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Abd Elazim NE, Awad SM, El-Naggar MS, Mohamed RH. Topical Ectoin Versus Topical Dexpanthenol for Managing Acute Radiodermatitis Associated With Breast Cancer Radiotherapy: A Randomized Double-Blind Study. Dermatitis 2023; 34:516-524. [PMID: 37792331 DOI: 10.1089/derm.2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background: Radiodermatitis is a common side effect of breast cancer radiotherapy; however, there is no current consensus regarding an effective standard therapy. Objective: To evaluate the efficacy of topical ectoin versus dexpanthenol in the management of acute radiodermatitis after breast cancer radiotherapy. Methods: Fifty patients randomly used dexpanthenol 5% cream (25 patients), or ectoin 7% cream (25 patients), applied twice daily to the irradiated area during and for 2 weeks after radiotherapy. The study was stratified by the radiotherapy schedule and was double-blind. Radiodermatitis grade, radiation-associated symptoms, and adverse events were assessed weekly during radiotherapy and 2 weeks thereafter. Skin-related quality of life (QOL) scores were measured using the Skindex-16 questionnaire. Results: Both agents were effective in preventing severe radiodermatitis (≥G3). Ectoin had a lower radiodermatitis grade level than dexpanthenol, with a significant difference at week 2 (P = 0.008). Radiation-associated pain (P = 0.003) and itching (P = 0.001) were lower with ectoin than dexpanthenol. Side effects were not significantly different between the 2 treatments (P = 0.107). Ectoin showed less QOL impairment than dexpanthenol. The radiation schedule was an independent predictor for radiodermatitis persistence. Conclusion: Ectoin showed some clinical benefit over dexpanthenol in improving radiation dermatitis and the radiation schedule is a predictor of radiodermatitis persistence.
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Affiliation(s)
- Nagwa E Abd Elazim
- From the Department of Dermatology, Venereology and Andrology, Assiut University Hospital, Assiut, Egypt
| | - Sara M Awad
- From the Department of Dermatology, Venereology and Andrology, Assiut University Hospital, Assiut, Egypt
| | - Maha S El-Naggar
- Department of Clinical Oncology and Nuclear Medicine, Assiut University Hospital, Assiut, Egypt
| | - Rania H Mohamed
- From the Department of Dermatology, Venereology and Andrology, Assiut University Hospital, Assiut, Egypt
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Wang J, Zhou B, Yang X, Tridandapani S, Lin J, Torres MA, Liu T. Ultrasound-Based Grading System for Radiation-Induced Acute Breast Toxicity. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1307-1317. [PMID: 36583524 DOI: 10.1002/jum.16144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/11/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To introduce an ultrasound-based scoring system for radiation-induced breast toxicity and test its reliability. METHODS Breast ultrasound (BUS) was performed on 32 patients receiving breast radiotherapy (RT) to assess the radiation-induced acute toxicity. For each patient, both the untreated and irradiated breasts were scanned at five locations: 12:00, 3:00, 6:00, 9:00, and tumor bed to evaluate for heterogenous responses to radiation within the entire breast. In total, 314 images were analyzed. Based on ultrasound findings such as skin thickening, dermis boundary irregularity, and subcutaneous edema, a 4-level, Likert-like grading scheme is proposed: none (G0), mild (G1), moderate (G2), and severe (G3) toxicity. Two ultrasound experts graded the severity of breast toxicity independently and reported the inter- and intra-observer reliability of the grading system. Imaging findings were compared with standard clinical toxicity assessments using Common Terminology Criteria for Adverse Events (CTCAE). RESULTS The inter-observer Pearson correlation coefficient (PCC) was 0.87 (95% CI: 0.83-0.90, P < .001). For intra-observer repeatability, the PCC of the repeated scores was 0.83 (95% CI: 0.78-0.87, P < .001). Imaging findings were compared with standard clinical toxicity assessments using CTCAE scales. The PCC between BUS scores and CTCAE results was 0.62 (95% CI: 0.35-0.80, P < .001). Among all locations, 6:00 and tumor bed showed significantly greater toxicity compared with 12:00 (P = .04). CONCLUSIONS BUS can investigate the cutaneous and subcutaneous tissue changes after RT. This BUS-based grading system can complement subjective clinical assessments of radiation-induced breast toxicity with cutaneous and subcutaneous sonographic information.
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Affiliation(s)
- Jing Wang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Boran Zhou
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Srini Tridandapani
- Department of Radiology, University of Alabama, Birmingham, Alabama, USA
| | - Jolinta Lin
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Mylin A Torres
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Tian Liu
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
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Gao Y, Rosas JC, Fink H, Behrens S, Chang-Claude J, Seibold P. Longitudinal changes of health-related quality of life over 10 years in breast cancer patients treated with radiotherapy following breast-conserving surgery. Qual Life Res 2023:10.1007/s11136-023-03408-y. [PMID: 37093543 PMCID: PMC10393846 DOI: 10.1007/s11136-023-03408-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] [Accepted: 03/16/2023] [Indexed: 04/25/2023]
Abstract
PURPOSES The study intended to (1) assess changes of health-related quality of life (HRQoL) between early treatment-related time points and 10 years post-treatment in a cohort of breast cancer (BC) patients who received radiotherapy (RT), (2) to evaluate differences in HRQoL between long-term BC survivors and unaffected women from the same geographical region and (3) to identify determinants of long-term HRQoL in the survivor cohort. METHODS 292 BC patients were recruited prior to RT after breast-conserving surgery between 1998 and 2001 in Germany and prospectively followed up for a median of 11.4 years (range 10.3-12.8 years). HRQoL was assessed using EORTC QLQ-C30 at pre-RT (baseline), during RT, 6 weeks after RT, and at the 10-year follow-up. Changes in mean HRQoL scores over time were assessed using linear-mixed models. HRQoL in long-term survivors and controls was compared using Wilcoxon rank-sum test, stratified by age groups. Multivariable linear regression models were used to identify determinants for HRQoL in long-term BC survivors. RESULTS Compared to baseline level (mean summary score of 64.9), global health status/quality of life (GHS/QoL) declined during RT (62.4) and improved 6 weeks after RT (69.9) before decreasing to baseline level at the 10-year follow-up (66.7). Most functional domains deteriorated or remained stable at 10 years post-diagnosis compared to post-RT scores, except for role functioning which improved, while dyspnea and diarrhea significantly deteriorated between those two time points. There were no significant differences in long-term GHS/QoL between BC survivors 10 years post-RT and controls for all age groups (p > 0.05). However, deficits in specific HRQoL domains such as emotional burden, sleep problems or fatigue were found to more strongly affect survivors, in particular those younger than 65 years, compared to controls. In the determinant analysis, being overweight was associated with lower GHS/QoL and physical functioning, while living with others was found to be associated with better physical functioning, and decreased dyspnea and pain levels. Certain comorbidities such as depression had a strong association with multiple HRQoL domains, including lower GHS/QoL and functioning as well as a higher level of fatigue, pain, sleep/intestinal problems, and financial difficulties. Side effects such as lymphedema/pain and fibrosis were associated with worse physical and social functioning, respectively. CONCLUSION The long-term GHS/QoL remained comparable when compared with the control population while restrictions in certain functional and symptoms domains in long-term BC survivors persisted over 10 years, in particular among younger survivors. Targeted screening to identify cancer survivors at risk for psychosocial/other impairment accounting also for comorbidities and treatment side effects may be warranted in long-term aftercare to address unmet health needs.
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Affiliation(s)
- Yifeng Gao
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Juan C Rosas
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
| | - Hanna Fink
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69221, Heidelberg, Germany.
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Köksal M, Hoppe C, Schröder AK, Scafa D, Koch D, Sarria GR, Leitzen C, Abramian A, Kaiser C, Faridi A, Henkenberens C, Schmeel LC, Giordano FA. Decision regret in breast cancer patients after adjuvant radiotherapy. Breast 2023; 68:133-141. [PMID: 36758448 PMCID: PMC9939714 DOI: 10.1016/j.breast.2023.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Breast cancer patients often engage in shared decision-making to select an individualized treatment regimen from multiple options. However, dissatisfaction with treatment outcomes can lead to decision regret. We evaluated decision regret and physical and psychological well-being among breast cancer patients who underwent adjuvant radiotherapy and explored their associations with patient, tumor, treatment, and symptom characteristics. METHODS This cross-sectional study involved retrospectively obtaining clinical data and data collected through interviews carried out as part of regular long-term medical aftercare. Decision regret regarding the radiotherapy was assessed using the Ottawa Decision Regret Scale, physical and psychological well-being were assessed using the PROMIS Global Health-10 questionnaire, and patients were asked about their treatment outcomes and symptoms. The questionnaire was administered 14 months to 4 years after completion of radiotherapy. RESULTS Of the 172 included breast cancer patients, only 13.9% expressed high decision regret, with most patients expressing little or no decision regret. More decision regret was associated with volumetric modulated arc therapy, chest wall irradiation, use of docetaxel as a chemotherapy agent, lymphangiosis carcinomatosa, new heart disease after radiotherapy, and lower psychological well-being. CONCLUSION Although most patients reported little or no decision regret, we identified several patient, treatment, and symptom characteristics associated with more decision regret. Our findings suggest that psychological well-being influences patients' satisfaction with therapy decisions, implying that practitioners should pay special attention to maintaining psychological well-being during shared decision-making and ensuring that psychological assessment and treatment is provided after cancer therapy to deal with long-term effects of radiotherapy.
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Affiliation(s)
- Mümtaz Köksal
- Department of Radiation Oncology, University Medical Center Bonn (UKB), Bonn, Germany.
| | - Clara Hoppe
- Department of Radiation Oncology, University Medical Center Bonn (UKB), Bonn, Germany
| | | | - Davide Scafa
- Department of Radiation Oncology, University Medical Center Bonn (UKB), Bonn, Germany
| | - David Koch
- Department of Radiation Oncology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Christina Leitzen
- Department of Radiation Oncology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Alina Abramian
- Department of Senology and Breast Center, University Medical Center Bonn (UKB), Bonn, Germany
| | - Christina Kaiser
- Department of Senology and Breast Center, University Medical Center Bonn (UKB), Bonn, Germany
| | - Andree Faridi
- Department of Senology and Breast Center, University Medical Center Bonn (UKB), Bonn, Germany
| | - Christoph Henkenberens
- Department of Radiation Oncology, Harzklinikum Dorothea Christiane Erxleben, Wernigerode, Germany
| | - Leonard C Schmeel
- Department of Radiation Oncology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim (UMM), Mannheim, Germany
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Psychosocial Interventions for the Treatment of Cancer-Related Fatigue: An Umbrella Review. Curr Oncol 2023; 30:2954-2977. [PMID: 36975439 PMCID: PMC10047125 DOI: 10.3390/curroncol30030226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/04/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Cancer-related fatigue is one of the most common symptoms of cancer and one of those referred by patients as the most disabling. However, we still do not have enough evidence to allow us to recommend effective and personalized approaches. Goal: To provide evidence on the efficacy of ASCO-recommended psychosocial interventions for reducing cancer-related fatigue. Methodology: A general quantitative systematic review for nonprimary clinical interventions that allows the collection, synthesis and analysis of already published reviews. Systematic reviews of RTCs were selected as these make up the body of knowledge that provides the most evidence in an umbrella format. The results do not provide clear or comparable evidence regarding the different interventions, with moderate evidence standing out for cognitive interventions and mindfulness. Conclusions: Research gaps, study biases and the need for further research to ask more precise questions and to make reliable recommendations to mitigate the impact of cancer-related fatigue are evident.
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Braudy R, Atoms B, Coghlan J, Staples M, Moga D, Tollefsrud R, Lawrence RL, Ludewig P, Koehler L. Shoulder Kinematics of Axillary Web Syndrome in Women Treated for Breast Cancer. Arch Phys Med Rehabil 2023; 104:403-409. [PMID: 36202228 DOI: 10.1016/j.apmr.2022.09.014] [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: 03/15/2022] [Revised: 08/29/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To better understand how the shoulder moves in breast cancer survivors with axillary web syndrome (AWS), we compared 3-dimensional (3D) shoulder kinematics during shoulder elevation among breast cancer survivors with and without AWS 5 years postoperatively. Although research consistently shows decreased shoulder range of motion with AWS, we do not understand the underlying biomechanics. DESIGN Nested case control study. SETTING University Academic Breast Center. PARTICIPANTS Twenty-five women who had surgery 5 years previously for unilateral breast cancer with the removal of at least 1 lymph node participated in this study (N=25). Twelve participants had AWS; 13 women did not have AWS. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Three-dimensional shoulder kinematic data during shoulder forward flexion, scapular plane abduction, and coronal plane abduction were collected using 3D electromagnetic motion tracking. Kinematic data were extracted at 30°, 60°, 90°, and 120° of arm elevation for scapular upward rotation, internal rotation, and posterior tilt as well as for glenohumeral external rotation. RESULTS Women with AWS demonstrated 15.2° less scapular upward rotation at 120° humerothoracic elevation (95% confidence interval [-25.2, -5.2], P=.005), regardless of plane. No significant between-group differences were found for any other angle of scapular upward rotation, nor for scapular internal rotation, scapular posterior tilt, or glenohumeral axial rotation at any angle. CONCLUSIONS Five years after surgery for breast cancer, women diagnosed with AWS have altered scapulohumeral kinematics that may place them at an increased risk of shoulder pain based on existing kinematic literature in healthy cohorts. This information can help guide rehabilitation programs for breast cancer survivors to facilitate pain-free upper extremity function after treatment.
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Affiliation(s)
- Renata Braudy
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN.
| | - Brittany Atoms
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Jenna Coghlan
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Meaghan Staples
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - David Moga
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Ryan Tollefsrud
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Rebekah L Lawrence
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Paula Ludewig
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN; Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
| | - Linda Koehler
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN; Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN
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Ahmadsei M, Christ SM, Seiler A, Vlaskou Badra E, Willmann J, Hertler C, Guckenberger M. Quality-of-life and toxicity in cancer patients treated with multiple courses of radiation therapy. Clin Transl Radiat Oncol 2022; 34:23-29. [PMID: 35313618 PMCID: PMC8933336 DOI: 10.1016/j.ctro.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Multiple repeat radiotherapy courses are used more frequently. Prediction of tolerability, quality of life and toxicity remains a challenge. Patients treated with a minimum of five radiotherapies show a stable quality of life. Yet, fatigue and low levels of hemoglobin and lymphocytes are long-term side effects.
Background Treatment of metastatic cancer patients with multiple repeat courses of radiotherapy has become more frequent due to their improved overall survival. However, very little is known about their long-term outcome. This analysis reports on the quality-of-life, hematologic toxicity, patient-reported experiences and satisfaction, and psychological distress of cancer patients treated with multiple repeat radiotherapy. Methods All patients treated with ≥5 courses of radiotherapy between 2011 and 2019 at the Department of Radiation Oncology, University Hospital Zurich (USZ) were screened for this study. A course of radiotherapy was defined as all treatment sessions to one anatomical site under one medical indication. All patients completed two questionnaires: EORTC QLQ-C30 questionnaire for quality-of-life and a questionnaire evaluating psychological distress and patient-reported experiences. Hematologic toxicities were assessed via a recent blood sample. Results Of n = 33 patients treated with ≥5 radiotherapy courses and being alive, 20 (60.6%) participated in this study. The most common primary tumor was non-small cell lung cancer (n = 14, 42.4%). The most common sites of irradiation were brain (n = 78, 37.1%) and bone metastases (n = 59, 28.1%). All participating patients reported that they had experienced a subjective benefit from multiple repeat radiotherapy and denied increased side effects in later radiotherapy courses. Yet, 45% (n = 9) of the patients reported an increase of psychological distress with increasing numbers of radiotherapy treatments. While global health status was stable, patients having received multiple repeat radiotherapy reported increased fatigue (p = <0.006). Blood analysis showed significantly reduced hemoglobin and lymphocyte levels compared to the healthy population (p = <0.03). Discussion and conclusion Patient-reported experiences and satisfaction of long-term cancer patients treated with multiple repeat radiotherapy are positive. However, increased levels of fatigue and significantly reduced hemoglobin and lymphocyte levels were observed. These data indicate the need to further investigate the effects of multiple courses of radiotherapy in chronic cancer patients.
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Lam E, Wong G, Karam I, Zhang L, Lou J, McCurdy-Franks E, Razvi Y, McKenzie E, Chow E. Impact of adjuvant breast radiotherapy on patient-reported fatigue. Support Care Cancer 2021; 30:1283-1291. [PMID: 34468825 DOI: 10.1007/s00520-021-06521-1] [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: 03/02/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Breast cancer patients receiving adjuvant radiotherapy (RT) benefit from local control. However, RT can give rise to increased fatigue, lowering quality of life. The aim of this study was to prospectively identify trends and risk factors in patient-reported fatigue associated with breast RT. MATERIAL AND METHODS Patients were assessed using the Edmonton Symptom Assessment Scale (ESAS) before, once per week during RT, up to 6 weeks after RT completion, and 1-3 months post RT. Patients were included in the analysis if the ESAS was completed before, at least once during, and at least once after RT. RESULTS A total of 651 patients were included. Fatigue scores increased significantly during weeks 1-3 (p < 0.001) and weeks 5-6 (p < 0.0001) during RT compared to baseline. After RT completion, fatigue scores did not change significantly compared to baseline. Mastectomy patients who received previous chemotherapy experienced significantly more fatigue compared to mastectomy patients without previous chemotherapy (p = 0.0002). Patients less than 50 (p = 0.002), 50-59 (p = 0.007), or 60-69 (p = 0.048) years of age at RT start were more likely to have higher proportions of moderate or severe fatigue compared to patients ≥ 70 years of age. CONCLUSIONS Fatigue associated with breast irradiation increased up to 6 weeks during RT and returned to near baseline scores at 1-3 months post treatment. Given that fatigue was significant in mastectomy patients, further research is needed to reduce fatigue among this cohort, especially those who have received previous chemotherapy and younger patients who are receiving breast RT.
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Affiliation(s)
- Emily Lam
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Gina Wong
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Irene Karam
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Yasmeen Razvi
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Erin McKenzie
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Edward Chow
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. .,Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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Management of breast cancer: an overview for therapeutic radiographers. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920000011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:The management of breast cancer patients from diagnosis to treatment and beyond can be variable depending on factors including tumour extent and location, histology, genetics, health and wellbeing of the patient as well as personal patient preferences. The therapeutic radiographer’s role is not only vital to ensure safe and accurate radiotherapy delivery but also crucially, as the regular patient interface, they must be fully empowered to engage effectively with all aspects of the patient care pathway. They must be knowledgeable and up to date with evidence-based practices relating to the patient experience including surgery, chemotherapy, endocrine therapy and radiotherapy.Aim:The aim of this paper is to outline the breast cancer management pathway, highlighting the potential side effects that occur as a result of breast radiotherapy treatment and concomitant treatment in order to inform therapeutic radiographers and best practice.Discussion:The treatment pathway for breast cancer patients varies greatly depending on a wide range of factors and is very much individualised for each patient. Each treatment modality has its advantages and disadvantages, and all come with a number of side effects that can affect a patient’s daily living. Toxicities can arise during radiotherapy treatment or months after treatment, and education regarding the management of these is essential for effective patient care. Many technological advances in radiotherapy treatment techniques and regimes have the potential to decrease radiation-induced side effects. Despite attempts to standardise clinical guidelines on the use of topical agents and dressings, historical opinions and ideas are still evident in clinical practice. The use of grading systems in radiotherapy tends to only record patients’ physical symptoms and not their holistic wellbeing and emotional needs.Conclusion:Therapeutic radiographers must ensure that they remain equipped with the skills and knowledge to correctly manage and/or signpost services effectively. This overall outline of the management of patients with breast cancer is designed to help therapeutic radiographers reflect on the current practices and to inspire them, where evidence dictates, to seize opportunities, to explore improvement and to enhance best practice.
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10
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Ettridge K, Caruso J, Roder D, Prichard I, Scharling-Gamba K, Wright K, Miller C. A randomised online experimental study to compare responses to brief and extended surveys of health-related quality of life and psychosocial outcomes among women with breast cancer. Qual Life Res 2020; 30:407-423. [PMID: 32990882 DOI: 10.1007/s11136-020-02651-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Collecting patient-reported outcomes is important in informing the well-being of women with breast cancer. Consumer perceptions are important for successful implementation of monitoring systems, but are rarely formally assessed. We compared reactions to two different surveys (assessing psychosocial outcomes and/or Health-related Quality of Life (HrQoL) outcomes) among Australian women with breast cancer. METHODS Women (18 + years) within 5 years diagnosis of breast cancer were randomly allocated to complete one of two online surveys: (i) minimum HrQoL measures or (ii) minimum HrQoL measures plus psychosocial outcomes (body image, depression, anxiety stress, fear of cancer recurrence, decisional difficulties and unmet need). Participants completed questions regarding their perceptions of the survey, including qualitative feedback. RESULTS Data were available for 171 participants (n(i) = 89; n(ii) = 82), with 92% (n = 158) providing 95-100% complete data. Perceptions were comparable between survey groups, and high (80-100%) regarding time burden, ease of completion, comprehensible, appropriateness and willingness to participate again and moderately high (67-74%) regarding willingness to answer more questions and relevance. Qualitative feedback indicated gaps across both surveys, including financial/work-related issues, satisfaction with information and care, need for nuanced questions, and impact of side effects/treatment, and from the minimum set only, emotional well-being and support. Impairment in some HrQoL and psychosocial outcomes were observed among participants. CONCLUSIONS Assessment of HrQoL and psychosocial outcomes was well received by consumers. Results alleviate concern regarding possible patient burden imposed by longer more in-depth surveys. The importance placed on assessment brevity should not outweigh the need to assess outcomes that consumers consider important.
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Affiliation(s)
- Kerry Ettridge
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia.
| | - Joanna Caruso
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia
| | - David Roder
- University of South Australia, Adelaide, SA, Australia
| | - Ivanka Prichard
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Katrine Scharling-Gamba
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia
| | - Kathleen Wright
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia
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11
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Ramseier JY, Ferreira MN, Leventhal JS. Dermatologic toxicities associated with radiation therapy in women with breast cancer. Int J Womens Dermatol 2020; 6:349-356. [PMID: 33898697 PMCID: PMC8060663 DOI: 10.1016/j.ijwd.2020.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/24/2020] [Accepted: 07/29/2020] [Indexed: 12/24/2022] Open
Abstract
Breast-conserving surgery with adjuvant radiation therapy has become the standard of care for women with early stage breast cancer, and as a result, a large number of patients are affected by the cutaneous sequelae of radiation therapy. These dermatologic toxicities may present during treatment or years later and can significantly impact patients’ quality of life. In this review, we discuss the clinical presentation, prevention, and management of radiation-induced cutaneous toxicities in women with breast cancer, including radiation dermatitis, radiation recall, radiation-induced morphea, radiation-induced fibrosis, and cutaneous malignancies in irradiated skin.
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Affiliation(s)
- Julie Y Ramseier
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Michelle N Ferreira
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Jonathan S Leventhal
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
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12
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Kowalczyk L, Deutschmann C, Crevenna R, Konrad S, Singer CF, Farr A. Radiotherapy-Induced Fatigue in Breast Cancer Patients. Breast Care (Basel) 2020; 16:236-242. [PMID: 34248464 DOI: 10.1159/000509410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
Background A large proportion of breast cancer patients who undergo adjuvant radiotherapy suffer from radiotherapy-induced fatigue. The possible causative factors of this specific side effect are diverse. Summary Prevalence, duration, and severity of radiotherapy-induced fatigue are dependent on the type of radiotherapy, as well as on the irradiated volume, dose scheme, on the number of radiation fields, the combination with other treatments, diurnal rhythm, smoking, and time-to-hospitalization. Recommended treatments include non-pharmacologic interventions, such as physical and psychosocial interventions. Pharmacologic therapies include treatment with methylphenidate and modafinil. In addition to its early detection with standardized instruments, adequate education to breast cancer patients about risks and predisposing factors of radiotherapy-induced fatigue is essential. Multidimensional strategies help to maintain the patients' quality of life and therefore guarantee treatment adherence and efficacy. Key Messages Radiotherapy-induced fatigue is an underreported, underdiagnosed, and undertreated side effect. This review provides an overview of radiotherapy-induced fatigue in breast cancer patients receiving adjuvant radiotherapy.
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Affiliation(s)
- Lidia Kowalczyk
- Clinical Unit of Anesthesiology and Perioperative Intensive-Care Medicine, University of Veterinary Medicine, Vienna, Austria
| | - Christine Deutschmann
- Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Konrad
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
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Quality of life after breast-conserving therapy and adjuvant radiotherapy for non-low-risk ductal carcinoma in situ (BIG 3-07/TROG 07.01): 2-year results of a randomised, controlled, phase 3 trial. Lancet Oncol 2020; 21:685-698. [PMID: 32203696 DOI: 10.1016/s1470-2045(20)30085-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND BIG 3-07/TROG 07.01 is an international, multicentre, randomised, controlled, phase 3 trial evaluating tumour bed boost and hypofractionation in patients with non-low-risk ductal carcinoma in situ following breast-conserving surgery and whole breast radiotherapy. Here, we report the effects of diagnosis and treatment on health-related quality of life (HRQOL) at 2 years. METHODS The BIG 3-07/TROG 07.01 trial is ongoing at 118 hospitals in 11 countries. Women aged 18 years or older with completely excised non-low-risk ductal carcinoma in situ were randomly assigned, by use of a minimisation algorithm, to tumour bed boost or no tumour bed boost, following conventional whole breast radiotherapy or hypofractionated whole breast radiotherapy using one of three randomisation categories. Category A was a 4-arm randomisation of tumour bed boost versus no boost following conventional whole breast radiotherapy (50 Gy in 25 fractions over 5 weeks) versus hypofractionated whole breast radiotherapy (42·5 Gy in 16 fractions over 3·5 weeks). Category B was a 2-arm randomisation between tumour bed boost versus no boost following conventional whole breast radiotherapy, and category C was a 2-arm randomisation between tumour bed boost versus no boost following hypofractionated whole breast radiotherapy. Stratification factors were age at diagnosis, planned endocrine therapy, and treating centre. The primary endpoint, time to local recurrence, will be reported when participants have completed 5 years of follow-up. The HRQOL statistical analysis plan prespecified eight aspects of HRQOL, assessed by four questionnaires at baseline, end of treatment, and at 6, 12, and 24 months after radiotherapy: fatigue and physical functioning (EORTC QLQ-C30); cosmetic status, breast-specific symptoms, arm and shoulder functional status (Breast Cancer Treatment Outcome Scale); body image and sexuality (Body Image Scale); and perceived risk of invasive breast cancer (Cancer Worry Scale and a study-specific question). For each of these measures, tumour bed boost was compared with no boost, and conventional whole breast radiotherapy compared with hypofractionated whole breast radiotherapy, by use of generalised estimating equation models. Analyses were by intention to treat, with Hochberg adjustment for multiple testing. This trial is registered with ClinicalTrials.gov, NCT00470236. FINDINGS Between June 1, 2007, and Aug 14, 2013, 1208 women were enrolled and randomly assigned to receive no tumour bed boost (n=605) or tumour bed boost (n=603). 396 of 1208 women were assigned to category A: conventional whole breast radiotherapy with tumour bed boost (n=100) or no boost (n=98), or to hypofractionated whole breast radiotherapy with tumour bed boost (n=98) or no boost (n=100). 447 were assigned to category B: conventional whole breast radiotherapy with tumour bed boost (n=223) or no boost (n=224). 365 were assigned to category C: hypofractionated whole breast radiotherapy with tumour bed boost (n=182) or no boost (n=183). All patients were followed up at 2 years for the HRQOL analysis. 1098 (91%) of 1208 patients received their allocated treatment, and most completed their scheduled HRQOL assessments (1147 [95%] of 1208 at baseline; 988 [87%] of 1141 at 2 years). Cosmetic status was worse with tumour bed boost than with no boost across all timepoints (difference 0·10 [95% CI 0·05-0·15], global p=0·00014, Hochberg-adjusted p=0·0016); at the end of treatment, the estimated difference between tumour bed boost and no boost was 0·13 (95% CI 0·06-0·20; p=0·00021), persisting at 24 months (0·13 [0·06-0·20]; p=0·00021). Arm and shoulder function was also adversely affected by tumour bed boost across all timepoints (0·08 [95% CI 0·03-0·13], global p=0·0033, Hochberg adjusted p=0·045); the difference between tumour bed boost and no boost at the end of treatment was 0·08 (0·01 to 0·15, p=0·021), and did not persist at 24 months (0·04 [-0·03 to 0·11], p=0·29). None of the other six prespecified aspects of HRQOL differed significantly after adjustment for multiple testing. Conventional whole breast radiotherapy was associated with worse body image than hypofractionated whole breast radiotherapy at the end of treatment (difference -1·10 [95% CI -1·79 to -0·42], p=0·0016). No significant differences were reported in the other PROs between conventional whole breast radiotherapy compared with hypofractionated whole breast radiotherapy. INTERPRETATION Tumour bed boost was associated with persistent adverse effects on cosmetic status and arm and shoulder functional status, which might inform shared decision making while local recurrence analysis is pending. FUNDING National Health and Medical Research Council, Susan G Komen for the Cure, Breast Cancer Now, OncoSuisse, Dutch Cancer Society.
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Kindts I, Laenen A, van den Akker M, Weltens C. PROMs following breast-conserving therapy for breast cancer: results from a prospective longitudinal monocentric study. Support Care Cancer 2019; 27:4123-4132. [DOI: 10.1007/s00520-019-04698-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 02/11/2019] [Indexed: 11/12/2022]
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Psychological Support. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-52619-5_114-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Sosin M, Gupta SS, Wang JS, Costellic CD, Gulla A, Bartholomew AJ, O'Neill SC, Hechenbleikner EM, Collins BT, Rudra S, Collins SP, Chaldekas KM, Seevaratnam S, Langan RC, Willey SC, Tousimis EA. A Prospective Analysis of Quality of Life and Toxicity Outcomes in Treating Early Breast Cancer With Breast Conservation Therapy and Intraoperative Radiation Therapy. Front Oncol 2018; 8:545. [PMID: 30560085 PMCID: PMC6287037 DOI: 10.3389/fonc.2018.00545] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 11/05/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction: Intraoperative radiation therapy (IORT) is a minimally invasive radiation option for select patients with early stage breast cancer. This prospective, single institution, pilot study summarizes patient-reported quality of life (QoL) outcomes and clinician-reported toxicity following IORT following breast conservation therapy. Methods: Forty-nine patients were enrolled in a prospective study from 2013 until 2015 to assess QoL and toxicity following breast conservation therapy and IORT. Nine patients did not meet criteria for IORT alone on final pathology and required whole breast irradiation afterwards. These patients were evaluated separately. Validated QoL questionnaires were provided to patients at 1-week, 1-month, and subsequent 6-month intervals for 2 years. Radiation-related toxicity symptoms were evaluated by clinicians at the same time intervals. Likert scale responses were converted to continuous variables to depict patient-reported and clinician-reported outcomes. Results: Outcomes were analyzed as weighted averages of the Likert scale for each symptom. Responses for negative QoL symptoms ranged largely from 0 (none) to 2 (moderate). Responses for positive QoL symptoms ranged largely from 3 (quite a bit) to 4 (very much). Seventy-five percent of patients developed a toxicity; however, 99% of the toxicities were grades 1 and 2. All toxicities demonstrated a downward trend over time, with the exception of breast fibrosis and nodularity, which increased over time. There were no local recurrences upon 2-year follow up. Conclusion: Early stage breast cancer treated with IORT yields favorable QoL outcomes and minimal toxicity profiles with adequate short-term local control.
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Affiliation(s)
- Michael Sosin
- Department of Surgery, Division of Breast Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Surupa Sen Gupta
- Department of Surgery, Division of Breast Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Jessica S Wang
- Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Corinne D Costellic
- Department of Surgery, Division of Breast Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Aiste Gulla
- Department of Surgery, Division of Breast Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Alex J Bartholomew
- Department of Surgery, Division of Breast Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Suzanne C O'Neill
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, United States
| | - Elizabeth M Hechenbleikner
- Department of Surgery, Division of Breast Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Brian T Collins
- Department of Radiation Medicine, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Sonali Rudra
- Department of Radiation Medicine, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Sean P Collins
- Department of Radiation Medicine, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Krysta M Chaldekas
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, United States
| | - Sulakshana Seevaratnam
- Department of Surgery, Division of Breast Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Russell C Langan
- Department of Surgery, Division of Breast Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Shawna C Willey
- Department of Surgery, Division of Breast Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
| | - Eleni A Tousimis
- Department of Surgery, Division of Breast Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
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Abrahams H, Gielissen M, Verhagen C, Knoop H. The relationship of fatigue in breast cancer survivors with quality of life and factors to address in psychological interventions: A systematic review. Clin Psychol Rev 2018; 63:1-11. [DOI: 10.1016/j.cpr.2018.05.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 12/24/2022]
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Prospective study of shoulder strength, shoulder range of motion, and lymphedema in breast cancer patients from pre-surgery to 5 years after ALND or SLNB. Support Care Cancer 2018; 26:3277-3287. [PMID: 29651594 DOI: 10.1007/s00520-018-4186-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 03/28/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Determine the changes in shoulder strength, shoulder range of motion, and arm volume in breast cancer patients treated with sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) METHOD: Sixty-eight SLNB and 44 ALND patients were followed up from pre-surgery to 5 years after surgery. Primary outcomes were the differences between affected and non-affected sides for the following: shoulder strength measured by dynamometry, shoulder range of motion measured by goniometry, and lymphedema measured by volume. As a secondary outcome, health-related quality of life (HRQL) was assessed by the Short Form-36 Health Survey (SF-36) and the Functional Assessment of Cancer Therapy for breast cancer (FACT-B+4) questionnaires. Changes over time were tested for SLNB and ALND using univariate repeated measures analysis of variance. Generalized estimating equation models were constructed to assess the effect of SLNB and ALND over time. RESULTS After 5 years, the ALND group had significant loss of strength for internal rotators (1.39 kg, p = 0.001) and significant arm volume increase (132.45 mL, p = 0.031). The ALND group had a greater number of patients with clinically relevant internal rotator strength loss (38.7 vs. 13.6%, p = 0.012) and a greater number of lymphedema requiring treatment (33.3 vs. 3.4%, p < 0.001) than the SLNB group. A loss of strength for shoulder external rotators, shoulder range of motion, and HRQL in physical and arm domains persisted at 5 years in both SLNB and ALND groups. CONCLUSION These results could help understand and plan the prevention, needs, and long-term care of breast cancer patients.
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Habibullah G, Gul R, Cassum S, Elahi R. Experiences of the Breast Cancer Patients Undergoing Radiotherapy at a Public Hospital Peshawar Pakistan. Asia Pac J Oncol Nurs 2018; 5:184-194. [PMID: 29607379 PMCID: PMC5863428 DOI: 10.4103/apjon.apjon_70_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective This study aimed to explore the experiences of female breast cancer patients undergoing radiotherapy (RT) in a public hospital in Peshawar, Pakistan. Methods This study employed a descriptive exploratory method. A purposive sample of 14 breast cancer women undergoing RT was selected for this study. Data were collected over the period of 5 months, using a semi-structured interview guide and conducting in-depth face-to-face interviews. These interviews were audio taped and transcribed by a bilingual transcriber. The translated version of the interview was coded, and the analysis was done manually. Results Four main categories emerged from data analysis, which were: feelings and perceptions of the patients, their challenges, coping strategies, and teaching and informational needs. Conclusions Women undergoing RT in this culture experience more intense psychological effects, as compared to the physical effects. Keeping in mind, the magnitude of the emotional stress experienced by the participants, recommendations for policy reforms, and training for female RT staff are suggested based on findings of this research.
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Affiliation(s)
| | - Raisa Gul
- Shifa College of Nursing, Tameer-e-Millat University, Islamabad, Pakistan
| | - Shanaz Cassum
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Rehana Elahi
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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Montgomery GH, Sucala M, Dillon MJ, Schnur JB. Cognitive-Behavioral Therapy Plus Hypnosis for Distress During Breast Radiotherapy: A Randomized Trial. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2017; 60:109-122. [PMID: 28891772 DOI: 10.1080/00029157.2017.1335635] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Radiotherapy is a common and effective treatment for women with breast cancer. However, radiotherapy has also been shown to adversely affect patients' emotional well-being. Currently, few mind-body interventions are designed to improve patients' quality of life during radiotherapy. One intervention which has demonstrated clinical efficacy in the breast cancer radiotherapy setting is Cognitive-Behavioral Therapy plus Hypnosis. The goal of this study was to investigate the impact of Cognitive-Behavioral Therapy plus Hypnosis on emotional distress in women with breast cancer undergoing radiotherapy. One hundred patients were randomly assigned to either the Cognitive-Behavioral Therapy plus Hypnosis (n = 50) or Attention Control (n = 50) group. Results revealed significant benefits of Cognitive-Behavioral Therapy plus Hypnosis on emotional distress at the mid-point (d = 0.54), the conclusion (d = 0.64), and 4 weeks following the conclusion (d = 0.65) of radiotherapy (all ps < 0.05). In summary, results support further study of Cognitive-Behavioral Therapy plus Hypnosis as an evidence-based intervention to reduce emotional distress in women with breast cancer. Cognitive-Behavioral Therapy plus Hypnosis has the benefits of being brief, noninvasive, lacking side-effects, and producing beneficial effects which last beyond the conclusion of radiotherapy. Given these strengths, we propose that Cognitive-Behavioral Therapy plus Hypnosis is a strong candidate for greater dissemination and implementation in cancer populations.
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Lee TS, Morris CM, Czerniec SA, Mangion AJ. Does Lymphedema Severity Affect Quality of Life? Simple Question. Challenging Answers. Lymphat Res Biol 2017; 16:85-91. [PMID: 28453410 DOI: 10.1089/lrb.2016.0049] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Lymphedema can have a negative impact on the function and quality of life (QOL) of patients, but most studies have examined lymphedema as a binary variable, rather than a multidimensional disease that ranges in severity. This study explored the potential impact of lymphedema severity on function and overall QOL. METHODS AND RESULTS Of the 54 lymphedema patients recruited, 40 reported their most severe swelling to be in a limb. These participants underwent bioimpedance measurement (L-Dex®) and completed either the disabilities of the arm, shoulder, and hand (DASH) questionnaire or the lower extremity functional scale (LEFS). All participants completed the lymphedema quality of life questionnaire (LYMQOL) and were categorized for severity using International Society of Lymphology (ISL) stage. Mild (Stage 0-I), moderate (Stage IIa), and severe (Stage IIb-III) lymphedema accounted for 22%, 50%, and 28% of the participants, respectively. The median [inter-quartile range (IQR)] L-Dex score was 17.8 (6.6-52.7) for arm participants and 36.4 (15.9-93.5) for leg participants. Apart from a mild difference in LYMQOL ARM Appearance domain (p = 0.046), ISL staging did not have any relationship with DASH, LEFS, and LYMQOL domains, or overall QOL. Higher L-Dex was related to poorer function (DASH p = 0.015; LEFS p = 0.019), but was not related to overall QOL of limb lymphedema participants (p > 0.05). CONCLUSIONS Lymphedema severity did not appear to impact QOL. ISL staging may not be used alone to describe lymphedema severity. Other methods such as bioimpedance, imaging, and self-report of symptoms are required to fully evaluate the impact of lymphedema severity on function and QOL.
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Affiliation(s)
- Teresa S Lee
- 1 Northern Sydney Cancer Centre, Royal North Shore Hospital , St Leonards, Australia .,2 Melanoma Institute Australia , North Sydney, Australia .,3 University of Sydney , Sydney, Australia
| | - Carol M Morris
- 1 Northern Sydney Cancer Centre, Royal North Shore Hospital , St Leonards, Australia .,2 Melanoma Institute Australia , North Sydney, Australia
| | | | - Andrea J Mangion
- 5 Lymphedema Education and Training Institute , Sydney, Australia
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Lipsett A, Barrett S, Haruna F, Mustian K, O'Donovan A. The impact of exercise during adjuvant radiotherapy for breast cancer on fatigue and quality of life: A systematic review and meta-analysis. Breast 2017; 32:144-155. [DOI: 10.1016/j.breast.2017.02.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/25/2017] [Accepted: 02/01/2017] [Indexed: 11/26/2022] Open
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Muszalik M, Kołucka-Pluta M, Kędziora-Kornatowska K, Robaczewska J. Quality of life of women with breast cancer undergoing radiotherapy using the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire. Clin Interv Aging 2016; 11:1489-1494. [PMID: 27799754 PMCID: PMC5076547 DOI: 10.2147/cia.s113530] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Breast cancer is one of the most common cancers in women, particularly among older women. This illness along with its treatment has a great impact on a woman's subjective opinion of her quality of life and functioning in everyday life. The aim of this research was to assess the quality of life in women undergoing radiotherapy for the treatment of breast cancer. PATIENTS AND METHODS The research was carried out in 120 patients with breast cancer undergoing radiotherapy in the Oncological Center in Bydgoszcz, Poland. Among the 120 examined patients, there were 30 women aged between 20-50 years and the remaining were over 50 years of age, including 42 women over the age of 60. Demographic and clinical data were collected and the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire (version 4) was used to assess health-related quality of life (HRQOL) of the patients. Statistical analyses were conducted using Statistica, version 10.0. RESULTS Patients with breast cancer undergoing radiotherapy rated their quality of life with an average of 113.83 points. Older patients above 71 years of age also displayed significantly higher HRQOL (122.70 points). A lower level of fatigue was noticed among patients ≤50 years and ≥71 years of age. Education and marital status also had an important impact on HRQOL. Educated women with a good financial situation had a significantly higher HRQOL, compared to those with a lower education and in poor living conditions. CONCLUSION HRQOL and state of fatigue in breast cancer patients treated with radiotherapy depended upon their age. Both were high among women aged 71 years and above, while younger patients (51-70 years of age) had slightly lower values. Results suggest that sociodemographic factors influence the conditions of life of women treated with radiotherapy for breast cancer in a significant way. Overall, patients tolerated this type of treatment well.
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Affiliation(s)
- Marta Muszalik
- Department and Clinic of Geriatrics, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz
| | | | | | - Joanna Robaczewska
- Department and Clinic of Geriatrics, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz
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Quantification of patient-reported outcome measures of radiation-induced skin reactions for use in clinical trial design. Support Care Cancer 2016; 25:67-74. [PMID: 27554211 DOI: 10.1007/s00520-016-3376-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Skin toxicity is a common effect from radiotherapy, although difficult to predict on an individual basis, and there is little evidence-based management. This study aimed to quantify inter-patient variation in patient-reported outcome measures for radiation-induced skin reactions (RISR) to enable the determination of the number of patients required for adequate power in a comparative trial of RISR management strategies. METHODS The study included 154 patients scheduled to receive breast cancer radiotherapy. Patients filled in a weekly questionnaire during and up to 4 weeks following the end of radiotherapy scoring five aspects of their experience of RISR: skin redness, and bother from redness like itching, burning sensation and tenderness/pain. RESULTS Assessment of patients' reported experience of their RISR was shown to be feasible, with 91 % of patients returning at least two questionnaires. The mean score increase between weeks 1 and 4 was 25 points (p value <0.0001, 95 % CI 21-29), and the estimated standard deviation at 4 weeks was 18 (95 % CI 16-21). CONCLUSIONS Patients' assessment of their reaction was not predicted on the basis of treatment and patient-related characteristics. Based on the observed variance in scores at 4 weeks, we could calculate the sample size required for a comparative study of two RISR management policies would be 200 patients to have statistical power to detect a clinically significant difference in patient-rated scores of their skin reactions. A trial employing this tool would help provide an evidence base to guide policy in advising patients how to manage their RISR.
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Finkel MA, Cooper BT, Li X, Fenton-Kerimian M, Goldberg JD, Formenti SC. Quality of Life in Women Undergoing Breast Irradiation in a Randomized, Controlled Clinical Trial Evaluating Different Tumor Bed Boost Fractionations. Int J Radiat Oncol Biol Phys 2016; 95:579-89. [DOI: 10.1016/j.ijrobp.2016.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/09/2015] [Accepted: 02/01/2016] [Indexed: 01/22/2023]
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Haddou Rahou B, El Rhazi K, Ouasmani F, Nejjari C, Bekkali R, Montazeri A, Mesfioui A. Quality of life in Arab women with breast cancer: a review of the literature. Health Qual Life Outcomes 2016; 14:64. [PMID: 27117705 PMCID: PMC4847355 DOI: 10.1186/s12955-016-0468-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 04/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background Quality of life has become an important concept in cancer care. Among the quality of lifestudies in cancer patients, breast cancer has received most attention. This review reports on quality of life in Arab patients with breast cancer. Methods The search was conducted using inclusion and exclusion criteria and in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases consulted were PubMed, Sciences Direct, Index Medicus for Wordl Health Organization Eastern Mediterranean, African Journals Online and African Index Medicus. Results Thirteen articles from eight countries met the inclusion criteria. The EORTC quality of life questionnaires (QLQ-C30 and QLQ-BR23) were the most used instrument (7 out of 13). The results showed that good scores of global health were recorded at Arab women living in United Arab Emirates (mean score = 74.6) compared to other countries. The results indicated that there was a difference in quality of life scores and its associated factors among Arab women with breast cancer. Conclusion This paper is the first that reviewed published research on quality of life among Arab women with breast cancer. We found that insufficient results-related information is available. Electronic supplementary material The online version of this article (doi:10.1186/s12955-016-0468-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bouchra Haddou Rahou
- Laboratory of Genetic, Neuroendocrinology and Biotechnology, University Ibn Tofail, Faculty of Sciences, Kenitra, Morocco.
| | - Karima El Rhazi
- Department of Epidemiology and Public Health, Faculty of Medicine and pharmacy of Fez, Sidi Mohamed Ben Abdillah University, Sidi Mohamed Ben Abdillah, Morocco
| | - Fatima Ouasmani
- Laboratory of Genetic, Neuroendocrinology and Biotechnology, University Ibn Tofail, Faculty of Sciences, Kenitra, Morocco
| | - Chakib Nejjari
- Department of Epidemiology and Public Health, Faculty of Medicine and pharmacy of Fez, Sidi Mohamed Ben Abdillah University, Sidi Mohamed Ben Abdillah, Morocco
| | - Rachid Bekkali
- Fondation Lalla Salma Prevention and Treatment of Cancers, Rabat, Morocco
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Abdelhalem Mesfioui
- Laboratory of Genetic, Neuroendocrinology and Biotechnology, University Ibn Tofail, Faculty of Sciences, Kenitra, Morocco
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Arraras JI, Manterola A, Asin G, Illarramendi JJ, Cruz SDL, Ibañez B, Delfrade J, Salgado E, Zarandona U, Cambra K, Vera R, Dominguez MA. Quality of life in elderly patients with localized breast cancer treated with radiotherapy. A prospective study. Breast 2016; 26:46-53. [PMID: 27017241 DOI: 10.1016/j.breast.2015.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/12/2015] [Accepted: 12/17/2015] [Indexed: 11/12/2022] Open
Abstract
PURPOSE There is a debate on the role of adjuvant Radiotherapy (RT) in elderly breast cancer patients. The aim is to study Quality of Life (QL) throughout the treatment and follow-up periods in early stages breast cancer patients who have started radiotherapy, and to compare the QL of axillary surgery groups. METHODS 173 patients, ≥65 years completed the EORTC QLQ-C30 and QLQ-BR23, and the Interview for Deterioration in Daily Living Activities in Dementia(IDDD) questionnaires three times throughout treatment and follow-up periods. Linear mixed effect models were used to evaluate longitudinal changes in QL, and whether these changes differed among axillary surgery groups. RESULTS QL scores were high (>70/100 points) in most QL areas, with moderate limitations (>30) in sexual functioning and enjoyment, future perspective and global QL. In six areas there was a decline at the RT sessions end, that after 6 weeks was recovered. For three areas, there was an improvement in the follow-up measurement compared to the previous assessments. Changes in seven areas were <5 points. Axillary node dissection patients had a body image decrease (6 points) in the follow up period. The lymphadenectomy group had more fatigue (10 points, p = 0.078) than the other two axillary surgery groups. CONCLUSIONS Results orientate towards good patients' adaptation to their disease and treatments, and to administering RT in early stages breast cancer patients. QL differences between the axillary surgery groups and in their evolutions were few but have appeared in key QL areas.
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Affiliation(s)
- Juan Ignacio Arraras
- Complejo Hospitalario de Navarra, Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain; Complejo Hospitalario de Navarra, Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain.
| | - Ana Manterola
- Complejo Hospitalario de Navarra, Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Gemma Asin
- Complejo Hospitalario de Navarra, Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Jose Juan Illarramendi
- Complejo Hospitalario de Navarra, Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Susana de la Cruz
- Complejo Hospitalario de Navarra, Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Berta Ibañez
- Fundación Miguel Servet-NavarraBiomed, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Irunlarrea 3, 31008 Pamplona, Spain
| | - Josu Delfrade
- Instituto Salud Pública, CIBER Salud Pública, Leyre 3, 31003 Pamplona, Spain
| | - Esteban Salgado
- Complejo Hospitalario de Navarra, Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Uxue Zarandona
- Complejo Hospitalario de Navarra, Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain; Complejo Hospitalario de Navarra, Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Koldo Cambra
- Fundación Miguel Servet-NavarraBiomed, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Irunlarrea 3, 31008 Pamplona, Spain
| | - Ruth Vera
- Complejo Hospitalario de Navarra, Medical Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
| | - Miguel Angel Dominguez
- Complejo Hospitalario de Navarra, Radiotherapeutic Oncology Department, Irunlarrea 3, 31008 Pamplona, Spain
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Kashaf MS, McGill E. Does Shared Decision Making in Cancer Treatment Improve Quality of Life? A Systematic Literature Review. Med Decis Making 2015; 35:1037-48. [DOI: 10.1177/0272989x15598529] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/22/2015] [Indexed: 11/15/2022]
Abstract
Background. The growing consensus espousing the use of shared decision making (SDM) in cancer treatment has coincided with the rise of health care evaluation paradigms that emphasize quality of life (QOL) as a central outcome measure. This review systematically examines the association between treatment SDM and QOL outcomes in cancer. Methods. A range of bibliographic databases and gray literature sources was searched. The search retrieved 16,726 records, which were screened by title, abstract, and full text to identify relevant studies. The review included 17 studies with a range of study designs and populations. Data were extracted on study methods, participants, setting, study or intervention description, outcomes, main findings, secondary findings, and limitations. Quality appraisal was used, in conjunction with a narrative approach, to synthesize the evidence. Results. The review found weak, but suggestive, evidence for a positive association between perceived patient involvement in decision making, a central dimension of SDM, and QOL outcomes in cancer. The review did not find evidence for an inverse association between SDM and QOL. The poor methodological quality and heterogeneity of the extant literature constrained the derived conclusions. In addition, the literature commonly treated various subscales of QOL instruments as separate outcomes, increasing the probability of spurious findings. Conclusions. There is weak evidence that aspects of shared decision-making approaches are positively associated with QOL outcomes and very little evidence of a negative association. The extant literature largely assessed patient involvement, only capturing one aspect of the shared decision-making construct, and is of poor quality, necessitating robust studies examining the association.
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Affiliation(s)
- Michael Saheb Kashaf
- Johns Hopkins University School of Medicine, Baltimore, MD (MSK)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK (EM)
| | - Elizabeth McGill
- Johns Hopkins University School of Medicine, Baltimore, MD (MSK)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK (EM)
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Wennman-Larsen A, Petersson LM, Saboonchi F, Alexanderson K, Vaez M. Consistency of breast and arm symptoms during the first two years after breast cancer surgery. Oncol Nurs Forum 2015; 42:145-55. [PMID: 25806881 DOI: 10.1188/15.onf.145-155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the severity and development of breast and arm symptoms separately during the two years following breast cancer surgery, and to examine whether previously defined predictors of arm symptoms are associated with breast symptoms. DESIGN Prospective cohort study with two-year follow-up. SETTING Three institutions in the Stockholm, Sweden, region. SAMPLE 645 women, aged 20-63 years, enrolled within 12 weeks of surgery for primary breast cancer. METHODS Baseline register and questionnaire data with five follow-ups were submitted to descriptive, inferential, and logistic regression analysis. MAIN RESEARCH VARIABLES Severity of breast and arm symptoms measured by the European Organisation for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire. FINDINGS Most participants had undergone breast-conserving
surgery and sentinel lymph node dissection, and were scheduled for postoperative radiation therapy. Overall mean levels of breast and arm symptoms were low, but with large individual variations. At all six time points, the mean levels of breast symptoms were significantly higher than those of arm symptoms. Overall, the mean level of both types of symptoms decreased during follow-up. A body mass index (BMI) of 25 or greater and breast symptoms at eight months were associated with having breast symptoms at two years. Arm symptoms at baseline and at eight months, and radiation therapy and a BMI of 25 or greater were associated with having arm symptoms at two years. CONCLUSIONS Breast symptoms show different patterns of change and are not associated with the same factors as arm symptoms. IMPLICATIONS FOR NURSING For nurses monitoring women treated for breast cancer, the results of this study provide knowledge regarding the importance of early symptom identification and long-term symptoms after treatment.
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Reis D, Walsh ME, Young-McCaughan S, Jones T. Effects of Nia exercise in women receiving radiation therapy for breast cancer. Oncol Nurs Forum 2014; 40:E374-81. [PMID: 23989030 DOI: 10.1188/13.onf.e374-e381] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To compare a 12-week nontraditional exercise Nia program practiced at home to usual care on fatigue, quality of life (QOL), aerobic capacity, and shoulder flexibility in women with breast cancer undergoing radiation therapy. DESIGN Randomized clinical trial. SETTING Large community-based hospital in the midwestern United States. SAMPLE 41 women with stage I, II, or III breast cancer starting radiation therapy. METHODS 22 women were randomized to the Nia group and 19 to the usual care group. Those in the Nia group were instructed to practice Nia 20-60 minutes three times per week for 12 weeks. Those in the usual care group were instructed to continue normal activities. MAIN RESEARCH VARIABLES Fatigue, QOL, aerobic capacity, and shoulder flexibility. FINDINGS Controlling for baseline scores, change over time between groups was significantly different for the women who practiced Nia at least 13 times during the 12-week period; those in the Nia intervention reported significantly less fatigue between weeks 6 and 12, as compared to control group (p = 0.05). No statistical differences in QOL, aerobic capacity, or shoulder flexibility were found, but trends favoring Nia were identified. CONCLUSIONS For women undergoing radiation therapy for breast cancer, Nia can help relieve fatigue. Additional research in arm and shoulder mobility and preservation also may be beneficial. IMPLICATIONS FOR NURSING Oncology nurses are in a unique position to offer suggestions to help manage fatigue, and Nia could be considered as part of a cancer survivorship program. KNOWLEDGE TRANSLATION Exercise is beneficial for women with breast cancer, and interest is growing in nontraditional exercise options. Nia can benefit women with breast cancer undergoing radiation therapy.
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Affiliation(s)
- Debra Reis
- ProMedica Cancer Institute, Sylvania, OH
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Akça M, Ata A, Nayır E, Erdoğdu S, Arıcan A. Impact of Surgery Type on Quality of Life in Breast Cancer Patients. THE JOURNAL OF BREAST HEALTH 2014; 10:222-228. [PMID: 28331675 PMCID: PMC5351519 DOI: 10.5152/tjbh.2014.1919] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 07/13/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Breast cancer can lead to alterations in quality of life of the patients. The aim of this study is to evaluate the changes in quality of life of the female patients who had undergone surgical treatment for breast cancer. MATERIALS AND METHODS A total of 250 female patients (breast-preserving surgery (BPS), n=27, 11%; modified radical mastectomy (MRM), n=194, 77%, and simple mastectomy (SM), n=29; 11%) aged between 28-55 years (47.4±6.4 yrs) were included in the study. Patient information, demographic characteristics, income, and treatment modalities applied were recorded. Validated Turkish versions of EORTC QLQ-C30, and EORTC-BR23 questionnaires were used for all patients. RESULTS Breast-preserving surgery has a more favorable impact on general well-being, physical role, cognitive, psychological, and social functions, and symptom scale scores. When the identical parameters were taken into consideration, relatively favorable outcomes of BPS on the patients were observed relative to mastectomized patients. Besides, though not statistically significant, BPS has more patient-friendly effects on sexual function and sexual satisfaction in comparison with mastectomy. Patients with advanced stage disease and elder patients had more unfavorable health related quality of life (HRQoL) scores than younger patients, and those in their early stages of breast cancer. CONCLUSION Quality of life of BPS patients is less adversely affected relative to mastectomized patients. In the decision-making process, quality of life should be taken into consideration.
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Affiliation(s)
- Mustafa Akça
- Department of Internal Medicine, Mersin University, Faculty of Medicine, Mersin, Turkey
| | - Alper Ata
- Clinic of Medical Oncology, Mersin State Hospital, Mersin, Turkey
| | - Erdinç Nayır
- Department of Medical Oncology, Mersin University, Faculty of Medicine, Mersin, Turkey
| | - Süleyman Erdoğdu
- Department of Medical Oncology, Mersin University, Faculty of Medicine, Mersin, Turkey
| | - Ali Arıcan
- Department of Medical Oncology, Mersin University, Faculty of Medicine, Mersin, Turkey
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Hofsø K, Bjordal K, Diep LM, Rustøen T. The relationships between demographic and clinical characteristics and quality of life during and after radiotherapy: in women with breast cancer. Qual Life Res 2014; 23:2769-77. [PMID: 24952109 DOI: 10.1007/s11136-014-0736-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this longitudinal study was to investigate quality of life (QOL) before, during, and after the course of radiotherapy (RT) and to identify risk factors for diminished QOL in women with breast cancer. METHODS Patients (N = 188) completed the short-form 12 (SF-12), the Karnofsky Performance Status Scale, Memorial Symptom Assessment Scale, and the Self-Administrated Comorbidity Questionnaire 1 week prior to the start of RT. To assess changes in QOL, patients also completed the SF-12 1, 2, 3, and 6 months after the baseline. A random-intercept and slope model (mixed model) for each patient was used to estimate linear trends for the mental component score and physical component score of QOL (five time points for each patient). Descriptive statistics were used to analyze demographic and clinical characteristics. RESULTS The physical component score (PCS) did not change significantly (p = 0.078) during the course of RT in women with breast cancer. An increase in the number of symptoms and a higher comorbidity profile was negatively related to the PCS. The mental component score (MCS) did not change from the start of RT until the 2-month assessment, but increased significantly after 2 months (p = 0.044). An increase in the number of symptoms was negatively related to the MCS. CONCLUSION The MCS and PCS of QOL remained stable at a diminished level except for the MCS which improved between 2 and 6 months after the start of RT. The total number of symptoms was the only variable that was negatively associated with both component scores (MCS and PCS) during the 6 months.
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Affiliation(s)
- Kristin Hofsø
- Centre for Shared Decision Making and Collaborative Research, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, 0424, Oslo, Norway,
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Montgomery GH, David D, Kangas M, Green S, Sucala M, Bovbjerg DH, Hallquist MN, Schnur JB. Randomized controlled trial of a cognitive-behavioral therapy plus hypnosis intervention to control fatigue in patients undergoing radiotherapy for breast cancer. J Clin Oncol 2014; 32:557-63. [PMID: 24419112 DOI: 10.1200/jco.2013.49.3437] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The objective of this study was to test the efficacy of cognitive-behavioral therapy plus hypnosis (CBTH) to control fatigue in patients with breast cancer undergoing radiotherapy. We hypothesized that patients in the CBTH group receiving radiotherapy would have lower levels of fatigue than patients in an attention control group. PATIENTS AND METHODS Patients (n = 200) were randomly assigned to either the CBTH (n = 100; mean age, 55.59 years) or attention control (n = 100; mean age, 55.97 years) group. Fatigue was measured at four time points (baseline, end of radiotherapy, 4 weeks, and 6 months after radiotherapy). Fatigue was measured using the Functional Assessment of Chronic Illness Therapy (FACIT) -Fatigue subscale and Visual Analog Scales (VASs; Fatigue and Muscle Weakness). RESULTS The CBTH group had significantly lower levels of fatigue (FACIT) at the end of radiotherapy (z, 6.73; P < .001), 4-week follow-up (z, 6.98; P < .001), and 6-month follow-up (z, 7.99; P < .001) assessments. Fatigue VAS scores were significantly lower in the CBTH group at the end of treatment (z, 5.81; P < .001) and at the 6-month follow-up (z, 4.56; P < .001), but not at the 4-week follow-up (P < .07). Muscle Weakness VAS scores were significantly lower in the CBTH group at the end of treatment (z, 9.30; P < .001) and at the 6-month follow-up (z, 3.10; P < .02), but not at the 4-week follow-up (P < .13). CONCLUSION The results support CBTH as an evidence-based intervention to control fatigue in patients undergoing radiotherapy for breast cancer. CBTH is noninvasive, has no adverse effects, and its beneficial effects persist long after the last intervention session. CBTH seems to be a candidate for future dissemination and implementation.
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Affiliation(s)
- Guy H Montgomery
- Guy H. Montgomery, Daniel David, Sheryl Green, Madalina Sucala, and Julie B. Schnur, Icahn School of Medicine at Mount Sinai, New York, NY; Daniel David and Madalina Sucala, Babeş-Bolyai University, Cluj-Napoca, Romania; Maria Kangas, Macquarie University, Sydney, New South Wales, Australia; Dana H. Bovbjerg, University of Pittsburgh Cancer Institute, University of Pittsburgh; and Michael N. Hallquist, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
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Im EO, Rendell MO, Chang SJ, Chee E. Predictors of Quality of Life in Cancer Survivors: White and Asian American Women. WOMEN & THERAPY 2014; 37:282-300. [PMID: 26052175 DOI: 10.1080/02703149.2014.897554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The purpose of this study is to compare the pathways through which multiple contextual factors influence the quality of life in Asian American and White women living with cancer. This is a secondary analysis of the data from 95 Asian American women and 113 White women. The data were analyzed using hierarchical multiple regression analyses and structural equation modeling. Multiple factors explained higher percent of total variances of the quality of life scores in Whites compared with that in Asian Americans.
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Affiliation(s)
- Eun-Ok Im
- School of Nursing, The University of Pennsylvania
| | | | - Sun Ju Chang
- School of Nursing, The University of Pennsylvania
| | - Eunice Chee
- School of Engineering, the University of Pennsylvania
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Alcântara-Silva TRDM, Freitas-Junior R, Freitas NMA, Machado GDP. Fatigue related to radiotherapy for breast and/or gynaecological cancer: a systematic review. J Clin Nurs 2013; 22:2679-86. [PMID: 23651041 DOI: 10.1111/jocn.12236] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2012] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To assess the profile, evaluation criteria and fatigue treatment. BACKGROUND Fatigue, characterised by tiredness, weakness or lack of energy, involves physical, cognitive and emotional aspects. Its aetiology is not well defined and the prevalence ranges from 30-70% in women with breast cancer, reaching up to 80% when they are undergoing radiotherapy. This is one of the most frequent side effects of radiotherapy, and it may interfere with self-esteem, social activities and quality of life. DESIGN Literature systematic review. METHODS A search for studies published from 2000-2010 was carried out in Pubmed, Scielo and Bireme databases, using the descriptors fatigue and radiotherapy and their correlates in Portuguese. RESULTS We selected 12 articles of 1085 found. The number of studies involving breast cancer was higher than those related to gynaecological cancer. Functional Assessment of Cancer Therapy-Fatigue was the most used scale specifically for the evaluation of fatigue. Pretreatment fatigue level may be an important risk factor to aggravate it during radiotherapy and decrease the quality of life. Five studies proposed interventions, all of them involving nonpharmacological therapies: cognitive-behavioural therapy associated with hypnosis, moderate-intensity physical exercises, stretching programmes, yoga and polarity therapy. The studies showed good results in relation to fatigue, physical and psychological aspects, and quality of life. CONCLUSION Early detection of fatigue, using appropriate scales, is relevant to propose suitable treatments and achieve better clinical conditions, adherence and continuity of radiotherapy treatment, aiming to ensure more effective responses. RELEVANCE TO CLINICAL PRACTICE Fatigue is a frequent symptom in patients undergoing radiotherapy. It may become a factor that limits or prevents the continuity of radiotherapy and therefore should be diagnosed in the initial appointments, so that it can be properly treated.
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Kaptein AA, Yamaoka K, Snoei L, van der Kloot WA, Inoue K, Tabei T, Kroep JR, Krol-Warmerdam E, Ranke G, Meirink C, Does A, Nortier H. Illness perceptions and quality of life in Japanese and Dutch women with breast cancer. J Psychosoc Oncol 2013; 31:83-102. [PMID: 23311973 DOI: 10.1080/07347332.2012.741092] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Knowledge on cross-cultural quality of life (QOL) and illness perceptions may help women with breast cancer cope more effectively. The self regulation model (SRM) guided the current exploratory longitudinal pilot-study. Central to SRM is the perception of health threats and their effects on QOL. Illness perceptions and QOL were assessed in 22 Dutch and 21 Japanese patients with breast cancer who filled out questionnaires before, 1 week, and 8 weeks after the first chemotherapy course. The questionnaires assessed QOL and illness perceptions. Patients' scores were compared with groups of patients with other chronic somatic illnesses (asthma, diabetes). Patients in both samples reported major impact of chemotherapy on global health status, physical functioning, role functioning, emotional functioning, constipation and diarrhea. Differences between Japanese and Dutch patients were limited to social functioning and financial problems. Japanese patients expressed stronger concerns about their illness than Dutch patients. Results of the Japanese and Dutch patients with breast cancer differed from data in patients with asthma on consequences, timeline, concern and emotional response. Results of Japanese patients differed from patients with type 2 diabetes on timeline and concern, whereas Dutch patients differed on timeline and consequences. Japanese and Dutch breast cancer patients have-overall-similar illness perceptions and QOL responses and are aware of the typical characteristics of their disease. The results support the feasibility of cross-cultural psychosocial research in oncology and offer implications for clinical interventions which impact on self-efficacy to empower patients with breast cancer.
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Affiliation(s)
- Adrian A Kaptein
- Medical Psychology, Leiden University Medical Centre, Leiden, The Netherlands.
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Santos DED, Rett MT, Mendonça ACR, Bezerra TS, Santana JMD, Silva Júnior WMD. Efeito da radioterapia na função pulmonar e na fadiga de mulheres em tratamento para o câncer de mama. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000100009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O presente estudo comparou a função pulmonar e a fadiga de mulheres antes e após a radioterapia (RT) adjuvante para tratamento do câncer de mama, e correlacionou a função pulmonar com a dose de radiação e fadiga. Foi conduzido um estudo observacional longitudinal envolvendo 20 mulheres. A função pulmonar foi avaliada pela espirometria (ClementClarke®) e manovacuometria (GlobalMed®, modelo MVD 300), e a fadiga pelo Functional Assessment of Cancer Therapy Fatigue (FACT-F). Todas as avaliações foram realizadas antes da primeira sessão e uma semana após o término da RT adjuvante. Para a análise estatística foram utilizados os testes Wilcoxon Signed Rank Test e correlação de Spearman, adotando-se nível de significância p<0,05. Na espirometria, encontrou-se redução significativa da capacidade vital forçada (23,52%), do volume expiratório forçado no primeiro segundo (26,23%) e do pico de fluxo expiratório (10,12%) (p=0,001). As pressões expiratórias e inspiratórias máximas também diminuíram significativamente (25,45 e 32,92%, respectivamente). Observou-se diminuição significativa do bem-estar físico e do bem-estar funcional, e um aumento significativo da fadiga no FACT-F (p=0,001). Não foram observadas correlações entre as variáveis da função pulmonar com a dose de radiação e fadiga. Em curto prazo, a RT promoveu redução na função pulmonar, mas a mesma permaneceu próxima à normalidade para a amostra estudada. Observou-se aumento significativo da fadiga e diminuição dos escores dos domínios bem-estar físico e funcional.
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Sickness absence in relation to breast and arm symptoms shortly after breast cancer surgery. Breast 2013; 22:767-72. [PMID: 23411122 DOI: 10.1016/j.breast.2013.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 12/19/2012] [Accepted: 01/18/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To determine whether and, to what extent, breast and arm symptoms are associated with sick leave (SL) shortly after breast cancer (BC) surgery, and to investigate the associations of these symptoms and different surgical procedures with SL, adjusting for age and work posture. Women (n = 511), aged 26-63 years, who worked ≥ 75% before a BC diagnosis, were included within 12 weeks of surgery. RESULTS 31% reported breast symptoms and 22% arm symptoms; and, of these, 47% reported both. Having strenuous work postures increased the OR for being on SL most (OR 2.60), followed by breast symptoms (OR 2.40), more extensive axillary (OR 2.24) or breast surgery (OR 2.13), and arm symptoms (OR 2.06). CONCLUSIONS Breast and arm symptoms are as strongly associated with being on SL as types of breast and/or axillary surgery. Early self-reported symptoms are important to consider in guidelines for SL and rehabilitation after BC surgery.
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Khan F, Amatya B, Ng L, Demetrios M, Zhang NY, Turner-Stokes L. Multidisciplinary rehabilitation for follow-up of women treated for breast cancer. Cochrane Database Syst Rev 2012; 12:CD009553. [PMID: 23235677 PMCID: PMC8078577 DOI: 10.1002/14651858.cd009553.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Breast cancer is the most common malignancy in women worldwide. Multidisciplinary rehabilitation aims to improve outcomes for women but the evidence base for its effectiveness is yet to be established. OBJECTIVES To assess the effects of organised multidisciplinary rehabilitation during follow-up in women treated for breast cancer. SEARCH METHODS We searched the Cochrane Breast Cancer Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, AMED, PEDro and LILACS in December 2011. SELECTION CRITERIA Randomised and controlled clinical trials (RCTs, CCTs, respectively) that compared multidisciplinary rehabilitation with some form of control intervention (such as a lower level or different type of intervention, minimal intervention, waiting list controls or no treatment, interventions given in different settings). DATA COLLECTION AND ANALYSIS The type of data retrieved did not allow for quantitative synthesis and therefore a narrative synthesis was provided. The methodological quality of the included studies was evaluated by three authors using the risk of bias tool. MAIN RESULTS Two RCTs, including 262 participants, met the inclusion criteria. Both trials scored poorly for methodological quality. There was 'low level' evidence that multidisciplinary rehabilitation produced short-term gains at the levels of impairment (that is range of shoulder movement), psychosocial adjustment and quality of life after breast cancer treatment (up to 12 months). No evidence was available for the longer-term functional outcomes for caregivers or the cost effectiveness of these programmes. It was not possible to suggest the most appropriate frequency and duration of therapy or choice of one type of intervention over another. AUTHORS' CONCLUSIONS There was 'low level' evidence that multidisciplinary rehabilitation can improve the outcomes of people with breast cancer in terms of functional ability, psychosocial adjustment and participation in social activities. There was no evidence available on functional gain at the level of activity. This review highlights the limitations of RCTs in rehabilitation settings and the need for high-quality trial-based research in this area. Regular evaluation and assessment of breast cancer survivors for rehabilitation is recommended.
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Affiliation(s)
- Fary Khan
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, Royal Park Campus, Melbourne, Australia.
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Abu-Saad Huijer H, Abboud S. Health-related quality of life among breast cancer patients in Lebanon. Eur J Oncol Nurs 2012; 16:491-7. [DOI: 10.1016/j.ejon.2011.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 11/10/2011] [Accepted: 11/26/2011] [Indexed: 11/12/2022]
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Versmessen H, Vinh-Hung V, Van Parijs H, Miedema G, Voordeckers M, Adriaenssens N, Storme G, De Ridder M. Health-related quality of life in survivors of stage I-II breast cancer: randomized trial of post-operative conventional radiotherapy and hypofractionated tomotherapy. BMC Cancer 2012; 12:495. [PMID: 23098579 PMCID: PMC3492203 DOI: 10.1186/1471-2407-12-495] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 10/18/2012] [Indexed: 12/02/2022] Open
Abstract
Background Health-related quality of life (HRQOL) assessment is a key component of clinical oncology trials. However, few breast cancer trials comparing adjuvant conventional radiotherapy (CR) and hypofractionated tomotherapy (TT) have investigated HRQOL. We compared HRQOL in stage I-II breast cancer patients who were randomized to receive either CR or TT. Tomotherapy uses an integrated computed tomography scanner to improve treatment accuracy, aiming to reduce the adverse effects of radiotherapy. Methods A total of 121 stage I–II breast cancer patients who had undergone breast conserving surgery (BCS) or mastectomy (MA) were randomly assigned to receive either CR or TT. CR patients received 25 × 2 Gy over 5 weeks, and BCS patients also received a sequential boost of 8 × 2 Gy over 2 weeks. TT patients received 15 × 2.8 Gy over 3 weeks, and BCS patients also received a simultaneous integrated boost of 15 × 0.6 Gy over 3 weeks. Patients completed the EORTC QLQ-C30 and BR23 questionnaires. The mean score (± standard error) was calculated at baseline, the end of radiotherapy, and at 3 months and 1, 2, and 3 years post-radiotherapy. Data were analyzed by the 'intention-to-treat' principle. Results On the last day of radiotherapy, patients in both treatment arms had decreased global health status and functioning scores; increased fatigue (clinically meaningful in both treatment arms), nausea and vomiting, and constipation; decreased arm symptoms; clinically meaningful increased breast symptoms in CR patients and systemic side effects in TT patients; and slightly decreased body image and future perspective. At 3 months post-radiotherapy, TT patients had a clinically significant increase in role- and social-functioning scores and a clinically significant decrease in fatigue. The post-radiotherapy physical-, cognitive- and emotional-functioning scores improved faster in TT patients than CR patients. TT patients also had a better long-term recovery from fatigue than CR patients. ANOVA with the Bonferroni correction did not show any significant differences between groups in HRQOL scores. Conclusions TT patients had a better improvement in global health status and role- and cognitive-functioning, and a faster recovery from fatigue, than CR patients. These results suggest that a shorter fractionation schedule may reduce the adverse effects of treatment.
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Affiliation(s)
- Harijati Versmessen
- Department of Radiation Oncology, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium.
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Reidunsdatter RJ, Rannestad T, Frengen J, Frykholm G, Lundgren S. Early effects of contemporary breast radiation on health-related quality of life - predictors of radiotherapy-related fatigue. Acta Oncol 2011; 50:1175-82. [PMID: 21871005 DOI: 10.3109/0284186x.2011.604345] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to report on early effects of contemporary radiotherapy (RT) on health-related quality of life (HRQOL) and explore treatment-related contributors to the development of fatigue during RT in breast cancer (BC) patients. MATERIAL AND METHODS Consecutive BC patients (n = 248) referred for postoperative RT at St. Olavs University Hospital in Trondheim, Norway were enrolled from February 2007 to October 2008. Clinical- and treatment data were recorded, and HRQOL were assessed before starting (baseline) and immediately after ending RT using the "EORTC QLQ-C30" and the breast module "EORTC QLQ-BR23". Change scores from baseline were calculated. Predictors of increased fatigue during RT were explored with multiple regression analysis adjusted for relevant confounders. RESULTS The global QOL- and all functional scales remained stable, except for "future perspective" which improved significantly during RT. Breast symptoms and fatigue increased significantly during RT. Groups with elevated baseline fatigue remained more stable during RT than those with lower levels at baseline. The body volume receiving 40 Gy or more (V40) was a significant predictor of increased fatigue during RT adjusted for chemotherapy, comorbidity and age (p = 0.035). CONCLUSION Contemporary RT has limited early effects on HRQOL. V40 is a significant predictor of RT-related fatigue.
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Affiliation(s)
- Randi J Reidunsdatter
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Technology and Science, Trondheim, Norway
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Return to work after treatment for breast cancer: single center experience in a cohort of 273 patients. Bull Cancer 2011; 98:E69-79. [DOI: 10.1684/bdc.2011.1401] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cheng SY, Lai YH, Chen SC, Shun SC, Liao YM, Tu SH, Chen CS, Hsiang CY, Chen CM. Changes in quality of life among newly diagnosed breast cancer patients in Taiwan. J Clin Nurs 2011; 21:70-9. [DOI: 10.1111/j.1365-2702.2011.03735.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Silva S, Bettencourt D, Moreira H, Canavarro MC. Qualidade de vida de mulheres com cancro da mama nas diversas fases da doença: o papel de variáveis sociodemográficas, clínicas e das estratégias de coping enquanto factores de risco/protecção. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s0870-9025(11)70009-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It's not over when it's over: long-term symptoms in cancer survivors--a systematic review. Int J Psychiatry Med 2010; 40:163-81. [PMID: 20848873 DOI: 10.2190/pm.40.2.c] [Citation(s) in RCA: 448] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The number of cancer survivors is steadily increasing. Following completion of primary cancer treatment and many years thereafter, specific symptoms continue to negatively affect cancer survivors. The purpose of this article is to review the evidence of symptom burden following primary treatment for cancer in survivors of the most common types of cancer (breast, gynecological, prostate, and colorectal). METHODS A systematic review of literature published between the years 2000-2008 that reported late-effects and/or long-term psychosocial symptoms associated with cancer survivorship post-completion of primary cancer treatment was conducted. The symptoms include physical limitations, cognitive limitations, depression/anxiety, sleep problems, fatigue, pain, and sexual dysfunctions. RESULTS Symptom burden associated with cancer survivorship was consistent among the four most common types of cancer (breast, gynecological, prostate, and rectal/colon), despite various types of treatment exposure. Generally, across the cancer groups, depressive symptoms, pain, and fatigue were commonly found in cancer survivors. CONCLUSIONS Based on longitudinal and cross-sectional evidence, cancer survivors can experience symptoms for more than 10 years following treatment. These symptoms were present in survivors of all four cancer types who underwent a wide variety of treatment. The results indicate that these symptoms should be evaluated and managed to optimize long-term outcomes.
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Miaskowski C, Dodd M, Lee K, West C, Paul SM, Cooper BA, Wara W, Swift PS, Dunn LB, Aouizerat BE. Preliminary evidence of an association between a functional interleukin-6 polymorphism and fatigue and sleep disturbance in oncology patients and their family caregivers. J Pain Symptom Manage 2010; 40:531-44. [PMID: 20570482 PMCID: PMC2952712 DOI: 10.1016/j.jpainsymman.2009.12.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 12/19/2009] [Accepted: 01/28/2010] [Indexed: 10/19/2022]
Abstract
CONTEXT Fatigue and sleep disturbance are common problems in oncology patients and their family caregivers (FCs). However, little is known about factors that contribute to interindividual variability in these symptoms or to their underlying biologic mechanisms. OBJECTIVES An evaluation was done on whether genetic variation in a prominent proinflammatory cytokine, interleukin-6 (IL-6 c.-6101A>T [rs4719714]), was associated with mean ratings of evening fatigue, morning fatigue, and sleep disturbance, as well as with the trajectories of these symptoms. METHODS Over six months, participants completed standardized measures of fatigue and sleep disturbance. Linear regression was used to assess the effect of the IL-6 genotype and other covariates on mean fatigue and sleep disturbance scores. Hierarchical linear modeling was used to determine the effect of the IL-6 genotype on symptom trajectories. RESULTS Common allele homozygotes reported higher levels of evening fatigue (P=0.003), morning fatigue (P=0.09), and sleep disturbance (P=0.003) than minor allele carriers. Predictors of baseline level and trajectories of evening fatigue included age, gender, and genotype (intercepts) and baseline level of evening fatigue (slope). Predictors of baseline level and trajectories of morning fatigue included age and genotype (intercept) and age and baseline level of morning fatigue (slope). Predictors of baseline level and trajectories of sleep disturbance included age and genotype (intercept) and baseline level of sleep disturbance (slope). CONCLUSIONS Findings provide preliminary evidence of a genetic association between a functional promoter polymorphism in the IL-6 gene and severity of evening fatigue, morning fatigue, and sleep disturbance in oncology patients and their FCs.
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Affiliation(s)
- Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA 94143-0610, USA.
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Welzel G, Hofmann F, Blank E, Kraus-Tiefenbacher U, Hermann B, Sütterlin M, Wenz F. Health-related quality of life after breast-conserving surgery and intraoperative radiotherapy for breast cancer using low-kilovoltage X-rays. Ann Surg Oncol 2010; 17 Suppl 3:359-67. [PMID: 20853059 DOI: 10.1245/s10434-010-1257-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intraoperative radiotherapy (IORT) is currently being evaluated as a novel approach during breast-conserving surgery (BCS). IORT can be used either as a tumor bed boost followed by external-beam radiotherapy (EBRT) or as a single treatment. In a matched-pair study, we assessed quality of life (QoL) in 69 patients with early breast cancer treated with BCS and/or IORT and/or EBRT. METHODS Patients were matched for age and time since BCS. IORT was provided with 50 kV x-rays (Intrabeam) delivering 20 Gy at the applicator surface. EBRT (46 to 50 Gy in 2-Gy fractions in the IORT with EBRT group, and 56 Gy in 2-Gy fractions in the EBRT group) was initiated after completion of wound healing and/or chemotherapy. The mailed questionnaires included the European Organization for the Research and Treatment of Cancer QLQ-C30 and BR23, FACT-F, HADS, Body Image Scale, and Rosenberg Self-Esteem Scale. At 18 to 70 months' follow-up (median 47 months), all patients were disease free. RESULTS We found only a few differences between the three groups. There was a trend toward more pain (mean ± standard deviation; 42.8 ± 32.9 vs. 27.5 ± 34.7) and reduced QoL (57.6 ± 20.7 vs. 70.3 ± 23.9) after IORT with EBRT compared with EBRT, respectively. IORT patients reported comparable QoL (70.3 ± 23.0), and less breast symptoms and body image concerns compared to EBRT (8.6 ± 12.3 vs. 19.2 ± 23.8, and 1.7 ± 3.3 vs. 3.4 ± 4.4, respectively). IORT alone resulted in significantly fewer breast symptoms (8.6 ± 12.3; P = 0.012) and less pain (23.9 ± 24.5, P = 0.041) compared with IORT with EBRT (26.1 ± 27.6; 42.8 ± 32.9, respectively). CONCLUSIONS Patients with early breast cancer after BCS and IORT with or without EBRT present with comparable QoL like patients receiving EBRT without a boost. IORT patients show the lowest rate of breast symptoms.
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Affiliation(s)
- Grit Welzel
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, Mannheim, Germany.
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Freedman GM, Li T, Anderson PR, Nicolaou N, Konski A. Health states of women after conservative surgery and radiation for breast cancer. Breast Cancer Res Treat 2010; 121:519-26. [PMID: 19768651 PMCID: PMC2874617 DOI: 10.1007/s10549-009-0552-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 09/10/2009] [Indexed: 11/28/2022]
Abstract
The aim of the study is to use the EQ-5D instrument to evaluate the long-term health states of women with early stage breast cancer treated by breast-conserving surgery and radiation. A total of 1,050 women treated with conservative surgery and radiation with or without systemic therapy completed 2,480 questionnaires during follow-up visits. The EQ-5D is a standardized and validated instrument for measuring quality of life outcomes. The descriptive system uses 5 dimensions of health with three possible levels of response that combine into 243 (3(5)) possible unique health states that are each assigned a values-based index score from 0 to 1. The visual analog scale (VAS) rates health on a simple vertical line from 0 to 100. Higher scores correspond to better health status. The mean index scores were 0.89 (95% CI: 0.87-0.91) at 5 years, 0.9 (95% CI: 0.86-0.94) at 10 years, and 0.9 (95% CI: 0.83-1.0) at 15 years. There were no significant differences in health states between patients by age when compared with U.S. controls. There was a statistically significant positive correlation between the results of the VAS and descriptive system. Significant trends in health dimensions over 15 years were increased problems with self-care and decreased problems with anxiety/depression, pain/discomfort, and performing usual activities. This study of EQ-5D is unique and demonstrates very high quality of life in patients long-term after breast-conserving surgery and radiation. These health states are comparable to the adult female U.S. population. These data will provide valuable patient utility information for informing decision analyses investigating new treatments in women with breast cancer.
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Affiliation(s)
- Gary M Freedman
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
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Hopwood P, Haviland JS, Sumo G, Mills J, Bliss JM, Yarnold JR. Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised Standardisation of Breast Radiotherapy (START) trials. Lancet Oncol 2010; 11:231-40. [DOI: 10.1016/s1470-2045(09)70382-1] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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