conserving surgery (BCS) was performed in 2884 patients (19.5%). The 5-year and 10-year OS rates were 92.9% (13 689 of 14 732) and 87.4% (3287 of 3760), while the 5-year and 10-year DFS rates were 89.0% (12 916 of 14 512) and 82.9% (3078 of 3713), respectively. Multivariate analysis found that for patients with IDC, age, BCS, invasive tumor size, tumor grade, lymphovascular invasion (LVI), the number of lymph node metastases (LNMs), distant metastasis, Ki67, and HR status were associated with OS, whereas invasive tumor size, tumor grade, LVI, the number of LNMs, HR status, and ERBB2 status were associated with DFS. After propensity score matching, BCS was equivalent to mastectomy with respect to survival in patients with IDC. Conclusions and Relevance This cohort study of patients with BC who underwent surgery in China provides valuable insights into the histopathological characteristics and survival outcomes of this population. The diverse histopathological features emphasize the necessity for customized treatment strategies. The relatively low BCS rate in the study population suggests the need for heightened awareness and adoption of this approach, considering its potential advantages for survival.
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Affiliation(s)
- Gang Liu
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qichen Dai
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Cheng
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jidong Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yipeng Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Afshar-Bakshloo M, Albers S, Richter C, Berninger O, Blohmer JU, Roehle R, Speiser D, Karsten MM. How breast cancer therapies impact body image - real-world data from a prospective cohort study collecting patient-reported outcomes. BMC Cancer 2023; 23:705. [PMID: 37507687 PMCID: PMC10375629 DOI: 10.1186/s12885-023-11172-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND In breast cancer patients body image (BI) is a crucial aspect of quality of life (QoL). This study examined the postoperative impact of different surgical approaches on long-term BI analyzing real-world data to guide pre- and postoperative patient care and preserve QoL. METHODS EORTC QLQ-BR23 BI scores were collected electronically in 325 breast cancer patients within routine clinical care for a duration of 41.5 months (11/17/2016 - 4/30/2020) at predefined time points preoperatively and repeatedly up to two years after breast-conserving surgery (BCS) (n = 212), mastectomy alone (M) (n = 27) or mastectomy with immediate breast reconstruction (MIBR) (n = 86). Higher scores indicated better BI. A linear mixed regression model was used to analyze the impact of BCS, M and MIBR, as well as non-surgical therapies on BI at treatment initiation and over time. RESULTS BI scores deteriorated by 5 points (95%-confidence interval (CI) -8.94 to -1.57, p≈0.005) immediately after BCS, by 7 points (95%-CI -12.13 to -1.80, p≈0.008) after MIBR and by 19 points (95%-CI -27.34 to -10.34, p < 0.001) after M. The change over time after BCS (+ 0.10 points per week, 95%-CI -0.17 to 0.38), MIBR (-0.07 points per week, 95%-CI -0.35 to 0.20) and M (+ 0.14 points per week, 95%-CI -0.19 to 0.48) were not statistically significant (each p > 0.05). At treatment initiation chemotherapy was associated with a 22-point decline (95%-CI -25.39 to -17.87, p < 0.001) in BI score, while radiotherapy was associated with a 5-point increase (95%-CI 1.74 to 9.02, p≈0.004). However, over time chemotherapy was associated with a score recovery (+ 0.28 points per week, 95%-CI 0.19 to 0.37, p < 0.001), whereas for radiotherapy a trend towards BI deterioration was observed (-0.11 points per week, 95%-CI -0.23 to 0.02, p≈0.101). CONCLUSIONS Breast cancer surgery negatively affects BI. BCS and MIBR presumably harm BI less than M in the early postoperative period. Our data suggests BI to be deteriorating in the long term after MIBR while improving after BCS or M. Radiotherapy seems to have an additional negative long-term impact on BI. These findings should be confirmed in further studies to enable evidence-based patient information as part of preoperative shared decision-making and postoperative patient care.
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Affiliation(s)
- Melissa Afshar-Bakshloo
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Albers
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Chiara Richter
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ottilia Berninger
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dorothee Speiser
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology With Breast Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Zhang Y, Zhang X, Li N, He H, Chen J, Zhu M, Zhang M. Factors associated with psychosocial adjustment in newly diagnosed young to middle-aged women with breast cancer: A cross-sectional study. Eur J Oncol Nurs 2023; 65:102357. [PMID: 37321131 DOI: 10.1016/j.ejon.2023.102357] [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: 03/13/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To examine the psychosocial adjustment of young to middle-aged women who were newly diagnosed with breast cancer and to determine the comprehensive risk factors contributing to psychosocial adjustment. METHODS This study was carried out on 358 young to middle-aged women who recently received a breast cancer diagnosis in two hospitals in Guangzhou, China. Participants reported data about sociodemographic characteristics, disease and treatment information, coping modes, social support, self-efficacy, and psychosocial adjustment. To analyze the data, the researchers utilized independent t-tests, one-way analysis of variance, and multiple linear regression. RESULTS The results showed that the participants exhibited a moderate level of psychosocial maladjustment, with a mean score of 42.44 ± 15.38. Additionally, 30.4% of the participants were classified as having severe psychosocial maladjustment. The study identified the coping mode of acceptance-resignation (β = 0.367, P < 0.001), mode of avoidance (β = -0.248, P = 0.001), social support (β = -0.239, P < 0.001), self-efficacy (β = -0.199, P = 0.001) as factors that impacted the level of psychosocial adjustment. CONCLUSIONS Psychosocial adjustment among young to middle-aged women who were newly diagnosed with breast cancer is affected by self-efficacy, social support, and coping modes. Healthcare professionals should pay attention to psychosocial adjustment in young to middle-aged women with breast cancer at the time of diagnosis, and could formulate effective interventions to improve their psychosocial adjustment by increasing self-efficacy, promoting social support, and encouraging effective coping.
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Affiliation(s)
- Yiheng Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | | | - Na Li
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Haiyan He
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Juanjuan Chen
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Mengyao Zhu
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Meifen Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Franco-Rocha OY, Wheldon CW, Trainum K, Kesler SR, Henneghan AM. Clinical, psychosocial, and sociodemographic factors of sexual and gender minority groups with cancer: A systematic review. Eur J Oncol Nurs 2023; 64:102343. [PMID: 37290162 DOI: 10.1016/j.ejon.2023.102343] [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: 01/31/2023] [Revised: 04/07/2023] [Accepted: 04/29/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Psychosocial health varies depending on demographic and clinical factors and the social context in which individuals grow and live. Sexual and gender minority (SGM) populations experience health disparities due to systemic factors that privilege cisgender and heterosexual identities. We reviewed the literature on the psychosocial, sociodemographic, and clinical factors in SGM groups with cancer and described the associations among these factors. METHODS We conducted a systematic review according to Fink's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in the PubMed, PsycInfo, Cumulative Index of Nursing and Allied Health Literature, and LGBTQ+ Life databases. Quantitative articles published in English or Spanish were included. Grey literature and studies with participants in hospice care were excluded. The quality of the publications was assessed with the Joanna Briggs Institute criticalappraisal tools. RESULTS The review included 25 publications. In SGM groups, systemic cancer treatment was associated with worse psychosocial outcomes; and older age, employment, and higher income were associated with better psychosocial outcomes. CONCLUSIONS SGM groups with cancer are different from their heterosexual cisgender peers in sociodemographic, psychosocial, and clinical factors. Clinical and sociodemographic factors are associated with psychosocial outcomes among SGM individuals with cancer.
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Affiliation(s)
- Oscar Y Franco-Rocha
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Christopher W Wheldon
- Department of Social & Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B, Moore Ave., Ritter Hall Annex 9th Floor, Room 955, Philadelphia, PA, 19122, USA.
| | - Katie Trainum
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Shelli R Kesler
- School of Nursing, Department of Diagnostic Medicine, Dell Medical School, The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Ashley M Henneghan
- School of Nursing, Department of Oncology, Dell Medical School, The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
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Togawa R, Hederer J, Ragazzi M, Bruckner T, Fastner S, Gomez C, Hennigs A, Nees J, Pfob A, Riedel F, Schäfgen B, Stieber A, Lux MP, Heil J, Golatta M. Imaging of lumpectomy surface with large field-of-view confocal laser scanning microscopy 'Histolog® scanner' for breast margin assessment in comparison with conventional specimen radiography. Breast 2023; 68:194-200. [PMID: 36842192 PMCID: PMC9988675 DOI: 10.1016/j.breast.2023.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/05/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE The Histolog® Scanner (SamanTree Medical SA, Lausanne, Switzerland) is a large field-of-view confocal laser scanning microscope designed to allow intraoperative margin assessment by the production of histological images ready for assessment in the operating room. We evaluated the feasibility and the performance of the Histolog® Scanner (HS) to correctly identify infiltrated margins in clinical practice of lumpectomy specimens. It was extrapolated if the utilization of the HS has the potential to reduce infiltrated margins and therefore reduce re-operation rates in patients undergoing breast conserving surgery (BCS) due to a primarily diagnosed breast cancer including ductal carcinoma in situ. METHODS This is a single-center, prospective, non-interventional, diagnostic pilot study including 50 consecutive patients receiving BCS. The complete surface of the specimen was scanned using the HS intraoperatively. The surgery and the intraoperative margin assessment of the specimen was performed according to the clinical routine consisting of conventional specimen radiography as well as the clinical impression of the surgeon. Three surgeons and an experienced pathologist assessed the scans produced by the HS for cancer cells on the surface. The potential of the HS to correctly identify involved margins was compared to the results of the conventional specimen radiography alone as well as the clinical routine. The histopathological report served as the gold standard. RESULTS 50 specimens corresponding to 300 surfaces were scanned by the HS. The mean sensitivity of the surgeons to identify involved margins with the HS was 37.5% ± 5.6%, the specificity was 75.2% ± 13.0%. The assessment of resection margins by the pathologist resulted in a sensitivity of 37.5% and a specificity of 81.0%, while the local clinical routine resulted in a sensitivity of 37.5% and a specificity of 78.2%. CONCLUSION Acquisition of high-resolution histological images using the HS was feasible in clinical practice. Sensitivity and specificity were comparable to clinical routine. With more specific training and experience on image interpretation and acquisition, the HS may have the potential to enable more accuracy in the margin assessment of BCS specimens.
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Affiliation(s)
- Riku Togawa
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Johanna Hederer
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Moira Ragazzi
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Thomas Bruckner
- Institute of Medical Biometry (IMBI), Heidelberg University, 69120, Heidelberg, Germany
| | - Sarah Fastner
- Breast Unit, Sankt Elisabeth Hospital, 69121, Heidelberg, Germany
| | - Christina Gomez
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - André Hennigs
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Juliane Nees
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - André Pfob
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Fabian Riedel
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Benedikt Schäfgen
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Anne Stieber
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Frauenklinik St. Louise Paderborn, St. Josefs-Krankenhaus, 33098, Salzkotten, Germany
| | - Jörg Heil
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany; Breast Unit, Sankt Elisabeth Hospital, 69121, Heidelberg, Germany
| | - Michael Golatta
- Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany; Breast Unit, Sankt Elisabeth Hospital, 69121, Heidelberg, Germany.
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Boing L, de Bem Fretta T, Stein F, Lyra VB, Moratelli JA, da Silveira J, Dos Santos Saraiva PS, Bergmann A, Lynch BM, de Azevedo Guimarães AC. Can mat Pilates and belly dance be effective in improving body image, self-esteem, and sexual function in patients undergoing hormonal treatment for breast cancer? A randomized clinical trial. Arch Womens Ment Health 2023; 26:141-151. [PMID: 36715766 DOI: 10.1007/s00737-023-01294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/18/2023] [Indexed: 01/31/2023]
Abstract
The purpose of this study is to examine the effects of a 16-week exercise intervention (mat Pilates or belly dance) on body image, self-esteem and sexual function in breast cancer survivors receiving hormone therapy. Seventy-four breast cancer survivors were randomly allocated into mat Pilates, belly dance, or control group. The physical activity groups received a 16-week intervention, delivered 3 days a week, and 60 min a session. The control group received three education sessions. Data collection occurred at baseline, post-intervention, 6 and 12 months of follow-up with a questionnaire including body image (Body Image After Breast Cancer Questionnaire), self-esteem (Rosenberg Self-Esteem Scale), and sexual function (Female Sexual Function Index) measures. The belly dance group significantly improved body image on limitations scale in the short term and long term, the mat Pilates significantly improved body image on limitations only in the long term, and the control group significantly decreased body image on limitations in the long term. The belly dance group experienced reduced discomfort and pain during sexual relations in the short and long term. All groups showed a significant improvement in self-esteem, but orgasm sub-scale scores declined over time. No adverse events were found for any of the exercise intervention groups. Belly dance seem to be more effective than mat Pilates and control group in improving limitations of body image and sexual discomfort in the short term for breast cancer survivors. ClinicalTrials.gov (NCT03194997) - "Pilates and Dance to Breast Cancer Patients Undergoing Treatment".
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Affiliation(s)
- Leonessa Boing
- College of Health and Sport Science, Santa Catarina State University, Pascoal Simone, 358 - Coqueiros, 88080350, Florianopolis, SC, Brazil
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | | | - Francine Stein
- College of Health and Sport Science, Santa Catarina State University, Pascoal Simone, 358 - Coqueiros, 88080350, Florianopolis, SC, Brazil
| | - Vanessa Bellani Lyra
- College of Health and Sport Science, Santa Catarina State University, Pascoal Simone, 358 - Coqueiros, 88080350, Florianopolis, SC, Brazil
| | - Jéssica Amaro Moratelli
- College of Health and Sport Science, Santa Catarina State University, Pascoal Simone, 358 - Coqueiros, 88080350, Florianopolis, SC, Brazil
| | - Juliana da Silveira
- College of Health and Sport Science, Santa Catarina State University, Pascoal Simone, 358 - Coqueiros, 88080350, Florianopolis, SC, Brazil.
| | - Patrícia Severo Dos Santos Saraiva
- College of Health and Sport Science, Santa Catarina State University, Pascoal Simone, 358 - Coqueiros, 88080350, Florianopolis, SC, Brazil
| | - Anke Bergmann
- Clinical Epidemiology, National Institute of Cancer, Rio de Janeiro, Brazil
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
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Álvarez-Pardo S, De Paz JA, Montserrat Romero-Pérez E, Portilla-Cueto KM, Horta-Gim MA, González-Bernal JJ, Fernández-Solana J, Mielgo-Ayuso J, García-Valverde A, González-Santos J. Factors Associated with Body Image and Self-Esteem in Mastectomized Breast Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5154. [PMID: 36982062 PMCID: PMC10048946 DOI: 10.3390/ijerph20065154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Body image (BI) and self-esteem (SE) are two fundamental aspects in the evolution of breast cancer (BC), mainly due to surgery, treatment, and the patient's conception of BI. A dissatisfaction with BI and low SE decreases the subject's quality of life and increases the risk of recurrence and mortality by BC. The aim of this study is to find out if there is any degree of association between the sociodemographic data of the sample and their BI and SE. A cross-sectional, descriptive study was conducted with 198 women diagnosed with BC, aged 30-80 years, in Mexico. Women's BI and SE were assessed using two questionnaires, Hopwood Body Image Scale (S-BIS) and Rosenberg Self-Esteem Scale (RSES). The results show significant differences in several items when the variable sense of humor is taken into account, indicating that women with a sense of humor report higher satisfaction with their BI and higher SE. The age also indicates a significantly better BI in women over 50 years of age, as well as the education level variable, where those women who had studied up to secondary reported higher satisfaction with their BI; the family history shows that those women without a family history report better SE. All these data are supported by stepwise regression, which shows that educational level and sense of humor are predictors of BI, and family history along with breast reconstruction and sense of humor are predictors as of SE. In conclusion, it is important to take into account the characteristics of women with BC, particularly age and sense of humor, in order to reduce the impact of the disease on their BI and SE with the help of a multidisciplinary team.
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Affiliation(s)
| | | | | | | | - Mario A. Horta-Gim
- Division of Biological Sciences and Health, University of Sonora, Hermosillo 83000, Mexico
| | | | | | - Juan Mielgo-Ayuso
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain
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Price J, Sharma S, Brunet J. Women's experiences with yoga after a cancer diagnosis: A qualitative meta-synthesis – Part II. Complement Ther Clin Pract 2023; 51:101752. [PMID: 37018936 DOI: 10.1016/j.ctcp.2023.101752] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023]
Abstract
A review of qualitative research exploring women's experiences with yoga after a cancer diagnosis can provide important insights into their motives, barriers, and preferences for yoga participation, which can be used to enhance engagement. In this meta-study meta-synthesis, 6 electronic databases were systematically searched to identify qualitative studies focused on women diagnosed with cancer who engage in yoga. The search yielded 6878 results after de-duplication; of these, 24 articles were eligible and included. Extracted data pertaining to the results, methods, and theoretical approach(es) were analyzed. This paper synthesizes and integrates results from 16 of the 24 articles focused on women's motives, barriers, and preferences for participating in yoga programs and interventions; it is Part II of a 2-part meta-study meta-synthesis. Motives to participate in yoga included: rehabilitation, physical activity, social support, and novel experience. Barriers centred around time constraints, lack of intentionality, online adaptation difficulties, health condition, and cost. Main approaches to delivering yoga comprised: in-person, in-person with an at-home component, asynchronous online, and synchronous online. Each mode of delivery presented its own benefits and challenges, with suggestions for improvement; participants highlighted the value of supportive and knowledgeable instructors, the ability to connect with others, and the importance of comprehensive classes focused on more than just movement. Participants' challenges also highlighted a need to actively seek solutions to anticipated challenges prior to delivering interventions and programs. Findings provide information that can be used to develop and deliver yoga interventions and programs to women diagnosed with cancer that prioritize their needs and preferences. REGISTRATION: PROSPERO; registration number: CRD42021229253; February 17, 2021.
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43
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Grocott B, Reynolds K, Logan G, Hebbard P, El-Gabalawy R. Breast cancer patient experiences of perioperative distress and anxiety: A qualitative study. Eur J Oncol Nurs 2023; 63:102299. [PMID: 36893576 DOI: 10.1016/j.ejon.2023.102299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/01/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
PURPOSE Distress, often manifesting as anxiety, is common in breast cancer patients and becomes particularly elevated before surgery. This study investigated perspectives of those undergoing breast cancer surgery concerning what enhances and reduces distress and anxiety across the perioperative period (i.e., from diagnostic evaluation to recovery). METHODS The present study conducted qualitative semi-structured individual interviews with 15 adult breast cancer surgery patients within three months post-operation. Quantitative surveys provided background information (e.g., sociodemographics). Individual interviews were analyzed using thematic analysis. Quantitative data were analyzed descriptively. RESULTS Four main themes emerged from qualitative interviews: 1) "fighting an unknown" (sub-themes: uncertainty, health-related knowledge and experience); 2) "the cancer takes away the control" (sub-themes: "living at the whim of others", trusting care providers); 3) person at the centre of the patient (sub-themes: "managing life:" caregiving and work-related stressors, "everybody jumped in to help:" emotional and instrumental support); and 4) physical and emotional impacts of treatment (sub-themes: pain and impacted mobility, "losing a part of yourself"). Breast cancer patients' experiences of surgery-related distress and anxiety were contextualized by broader experiences of care. CONCLUSIONS Our findings illustrate the illness-specific experience of perioperative anxiety and distress in breast cancer patients and inform patient-centered care and intervention.
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Affiliation(s)
- Bronwen Grocott
- Department of Psychology, Faculty of Arts, University of Manitoba, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Kristin Reynolds
- Department of Psychology, Faculty of Arts, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Gabrielle Logan
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Pamela Hebbard
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada; CancerCare Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Psychology, Faculty of Arts, University of Manitoba, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada; CancerCare Manitoba, Canada.
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Chen J, Li J, Qiao H, Hu R, Li C. Disruption of IDO signaling pathway alleviates chronic unpredictable mild stress-induced depression-like behaviors and tumor progression in mice with breast cancer. Cytokine 2023; 162:156115. [PMID: 36599202 DOI: 10.1016/j.cyto.2022.156115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Abstract
Women with breast cancer (BC) are often combined with psychological disorder such as depression and anxiety. Depression is associated or correlated with increased toxicity and severity of physical symptoms. However, the mechanism of BC progression related to the regulation of emotion-related circuitry remains to be further explored. The study aims to investigate indoleamine 2,3-dioxygenase (IDO) pathway mechanism underlying stress-induced progression of BC. BC cell line 4T1 was subcutaneously inoculated into BALB/c mice, and they then received daily chronic unpredictable mild stressors (CUMS) for 12 weeks. Depression-like behavior tests were conducted, including sucrose preference test (SPT), tail suspension test (TST), forced swimming test (FST), and novelty suppressed feeding test (NSF). The levels of 5-Hydroxytryptamine (5-HT) and inflammatory factors, IL-6, CXCL1, IL-10 and IL-4 were measured by enzyme linked immunosorbent assay (ELISA) of mouse serum. Immunohistochemical staining was performed to detect Ki67- or FOXP3-positive tumor cells. The status of IDO signaling pathway was assessed by immunoblotting analysis. CUMS induced depression-like behaviors, decreased the level of 5-HT, promoted tumor progression, enhanced the immunohistochemical staining of Ki-67, and promoted the activation of IDO signaling pathway in BC mice. The IDO signaling pathway was disrupted in mice by lentiviral transduction of shRAN-IDO. Lentivirus-mediated IDO knockdown attenuated CUMS-induced depression-like behaviors, increased the level of 5-HT, inhibited tumor progression, and reduced the immunohistochemical staining of Ki-67 in BC mice. The present study suggests that disruption of IDO signaling pathway alleviates CUMS-induced depression-like behaviors and inhibits tumor progression in BC mice.
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Affiliation(s)
- Jun Chen
- Department of Acupuncture and Massage, Shaanxi University of Chinese Medicine, 1 Middle Section of Century Avenue, Qindu District, Xianyang 712046, China
| | - Jing Li
- Department of Chinese Medicine, The Sixth Medical Center of PLA Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China.
| | - Haifa Qiao
- Department of Acupuncture and Massage, Shaanxi University of Chinese Medicine, 1 Middle Section of Century Avenue, Qindu District, Xianyang 712046, China
| | - Rong Hu
- Department of Chinese Medicine, The Sixth Medical Center of PLA Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China
| | - Chaoqun Li
- Department of Chinese Medicine, The Sixth Medical Center of PLA Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China
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Li RQ, Zhao XH, Zhu Q, Liu T, Hondermarck H, Thorne RF, Zhang XD, Gao JN. Exploring neurotransmitters and their receptors for breast cancer prevention and treatment. Theranostics 2023; 13:1109-1129. [PMID: 36793869 PMCID: PMC9925324 DOI: 10.7150/thno.81403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
While psychological factors have long been linked to breast cancer pathogenesis and outcomes, accumulating evidence is revealing how the nervous system contributes to breast cancer development, progression, and treatment resistance. Central to the psychological-neurological nexus are interactions between neurotransmitters and their receptors expressed on breast cancer cells and other types of cells in the tumor microenvironment, which activate various intracellular signaling pathways. Importantly, the manipulation of these interactions is emerging as a potential avenue for breast cancer prevention and treatment. However, an important caveat is that the same neurotransmitter can exert multiple and sometimes opposing effects. In addition, certain neurotransmitters can be produced and secreted by non-neuronal cells including breast cancer cells that similarly activate intracellular signaling upon binding to their receptors. In this review we dissect the evidence for the emerging paradigm linking neurotransmitters and their receptors with breast cancer. Foremost, we explore the intricacies of such neurotransmitter-receptor interactions, including those that impinge on other cellular components of the tumor microenvironment, such as endothelial cells and immune cells. Moreover, we discuss findings where clinical agents used to treat neurological and/or psychological disorders have exhibited preventive/therapeutic effects against breast cancer in either associative or pre-clinical studies. Further, we elaborate on the current progress to identify druggable components of the psychological-neurological nexus that can be exploited for the prevention and treatment of breast cancer as well as other tumor types. We also provide our perspectives regarding future challenges in this field where multidisciplinary cooperation is a paramount requirement.
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Affiliation(s)
- Ruo Qi Li
- General Surgery Department, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China.,These authors contributed equally to this work
| | - Xiao Hong Zhao
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, New South Wales, Australia.,These authors contributed equally to this work
| | - Qin Zhu
- General Surgery Department, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China
| | - Tao Liu
- Children's Cancer Institute Australia for Medical Research, The University of New South Wales, Sydney, NSW, Australia
| | - Hubert Hondermarck
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, New South Wales, Australia
| | - Rick F Thorne
- Translational Research Institute, Henan Provincial and Zhengzhou City Key laboratory of Non-coding RNA and Cancer Metabolism, Henan International Joint Laboratory of Non-coding RNA and Metabolism in Cancer, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Academy of Medical Sciences, Zhengzhou University, Henan, China
| | - Xu Dong Zhang
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, New South Wales, Australia.,Translational Research Institute, Henan Provincial and Zhengzhou City Key laboratory of Non-coding RNA and Cancer Metabolism, Henan International Joint Laboratory of Non-coding RNA and Metabolism in Cancer, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Academy of Medical Sciences, Zhengzhou University, Henan, China
| | - Jin Nan Gao
- General Surgery Department, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China
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46
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Li W, You F, Wang Q, Shen Y, Wang J, Guo J. Effects of Tai Chi Chuan training on the QoL and psychological well-being in female patients with breast cancer: a systematic review of randomized controlled trials. Front Oncol 2023; 13:1143674. [PMID: 37197428 PMCID: PMC10183581 DOI: 10.3389/fonc.2023.1143674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
Background Tai Chi Chuan (TCC) may have a positive impact on physical and psychological well-being in breast cancer patients, but the evidence remains limited and inconclusive. This systematic review aims to evaluate the effects of TCC on the quality of life (QoL) and psychological symptoms in women patients with breast cancer. Methods This review has been registered on PROSPERO (ID: CRD42019141977). Randomized controlled trials (RCTs) of TCC for breast cancer were searched from eight major English and Chinese databases. All trials included were analyzed in accordance with the Cochrane Handbook. The primary outcomes were QoL, anxiety, and depression in patients with breast cancer. Fatigue, sleep quality, cognitive function, and inflammatory cytokine were the secondary outcomes. Results Fifteen RCTs involving a total of 1,156 breast cancer participants were included in this review. The methodological quality of included trials was generally poor. The pooled results suggested that TCC-based exercise could significantly improve QoL [standardized mean difference (SMD)=0.35, 95%CI: 0.15-0.55, I 2 = 0, model: fixed, IV], anxiety [weighted mean difference (WMD)=-4.25, 95%CI: -5.88 to -2.63, I 2 = 0, model: fixed, IV], and fatigue (SMD=-0.87, 95%CI: -1.50 to -0.24, I 2 = 80.9%, model: random, DL) compared other controls, with moderate to low certainty of evidence. The improvement of QoL and fatigue by TCC was also clinically meaningful. However, TCC-based exercise failed to show any between-group differences in depression, sleep quality, cognitive function, and inflammatory cytokine. Post-hoc analysis revealed that TCC-based exercise outperformed the other exercise in improving shoulder function with very low certainty of evidence. Conclusion Our findings manifested that TCC-based exercise is helpful for improving the QoL, anxiety, and fatigue in patients with breast cancer within the range of comparisons covered in this study. However, the results must be treated with great caution because of the methodological flaws of included trials. Larger, well-designed, and conducted randomized controlled trials with longer follow-up is warranted in the future to evaluate the important outcomes of TCC for breast cancer. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019141977, identifier, CRD42019141977.
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Affiliation(s)
- Wenyuan Li
- Evidence Based Traditional Chinese Medicine Center of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Traditional Chinese Medicine Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fengming You
- Traditional Chinese Medicine Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Teaching and Research Office of Oncology in Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Departmental Office of Scientific Research, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiaoling Wang
- Departmental Office of Scientific Research, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yifeng Shen
- Clinical Medicine School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jundong Wang
- Evidence Based Traditional Chinese Medicine Center of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Traditional Chinese Medicine Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Guo
- Teaching and Research Office of Oncology in Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Clinical Medicine School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Jing Guo,
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Current Considerations in Surgical Treatment for Adolescents and Young Women with Breast Cancer. Healthcare (Basel) 2022; 10:healthcare10122542. [PMID: 36554065 PMCID: PMC9777860 DOI: 10.3390/healthcare10122542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Adolescents and young women (AYA) with breast cancer represent a unique patient population, compared to the general population with breast cancer. We performed a literature review to evaluate the factors that influenced the surgical outcomes in this patient population. Fifty-two studies were identified, which evaluated breast surgery type, axillary surgery, contralateral prophylactic mastectomy (CPM), surgical timing, psychological factors, disparities, and imaging use. AYA patients had equivalent oncologic outcomes with breast conserving surgery (BCS) or mastectomy. CPM did not improve survival. There are limited data on axillary management in the AYA population, and while more data would be beneficial, this is currently extrapolated from the general breast cancer population. A shorter time to initiate treatment correlated to better outcomes, and disparities need to be overcome for optimal outcomes. AYA patients appreciated involvement in clinical decisions, and shared decision making should be considered whenever possible. Providers must keep these factors in mind when counseling AYA patients, regarding the surgical management of breast cancer.
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Tesch ME, Rosenberg SM, Collins LC, Wong JS, Dominici L, Ruddy KJ, Tamimi R, Schapira L, Borges VF, Warner E, Come SE, Partridge AH. Clinicopathologic Features, Treatment Patterns, and Disease Outcomes in a Modern, Prospective Cohort of Young Women Diagnosed with Ductal Carcinoma In Situ. Ann Surg Oncol 2022; 29:8048-8057. [PMID: 35960452 DOI: 10.1245/s10434-022-12361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) is uncommon and understudied in young women. The objective of this study is to describe clinicopathologic features, treatment, and oncologic outcomes in a modern cohort of women aged ≤ 40 years with DCIS. PATIENTS AND METHODS Patients with DCIS were identified from the Young Women's Breast Cancer Study, a multisite prospective cohort of women diagnosed with stage 0-IV breast cancer at age ≤ 40 years, enrolled from 2006 to 2016. Clinical data were collected from patient surveys and medical records. Pathologic features were examined by central review. Data were summarized with descriptive statistics and groups were compared with χ2 and Fisher's exact tests. RESULTS Among the 98 patients included, median age of diagnosis was 38 years; 36 (37%) patients were symptomatic on presentation. DCIS nuclear grade was high in 35%, intermediate in 50%, and low in 15% of lesions; 36% of lesions had comedonecrosis. The majority of patients underwent bilateral mastectomy (57%), 16 (16%) underwent unilateral mastectomy, and 26 (27%) underwent lumpectomy, most of whom received radiation. Few (13%) patients were receiving tamoxifen therapy 1 year postdiagnosis. Over a median follow-up of 8.4 years, six patients (6%) had disease recurrence, including five locoregional and one distant event. CONCLUSIONS A high proportion of young women with DCIS underwent mastectomy with or without contralateral prophylactic mastectomy. Although DCIS was frequently symptomatic on presentation and exhibited unfavorable pathologic factors, clinicopathologic features were overall heterogeneous and few recurrences occurred. This underscores the need for careful consideration of treatment options in young women with DCIS.
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Affiliation(s)
| | | | - Laura C Collins
- Beth Israel Deaconess, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Julia S Wong
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Laura Dominici
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Lidia Schapira
- Stanford University, Stanford, CA, USA.,Stanford Cancer Institute, Stanford, CA, USA
| | | | - Ellen Warner
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Steven E Come
- Beth Israel Deaconess, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA. .,Brigham and Women's Hospital, Boston, MA, USA.
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He C, Yang T, He Y, Guo S, Lin Y, Wu C, Gao L, Liu X, Wu S, Cao B. Relationship between family functioning and self-transcendence in patients with breast cancer: A network analysis. Front Public Health 2022; 10:1028860. [PMID: 36466501 PMCID: PMC9714448 DOI: 10.3389/fpubh.2022.1028860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background For patients with breast cancer, family functioning is an important factor affecting self-transcendence, which is a key source of happiness. However, network analysis studies of family functioning and self-transcendence are lacking, particularly among patients with breast cancer. Purpose The present study investigated the network structure of family functioning and self-transcendence in patients with breast cancer and aimed to identify bridge items to provide some theoretical support for the improvement and intervention of self-transcendence in patients with breast cancer. Methods A total of 294 patients with breast cancer were enrolled in our study. Self-transcendence was evaluated with the Self-Transcendence Scale. Family functioning was evaluated with the Family Adaptation, Participation, Growth, Affection, Resolution (APGAR) Scale. Network analyses were used for the statistical analysis. Results In the network of family functioning and self-transcendence in patients with breast cancer, there were 22 edges across communities, of which the 5 strongest edges connected to the 5 dimensions of family functioning are "Adaptation" with "Enjoyment of hobbies", "Participation" with "Life enjoyment", "Growth" with "Acceptance of bodily changes", "Affection" with "Life enjoyment", "Resolution" with "Help acceptance". "Adaptation" had the highest bridge expected influence value (0.30) in the family functioning community, while "Life enjoyment" had the highest bridge expected influence value (0.27) in the self-transcendence community. Conclusion Complex patterns of associations existed in the fine-grained relationship between family functioning and self-transcendence in patients with breast cancer. From the perspective of network analysis, the "Adaptation" aspect of family functioning and the "Life enjoyment" aspect of self-transcendence may be the best targets for improving self-transcendence. These results have important implications to clinical practice, which provided potential targets for interventions to improve self-transcendence from the perspective of family functioning.
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Affiliation(s)
- Chunyan He
- Department of Nursing, Fourth Military Medical University, Xi'an, China
| | - Tianqi Yang
- Department of Psychology, Fourth Military Medical University, Xi'an, China
| | - Yang He
- Department of Psychology, Fourth Military Medical University, Xi'an, China
| | - Sijin Guo
- Xijing Hospital Affiliated With Air Force Medical University, Xi'an, China
| | - Yawei Lin
- Department of Nursing, Fourth Military Medical University, Xi'an, China
| | - Chao Wu
- Department of Nursing, Fourth Military Medical University, Xi'an, China
| | - Li Gao
- Department of Nursing, Fourth Military Medical University, Xi'an, China
| | - Xufeng Liu
- Department of Psychology, Fourth Military Medical University, Xi'an, China
| | - Shengjun Wu
- Department of Psychology, Fourth Military Medical University, Xi'an, China,Shengjun Wu
| | - Baohua Cao
- Department of Nursing, Fourth Military Medical University, Xi'an, China,*Correspondence: Baohua Cao
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Effects of an online mindfulness-based intervention on Fear of Cancer Recurrence and quality of life among Chinese breast cancer survivors. Complement Ther Clin Pract 2022; 49:101686. [DOI: 10.1016/j.ctcp.2022.101686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/30/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022]
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