"Who am I?" A qualitative meta-synthesis of Chemotherapy-induced alopecia and body image perception in breast cancer patients

Impact of social support on body image during chemotherapy in patients with breast cancer: The chain mediating role of depression and self-efficacy

Objective

To explore the mediating roles of depression and self-efficacy in the relationship between social support and body image in patients with breast cancer during chemotherapy.

Methods

A convenience sampling method was employed to survey 647 breast cancer chemotherapy patients. The survey included validated scales assessing social support, depression, self-efficacy, and body image. The chain mediation model was established using Mplus 8.3 software.

Results

Social support was negatively correlated with depression (P < 0.001) and poor body image (P < 0.001) and positively correlated with self-efficacy (P < 0.001). Social support indirectly affected body image through three mediating pathways: depression (β = -0.084, P < 0.001), self-efficacy (β = -0.060, P < 0.01), and the depression-self-efficacy pathway (β = -0.058, P < 0.001). The indirect effect accounted for 55.96% of the total effect.

Conclusions

The results support our hypothesis. Enhancing social support, alleviating depression, and improving self-efficacy through psychological interventions are recommended to improve body image in breast cancer patients during chemotherapy.

A systematic review on the effects of logotherapy and meaning-centered therapy on psychological and existential symptoms in women with breast and gynecological cancer

PURPOSE

Women diagnosed with breast cancer (BC) and gynecological cancer (GC) face psychological and existential challenges common to all cancers, such as anxiety and depression, along with specific issues related to body image and sexuality. Logotherapy and meaning-centered therapy (MCT) have shown positive effects on the psychological well-being of cancer patients.

METHODS

A systematic review was conducted following PRISMA guidelines to assess the impact of logotherapy and meaning-centered therapy (MCT) on women diagnosed with BC and GC from January 2014 to December 2024. Empirical research articles published in English were included, while literature reviews, meta-analyses, doctoral theses, preprints, books, and studies involving other cancer types or metastatic/comorbid conditions were excluded. The search was conducted across Web of Science, Scopus, and PubMed databases using terms like uterine cancer, ovarian cancer, breast cancer, mastectomy, logotherapy, and MCT. The Boolean operators AND and OR were used in the Title and Abstract search fields across all three databases, as well as in the Topic search field for the WoS database.

RESULTS

Out of the 36 articles initially obtained, 29 remained after eliminating duplicates and, finally, six papers were selected. The included studies examined various psychological and existential issues in patients with breast and gynecological cancer, including anxiety, distress, depression, hopelessness, death anxiety, post-traumatic stress, perception of physical symptoms, quality of life, post-traumatic growth, spiritual well-being, and meaning in life.

CONCLUSION

Findings suggest that logotherapy decreases depressive symptoms, anxiety, and post-traumatic stress, whereas improves meaning in life, quality of life, physical symptom perception, and post-traumatic growth in women with BC and GC. Implementing logotherapy in cancer care units through a multidisciplinary approach could be valuable, considering biopsychosocial factors, and incorporating aspects of self-image and sexuality in treatment would also be beneficial.

Lived experiences of gynaecological cancer survivors in Oman: a qualitative study

OBJECTIVE

A significant number of patients with gynaecological cancers survive their disease and are considered cured. However, the diagnosis of cancer and its treatment can affect quality of life adversely. We sought to explore the lived experiences of women surviving gynaecological cancers in Oman.

METHODS

Omani patients with gynaecological cancers who had completed their treatment more than 1 year ago and were following up in the medical oncology clinic at a major cancer centre in Oman were interviewed. A qualitative study design was employed using face-to-face semistructured individual interviews. To prevent recall bias, women diagnosed with cancer within the past 5 years only were included. The sample size was determined using data saturation, where data collection revealed no new information. All interviews were tape recorded and transcribed verbatim. Transcripts were analysed using a standardised thematic analysis approach.

RESULTS

Four main themes emerged: 'Beliefs and attitudes'; 'Living with Treatment Complications'; 'Living with cancer' and 'Coping with the Cancer Journey'.

CONCLUSIONS

The diagnosis of cancer had a profound effect on the lives of women with gynaecological cancer. The diagnosis negatively affected their lives throughout their cancer journey due to social role changes, fertility and sexual problems. Religion and social support played major roles in coping with the disease. This is the first study describing the lived experiences of Muslim and Omani survivors of gynaecological cancers and may help to determine their survivorship needs.

Beyond pink ribbons: The unmet needs of women with breast cancer

Breast cancer is the most frequently diagnosed cancer worldwide. The treatment options for breast cancer can cause side effects and adversely impact quality of life. Side effects, including fatigue, pain, cognitive changes, and psychosocial complications, can be life altering and continue beyond treatment into survivorship. Traditionally, health professionals focused almost entirely on achieving cancer survival; however, due to significant success in cancer treatment outcomes, most women now live beyond their breast cancer treatment. Consequently, addressing side effects and compromises in quality of life are becoming more important issues to include in a comprehensive approach to breast cancer treatment. For women, these unmet needs may involve body image concerns, sexual dysfunction, and other lifestyle challenges, and may not have previously been given sufficient recognition or priority. It is necessary for us, as oncology healthcare professionals, to modify our delivery of cancer care and ensure that more comprehensive care is provided to women. By addressing women's unmet needs, we can contribute to achieving the United Nations' Sustainable Development Goals regarding improving health and equality. This commentary seeks to emphasise the advantages of providing comprehensive care for women with breast cancer and advocates for cancer care professionals to actively participate in initiating and implementing this care.

Validating the Core Set for Vocational Rehabilitation in a Population of Cancer Survivors: A Cross-Sectional Study

PURPOSE

The Core Set for Vocational Rehabilitation (CS-VR), a checklist based on the International Classification of Functioning, Disability and Health (ICF), captures the work functioning of individuals requiring VR. By listening to cancer survivors' experiences and stakeholders' perspectives, the CS-VR-Onco of 85 ICF-based categories was obtained. The aim of this study was to assess the concurrent validity of the CS-VR-Onco by measuring this tool's ability to detect differences among cancer survivors in terms of perceived return to work (RTW)-related difficulties.

METHODS

A sample of 300 working-age individuals with a first diagnosis of cancer was selected through the local Cancer Registry. Of these 300, those employed individuals who had returned to work were deemed eligible. Through a guided interview, participants reported and described their perceived RTW-related difficulties using the terminology of the CS-VR-Onco. Frequencies and means were used to compare the results of (a) cancer survivors who reported having had difficulties with those who had not, and (b) cancer survivors who had undergone chemotherapy (CT) with those who had not.

RESULTS

Of the 104 respondents, 35 cancer survivors (Group 1) reported having had RTW-related difficulties and CS-VR-Onco-described problems, while 54 reported no difficulties but did highlight some problems (Group 2), and 15 reported neither difficulties nor problems (Group 3). The categories of the CS-VR-Onco that were prioritized were similar across groups, but Group 1 had higher frequencies than did Group 2 + 3 in 69 categories out of 85. In the second comparison, 40 cancer survivors who had undergone CT had higher frequencies than did 64 cancer survivors who had not undergone CT, but this trend was not applicable to 23 categories of the CS-VR-Onco. Seven categories were not reported as problems by all participants.

CONCLUSION

The CS-VR-Onco identified more problems in cancer survivors who reported RTW-related difficulties and differences between cancer survivors who had undergone CT and those who had not. These results contribute to assessing the preliminary validity of the tool.

Exercise interventions for self-perceived body image, self-esteem and self-efficacy in women diagnosed with breast cancer: a systematic review with meta-analysis and meta-regressions

PURPOSE

To synthesise the effectiveness of exercise interventions on self-perceived body image, self-esteem and self-efficacy in women diagnosed with breast cancer who are undergoing or have completed primary adjuvant treatments.

METHODS

A systematic review was conducted with meta-analysis and meta-regressions. Five electronic databases were searched from inception to June 2023, and hand searches were performed to explore the reference lists of similar systematic reviews. The established selection criteria were randomised clinical trials that evaluated any type of physical exercise intervention with self-perceived body image, self-esteem and self-efficacy as outcomes. No restrictions were imposed with respect to the control group. Main characteristics were extracted for each study. Meta-analyses, meta-regressions and sensitivity analyses were performed. The certainty of evidence for each outcome was graded using the GRADE approach. The risk of bias was evaluated using the RoB2 Cochrane tool.

RESULTS

Twenty studies, comprising 19 different samples (n = 2030), were included. In general, meta-analysis indicated that physical exercise interventions were not superior to controls for improving self-esteem and body image in women diagnosed with breast cancer. However, subgroup meta-analysis showed a significant difference in self-esteem improvement for resistance exercise (SMD = 0.31; 95% CI = 0.07, 0.55; p = 0.01; I2 = 0%) and supervised exercise (SMD = 0.25; 95% CI = 0.08, 0.42; p = 0.0004; I2 = 0%) compared with controls. Self-efficacy results were scarce and controversial. In addition, serious concerns were mainly detected in terms of the risk of bias and indirectness of the evidence, which caused the certainty of evidence to be very low for all outcomes.

CONCLUSION

Supervised exercise and resistance training appear to be effective exercise modalities for improving self-esteem in women diagnosed with breast cancer. In contrast, exercise interventions are not significantly associated with improvements in body image, while results on self-efficacy are controversial. However, due to the study's limitations, further research is needed.

Symptom network and quality of life of breast cancer patients receiving multimodal cancer treatment: Cross-sectional study

PURPOSE

Breast cancer patients experience symptoms and side effects from multimodal treatments, which often include menopausal symptoms resulting from cytotoxic chemotherapy or estrogen suppression therapy. This study aimed to explore the symptom network and clusters and its relationship to quality of life (QoL) in breast cancer patients who receive multimodal cancer treatment and experience treatment-related menopausal symptoms.

METHODS

A correlational study was conducted. Breast cancer patients receiving multimodal cancer treatment and experiencing treatment-related menopausal symptoms were included while they were receiving radiation therapy (N = 250). Symptoms, functions and QoL were assessed using the EORTC QLQ-C30 and BR45. Network analysis, principal component analysis, exploratory factor analysis, and multiple linear regression analysis were conducted.

RESULTS

Fatigue was the most central symptom in the symptom-only network as well as in the network consisting of symptoms and QoL. Fatigue, systemic therapy side effects, appetite loss, and cognitive symptoms demonstrated significant associations with QoL. The cancer and treatment related symptom cluster consisted of fatigue, cognitive symptoms, emotional symptoms and systemic therapy side effects. Breast cancer therapy-specific symptoms, such as arm symptoms, skin mucosis symptoms, and breast symptoms, formed a cluster with pain.

CONCLUSION

Fatigue was the most central symptom in breast cancer patients receiving multimodal cancer treatment and experiencing menopausal symptoms. Evaluation of fatigue and providing interventions to manage fatigue would contribute to improvement of QoL of breast cancer patients receiving multimodal cancer treatments. Future network analysis and symptom cluster studies should specify the population of interest and the treatment phase using comprehensive symptom evaluation tools.

Comparison of the Efficacy, Safety, and Quality of Life of Pegylated Liposomal Doxorubicin-Cyclophosphamide versus Epirubicin-Cyclophosphamide in Patients with Early-Stage HER2-Negative Breast Cancer: A Prospective, Randomized, Multicenter, Phase II Study

INTRODUCTION

This multicenter, phase II randomized, non-inferiority study reports from the first prospective two-armed randomized control trial that compared the efficacy, safety, and quality of life (QoL) of pegylated liposomal doxorubicin (PLD)-based and epirubicin-based as adjuvant chemotherapy for stage I-II human epidermal growth factor receptor 2 (HER2)-negative breast cancer.

METHODS

Patients with stage I/II HER2-negative breast cancer received PLD (37.5 mg/m2, Q3W, 5 cycles, LC arm) plus cyclophosphamide (600 mg/m2) or epirubicin (90 mg/m2, Q3W, 4 cycles, EC arm) plus cyclophosphamide (600 mg/m2). Randomization was stratified by lymph node and ER and PR status. The primary endpoint was disease-free survival (DFS), and secondary endpoints were overall survival (OS), safety profiles, and QoL. QoL was assessed using the EORTC-QLQ-C30 and QLQ-BR23 questionnaires.

RESULTS

A total of 256 patients were assigned to LC (n = 148) and EC (n = 108). There was no difference in 5-year DFS and OS rate between the two groups. LC-based adjuvant regimens had significantly less alopecia and low-grade 3-4 hematologic adverse events (AEs). Significantly improved QoL was observed in the LC arm during and after treatment for symptoms including fatigue, nausea and vomiting, and systemic therapy side effects.

CONCLUSION

Comparable efficacy and safety between adjuvant PLD and epirubicin for stage I-II HER2-negative breast cancer was observed. There was no difference in the 5-year DFS and OS rates between the two treatment arms. However, low-grade 3-4 AEs and a trend of favorable QoL symptom scales were observed in the LC arm, suggesting that PLD-containing regimen could become a new standard treatment for early-stage HER2-negative breast cancer patients.

The efficacy of HDDPiW-jSB solution on docetaxel-induced alopecia of rats

OBJECTIVE

Chemotherapy induced alopecia (CIA) is one of the most common side effects in cancer patients, however; it doesn't have an effective pharmacological treatment yet. In this study we aimed to research the protective effect of newly developed HDDPiW-jSB solution on docetaxel (DTX) -induced rat alopecia model.

MATERIAL AND METHODS

Docetaxel (10 mg/kg/week) was administered to the 6-8 months old rats for three weeks. HDDPiW-jSB solution was applied once or twice a week for 4 weeks beginning prior to one week before DTX. Rat hair follicles were evaluated with hematoxylin-eosin and immune-histochemical staining.

RESULTS

In the first stage of this study, alopecia was successfully developed by DTX (10 mg/kg/three times) application. In the second stage of the study, application of HDDPiW-jSB solution, did not change the study parameters significantly on control group. The solution improved the anagen hair follicle count and Bcl-2 levels in the skin samples of DTX-induced alopecic rat groups, especially when applied twice weekly. Additionally, level of Caspase 3 was decreased. HDDPiW-jSB solution was safe when applied on the skin.

CONCLUSION

Topical HDDPiW-jSB solution could be effective and safe for the protection of DTX-induced alopecia in rat models.

Validation and responsiveness of the English version of the Chemotherapy-Induced Alopecia Distress Scale (CADS) in breast cancer patients

PURPOSE

This study aimed to validate the Chemotherapy-Induced Alopecia Distress Scale (CADS) in a diverse English-speaking population and patients with endocrine treatment-induced alopecia (EIA).

OBJECTIVE

Chemotherapy and endocrine therapy commonly cause alopecia in breast cancer patients, leading to significant psychological and social challenges. The CADS was developed to assess the psychosocial impact of alopecia, but its generalizability beyond Korean patients requires further investigation.

METHODS

Data from the CHANCE study (NCT02530177), which focused on non-metastatic breast cancer, was used. The cohort included 256 patients, and CADS data were collected at baseline, 6 months after chemotherapy completion, or 12 months after initiating endocrine therapy. The CADS questionnaire comprised 17 items covering physical and emotional health, daily activities, and relationships. Reliability was assessed using Cronbach's alpha, and responsiveness was measured by effect size.

RESULTS

The CADS exhibited good reliability, with Cronbach's alpha of 0.91 for the overall score, indicating acceptable internal consistency in both chemotherapy (0.89) and endocrine therapy (0.86) groups. Longitudinal responsiveness was supported by an effect size of 0.49 between decreasing satisfaction with hair growth and increasing emotional distress. Cross-sectional validity was confirmed, with effect sizes of 0.91 and 0.92 for satisfaction with hair growth and emotional and activity domains, respectively.

CONCLUSION

The CADS is a valid and responsive tool for assessing the psychosocial impact of chemotherapy-induced alopecia and endocrine treatment-induced alopecia in a diverse Western patient population.

Understanding Patient Preferences Regarding the Important Determinants of Breast Cancer Treatment: A Narrative Scoping Review

Objective

Conventionally, optimal treatment strategies for breast cancer have been largely determined by physicians, with a scant understanding of patients' treatment values and preferences. Incorporating patient preferences in the decision-making process for breast cancer treatment is gaining recognition and can potentially improve treatment outcomes and compliance. This scoping review aims to synthesize evidence on the key determinants that are most valued by breast cancer patients when deciding on their treatment options.

Methods

We searched three electronic databases (PubMed/MEDLINE, SCOPUS, and CINAHL Plus) utilizing a systematic scoping review method. Two reviewers independently screened, applied inclusion criteria, reviewed, and synthesized findings. A mixed-method narrative approach combining the inductive thematic analysis and content analysis methodologies was used to synthesize and summarize the findings.

Results

The review included 22 studies, leading to the conceptualization of 5 overarching themes and 17 sub-themes. Among these, the most frequently cited theme was treatment benefits, followed by treatment-related process, treatment-related risk, quality of life, and cost of treatment. Women with breast cancer highly value treatments that offer good effectiveness, prolong survival, prevent recurrence, and maintain quality of life. Patient concerns include treatment-related side effects, safety, the risk of secondary cancer, and direct or indirect out-of-pocket costs. Additionally, patients also consider treatment duration, mode of administration, physician recommendation, and treatment availability and accessibility when deciding on their preferred treatment.

Conclusion

The evidence synthesized in this review offers insights into refining breast cancer treatment strategies to align more closely with patient values. Recognizing and integrating patient perspectives in breast cancer care could potentially lead to improved treatment outcomes, enhanced patient compliance, and more personalized care. Healthcare professionals are encouraged to incorporate these key determinants in their treatment decision-making processes, aiming to deliver a patient-centered care that aligns with the unique preferences and values of each patient.