Rehabilitation of patients with primary breast cancer: assessing the impact of adjuvant therapy

Medication adherence skills training for African-American breast cancer survivors: the effects on health literacy, medication adherence, and self-efficacy

There are gaps in research regarding medication adherence, self-efficacy in proper medication adherence, and health literacy among breast cancer survivors. This pilot randomized controlled study was conducted to provide information addressing health literacy with respect to medication adherence and self-efficacy in African American breast cancer survivors. The study sample consisted of an intervention group (n = 24) of medication adherence skills training (MST) and a control group (n = 24), with a total sample population of 48 participants. The MST workshop was a collaborative intervention between pharmacy and social work and was designed to address issues that may be encountered while taking multiple medications for various acute and chronic conditions, increase participant confidence in accessing necessary resources for improved medication usage, and enhance personal self-efficacy regarding health care. A statistically significant relationship was detected between initial health literacy and medication adherence, as well as initial health literacy and self-efficacy. These findings indicated that individuals with higher health literacy were more likely to have higher levels of self-efficacy and were more likely to adhere to medication instructions. Analysis of the intervention and treatment groups did not show a statistically significant effect on health literacy, medication adherence, or self-efficacy from pre-test to post-test.

A pilot randomized study of skills training for African American cancer survivors

This study tested the efficacy of a psychosocial group intervention for African American breast cancer survivors based on the Cancer Survival Toolbox with the specific aim of decreasing distress and improving aspects of psychosocial functioning and quality of life. This pilot study utilized a randomized, repeated measures, experimental design. The study sample (N = 71) consisted of an intervention group (n = 23) of cancer survival skills training for 6 weeks and a control group (n = 48). The study could not confirm that cancer skills training in a psychoeducational group setting had a positive effect on decreasing stress or improving aspects of psychosocial functioning and quality of life.

Coping skills among African-American breast cancer survivors

Women with a diagnosis of breast cancer, particularly African-American women, face multiple barriers to survival. Although research exists regarding the unique barriers faced by African-American breast cancer survivors, there has been little research into the various coping needs or coping strategies used among African-American women. The purpose of this article is to provide information from an exploratory study of data investigating the coping skills of 30 African-American women diagnosed and treated for breast cancer. Quantitative data was collected via a self-report questionnaire based on the pretest of the Breast Cancer Survivors Toolbox. The study sample was evaluated to determine overall coping skills followed by an analysis of individual categories of coping skills (e.g., communication, information seeking, negotiating, social support systems, cultural norms). Although limited by the non-random sampling technique and self-report, the results of the study support the need for further research regarding the use of interventions and strategies tailored to improve coping skills used by this population.

Impact of surgery and chemotherapy on the quality of life of younger women with breast carcinoma: a prospective study

BACKGROUND

Studies that prospectively and simultaneously evaluate, within the first year of diagnosis, the impact of surgery and chemotherapy on quality of life (QOL) of younger women (60 years or younger) with early stage breast carcinoma are limited.

METHODS

Quality of life of 103 women who had surgery (lumpectomy, 49; mastectomy, 54) approximately 1 month before the start of the study was evaluated at baseline and again after 5 months. Thirty-two women received chemotherapy during the study.

RESULTS

Over time, subjects reported improvement in body image and physical, emotional, and functional well-being (P < 0.001). They were less bothered by swollen/tender arms and worried less about risk of cancer to family members (P < 0.001). However, satisfaction with sex life, social support, and social/family well-being declined (P < 0.001). In the period closer to surgery, women with mastectomy reported poorer body image (P = 0.001) and worse functional (P = 0.08) and physical well-being (P = 0.10). Women with lumpectomy worried more about the effects of stress on their illness (P < 0.01) and had lower emotional well-being (P = 0.06). By 6 months after surgery, the two groups reported similar QOL scores. Chemotherapy had a negative impact on women's sexual functioning (P = 0.01) and their physical well-being (P = 0.09). Women who received chemotherapy also reported more shortness of breath (P = 0.07). Post hoc analysis showed that women with breast reconstruction had higher emotional well-being at baseline than those with lumpectomy (P = 0.001) and mastectomy alone (P < 0.01).

CONCLUSIONS

Younger women with breast carcinoma could experience a range of adjustment problems at various points in the treatment cycle. Interventions that would help reduce the negative impact of treatment on QOL need to be designed and integrated into routine clinical practice.

A comparison of two quality-of-life questionnaires for cancer clinical trials: the functional living index--cancer (FLIC) and the quality of life questionnaire core module (QLQ-C30)

Choosing a measure instrument for a study raises the question of whether instruments designed for the same purpose produce the same results. We investigated this question for two instruments designed to measure subjective quality of life (QOL) in cancer clinical trials: the Functional Living Index-Cancer (FLIC) and the Quality of Life Questionnaire Core module (QLQ-C30). These were administered concurrently to 98 cancer patients. Four patient groups were defined: (1) well, no chemotherapy (n = 23); (2) adjuvant chemotherapy (n = 24); (3) stable disease, active chemotherapy (n = 24); (4) progressive disease (n = 27). Both instruments have global, role, social, emotional, pain, and nausea scales; QLQ-C30 also assesses physical function, cognitive function, and fatigue, while FLIC assesses hardship. Correlation analysis indicated convergent validity for the global, role, emotional, pain and nausea dimensions, but not the social dimension. Both instruments indicated that groups 1 and 2 had better QOL than group 4 in at least one dimension. However, different dimension-specific results meant that qualitatively different conclusions would have been drawn if either instrument had been used singly: FLIC indicated that group 1 had better role function that group 4 and suffered less hardship and that group 1 suffered less nausea than group 3, while the QLQ-C30 data indicated that group 2 had better physical function than group 4. The only consistent result was for pain: both instruments indicated group 4 had more pain than either groups 1 or 2. Thus the choice of QOL instrument for use in a particular trial will affect both the results and conclusions. It is important, therefore, to consider carefully which instrument is most likely to detect important differences relevant to the patients' lives in that setting.

Communication between patients with breast cancer and health care providers. Determinants and implications

BACKGROUND

This study evaluated the perceptions of patients with breast cancer of their medical interactions with providers. The determinants and psychological consequences of communication problems also were examined.

METHODS

Ninety-seven patients with Stage I or II breast cancer completed a set of validated questionnaires before initiating postoperative therapy. Data on psychological distress were collected at baseline and 3-month follow-up, and multivariate models were fit to explain the relationship between pretreatment communication problems and subsequent psychological distress. Data on clinical variables were abstracted from medical records.

RESULTS

A substantial proportion of patients (84%) reported difficulties communicating with the medical team. Communication problems were more common among patients who were less optimistic about their disease and had less assertive coping styles. Patient-reported communication problems were associated with increased anxiety, depression anger, and confusion at the 3-month follow-up. The association between communication problems and mood disturbance remained significant, although small, after adjusting for baseline mood disturbance, demographic, clinical, and coping style variables.

CONCLUSION

Interventions that enhance communication between patients with breast cancer and their providers may improve patients' psychological adjustment to treatment. Conversely, interventions that lower distress and modify coping style may enhance communication.

CAncer Rehabilitation Evaluation System--short form (CARES-SF). A cancer specific rehabilitation and quality of life instrument

The CAncer Rehabilitation Evaluation System (CARES) (CARES Consultants, Santa Monica, CA) a rehabilitation and quality of life instrument with well-documented reliability and validity, has been shortened. This report describes the development and psychometric properties of the new instrument, the CAncer Rehabilitation Evaluation System--Short Form (CARES-SF). The data from four existing samples of cancer patients demonstrate that the CARES-SF is highly related to the CARES (r = 0.98), has excellent test-retest reliability (86% agreement), concurrent validity with related measures, and acceptable internal consistency of summary scales (alpha = 0.85 to 0.61). In a new sample of breast cancer patients evaluated at three points in time (1 month, 7 months, and 13 months after diagnosis) the instrument appears to be sensitive to change and is highly related to the Functional Living Index--Cancer (FLIC), an existing quality of life instrument. The authors conclude that the CARES-SF has excellent potential as a quality of life instrument for use in clinical trials.

Breast cancer: psychosocial consequences for the patient

Women with breast cancer experience various psychosocial problems throughout the continuum of the disease. The psychosocial impact and adjustment of women with breast cancer during the phases of pretreatment, primary treatment, adjuvant therapy, recurrence, and advanced disease have numerous implications for nursing practice and research.

Assessing the quality of life--a study in newly-diagnosed breast cancer patients

Quality of life (QL) assessment is an increasingly important component of clinical research, especially with cancer patients. The literature strongly supports the view that QL should be assessed by the patient rather than the clinician. While clinical parameters such as performance status or toxicity ratings may bear some relationship to QL, they are not a substitute for its measurement. In spite of these observations, clinicians have been reluctant to accept the need for patient-rated measures of QL. In this paper, data from a sample of 109 newly-diagnosed breast cancer patients were used to examine the relationship between expert-rated measures and a patient-rated measure of QL; to determine whether the Cancer Rehabilitation Evaluation System (CARES), an instrument for assessing the rehabilitation needs of cancer patients, is a measure of QL; to explore whether there are any medical, social or demographic variables which the clinician can use to predict how patients assess their QL; and to determine which variables (expert-rated scales, medical, social or demographic variables, or rehabilitation needs) have the most effect on how patients evaluate their QL. In this sample, patient ratings of QL were widely distributed and were only moderately correlated with the expert-rated Karnofsky Performance Status (r = 0.53) and Global Adjustment to Illness Scale (r = 0.59). In addition, there were no significant correlations between important clinical variables (axillary node status, type of surgery, receipt of chemotherapy) and patient-rated QL. Among the clinical variables and instruments studied, the Global CARES score demonstrated the best correlation (r = -0.74) with the patient-rated assessment of QL. A stepwise multiple linear regression procedure was performed with QL as the dependent variable in order to identify which factors accounted for the most variance in patient assessment of QL. The potential predictor variables used in this procedure were chosen from among those that would be available to a clinician. The Global CARES score was the best single predictor of QL, accounting for 55% of the variance, followed by Karnofsky Performance Status, the Medical Interaction and Sexual summary scales of the CARES, and the patient's educational status. Data from the CARES provided additional descriptive information about the type and frequency of rehabilitation problems experienced by these patients in relation to their ratings of QL.(ABSTRACT TRUNCATED AT 400 WORDS)